IamA Psychologist who works with criminal offenders, particularly sexual offenders. AMA!

Can pedophiles actually change? or is it an innate sexual attraction thats hardwired in?

This is a fairly controversial and charged question for some in the field. So, for this question, I am providing my opinion with the understanding that other colleagues probably might disagree with me.

I believe Pedophilic Disorder is a sexual orientation with individual that are attracted to child features. In other words, an individual with pedophilia has the same ingrained attraction that a hetersexual female may feel towards a male, or a homosexual feels towards their same gender. With that being said, it needs to be said that sexuality is more of a spectrum than a finite category. We know that heterosexuals may engage in homosexual behavior, and deny they are bisexual or homosexual. We know that individuals with pedophilia may engage in sexual behavior with adults. For some, they may use this as a cognitive distortion to explain away their sexualization of prepubescent children. Others may acknowledge they can engage in behaviors towards children and adults. Diagnostically, the DSM-5 allows for "Nonexclusive Type" to be diagnosed, which signifies an individual holds both sexual attraction and/or behavior toward children and adults.

Edit: So first, this is the second part of the response to the question. I previously provided this as a response to another comment, but most probably did not see it due to the original comment being downvoted. I'm a bit concerned, as some of the comments I am reading in this thread suggest that I hold a view that Pedophilic Disorder is untreatable. Not true. Treatment, to me, isn't about modifying the orientation per se, but getting the individual to find more appropriate behaviors to engage in. Second, as some others rightly point out, an individual can have pedophilic interests without ever acting on these behaviorally. However, as I am working with criminal offenders, my experience is entirely weighted to those who have engaged in this behaviorally. As such, I'm not in a position to discuss those who merely hold sexual interest in children that do not act upon them.

My reply about treatment was as follows: Yes, my apologies you are right in that I did only answer half the question. I do believe we can change the behavior of Pedophilic Disorder, with the understanding that the attraction may always remain. So the goal, as noted in this response, is to understand what the individual needs to change to ensure they are less likely to offend in the future. When working with someone who evidences Pedophilic Disorder, the three largest things I focus on in treatment is: 1. Do you understand who can and can't provide consent? How will you go through and identify this? 2. Can you identify the risks or situations which would increase when you engage in sexual activity with someone who can't provide consent? How can you avoid these or limit them? 3. What can you focus on positive in your life which can replace or mitigate when you may be most likely to offend? What are some things you can do which are adaptive and help you in the long run?

I hope this answers your question.

Second Part of Edit: In hindsight, it was an error on my part not to take some more time to discuss the varying views in the field about pedophilia. My response sort of hints at this, but under-served it. First and foremost, my view of pedophilia being an orientation is fairly controversial in itself. Some in the field hold this view, but the American Psychiatric Association had to go back on some language it originally provided in DSM-5 that indicated Pedophilia Disorder is an orientation. To myself, based on my knowledge of the literature and experience in assessment/treatment, this view I feel fits best. Others disagree. That is OK! However, I am not interested in spending time discussing views I don't hold. I acknowledge they are out there, I acknowledge my view my ultimately not be found to be correct as we keep researching this area, but I just feel that right now based on my knowledge that the orientation view towards pedophilic disorder holds the most credence. So with that being said, here are a few links that provide some more information on the view of pedophilia and its treatment in the field.

Link 1: Text from Google which I have used and clearly lays out assessment and treatment of Pedophilic Disorder

Link 2: Wikipedia (yeah, I know, but the page itself wasn't terrible and a good shotgun to the various issues concerning Pedophilia Disorder) with the section and the Development and Sexual Orientation view towards Pedophilic Disorder

Link 3: WebMD article which is another decent shotgun approach for the general public on Pedophilic Disorder

Link 4: This is an Association for the Treatment of Sexual Abusers (ATSA - highly recommend joining this organization if you have an interest in serving this population) presentation by Dr. Pamela Yates on the Self-Regulation Model to Offending. This is the broad model I subscribe to when conceptualizing sexual offending

Keeping in mind that there is attraction that is sexual in nature, that it is an arousal based on knowledge of the physical features of another person and the instigation of the biological imperative to mate. But what about other features of attraction, particularly the psychological aspect as it relates to the concept of emotional connection? From research on the science of attraction, for instance, we tend to be attracted to those who most closely remind us of our childhood image and experience of our mother or father. If a girl experienced emotional abandonment from her father, she interprets and understands that as the form of love. The emotion of anxiety that is the physiological manifestation of a fear of abandonment, later on in life, becomes understood as attraction and love. So this woman then would find attractive the subconscious patterns of abandonment in a male partner because it models her childhood experience of love from her father. But that childhood experience was governed by a desperate need for validation, and so as an adult, her attractions to men are based on validation seeking tendencies, where emotional hunger is confused as love. Kernberg argued that our ability to engage in constructive and positive relationships as adults is highly influenced by the stage at which a developmental failure had occurred preventing full psychological birth. So in regards to pedophiles, is there a view that argues that their attraction to children is based on emotional validation and psychological healing, where there is that anxious neurotic drive to seek after it, as opposed to it being purely sexual?

Yes, emotional identification with children is a know risk factor for possible offending against children. However, emotional identification is not the sole mechanism, and some degree of sexual interest is needed as well. Think how many are interested in childlike activities (comics, shows, games, etc.), but don't offend. It's a factor, but the largest factor in my opinion is sexual attraction toward children.

