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1. American Psychological Association, Code of Ethics of the APA, Washington, DC, 2002.

2. Association for the Treatment of Sexual Abusers, Code of Ethics of the ATSA, Beaverton, OR, 2001.

3. Burton, D. & Smith-Darden, J., North American Survey of Sexual Abuser Treatment and Models 2000, Brandon, VT: Safer Society Foundation, 2001.

4. Center for Sex Offender Management, "Understanding Juvenile Sexual Offending Behavior," December 1999.

5. Levine, J., "A Question of Abuse," Mother Jones, July/August 1996.

6. Miller, J., “On Mitigating Professional Arrogance in the Treatment of Sex Offenders,” Medicine and Law, vol. 11, pp. 485-491, 1992.

7. National Mental Health Association, “Position Statement on Involuntary Treatment,” Alexandria, VA, 2004.

8. National Mental Health Association, “Position Statement on Children With Emotional Disorders In The Juvenile Justice System,” Alexandria, VA, 1998.

9. Righthand, S. & Welch, C., "Juveniles Who Have Sexually Offended," U.S. Office of Juvenile Justice and Delinquency Prevention, March 2001.

10. "Understanding Juvenile Sexual Offending Behavior," Center for Sex Offender Management, December 1999.

11. Yankowski, L., Testimony to the Arizona Senate's Committee on Children's Psychological Treatment Programs, September 16, 1992.

Ethical Treatment for All Youth
Email: etay@ethicaltreatment.org

About the author


"Any community's arm of force - military, police, security - needs people in it who can do necessary evil, and yet not be made evil by it. To do only the necessary and no more. To constantly question the assumptions, to stop the slide into atrocity."
--Lois McMaster Bujold

The following are basic therapeutic and ethical principles generally accepted by the mental health community:

  • Therapy should respect the dignity of the patient.

  • Therapy should be based on accurate diagnosis of the patient's condition.

  • Therapy should be safe, effective, and humane.

  • Therapists should work to end the stigma facing their patients.

  • Therapy should be administered only with the informed consent of the patient.

  • Patients should have the means to file grievances regarding treatment.


The Code of Ethics of the American Psychological Association (APA) states the following as one of its general principles: “Psychologists respect the dignity and worth of all people.”1 Similarly, the Code of Ethics of the Association for the Treatment of Sexual Abusers (ATSA) says, “ATSA members have a long tradition of dedication to supporting values of basic human dignity and respect.”2 The National Mental Health Association (NMHA) says

Treatment should be provided in an atmosphere of empathy and respect for the dignity of the child...Programming in facilities should be appropriate to the child’s age, gender and culture...Facilities should train staff to use behavior management techniques that minimize the use of intrusive, restrictive, and punitive control measures.8

It is hard to imagine how the methods used with children labeled as sex offenders respect their dignity. Cognitive restructuring requires the youth to repeatedly make public all of his sexual thoughts, feelings, fantasies, and acts, and often involves antagonistic confrontation and humiliation for the presence of these feelings.  The use of plethysmographs, polygraphs, aversion therapy, and masturbatory satiation are intimate, intrusive, punitive, and humiliating, particularly when done in the adversarial atmosphere of law enforcement. These methods involve manipulation of the genitals and the showing of pornographic materials. 

Accurate diagnosis

The APA Code of Ethics says

Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation.1

As already noted, the concept of sexual abnormality among youth is based on the incorrect assumption that normal childhood sexuality has been scientifically defined. Furthermore, as shown elsewhere on this site, the Center for Sex Offender Management, the U.S. Office of Juvenile Justice, and legal scholars have noted that the instruments used to diagnose sexual deviance among children and teenagers are unreliable and scientifically unestablished. For that reason they are not admissible in court. Youth and their parents are rarely informed of these facts.

Safety, effectiveness, and humaneness

The APA Code of Ethics states as another general principle:

Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons.1

The Center for Sex Offender Management notes that chemical castration and arousal reconditioning suffer from the following shortcomings:

  • Studies examining the effectiveness of techniques such as arousal reconditioning and drug therapies are inconsistent.

