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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

a workbook for ages 11-21

Jefferson County, TX
treatment program
assorted materials
(Warning: these materials are sexually explicit and seethe with hatred.)

Comparison with treatment
for conduct disorder


1.  Abel, G. & Harlow, N., The Stop Child Molestation Book, Xlibris, 2001.

2. Anonymous, “Molested,” Salon Magazine, February, 1997.

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

4. Chaffin, M. & Bonner, B., "Don't Shoot, We're Your Children": Have We Gone Too Far in Our Response to Adolescent Sexual Abusers and Children With Sexual Behavior Problems?", Child Maltreatment, vol. 3, no. 4 (Nov.), 1998, pp. 314-316.

5.  Kahn, T.J., Pathways:  A Guided Workbook for Youth Beginning Treatment, Brandon, VT:  Safer Society Press, 1999.

6.  Kahn, T.J., Roadmaps to Recovery:  A Guided Workbook for Young People in Treatment, Brandon, VT:  Safer Society Press, 1999.

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

8. 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.

9.  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.

10. Young, A., “Sex Therapy 'Nightmare' Or Cure?”, Arizona Republic, July 26, 1992, Final edition, p. A1.

11.  Zimring, F.E., An American Travesty:  Legal Responses to Adolescent Sexual Offending, Chicago:  University of Chicago Press, 2004.

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

About the author


The methods described on this page are used in a one-size-fits-all approach on all children or adolescents labeled as having sexual behavior problems, regardless of whether their acts were consensual experimentation, consensual romantic relationships, or actually coercive behavior.  These methods are also used for non-contact behavior such as peeping, indecent exposure, making sexual advances, or viewing pornogaphy.  A popular treatment workbook for young people 11-21 years old puts it this way:

Some clients have touched younger children in sexual ways. Other clients have acted out in other sexual ways by exposing their private parts or by spying on other people.  Some clients have been physically violent or forceful in making another person do sexual things.  Other clients have gotten into trouble for sexual harassment, or they are too preoccupied with sex and pornography.  Regardless of your specific problem, Pathways is for you.5

Cognitive restructuring

Cognitive restructuring attempts to convince children and teenagers that their prohibited sexual behaviors, regardless of whether they were consensual or coercive, were harmful and reprehensible. The approach is based on the assumption that all such behaviors are aggressive and result from distorted beliefs and thoughts called "cognitive distortions." The child's failure to believe that his behavior was coercive and harmful is considered a cognitive distortion.
The American Academy of Child and Adolescent Psychiatry describes cognitive restructuring this way:

This is an attempt to correct the cognitive distortions and the irrational beliefs that support the sexual offending behavior and to replace them with reality-focused and culturally acceptable beliefs.8

While identifying and eliminating cognitive distortions are part of mainstream cognitive-behavioral therapy, the term "cognitive distortion" has a very different meaning here. In mainstream therapy, it refers to misinterpretations of events or other people's actions as signs of one's own inadequacies, which lead to depression and poor self-esteem. However, juvenile sex offender therapists use the term to refer to what they believe are fundamental defects or abnormalities in the minds of these children that are criminal in nature.5 These include the presumed chronic tendency to deny, rationalize, and minimize the perversity and destructiveness of their feelings, thoughts, and actions.2, 4, 5, 6, 8 In effect, identifying and correcting cognitive distortions in mainstream therapy is a humane act that leads to a healthy self-concept, while the process in juvenile sex offender therapy is exactly the opposite. (For more information about sex offender treatment providers' misunderstanding of cognitive distortions and criminal thinking patterns, see these letters from a reader who experienced treatment and researched the topic.)

Thus, peer group sessions and workbook assignments require participants to provide detailed descriptions of the sex acts they engaged in, to acknowledge how devastating they were, and to accept blame for all harm that occurred to all people involved. 
The children and adolescents are also often required to describe the devious methods of "grooming" they used to manipulate their victims into complying with their request for sexual activity.  Because of the assumption that all children with sexual behavior problems lie, treatment providers also expect them to reveal that they have committed other sex crimes previously unreported.  These disclosures are required repeatedly throughout the treatment process, in an atmosphere of shaming and castigation.  Failures to disclose more crimes to the satisfaction of the therapist or peers lead to accusations of denial or minimization.2, 5, 6, 8

