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See excerpts
from actual treatment materials:
Steps to Healthy
Touching
a workbook for ages 5-12
Roadmaps to
Recovery
a workbook for ages 6-12
Pathways
a workbook for ages 11-21
Sources for
this comparison:
Abel,
G. & Harlow, N., The Stop Child Molestation Book,
Xlibris, 2001.
American Academy of
Child & Adolescent
Psychiatry, “Facts
for
Families: Conduct
Disorders,”
1997.
Braithwaite,
K.
& Duff, J., “Conduct
Disorder in Children and Adolescents,” Doncaster, VIC,
Australia: Behavioural Neurotherapy
Clinic, 2001.
Kahn, T.J., Pathways: A
Guided Workbook for Youth Beginning Treatment,
Brandon, VT: Safer Society Press, 1999.
Kahn, T.J., Roadmaps to
Recovery: A
Guided Workbook for Young People in
Treatment, Brandon, VT: Safer Society Press,
1999.
MacFarlane,
K.
& Cunningham, C., Steps to Healthy Touching, Indianapolis:
Kidsrights,
2003.
Searight,
H.R.,
Rottnek, F., & Abby, S.L., “Conduct Disorder: Diagnosis
and Treatment in Primary Care, American Family
Physician, April 15, 2001.
Shaw, J., “Practice
Parameters
for the
Assessment and Treatment of Children and Adolescents Who Are Sexually
Abusive
of Others,” Journal of the American Academy of Child and
Adolescent
Psychiatry, 38(12 Suppl):32S-54S, 1999.
Steiner,
H.
& Dunne, J.E., “Summary of the
Practice Parameters for the
Assessment and
Treatment of Children and Adolescents with Conduct Disorders,”
Journal of
the American Academy of Child and Adolescent Psychiatry,
36(10suppl), 1997.
Zimring, F.E., An American
Travesty: Legal Responses to Adolescent
Sexual
Offending, Chicago: University of Chicago Press,
2004.
About the author
|
STRIKING COMPARISONS
The table below compares treatment for
children and
adolescents who have sexual behavior problems with those who have a
pattern of
committing violent (non-sexual) crimes and are
diagnosed with conduct disorder. Notice that the harsh and adversarial
methods (including attempts to control thoughts and feelings) used on
youth with sexual behavior problems are not even used with children who
commit violent crimes.
|
Child/adolescent with
conduct
disorder |
Child/adolescent with
sexual behavior
problem |
Target behaviors –
any of |
violating curfew
running away
truancy
theft
breaking and entering
destruction of property
bullying, threatening
arson
robbery
use of dangerous weapon
cruelty to people or animals
assault
|
preoccupation with sex/pornography
obscene phone calls
consensual sex play with sibling or
younger child
consensual sex with younger
romantic partner
peeping
indecent exposure
suggesting sexual activity to
younger child
sexual harassment
sexual coercion
rape
|
Threshold for treatment
|
Pattern must be present over 6 month period.
There must be clinically significant impairment in social, academic or
occupational functioning. |
Often after only one incident.
No requirement of impairment. |
| Characteristics of client |
These are not
assumed for all patients; individual differences are recognized:
Inability to appreciate others'
welfare
Lies
Little guilt or remorse
Views others as malicious |
These are assumed
for all "offenders" even if not actually present:
Denies behavior or its harmfulness
Lies
Minimizes harm
Rationalizes behavior |
| Treatment priority |
Least restrictive intervention that
fulfills patient needs |
Protection of community |
| Therapist-client relationship |
Therapeutic/supportive |
Adversarial |
Professional
language
(excerpt on assessment) |
Therapeutic language:
- no need to confront to overcome denial etc.
- client is called "patient" or "child" rather than "offender"
- no data gathered from victims.
- no physiological measurement of client's feelings or thoughts
“Although the order of obtaining data
may vary, the evaluator should interview both the patient and the
parents, separately and together, to obtain history. It also may be
desirable to interview other family members and professionals familiar
with the patient. Releases for
contact with medical, school, social
service, and juvenile justice personnel should be obtained as
indicated…DSM-IV target symptoms may not be apparent or acknowledged
during the patient interview,
but may be detected by interviewing
parents and other informants.”
