Out of the frying pan, into group therapy

A new Supreme Court ruling could increase the number of former sex offenders released into the community. For these ex-cons, the end of detention marks the beginning of intense, and possibly endless, therapy.

Published January 24, 2002 8:00PM (EST)

Bert, a wide-hipped man in his 40s, perches on a stool to the left of a white marker board. He writes down numbers as men in the room call them out. When the math is done, participants in the tally -- 16 sex offenders who range in age from their 20s to 60s -- learn that, all together, they have had 214 victims.

Primarily pedophiles, rapists and perpetrators of incest, the men sit in a nondescript office space in a small Wisconsin town -- across a river, between a feed mill and a car dealership. They meet every Saturday afternoon with Joe Henger, a psychotherapist who facilitates therapy for sex offenders at confidential sites around the state.

These are Henger's highest-risk clients. Most have spent many years in prison, and their parole agents will check to see whether they attended this mandatory weekly session. They all face a possible lifetime of therapy, as well as constant, and sometimes humiliating, surveillance in their communities -- but they are considered lucky. They have, as Henger says, "ducked the bullet" of indefinite civil commitment, a means by which courts in Wisconsin and 15 other states can detain prison inmates identified as violent sex offenders -- even if they have served their sentences.

Indefinite commitment is the subject of intense national debate, focused mainly on the constitutional rights of offenders. Just this week, the U.S. Supreme Court issued a ruling in a Kansas case that adds to the state's burden in justifying commitment. Previous to Tuesday's ruling, states with commitment laws had two basic standards for holding an offender: proof of a mental disorder that predisposes the offender to engage in sexual violence, and evidence that the offender is likely to reoffend if released. In a 7-2 decision, the Supreme Court ruled that the state must also show that the offender poses a "serious difficulty in controlling behavior."

Further constitutional challenges, arguing, for instance, that commitment constitutes double jeopardy, have been unsuccessful. The laws overcome the charge by shifting the status of sex offenders from inmates to "patients," who are not considered "incarcerated" but rather "in treatment" at secure facilities. (In some states, offenders serve their commitments in the community with supervision.)

Proponents of civil commitment laws point out that, once inmates become patients, their status is significantly enhanced, while the community is protected from a threatening presence. "Patients" are required by law to have access to treatment (prisons have no legislative mandates to provide treatment), and patient housing, while it sometimes resembles a prison, is specialized in states where there is no option to serve commitments in the community: It might be a building specifically designed for sex offenders, a mental hospital or wing of a prison. The patients have the ability to petition the courts for release based on their progress in treatment -- typically, once a year.

In each of the 16 states with civil commitment laws, no more than a handful of patients have been released after completing treatment. Some lawyers have initiated suits claiming that the dearth of releases shows that conditions for committed offenders are more punitive than therapeutic, and as such constitute double jeopardy. So far, these efforts have failed. The U.S. Supreme Court ruled last year that deficiencies in Washington state's treatment program for a particular patient did not constitute double jeopardy, or grounds for release.

At the moment there are about 1,200 committed offenders nationwide. Case by case, county judges will decide whether individual offenders, supported by the recommendation of mental health professionals who treat them, are ready for release.

When Washington state enacted the country's first commitment law for sexually violent persons in 1990, treatment for offenders was in total disarray. Mental health professionals were using primarily psychoanalytic, humanistic or behavioral models with widely varied results. In a 1998 issue of "Psychology, Public Policy, and Law," two articles written by psychologists and academics reviewed studies of the methods and concluded that they had very limited impact. In one article, three researchers concluded that "even more discouraging" than the lack of the methods' effectiveness was "the suggestion that [humanistic and psycho-dynamic treatments] may even increase the likelihood of new sexual offenses."

In the past decade, as more states enacted commitment laws, there was a move to use cognitive-behavioral therapy -- sometimes in coordination with medication -- to treat the majority of violent sex offenders. It will take years to test the impact on recidivism of this particular approach, but early reports indicate a better outcome than previous therapies -- so far.