“Between my two sons...there was no penetration, no force, no threats...My youngest son confessed in tears that he'd enjoyed it...Our son tells the same story over and over again...nothing has changed, nothing new has come forth. For this reason he is perceived as being more recalcitrant than the other boys, 'frozen' in his denial...all are tarred with the same brush. All are child molesters in the world's eyes now, and it's an unforgivable sin.” 2
--Anonymous, published in Salon magazine

Group sessions and workbook assignments also require all participants to admit that they engage in criminal thinking patterns, and to identify those patterns in their lives. They must also repeatedly describe their on-going sexual feelings and fantasies (and sometimes masturbatory habits) in detail, and admit they are dangerous.  If they fail to do so, again, therapists and group members confront them--sometimes very aggressively--for suffering from cognitive distortions.2, 4, 5, 6, 8

These kinds of adversarial methods are never recommended in treatment programs for children and adolescents who commit violent non-sexual acts (i.e., those with conduct disorder, who commit such acts as aggravated assault, use of weapons, cruelty to people or animals, robbery, or arson).9  The field of psychology provides no scientific evidence of their therapeutic benefits.  Their only purpose seems to be for self-castigation and humiliation. 

Cognitive restructuring is used by approximately 84% of programs for juvenile sex offenders and 68% of programs for younger children with sexual behavior problems.3

Victim Clarification

Another approach that is not part of treatment for those who victimize others non-sexually,9 but is used for juveniles with sexual behavior problems, is that of helping them understand the damage they have done to their victims.  This might seem to be an appropriate method for youth who have committed an aggressive offense--sexual or non-sexual--but again, it is used only for sexual misbehavior, and it is used for sexual misbehavior which is consensual, where there is no victim.2, 7 

Only “40 percent of the juveniles from a sample of 91 displayed expressive aggression in their sex offense(s)...Becker and her colleagues noted that the juveniles in their sample included adolescents who engaged in consensual sexual behavior with a peer-aged relative...most interventions designed to address sibling sexual behavior assume a victim-perpetrator model...it is progressively less appropriate (and may be damaging) when sibling cases involve inappropriate mutual sexual behavior or, especially, age-appropriate sex play." 7
--U.S. Office of Juvenile Justice

Victim clarification work is often extreme, requiring the youth to do the following:2, 5, 6

  • repeatedly list and describe all their victims
  • describe in detail the demeanor, behavior, and feelings of all their victims during the offense, and again after the offense
  • speculate about all possible harmful effects on all their victims
  • relive their own actions from victim's perspective
  • learn about "indirect victims"; i.e., family and friends of both victim and perpetrator
  • describe in detail every incident of their own victimization
  • listen to multiple stories of victimization
  • learn about the findings of research on the effects of sexual abuse
As with cognitive restructuring, to avoid being accused of denial, young people whose sexual misbehaviors were consensual must say that they coerced their "victims." And again, victim clarification is often done in an atmosphere of shaming, where the intent seems to be humiliation and self-castigation.  Victim clarification is used by 81% of programs for juvenile offenders and 53% of programs for younger children.3

Relapse prevention/Assault cycle

Relapse prevention is based on the assumption that all undesirable or illegal sexual behaviors constitute an addiction, regardless of whether they are consensual or coercive.  Thus, its approach is taken from the twelve step model of Alcoholics Anonymous (AA).  Repeating prohibited sexual behavior is referred to as a relapse, and children and teenagers are taught to recognize those things that lead to a relapse in order to prevent such behavior in the future. The method requires them to identify and describe their feelings, thoughts, and actions before their sexual behavior.  These precursors are referred to as "danger signs" or part of the "sexual assault cycle."  Treatment attempts to teach young people to intercept these dangerous sexual thoughts and feelings, to imagine their negative consequences, and to change their behavior.5, 6, 8 This approach is used on all juveniles with sexual behavior problems in spite of a lack of empirical evidence supporting its use:

...most programs have learning about the “sexual assault cycle” at their core, but despite the fact that the sexual assault cycle has been in use in sex offender treatment for nearly 20 years, the model has not been empirically validated...The prevailing view is that early clinical intervention is needed to break the cycle of sexual deviance, and that intervention should take the form of lengthy, offense-specific, peer-group therapy. There is not a shred of scientific evidence to support this stance...although the cycle may fit many juveniles who have committed sex offenses, it does not explain the abusive behavior of all such offenders, including those described as "naive experimenters'"... 7
--U.S. Office of Juvenile Justice

The approach also requires the child to admit that, like the alcoholic, he has a life-long condition that cannot be cured.  A treatment workbook for 11-21 year-olds tells its young readers, "
Completing Pathways will not 'cure' you of your problem--there is no cure--but it will teach you how to recognize and control your problem behaviors."  Its final exam contains the following questions:

