Jeffrey Epstein, a financier and former schoolteacher, was charged with trafficking dozens of girls, some as young as 14. He engaged in sex acts with them in his multiple mansions. It is unknown whether he was sexually abused himself, but in his early 20’s, he cultivated his grooming skills while teaching. He used his wealth and position to abuse hundreds of minors, including hiring minions to deliver his victims.
Epstein never faced those charges in court, dying by suicide in 2019. He was a tragedy to himself and a pariah to countless others.
Some of his victims will repeat what he taught them and become sexual abusers, while others may be able to choose a different path and recover through their lifetimes.
Robin Davis is a successful financier. He was sexually assaulted when he was 10 years old. Following New York’s passage of the Child Victims Act (which allowed lawsuits to be filed regardless of the expiration of the statute of limitations and although all parties were deceased), at age 79, Davis sat in a courtroom to confront the ghost that haunted him for seven decades.
In addition to being a successful financier, he was also a well-known philanthropist. His life’s passion was for fighting child abuse. (New York Times, August 5, 2024).
Recovery can take many forms.
The purpose of this article is to address treatment modalities for childhood sexual abusers and the victims of their abuse. There is a wide range of treatments, some more successful than others.
Child molesters are individuals who have committed a sexual offense against a child victim. Some believe that one important factor in this deviant development is a history of sexual victimization during their own childhood, and emotional and physical abuse as well. All three (childhood sexual abuse, physical and emotional abuse) together increase one’s vulnerability to becoming a perpetrator. The conclusion is not that individuals who have had these experiences become child molesters, only that the probability is increased.
Child sexual abuse is a public health hazard with life-changing consequences. Child abusers hold no status, trust, or faith that they can recover. Thus, successful psychological intervention with individuals who have sexually offended children is critical. Society has a responsibility to try.
What are the psychological interventions used to treat these individuals and to decrease recidivism? Since it is such a complex group of variables in predicting behaviors, the one-size-fits-all approach has been ineffective.
Negative attitudes towards this group lead to punitive treatment such as containment and monitoring (e.g., the sexual offender registry), which has yielded less than positive results in predicting recidivism.
Recidivism is difficult to monitor. The only way to ascertain data is if an individual is caught.
The solely behavioral approach views deviant sexual behavior as a distorted manifestation of sexual desires resulting from conditioned behavior (being sexually abused as a child). The goal of treatment is conditioning treatment—aversive in nature. This approach is again punitive in nature and pays little attention to thought and emotions.
The lack of success of this model led to the treatment more universally used today. It is called cognitive behavioral therapy (CBT), and it addresses the interplay between emotions, behavior, and thoughts.
Cognitive behavioral therapy rests on the idea that problems are based on faulty or unhelpful ways of thinking as well as learned patterns of unhelpful behavior. The premise is that people can learn better ways of coping with mental unease, thus relieving their symptoms.
In addition, a relapse prevention (RP) model to deal with addictive behaviors has been added to CBT. This modality focuses on helping individuals to identify high-risk situations that might cause persons to recidivate. RP helps perpetrators to develop individual strategies to cope with these situations (e.g., staying away from children).
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Empirical results are not yet definitive in findings of successful treatment, but efforts continue. The most important factor is a willingness to fully participate in treatment.
Elizabeth Hartney, Ph.D. (January 4, 2024) describes a cycle of abuse that occurs when people who were victimized can become abusive.
She has multiple theories:
- A person may reassert their own sense of personal power and grandiosity that compensates for feelings of inadequacy and insecurity. An adult exerts power over a child. (e.g., from 1996 to 2014, Larry Nasser, as team doctor for the United States women’s national gymnastics team, used his position to exploit and sexually assault hundreds of young athletes.)
- For victims, the abuse may be repeated in adult relationships. If one connects feelings of love with their sexual trauma, there is a disconnect between love and gentleness.
- Attachment theory suggests that some victims just avoid adult relationships.
- Feelings of shame and anger and what some have described as “dirtiness” can ruin a victim’s life, as they shy away from relationships.
- Abused children may believe that they are not good enough to deserve a genuinely caring relationship.
The damage is significant for those sexually abused as children. It has cost or damaged lives not only through suicide but also through a victim’s inability to have adult relationships that are mutual and loving.
Sexual assault for victims results in severe physical and emotional trauma that may affect their adult relationships for a lifetime. Not unlike treatment for offenders their treatment must be individualized.
There are several evidence-based treatments available for post-traumatic stress disorder (PTSD), a mental and behavioral disorder that develops from a traumatic event such as sexual assault. Symptoms may include disturbing thoughts, feelings, or reliving events that occurred.
Medication can serve as an adjunct to the treatments described below.
These treatments include psychodynamic psychotherapy, trauma-focused cognitive behavioral therapy (TF-CBT), and eye movement desensitization and reprocessing therapy (EMDR).
The distinguishing feature of psychodynamic psychotherapy is the focus on the feelings and emotions occurring in therapy sessions. A therapist creates a safe space with non-judgmental emotional support as well as a physically comfortable environment.
The focus of treatment is on the expression of feelings. Victims may experience re-occurring patterns (such as getting into abusive relationships) or reliving the actual experience itself. The concentration in this treatment is on the therapeutic relationship as well as other relationships in the person’s life. This modality is long-term.
The trauma-focused cognitive behavioral treatment approach (TF-CBT) is a briefer, recovery-building model for trauma-impacted children, adolescents, and adults that adapts CBT for healing from trauma.
There are several phases to TF-CBT, including learning relaxation skills to calm a physiological response (such as panic), speaking about the trauma, and education about cognitive skills.
Unlike psychodynamic therapy, this modality is more skills-based, intended to develop a method to manage rapidly changing feelings.
This is not to say the individual is discouraged from talking about their experiences, but the chronicle of events is tied to learning to transfer and manage feelings.
Eye movement desensitization and reprocessing (EMDR) is another treatment that deals with distress associated with traumatic memories. During this therapy, the therapist will move his or her fingers back and forth in front of the patient’s face so that the patient is able to follow with his or her eyes. Other people may use a metronome or foot or hand tapping. While the patient follows the rhythmic movement, the therapist will ask the patient to recall a traumatizing event. The therapist then asks the patient to gradually leave their negative thoughts. (For example, feelings of vulnerability can be counteracted by saying repeatedly “I am safe, I can choose who to trust, I can trust myself”).
The hallmark of EMDR is the regular back and forth of lateral eye movements—called bilateral stimulation— while focusing on the disturbing memory.
Mental health professionals have made in-roads in the treatment of sexual abuse perpetrators and for those trauma victims who have experienced this abuse.
The future holds promise, cautions, and hope.
To find a therapist near you, visit the Psychology Today Therapy Directory.
