Perpetrators of child sexual abuse are a clientele that some counselors may find challenging to treat. According to the Department of Justice Office of Justice Programs, the term “sex offender” refers to a person who is convicted of a sex offense, which is defined as “a criminal offense that has an element involving a sexual act or sexual contact with another” as well as one that is an offense against a minor.

As of April, 767,023 people were listed in the sex offender registries in the United States, according to SafeHome.org. This number, however, may not reflect the total number of people who have sexually abused children. The Rape, Abuse and Incest National Network (RAINN) reports that the majority of sexual assaults are never reported to law enforcement.

Courtney T. Evans, a licensed clinical mental health counselor with a private practice, Purpose in Grace Counseling, in Eden, North Carolina, says mental health treatment, specifically sex offender therapy, is a recommended form of counseling to reduce recidivism rates among perpetrators of sexual assault.

“While traditional therapy seeks to reduce feelings of anxiety and inadequacy, sex offender therapy seeks to confront the offender with thinking errors, promoting accountability and acceptance for actions,” notes Evans, a member of the American Counseling Association who specializes in treating people with trauma-related disorders, specifically children who have been sexually abused. “Sex offenders are given tools in counseling, but just like someone who attends Alcoholics Anonymous meetings long term, sexual offenders should engage in lifelong support.”

Risk factors

Community safety is the first goal of sex offender therapy, says Pablo Serna, a licensed professional counselor and independent contractor at Henger Enterprises, a therapeutic practice specializing in sexual offender risk assessment and evaluation and sex offender programming in Wisconsin.

Serna has counseled adult male sex offenders, including those who have abused children, for eight years. Most of his clients are mandated by the court to undergo sexual offense treatment or their probation officer may refer them to the practice where he works.

Serna treats perpetrators using group therapy, and he says group members can range from those who fully admit to an offense to those who admit they’ve done something wrong but are not willing to accept full responsibility for their actions.

“As a facilitator, I will introduce concepts in a general way prior to moving to [the topic of] offenses so members will grasp the idea before applying it to their offense,” Serna explains.

If a group member is reluctant to participate, Serna says he applies ideas from motivational interviewing. For example, he may empathize with the member about how group therapy can be uncomfortable or how the member does not want to be in the group. “I will admit I cannot make him participate and ultimately, he has the choice to participate,” Serna says. “Yet I point out discrepancies like ‘If you want your probation agent off your back, is not participating [going] to help with that?’”

The end goal for clients, Serna says, is to “prevent further victimizations by demonstrating an understanding of their [clients’] thinking and the risk factors that contributed to their offense and [having them] assist in developing interventions.”

Serna and his colleagues use a sex offender treatment curriculum that was developed by Joseph Henger, the president and clinical director of Henger Enterprises. The curriculum involves the perpetrator understanding the cycle of sexual abuse and relapse prevention to help them develop positive lifestyle changes. The curriculum’s main focus is to diminish deviant arousal and overcome pro-offending beliefs and behaviors, Serna says.

Serna and his colleagues also use Static 99R, an actuarial risk assessment tool developed by Karl Hanson and David Thorton. The Static 99R has 10 risk factors for assessing people who have been convicted of a sexual offense. The score of the risk factors characterizes a person’s relative recidivism as below average, average, above average and well above average.

The risk factors are divided into three categories: static, dynamic and acute. The static category refers to risk factors that do not change; the dynamic category notes personality traits or learning deficits that can change with an outside intervention, such as counseling; and the acute category refers to factors that are temporary or that can easily change because of the person’s environment or relationship with others.

According to Serna, static risk factors can include a person’s age, their prior criminal record, their gender and the relationship of the perpetrator to the victim. Dynamic risk factors are ones that can change over time, such as whether the person has any positive life influences, displays impulsivity, has problem solving skills, has an increased sex drive or any deviant sexual interests (such as voyeurism or exhibitionism) or if the person has cooperated with the probation, parole or correctional authorities involved in the assessment and management of their sexual offending behavior.

Dynamic factors, Serna says, can shed light on the person’s motivations to commit a sexual offense. He’s noticed that several of his clients who have perpetrated a childhood sexual offense have a few risk factors in common: a deviant sexual interest or attraction to children, an emotional connection to children or a hypersexual nature.

