Dr Frans E. J. Gieles, 2006
Table of Contents
This is a short explorative study concerning the methodology of the sex offender treatment (SOT), presently frequently used as routine in the Netherlands and abroad.
An explorative study wants to explore a problem and present it to the reader in order to stimulate further thinking and research, possibly leading to improvement and development of the methodology.
The basis is
A short exploration of the literature is not much of one, but I read in literature of 2006 nearly the same as in literature of 1996. There seem to be only a few changes and developments, only in detail within the chosen model, but the model itself is the same. My impression is: much of the same.
Fifteen clients are not many, but data are extremely scarce and very difficult to get. This is because the clients are not allowed to tell about their own treatment. If they do,
In several countries, this can be for many years in awful and dangerous circumstances.
Nevertheless, fifteen narratives reached me, some by letter or e-mail, and some only by word of mouth because of the forbidden character of it. The narratives match greatly, thus they may be an indication.
Also the therapists keep silence. They refuse to speak about their clients, except for mentioning of successful cases in the literature, while remaining silent about themselves. They only write fine things in the literature, about 'safe groups' and 'understanding therapists', but how they see, do and experience their work has not been told. My impression is that they have few self-critics in a closed stronghold believing in an ideology.
The public and the courts don't know better than that there is a treatment by experts, but they don't know what happens within the clinics. Let's have a look within those walls, as far as literature and clients have given us information. Let us look critically.
What is treatment?
Treatment is methodically acting by therapists targeted to clients, patients of to those who otherwise need help: therapists follow a methodology.
What is a methodology?
How can a methodology be described?
Methodology can be described as a way of acting, as a repertory of ways to act.
How can ways of acting be described?
|To do this, I have developed a method in my
dissertation, in which the concept 'course of action' is unfolded in
seven elements. With these seven elements at hand, one can describe,
compare and develop methodology.
These seven elements form the further structure of this article. →
How does the therapist see his clients and the situation? How is his interpretation of what he sees? What is his framework of interpretation? This will highly influence his aims and his method, but also how he interprets the outcome later on.
The answer is written in the literature and this matches with what the clients have experienced.
The seven elements of acting (methodologically)
(1) The way the situation is seen and interpreted.
(2) The aims chosen.
(3) The method of working.
(4) The way the outcome is seen and interpreted.
(5) The feeling afterwards.
(6) Insights: the ideas and questions arisen.
(7) The way to search for better courses of action.
The first and most important characteristic of the view of the therapists is already given in the title of this essay: the therapists view of the client is primarily and exclusively
The client sees himself in a different way
In the literature, the client appears as someone who does not take responsibility for his acts, someone who says 'I could do nothing about it, it happened by itself' - thus, as an automatically behaving being.
None of the fifteen clients who have told me the narrative of their treatments sees himself in that way. Each sees himself as a person with an inner life, with his own biography and able to act consciously, as a whole and as an individual. One may have made a mistake, but one keeps being more than an offender. They do not reduce themselves to offenders. They have felt sharply that they have been seen and approached in that reductionistic way.
(2) The aims
Aims are important to direct human acting. After the act, one looks back to the aims to see if the act was successful.
The predominant aim is: prevention of recidivism. The therapists see this as a mandate from society and court. To prevent re-offending, one should modify the behavior and cognitions of the client, thus this is the first and dominant sub-aim.
Note that the aim is neither to cure nor to help the client: the aim is to adapt his behavior and his cognitions. Thus, the model is the cognitive-behavioral model, and the motto is: "No cure but control".
We can put the aim in other words. The therapists see a client who, in their view, behaves automatically. They want to change the client in an acting being, who takes responsibility for his chosen ways of acting and his acts, a client who avoids the wrong acts and does the good ones.
A fine aim, of course. Let's now have a look at how the therapists work on this aim.
(3) The way of acting
A way of action is a repertory of possible ways of acting the actor can choose, and an advice.
Marked is that all clients are treated with the same methodology. This methodology, originating from the treatment of addicts, is used for violent offenders, exhibitionists, rape offenders and pedosexuals, including those who swear that the contacts were consensual, and including those who have not touched any child but have downloaded illegal pictures.
Are downloaders offenders? Yes: 'downloading is co-abuse, thus abuse, and it leads [automatically] to abusive behavior. Thus they are potential sex offenders, thus offenders. At any rate, they are viewed and approached as sex offenders.
The methodology concerned is a routine. We come across the next ways of acting.
1. Conditions beforehand
The therapist creates conditions to join the treatment. Those who must join (by order of the judge or probation officer) or who wants to join (to placate the judge), are confronted with a difficult choice. The conditions may as it happens thoroughly intervene in the life of the client. One has to abandon any contact with any child, resign the sport club and avoid other pedophiles.
2. Keeping distance in a hierarchical relationship
The relation between therapist and client is not helping, subservient and equal, but hierarchical, distance keeping and based on (enlargement and underlining of) the differences. One avoids each kind of nondirective therapy and is, without any hesitation, only, always and exclusively directive.
The vision is that this is necessary in the forensic field. One consciously creates "a creative uncomfortable feeling" ('t Hoof 2000) because otherwise the client will not change. The therapists know that the clients feel ill at ease and they do not want to change it; moreover, they stimulate it. They confront. One creates and beholds an "unbridgeable distance" and does not want to bridge this (Deneer 2004, p. 22). One postulates that "hostility (...) is inherent to the therapy situation" (Idem).
