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A CONVERSATION WITH MARK CHAFFIN

Sent: Wednesday, June 23
To:Mark-Chaffin@ouhsc.edu
Subject: State of treatment

Dear Dr. Chaffin:

I am currently researching the topic of juvenile sex offenders and recently found your 1998 article "Don't Shoot: We're Your Children" published in Child Maltreatment. Since the time that article was published, has the situation improved? Do the harmful practices you described still continue? What kinds of safeguards have been put into place to insure that they don't? You also wrote that many of the assumptions upon which treatment is based have not been empirically verified. Is that still true? What kind of efforts, if any, have been made to determine how valid these assumptions are?

I thank you for any information you can give me.

Subject: RE: State of treatment|
Date: Thu, 24 Jun 2004 08:00:51 -0500
From: "Chaffin, Mark J. (HSC)" <Mark-Chaffin@ouhsc.edu>

Some change, but in different directions. In some places, there is widespread retreat from the "little pedophile" approach. However, it other places (Colorado for example) it has become even more harsh (multiple mandatory polygraphs, registration, etc.). For example, in some districts of Ohio, young prepubescent children are reportedly routinely required to be in 2-3 years of out-of-home treatment before reunification can be considered. My own read is that we are seeing polarization of opinion in the field at this point.

Basically, the state of treatment outcome research is the same. The most significant change of which I'm aware is John Hunter's work on empirically derived population subtypes. Some additional major articles include Michael Caldwell's analysis of risk prediction with juveniles, Borduin's replication of the first small MST outcome trial, and Prentky and Righthand's ongoing work on risk assessment tools.

An interesting new book on the topic by Franklin Zimring (a law professor) was just released.

MC

Mark Chaffin, Ph.D.
Center on Child Abuse and Neglect
University of Oklahoma Health Sciences Center
P.O. Box 26901
Oklahoma City, OK 73190
(405) 271-8858

Dear Dr. Chaffin:

Thanks so much for the information. I might try to get hold of the book by Zimring. Do you have any idea how many children and adolescents are in treatment at any given time, or how many begin treatment in a given year?

Also, I'm wondering if you have an opinion on Gene Abel and Nora Harlow's book "The Stop Child Molestation Book." It has some surprising statistics and approaches. It says that 1 out of every 20 boys develops pedophilia (usually in puberty or earlier). Abel and Harlow recommend that parents question their sons about their sexual fantasies in 6th grade, and have them tested if they involve younger children (or they've been abused by an older child or adult). If the boy tests positive, they recommend SSRIs, cognitive restructuring, victim empathy training, and arousal reconditioning (covert sensitization, imaginal desensitization, or olfactory aversion).

Any insight or comments you have would be appreciated.

There is no national surveillance system to track how many youth are in treatment programs. Some (though by no means all) treatment programs are queried every few years by the Safer Society organization, which publishes summaries on programs. Check their web site.

I'm not familiar with this book (is it very old?). I would disagree with all of those recommendations that you describe.

Mark Chaffin, Ph.D.
Center on Child Abuse and Neglect
University of Oklahoma Health Sciences Center
P.O. Box 26901
Oklahoma City, OK 73190
(405) 271-8858
mark-chaffin@ouhsc.edu

"The Stop Child Molestation Book" was published in 2001 by Xlibris and can be purchased at http://www1.xlibris.com/bookstore/bookdisplay.asp?bookid=13270

The book includes endorsements by Lucy Berliner of the National Resource Center on Child Sexual Abuse; Fred Berlin, director of the National Institue for the Study, Prevention, and Treatment of Sexual Trauma; and Brent Warberg, board member of the Association for the Treatment of Sexual Abusers.

Abel and Harlow also publicize their recommendations on their website. Their list of warning signs of a sexually troubled child can be found at http://www.stopchildmolestation.org/pages/sexuallytroubledchild.html and their advice to parents for finding a sex-specific therapist for their child is at http://www.stopchildmolestation.org/pages/questions.html

I have serious reservations about Abel and Harlow's recommendations, too, and I don't want to take too much of your time, but I'd be interested in hearing your reasons for disagreeing with them.

Well, the problem is that in all the controlled clinical trials to date, "sex-specific" therapy has performed no better than standard therapy for young children with sexual behavior problems. In fact, sexual behavior problems in young children do not appear persistent in many cases, and seem to diminish quickly with simply the passage of time--and maybe a little quicker if there is treatment. Treatment also seems to help more if the case is more severe. Our group is putting the final touches on a developmental analysis of these behaviors, and this is how its looking.

Also, we have begun a 10-year follow-up of these children. Self-report data is just beginning to be collected, but from examinations of criminal justice and child welfare databases, it thus far appears that only a tiny percentage of young children with sexual behavior problems advance on to later sex offending, including those who receive very minimal standard treatment. So, I just don't think the prognosis or the need for specialized care is quite as acute as A and H portray it.

MC

Thanks for your comments. It's interesting that you write that sex-specific therapy is no more effective than traditional therapy for young children. What about for older children? Abel and Harlow write that older children and teenagers who have deviant sexual feelings (especially for younger children) as determined by AASI, polygraphs, or plethysmographs must receive sex-specific therapy because traditional therapy is ineffective at changing sexual thoughts, it doesn't address denial, and it doesn't protect their victims.

