Clinician Prejudice Toward Sex Offenders
Perverts and Rapists and Creeps, Oh My!
A couple of weeks ago my colleague Jenner Bishop posted an open letter on the IITAP (International Institute for Trauma and Addiction Professionals) listserv about clinician prejudice toward sex addicts and sex offenders. Jenner had just come from a “suite meeting” for an office she’d recently rented, at which she’d been bombarded with angry questions from the other therapists about how they were supposed to protect their clients from her “unsupervised” sex addicts and offenders. She had explained that she doesn’t work with violent offenders, and that the offending behaviors of her clients were typically something along the lines of hiring prostitutes and/or looking at illegal pornography – which the other therapists’ clients were probably also doing, even if the therapists weren’t aware of it – but Jenner’s fellow professionals just wouldn’t let it go.
I was shocked. Eventually someone admitted that – despite the landlord sending around an advance email informing tenants the potential new renter is a Certified Sex Addiction Therapist – they wish they’d further investigated what a CSAT does, because they’d have informed the landlord that my practice is incompatible with theirs. You know, I just forget. We’re on the front lines of healing such a grossly misunderstood population. And it’s not just the masses, it’s fellow clinicians with these massive prejudices and blind spots.
Jenner is absolutely right. The world is filled with sexual prejudice of all types, and even highly trained professionals are not immune to this bias. I face this fact every single day both in my educational efforts and in my practice. Honestly, even the most basic and factual of my blogs is likely to draw “friendly fire” from certain colleagues. And only a year ago I had to host a three-day staff training session at one of the addiction treatment facilities I work for, the sole purpose of which was to calm the staff’s fears about working with a sexually addicted, potentially offending population. And their concerns – their prejudices if you will – were exactly the same as what Jenner recently faced. In other words, they were convinced that the facility’s sexually addicted clients were monsters who were going to be molesting and raping all over campus. Never mind the fact that they’d been treating these same people for years as part of the chemical dependency population.
Ignorance = Fear
The good news when it comes to clinicians is proper education can help to alleviate concerns. While it is true that some people’s prejudices toward sex offenders are simply too deep to overcome, for the most part therapists are open-minded individuals who respond well to unbiased, factual information. And that is my goal with this blog – to present the facts about who sex offenders are and the risks these men and women do and don’t present.
For starters, many clinicians don’t fully understand what sexual offending is. Oftentimes therapists, like the general public, are of the opinion that there is a one-size-fits-all definition. In reality, there is a clinical definition, along with multiple legal definitions. The clinical definition of sex offending is nonconsensual sexual activity. Essentially, a person’s carnal activity is nonconsensual (offending) if one or more of the following occurs:
- The activity is forced
- The other person is incapacitated and can’t consent (drugged, drunk, passed out, etc.)
- The other person is mentally unable to consent to the activity (developmentally disabled, psychologically disturbed, etc.)
- The other person is too young to consent
- The other person has been subjected to a non-forcible sexual experience that he or she did not invite or agree to (exhibitionism, voyeurism, frotteurism, etc.)
The legal definition of sex offending is sometimes quite different, and it varies from state to state and nation to nation. Consider, for instance, a fully cognizant 19-old-male and a fully cognizant 17-year-old female who engage in consensual sex after dating for nearly two years. In one state this might be a crime, while in a neighboring state it might not be. And in the states where it is a crime the caliber of the offense and the potential consequences might vary significantly. Even more confusing is the fact that laws sometimes change. Behavior that was illegal last year might not be today, and vice versa. Either way, from a clinical perspective this behavior is unlikely to be considered sexual offending. Another interesting example is same-sex sexual activity between consenting adults. Such behavior was illegal in most of the United States until the late 20th century, and it is still illegal in several countries. So even though consensual gay sex was (and in some places still is) by law a sex offense, it does not now nor did it ever meet the clinical standard. In other words, from a legal perspective sexual offending is subjective, based primarily on the collective moral code of a specific community at a particular time.
From the clinical perspective, sexual offending typically involves one or more of the following behaviors:
- Exhibitionism – illegal in-person, legal online
- Voyeurism – illegal in-person, legal online
- Frotteurism (rubbing against a non-consenting person for sexual gratification) – illegal
- Sexual harassment – can be either illegal or legal, depending on circumstances
- Incest – illegal
- Viewing, downloading, or creating child pornography – illegal
- Sexual activity with a minor or mentally disabled adult – illegal
- Rape – illegal
- Abuse of a professional role to obtain sex – can be either illegal or legal, depending on circumstances
Categories of Sex Offenders
Much of the clinical prejudice toward sex offenders stems from the fact that in addition to not knowing what offending is, some clinicians have very little factual information about who the perpetrators actually are. Generally speaking, sex offenders, regardless of age and/or gender, fall into one (or more) of the following four categories:
- Violent sex offenders: Violent sex offenders are the least prevalent type of sexual offender. Nevertheless, they (along with fixated child offenders) get by far the most media attention. These are people who commit forcible rape and “snatch and grab” child molestations. They are unlikely to enter treatment outside of incarceration, and they usually do not respond positively to treatment if and when they finally receive it. Unfortunately, the public has a tendency to perceive all sexual offenders as falling into this category, even though these individuals are in fact a small minority of the overall sex offender population.