3. The group
Primarily the therapy is given in a group with usually two leaders from the staff. Only sometimes there is an additional individual therapy. The groups are formed from the type of offense, thus from the offense behavior, not the type of human or problems.
In a group, the clients may support and understand one another. Clients can be models for one another and talk to one another. The therapists believe that this type of clients in an individual therapy will manipulate the therapist and will lie. In a group, they quickly recognize this and can talk about it.
Consequently, the most intimate matters must be told in a group. It is not permitted to tell outsiders about what is said in the group. It is also forbidden to have contact with the group members except during the group sessions. This is to prevent that the clients outside the group speak "pedophile-friendly" between them (Deneer 2004, p. 98). Thou shalt not speak pedophile-friendly.
4. A workbook with questionnaires
This work book contains questionnaires and schemes which in the course of time, mostly at home, have to be filled out and then are discussed in the group.
This is the exact history of the offense itself and of all what, minute by minute, happened before. The aim is to show that there really have been moments and opportunities to make choices. One can no longer say that 'it happened to me'. There were choices, one is responsible and has to acknowledge one's responsibility.
Here we see that the therapists approach the clients not as behaving beings who automatically react to stimuli, but as acting beings who are able to make choices and who are responsible. Confusing is that they normally view and approach the client as a behavior automaton, but suddenly they take another approach. The latter approach is the better one, but why is the first one the main approach during the treatment process?
b. The offense chain
This is a more general pattern that might precede a possible relapse of the offense. The pattern describes situations, feelings, cognitions, fantasies and triggers or disinhibitors (alcohol, other drugs, fantasies, thoughts) which have resemblance with the delict scenario, thus which might lead to a relapse.
One makes a difference between the causing factors: there are static factors, which you cannot change, such as the past, and dynamic factors, which you can change, such as thinking, feeling, doing or not doing. We do not read about motives or reasons, only about factors. Factors cause behavior. Here, the client is again the behaving being with his mechanisms that cause crime behavior.
Again, the therapists view and approach the client as an acting being, able to choose and to consciously break the chain and prevent relapse. Nevertheless, the concept offence chain presupposes that this chain, if not broken, automatically causes a relapse.
This reasoning is dubious. The traffic offense happened after the drink, but not every drink leads to a traffic offense. What happens before, is not necessarily a cause, let alone a mechanism. The kind of reasoning here is one of chance, and not every correlation may be seen as necessarily causal. One links the dependent variable (offense) directly and linearly with the independent variable (drink, fantasy). One selects on the dependent variable, the wrong cases, and does not consider the good cases. Not everyone who gives extra lessons will abuse children. Nevertheless, the therapists view giving extra lessons, football training or foster care as a great danger that one must avoid, thus one must avoid any contact with any child. Remarkably, in incest cases the fathers are often allowed or obligated to contact their children.
In several papers, the client's sexuality is mapped out, as it has been and as it should become.
The basic vision is that there exist healthy and unhealthy scripts. One supposes that the clients have unhealthy scripts, and one strives for the healthy ones. The scripts of the staff are not to be discussed; these are supposed to be healthy.
d. The funnel
In a funnel, the walls come gradually nearer to each other. Just as on a slide, there comes a point of no return. The image of a funnel refers to contacts with children. At the top, one works, for example, at a school; lower in the funnel one gives extra lessons, one creates an intimate and special relationship. At the foot of the funnel there is sexual contact. (Deneer 2004, p. 108)
Sliding in the funnel is viewed as a more or less automatic process. Thus, the clients have to avoid any situation at the top, thus do not work at a school, do not give extra lessons, do not establish an intimate and special relationship, better avoid each contact with any child. Any contact might become intimate, and then, automatically, the offence chain will be started.
The literature usually describes a case in which things happened in that way. No one mentions that there are thousands of cases in which the course of events was different and good. The bad case isn't a law, there is no mechanism; the human being is not an machine.
5. Lots of orders
During the course of the treatment process, the therapists give lots of personal orders. The clients must
A method to de-sexualize is the STOP method. Directly after any sexual thought or desire, one has to think of other things, preferably awful things - for example the smell of chlorine or ammonia, of which a small bottle is always at hand.
6a. Narrative coercion: the 'thinking errors'
Narrative coercion means that the one hinders the other to tell his own narrative and forces him to rewrite his personal narrative until it is just what the first one wants to hear. For therapists, this is strange, because exactly one's own personal narrative helps to develop identity, ability to act, and responsibility - aims a therapist wants to achieve.
However, the therapists in a sex offender treatment view the personal narratives of the clients as expressions of cognitive distortion, as we already saw in the diagnostic process (Gieles 2006). The therapists don't want to hear that narrative. They continuously correct the narrative using all their power, in a dogmatic or fanatic - thus irrational and ideological - way.
The order to rewrite one's personal narrative is a paradox, and not a therapeutic one. The therapists force the clients to tell everything and not to hide anything. The staff does not tell anything about themselves; it is even forbidden to ask such questions. But the staff does not want to hear specific thoughts of the clients. The client must tell his own personal narrative, but at the same time he is forbidden to tell the same, because the therapist does not want to hear it: it has to be re-written.
The therapists are very alert to thinking errors.
