Working with sex offenders
Therapy Today, June 2015 Volume 26 Issue 5

Psychotherapists in private practice could have a key preventive role working with clients at risk of sexual offending, argues Andrew Smith

I have been working for the last 11 years with people (they are almost exclusively men) who have been convicted and accused of sexual offending, initially for Ray Wyre Associates and then for the past nine years with the Lucy Faithfull Foundation. My main role has been as risk assessor, primarily in the family court system, and then as therapist, to help lower and manage risk. In the last two years I have worked in private practice with people displaying compulsive or potentially harmful sexual impulses

Up until recently, the main treatment for people who have committed sexual offences in England and Wales has been lengthy groupwork treatment programmes, run by the prison and probation services.¹ In this article I want to make the case for the potential preventive benefits of providing better access to counselling provision in the community as an effective way to reduce and manage risk of offending.

Working as a private therapist in this field presents challenges distinct from those of working for an agency, which will have clear organisational policies and procedures in place. In this role I am integrated within a multi-agency setting, working with social services, the probation service and the family courts, where it is generally understood by all that information will be shared and the main purpose of any intervention is increased public protection.

Working as a private therapist in this field places responsibility for complex ethical decisions squarely on the individual practitioner. Counsellors cannot be legally bound by a client to maintain absolute confidentiality; there are statutory duties to report certain criminal acts, and also if a practitioner has reasonable cause to believe that a client (or another person) is likely to place an adult or a child at risk of serious harm, and disclosure could avert that harm, then the practitioner must consider their ethical duty not only to the client but also to the child(ren) or potential victim concerned and to the public.² Those working in government, organisational or agency settings should be following their policies and procedures. For those who work independently, these are matters for supervision, and where necessary for expert professional advice on child protection law and practice, which should be available from the legal department of the local authority, social care services, specialist lawyers such as Children Panel solicitors, the Department of the Official Solicitor, CAFCASS duty officers, and from professional organisations such as BACP³ and UKCP.

StopSO (Specialist Treatment Organisation for the Prevention of Sexual Offending) is a not-for-profit organisation that aims both to help people who have committed a sexual offence, or are at risk of doing so, to access therapy, and to support therapists working in this field. It publishes a list of private counsellors and therapists trained and willing to work with sexual offenders. It also offers training and support, including a list of supervisors, to counsellors and psychotherapists to help them make the transition to working with this client group. It offers similar support to therapists working with partners of men with sexual offending problems and with couples.

The core therapeutic tasks when working with sexual offenders can be summarised as:

forming an unconditionally non-judgmental therapeutic alliance in which the client develops self-acceptance and self-compassion
helping the client to gain insight into how life experiences and unconscious coping methods can form a pathway to sexual offending
assisting the client to overcome shame, in order to de-objectify victims and raise awareness of victim suffering
helping the client to develop the self-management skills to establish a constructive lifestyle in which needs and desires can be met and realised prosocially rather than antisocially.

As a therapist, but also as a member of society, I cannot be unaffected by the demonised identity that sex offenders embody in the public mind. Some behaviour (sex offences, particularly against children) is considered taboo and polluting, provoking particular anxiety among practitioners. Other behaviour (ie violent armed robbery) may be equally harmful yet not provoke pollution beliefs.⁴ Below are two quotes from my own research into the experiences of probation officers working with sex offenders, which illustrate their conflicted feelings.⁵

‘His sexual activity I just found so depraved and bizarre… I remember leaving the prison, and during the interview I wanted to get up and walk out… the main thing is based on respect… they are individuals who need respect even if they haven’t dished an awful lot out to others, and to work with them I’ve got to respect them as a human being’ (Probation officer ¹⁴).

‘Yeah, I said that at the beginning, didn’t I, that I couldn’t empathise with them and maybe on one hand I don’t want to, and maybe that is your safeguard for yourself, that you don’t empathise with them. It sounds awful, but do they deserve now to have a happy life?… I like to say “Yes they do,” but there’s, you know… With sex offenders, I do hope that they go on to have more productive lives, then a prejudice I suppose... I hope it’s not that pleasant’ (Probation officer ⁹).

Successful therapy with sex offenders is hugely dependent on the quality of the therapeutic relationship,⁶ as it is of course with other client groups.⁷ The treatment of sex offenders in the criminal justice system is increasingly focused on helping them to establish satisfying lifestyles in which their needs and desires are met prosocially rather than antisocially through offending.⁸ The self-reflections of the probation officers show how emotionally complex this therapeutic task can be. Working with people who have sexually offended can be a prime site for unhelpful transference and projection – for therapists as well as probation officers – and such difficulties will be compounded if the therapist has unresolved abuse or victim issues in his or her own background.