I wonder what your thoughts are on the ethics of Abel and Harlow's recommendations. That's where my misgivings lie. Some researchers (such as Paul Okami of UCLA) say that children are being labeled as sexually abnormal in the absense of scientific norms. (In fact, everything I've read by researchers who specialize in child and adolescent sexuality say that normal feelings and behavior have yet to be determined.) Abel and Harlow (and others) seem to be doing this when they define sexually troubled children as those whose behavior is "beyond developmental norms" (which don't even exist), or whose feelings are "deviant" according to the AASI, polygraphs, or plethysmographs, which, as far as I can tell, have never been validated on a representative sample of children.

It seems to me that labeling children as sexual deviants, perpetrators, or pre-pedophiles (as Abel and Harlow would do to 5% of all boys) places on them a stigma unequalled by any other. I think it would be an emotional death sentence. I was a high school teacher for 13 years, and calling a student "stupid" would have gotten me severely reprimanded if not fired. Calling a child "deviant" or "pedophile" seems even worse (much like calling him a "pervert" or "faggot"). Is there anyone hated more in our society than sex offenders? This is especially bad when, as Okami writes, it is done because children's sexual feelings or behaviors are socially inappropriate rather than literally coercive.

Also, as someone who is familiar with the methods used a few decades ago to change the feelings of gay men, I'm extremely disturbed by Abel and Harlow's recommendations that similar methods (aversion therapy and covert sensitization) be used on older children and teenagers to change their sexual feelings. Psychiatrists and psychologists acknowledge that these methods caused depression, nightmares, suicidal thoughts, and mental illness among adult gay men. (There is currently a study going on in the UK investigating these effects.) I've read personal stories of both gay men and "deviant" youth who experienced severe trauma as a result of these methods. This shouldn't be surprising since they amount to manipulating deep inner feelings whose development we do not understand. This also applies to the intensely harmful forms of cognitive restructuring you described in "Don't Shoot."

These effects of labeling and treatment sound identical to the effects of child sexual abuse itself, so I have trouble understanding how a profession dedicated to protecting children can allow these crude methods to be used or promoted by its own members.

For teenagers, there are no comparative studies examining sex-offender specific vs. non-specific services. If there were, I would hypothesize that the contrast would be different depending on the population subgroup. For example, among teens with strong sexual attraction toward young children (a small subgroup), one might predict benefits in favor of specific treatments such as A and H suggest. However, among more generally delinquent and experimenter subgroups (the majority of teen sex offenders), one might see very different outcomes.

Actually, there are fairly good norms for childhood sexual behavior (see Friedrich's work). Most of the kids labeled as "Children with Sexual Behavior Problems" in the research literature score quite outside the normal range and do exhibit quite rare sexual behaviors the virtually anybody would consider problematic. Usually, there is a second criterion for labeling a child as having sexual behavior problems, and that is that the behavior has not responded to normal discipline or correction procedures. However, I'm not sure how well people have followed this second criterion in labeling children.

MC

I read Freidrich's 1998 article in Pediatrics, and it seemed to report less extensive behavior than other articles I had read (those by Loretta Haroian of the Institute for the Advanced Study of Human Sexuality, David Weis in the International Encyclopedia of Sexuality, and Floyd Martinson), particularly as children approach late childhood. I'm guessing that's because Freidrich relied on mothers' observations, and most children's sexual behavior is hidden from adults, especially at later ages.

I do seem to be getting conflicting information about the existence of norms for child and adolescent sexual feelings and behavior. Articles and books written in the 1980s and 1990s by Haroian, Weis, and Martinson (who I understand is world renowned for his research and expertise in child sexuality) say that little is known about normal child sexuality. A year ago, I wrote to the Kinsey Institute regarding this question, and Jennifer Bass, Head of Information Services, wrote only that some years ago, when the institute convened a research seminar on childhood sexual development, they found it impossible to develop consensus statement on what constitutes healthy or normal childhood sexuality. Have things significantly changed since then?

I'm also getting conflicting information about the frequency with which children are labeled as sex offenders for non-coercive behavior. There seems to be quite a lot of anecdotal evidence that this is happening, and that the children are mandated to treatment that assumes they are aggressive. See for example the work of Paul Okami and Ralph Underwager, as well as some reports in the media. Okami writes that what many sexuality researchers consider normal "sexual rehearsal play" is defined by therapists such as Toni Cavanaugh Johnson as perpetration behavior. Salon magazine had a harrowing story of a boy placed in treatment for consensual behavior: http://www.salon.com/feb97/molested970228.html; Spin magazine carried an article that won runner up for the Casey award in journalism: http://www.geocities.com/seamusmcgraw/unforgiven.html; also see Mother Jones magazine: http://www.motherjones.com/mother_jones/JA96/levine.html). I have personally corresponded with parents whose children were placed in treatment due to consensual activity.