This wording is not correct. It does not refer to errors in (logical) thinking, but to having the wrong thoughts, i.e. the thoughts of which the staff disapproves - and you know: the staff is always right and never makes thinking errors.
The most important are
The therapists train the group to detect and correct thinking errors. That's handy, a group doing the job. But the staff is always right and has always the last word.
The staff is always right. The clients must speak about the offense - even if there was no offense.
The personal narrative has been rewritten, thus the treatment is successful. Clearly, the staff did not accept the positive feeling of the man. Well, there we go, after about one year of narrative coercion, the man tells the narrative that the staff wants to hear: a negative feeling, after which the staff is pleased with the success of the treatment.
Another client told me:
The client had fallen into the pitfall. If he wanted to ever be released, he must write his letter to 'the victim'.
These passages illustrate not only the narrative coercion, a crucial element in the method, but also several other topics.
The therapists believe that fantasies nearly automatically will lead to (offense) behavior. This may last a fifteen years, but the offending behavior shall come - this in contrast with the recidivism rates. They also believe that this holds for every client - again in contrast with the low recidivism rates for treated offenders - apart from the dossier and the facts.
Clearly, a strong irrational belief in machine-like behavior chains dominates, in contrast to a strong irrational belief in machine-like behavior chains dominates, in contrast to the facts and the dossier, and surely apart from what the client says about his own acting. His narrative does not count, cannot be true, because it may not be true. The client only manipulates, they believe. Of course, the staff never manipulates, they believe.
Here we see that element (1) of the cycle of acting, the interpretation of the situation, dominates the other elements - in this case, it limits the way of acting. The interpretation chosen is in every way maintained, apart from the facts.
Are there no facts? No problem: they suppose them. After all, the clients routinely lie, that is their character, quite different from us - so they believe. Are there no facts? No problem: they shall come. They can wait for ten or fifteen year (but cf. the recidivism rates), because they always are right, of course. Their narrative is true, so they believe, the client's narrative may not exist at all.
This has a strange consequence. They want to educate the clients to acting people with responsibility for their acts. To reach this aim, the personal narrative about their own way of acting is crucial. Nevertheless, they approach and treat their clients as behavior engines. This kind of approach and treatment might change the behavior, but not the personality. If the behavior change is true, it is because the first thing the clients learn is to lie and to pretend.
... that 'the therapist [anyway] must have a victim' - and thus an offender, otherwise there would be no one and nothing to treat.
In my view, the client did not make any thinking
error in this case. He keeps thinking clearly, in spite of the attack on his
brains, his integrity, end more - see the other quotes.
The therapist's reaction is typical, said the client to me, because of its bluntness. Why didn't he ask the client what was meant by 'love'? What he feels and thinks about that feeling? Which associations come into his mind? How he thinks to act, or not to act, on this feeling?
There are a lot of forms of love: eros, agapè, philia. Even the Pope makes this differentiation and speaks with nuance about this subject. The client told me that he would explain love as platonic, but after the blunt reaction of the therapist he kept silence. Speaking hadn't any sense. The 'therapy' only will lead to no love, not even platonic, not any contact with any child.
In my view, this is neither therapy, nor helping, but ideology.
Confounding love and sex, to which the therapist may have referred, is more or less a standard mistake in our society. Not only do lots of youngsters confound love and sex, also lots of adults do. (Hamaker 2005)
This was an intermezzo. We return to element (3), the way of acting, particularly to the crucial point:
6b. Narrative coercion: the 'thinking errors' - 2
What has the client said about this topic?
Here we see the cognitive distortion we have read about in the literature.
7. Normalizing fantasies
The therapists do not only break into the client's thinking, but also into his fantasizing. They believe that fantasies precede an offense. In the behavioral model, one views this as a causal relation in a mechanical and automatic way: the fantasy causes the offense. Thus the client can or shall relapse, and the fantasies are the predictors of relapse. Thus, to prevent relapse, the therapists combat specific fantasies; they want to normalize them. So, they continuously ask the clients if they have masturbated and what were the fantasies. Then they judge: wrong, and they press the point of inhibiting one's fantasies.
Endless repeated is the threat to end the treatment because a client does not cooperate enough. For the client, this may have drastic consequences, because he than breaks the conditions of the probation officer, and thus those of the court. The treatment center mentions this to the probation officer, who in turn tells it to the prosecutor, who will demand that the suspended sentence has to be executed, or that a closed clinic will be the next place. The choice is between cooperation or landing behind bars. A heavy form of coercion, fully used - speaking about power misbalance and coercion...
Before each weekend, the clients have to tell their plans, and after the weekend the have to report about the weekend. Don't plan a swimming pool or anything like that, but also do not visit anyone with similar feelings.
The Monday morning report has to answer questions like
It is a severe interrogation. Whoever is not open enough, or does not cooperate, ... etc.
Staff members visit the clients at their home and they attend to what is on the walls and on the book and video shelves.
Is this therapy: sending back a person into loneliness and isolation, which exactly had been the grounds of the offense (downloading illegal pictures)? Or is this narrowness of vision, ideology?
Another kind of coercion and control is the endless repetition of orders and bans. In a community setting, the therapist cannot have a 24-hour control of the clients. The solution is the endless repetition of the orders and the bans.
