Myth vs Fact

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Where we are at is better than where we were but is it where we really want to be?

It is a chilly day in October, 2014 and as I write this I am sitting in my hotel room in the southern area of the State of Wisconsin. I am attending a series of workshops about childhood sexual abuse and, before I begin, I will share that this is my 14th year attending this particular training, which is hosted by a well-established University and many of the presenters are well known and respected for their work in this field. There are some reasons I write this to you today with a sense of urgency as I feel uneasy about one of the workshops I attended in particular. Before I tell you my story I can't help but think that so much of what we think we know about this juveniles who sexually harm is based on very little evidence or research. Although evidence and research is growing in the United States about this particular field and we are feeling more confident about how to successfully treat juveniles who sexually offend, the fact is, there is a lot of misinformation floating around out there. For example, there is a common belief that if a person was a victim of sexual abuse they are then at a higher risk to offend on others. This is simply not the case. Most victims do not go on to exploit others. What seems to be related to recidivism, in fact, is sometimes not related at all in many aspects. Some research has shown that clinical judgment (or what we think we know based on our years of experience) in determining a person's risk to re-offend is really no more accurate than flipping a coin. Imagine for a moment, if you will (understanding that perhaps you already are a parent of a child with sexual behavior issues), that your son or daughter had to see me for a psycho-sexual evaluation to determine their future risk to re-offend and my session with your family took 5 seconds. I could flip a coin and tell you an answer based on whether the coin lands heads or tails that may be more accurate than sitting with your family for hours or even meeting with your family for weeks. It may surprise you that some research actually found that flipping a coin was more accurate than clinical judgment only. There are some reasons for this. In particular, there is a thought that the clinician's judgment could be biased or tainted. Many of the youth who sexually offend that I have worked with are good manipulators and have power and control issues and would love to get you to believe that they would never do it again. I also believe it is sometimes human nature for youth who sexually harm to be in denial and some truly believe it won't happen again is common despite not actually learning the tools to address their unhealthy sexual behavior.

In order to address this bias issue I believe it is important to use a combination of written (clinically non-biased) assessments and clinical judgment in formulating the guess about future risk. If you visit the member's area of this website you will be able to download some assessment tools that are very popular, and even free! In fact, I tend to use a minimum of 3 tools in the assessments I do (ERASOR, JSOAP-II, and JSORRAT-II) to assist me in arriving at a professional judgment about risk level. It continues to amaze me the number of clinicians who do not use any of these tools at all. If you work in this field it is very important to stay up-to-date with the research and literature. I am continuously surprised about some of the comments I hear, even from the "teachers" in this field. For example, I heard today from someone teaching on the subject of Adolescents Who Sexually Harm in one of the workshops I attended that "These kids really don't know what they are doing, most of what they do is impulsive." This is very disturbing to me and perhaps those in the workshop who are really there to learn about working with youth who sexually offend left believing this to be the case. On one hand, I become angry when I hear this type of misinformation while on the other hand I understand this is the true reality of our ignorance as a society when it comes to understating this population. I believe there are some youth who offend impulsively but I am also aware that many youth with sexual behavior problems groomed their victims and set up their offending before they ever harmed. If anything, I believe the opposite argument can be made regarding this type of comment; being: if a youth who sexually offends is truly impulsive then warning signs may be non-existent and who they choose to offend may not matter and risk may actually be elevated.

I also heard today that the particular treatment program I was learning about places youth in "short- term treatment" when that particular youth does NOT admit to their offense(s) and "long-term treatment" for youth admitting what they have done. Fact: it is common for youth who sexually offend to deny their offenses initially and sometimes it can take months before they feel comfortable enough to admit this. They may feel ashamed, embarrassed or like they are going to get into a lot of trouble. Maybe they feel they have already lied to their parents and struggle admitting they lied for concerns their parents will not trust them again or even disown them. It's likely, their first contact regarding a report of sexual harm is with a police officer and they are too worried about what will happen to them if they admit. I believe there is a lot that needs to be attempted therapeutically before a decision about length of treatment should be made. It may be easier for certain youth to admit when they are in a group process with other youth who successfully admitted and are able to talk about their experience admitting and how to address their fears of admitting. I am also very concerned about the message this type of thinking sends to not only our professionals working in the field but also the youth.

I learned today that this same treatment program requires youth who have sexually offended to attend 18 months of group therapy (when they are admitted to the "long-term treatment" program or the program where youth admit to their offenses). Some youth may need lengthy treatment while others may not. My philosophy is that each youth's treatment should be individualized and based on that particular youth's need. We must be careful about not labeling youth with offending issues or making them reliant on the treatment process. I believe it can be argued that sometimes a lengthier treatment regimen can make matters worse and lead to a higher recidivism rate than doing nothing at all, especially when it involves youth who sexually offend.

So, now that I really have you confused! What is the right approach to treatment? Unfortunately, my answer to this question may confuse you even more! The current approach in this field is to adopt "Evidenced Based" practices, or simply put: practices that have been shown to work and for which there is empirical evidence supporting their success. The same treatment program that presented today is modeling an evidenced based program from Canada and they seem to be finding that it works for their area although without further research this is not known for sure. I am certainly not suggesting that the Canada based program is unsuccessful or won't work here in the United States but I also believe we need to be very careful about how we decide what is and what isn't evidenced based for the particular areas we serve. Evidenced based programs already exist in Wisconsin and why this particular treatment program is choosing to use a model from Canada is beyond me although I am encouraged that it appears to be working for them thus far.

The terminology "Evidenced Based" can be tricky to think about. Sometimes, I have a difficulty understanding what is "Truly" "Evidenced Based". Some argument can be made that for a program to be truly "Evidenced Based" it needs to be practiced exactly the same as where it is successful and with the same population. I am not putting down the idea of utilizing evidenced based services because, to date, it appears to be the best approach that we can offer and, in my opinion, far exceeds practices of the past. Some research has shown that a therapist's style and relationship with a client can help to make or break success. With this said, in order for a program to be truly "Evidenced Based" wouldn't it make sense that not only does the program need to be the same and with the same clients but the therapists running it also need to be the same or doing exactly the same thing? I believe the best approach for those of you who want to treat youth who sexually offend is to learn about the evidenced based practices in your area, make an effort to model your program in a similar fashion, and do your own research to make sure that what you are doing actually works. Additionally, take into consideration the individual needs of the youth and their family, don't generalize your treatment approach to everyone and include non-biased assessments in your intake process.

As the title suggests, I think where we are at in understanding juveniles who sexually offend is far off better than where we were in the past but I also think we have a long way to go in adequately understanding risk factors and making better judgments and predictions about risk and therapeutic approaches. In a ever changing and toxic society, where increasingly hardcore sex appears to be a increasing focus, it's difficult to hypothesize what direction risk assessment and treatment for youth will take. It is arguably one of the most important times in our history for treatment providers to stay educated about what works and what doesn't

I created this website, in part due to some of the reasons noted above, as well as to teach others what has been found to work and what hasn't. I certainly cannot guarantee that what is offered here will work for your particular program or area. I will work to continue to add resources and information about youth who sexually offend. Lastly, I am aware that the terminology "Juvenile Sex Offenders" is negatively associated with youth who sexually offend but I am also aware that the terms "Juvenile Sex Offenders" is the most widely searched terminology for this population. I will be adding other sub-domains that have a more positive association and would be interested to know of any you may have in mind. Thank you for visiting and please contact me with any comments or suggestions you may have.

Tom Cleereman, MSW, LCSW