Clients often tell Serna that they feel they don’t fit in with their peers and that they feel more comfortable doing things that children do, such as playing video games. And a deviant sexual interest in children, he says, is often what allows perpetrators of sexual abuse to give themselves permission to cross social boundaries in order to have sexual contact with someone they know is a minor.

For others, a hypersexual nature plays a part in their motivations. “Some people are pretty indiscriminate” when it comes to sex, Serna notes. They want to have sex with whomever says yes or whomever is available. These clients define themselves by their sexual acts, he says, because it gives their ego a boost and helps them to feel better about themselves.

Although the assessment tool does not consider if the person was sexually abused in childhood or if it is even a risk factor for their behavior, Serna has found that the client’s own childhood sexual abuse can play a role. He has worked with clients who have abused children and tried to justify their actions by saying, “I was abused as a child. I learned to live with it, so I figured my victim would” or “The person is too young; they won’t remember it.”

Serna says other examples of distorted thinking include:

• “She’s attracted to me; she’s older than her age.”
• “I needed my sexual needs met. The person was there at the time.”
• “I’m not going to take the time to find out how old this person is.”
• “If a girl is able to have her period, she’s good for sex.”

Serna establishes some ground rules with his clients, including having mutual respect, not using objectified language (e.g., sexist or racist slurs), displaying respectful behavior (e.g., not falling asleep during group sessions), respecting the privacy of other group members and completing assigned therapeutic work.

Taking responsibility

Evans, an assistant professor of counseling at Liberty University, says the current treatment for perpetrators of sexual abuse focuses on the management of the offender. “Most programs are victim-centered approaches,” she explains. “The goal of counseling sex offenders is to prevent recidivism, while different acts and regulations pave the way for enhancing public safety and protecting victims through supervision, re-entry, registration and community notification.”

Evans says that sexual deviance (e.g., sexual interests for children over adults, abnormal preoccupation with sex) among people who sexually abuse children is often associated with an increased likelihood of sexual reoffending. “Child sexual offending may be part of a broader pattern of criminal behavior, underpinned by antisocial, impulsive and aggressive tendencies and a lack of empathy,” she notes. “This is why sexual offender counseling focuses on building empathy and taking responsibility.”

A cognitive behavioral technique that Serna uses in counseling is covert conditioning, a therapeutic approach created by John Morin and Jill Levenson. In their book Road to Freedom: A Comprehensive Competency-Based Workbook for Sexual Offenders in Treatment, Morin and Levenson note that covert conditioning helps perpetrators of sexual abuse control their arousal by linking “deviant sexual thoughts with images (pictures in your mind) of some of the terrible consequences of sex offending.”

Serna often asks clients to write a script about the distorted thinking or triggers that might occur before they decide to engage in a risky situation. Then, they write a second script that includes the negative consequences they will experience if they move forward with their desires.

The purpose of this exercise, Serna says, is for clients to attach the triggers for their behavior in risky situations to a realistic consequence, such as being incarcerated or dealing with feelings of shame or embarrassment.

When clients review the scripts repeatedly in group therapy, the recognition of their unhealthy thought patterns and the negative consequences “becomes automatic,” Serna notes. The scripts also include a part that allows clients to create a way to escape risky situations or distorted thinking patterns so they can apply and reinforce interventions with alternative thinking and behaviors, he adds.

People who sexually abuse children need to be aware of triggers, Serna stresses, but it is even more important for them to understand the problematic thinking and choices of their behavior and identify appropriate interventions.

“If they stick with me, they’re going to have a level of responsibility,” he says.

The importance of self-care

Although sexual offense therapy is an important tool in helping to reduce crimes of a sexual nature, it can also take a toll on the counselors themselves. In fact, research has found that mental health professionals who treat perpetrators of sexual assault often need psychological support themselves.

In an article on counseling sex offenders and self-care, which was published in Cogent Social Services in 2019, Evans, along with Courtney Ward, explored the impact of burnout and secondary/vicarious trauma on counselors who work with people who commit sexual abuse, and they found that mental health professionals who do this kind of work often “have a high rate of burnout and stress.”