In the literature and usage, one speaks of "psychotherapy" and "the therapists". But the vision, attitude, aims and ways of acting, described above, are quite the antithesis of what we may call "therapy". In the ways of acting, we see not any attention for the client's psyche, only his cognitions and behavior.
Please, call things what they are. This is not psychotherapy. Call it what it is: behavior modification by use of power, especially Narrative coercion as method of behavior modification. By the way, 'influencing behavior by use of power' is exactly what the clients are accused of doing.
9. Sometimes - but more often - lust inhibiting medicines
In some cases, lust inhibiting medicines or anti-depressants are given. The latter have a near-term effect of inhibiting lust and obsession. In some cases, taking these medicines was set as a precondition for treatment, even without having seen, let alone having examined the patient. But still taking the medicines is mostly voluntary, and there are people who have said to benefit from them. Politicians in the Netherlands propose to demand that these medicines be taken by every moral offender as a condition for release.
10. In the USA routinely: mechanical detectors
Now, we will have a look at the outcome and the way it is interpreted.
(4) Seeing and interpreting the outcome
By describing the ways of acting, the narrative about the action is still not complete and the methodology is still not completely described. There will follow another four elements.
After acting in a certain way to reach certain aims, the actor observes the result: has something changed? Is this an improvement? What does the actor observe and how does he interpret it? The answers to these questions will lead to the coming actions. 'Oh! The potatoes are a porridge now! Next time I will cook shorter and with less water.'
The sex offender therapist primarily wants to prevent recidivism, thus this is what they want to observe. We may ascertain that the recidivism rates of treated sex offenders are quite low. Thus, the sex offender treatment does its work - as do other methodologies, which seem to have slightly more recidivism. But the differences are viewed as great enough to, since the 80's, reject individual therapy and choose the cognitive-behavioral model.
This article concerns the treatment method, not the recidivism rates. Thus, I give some links and only one recent (translated) quote.
Observing and interpreting these kinds of outcomes are only possible after recidivism research, thus only after some years and covering a correct, large enough, sample. On short notice, the therapists work with repeat of the questionnaires (do the clients masturbate less?) and the final presentations of the clients, in which they present their offense chain and tell how they avoid stimuli and triggers, as well as how their cognitions have been changed. One by one fine presentations - but are they true?
At the present time, the therapists look at the clients' lifestyles. To follow them, there are after-care groups. Does the client have a job, housing, income, activities? Particularly: does he avoid stimuli (read: children) and triggers (TV, film, book, pictures, alcohol, drugs, specific contacts)?
Element (3), the way of acting, was the way the therapists worked. Now, describing element (4), the outcome and its interpretation, the clients also have to have a voice in the choir.
Roughly speaking, the clients who told me their narratives said that they had not been changed not a single iota. They reported that the outcome of the way the therapists acted was that they had learned to pretend. This, they said, is the only way to end the treatment, to be released, and to be freed from the pestering. Thus, they said to have leaned to simulate, to play the game, and simply to lie.
Supposing this outcome, some clinics work with lie-detectors. Thus, the therapists combat the lies that the same therapists have triggered. In the USA and Canada, this is already routine. These detectors are well-known as not being reliable; the lie-detector can lie. But it is a disaster for the clients if a lie is detected.
Does the outcome of the 'therapy' show us improvement, solution of problems? The clients to whom I have spoken said no.
This is the outcome of a way of acting in which no attention is given to the psyche, and attention only to the cognitions and the behavior.
What is my interpretation of this outcome?
It was not psychotherapy, no therapy at all. It was behavior modification by narrative coercion and other kinds of compulsion. No cure but control.
(5) The feeling afterwards
After observing and interpreting the outcome, the act itself is completed, but still not the narrative about the act. Something that still has to be told keeps hanging: a feeling afterwards, which is somewhere between pleasant and tedious, but also a feeling about the correctness of the act, thus an ethical reverberation. Another aspect of the feeling afterwards is the answer to questions such as 'Was the act suited to me? Was it authentic? Was it my act? Or did I only follow others?'
Initially, these feelings are vague. They are known by helpers as 'the feeling you take home'. Gradually, the feeling will become clearer. It may keep hanging for a long time. One feels the wish to speak about it to the team. Not speaking about it can hinder progress, expressing the feeling can clear the air for the whole team. Speaking about the feeling afterwards helps to develop methodology. It is an important element for the description and development of a methodology.
However, I cannot describe the element from the view of the therapists, because nobody has written or spoken about it. Are they content? Do they feel uneasy or doubtful? Do they feel true to themselves, or do they feel a kind of alienation? We don't know. The only feeling that the literature suggests, is that they experience their work as difficult, but also feel some pride and a confirmation of their own expertise.
The clients tell us quite more. Their feelings afterwards are for the most part negative to very negative. In one case so negative that the client was barely able to speak about it and give more than a rough description. "Too terrible for words", was said; one could not find the words and preferred to avoid recalling the feelings.
"The consequences afterwards? I have listed them: →
"I could constantly hear welling up in my brain the words, 'Sex is wrong. Love is wrong.' I was intensely angry because these people had knowingly and intentionally sought to destroy my capacity to live and function."
"There are eight teenage boys and two therapists, and all the rest of us are parents and grandparents. We are bewildered, we are depressed and we are all consigned to this room for months. I am sick for hours beforehand and a day or more afterwards, unable to sleep in peace, to eat, to hold a casual conversation.