5.  What have you learned about your sexual urges, and how have you learned to control your deviant sexual fantasies?
6.  How do your thinking patterns contribute to your victimizing other people, either in a sexual way or a non-sexual way?
10.  What is it about you (your personality) that allowed you to commit a sex offense in the first place?
13.  What are the factors that might eventually lead you to having sexual behavior problems in the future?5

In the same way that the AA member says to the group, "I am an alcoholic," the child must take on a permanent identity as a sex offender:

We have encountered young teenagers (13 to 15) who, as part of their treatment, have been compelled to recite daily lay-outs or creeds including phrases such as 'I am a pedophile and am not fit to live in human society...I can never be trusted...everything I say is a lie...I can never be cured'...We have listened to teenage boys hesitantly confess that they admitted to offense histories and deviant fantasies they did not have, simply because it was expected and required before they would be eligible for release from residential programs. Our impression is that these incidents cannot be dismissed as isolated examples of overly zealous practice but are directly derived from an uncritical application of prevailing treatment models.4
--Therapists Mark Chaffin and Barbara Bonner

"I'm furious about what that hospital has done," said the mother of a 12-year-old girl who spent six weeks in the program. "My daughter was the victim of sexual abuse. They never once focused on that, but they definitely nailed her as a child molester, as a pedophile"...Therapists insisted that the girl was a rapist. The girl wouldn't admit that, but her therapists persisted until one day she tried to kill herself, the mother said. "They found her in the bathroom with a plastic bag over her head," she said. "At the beginning of the (group-therapy) meetings, they'd make her identify herself as a perpetrator. To this day, she's traumatized by it, she cries about it. They kept telling her she'd do it again and there was no way she could prevent it." 10
--Journalist Alison Young, Arizona Republic

There are three crucial differences between AA and the approach here, however.  First, of course, the AA member is an adult who has freely chosen to participate, while the child or adolescent "offender" has been forced into treatment.  Secondly, the stigma of being a sex offender is dramatically more intense than that of being an alcoholic.  Thirdly, while the alcoholic needs only avoid drinking alcoholic beverages the rest of his life, at least some of these children are thought to require life-long tracking, supervision, registration, restrictions on movement and employment, and community notification of their presence.1, 5, 11

Relapse prevention is used by 89% of juvenile offender programs and 77% of programs for younger children.3


None of the harsh adversarial approaches described here are used on even the most violent conduct-disordered child or adolescent (or adult non-sexual offender, for that matter).  In fact, these methods are not based on any empirical evidence in either psychology or criminology:

The field has evolved conventional wisdoms that, like all conventional wisdoms, became accepted as fact when repeated and reinforced often enough. In some cases, they may shade into dogma. These might include beliefs, for example, that sex offender-specific treatment is the only acceptable and effective approach...that denial must be broken; that hard, in-your-face confrontation is synonymous with good therapy;...that deviant arousal, deviant fantasies, grooming, and deceit are intrinsic features;...that the behaviors always involve an offense cycle or pattern...that they have a compulsive incurable, life-long disorder; and that these youngsters are such dangerous predatory criminals that neighborhoods must be notified of their presence. Despite their wide acceptance, it is our opinion that clear, empirical scientific support for each and every one of these conventional wisdoms is either minimal or nonexistent.4
--Therapists Mark Chaffin and Barbara Bonner

These methods present the child or adolescent with a picture of himself as a permanently defective and dangerous person with criminal thinking patterns, deviant sexual feelings, and a history of committing heinous acts worse than physical assault or cruelty--in short a subhuman unworthy of the supportive therapies and ethical protections given to other troubled children.

He shows no signs of a compulsion, or being predatory, no signs of anything except a deep-seated shame and remorse, and the desire to suppress his own blossoming sexual nature...I've learned another rule. I should give my son all my anger. I should direct this undying rage at him—rage for the fear, the guilt, the lost privacy, the exposure and grief. It is his fault, and I must not forgive...I am to give all this to a boy, who is not allowed to have any goodness in him anymore.” 2
--Anonymous, published in Salon magazine

No wonder, then, that some treatment providers consider it acceptable to make crude attempts at changing these young people's sexual feelings and fantasies through methods similar to those used 50 years ago to "cure" homosexuality.

Continue to Arousal Reconditioning                    Examine Sample Treatment Materials

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