The scandal that has engulfed the Roman Catholic Church has thrown light on a form of sexual abuse that, perhaps more than any other, has always hidden in the shadows.
The sexual victimization of children by adults reaches far beyond the church to permeate society. Some experts say that as many as one in four girls and one out of six boys under the age of 18 will be molested at least once in their lives.
But as troubling as the extent and harm of the abuse may be, health care professionals working in the field say society must decide not just how to punish the abusers, but how to treat them.
Such decisions will not be easy. Reports that some priests accused of molesting children were dispatched to church-run programs only to subsequently molest again have ignited public outrage, sparking calls for harsher prison sentences for molestation and casting doubt on the effectiveness of all treatment programs.
The doubt is warranted, critics of such programs say. They contend that people who have abused children can never be fully trusted, that treatment can do little to curb desires so deeply ingrained.
"For those who've crossed the line and acted on their darkest fantasies, it's very difficult, if not impossible, to go back," says Ruben Rodriguez, director of the exploited-child unit at the National Center for Missing and Exploited Children in Alexandria, Va. "Unless treatment programs have a 100% success rate, the only way to safeguard children is to take these people out of the mainstream."
While that view is shared by many victims and their families, some therapists and law enforcement professionals insist that simply locking up sex offenders doesn't protect children. Every month, California releases 250 to 300 sex offenders from prison or jail, and more than 94,000 registered sex offenders are currently living in the state, roughly two-thirds of whom were convicted of crimes against children.
Only treatment, therapists say, in combination with incarceration, can stem what some say is a problem of epidemic proportions.
"We can't beam these people to Mars--they're going to be back on the streets eventually," says Father Stephen J. Rossetti, a psychologist and president of St. Luke Institute, a church-run psychiatric hospital in Silver Spring, Md. "If they get treatment, it reduces the likelihood that they'll re-offend."
However, in figuring out which treatment strategy works bests, scientists are still grappling with many unknowns. Because child sexual abuse frequently isn't reported, we don't have a true picture of all perpetrators (although they're usually a relative or close acquaintance of the victim), and we don't fully understand what compels adults to be sexually intimate with adolescents or young children.
Complicating matters is the fact that sexual deviants are a diverse group, from one-time abusers to fixated pedophiles who may have committed hundreds of crimes against children as young as 2 and 3. And they come from every stratum of society, ranging from the homeless to corporate executives and elected officials.
What therapists and law enforcement officials do know, based on the nation's hodgepodge of treatment programs, is that some abusers respond better to therapy than others. The so-called "situational" molesters who turn to children out of curiosity, stress or convenience, for example, usually require less stringent interventions than either classic serial pedophiles, who make up 5% to 10% of sexual deviants, or violent sexual predators. And some therapists believe the threat of lengthy prison sentences is the only leverage they have to get offenders to change.
"The hard-core sex offenders have a propensity for this, and no matter what you do, they will re-offend the first chance they get," says Jerome Marsh, a parole official with the California Department of Corrections. "For the majority of offenders, though, treatment--along with tight controls and supervision--can work."
For Abusers, Combining Therapy and Medication
Therapy for abusers has evolved in recent decades. In the past, treatment programs often relied on so-called talk therapy, in which those with sexual feelings for children were encouraged to explore the roots of their feelings. By understanding the source of their urges, it was believed, the abuser could triumph over them. Faith-based retreats, on the other hand, prescribed prayer, meditation and spiritual cleansing as a way to overcome such desires.
Most doctors and therapists no longer hold out hope of a "cure." They do agree, however, that some sexual deviants can learn to curb their impulses, in much the same way that recovering alcoholics stay sober.
Most treatment programs now use cognitive behavioral therapy, in which abusers must acknowledge the wrongness of their actions and the harm they've caused. They subsequently learn various ways to control their behavior, such as avoiding playgrounds or being alone with children.