These boys, including my son, are sex offenders. We, as their parents, are complicit in crimes hard to explain or define. Recently I asked my 14-year-old son what he's learned from the painful events of the last year, and he said, "I've learned sex is bad. I don't want to think about it anymore."
I believe the cure has been much worse than the disease.
Each of the boys in our therapy program must 'disclose', again and again, to all of us. Public confession is believed to be more than a good -- it's considered necessary to healing, a sign of responsibility, the willingness to take responsibility for one's crimes upon oneself.
depression sadness always have watery eyes to withdraw into oneself anger when the person "wakes up" afterwards traumatized feeling inferior to others feel ugly and unworthy feel crushed scared of people no more self-confidence isolation insecurity stress brainwash feeling of being had feeling of oneself not having being respected for his beliefs feeling of not being able to express oneself enough terrorism discrimination."
He's learning about 'ownership' and 'restitution' and 'errors of thought'.
I don't believe that it is his fault that the system is so cruel, the therapy so shallow, the philosophy so unintelligent."
(A mother's story)
As an external coach, I was present at the final presentation of a client. Once out of the clinic, he said: "So, at long last this half year of pretending has come to an end!" Now, I will become myself again, the person I always have been and will be."
At the end of the therapy, a client got the advice to enter [real] psychotherapy. I too advised this to him. The client: "Oh no! I am being had with therapy! Never more!"
In this case, the method of the 'therapy' has effectively prevented entering real psychotherapy.
In this element of the cycle of acting, not only the observing of the feeling afterwards is important, but also the interpretation of that feeling. This interpretation will influence the future ways of acting.
It is here where the shoe pinches
The therapists surely know that the feeling afterwards of their clients is very negative. Knowing this, they do not say: 'Oh, that's a pity. We have to review our methodology." No, they say that it is good so. The negative feelings are consciously and purposefully evoked, otherwise the clients would not have been changed. They gladly make a comparison with the dentist.
(6) The ideas and questions arisen
Acting evokes insights, ideas for future action: 'Too early sowing maize does not result in a better crop'. Especially by developing methodology, the insights have the form of questions: 'Or might I have sowed in too dry ground?'
The ideas of the therapists are written in the literature.
"For all types of offenders it is true that sex offender treatment cannot offer cure. We only try to prevent recidivism. It is pure behavior therapy."
(Frenken & van der Zalm 1996)
Clearly, there is knowledge about the negative feelings afterwards of the clients. However, these are necessary and unavoidable, painful but needed and ultimately beneficial.
In my view, the necessity and the benefit has to be proved. We might see that cognition and behavior have been changed, but if depression and obsession still exist, if the inner has not been changed, what is the benefit of this method?
What is absent in the literature, are new insights. Yes, sometimes there are, but always within the same model. The model as such is never discussed. Thus, it does not raise any questions. The literature is much the same; there is no development. One refines the model, but does not develop the model itself. Worldwide the model is simply seen as a reality that is as it is.
The methodology of the SOTP Report (1996) does not differ much from the more recent literature and the experiences of the clients nowadays.
In Gieles 1997, I write:
"For the staff, a certain kind of personal quality is needed, not a specific academic or professional degree. This staff has to work 'in a consequent way', that is: following precisely the prescribed method. Thus, staff will work on a non-personal level, whilst the offenders are seen as ‘persons with the wrong behavior, thinking, feeling and fantasy’, this in a non-personal way too. Only in the talking about the offense circle, one works on the individual level; however, staff keeps seeing the client as ‘the offender’. His behavior is seen as deviant and leading to an offense, thus wrong and anti-social, whilst the staff keeps seeing themselves as normal and social. Staff keeps being on the level of the behavior. There is not a word about individual (or group-) psychotherapy.
It is simply treatment, not therapy. The treatment is based on a very simplistic way of thinking that equates political correctness with being right and political incorrectness with being wrong."
The clients told me that they are not allowed to ask the staff members what their education is. One does not need academic staff members, but docile ones.
Whoever has an academic degree, will supposedly tell this. This evokes the assumption that the staff members, in the literature called psychotherapists, factually are not psychologists at all and thus not allowed to practice psychotherapy.
Might it be possible to improve the way of acting, the methodology? This question leads us to the seventh and last element of the cycle of action that concerns the improvement of the way of acting.
(7) The way to search for better courses of action
This element completes the course of action and the narrative about it, it creates room for the next action. 'I will buy a book about sowing maize', says the farmer, or 'I will go and talk to my neighbor farmers' - and than he can go to sleep, the narrative has been told.
What do the sex offender therapists tell us about this element? Regrettably nothing. They want to refine the method within the chosen model, but not to discuss the model itself.
Also the clients keep silence concerning this element. They say no more than 'Let them listen to us!', 'Let them respect us as humans!', or 'Let them read: Brongersma, Sandfort, Bernard, ... Gieles!' And than they keep silence and end the interview or the letter.
Where therapists and clients keep silence, the investigator may speak. What the literature, the therapists and their clients have told us, is in summary put in an overview, the course of action, a scheme with two columns - to which a third column is added.
The investigator has also completed an act: he has described a methodology. Also he has a vision, etceteras, a feeling afterwards, insights and questions, and maybe also ideas about improving the methodology described. In this chapter no therapists or clients are speaking. Now the investigator in his turn speaks - and critically.