Does this answer change if we're talking about ephebophilia (attraction to teens, for those wondering) and hebephilia (attraction to pubescent children, older than a pedophile)?

And, I almost hate to ask this, but what about infantophilia? I imagine and hope that's really rare

Some of my colleagues use these terms, I don't. My view is we are aware of the fact that it is normative for others to have some sexual interest in teenagers despite the fact that legally this would be prohibited. Something like 'Jailbait' does not come into common usage if the construct wasn't there.

Think for a moment about Britney Spears, Justin Bieber, or Miley Cyrus as teenagers and the interest they received. Its taboo as an adult to acknowledge this, but it would be considered normative. As such, it isn't a disorder. Pre-pubescent children don't meet this 'normalized' standard. This is why it is cast more into the realm of the pathological.

I can think of only one individual I have ever met with who has acknowledge sexual attraction towards toddlers. I don't have much familiarity with infantophilia, and my educated guess is it is an incredibly rare event.

You did not answer his question. The answer is yes. If you look at any of the literature resulting from the very positive results of the RNR and Good Lives models, there is hope. It is effective. In fact, recently Minnesota has had a massive federal ruling changing the "whole game" in regards to treating sex offenders. Sexually Dangerous as a finite position no longer exists. Treatment changes, the ability to understand consent changes, and being able to live a "normal" life exists.

Yes, my apologies you are right in that I did only answer half the question. I do believe we can change the behavior of Pedophilic Disorder, with the understanding that the attraction may always remain. So the goal, as noted in this response, is to understand what the individual needs to change to ensure they are less likely to offend in the future. When working with someone who evidences Pedophilic Disorder, the three largest things I focus on in treatment is: 1. Do you understand who can and can't provide consent? How will you go through and identify this? 2. Can you identify the risks or situations which would increase when you engage in sexual activity with someone who can't provide consent? How can you avoid these or limit them? 3. What can you focus on positive in your life which can replace or mitigate when you may be most likely to offend? What are some things you can do which are adaptive and help you in the long run?

Can you help clarify between these two statements?

I believe Pedophilic Disorder is a sexual orientation with individual that are attracted to child features. In other words, an individual with pedophilia has the same ingrained attraction that a hetersexual female may feel towards a male, or a homosexual feels towards their same gender.

And then

I do believe we can change the behavior of Pedophilic Disorder, with the understanding that the attraction may always remain.

I might be reading this wrong, but this sounds very similar to the "pray the gay away" therapy and ideas that were included in the DSM up until 1986. If Pediophilia is a sexual orientation, how can it be considered a disorder when others have been declassified as such?

The term 'disorder' is what is in play here. First, we need to understand what the DSM classifies as a disorder can, and does, change over time. You are correct that the DSM once classified homosexuality as a 'disorder' and that this ended under DSM-III (I believe, may have been DSM-II).

So, generally speaking, how does the DSM classify something as a disorder? There are two core components that are used. First, a disorder is combination of identified symptoms (i.e. syndrome). Second, these symptoms must result in some form of dysfunction for the individual OR others (i.e. disability in other realms of functioning as a result of the disorder). In other words, DISORDER = DYSFUNCTION + SYMPTOM. If you don't see both components, we aren't talking about a disorder in the DSM sense.

Pedophilic Disorder meets both prongs. The primary symptom is sexual interest in prepubescent children. The primary dysfunction is the harm this behavior can cause upon others (the child). A child cannot consent to the sexual activity, so engaging in sexual activity with a child does impart some degree of harm.

Homosexuality was determined not to meet the dysfunction on the two pronged criteria. Sure, interest in your own gender could be considered a symptom (for argument sake here, not my position). However, as long as the behavior is confined to individuals who can provide consent, the only harm which results is due to others view of the behavior.

I hope this helped spell this out a bit more.

Where I work, PPG and various evaluations (STABLE-2007, SVR-20) also solidify this experience.

Interesting, I am aware some jurisdictions are very much against the use of the PPG as part of the assessment/treatment of sexual abusers. I'm curious about your experience in using this instrument, and if you have found it to be beneficial for assessment and treatment? I guess this is an AMA during an AMA... :)

Do any of your patients regret what they have done?Also are these offenders mentally ill?

I would say that the majority of my clients do regret what they have done. However, I must note that regret comes in 'degrees.' For some, they may regret they engaged in the behavior as they now have consequences for the behavior. For others, they may regret one or two of their crimes, but others they do not. Some only regret hurting a particular individual (e.g. their children now can't seem them easily, as they are incarcerated).

I would say the majority of those I have worked with struggle with mental health difficulties. That being said, this is a weighted view. As a psychologist, I am generally called on to meet with those who are struggling the greatest. I don't see the garden variety individual with little mental health difficulties. I see folks with long histories of substance abuse, mental health disorders, poor relational histories, etc. I believe that approximately 1/3 of individuals in the facility I work at require some form of mental health services. This doesn't mean all have 'mental illness' in the sense you probably imagine it. For example, one person I met with had his child die while he was serving his time. He was struggling with this loss, but this would be expected for just about anyone. That isn't a mental health disorder, that's struggling with life.

I hope this answers your question.

What proportion of offenders were not subject to abuse as children themselves?