(Steiner & Dunne)
|
Adversarial language:
"Important
sources of information include medical and psychological reports,
offense reports, victim statements,
protective
services reports, and
probation reports. The collateral information should be obtained before
the individual interview; otherwise one is left relatively unprepared
before the offender's normal
proclivity to minimize and deny…Because in
many cases laws have been transgressed, the offender is often less than
forthcoming...The interviewer confronts
minimization,
denial, and the
apparent omissions of important information… Some authors have
recommended the use of phallometric testing, the measuring of penile
erection in response to various stimuli, as a way to determine
sexual
preferences.”
(Shaw) |
Features
of Treatment
|
Child/adolescent
with
conduct disorder |
Child/adolescent
with
sexual behavior problem |
| Prosecution |
Not
part
of treatment |
Considered
part
of treatment |
| Juvenile
justice
to support
supervision and limit-setting |
yes |
yes |
| Traditional
individual
psychotherapy |
May
be
helpful: Usually a combination
of behavioral and explorative. |
Discouraged
for
fear that patient will manipulate
therapist. |
| School |
Build
parent-school
alliance, ensure
appropriate academic placement. |
Not
mentioned |
| Community
|
Encourage
involvement
in structured,
supervised peer & community activities.
Replace deviant peer group with socially appropriate one. |
Not
mentioned |
| Family
therapy |
Improve
parent-child
communication.
Teach parents use of consistent, non-harsh discipline with clear rules,
rewards, consequences.
Encourage parents to monitor whereabouts of children, and supervise
exposure to violent entertainment.
Encourage parent-child play. |
Improve
parent-child
communication.
To build an accountability system.
To teach parents about sexually abusive behavior, risk and protective
factors, and characteristics of sexual abusers.
To teach parents styles of interaction and management of their
children's sexual behavior. |
| Psychoeducational
interventions |
Social
skills
training
Anger management
Assertiveness training |
Sex
education
including deviancy
Control of sexual impulses
Victim awareness/empathy
Cognitive restructuring
Anger management
Assertiveness training
Social skills training
Stress reduction
Autobiographical awareness |
| Disclosure
&
Self-castigation |
Not
used |
Recount
every
illegal sexual act in
detail (including planning, method, and aftermath).
Pressure to disclose more crimes.
Describe all hurtful and selfish non-sexual behavior.
Describe family history of selfish, hurtful, or illegal behavior.
Use of polygraph (lie detector). |
| Victim
clarification |
Not
used |
Describe
all
victims, their reactions
and feelings, and all possible effects on them.
Relive own actions from victim's perspective.
Education about effects on indirect victims (family & friends of
victim & self).
Describe in detail every incident of own
victimization.
Listen to stories of victimization.
Education about effects on victim. |
| Changing
thoughts
and feelings |
Not
attempted |
Admit
and
identify criminal thinking
patterns (denial, minimization, rationalizing, etc.).
Disclose all thoughts/feelings before, during, and after crime.
Replace dangerous feelings and thoughts with right ones.
Change sexual fantasies through behavioral reconditioning (Covert
sensitization, aversion therapy, masturbatory satiation, or other
sexual arousal reconditioning). |
| Monitoring
of
thoughts and feelings |
Not
done |
Both
sexual
and non-sexual, including
fantasies and masturbation habits:
By therapist through required daily journals.
Reported to therapy group weekly.
By polygraph (lie detector) and/or plethysmograph attached to genitals |
| “No-cure”/Addiction
Model |
Not
used |
Admit
no
cure.
Take on identity as offender.
Identify cycle of dangerous feelings & behavior.
Identify tempting, dangerous situations.
Analyze tendency to overcome inhibitions and victim resistance.
Identify maintenance behaviors.
Develop relapse prevention plan. |
| After
treatment |
No
action
prescribed |
Restrict
future
movement & jobs.
Continued monitoring of thoughts, feelings, and behavior.
Registration and tracking.
|
See sample materials
used in treatment
Read conversations
with treatment providers
|
When
experts are wrong
Casualties of war
Diagnosis
Lack of
knowledge
Confused
definitions
Criminalization
Invalid
instruments
Treatment
Humiliation
as
therapy
Arousal
reconditioning
Dangerous
drugs
Sriking comparisons
Sample
materials
Convos
with
providers
Ethical
violations
Deja vu
|