The act of critically speaking about a methodology follows the same course of action as the act of describing the methodology: following the seven elements of the course of action. I will be short and sharp and will raise questions, ending with element (7): how can we improve a methodology?
(1) Observing an interpretation of the situation
The way the therapists and the literature view their clients is markedly reductionistic and one-sided.
"The uncritical enthusiasm for a single model of intervention - currently the cognitive-behavioral approach but formerly both psychodynamic and family systems models were popular - may lead to overoptimistic expectations, outright failures, therapeutic hopelessness and an inefficient use of scarce resources."
(Craissati 1998, p. 11)
In her chapter two and from page 72, she explicitly combines the psychoanalytic model with the method described here.
The offense dominates the whole methodology. Is it really true that someone only by committing, say, a severe traffic offense with serious consequences, suddenly changes into a complete other kind of human being? Is one within some seconds suddenly so different, and only an offender?
The vision described here is quite contrary to all that has ever been written about the therapeutic way of seeing or 'the clinical eye'. Is forensic psychiatry, psychology and orthopedagogy so essentially different from the 'normal' sciences? May the juridical scope here dominate over the clinical scope? I say: no.
I am a PhD in the forensic orthopedagogy. Is a troublesome teen who has committed an offense so essentially different from a teen who, juridically speaking, not has committed an offense? I say: no. The difference is juridically important, but not clinically. A clinician may not let himself be led astray to juridical thinking and acting. He has to act as a clinician, not as a jurist, detective, prosecutor, judge or prison officer.
Is a man who intensively and personally goes about with children, a teacher or a father, who has committed an offense so essentially different from such a man who has not committed an offense? I say: no. The difference is juridically important, but not clinically. A clinician may not let himself be led astray to juridical thinking and acting. He has to act as a clinician, not as a jurist, detective, prosecutor, judge or prison officer.
His vision must be that of the clinician, the helper.
"I like it to show that I do have respect for them, in spite of the offense. After all, they are normal people who have made a mistake."
(Josita van de Put, therapist, in Schoon 2004)
(2) The aims
Trying to prevent recidivism is a noble aim. However, should this be the so heavily dominating or the heavily dominant aim? Shouldn't aims such as curing obsession or depression or helping to mentally grow as a person be equally noble and meaningful?
(3) The ways of acting
The usual way of acting nowadays boils down to an enormous (ab)use of power and coercion within a very limited vision and very limited aims. In no way can I recognize this as 'psychotherapy', although one uses this word. What I have described above makes my hair stand on end. It is far too much use of narrative and other forms of coercion, it is manipulation - just for what the patients are blamed. It is grooming into the politically correct model in which the therapist feels comfortably nestled.
This model gives the therapist every opportunity for projection: It would be the client who (ab)uses power, who makes thinking errors, who grooms, who has to be corrected, who must be open, whose actions - not: behavior - have to be criticized; not the therapist of course.
Yet, dear therapists, there are reasons for criticism. Take a look at the outcome of your way of actions.
(4) The outcome and the interpretation of it
Here above is written that the clients primarily learn to pretend and that the obsession and depression keep going on. The clients are 'not changed, not in the slightest'. How can anyone interpret this outcome as "OK" instead of as a reason to start a process of thorough self-criticism? Am I allowed to choose the latter interpretation?
(5) The feeling afterwards
Here, the therapists completely fail to turn up. They keep silence and only express some pride about their 'expertise'. The clients did not fail to turn up, in spite of all the severe bans imposed on them. They have spoken - see above, from "we learn here to pretend" to "too awful for words". Still they have found words, words that might make the therapist think. What hinders them from being self-critical?
(6) The insights
Here above, I have written that the therapists only want to refine their ways of acting, but only within the chosen model. However, in my view this model is too limited, and the ways of acting within this model are in my view far from psychotherapeutic, even not therapeutic at all, moreover, inhuman and ethically very debatable. What I see, is not psychotherapy, no therapy, but ideology, a closed system of ideas in which one has a strong belief and not any doubt.
My insight is that the therapists their ideas nicht im Frage stellen, only within their methodology, model and vision, but refuse to view self-critically their model and vision itself. The latter is not characteristic of a methodology, but of an ideology. A methodology develops itself, an ideology asks only for believers and does not allow criticism.
(7) Insights about the improvement of the ways of action and the methodology
My insights can be described in the same seven elements of the course of action, be it now on a more abstract level, on a meta level.
(1) Review the basic vision. View the clients as fellow human beings, not as aliens, try to understand them. Have more respect for the clients. View also the client as an acting human being. Do not generalize them, but make a differentiation. Have an eye for the human being, not only for the offense.
Howitt makes a differentiation by giving seven models to explain and understand pedophilia, each model with its own way of treatment. There is more under the sun than the cognitive-behavioral model.
(Howitt 1995; the models are explained in Gieles 2001b, What has got into those people?, chapter Models, ways of thinking; for a quick view, see the scheme Models of explanation in Gieles, lecture 2005.)
(2) Don't focus so heavily on prevention that this aim is so dominant. Choase a;so as aims helping, therapy, psychotherapy, development of the person. Do not choose 'behavior modification' as the aim, but 'development of acting'.