The cognitive-behavioral group therapy employed by Henger conforms to the guidelines recommended by the Association for the Treatment of Sexual Abusers (ATSA). The ATSA, an Oregon-based international organization of approved professionals who work with offenders, has provided standards for professionals in the field of sex offender evaluation and treatment since 1984. According to ATSA executive director Connie Isaac, core elements of successful therapy for sexual abusers must include disclosure, victim empathy and relapse prevention. Henger incorporates these elements into his own approach, which he describes as "heavy in problem solving and role playing."

On the September night when Henger's high-risk offenders add up the number of their victims, one of the men brings out a yellow legal pad full of notes -- preparation for "disclosure." Nick, the son of a minister, tells the group a bit about himself and then describes -- minute by minute -- the details of his single crime. He says that his father beat and sexually humiliated him as a child, and he contemplated suicide; but, he tells the group, his father had drilled into him as a child that he would go to hell if he took his own life.

Instead, Nick nursed a fantasy about sexually degrading his stepmother and eventually showed up one night at the house of the mother of an acquaintance, a woman in her 60s who looked like his stepmother. When he rang the bell and she welcomed him in, he sexually assaulted her.

Henger later describes the disclosure process as "undercover" work. "I go in and understand these offenders' worlds. Then I can figure out a logic they'll buy into and reprogram them." He says that Nick's anger toward his father is so powerful that he has projected his rage onto his mother and stepmother instead. He categorizes Nick's crime as "a classic rape about anger."

As he does with each of his clients, Henger will use Nick's account to help him identify all the triggers that led up to the assault, and then find ways to avoid or interrupt them. He will then have Nick describe his crime again, from the perspective of the victim, to begin the process of victim empathy.

As it happens, victim empathy is the subject of Henger's meeting with the same men three weeks later. They bring in their homework assignments -- letters they have written to their victims. Each letter had to address a series of 13 questions, starting with "Why did you do those things to me?" Their answers had to explain why they committed their crimes and why the victim is no longer in danger. The men never send the letters, but the project gives Henger a chance to assess each participant's degree of victim empathy.

Henger asks one of the men to read the 13 questions to Matt. Matt, in his 40s, sexually assaulted 33 boys over a period of 22 years. His hands shake as he tries to give his answer to question No. 3, "Will you ever do those things to me again?" He stammers, "This is really hard for me."

Henger has some other men respond and returns to Matt for No. 9, "How did you feel when you were hurting me?" At first Matt replies, "I felt anger, fear, depressed and low self-esteem."

A couple of the men are clearly unconvinced and shoot back, "Come on ... "

"OK. I was pretty much excited," Matt divulges. "I felt the boys owed me for all the grooming and all the gifts I gave them." (Grooming refers to the process a sex offender uses to gain the trust of a vulnerable person, most often a child, and break down the victim's fears and defenses so he or she will accept the perpetrator's sexual advances.)

Another man nods and adds, "When I would give something before, I gave it with a sense of wanting something in return. Now when I do things for people, it's not for what I can get down the road."

Peter starts to cry and reveals, "My daughters were holding out their arms for love and attention and I treated them like shit. They would ask, 'Why Daddy?' and I'd say, 'Shut up. I'm not your fucking father.'"

Some of the men are confused. Roberto, who molested his daughter, asks, "Were they your real daughters?" Peter says they were and Bert shakes his head: "Double hurt -- to rape and disown."

At another point in the letters work, Peter says he committed his crimes because "I was getting back at the bitches who hurt me in the past." Henger immediately interrupts, "If you're using the word 'bitches,' it shows you haven't learned much."

The group continues going through victim empathy letters the following week, in late October. Henger has Steven answer question No. 13: "When you think of me now, what are your thoughts?" Steven, who is young and Latino, has an unusual case. His victim was a young girl who picked up the letter-size pictures of his penis that he placed at a bus shelter for her to find. Steven masturbated in the bushes while watching her and eventually planned to have sexual contact with the girl. He fantasized and masturbated at home about other potential victims.