For answering this question, I will assume we are talking about physical and sexual abuse. This is not to undermine the impact of psychological abuse, its just that psychological abuse can be harder to quantify. I'll also note I am speaking to my own experience with this population; I am certain you could pull literature that will give you some ranges for a larger number of studied individuals than who I have interacted with professionally.

In my experience, I would say at least a third of those I work with have been physically (including neglect) and sexually abused during their childhood. I would say of this third, a very large majority (~80+ percent) had the abuse perpetrated by a trusted caregiver. Now, this opens up a question. Did the abuse result in them becoming abusive/criminal themselves? For some (particularly sexual offenders when you conceptualize their offending with regards to their history) there appears to be a correlate between the abuse they experienced and their perpetration of abuse against others. However, my understanding of the literature is clear and most individuals who are abused do NOT go on to abuse others themselves. What this suggests is that while abuse may play a role in the decision these individuals made to go on to offend, it is not the sole explanation for this choice, and other factors need to be considered.

I hope this answers your question.

Did you ever find yourself sympathising with the criminals instead of the victims?

No, not really. See, for me, it is very important I am as objective as possible in serving this population. ESPECIALLY when I need to do assessments. So if I find myself experience counter-transference (which sympathizing could be evidence of) I need to consult with my colleagues and either resolve it to maintain as much objectivity as possible, or consider if the counter-transference is detrimental to my work having the client referred to a colleague. I will point out that 100% objectivity in a helping profession is impossible, and I am not attempting to suggest I approach my work in a mechanical manner. I do try and remain as impartial to what I do as possible though, and I am seeking to note when I do something that is outside of the norm for me.

With that said, there are times I find someone has drawn a bad lot in life, or seemed to have the deck stacked against them. To me, it is one thing to acknowledge this individual's circumstance, but a completely different thing to start making excuses for their behavior, or 'pulling' for them in a personal way.

Now, I do understand why most folks may have did what they did. After all, that's part of my job. So I do bring empathy (defined here is understanding another's experience) to my work. Is that sympathizing in the sense you use the word? I don't think so. I think sympathizing requires something more, like 'taking it easy' in the work, or allowing that emotion to start changing my opinions or my interventions.

I hope this answers your question.

I'm a grad student currently taking Ethics and Professional Issues in Counseling. Dude. Your ethics game is strong. You would have nailed my last test.

This population has a knack for making you strongly consider and understand your ethics, your professional practice responsibilities, the laws you practice under, and the rules of your facility. They will try and find ways to 'jam you up' if you are lacking in your knowledge of any of those areas. Some of the more criminally inclined will misquote things, and its your duty to know why its wrong and what you need to do right. Enjoy your studies!

What do you feel is the most important type of education to prevent sexual assault?

Basic, sensible, sexual education which focuses on consent. Not this 'abstinence only' shit some try and use in order to pretend that sexual behavior is not normative for adolescents. Understanding when consent is and is not provided should be part of that education. Understanding that consent is a moving target during activity, and that consent can be provided some part of the activity and not others would be great.

I'd also think destigmatizing abuse so others can talk about their experience, ending 'slut shaming' when females want to show their sexuality or engage in sexual behavior and end up being victimized because of someone elses inability to adequately control themselves, and also understanding males are sexually abused and are no less masculine for having this inflicted upon them would be great places to start.

Also, that women can sexually assault other women or girls. They don't tell little girls to look out for that, they usually just hear "look out for men."

Edit: Anyone can be a victim of assault, I was simply speaking as a woman who was molested by older girls when I was a child. I didn't realize I was a victim because girls didn't do that. (From my understanding at nine years old.)

Yes, thank you. You are absolutely correct and I apologize for my failure to highlight this as well.

how do they become like that? I mean, what made them go from normal person to offender? And what can you do to make sure your kid doesn't become that? What are the signs that a kid might become an offender?

This is a great question, but one that is going to take some time to answer. I want to pull some literature as some terms I am going to use regarding 'criminogenic needs' (which is what the core issue of your question is) need to be operationally defined and precise in application.

I am responding to let you know I have read this question AND will respond to it later today. I want to make sure I give it the attention it deserves.

EDIT: I have answered this question, and had to post it in two parts in order to answer it.