(3) Review the use of power and coercion within the way of acting. Listen to the clients without judging. Change the way of acting so that simulating, pretending and lying no longer are needed. Stop the narrative coercion. Take and respect the own personal narrative as the starting point for development of the identity, the personality and the ways of acting. (Oosterwijk 2005)
Add methods of helping and real therapy to your repertoire. Be attend to the psyche, not only to the behavior. Use methods to combat obsession and depression.
(4) Observe not only recidivism and behavior. Have a look to the development of the inner psyche.
(5) Be conscious of your own feelings afterwards, write them down, tell about them, speak and think about them. Be open for feelings such as doubt and alienation. Abandon that pride and become self-critical. Do not ask for obedient therapists, but for well-educated and critically thinking staff members.
(6) Choose a broader theoretical basis and framework than the cognitive behavioral model. There is more under the sun.
((7) Start a process of development of the methodology by describing one's own ways of action (along the seven elements) and start a debate with one another and with outsiders. Be open for criticism and change.
Nobody knows what is happening within the walls of the sex offender treatment clinics. Now and then we get a glimpse, and that's it. The clients are not allowed to speak. Nevertheless, they have spoken. The staff keeps silence. Oh yes, they write fine literature about 'the safe climate in the groups' and about 'the understanding psychotherapists', but none of the clients who have spoken here above have experienced any safety or understanding - their narrative was the contrary. There was not even any attempt at understanding, so they reported: No effort is ever made to understand anyone."
By doing so, the methodology of these clinics cannot be corrected.
Within our family, we spoke of "the priest syndrome". This referred to the fact that priests (my brothers) never are corrected by lack of a partner and teen children, and critical parishioners. By that, they developed one-sidedly into quite atypical personalities.
The same has happened with the methodology of those clinics: they are not critically observed and are never corrected. In the literature, I sense a certain pride - which I view as narcissistic, namely coming from isolation, a closed ivory tower, in which the so-called experts believe in their own expertise.
The clients have absolutely other ideas. Having spoken to them, I do, too.
There is a modern word for this syndrome, coming from how police and prosecutors, and even courts, work - all of whom have no critics or are not open to it: tunnel vision. Tunnel vision is characteristic of people with narcissism-like syndromes. They live in an ivory tower, with their self-believed expertise.
"Professional, very professional", said a heavily criticized Dutch professor about himself and his way of acting (Van Dongen & Meerhof 2005). In that case, he was quite wrong with his suspicion that an eleven year old boy might have committed a murder - and thus was approached as the suspect and too harshly interrogated.
The clients feel themselves harshly approached and badly treated. The therapists know this, but they are not impressed by this knowledge. It is part of their therapy, their way of acting, their view; they consciously create distance and "a creative uncomfortable feeling". Otherwise, the clients will not change their behavior. Cure is not an aim: No cure but control. Formally, this control should be control from within, but factually it is only control from without.
... it must set us thinking that the clients leave the clinic with the same preference, obsession or depression with which they entered the clinic. Their cognitions and behavior might have been slightly changed - if this is true and not simulated, but their inner self, their psyche has not been changed, neither grown nor developed. To the inner self or psyche, no attention at all is given, which after all should be the kernel of any psychotherapy.
It is not psychotherapy, it is treatment - read: behavior modification - with undesired, non-therapeutic results.
The emphasis on the differences between therapists and clients, the explicit creating of distance, and especially the unlimited use of narrative and other coercion has a shadow side, it bears a danger: seeming contact, pretended adaptation, failing to see what is in front of one's eyes, projection and counter-transference. The temptation is great to project one's own shadow side onto the clients, and there is no correction just as in the case of the priest-syndrome. Power creates corruption, we know. The therapists have unlimited power and no correction or control. In my view, this is no reason to be proud, it is a reason to be self-critical.
The clinics should start processes of developing methodology. This starts with looking critically at oneself and with listening to clients and outsiders - and thus with being more open.
Such a self-investigation may start with a critical look to the vision on the clients. In the actual methodology, one only has an eye for the offense and one focuses on 'behavior'. By doing so, one does not see the human and his psyche. In my view, a fundamental revision of the methodology, starting with element (1), the interpretation of the situation, is absolutely necessary.
One should start with the vision of the human, thus on a philosophical level. Then, review the aims and the ways of working, which might be done on the level of psychology and psychiatry in the broadest sense, thus not only on the level of cognitive-behavioral psychology. Look around: there is so much more under the sun.
For convenience of English speaking readers, the Dutch sources are given as indented lines.
