Table of Contents 

Introduction 

     Quotes  
     This study 
     What is treatment?  
     What is a methodology? 
     How can a methodology be described? 
     The seven elements of acting (methodologically) 

The methodology 

(1) Interpretation 
     The client sees himself in a different way 

(2) The aims 

(3) The ways of acting 
     1.   Conditions beforehand 
     2.   Keeping distance in a hierarchical relationship 
     3.   The group 
     4.   A work book with questionnaires           
           a. The delict scenario 
           b. The offense chain 
           c. The sexual script 
           d. The funnel 
     5.   Lots of orders 
     6a. Narrative force: the 'thinking errors' 
     ---  Intermezzo ---
     6b. Narrative coercion: the 'thinking errors' - 2 
     7.   Normalizing fantasies 
     8.   Other kinds of coercion and control 
     ---  A remark  ---
     9.   Sometimes - but more often - lust inhibiting medicines 
     10. In the USA routinely: mechanical detectors 

(4) Seeing and interpreting the outcome 

(5) The feeling afterwards 
     It is here where the shoe pinches 

(6) The ideas and questions arisen 

(7) The way to search for better courses of action 

A critical view 
     Scheme 

Epilogue 
     Ivory tower 
     Nevertheless ... 
     Developing methodology 

Sources 

Introduction

Quotes

Therapist: "But sir, you are an offender!"
Client: "I was an offender, twelve years ago, but now no longer! And never again!"
Therapist: "But sir, our expertise tells us that offenders ten, fifteen of twenty years later can re-offend. And you have a severe distortion, according to the experts."

Therapist: "OK sir, you may place yourself in the care of our treatment here ... but you have to cancel that football club of yours, or at least your function as a youth trainer."
Client: "But nothing ever has happened, I am not an offender!"
Therapist: "No, still not, but you are a potential offender."
Client: "Oh no! Never ever!"
Therapist: "Sir, my expertise tells me that you very well might become an offender. That's why I advise you to place yourself in the care of our treatment. After all, you do have a distortion."

This study

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? 

"A 'methodology' is seen as a repertory of possibilities for action, which can be argued as being correct, which are usable and fruitful and which can be chosen, performed and justified by [... the therapists]. 
A methodology has thus possible ways of acting to choose, and an advise for the right choose.
The ways of acting and the advise has to be put into words by adequate concepts with which is is possible to meaningfully speak and think about the acting. 
The possibilities of acting ought not only to be 'usable' and 'fruitful', but also 'argued as correct'. In that argumentation, ethical norms will play a role."
(Gieles 1992)

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?
 

These seven elements form the further structure of this article.   →

The methodology 

(1) Interpretation 

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

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".

"Treatment in an ambulant forensic setting is predominantly targeted at the prevention of re-offending, thus at immediately changing the offense behavior."
(Deneer 2004, p. 174 and other pages)

"Helping offenders is not therapy for forensic patients, but forensic therapy for people who have committed irresponsible sexual behavior that have caused harm."
&
"Helping offenders is mandate-bounded therapy, and the mandate is to prevent recidivism."
(Walravens et alia 2006, pp 120 & 124)

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. 

This is different from what the Dutch psychiatrist Roelofs (1997) says. He makes a clear difference between types of clients, each with a different treatment methodology: 
"Routine programs for all paraphilias do not exist, we have to make distinctions."
And:
"A general integrative theory to explain all sexual delinquency is an illusion, because of the heterogeneity of the population." 
And:
"Categorical treatment of sexual offenders is a waste of money because of the heterogeneity."

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. 

Therapist: "OK sir, you can join, but we confront you with the condition that your foster child goes away."
Client: "What? You are neither his parent nor his guardian! You have no authority! You are not a Juvenile Court Magistrate!" 
Therapist: "Sir, we always put this condition. In cases of incest, we always remove the offender from the family. Our principle is: no potential offender and a potential victim under the same roof."
Client: "But in all those years, nothing sexual ever has happened and this will also not happen. I am surely not an incest offender."
Therapist: "Our expertise tells us that this might happen, and our principle is: absolute priority for prevention."

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). 

"The staff is always right. What the staff says, may not be discussed. Questions about their person or education are forbidden; in contrast, the staff may ask any question and may expect very personal answers."

One of the most uttered complaints of the clients is that "we are approached as toddlers". 