  • Concerns about the appropriateness of techniques exposing juveniles to physically or emotionally painful stimuli or involving masturbation render arousal reconditioning questionable.

  • Little information exists about the safety and effectiveness of these drugs when used on juveniles.4

Similarly, the U.S. Office of Juvenile Justice writes:

Other techniques include various forms of behavioral conditioning and are much more invasive and aversive. Such techniques raise concerns regarding practicality, effectiveness, and/or ethics...Several studies of sex offender treatment programs have demonstrated high rates of treatment dropouts.9

Arousal reconditioning and cognitive restructuring reach into the innermost sexual feelings of children and teenagers and attempt to manipulate those feelings. In light of our total lack of knowledge about normal sexual feelings among youth, or how sexuality develops throughout childhood and adolescence, these methods are experimental, and amount to messing with something we don't understand. The National Mental Health Association condemns such experimentation on children:

Under no circumstances, should incarcerated children be the subjects for medical research without proper ethical review and informed consent.8

Arousal reconditioning and the insistence that the child identify himself or herself as permanently defective with criminal thinking patterns and deviant sexual feelings can cause profound damage to his or her self-concept and understanding of sexuality. There is no other area in the mental health field where lie detectors, devices connected to genitals, exposure to visual or audio pornography, required masturbation, pain, shame, and humiliation are considered therapeutic. In fact, this approach seems shocking, until one realizes that the intention is not to enhance mental health. These are the trappings of law enforcement, not of mental health care. The goal is not psychological healing, but rather the control of feelings and behavior.


The major mental health organizations have launched campaigns to fight stigma and educate the public about its effects.

According to these organizations, stigma can lead to devastating psychological and social consequences, including fear or mistrust by others, suspicion, rejection, or isolation from family and friends, and lack of access to health care.

Health-care workers often have difficulty discerning what harms a person's well-being more—the disease or the isolation and rejection encountered as a result of having the disease.
--“Plight of the Untouchables”, Science News

It doesn't take much to imagine the effect on a child's self-concept and outlook for the future when he is permanently stigmatized as a “deviant,” “perpetrator,” or “sex offender,” and required to make public all of his “deviant” feelings in a context of shame and humiliation. Most disturbing is the fact that these children are labeled based on a lack of knowledge, often for mutually desired non-coercive behavior, and sometimes with non-validated, unreliable plethysmographs or lie detectors. Certainly the use of these devices on youth severely compound their stigma.

Informed consent

The Center for Sex Offender Management proposes the following solution to these problems:

Clinicians should consider developing additional consent forms to cover the use of more controversial assessment or treatment procedures (e.g. phallometric [plethysmograph] assessment, aversive conditioning, and "off-label" use of medications)...Clients should understand that these procedures are voluntary and that they are free to decline them.4

However, consent forms do not adequately address the problem, as shown by attorney Lois Yankowski's testimony regarding the former juvenile sex offender program at Phoenix Memorial Hospital:

...children and parents were coerced into signing the consent by being told that their successful completion of the "program" was a prerequisite to being returned home....informed consent would have required that the child and his parent and/or guardian be made aware explicitly of several possible harmful and detrimental effects ranging from physical discomfort of using a noxious chemical, to severe emotional trauma...they were not told the specifics of the treatment prior to signing the consent and were not aware of the nature of the plethysmograph testing.11

In addition, when the child or youth has been convicted of a crime, the consequences of not signing "consent" forms would most likely include incarceration or some other kind of punishment. Even in the absence of such threats, and even if providers are honest about (1) the lack of knowledge about normal child sexuality, (2) the unreliability of assessment methods, and (3) the ineffectiveness and potential dangers of therapy, informed consent is impossible when parents are told that their child is a sex criminal and the only cure is the therapy, and the parents, out of shame and fear, can turn nowhere else for information or alternatives. This is in direct opposition to the statements of all mental health organizations:

The APA Code of Ethics says

Psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation.1

Similarly, the ATSA Code of Ethics says:

Informed consent is an essential component of the provision of any professional service. At the time of the initial appointment, each Client (adult and juvenile) and the parent or guardian of a juvenile Client, shall be informed verbally or in writing of:
  • The types of services proposed

  • Reasonable expectation of outcome

  • Alternatives to the type of services proposed

  • Potential benefits and risks involved in the services2

However, the ATSA Code of Ethics section on informed consent fails to address the concept of voluntary consent.