A mother's story; A mother discovers that the legal system's nightmarish "cure" for child sexual abuse can be worse than the disease; SOHopeful Forum, Posted March 02, 2005; written Feb. 28, 1997
< http://www.helping-people.info/Treatment/mother.htm >
Anderson, James D., How To Survive in Prison as an Innocent Man Convicted of a Sex Crime; Sex Offender Treatment; ITP 1997 # 9
< http://www.helping-people.info/Treatment/anderson_survive_itp.htm >
Ayadi, Malika el, Kind wil niks, een kind wil niks, een kind wil niks, een kin...; Pedoseksualiteit, Trouw 7 maart 2000
Baskins, Jay, Quiet, Solitude and the Telling of One's Own Story; 2003
< http://www.helping-people.info/Treatment/quiet.htm >
Bergner, Daniel, The Making of a Molester; The New York Times Magazine, January 23, 2005,
< http://www.helping-people.info/Treatment/making_molester.htm >
Bruinsma, F., Behandeling verstandelijk zwakbegaafde zedendelinquenten; Tijdschrift voor Orthopedagogiek # 35, 1996
Craissati, Jackie, Child Sexual Abusers; a community treatment approach; Psychology Press Ltd, 1998
Deneer, Birgit (red/), Gevaarlijke groepen; groepsbehandeling in de ambulante forensische psychiatrie; Hoputen 2004
Dings, Matt, Koepelsessies; HP - De Tijd 19 december 2003
Dongen, Menno van & Meerhof, Ron, ‘Ik geef een deskundig oordeel, zeer deskundig’; De Volkskrant 26 september 2005
Ehrenreich, Ben, Predator or Prey? LA Weekly, August 20 - 26, 2004
< http://www.helping-people.info/Treatment/predator.htm >
Elst, Annette van der, We moeten tbs'ers niet langer ontmenselijken; Filosofie Magazine juli 2004
Ferroul, Yves, Sexual perversion does not exist; Summary of a lecture at 15th World Congress of Sexology, Paris, June 2001
< http://www.helping-people.info/articles/ferroul_en.htm >
Finkelhor, D. and Araji, S. (1986). Explanations of Pedophilia: A Four Factor Model. The Journal of Sex Research. 22(2), 145-159.
Fog, Agner, Ph.D, Paraphilias and Therapy, in: Nordisk Sexologi, vol. 10, no. 4, 1992, pp. 236-242
< http://www.helping-people.info/articles/fog_eng.htm >
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< http://www.helping-people.info/articles/fredriksen_frame.htm >
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Gieles, Frans E.J., Conflict and Contact; An investigation into various possibilities for action open to child care workers when managing collisions and conflicts in daily life. Dissertation by Frans E.J. Gieles. University of Groningen, The Netherlands, 1992.
< http://www.human-being.nl/Library/cc_summary.htm >
Gieles, Frans E.J., (2001a) Helping people with pedophilic feelings; Lecture at the 15th World Congress of Sexology, Paris, June 2001 & the congress of the Nordic Association of Clinical Sexology, Visby, Sweden, September 2001 - with lot of literature:
< http://www.helping-people.info/ >
Gieles, Frans E. J., The Treatment of Imprisoned Sex Offenders; A summary and an analysis, 1997 - Program, development, from HM Prison Service (SOTP Report, February 1996) [Sexual Offenders Treatment Program]
< http://www.helping-people.info/Treatment/sot/sotp_summ.htm >
Gieles, Frans E.J., There must be a scapegoat; Pitfalls, traps and mistakes in forensic personality investigation; 2006
< http://www.helping-people.info/scapegoat.htm >
Gieles, Frans E. J., Lecture about ‘pedophilia’; University of Nijmegen, November 10, 2005, and of Tilburg, November 14, 2005 (Dutch); Amsterdam, School for International Training, (English) March 28, 2006
< http://www.human-being.nl/Library/lect/text.htm >
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Hamaker, Machteld, Jongeren en geluk: liefde als merkproduct; Prana 151, oktober 2005
(Een excellent artikel, geschreven door een tiener.)
Hanson, Karl R., & Harris, Andrew, Dynamic Predictors Of Sexual Recidivism, 1998-1, Corrections Research, Department of the Solicitor General Canada
< http://www.helping-people.info/articles/hanson_dyn_frame.htm >
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Howitt, Dennis, Paedophiles and Sexual Offences against Children; Loughborough University, UK; John Wiley & Sons [Out of sale] 1995
< http://www.ipce.info/host/howitt/index.htm >
Two sections of Chapter 7 of Paedophiles and Sexual Offences against Children: Introduction to Chapter 7 (pp 189 - 192) and Support Therapies
(pp 215 - 218)
Kamerman, Sheila, 'Ik wist toen nog niet dat het verkeerd was', jonge verkrachters moeten zich verplaatsen in slachtoffe5r; NRC 29 november 2005
Leonard, Geoffrey, Cognitive Therapy, 30th April 2005
< http://www.helping-people.info/Treatment/cognitive_therapy.htm >
Naerssen, Alex van, Man-Boy Lovers: Assessment, Counseling, and Psychotherapy
, Journal of Homosexuality 20, 1/2, 1990
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Rubin, Debra, Pedophile profile belies urban legends; Washington Jewish Week, November 9, 2005
< http://www.helping-people.info/Treatment/sot/rubin_berlin.htm >
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SOTP (several authors): The Treatment of Imprisoned Sex Offenders, Program, Development, from HM Prison Service (SOTP Report, February 1996)
< http://www.helping-people.info/Treatment/sotp/sotp_content.htm >
A critical summary is
Gieles, Frans E. J., The Treatment of Imprisoned Sex Offenders; A summary and an analysis, 1997 - Program, development, from HM Prison Service (SOTP Report, February 1996) [Sexual Offenders Treatment Program]
< http://www.helping-people.info/Treatment/sot/sotp_summ.htm >
Walravens, Geertje, Kris Vanhoeck, Flip Van Canegem & Jessica Opsteyn, Zeg het aan (n)iemand; Therapie voor plegers van zedenfeiten; Acco, Leuven 2006
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Zessen, Gertjan van, A Model for Group Counseling with Male Pedophiles, Journal of Homosexuality 20, 1/2, 1990