- Fixated (dedicated) child offenders: The primary and often sole sexual orientation of fixated child offenders is toward children – either prepubescent (pedophiles) or adolescent (hebephiles). They have little to no interest in sex with adults. Approximately 10 percent of the men and women who commit sexual offenses against children fall into this category. These individuals sometimes set up their lives so they have access to and can become emotionally (and later physically) intimate with minors. Often they relate to their victim as a peer or equal, adapting their interests and behaviors to the level of their victim(s) and experiencing themselves as children. Typically their sexual interest in kids has nothing to do with childhood sexual trauma or early abuse. They were born with this orientation. Ever since they became interested in sex their thoughts were about children. Attempts to change a fixated child offender’s orientation will almost certainly be unsuccessful, no matter how hard the therapist and client try. Former Penn State football coach Jerry Sandusky is a classic example of a fixated child offender, in that he set up his life so he could have ready access to victims (founding a child-oriented charity and even adopting a son).
- Regressed (situational) child offenders: With regressed child offenders the sexual interest in kids is not exclusive. Approximately 90 percent of child offenders fall into this category. Usually regressed child offenders are equally or even more aroused by adults than minors. Many have adult sexual and romantic relationships, though others find adult sexuality threatening and avoid it or abandon it. When these people offend against children the behavior is opportunistic, meaning they don’t set up their lives so they can have contact with and offend against minors. When under stress, the influence of substances, or both they sometimes turn to a child/teen relationship as an unhealthy way to meet their need for intimacy. Their sexual offending is nearly always driven by life stressors and/or underlying psychological issues such as depression, severe anxiety, attachment deficit disorders, low self-esteem, etc. Typically these individuals see their victims as pseudo-adults. Because of this fantasy/misperception, they may feel as if they are not actually victimizing the child with whom they are being sexual. Regressed child offenders usually respond quite well to treatment.
- Sexually addicted sex offenders: Sexually addicted sex offenders (SASOs) comprise anywhere from 55 to 75 percent of the sex offender population. That said, not all sex addicts are sex offenders. In fact, most are not. SASOs, like other sex addicts, use sexual fantasy and ritualized sexual behavior patterns as a way to dissociate from uncomfortable thoughts and emotions, including seemingly benign feelings like boredom. In other words, their behavior is driven by life stressors and underlying psychological conditions such as anxiety, depression, low self-esteem, attachment deficit disorders, and unresolved trauma. Anecdotal evidence from clinicians working in the field indicates that most sexually addicted sex offenders don’t start out offending. Rather, their behavior escalates over time from “vanilla” activities like legal pornography, webcam sex with adults, and casual adult sexual hookups to offending behaviors like prostitution, public sex, voyeurism and exhibitionism, viewing illegal pornography, inappropriate sexual behavior with minors, etc. Typically, SASOs respond well to treatment.
The Clinical Reality
In the clinical community there are two highly destructive beliefs about sex offenders.
- No sex offender is treatable.
- All sex offenders are treatable.
These two opposing opinions, neither of which is accurate, have caused a great deal of confusion, the wasting of valuable resources, and harm to the offender population, the therapists who treat those men and women, and society as a whole. The simple fact is some sex offenders can be successfully treated, while others cannot. Generally speaking, violent sex offenders and fixated child offenders do not respond well to treatment, while regressed child offenders and SASOs usually benefit greatly from proper clinical intervention.
These latter individuals, the “treatable” sex offenders, are the people that I see in my practice, and that Jenner sees in hers. They present little danger in a therapeutic setting. The odds of such a client taking advantage of another vulnerable person while sitting in the waiting room of a clinic are infinitesimally small; it’s about as likely as a recovering drug addict robbing his or her therapist’s office as a way to pay for his/her next fix. It’s possible, sure, but it doesn’t happen. In other words, we have every reason to treat these individuals, and little to no reason not to.
In next week’s blog I will discuss ways to effectively (and ineffectively) treat sexual offenders.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.
Weiss LCSW, R. (2013). Clinician Prejudice Toward Sex Offenders. Psych Central. Retrieved on February 22, 2017, from https://blogs.psychcentral.com/sex/2013/04/clinician-prejudice-toward-sex-offenders/