The National Mental Health Association (NMHA) also affirms “the right to refuse treatment,” and then it goes farther, saying:

The child and the child’s family or guardian should participate in the development, review, reassessment and revision of both the treatment plan and the discharge plan.8

In the case of juvenile sex offender therapy, parents are never given this opportunity. Furthermore, the fact that juvenile sex offender treatment is involuntary, and 68% of programs are outpatient programs,3 violates the position of NMHA. This position rejects involuntary outpatient treatment, and accepts involuntary inpatient treatment only in extreme situations:

Involuntary treatment is only appropriate for a very small subset of people with mental illness, and then only if the person is at imminent risk of danger to themselves or others, or substantially incapable of self-care...we do not support the use of involuntary outpatient treatment. It is an overly simplistic and misguided solution to an extremely complex problem. Treatment can only be effective when a consumer embraces it, not when it is coercive and the consumer is forced by the state to submit to treatment...7

The problem is that all children classified as sex offenders are assumed to be a danger to others, even when their behavior is mutually desired and non-aggressive.

Treatment for these youth is justified by the fact that they behaved sexually with others who were too young to consent. Particularly ironic is the fact that many treatment programs violate the principle of informed consent themselves.

Grievance procedures

Yankowski testified about the Phoenix Memorial Hospital program:

Many of the parents of the children in the program are fearful of coming forward to challenge the program because they fear that there will be retaliation against them or their children.11

Similary, a San Diego program has been described in the following way:

Parents who take exception to either the charges or the treatment are considered part of the problem. Usually mandated to therapy themselves, they are counseled to overlook their own judgment, stop trusting their kids, and heed their betters.5

This opposes the statement of the NMHA on treatment of children in the juvenile justice system, which affirms “the right to assert grievances, to have grievances considered in a fair, timely and impartial manner, and the right to exercise rights without reprisal.”8 The NMHA says, “It is essential that patient rights be protected through such mechanisms as ombudsman programs, grievance and appeals procedures, and advocacy.”7 There are no such programs or procedures for children classified as sex offenders.


The treatment methods described on this site suffer from the following ethical problems:

  • They violate the dignity of the patient.

  • They rely on unscientific definitions and inaccurate assessment methods to label children as sexually deviant.

  • Their goal is to control feelings and behavior rather than to achieve mental health.

  • They are experimental, psychologically dangerous, and based on a lack of knowledge.

  • They intensely stigmatize children.

  • They disregard the principle of informed consent.

  • They do not recognize the right to assert grievances.

These ethical violations should not be so surprising. According to Jerome Miller, director of the National Center for Institutions and Alternatives, the alignment of therapists with the criminal justice system has resulted in “debilitating ethical and scientific implications”:

In the current national mood, psychiatrists, social workers, psychologists and others who have traditionally defined themselves as helpers, now stand in line to lend a gloss of scientific or clinical validity to criminal justice spectacles often inspired by a melange of political winds, ambitious prosecutors and pop psychology which plays to the worst impulses in the citizenry...we see the traditionally most bleeding of "bleeding hearts," the so-called "child protective" social workers, becoming indistinguishable from police investigators.6

Therapists are using desperate measures to solve what is perceived to be a frightful problem. But these are not Lorenzo's Oil cases where loving parents and compassionate doctors are searching for a cure for terminally ill children. These are fearful and embarrassed parents told by experts under threat of law what must be done to cure their children of an ill-defined and dreaded mental defect.

Continue to Deja Vu

Understanding the Issue

When experts are wrong
Casualties of war
   Lack of knowledge
   Confused definitions
   Invalid instruments
   Humiliation as therapy
   Arousal reconditioning
   Dangerous drugs
   Sriking comparisons
   Sample materials
   Convos with providers
Ethical violations
Deja vu