Archive for January 2015

Prelude

The following essay was started about three years ago and finally finished only recently. As you might notice, it is permeated with a certain feeling of anger regarding my chosen profession of applied psychology, a feeling that was originally sparked over the course of my university training (which is when I first sat down to write this essay). The reason for this feeling, which has mainly to do with what I perceive as rampant lack of skepticism within the field of psychology, is acknowledged and elaborated upon in the body of the text. Given I have had the opportunity to work, since graduating and obtaining my license to practice psychology, with colleagues who do not treat ideas in our field as hard-and-fast truths, but as objects open to discussion (which may or may not invalidate them), that feeling of anger has, in time, largely subsided. Although I finished writing this essay in another emotional state of mind than when I started writing it, I have chosen to leave intact whichever angry feelings seeped through my words when I first typed them—for the most part, to avoid invalidating my past self, but also to avoid invalidating my future self, which I am sure is not immune to a resurgence of frustration regarding his well-loved (another, complimentary feeling I hope comes through in my essay) profession.

Introduction

A Heck of a Kerfuffle.com recently celebrated its fourth birthday. On January 14, 2015, to be precise. During our first four years of “operation,” more than 35 short- to full-length articles exploring a variety of subjects were published. Further, we played host to more than 2,000 views per year from online travelers. In honor of this milestone, I thought I would share a little bit about what I learned on my first literary venture into cyberspace.

I would have loved to tell you that this blog was born out of sugar cups and rainbows. Alas, its origins are a tad more somber. The idea to develop my own blog, you see, was actually the product of frustration. Two years into my doctoral program in clinical psychology, I was exasperated. I had begrudgingly realized that the mandatory courses I was made to take embodied, at best, a forum for only a limited number of ideas and narrow discussion. Further, it appeared that fellow students were all too content feeding on the particular brand of knowledge professors were choosing to dish up. Likewise, professors seemed to have done the same during their own education, since none of them could explain to me how they had come to their conclusions, as if conclusions did not flow from underlying premises, instead spontaneously materializing out of la vérité itself.

Intent on compensating by fashioning my own education, I started to read. A lot. Books on the history of psychology and psychological theories, to find out how we got to where we are and if we happened to miss or leave behind important insights into human behavior. Books on alternate kinds of psychotherapy, because the training offered to me was either too esoteric (i.e., psychodynamic therapy) or too rigid and presumptuous (i.e., traditional cognitive-behavioral therapy). And books putting into question the very state of clinical psychology, to highlight the limits of knowledge we have come to consider absolute. Before long, my brain predictably began to writhe with ideas. But what to do with all of them? Instead of keeping my thoughts all to myself, I decided I would start writing them down, maybe even organize them into cohesive essays and share them with others. And such is how A Heck of a Kerfuffle was conceived. (Because I am not only passionate about psychology, I decided to broaden the scope of my new blog to cover other areas of interest, such as gastronomy and cinema. For the purposes of this essay, however, I choose to focus only on the process of writing about ideas in psychology.)

Before I go into the essays themselves and what writing them taught me about myself, I would like to recount to you how they came to find a permanent home on the Internet in the first place. Those of you who know me know that I am not particularly proficient at computers, and so learning to build my very own website represented a daunting task. Upon consulting, I was instructed to: find a web host, purchase a domain name, download web software to create my website, and design it to my liking. While all this makes sense to me now, getting there took some work. Going through the process, I have come to understand it in the following, less technical terms: purchase yourself a plot of Internet land, name your new domain, have builders erect your house, and furnish it to your liking. And voilà! You have got yourself a brand new home in Cyber City for everyone around the globe to visit. While I’m at it, I would like to thank Web Hosting Hub for helping pop my digi-cherry, and for providing consistently stellar service!

As you may have gathered from reading my first essays on my experiences as a clinical psychologist in training, I am skeptically inclined. Because I have elected to become a “mental health specialist,” this questioning attitude primarily manifests itself around the subjects of human behavior (or how to best understand it) and the modification of human behavior (or how to best go about it). In fact, some of my favorite insights from the past five years of clinical training and practice as a psychologist concern these particular issues. While I would describe my relationship with my chosen profession as marked with caution, even downright suspicion, do not get me wrong: I love what I do. I just refuse to let that affection dull my critical faculties and intellectually blind me.