"I felt rejected and was looking for someone to love me," reads Steven. He thought she liked the pictures because he left the images for other girls, but she was the only one to pick them up.

An older man in the group, Ken, tries to coach Steven: "Thinking she liked the pictures was a distortion," he says. Henger agrees and adds, "I don't think you thought she really liked it. That's bullshit. You really liked it."

Steven complains, "Loving kids got me into trouble." Almost everyone in the group joins in a sarcastic, "Awwww." Ken coaches some more: "You're stuck someplace. If you're hurting someone, that's not love."

Henger considers victim empathy the turning point in therapy. "Many of these men have no idea of the harm they create," he explains. "They are consumed with themselves. I can see the change when they realize they hurt somebody." He adds that the change cannot be solely demonstrated "on the surface" by shows of emotion. "A blubberer can be full of it," he says. Instead, Henger is looking for the offender to take full responsibility for his crime, not blame the victim in any way for what transpired, and to "refer to people as people, vs. objects."

Henger, who is 50, has been working with sex offenders for almost a decade. He had not planned on doing so when he trained as a therapist. Instead, after earning a masters degree in guidance counseling from the University of Wisconsin-Whitewater, he opened a private practice in which he worked, for the most part, with couples and families.

Henger had some clients who were victims of sexual abuse, but when he searched for institutions that offered training programs for treating the special issues of those clients, he couldn't find any. When he started doing his own research on the topic, he came to the conclusion that there were many more victims of sexual abuse than there were offenders. There was, he says, "a need to eradicate the source."

In 1991, Henger first set up a relapse prevention program for adolescent offenders. Then, in 1994, he discovered that Wisconsin was home to the Wisconsin Sex Offender Treatment Network, the nation's first program to train mental health professionals in up-to-date treatment specifically for sex offenders. Basically, the program created a network in which Lloyd Sinclair, a psychotherapist with 27 years of experience in the field, ran workshops for mental health professionals, who, once trained, could run therapy groups for offenders on parole and probation around the state. Henger signed up and became one of the inaugural graduates.

Once he began working exclusively with sex offenders, Henger never looked back. In nine years he has treated 2,000 male and female sex offenders in prisons and community settings. The makeup of his clientele is broad: He has treated indigents, firemen and heads of corporations. Reflecting national statistics, the vast majority are white and knew their victims. Says Henger, "Most of these guys can't talk to a stranger, let alone offend one."

Henger has done most of his work outside prisons. Offenders are challenged by living in a community, he says, and challenging situations create an opportunity to intervene -- opportunities to change deviant thinking and behavior. Prison programs usually offer a set number of treatment sessions, perhaps 30. Outside, Henger can work with his clients for years -- with more control. "In prison, a man will say anything to get out," says Henger. With a client on parole or probation, Henger's therapeutic supervision is enforced by probation agents; regular polygraph tests augment his analyses of progress.

A central, obligatory tenet of the ATSA manual and Henger's therapy is, "Members shall not make statements that a client is 'cured' or no longer at any risk to reoffend." As in Alcoholics Anonymous, the assumption in the treatment of sex offenders is that they "may require ongoing management."

Henger, a sturdy man with steady dark eyes, believes in the constant vigilance of therapy, telling his groups, "This is no different than a fireman or a military man in training. You need to keep a constant edge."

In fact, one of the men in the Saturday group reports that he has just seen a man in his apartment unit who resembles the last of his 30 victims. Taylor is obviously shaken: This particular victim committed suicide while Taylor was in prison.

Before he was arrested, Taylor had been a trusted man in his community who became a supervisor of adolescent boys. At a home owned by another child molester, Taylor groomed a series of primarily adolescent boys and molested them. (Taylor was abused by a man when he was young. Henger says 30 percent of male sex offenders were sexually abused as children. "One of the gifts that keeps on giving," he comments to the group.)

