Tzvi Pirutinsky

Therapist; Probation Offenders Program, Freehold, NJ

Ph.D. candidate; Columbia University, New York, NY

Email: [email protected]

Introduction

In recent years, there has been growing awareness of the painful and controversial issue of sexual abuse within our community. Many rabbonim, therapists, and community leaders have stepped forward to address the complex halachik, legal, cultural, and psychological dynamics involved. Survivors are increasingly able to access appropriate services, and communities are beginning to address abuse as it occurs. However, sexual offending behavior remains enigmatic and questions regarding offender treatment remain unanswered. Although science in this area is underdeveloped, this article describes current theory about offending behavior and addresses common concerns about treatment.

What causes abusive behavior?

Like all psychological phenomena, the etiology of sexually abusive behavior is complex, multi-faceted, and varies greatly between offenders. Despite decades of research, many questions still linger. Current theory suggests that four important areas contribute. 1) Biological: Although no specific genes, hormones, or neurological systems determine sexual offending, research suggests that biologically-linked risk factors (e.g., heightened sexual drive, aggression, impulsivity, disinhibition, lack of empathy) correlate with increased risk. 2) Behavioral: Offending behavior can develop as a result of learning and reinforcement. Youth exposed to an individual or environment that models inappropriate sexual behaviors may learn to act in similar ways. Moreover, the desire for inappropriate sexuality strengthens and becomes increasingly fixated through the repeated paring of inappropriate fantasies and images with pleasure. 3) Attachment & Intimacy: Many offenders have generalized social skills deficits, such as ineffective communication skills, social isolation, and problems in intimate relationships. Some theorize that these deficits may lead offenders to establish close relationships with children who are viewed as less threatening and more available. 4) History of maltreatment: Is it true that most offenders were abused themselves? This is an area of intense and ongoing research and debate. On one hand, research suggests that many offenders are survivors of sexual or physical abuse themselves. Yet we know that the vast majority of people subjected to abuse during their childhood or adolescence never commit offenses. Reviews of this research suggest that victimization does NOT cause offending, but rather represents a general risk factor for psychological difficulties of all types including sexually abusive behavior.

However, no single theory exists that adequately explains the origins of offending behavior and many identified risk factors are not amendable to treatment. Consequently, recent research and theory focuses on the pattern of behaviors and thoughts that maintains and enables offending behavior - with the hope that interventions at various points can disrupt these patterns. The most commonly used conceptualization is the Relapse Prevention model, which has been the primary theoretical framework of offender treatment programs over the past two decades.

According to this model (Figure 1), sexual offending results from a common cycle of behaviors that begin with a negative emotional state. To cope with these negative emotions, offenders resort to deviant fantasies that are relaxing and pleasurable. Similar to the way most people may make excuses for problematic behavior (driving beyond the speed limit, "cheating" on a diet, for smoking when one is trying to quit), offenders justify or rationalize these fantasies using distorted thinking such as "It doesn't hurt anybody", "Just this once", and "I screw up at everything, so who cares". Eventually, fantasies and the associated thought distortions increase desire and overcome normative internal barriers to abusive behaviors (e.g., "He won`t tell, I'll be gentle", "It feels good, how can it be wrong", "It won`t hurt her, she won`t remember"). The offender then covertly plans and eventually commits a sexual offense. Although not all aspects of this model apply to all offenders, it supplies an adequate and comprehensive model for most forms of sexual offending.

How are offenders treated?

Treatment generally focuses on identifying a particular offender's pattern and developing intervention strategies at each stage in the cycle. For example, treatment may involve developing alternative strategies to cope with negative emotions so that the offender does not resort to deviant fantasy. It may challenge and restructure the distorted thoughts surrounding deviant fantasies and behavior. It may identify "gateway behaviors" (e.g., viewing inappropriate images, using drugs or alcohol, inappropriate fantasies, disrespecting physical and emotional boundaries) and specific high-risk situations. These forms of treatment are not designed to "cure" sexual deviancy but rather help manage the risk of re-offending by promoting self-awareness, encouraging appropriate social-emotional skills, and challenging inappropriate behaviors and thoughts. Treatment often includes components addressing non-specific risk factors such as anger, impulsivity, social skills deficits, impaired empathy, emotional difficulties, personality disorders, and substance abuse.

Direct treatment of deviant sexual interests is controversial. Typical techniques include the pairing of inappropriate fantasies with distressing thoughts, images (e.g., humiliation from public exposure, incarceration, loss of occupation), and even smells (e.g., spirits of ammonia). Other techniques include the substitution of non-deviant fantasies, prolonged verbalization of deviant fantasizes to induce tedium, and relaxation techniques that teach offenders to tolerate urges without acting on them. Some medications (e.g., antiandrogens, neuroleptics, and serotonergic agents) reduce desire and may be helpful. Most importantly, treatment is only one component of an effective prevention strategy. Stable housing and employment, healthy social and leisure activities, and a vigilant support system all decrease risk for re-offending. Continued monitoring and support by law enforcement, professionals, the offender's social support system, and the entire community is crucial to prevention.

Does treatment work?

Early studies of treatment programs for offenders found no evidence that they worked. However, more recent and better-designed studies have found that treatment is somewhat successful. Estimates range from 5% - 40% reduction in re-offending. More importantly, research has demonstrated that outcomes among offenders who are motivated and engaged in treatment are good. Cognitive-behavioral and relapse-prevention based treatments appear to significantly reduce the likelihood of re-offending.

Conclusion

While knowledge of the etiology of deviant interests and effective offender treatment remains limited, substantial progress has been made. Current treatments - particularly when combined with legal, social, and community monitoring - can be effective. Although there is no "cure", motivated and responsible offenders who adhere to treatment and maintain adequate internal and external barriers can successfully manage their sexual behavior.

References

Association for the Treatment of Sexual Abusers (2011). Fact sheet: Things you should know about sex offenders and treatment. Beaverton, OR: Author.

Department of Justice (2003). Recidivism of sex offenders released from prison in 1994. Washington, D.C: Author.

Department of Justice (2011). The basics of sex offender-specific treatment. Washington, D.C: Author.

Grossman, L. S., Martis, B., & Fichtner, C. G. (1999). Are sex offenders treatable? A research overview. Psychiatric Services, 50, 349-361.

Facts and Fiction