Some sex offenders present themselves as great guys: guys who do the right thing, always helping others, considerate husbands and fathers, pillars of the community. More than anything else, they want to be ‘good’ and they want the world to know that they are ‘good’. Often these men have indeed been ‘good’ in many respects, apart from their offending, although apparent ‘good’ deeds are also frequently part of the grooming process. Whatever the reality, I usually have to bracket a range of negative feelings, ranging from mild irritation to anger, about the shift of focus from harm caused to victims to what appears to be self-congratulatory behaviour.

A typical example might be a client who starts a therapy session with the casual comment, ‘It’s hot out there. I was worried about being late so I had to run from the car park.’ The phrase ‘had to’ appears repeatedly in the client’s discourse, suggesting a compulsive moralistic and perfectionist agenda. For such a client, the repressed, non-conformist shadow side of the personality may have been acted out through sexual offending on the internet.

Some clients eventually come to see the lighter side of such a give-away verbal tic, and are amused when they or I bring attention to the habitual use of ‘oughts’, ‘musts’ and ‘have tos’. In a first session, however, clients tend to be far too anxious for such self-reflection, and some are apt to manage anxiety – as they have done for most of their lives – by masking it with displays of competence. Another typical opening gambit might be, ‘I was held up by roadworks on the motorway. I can’t stand people being late. I don’t like it in others, so I try to be on time myself.’ The client may have downloaded thousands of abusive images of children, many of the most serious kind, including adult men having penetrative sex with children. Nevertheless, he appears to want to impress me with his timekeeping.

The following is typical of the kind of statement an offender might make early on in an interview: ‘Look, I want to make one thing clear, I know I’ve messed up, but I want to do everything to make amends to my wife and grown-up children – who have both been super – and I also want to make amends to the Church. Only the leaders know, of course, but they have stood by me one hundred per cent.’

Internet offenders often express a desire to make amends to a partner, family members and friends for the betrayal and unhappiness caused by their offending. But they rarely mention making amends to the child victims in the images, or the impossibility of being able to do this now that the offence has been committed. It is important, however, not to challenge clients too early about this. At the start of therapy, many sexual offenders are likely to feel profound internal shame about their behaviour, which is too painful to explore at the beginning of the therapeutic process when anxiety is at its highest. For many, in my experience, empathising with the harm caused to victims tends to be the most painful step, and this is best done when the therapeutic relationship has been securely established and the client has developed sufficient trust in the therapist to allow her to accompany him to this dark place. If I were to challenge them immediately about their lack of empathy for their victims this would be, in the main, for the satisfaction of venting my own feelings of disapproval. The therapist has to be acutely aware of any judgmental and negative feelings towards the client in order to be able to bracket them appropriately. This is, I would argue, especially difficult with sex offenders.

Equally important is knowing when to raise difficult issues. To do this I also need to be aware of any feelings I may have about wanting to protect a client, and myself, from anxiety-provoking conversations. I find it is important in the first session to make it clear that I am willing to explore the reality of a client’s sexual offending in an open, non-judgmental, matter-of-fact way. This fosters a therapeutic climate in which the client is more likely to speak openly about hitherto shameful matters. There is usually some sting for clients in bringing up the actual details of sexual offending for the first time, but it has to be done; otherwise therapist and client can mutually collude in order to avoid addressing the main issue at hand.

It is often assumed that ‘once a sex offender, always a sex offender’. However the reconviction rate for sex offences is relatively low compared with that for many other crimes.⁹ Sex offending can be seen in terms of a continuum. At one end are the ‘critical few’ – the high risk sex offenders who are not motivated to change their ways and/or do not possess the emotional regulation skills to do so. At the other end of the scale are relatively low risk individuals who are unlikely to reoffend. Risk assessment of sex offenders is a highly specialised area, and should be conducted by a specialist risk assessor before the client begins therapy, so that any rehabilitative gains can be independently assessed. That said, I believe there is great potential for many sex offenders to reduce, manage or cease entirely harmful sexual behaviour.

Preventive role

It is always better to prevent harm happening than to attempt to deal with it after it has occurred. Sexual abuse is such a widespread problem, with much of it going undetected, that it is not possible for society to deal with the problem simply by arresting offenders after the event. Therapeutic work with people who have worrying thoughts and fantasies about sexual offending but who have not yet offended can make an important contribution to prevention.