"The way we are being treated completely becomes an insult to the intelligence, dignity and honor of our person. 
They can talk to us as if we were babies, they can treat us like people who know nothing, as if we were all false and that we somehow can't know what is good for ourselves and others." 

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. 

Because of that ban on telling to outsiders about the group, the clients were quite reluctant to tell me about their treatment, although all of them told me that they simply ignore the ban on contacts among each other outside the group. 

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. 

a. The delict scenario 

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. 

Craissati 1998, p. 38
Hanson & Harris 1998)

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.

Therapist: "Thus, you have to stop any contact with children."
Client: "Why is that?"
Therapist: "Because of your crime." 
Client: "But I haven't touched any child! I only have made photos!"
Therapist: "You keep being a potential offender."
Client: "But he, there [pointing to an incest father]? What he has done is worse! That is a real offense!" 
Therapist: "Yes, but he is a father, and that kind of contact is a natural one. Your contacts were not. Thus you have to abandon them." 
Client: "This is discrimination! Illegal and unconstitutional! An offense! I will report it!"
The therapists keeps silence and addresses another client. 

c. The sexual script 

In several papers, the client's sexuality is mapped out, as it has been and as it should become.

The workbook mentions a "safe attachment style" and an "unsafe attachment style". This wording is not correct; one refers to a style based on early experiences with attachment, which could be safe (enduring, stable, trustable) or unsafe (inconsistent, frail). The style itself is neither safe nor unsafe, the feeling with which one attaches oneself, or not, is neither safe nor unsafe. 
(Ten Hag 2004, Ten Hag & Van Horn 2004 and the literature mentioned there)

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

"The leader can require pretty much whatever he wants. He can say where a person can and cannot work, where he can or cannot live and what his daily activities must be. He can even dictate who his significant other will and will not be. On one occasion I saw him break up a couple because the woman was 'enabling'. What this meant was that she did not believe that the person had done everything he was accused of."

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. 

"We have to tell everything, and they want to know everything about us - this is a kind of inquisition, a mental dictatorship." ('t Hooft 2005)

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 attention is continuously directed to the pointing to and the undermining of thinking errors." (Deneer 2004, p. 160)

The most important are

[The therapist frequently] "asks what deviant thoughts they've had over the previous week." (Bergner 2005) 

[Therapist:] "Do you understand what a victim can feel?"
[Client:] "No. I can do nothing about it."
The group shouts: "Thiiiinking error!"
(Oostveen 1998)

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. 

"Wherever any discussion is going, they always manage to have the final word on everything, and get things their way, which becomes dogmatism, [...]
They will also call 'disinformation' everything that does not enter in their visions of things." 

Client: "But I love children!" 
Therapist: "You cannot love children, as long as you fancy them." 

The staff is always right. The clients must speak about the offense - even if there was no offense. 

"The mental 'forging' was surely there, and no matter how many times I would tell them that what happened wasn't what they 'want' to have happened, they would not derogate from saying I was the guilty one on everything, no matter what, and keep saying I didn't have any or much compassion for my 'victims'...
How can I get compassion when what they're saying is not what actually happened?"

Craisatie (1998, among others page 117) describes a client who, as a child, had frequented a group, which in the book was called 'a child pornography ring'. As a child, he never had seen this as being abuse. Contrarily, he said that he'd gotten a lot of love, comradeship and care, which he did not get at home. 

Craisatie describes it as an example of successful treatment that his client ultimately abandoned his feeling of being loved and changed it into the feeling of being abused although this occurred only gradually and very late in the treatment process.

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. 

Ehrenreich (2004) describes a man who for nineteen years was held in a closed clinic. He denied his offense, thus refused to speak about it, thus he did not cooperate, thus year after year his stay was renewed. 
Then, he changed tack: he 'acknowledged' his offense, he spoke about it, he did exactly what the therapists ordered, and said that he benefited from their treatment. This was the only way to be released. The man has been released. 
Then it turned out that is accusers had lied about everything they had said, under high pressure of the police: there never had been an offense. 

Another client told me: 

"They always hammer on 'my child victim'. I had to write a letter to that 'victim', a letter that should not be posted. Then I ask: 'What victim? There is no victim!'
They do not know my case, not at all. They simply suppose that there are 'victims' - plural. They do not read my file at all. They only generalize about everybody. 
They said they would read my case and speak about it later on, but now I had to write that letter. To whom? 'To my prospective victim', they said. 
I said: "There is no prospective victim, there never will be any!" 
But the therapist must have a victim and he said "I refer to the victim that you fantasize for yourself - after all, you have told us that you now and then have such fantasies'."