So, to answer this question, I am first going to boil it down to the following: “1. Why do people engage in criminal behavior? and 2. How can we help prevent people from engaging in criminal behavior?” If you feel this mischaracterizes your questions, please let me know. With that being said, I would respond as follows… 1. So, I’d like to first talk about development trajectory for Antisocial Personality Disorder (APD). Antisocial Personality Disorder is a condition that, essentially, means individuals have failed to conform to the social norms of lawful or rule abiding behavior, have engaged in some harm to others by doing so (via irresponsibility, assault, taking advantage of others, impulsivity, etc.), and generally lack empathy or use cognitive distortions (excuses) to explain away their behavior. Not all individuals who engage in criminal activity have APD, and technically speaking, you can meet criteria APD without having ever engaged in or been caught for criminal activity. (Note: When I say “meet criteria” I mean meeting enough criteria for diagnosis; I am not talking about Other Specified Personality Disorder with Antisocial Features, which is essentially a partial diagnosis for APD). Its also important to note that when I discuss APD some people think of psychopathy (or sociopathy); while there is correlation between the two, APD is NOT psychopathy. You can meet criteria for APD without evidencing high degrees of psychopathy, and you can have high degrees of psychopathy without meeting criteria for APD. Now, its usually a bad call in psychology to over-generalize. However, to try and keep this response from turning in to a mini-thesis, I am going to generalize a couple routes to criminal behavior through the lens of the Etiology of APD. I will term these ‘early course’ and ‘adolescent course.’ Why only those two? Because diagnostically, if someone does not evidence Conduct Disorder (essentially, a diagnosis in childhood/adolescence in which they do not follow rules/laws) prior to age 15, we cannot diagnose APD. So if I have someone who only began engaging in criminal behavior as a late adolescent/in adulthood, I automatically have ruled-out the diagnosis of APD. For early course folks, they generally have poor childhood developmental conditions (e.g. abuse, neglect, poor parental responsivity, etc.). They may meet criteria for Oppositional Defiant Disorder during childhood. These are the children who many will say they knew from an early age they ‘would be trouble.’ They probably start abusing drugs, or are around drugs, at a very early age (before age 10). They do poorly in school. These folks typically do not have strong peer supports, as peers want little to do with them or peers’ parents keep their children away due to their misbehavior. This is also assuming they go to school regularly enough to develop peer relationships. For adolescent course folks, they more or may not have poor childhood development conditions. Its unlikely they meet criteria for Oppositional Defiant Disorder, but possible they meet criteria for ADHD. Generally they do adequately enough in school. These folks usually start forming poor peer relationships. They may be more of followers. Its probably they haven’t started significant substance use until later (post age 10-12). Overtime, their behavior becomes more out of control if it wasn’t that way to begin with already. Parents usually struggle, if involved, to find ways to help them if they remain around poor peer groups or if substance use is not addressed. The early course folks are much harder to treat, in my experience have higher degrees of psychopathy, and usually don’t show ‘age out’ we expect for APD in the mid-40s. They tend to be more of your career criminals. The adolescent course folks can go either way. If they don’t meet full criteria for APD, and we get the substance use under control, I don’t see as much recidivism for them. Another important aspect of why individuals go on to criminally offend is the idea of Criminogenic Needs. These are various factors which can increase the risk of someone engaging in criminal activity. We work with eight of them in our facility. They are: Antisocial Cognitions (thoughts supporting criminal behavior), Antisocial Associates (peers who support criminal behavior), Antisocial Personality (diagnosis explained above), Poor family relationships (including poor relationships with significant others), Substance Use, Poor Employment, Poor Education, and Boredom. Some folks call these eight factors some different terms, but at their core they are all identifying the same Criminogenic Risk Factors. In part 2, I will discuss how we target these risk factors in treatment via the Risk-Need-Responsivity

Edit is because this showed up still as part 1 to the question, I kept everything else the same from the original post.

Part 2. So how do we prevent or lower the risk of someone engaging in criminal behavior? Lets talk about targeting someone at risk BEFORE they get in the system, and lets talk about what we can do once they have gotten into the system. First, lets discuss the idea of Risk-Need-Responsivity. Simply put, systems only have so many resources to help others out. So this allows a way to prioritize who needs the most care versus who doesn’t. If someone isn’t in the criminal system yet, most of the interventions are more about making sure they don’t get there to begin with. Their isn’t a lot of money per se for treatment interventions at this stage, because as a psychologist I wouldn’t be meeting with them to treat yet. Once in the system, that is not a guarantee that someone will get services. Even if they have mental health difficulties. Fact: Prisons are now one of, if not the largest, providers of mental health services in the United States. Think about that for a moment. In terms of where we are targeting the intervention, its too far downstream. Now, with that being said, people who have mental health difficulties are not inherently dangerous. That very vast majority will not get in the criminal system. Once there, however, things get tough. Because frankly, to get to see me, you need to be the worst of the worst in terms of your pathology. Not always, but the majority of whom I serve have very severe mental health difficulties, have had them for some time, and have a number of behaviors that go hand in hand with these that lead to their needing treatment (i.e. suicidality, assaultive behaviors). The Risk-Need-Responsivity is weighted to those with the highest risks and needs for treatment. Before they get in the system would be called a ‘primary intervention.’ These are interventions which seek to eliminate a problem before it starts. For example, a primary intervention would be cleaning up oily rags in a work area to ensure a fire doesn’t start. For those who engage in criminal behavior, this is providing pro-social opportunities for their development in childhood, to give them tools to succeed. This would be things like ‘Head Start’ the ‘DARE program (yes, I am aware its relatively ineffective, just an example)’ or things like sports or vocational hobbies. Generally, these are the interventions that stop things from starting. There is this idea of the ‘school to prison’ pipeline; those with poorer educational opportunities or from lower socioeconomic statuses are at a disadvantage and have a higher likelihood of ineffective opportunities which eliminates potential opportunities for criminal behavior. When you look at criminogenic needs above, its easy to see how targeting things like employment opportunities, good education, substance use, or having poor peer networks could help prevent criminality before it begins. A ‘secondary intervention’ is what happens once they get in the system, but might be at the misdemeanor level of an offense. These are interventions which seek to eliminate a problem that has been identified, but hasn’t progressed into something that is causing serious damage. An example of this would be putting out a smoldering set of oily rags before it starts on fire, or putting out the fire very quickly before an structural damage takes place. These would be things like substance use programs for first time offenders, or probation for first time small criminal behaviors. The idea is try and get the person back on the right path before the behavior becomes worse. Again using criminogenic needs, targeting any areas of difficulty now would be beneficial before the person engages in more criminal misbehavior. The problem though, and the reason I say you want to target things before the person gets in the system, is that once in the system things start getting very hard. Your employment opportunities may be more limited. People may wish to avoid you now because of the stigma (both real and imagined) of what a ‘criminal’ involves. Your opportunity for a ‘slip up’ is now gone. Going through the legal system is expensive, so any margin of error you had financial is gone. A ‘tertiary intervention’ is what happens once they are in the system at a felony level of offense. These interventions seeks to mitigate the damage that is being caused. An example would be firefighters putting water on an adjoining building to make sure the fire that started in the workshop doesn’t take out the neighbor as well. This is the point in which I start providing services to folks. Generally speaking, treatment gains at this level are fewer and farther between. This doesn’t mean our interventions are pointless, or that those at this stage are ‘untreatable.’ It does mean that they want to be at a place where they want to make changes (i.e. Contemplation or Preparation stage of the Transtheoretical Model of Change). If not, I have to use “Motivational Interviewing” which is a set of skills that focus on trying to resolve ambivalence towards making changes, and even then if the person doesn’t want to make changes these will not work. At that point, it becomes about educating them on where they are likely heading based on their decisions to this point, and how they can get help later if they choose. OK, this is a very long response. I think I covered all I want to cover to answer the question. I hope this was useful for yourself and others.