Thus, “understanding self-care factors that influence well-being is essential,” Evans says.

In the study, Evans and Ward acknowledged that this kind of work can be difficult for some counselors because they are required “to engage in traumatic material in graphic detail while maintaining an empathic relationship with the client.” In addition, they noted that “perpetrators/offenders of sexual abuse are [often] in denial or demonstrate little or no remorse for their abusive behavior, which may exacerbate the impact on the counselor.”

Evans says the detrimental effects on counselors who work with this population can include changes in their self-perception, changes in their thoughts about other people and their environment, problems in personal and romantic relationships, changes in their sexual performance, and depression.

“Personal factors can make a counselor more prone to countertransference,” Evans adds. For example, a counselor who works with this clientele could become more protective of their own children because of the material they deal with in session. If this happens, Evans recommends clinicians seek supervision and feedback on ways to distance their own lives from their clients’ lives, which can also help counselors become more sensitive to the ways countertransference can occur.

Serna says he has managed to remain largely unaffected by the content of his therapeutic sessions with clients who have sexually abused others. He currently leads about 14 to 15 two-hour group therapy sessions per week with clients who have sexually abused children, enticed children, have downloaded/distributed materials online in which children are sexually exploited or have sexually abused adults. Some group members have also abused adults.

“If it came to that point [being emotionally affected], then I would know that I can’t do this anymore,” he admits.

Serna says he remains objective and requires clients to reflect on their distorted thinking and feelings because they impact their own lives — not his. “It’s up to the offender to evaluate their own thoughts, rather than me making a judgment about it,” he explains.

With a career that spans 15 to 20 years in the field, Serna has counseled a diverse clientele from the chronically mentally ill to families and adolescents. And he says these experiences have helped him to recognize his own biases and the necessity to lean on his training to maintain a professional distance from difficult clients.

“I’ve learned how to take a step back and be objective,” he says. “I feel like, as a therapist, my role is to be objective.  So, when I hear these things, the only way to help them [clients] is to be objective.”

Serna says he maintains boundaries with his clients by not disclosing any personal information, such as his relationship status or if he has children. And he practices self-care by running three miles a day, playing piano and guitar, drawing and taking art classes in his spare time.

“I think keeping these boundaries permits me to separate my personal and professional life,” Serna explains. “When I am frustrated at work, I know it’s a professional issue and will look [to] the resources I have.”

Serna says if he ever gets emotional because he’s feeling frustrated, he’s trained himself to say, “OK, Pablo, this is becoming your issue now.”

Evans suggests that counselors who want to work with this population be “self-reflective regarding signs and symptoms of burnout and engage in self-care activities for prevention and alleviation.” Some self-care strategies include meditation, mindfulness, journaling and personal counseling — anything that promotes emotional well-being.

Overcoming barriers

Most of Evans’ students have not expressed an interest in treating perpetrators of child sexual abuse, largely due to preconceived notions that most people who commit sexual abuse are predators and highly resistant to treatment, she says. Personal morals and beliefs may also prevent students from choosing to work with this population, Evans adds.

But for counselors who are interested in working with this clientele, Evans recommends they seek training and certifications (such as the National Association of Forensic Counselors’ Certified Sex Offender Treatment Specialists and the Certified Juvenile Sex Offender Treatment Specialists certificates) so they can better help this population. It is also important for counselor educators to prepare students to work with difficult clients, particularly those who abuse children, Evans says.

“I think that most counselors have so much empathy for children, as we all should, and this influences feelings and thoughts related to harm to children,” she says. “This is a positive attribute in counseling, [but] it also greatly impacts services to sexual offenders.”

Perpetrators of sexual assault are often victims of sexual offenses themselves, Evans continues, so she advises counselors to take preventative action by “working with those who have experienced trauma and doing trauma screenings and, if warranted, assessments on each client.” Evans says understanding the client’s lifestyle and private logic is essential in understanding their current behavior and preventing future maladaptive behavior.

“I hope that counselor education can instill [an] understanding of sexual abuse, … not only for the victims [but also for] the motives and proper treatment for offenders,” she says. “This is … the best way to treat the problem [and] to work preventatively.”

 

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.