Therapy for Sexual Misconduct? It’s Mostly Unproven (NYT article, Nov 27th)

Interesting article today in the NYT challenging the idea that there is treatment for our modern blight of powerful men exploiting the vulnerable. I was especially interested in the comments of psychologists who sought to explain what they do to provide therapy.  The effort is brave, but several issues push heavily against their good intentions.  First, there is not, and never has been, any evidence that confrontation is an effective therapeutic process for any condition.  The same is true of empathy training and shaming, although society feels better that they are used against perpetrators of harm in lieu of punishment.

There are good technical reasons why confrontation and shame do not work, which I have blogged about previously.  In the case of ’empathy’, there are problems with trying to teach people this, especially those who enjoy the experience of dominating others or causing them to suffer.  You risk teaching them just how successful they have been and how much their victims will suffer in the future, so it is not always a good idea.  Obvious though this is, the logic has not filtered down to treatment programs very often.

With ‘Weinstein-type’ abusers it is not that they are incapable of empathy or being sorry for what they have done.  They are especially sorry when publicly humiliated and will articulate the experience of their victims convincingly, but real empathy is state dependent.  I mean by this, that in the therapy group or chair people do reflect, agonize, apologize, accept, understand and repent.  However, all of this is not available to them while in a state of sexual arousal.  It is as if sexual arousal obstructs access to the thoughts of what is important and the values that might inhibit them from harming others.  Teaching people to anticipate harm to others, to consider consequences of their behaviour for themselves, the victim and those around them while in a state of sexual arousal is very difficult to do, and typically not done in therapy.  I have done this in therapy with perpetrators, so I know just how difficult it is.

Even-so, the empirical and technical reason for failed therapy of individuals caught in the Weinstein moment are not the issues we must address.  Our society is organized in such a way as to facilitate harm of this kind.  Perpetrators continue for years, in the knowledge of those around them, but are not inhibited by this knowledge.  In the case Weinstein, his young female assistant appears to have been willing to make arrangements that she must have known would lead to abusive encounters with other young women.  Victims were so afraid of what would happen to them if they reported it, they let it pass, perhaps not understanding the long term harm to themselves and others.  No wonder perpetrators are capable of suspending critical appraisal of themselves and become so safe and confident in their abusive behaviour that it takes on an almost reckless quality such as in the ‘Trump on the bus’ moment, or getting your secretary to set it up.  Engaging individuals in therapy in these circumstances has an absurd quality that serves only the public who might hope that something is done about the evil ones among us.  If only it was so simple.




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