The client had fallen into the pitfall. If he wanted to ever be released, he must write his letter to 'the victim'. 

Intermezzo 

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. 

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. 

In my view, the staff makes a thinking error. 
The therapist must have a victim, he cannot work without one. In the quote here above: if not in the past, than in the future. After all, fantasies automatically shall lead to offending behavior. 

Here again we see the behaviorist vision on the human, the human as an engine. This vision concerns not the therapists themselves, but only their clients, the offenders. Was there no offense? Well, in that case it shall come in the future. 

Client: "But I love children!" 
Therapist: "You cannot love children, as long as you fancies them." 

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. 

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? 

"Respect for anyone's beliefs is one of the most important human rights, and one of the most unrespected ones when it comes to this kind of treatment.
This disrespect is often expressed verbally throughout the treatment by therapists, [...] often  expressed subtly, or literally by saying [...]: 'inadequate thoughts or beliefs', or 'deviant thoughts or beliefs'."

Here we see the cognitive distortion we have read about in the literature. 

"They say we might only want to see "our" side of things, when they are the ones who do this enormously." 

"As long as I speak about 'my young friend', I will not be released. I only may say 'my victim'. If I don't say this, I do not cooperate with the treatment."

"I told them that I love children, but they said I made a thinking error. Whoever falls in love with children, cannot love them. That is their opinion, and there is no discussion about it."

"I had written in one of the questionnaires that I think of children as 'beautiful little angels'. They said that this is not true, it is a thinking error to romanticize children, which is not allowed. 
The communication went on with: 
Therapist: "You cannot commit an offense with an angel, may I suppose? 
Client: "I do not at all want to commit any offense!" 
Therapist: "You do want that. That's why you are here."

"I said that sexual contact is not always inherently harmful, and that research had proven this. They didn't want to hear this anyway and they said that I was playing down my offense, which is absolutely forbidden. By wanting to discuss this topic, I disturbed the treatment process. They said that this could lead to ending the therapy."

"The session begins with everybody 'checking in'. We have to say whether we had any contact with minors or with the police during the week. We also need to announce any changes in our lives or anything else that might be of concern. Some of the members actually try to share something real about their lives, as they are very lonely. They don't seem to understand that this group is not about their well-being. People cannot talk about any suicidal ideation in the group. No effort is ever made to understand anyone. Once when I was critical on a couple of points about how society was treating the issue of the 'pedophile', I was called aside by the leader and told not to be negative in the group. It set a bad example for the others."

"Even those in the group who can barely read soon figure out what the right answers are. Also they understand that when we speak of these things we use the proper terms such as 'abuse' and 'my victim'. 

[* This undermines more or less the fine results mentioned by the SOT Report, mostly concluded from questionnaires.]

If a person fails to use this language or even hints at the idea that the 'victim' might have been a more than willing partner, he is called to task for this."

"The underlying assumptions are that the abuser is a highly manipulative and self-centered person who is incapable of empathy and who is suffering from a variety of 'thinking errors'. Thinking errors are not too hard to spot. Anything that is at variance with what the leader thinks is a 'thinking error'. Overall, the assumption is  the offenders are all sociopaths. The leader is quite open about this. He tells the group that one of his aims is to make the offenders less sociopathic."

"If your beliefs differ from what they're saying they will say that you minimize and/or banalize the facts..."

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. 

8. Other kinds of coercion and control 

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...

"Any family gathering he attends must be adults only; he has to leave right away if kids show up." (Bergner 2005)

Roy was on the beach with his wife. In the far distance there appeared children. Roy became panicked and took flight, away from his wife and the beach. He ran so fast that he injured himself on a fence. 
(Summarized from Bergner 2005)

Roy, the client, and his wife had not told their parents-in-law about his crime, and Roy had not told this [the not telling of it] clearly enough to his therapist. Immediately, all acquired privileges were withdrawn, among which were visiting his in-laws, and Roy was moved to a more severe group for more dangerous clients. 
(Summarized from Bergner 2005) 

"The constant threat of prison [...] keeps us from being able to [...] express ourselves because of the extreme fear [...] which generates all kinds of false affirmations regarding the patient [...] which can turn out to be, again, totally false since we weren't able to express ourselves freely at all because of this fear, and this at all times. [...] So if you don't talk 'like them', [...] the consequences can be devastating."