I became interested in this issue after meeting a young man who in high school had been falsely accused of child molestation, and coerced into a plethysmograph examination (using pornographic audiotapes) and covert sensitization even though an investigation determined that the accusation was false. I was disturbed to hear how he was treated, and when I read more about treatment, I was shocked to find that methods I thought had been discredited decades ago (arousal reconditioning methods such as aversion therapy and masturbatory satiation used on gay men) were still being used on teenagers and sometimes younger children.

It is one thing to require someone who has acted aggressively to take responsibility for the harm he has done. It is quite another to require a child to identify himself as fundamentally defective and unacceptable to society for his sexual feelings or non-coercive behavior. One of the most chilling moments in the Salon article I mentioned above is when the mother of the boy labeled as a child molester for consensual activity is told by her good friend that child molesters should be executed.

Usually in the medical or mental health profession, when one reads about treating children with serious illness, one almost always reads about the importance of reducing stigma and providing compassionate care. But other than your "Don't Shoot" article, in all my research, I have not seen a single article advocating compassion for "deviant" children or respect for their dignity, or condemning harmful methods. Other than you and your coauthor, are there any therapists in the field who are concerned about this and taking any kind of action?

There actually are quite a few prominent researchers and professionals who are advocating for a less "deviancy" focused and less harsh approach toward juvenile sex offenders. This is an ongoing shift that I would estimate is rapidly moving toward being the majority opinion within the next decade. I think the necessary first step--recognition that adolescents who commit sex crimes are not miniature versions of adult serial rapists or lifelong child molesters--is now generally accepted. Many of the recognized leaders in the field are advocating movement in this direction.

I would be a bit cautious about relying on the work of Okami and the late Dr. Underwager. He is not considered a reputable source. For example, he is on record as noting that it is "God's will" for adults to have sex with children, and other pro-pedophilia statements.

I would hope that things have moved on from the past, at least in professional circles. I think many people in my field of work these days would suggest that what is considered problematic or "offending" sexual behavior is defined more by issues of equality and consent, than by gender preference. Hence, sexual offenses against children or sexual assault are seen as problematic on an entirely different basis than the one that was applied to homosexuality.

One trend, which I consider unfortunate, has been efforts to co-opt the gay rights agenda for purposes of pro-pedophilia advocacy. I think this plays into the hands of those who would use inaccurate fear-based arguments such as, "gays want to molest your children so they shouldn't be school teachers, etc. etc."

MC

Dear Dr. Chaffin:

I very much hope you're right that the field is moving toward a more humane approach to juvenile sex offenders. That's why I object to Abel and Harlow's approach, which seems to be in the exact opposite direction. BTW, I've ordered Zimring's book, and I look forward to reading what he has to say.

Your statement about Underwager not being reputable sent me into a bizarre world. I did a quick Google search to find out more about his outrageous "God's will" statement, and found some websites confirming it. But although I didn't have time to check every site, the ones I did read didn't appear reputable either. They were about national or world-wide conspiracies among sexuality researchers, pedophiles, freemasons, the CIA, and pornographers, and seemed to distort what I understood Underwager to be saying in his articles. At his website, Underwager's c.v. looks credible, the papers I've read don't seem to promote pedophilia, and they seem to be well-referenced. I've also found other reputable sources that praise Underwager. On the other hand, I know that writers can easily distort things and mislead otherwise knowledgeable people.

I won't rely on Underwager, but I think my points still stand, since they've been confirmed by quite a few articles by others and my correspondence with parents of accused children. Could you tell me why Okami is not credible? Like Underwager, his article on child perpetrators appears to be supported by references.

I would agree with you about any efforts by pedophiles to exploit pro-gay advocacy to further their ends. (I have trouble believing any reasonable person would be swayed by such efforts.)

As far as the juvenile sex offender treatment profession moving on from the ways of the past, I realize that gender preference is no longer considered an indicator of deviance. On the other hand, it seems to me your "Don't Shoot" article, as well as others I've read, shows that many professionals continue to use the methods of the past: purposely shaming, humiliating, and stigmatizing children and teenagers for their abnormal sexual *feelings* (when normal feelings have not been scientifically established, and children most likely do not choose the feelings they have), requiring them to self-identify as fundamentally defective (and sometimes irredeemable), and sometimes attempting to change their feelings through crude arousal reconditioning methods. I've read articles describing the effects of these methods on both gay men in the past and juvenile offenders now, and they're very similar to each other. They also seem very similar to the effects of sexual abuse itself: nightmares, depression, anxiety, violent or suicidal tendencies. I believe it's especially horrifying that some leading professionals (such as Abel and Weinrott) continue to advocate these abusive methods to change sexual feelings. As far as I know, these kinds of methods are not even used on violent juvenile offenders whose offenses are non-sexual.

I believe the use of these harmful methods, and their attendant ethical problems, are the result of the acceptance of the criminal justice model by therapists, which according to Jerome Miller (director of the National Center for Institutions and Alternatives) has resulted in "debilitating ethical and scientific implications." (See his article about sex offender treatment: http://66.165.94.98/stories/medlaw92.html)

Dr. Chaffin did not reply to this email.

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