Taylor acknowledges in the meeting that his response to the victim look-alike gave him a "wake-up call" to alter his attitudes. In the group, Taylor has taken responsibility for his victim's death. However, Henger imagines that seeing someone who looked like this victim "hit Taylor in the solar plexus. It brought him back to the reality of how he needs to guard himself against his attraction to adolescents."

Henger is aware of the urgency in his work -- one out of four women and one out of seven men are sexually abused before the age of 18 -- and he describes his goal as "getting into the minds of the men and changing them to protect future victims." But he also believes that the media perpetuates an unrealistic image of sex offenders as "monsters" who nearly always go back to committing crimes after incarceration. He cites as a glaring example a TV show in which a reporter claimed that 90 percent of sex offenders revert to criminal behavior.

Experts in the field are reluctant to give a general figure for the rate of recidivism among sex offenders, who recidivate after incarceration at different rates over different periods of time, depending on the type of crimes committed. In the issue of "Psychology, Public Policy, and Law" published in spring 1998, researchers found that the rate of recidivism ranged from the low teens to more than 50 percent. In a recent phone interview, Dr. Fred Berlin, a researcher, clinician and teacher at the Sexual Disorders Clinic at Johns Hopkins University, said that "overall" an estimated 35 percent of untreated offenders commit new crimes. After weekly cognitive-behavioral therapy over a series of months, the number drops to around 15 percent. Henger's own data reflects a similar conclusion: Only 2 percent of his clients have been reconvicted, though he believes a higher percentage may have reoffended without being caught. Of the 2 percent who were sent back to jail, the majority were convicted for "hands-off" crimes like exhibitionism.

An important part of relapse prevention involves interrupting the arousal patterns of sex offenders. In his meetings, Henger is relentless on the subject.

"A month ago you were still masturbating to little children; are you still?" he asks Steven, the offender who left pictures of himself at the bus stop. Steven says he's "had the urge," but he hasn't.

"You need to fantasize about adult women," suggests a long-term member of the group. "Are you able to masturbate to adult women?" Henger asks.

"I'm attracted to kids more than adults," Steven admits.

"This won't go away by magic," Henger says. "You need to be proactive. You can't wait."

"It's too late then," a few men voice in unison.

Steven explains that the fantasies he has with adults feature women rejecting him. "Do not masturbate to women who reject you," Henger commands. He compares inappropriate masturbating to "gas on a fire."

"For homework," he tells Steven, "think out a consensual adult fantasy you could ejaculate to and tell us." The men in the group offer advice, explaining that a fantasy has to be about an unattainable man or woman. "Like Sigourney Weaver," suggests Matt.

Sam, a man who molested all three of his daughters, has been a participant in the Saturday group for years. He has had a total of 11 years of therapy, in prison and on parole -- without a relapse. (Henger has worked with him since his 1995 release from prison.) This Saturday, he tells the group that on Monday, he visited his middle daughter with his ex-wife. It is the first time he's seen her -- at the daughter's request -- since he went to prison.

"My daughter hugged me," Sam says, in tears. While they talked, his ex-wife held his right hand and his daughter held his left. "Up to 17 years old, she just felt manipulated and controlled," says Sam. "I have a chance to give back what she missed."

His daughter said the worst times for her have been the holidays and not having a father when she got married. Sam says, "I learned through therapy where my feelings weren't." Adds Bert, "The old Sam wouldn't cry for anyone."

As the group gets ready to leave, Bert says, "The hardest thing is going home." The participants don't really have time to think during the sessions, says Henger. They begin to internalize new perceptions and ideas afterward.

Henger goes home with his own burdens. When he first started treating sex offenders, he would tell his wife stories. "It was new, and there was a voyeuristic quality to it," he says. Now, he talks to parole and probation agents about his job and never discusses it at home.

On holidays, when Henger's extended family gathers for dinner, his relatives hold a round table. Each family member takes a turn, fielding questions from the others about their lives since they last met. When it's Henger's turn, he says, no one ever asks him about his job.

By Pegi Taylor

Pegi Taylor is a writer, educator and art model in Milwaukee.

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