Retired psychologist here working in another field. Kudos to you for dedicating your life to this much needed area. I assume from your posts you are working in a prison. I take my hat off to you- I interviewed in a prison for my post-doc hours and I knew there was no way I could hack it- and I'm a very large burly male. I hope your career is personally rewarding and brings you much happiness.

Question- do you ever think of going into another area of psychology? I imagine burn out is prevalent among your colleagues. Personally I went into high dollar "private pay" residential treatment and loved it. I couldn't imagine working in a prison for even a day.

I've thought about... However, when I worked in the community I found the work very disinteresting. I make good enough money in the public sector to take care of my needs and have some left over for my wants. More money, while enticing, is simply not enough to pull me from the work I am doing now.

I've had some limited experience with sex offenders - primarily pedophiles who have been caught and jailed. One recurring theme was that they seemed astonished to find themselves incarcerated on the Violent Offenders side of the jail, as they did not consider what they did as violent.

Is this common? I admit that my experience with them is limited, but do sex offenders generally think that they are not violent?

My experience has been that individuals who engage in pedophilia have predominately utilized grooming to engage in the offending. The idea of the person with the windowless van abducting children just doesn't happen with any degree of significant frequency in the population. Most I have worked with were in some position of authority (i.e. teachers, troop leaders, coaches, etc.) and they slowly groomed the child into the activity. The few I can think of who 'coerced' through physical violence sexual activity with a child usually did so when under the influence of a substance AND when their first attempt at persuasion/grooming did not work.

In terms of those who commit rape, I would say it seems to be an equal split between those who can acknowledge they used some form of coercion in the offending and those who struggle by distorting their role in the offending. For the latter, these are the guys who will say those they victimized were "asking for it" or "it wasn't that bad, it was only a little tap" or "they liked it, they just said they didn't afterward." They are much harder to work with in treatment, as we first need to cut through the distortions before they can start progressing in treatment.

What do you think that the role of pornography can be in the cycle of offending (either a stimulating or cathartic effect?)

I have seen the field trend toward allowing sexually explicit material as part of treatment programming. I see it as having some benefits; if we have a person who is sexually attracted to children, and they have interest in masturbating to pornography containing adults, it makes sense to me to allow that. However, for some, they could use the material inappropriately by fantasizing to more deviant themes while using the materials.

I've heard some argue that the widespread availability of pornography is one of the reasons we have seen the rate of sexual offenses/crime go down. I'm never a fan of correlation=causation, but the argument goes having access to the material sublimates the desire to offend, and creates and outlet for deviant fantasies to be explored without being acted upon. Interesting idea, but crime is going down in general as we have done a better job of educating the public on these issues and have evolved some of the dynamics for how we view relationships. So there are other explanations in my view, but this one touches on your question.

I hope this helped!

How much is the act of rape really just about wanting sexual release over a psychological need of some kind (e.g. an expression of power)?

I would say for most individuals, rape is very much about fulfilling some aspect of establishing power and control over an individual. They may not recognize the degree to which this dynamic is present in their offending, buts its there. Why they do so varies to the individual; some do so because they use it instrumentally in a domestic relationship to establish their power, some may do so to re-establish emotional control following a situation, some may do so as it is playing out some relational dynamic in their lives. There are other reasons why some go on to rape, but I think this response is the most concise way to answer your question.

I hope this answers your question.

Do you think sex offender registries actually deter or prevent sex offenses?

For very high risk offenders (which are a low percentage of the sexual offending population) in some respects yes. For most sexual offenders? No. If anything, stigmatizing them and restricting their access to pro-social development probably makes the reoffending problem worse. I also have an issue with the idea of 'lifetime' registries. Emerging research by Dr. Robert Hanson is showing that the longer a sexual abuser is in the community without issue, the lower their recidivism becomes over time. The degree of response a lifetime registry creates just isn't needed for the vast majority of offenders.