Many potential offenders, especially those who are motivated to seek counselling, may never act out their sexual thoughts, just as the average person may never live out their sexual fantasies. And they are, like any of us, subject to human difficulties with relationships, grief, depression, anxiety and loneliness, with which they require help, in addition to their offence-focused issues. If they are not able to access therapy, they may be at risk of being marginalised from the general community, and they may well turn to pro-offending paedophilic sub-groups for support, which may consolidate and encourage that part of themselves tempted to offend.¹⁰

Cognitive behavioural approaches and, increasingly, strengths-based programmes used in the criminal justice system can be effective in reducing reoffending. However some people who pose a sexual risk have embedded attachment and trauma issues. These issues are often best dealt with in long-term psychodynamic psychosexual therapy, as an adjunct to more offence-focused cognitive behavioural work.

Furthermore, trauma effects are often stored in body memories, impervious to exclusively talking therapies. Traditional talking methods can be augmented by a range of holistic methods such as body-mind approaches, EMDR, mindfulness, breathing techniques and promoting a positive lifestyle. These interventions are commonly used by therapists in private practice, and are transferable to people at risk of sexual offending.

As many as 50,000 people in the UK are viewing indecent images of children online.¹¹ The Director General of the National Crime Agency has declared publicly: ‘There is going to have to be a range of interventions which might fall short, for some of the lower risk [internet] offenders, of taking them to court.’¹¹ This is where psychotherapy potentially has a role.

The name and details in this composite case study are fictitious but the issues and interactions are typical of those I have experienced in my practice.

George is in his mid-50s. He was arrested after downloading thousands of abusive images of children, mainly teenage girls. He stressed he had been law-abiding all his life and loved his wife. They had raised two daughters, both now in stable relationships and with good careers. He vowed that he would never dream of harming a child in ‘real’ life, and could not explain his behaviour.

George had an indulgent but emotionally fragile mother, who periodically took to her bed with depression. He had one younger brother on the autistic spectrum. His father was in the army, emotionally disconnected and frequently physically absent too. He told George from an early age that he was relying on him to ‘take care of business’ while he was away. George had prided himself on being responsible and upstanding ever since.

George had chosen a wife completely unlike his mother. She provided the ‘fizz to our life’, as George put it. Even though she had felt shocked and betrayed by his secret internet activity, she had soon regained her sanguinity, believing that something would work out. But they were both conflict avoidant and George eventually came to see that there had always been a lack of emotional intimacy in their relationship.

George had risen to a moderately senior position at work but in his 40s had been passed over for promotion in favour of more junior colleagues. He had been made redundant and took premature retirement 12 months before the police called at his door to arrest him.

When he talked about work George’s anger was, for the first time, barely concealed. He had felt bullied by his line manager, that whatever he tried to do was not good enough. The strategies he had used – trying to be a generally ‘good guy’ – had been thrown in his face. He had still lost his job.

Depressed and angry and with much more time on his hands following his retirement, he began playing internet war games where he could act out the aggression he had always been too anxious to express in real life. He then began looking at pornography, deciding, resentfully, that he was going to explore the sexual experiences with teenage girls he felt had been denied him as a young man. The girls in the images became younger and younger as he began to access illegal sites. He talked of sometimes feeling a great sense of liberation as he looked at the prohibited images, and a sense of empowerment at breaking this powerful social taboo.

Gradually George began to gain more insight into how his life experiences and coping strategies had created an offending pathway. In understanding, though not excusing, his behaviour, he came to accept that he was not the monster he felt himself to be and that his offending had a sad logic to it. Once George had developed a degree of self-compassion, we could then go on to address more standard rehabilitative domains such as identifying effective fantasy management techniques and developing assertiveness and intimacy skills. At the beginning of the therapy his anxiety levels and sense of shame prevented him from focusing on the harm caused by his offending. By the end he was able to begin to de-objectify the children in the images and open himself up to understanding how his offending had helped sustain a market that exploits and abuses vulnerable children for financial profit and sexual gratification.

To contact StopSO email info@stopso.org.uk

Andrew Smith is a private therapist and trainer. He was awarded a PhD from Cardiff University in Feburary 2010 for his research into the strengths-focused rehabilitation of people who have sexually offended. He has an MA in solution-focused brief therapy and is a registered member of BACP

References

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10. Goode SD. Understanding and addressing adult sexual attraction to children: a study of paedophiles in contemporary society. New York: Routledge; 2010.
11. National Crime Agency. NCA Director General calls for wider debate on tackling indecent images of children. [Online.] London: National Crime Agency; 2014. www.nationalcrimeagency.gov.uk/news/news-listings/469-ncadirector-general-calls-for-wider-debate-on-tackling-indecent-images-of-children