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"The direct prescription of behaviors tends to produce compliance, not deep change," Gennari explains. "And compliance breeds hostility. It also lulls the community into a false sense of security, when all the dynamics of abuse are still going on underneath."
PPS therapists emphasize that 90 percent of sex offenders can be treated, but they screen the pedophiles and rapists who fall into the other 10 percent out of their groups. Clark takes them. Overall, she estimates, 85 percent of her clients are in some form of denial. "We have a man right now, he's been arrested, like, eight times for exhibitionism, and he says, 'But I'm not a sex offender.' OK, what do you do with that? Do you say, 'Aw, let's talk about your life'? No: 'You're a liar!'"
Until the late 1990s, no one paid much attention to sex-offender therapists' styles. But studies undertaken at Her Majesty's Prison Service in England found that "in both community and prison programs ... therapists who treated clients with respect, challenged supportively, and displayed empathy toward clients, generated far greater behavioral change than did more authoritarian, confrontative, and unempathic therapists."
A team of Canadian researchers discovered much the same phenomenon and recommended that "[sex-offender] therapists pay attention to the influence of their behavior in treatment and attempt to adopt a more empathic, warm and rewarding style.... Similarly, an excessively confrontational style should be eliminated."
One of the Canadian researchers is Yolanda Fernandez, clinical director of Rockwood Psychological Services in Kingston, Ontario. "When I travel and train therapists, those who are married to the confrontational model claim it works," Fernandez says. "And it does work, for some things. Both forms of therapy got equivalent decreases in treatment-specific goals, like taking responsibility for what you've done or reducing cognitive distortions. What the confrontational therapists didn't get were more generalized effects, like reductions in hostility, reductions in anger, reductions in rumination and increases in empathy."
Marie Clark counters that BSI's goals include all those aspects. "We do see a big problem with empathy," she concedes. But she argues that the problem lies with the sex offenders themselves and is not a function of BSI's approach.
Judith Becker, the former ATSA president, says what's important is to treat clients with respect without letting them slide away from accountability. "You have to hold sex offenders accountable for the behavior," Becker says, "but the therapeutic relationship is very important. The client has to feel a degree of comfort and trust in order to disclose important information the therapist needs to develop a plan for treatment.
"There are degrees of confrontation," Becker adds, speaking not about Clark (whom she doesn't know), but more generally about the range of styles within the profession. "Some people actually yell at their clients. But if someone yells, all you hear is the screaming, and you have a physiological response to that screaming. In the face of heightened anxiety, it's very hard to integrate information."
Clark says she has succeeded with clients other therapists couldn't reach. Conversely, other therapists say people who have gone through Clark's program come out raw: They know the lingo, but there has been no real change. These therapists believe Clark's cynicism can be a self-fulfilling prophecy.
Fred Jones, Clark's pseudonymous former client, agrees. Jones, who underwent treatment with another therapy group besides Clark's, says that in the other group "the attitude is: 'You can probably never completely change, but you can definitely control yourself.' Marie's attitude is 'It's just a matter of time until you do something heinous.'
"It affects you," Jones adds. "You have to protect your own hide, and that makes you extremely cautious and anxious. And she preys upon that vulnerability. Just keep admitting you did bad things, that's the goal: Admit it. Admit it."
A woman who went through one of Clark's nonoffender classes shudders at the memory: "She said she wished all sex offenders were dead; she'd dance on their graves. And then she did a little dance. I think she should be ashamed. And so should the people who take her word for everything."
Clark says that if she didn't believe offenders could be helped, she would have quit the field years ago. "Even though we have a certain ... what I call 'approach,' we continually reassess our program. Our goal is not to degrade the client. Our goal is to try to get them to accept responsibility in a manner we believe will be productive for them in the future. We can't get moral values into a 40-year-old, but we can tell them how to behave. We can tell them that how they think is much, much different from other people."
Mark Schwartz, a nationally recognized psychologist who directs the Masters and Johnson clinics, says that when he started working with sex offenders, he was "more like Marie. I'd be really confrontive and really go after them, like addicts. But that's not the solution."
Now, Schwartz says, he asks why; he probes for trauma and pathology and welcomes disclosures. He says he treats clients with respect and has always received respect in return. But he burned out a few years ago and withdrew his name from the state-approved provider list.
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