I hope this helps answer your question.

Hello!

Thanks for doing this AMA. Can you tell us your most intense experience in your career to date?

Sure, but I'm going to strip a ton of details.

The most intense experience I have had was when I was assaulted by a client. I had met with them as part of an assessment. During feedback, I gave them some information they particularly didn't care to hear. They first attempted to argue with me, then they attempted to intimidate me into changing my opinion, and when that failed, they assaulted me by shoving me and then striking me with an object in the room. The damage was not as bad as could have been (bruises and a couple scratches), and I am very thankful to my officers in the area who responded and got me separated before the individual continued to escalate.

Why did you choose to work with sex offenders?

The short answer is post-graduate school I had experience with criminal offenders, but not sexual ones. So I got involved with that population to increase the breadth of my experience in working in correctional settings. My end goal for my career is to have expertise working with the entire range of criminal behaviors. So at some point, I'll also seek out work in the community working on those on parole. I may also get involved with adolescent work at some point, as well as primary interventions for criminal behavior (community/school outreach).

Did you also worked with female offenders and whats the biggest difference to male offenders ?

I have no experience working with female offenders. I wanted to let you know I saw this question though. Sorry!

Do you ever find yourself needing to take a break after particularly disturbing sessions?

Not really. I have been working with this population long enough now that I am relatively desensitized to what they tell me. I usually also know their offending background, so its doubtful they are going to 'surprise me' with their offenses. Some days I take more time for self-care when I get off work, but when I'm on the clock I'm usually focused on the here and now in session.

I hope this helps answer your question.

Sheriff's Deputy and former CO here. Thanks for the AMA, I've found it really informative.

Based on your experience and observations, do you think most offenders want help? While I was working the jail I saw a different side of the inmates vs the staff that interacts with them on a short-term basis. Too many times I heard and saw an inmate manipulate medical staff if it helped their case.

Also, in your experience, are more offenders going to the Internet to help coordinate their crimes and does that have an effect on their recidivism?

Also, what do you think law enforcement could do to be more effective when working with these people?

Thanks again.

Edit: 3rd question

So, to come back to this question...

1. I think that most offenders want 'help' but their idea of what help entails and my idea of what help entails can drastically vary. Thats why I find it of the utmost importance the first time I meet with someone (and more to the point, it is an ethical responsibility) to clarify the nature of our working relationship, what we will be working on together, and to ensure any misconceptions about are worked are addressed immediately. You are correct that malingering (the technical definition of fabricating symptoms for a secondary gain, like medication for example) is a problem that spikes in the correctional world. Thats why I find it very important to clarify my role, to discuss what they want from services, and to keep a wary eye out for possible symptoms feigning/exaggeration.

2. I've heard of Facebook/Twitter/etc. being used more to assist in perpetration of crimes (especially for gangs), but I can't say I have really noticed this in our Pre Sentence Investigation Reports that we receive.

3. Well, first and foremost, finding a way that doesn't result in the us versus them mentality could go a long way. Not a 'Hug a Thug' provider by any means, but this population is so used to being dehumanized that trying to talk to them like you'd talk to your neighbor or friends can go a really long way. Just need to be alert to some of the criminally minded folks who view that as weakness and will try and use it against you. Now, I can talk about what works for our Correctional Officers. Motivational Interviewing techniques have increasingly been taught to non mental health providers, and they are effective when used right. Essentially, these are tools which help open communication with others to determine what their goals are, and having discussions with them about these goals and how they may be achieved. Generally, the core idea that gets taught is OARS (Open Ended Questions, Affirmations, Reflection of Content, Summarizing). In addition, I like the concept of "Verbal Judo" and using this to help deescalate someone.

I hope this answers your question!

I'm on a phone right now so answering this question will probably take some more typing. I will answer it later today when I'm back at a keyboard. Thanks!

Hello Doc

This is very fascinating, thank you for doing this. I have a couple of questions, if that's alright, if there is anything you do not wish to answer, that is understandable.

Firstly how does a normal plan for treatment (I don't know if this is the correct terminology) of a patient of yours focus on? I suspect it might be highly individual, but if there are something common, it would be very interesting to hear.

Also what are some of the common and more unique troubles you can run into, when working with this population?

As someone who is interested in psychology of violent behavior in individuals, more specifically individuals who commit crimes with a fatal outcome (such as serial killers like Jeffrey Dahmer, for example), do you have any recommendation for academic literature? I understand this might not be your field, but if you have any idea, what I should start to look into, it would be greatly appreciated. I'll be starting a minor in psychology at my university after the summer and this something I have wanted to get a better understanding of for a long time.

Thank you again for doing this AMA!

Edit: if anyone is wondering what the DSM-5 is, it's The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is a update to the American Psychiatric Association's (APA) classification and diagnostic tool. source If this is wrong, then please correct my mistake.

1. It is highly individual. For me, I focus my interventions on the reason they were referred. I may 'veer' into other areas if needed, but I am tasked with responding to the referral first and foremost. So, for example, if the referral is to provide brief counseling for an individual struggling with recently being incarcerated, I am not going to start focusing on their childhood. Similarly, a person may have a well established history of sadistically raping others, but if the referral is to focus on depressive symptoms than I am probably not going to focus treatment on the history of rape.