"Some of the high points [of a contract, to be signed at the start] are that 

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. 

"Hi Frans, you are my aunt now for a while. I am not allowed to visit you, thus I made up an aunt. You double up with laughter, so many aunts and grandmothers there are made up there."

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. 

One of the clients had, upon being suddenly released from his detention, found a temporary stay in the house of a mother, who also was a foster mother and a grandmother. Thus, photos of children and grandchildren were on the wall. The staff judged that this was a too heavy stimulus for the client. Thus, they ordered him to leave that house as quickly as possible. 

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? 

A client used to visit a family with children. He was befriended by the mother. The staff of the clinic traveled to the family and told the parents that they were no longer allowed to admit the man in their house. 

The mother: "But you are not the guardian here! The children are mine, I am the mother, I have the parental authority! You may be an expert, but you are not a Juvenile Court Magistrate!"
The therapist: "Madam, you will quickly lose that authority. If you still admit this man in your family, we report you to the Children's Protection Counsel and the Child Abuse Office. You are endangering your children, which is punishable. The court will condemn you and the Juvenile Court Magistrate, which indeed I am not, will take your children away."

The latter is, knowing the Dutch jurisdiction, all a lot of swank. But did the mother know this? She was impressed and out of balance - good for the children, isn't it? Someone was here using coercion and manipulating: the therapist himself. 

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. 

A remark 

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 

The lie-detector 
This engine is notoriously untrustworthy - it lies, to say so. Nevertheless, in the Netherlands experiments are going on to use the engine. 

The plethysmography 
This is a machine that measures the swelling of the penis by seeing specific pictures. 

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. 

< http://www.tegenwicht.org/33_politiek/bronnen_recidive.htm >, 
(It starts with Dutch, but also with some quite clear statistics. Scroll to below and see the last two articles of the page in English),  
< http://www.helping-people.info/articles/hanson_98_frame.htm > en 
< http://www.helping-people.info/articles/about_recidivism.htm >, 
< http://www.helping-people.info/articles/alexander.htm >, 
< http://www.helping-people.info/articles/kokish.htm >, 
< http://www.helping-people.info/articles/rearrest.htm >, 
< http://www.helping-people.info/articles/robinson_treatment.htm >, 
< http://www.helping-people.info/articles/alaska.htm >,  
< http://www.helping-people.info/articles/programmes_work.htm >, and 
< http://www.helping-people.info/Treatment/sot/rubin_berlin.htm >.

"Young group rapists do not relapse after policlinic treatment, research at the Free University of Amsterdam concluded. Those who got no therapy, relapsed in 12% of the cases. Solo rapists relapsed for 10%. If the latter have had therapy, it is 5%." (Kamerman 2005)

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. 

"'If we talked in there about what was really going through our minds, we'd all be wearing ankle bracelets.'' (Bergner 2005)

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. 

"At least once a year (sometimes more often, if the leader wants it that way) you have to take a lie detector test (a polygraph). You also pay for this. It costs about $300 per time. Actually the lie detector is an instrument of intimidation that is used as a part of an interrogation. And it frequently does have real legal consequences."

Does the outcome of the 'therapy' show us improvement, solution of problems? The clients to whom I have spoken said no. 

In at least one of the cases, known by me, there was clearly an obsession; in another case a very clear, heavy and repeating depression. In a half year of treatment, not any attention has been given to these problems. These clients were as obsessive and depressive at the end, as they were at the start of the treatment - Hmm.. 'treatment'? 'therapy'? 'helping?' Very clearly not in these cases.

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. 

"All of the group members look awful. All are depressed. At least one hallucinates a lot. All except one find the group depressing. I am fairly sure that they have all considered suicide. Any of them that I have talked with think about it a fair bit."

"Someone expressed that whenever he was seeing the road he used to take to get to that treatment place, he still gets violent flashes of what he went through there, and feels like taking another route to get where he's going, when possible.
He also often gets these violent flashes at any time, horrible memories being triggered by any random everyday life events here and there, which can cause discouragements and insecurities, to name just a few. 
This is called trauma."