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References:

1. Burton, D. & Smith-Darden, J., 1996 Nationwide Survey of Treatment Programs & Models, Brandon, VT: Safer Society Foundation, 2000.

2. Maryland Department of Health and Mental Hygiene, The Sex Offender Treatment Provider Directory For Maryland, Baltimore, 2003.

3.  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.

4.  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.

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


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

About the author

TREATMENT

"This all reminds me of heroic gynecology, which regarded the birth process itself as a pathological thing. What we've got now is heroic intervention in childhood sexuality by people who don't know what they are talking about."
--Vern Bullough, sexuality researcher and Professor Emeritus at State University of New York

As already shown, children and teenagers who engage in non-violent and non-coercive sexual behavior that is socially unacceptable are typically lumped together together with those who have engaged in abusive behavior. Older ones (age 12 and up) are labeled as juvenile sex offenders, while those under 12 are labeled as children who molest, sexually reactive children, sexualized children, sexually troubled children, or children with sexual behavior problems. Often they are pressured or mandated into treatment programs by the police, courts, or social services.

  • A survey conducted in 2000 found 291 programs in the U.S. for juvenile sex offenders (age 12 18).

  • The survey located 66 programs for children under 12.1

  • These numbers are probably underestimates. Just one state's directory of treatment programs lists 29 programs for adolescents and 16 for prepubescent children.2

Although the two age groups are usually kept separate for treatment, approaches for both are based on similar principles, are often provided by the same agencies, and frequently use similar methods.

The most common treatment model is cognitive-behavioral with relapse prevention, used by 80% of U.S. juvenile sex offender programs, and 52% of programs for children. This type of treatment attempts to change the way children and teenagers think about sexual behavior (the cognitive portion), as well as to change their sexual feelings and behavior (the behavioral portion).1
 

While cognitive-behavioral therapy is commonly used by mainstream therapists, the way in which it is used with children here bears little resemblance to its use for those with other disorders.  This is due to the criminological and adversarial approach taken by juvenile sex offender treatment providers.
5  This can be seen immediately in the language used in the literature:  while clients with other disorders (even those which involve commission of violent crimes) are referred to as "patients" or "children," those with sexual behavior problems are always referred to as "offenders" and "perpetrators." 3, 4

Methods vary from program to program, but the most common are relapse prevention, cognitive restructuring, victim clarification, arousal reconditioning, medication, victim restitution, aggression management, art or drama therapy, intimacy skills training, physiological monitoring (plethysmograph), and sex education. While some methods (such as relapse prevention, cognitive restructuring, and victim clarification) seem reasonable for children and teenagers who are truly aggressive, they are often implemented in a way that requires the youth to adopt identities as permanently defective criminals and engage in constant self-castigation. Furthermore, some of the methods (particularly sexual arousal reconditioning and use of the plethysmograph) are disturbing regardless of how they are implemented.


Understanding the Issue


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