2. Far and away, the most common issue I see for those I work with is substance use. In fact, I am usually very surprised when I don't see a diagnosis for some type of substance use difficulty when I get a referral and start doing a conceptualization for treatment. I may not be treating the issue (in fact, I would not as this would come from other providers), but its so common. Next most common thing I see is poor social supports in the community, i.e., under or unemployment, poor social relationships, poor history of education, difficulty with housing, etc. The third most common thing I see is a background of some type of abuse (i.e. sexual, physical, psychological) in childhood. I would prefer not to speak to any unique individuals I have served in order to ensure they cannot be potentially identified (no matter how unlikely that may be in this forum).

3. In order to save some typing, I recently responded to an AMA request in which I outlined some books I have enjoyed in the past. Please take a look at my past comments to find this as I have some additional recommendations and statements. Briefly, I will say that "Without Conscience" and "Inside the Criminal Mind" would be two places to start.

I hope this answers your questions.

Is there an average age you deal with?

I'd say the age range I see most often is individuals somewhere in their early 20's to mid 30's

When you work on treatment, how much do you identify with yourself in your professional role?

I'll parse this into two answers...

In terms of how much I identify myself (e.g. I live here, I like this hobby, this is my family, etc.) I try at all costs to avoid doing so. This population feeds off information, and will use it against you if possible. We talk about colleagues who have become 'impaired' and taken advantage of to do things like smuggle, engage in sexual activity, provide money, etc; its paramount for your safety and the safety of others you significantly limit what personal information you are sharing! More to the point, I firmly believe that regardless of who you are providing services too, self-disclosure should be a relatively rare event. If you do engage in self-disclosure it should be to serve the client and not to serve yourself. In my experience, the few times I have disclosed something to a client has had a very particular purpose behind it.

Now, in terms of how much I identify with my professional role, it is not possible to fully separate who I am as a person from who I am as a psychologist. I'm very inquisitive personally, and this is something that serves me well when I assess an individual. I generally want people to succeed and to do so on their own in my personal life, something that serves me well as a treatment provider. There is overlap. However, my responsibility is to ensure the overlap always is serving my clients, and not for my personal gain.

I hope that made sense and answered your questions.

Do you work with SAY? If so what are your experiences with this? Is it more difficult to work with them than an adult? Do you feel you are able to help them?

How do you distance yourself from your work? As in how do you keep yourself from having a break down? Also do you have a limit as to what clients you will take? For instance a potential client has done x y z and you don't believe you can stand to be in the same room with them because of what they have done.

SAY = Sexually Active Youths? I'm sorry, I'm not familiar with this acronym. If this is about treatment for adolescents or children, I have never provided service to this population and my knowledge was the core courses I got on lifespan development in graduate school. Sorry!

Regarding your other questions, I take a lot of time for self care. I drive a decent distance to work, so on bad days I have some ready to go CDs with my favorite songs that I rock out too. When I get home, I make sure I take time for my loved ones and spend at least 15 minutes doing a task I enjoy. Burn out is generally an inevitability with this population. If I notice I am getting burned out I speak with my colleagues to see if I can modify my workload. I take vacation if its getting bad. I process difficult cases with colleagues as well.

I do not have a limit to the clients I serve (e.g. won't work with pedophiles, or animal abusers as examples). I try not to 'judge' them in the sense that I denigrate their behavior. My job is to (hopefully) find ways to mitigate this behavior in the future. However, if I do come across an individual who touches a particular nerve and I have counter transference for that, I will usually refer them to a colleague or work through the transference with colleagues depending on its severity.

I hope this answered your questions.

Thanks for the AMA! Couple questions:

1. Are the majority of your cases more focused on mitigating future antisocial behaviours, or around more "generic" mental health concerns (e.g.: depression, anxiety, etc.)

2. What are your thoughts on the efficacy of psychological treatment in transitioning an ex-offender from prison to civilian life?

1. Most are more generic. In the past I worked exclusively with sexual offenders for SO treatment, now I work with sexual offenders if they are experiencing other mental health difficulties.

2. The resources in my experience range from non-existent to poor. There isn't a lot of publicly funded mental health services in the community to begin with, so a criminal offender is not a priority once they get back to the community when compared to the general public.

I hope this answered your questions.

Thank you for doing this AMA! Hopefully this isn't too personal of a question - but how does your work affect your relationships, particular intimate ones? I've always wanted to ask a professional such as yourself. It seems like it would be very difficult to reconcile work and your private life.

So what you are bringing up is a few ideas, including empathy fatigue, counter-transference, and burnout. I will speak broadly about how this work has impacted me.

First and foremost, I am probably a bit more suspicious of others now in my personal life than before I worked with this population. I know that the rate of crime is going down, that stranger violence is relatively rare, and that if I become a victim of a crime it will probably be non-violent or a property crime. However, still, I feel that I have a weary guard that has developed. Similarly, I have a grade A bullshit detector now. If my gut says something doesn't add up, I start asking questions until I'm satisfied things are on the up and up or I need to walk away.

In terms of impact on my private life, my relationships are primarily the same. There are some days where I might hold my significant other longer, or tell those around me I care for them a bit more. These 'bad days' don't happen with as much frequency as you would expect.

