Therapy for Sexual Misbehavior

Unhappily for all of us, the current wave of exposures of sexual harassers and even rapists has brought forth the usual suspects: psycho professionals who are happy to offer their services to treat the miscreants.

Some say that men like Harvey Weinstein, Kevin Spacey, Brett Ratner and Al Franken are sex addicts. In the case of Tiger Woods I disputed the point myself several years ago. In other cases the Washington Post has argued that these men are responsible for their behavior and do not suffer from an addiction.

As for the therapy on offer for sexually deviant behavior, we must recognize that there are different kinds of sexual misbehavior. While news reports about such behaviors often recommend counseling or therapy, as though these are going to solve the problem by washing them in a warm bath of empathy and insight, the truth is, Benedict Carey reports in the New York Times, that for the most part therapists can only offer a patchwork of approaches, none of which is especially effective.

We are grateful to Carey for presenting an outcome-based assessment of therapy approaches and sparing us the psychobabble about feeling our feelings.

Carey presents the current status of treatments for sexual misbehavior:

Whatever mix of damage control and contrition they represent, pledges like these suggest that there are standard treatments for perpetrators of sexual offenses. In fact, no such standard treatments exist, experts say. Even the notion of “sexual addiction” as a stand-alone diagnosis is in dispute.

“There are no evidence-based programs I know of for the sort of men who have been in the news recently,” said Vaile Wright, director of research and special projects at the American Psychological Association.

That doesn’t mean that these men cannot change their ways with professional help.

He continues:

The evidence that talk therapy and medication can curb sexual misconduct is modest at best, and virtually all of it comes from treating severe disorders, like pedophilia and exhibitionism, experts said — powerful urges that cannot be turned off.

Still, there is reason to think that these therapeutic approaches can be adapted to treatment of the men accused of offenses ranging from unwanted attention to rape.

  

Again, some severe criminal sexual disorders can be controlled with medication, but not very many and not very well. There is a chasm between unwanted attention and rape… so count me as skeptical of any treatment that pretends to help both of them.

As for the different types of sexual misbehavior, some do lend themselves to treatment:

The first group includes the college student failing out because he spends all his time surfing porn sites, or the man who is visiting prostitutes so often it’s threatening his livelihood and health.

Therapists treat these types much as they would substance abusers: with 12-step programs; group counseling sessions; and by teaching classic impulse-control techniques, like avoiding friends, social situations and places like bars that put them at high risk of repeating the behavior.

The services offered resemble those for other kinds of compulsive behavior, like gambling and drug use. There are life coaches, couples counselors and hypnotherapists, as well as residential clinics with names like Promises and Gentle Path at the Meadows.

Such behaviors are addictive. In some cases people who are addicted to pornography can cure their addiction by ceasing to watch pornography. If such behaviors become uncontrollable, then therapists use 12 Step programs.

Still, we should not be overly optimistic. Carey notes:

It is not at all clear how well such addiction-based approaches work — if at all. And that’s especially true for men in the more serious offender category, who are more likely to respond to confrontation, experts said.

Interestingly, he adds that shaming offenders—through public exposure-- often brings them to their senses. Considering that so many psycho professionals believe that guilt is the only sanction that causes people to change their behavior—see Monday’s post—it is good to see that many members of the profession understand that shaming is far more likely to change behaviors.

Admittedly, the therapists do not call it shame, but you will understand clearly what is at stake:

“Confrontation itself — being busted or outed, as so many are now publicly — is enough to curtail or end the behavior in many cases,” particularly when the offender has a lot to lose in terms of money and standing, said James Cantor, director of the Toronto Sexuality Center.

Of course, some therapists want their patients to feel empathy, but there is no real evidence that this works very well. Besides, as we have pointed out, following Paul Bloom, a man’s empathy for a man who has been accused of sexual misconduct and who has been pilloried in the press might just become very angry at women:

Dr. Reid helps patients cultivate victim empathy by having them attend court-sentencing hearings, where victims read detailed accounts “and the impact isn’t sugarcoated” so offenders can “start to understand how an assault forever changes lives.”

The evidence is weak for empathy training in offenders, through techniques like role-playing and taking a potential victim’s point of view, said Michael Seto, director of forensic rehabilitation research at the Royal Ottawa Health Care Group.

  

In many cases, therapy serves as little more than a “ruse” to provoke sympathy, to quiet the outcry and to prepare the miscreant “to return to the fold:”

But only if the harasser is willing, committed and genuinely humbled is therapy likely to be anything more than a ruse to buy some sympathy — and worse, perhaps an eventual return to the field.

What to make of the harasser who is entirely unrepentent? “I don’t think we have a diagnosis yet,” said Dr. Cantor. “And we certainly don’t have a treatment.”

We are happy to see the therapy issues put in some clear perspective.