ATASCADERO, Calif. — During five years of psychotherapy at a treatment center here for sex offenders who have finished their prison terms, Bill Price, a pedophile who admits to 21 victims as young as 3, has constructed a painstaking plan for staying straight.
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THE DEVICE A plethysmograph, used in assessing treatment, measures arousal as an offender is shown sexually suggestive pictures.
A requirement of his treatment, the plan catalogs on five single-spaced pages the tactics Mr. Price has learned to stop molesting.
There are 42 so far, including avoiding places where children congregate, abstaining from alcohol, shunning the Internet and sniffing ammonia whenever he has a deviant thought.
“It was just like a hunt for me,” Mr. Price, 59, a former Sunday school teacher, said of his sexual crimes. “I kept choosing children because they were easier prey; they were easier to deal with than women.”
Treatment plans like Mr. Price’s, known as relapse prevention, have been a cornerstone of efforts to reform sex offenders for the past 20 years. Yet there is no convincing evidence that the approach works, or that others do either.
Similar to aspects of Alcoholics Anonymous, relapse prevention has sex offenders own up to wrongdoing and resign themselves to a lifelong day-to-day struggle with temptation. But one of the few authoritative studies of the method, conducted in California from 1985 to 2001, found that those who entered relapse prevention treatment were slightly more likely to offend again than those who got no therapy at all.
Clinicians who work with sex offenders cling to relapse prevention nonetheless, and its durability speaks volumes about the troubled, politically fraught science of treating sex offenders. Not only is relapse prevention of questionable value, but so are the tests to gauge whether sex offenders in treatment still get inappropriately aroused, the drugs used for so-called chemical castration and the methods of predicting risk of reoffending.
Treatment methods have become particularly topical as thousands of sex offenders are confined or restricted beyond their prison terms under civil commitment laws on the books in 19 states. The laws have been found constitutional in part because they aim to provide treatment if possible; New York legislators announced last week that the state would soon allow civil confinement.
On average, the civil commitment programs cost four times more than keeping sex offenders in prison. But too little research has been conducted into how to treat sex offenders, experts say, putting psychotherapists and others working in civil commitment centers at a distinct disadvantage.
“It has never been regarded as a legitimate and recognized topic for research by psychologists,” said Robert A. Prentky, director of research at the Justice Research Institute in Boston. “There is a very strong undercurrent of disrespect for this area of research and perhaps even skepticism, frankly.”
As recently as the 1970s, research on treating sex offenders was practically nonexistent. Barbara Schwartz, a psychologist with New England Forensic Associates in Arlington, Mass., said that when she wrote her first paper on rehabilitating sex offenders in 1971, “I read everything there was to read, and I had a half of one page of references.”
That is partly because sex offenders present major challenges as research subjects. There are far fewer convicted sex offenders than most other kinds of criminals, so sample groups are unreliably small. And sex offenders tend to be so secretive that “it’s really hard to get information from them that you can have confidence in,” said Ted Shaw, a forensic psychologist in Gainesville, Fla., who has treated offenders since 1982.
Even now, in an advanced phase of California’s treatment program for the most persistent sex offenders, Mr. Price says he questions his ability to keep his urges in check. His relapse prevention plan says that if let out, he will seek more treatment at Pure Life Ministries in Kentucky, whose Web site says its goal is “leading Christians to victory over sexual sin.”
“I’m very afraid of just being out there,” Mr. Price said, sitting near the nasturtiums and petunias he had grown in a courtyard of the Atascadero State Hospital here, which includes a wing for civilly committed offenders. “I’m less dangerous than I was, but I’m definitely in touch with my dangerousness.”
Treatment in Phases