I feel what you really are trying to ask (and what some others have wanted to know as well) is the impact this work can have on my sex life. Well, I am using a throwaway for a reason! To get to the point, there really isn't any. If I am having difficulty being sexual because I am thinking about work, that is a sign that I am getting burnt out and need to consult or (if it ever became really bad) perhaps seeks some therapy for myself. When I'm at home, I'm at home. When I'm at work, I'm at work. I generally don't have the two cross over. I keep my work space free of personal effects to keep my mind on my work, and I do not bring work home with me. Its a rule I established with my significant other when I first entered the field, and I have never broken it to this day. If I need to work longer, I do it at work. I have never had a supervisor have an issue with this personal policy toward my work. As such, I feel any 'crossover' of work to home gets further reduced from this.

I hope this answered your question!

What is your stance on chemical sterilization for repeat offenders (or as a prohibitive measure for individuals afraid they will commit a sexual offense)? Have you seen it work? Is it something we should implement more broadly? What do you think are the ethical ramifications of that form of treatment?

I am ethically opposed to the use of mandatory chemical castration/sterilization of offenders. My understanding of the literature (and to be up front, I find it such a reprehensible idea that I have not spent a great amount of time reading up on it) is that it really doesn't work.

Ethically why I am opposed? We are physically harming our clients for starters. I get it, the general public views sexual offenders as 'less thans' and who a good chunk may feel are entitled to no sympathy, no humanity, and no rights. Well the great thing about the United States is we endow all individuals with basic liberties. Even in prison (although we restrict some of these liberties as well). We don't get to pick and choose who they apply to. Its why lady justice is blind. The moment we decide to marginalize a population and take away all basic liberties is the moment we have gone down some very troubling roads in this country. Prison is the punishment. Restricting them from the community, restricting some of their freedoms, and making them serve a length of time in this manner is the way we have decided to punish those in this country. Anything further is to fulfill some sense of vengeance we feel toward the population. To some this may feel good, but to me that cost is too high to be beneficial for society. Furthermore, instead of teaching offenders skills to alleviate the possibility of offending, we take a physical route with questionable effectiveness.

I hope this answers your question.

Thanks for doing this AMA. Is there a pattern of childhood abuse and neglect that is common amongst most offenders? How often are they aware of the impact their bad childhoods have left on them? Are most offenders regretful or indifferent?

I've answered a few other questions now which touch on these two themes. I want you to know I saw your question, but I would refer you to some of my other responses. Thanks for your interest!

Do you find there is a tendency to go softer on female sex offenders and if so, do you see that as an unwritten rule those in your profession are expected to follow or is public perception wrong? I believe society in general believes that women would never do such a thing and when they do that it's not as bad as when a male perpetrator does it. Although some face jail time, I've seen many female teachers caught having sex with young male pupils getting suspended sentences or other "slap on the wrist" type of sentences.

I don't have experience with female offenders, but I have kept tabs on a class action lawsuit in Minnesota which involves civilly committed sexual offenders as this lawsuit may reach the Supreme Court and impact all sexual predator commitment programs (I believe there are about 20 in the US).

Two things I learned from that lawsuit. First, the state of Minnesota had committed a female and some experts recommended her release as they explained female sexual offending is rare and does not generally entail the degree of recidivism male offenders may reach. I am unaware of any sexual offender risk tools (i.e. Static, Stable, SVR, etc.) which have been 'normed' for use with a female sexual offender. Second, out of something like 700 committed individuals in Minnesota, only one was a female.

I hope that kind of answers your question, but its fairly outside of my experience/knowledge.

Hello Doc! In your fieldwork, are you quite familiar with necrophilic people? If yes, what are the common traits for this kind of sexual "perversion"?

Thanks a lot.

This was a pretty oddball question that caught my attention... Congrats!

No, I have never worked with anyone who had necrophilia. I'm sure it exists, but honestly the harm that is entailed from sexualizing a corpse (unless you were directly response for making that individual a corpse...) would be much lower on my radar than say the harm from being an individual who engages in rape with folks who are living. Not that sexualizing a corpse is OK, just that in terms of who we are going to target interventions towards, we focus on were the higher risks and needs are.

I hope this answers your question.

Thank you so much for doing this AMA. As a Psychology undergrad, your responses are extra interesting.

I was wondering, from which theory do you approach your subjects? Do you follow a particular psychoanalytical author? Do you focus on behaviours and possibly even reinforcment programs? Or something else all-together?

So I feel you are asking about my theoretical orientation.

Broadly speaking, I primarily use Cognitive Behavioral Therapy with integration of Person-Centered Techniques. Most practitioners tend to be eclectic in my experience; I want to use what works best, so I may integrate other theories or techniques as needed.

In work with sexual offenders, I am a huge fan of Dr. Yates' self-regulation model for offending. I use it often in my conceptualization. While I meet with sexual offenders for different issues now, when I was providing formal sexual offender treatment the facility I was at focused on the use of Relapse Prevention, Risk-Need-Responsibility Principles, Cognitive Therapy, The Good Lives Model, and the Self-Regulation Model as part of its comprehensive treatment plannings.

Have you noticed any cororlation with either, the attractiveness of sex offenders (above or below average) or the size of their penis?

No. Apart from a couple of occasions with one individual with exhibitionistic disorder I worked with (in other words, he flashed me), I can say I have never seen the vast majority of my client's genitals.