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Outcome Research - Where Is It?

We reviewed Volumes 1, 2, and 4 of Sage Publications 1995 "VIOLENCE" AND ABUSE ABSTRACTS." (misplaced #3 - sorry! It's probably not very different.) There's a section in each issue headed, "Psycho-therapeutic Intervention and Treatment." We found 52 abstracts under that heading. Four described outcomes for victim treatment in measurable terms.

A study of group treatment for sexually abused boys showed mixed results when compared to controls.
A study of treatment for female victims of battering showed improvement using a pretest, post test design, but no controls and no direct measures.
A study compared two treatment methods for battered women; grief resolution counseling and feminist counseling. The grief resolution group improved, the feminist group didn't. ("Feminist" approaches dominate the field)
One abstract described a chapter in a book and cited studies indicating that parents, not therapists are a sexually abused child's most valuable resource. It was suggested that supportive services to help non offending parents overcome obstacles impeding their ability to be understand and supportive their children might be a more effective means of helping sexually abused children than psychotherapy for the children themselves. (Most states have Victim Restitution Funds to pay for victim therapy including therapy for non-offending parents, but not for supportive social services to assist the parents)

A few of the other 47 items were theoretical, suggesting how outcome research should be done. The bulk of material reviewed books, parts of book, and journal articles telling us all the wonderful and brilliant ways some therapists are treating abuse victims and suggesting that other therapists do the same. We found little or no regard for rational measurement of the actual outcomes of all that commitment, creative energy and money. There were in fact, more hard cover books on how to do treatment than there were journal articles measuring whether all this treatment helps anyone at all. Personally, we found it frightening.

When we perused the same three issues for articles about treating the people who do the victimizing, the picture was better. Roughly half the books and articles appeared to be anecdotal and theoretical. The remaining half described specific aspects of offender personalities in measurable terms or examined and compared the results of specific treatment approaches. In the 1980's, this kind of research led to the virtual abandonment of psychodynamic treatment of sex offenders in favor of cognitive - behavioral approaches that have proved more fruitful. Before that, as early as the 1950's and 60's, outcome research showed the futility of psychodynamic treatment of delinquents and highlighted more hopeful results with the "therapeutic community," or "guided group interaction" model that is now so widely used.

Why is offender treatment so much more scientifically refined than treatment available to victims? We, as a community and a society, tend to feel sympathetic concern for victims, whom we see as hapless but deserving. We are willing to pay for their treatment with government funds, charitable contributions, and insurance dollars. With money so widely available, therapists don't have to be particularly accountable. So long as a victim enjoys or somehow appreciates the therapeutic hour, relatively few questions are asked.

In contrast, offenders are viewed as evil and undeserving. Society is reluctant to do anything for them, so offender therapists have traditionally had to demonstrate they are doing something to them - that they are changing behavior. "Cost Effectiveness," comparing the dollars saved by treatment through crime reduction to the dollars spent on that treatment, is a currently popular model for deciding whether offenders will receive treatment. In other words, unlike victim therapists, offender therapists have to demonstrate results to get paid.

The paradox is that, although we are much more concerned for victims of crimes than for criminals, those few criminals who are getting treatment are probably receiving a much more effective service package than the large numbers of victims whom we treat with relative generosity.

It appears that, if we really want to minimize further victimization we may be spending our money in the wrong ways.

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