I should specify at this point I do not advocate fanatical skepticism, or disbelief for the sake of disbelief. On this point, I am in agreement with mathematician Henri Poincaré (1901), who noted: “To doubt everything or to believe everything are two equally convenient solutions; both dispense with the necessity of reflection” (p. xxii). That being said, I believe skepticism encourages reflection more so than other attitudes: in fact, thinking that something might likely not be true incites one to consider the evidence for why it might actually be true, more so, at least, than thinking that that something is very probably true in the first place. This, of course, presupposes that the skeptic is interested, to begin with, in knowing the truth, regardless of whether or not it accords with his own expectations. To reiterate, from an experiential standpoint, the sense that “This might not be true but I want to know if it is” provides, in its underlying tension, impetus toward reflection, more so than the “tension-less” sense that “This is probably true but I want to know if it is.” To be sure, some of us may adopt a skeptical stance because we do not want something to be true, in which case we might not be motivated to consider the evidence against it. This, however, is an example of skepticism misused, in that its purpose is to service our own biases, not the search for Truth. Thus, skepticism, to be epistemologically fruitful, must always be coupled with a desire to expose reality.

Writing in 1925, the father of psychoanalysis, Sigmund Freud noted: “When instructing our own disciples in the theory of psychoanalysis, we always observe how little impression we make on them in the beginning. They accept the analytical teachings with just as much equanimity as any other abstractions which have been fed to them. Some of them may have the earnest desire to be convinced, but there is no trace that they ever really are convinced” (p. 64). It appears times have changed. In contrast to Freud’s observations, I noticed, over the course of my training as a therapist, that many of my classmates wholeheartedly accepted all that modern clinical psychology is and has to offer: clinical psychology, they implicitly insisted, is an infallible science, so why think twice about it? It is, specifically, just like medicine, and so should command the same sort of deference. Psychologist Gary Greenberg observed a similar trend, only from a professor’s point-of-view, and identifies a “top-down” process of misguided attitude transmission: “[Most] students seem oblivious to the crucial epistemological problems that haunt their discipline. Their education continues to consist of largely technical training based on the assumption that they are “doing science”” (1997, p. 257).

I, for one, refuse to take part is such unrestrained naïveté. I understand we want to feel like what we do is important—and it can sometimes be—but I cannot merrily ride along the medical bandwagon. However much we may couch clinical psychology in the language of science, clinical psychology is just not medicine. Namely, what we refer to as “mental illness” has very little to do with actual, physical illness. Likewise, what we refer to as “psychological treatment” has very little to do with actual, medical intervention. Indeed, in both instances, any similarities can best be described as specious. As such, the usage of medical terms like “illness” or “treatment” to describe the problematic behaviors we seek to change in our clients, and the conversations we use to help our clients change, is simply misleading. As critics have leveled against us for decades, our brand of science is decidedly “soft,” whereas medicine’s is anything but.

Psychologist Jeffrey Kottler (2010) tells of “writers who believe that therapy, as a profession, could quite legitimately be housed in an academy of dramatic arts instead of a school of education, health, social work, medicine, or liberal arts. In this setting, therapists would speak of their craft as professional conversation, strategic rhetoric, or even a genre of interactional theater” (p. 297). I am inclined to agree: psychological treatment is actually reflective, didactic conversation about mainly moral issues, and thus very unlike actual, medical treatment (to find out more on the difference between mental and physical cures, see Szasz, 1987). On the subject of psychotherapy, the philosopher Jean Paul Sartre even went so far as to claim that “[there] is philosophy, but there is no psychology. Psychology does not exist; either it is idle talk or it is an effort to establish what man is, starting from philosophical notions” (cited in Rybalka, 2002, p. 245).

I understand it is hard to enter a helping relationship when so much of what we do is so, for lack of a better word, fuzzy. But I believe it is imperative that we acknowledge this in order to do good work; otherwise, we are just being pretentious, when humility—my own values tell me—should drive us as responsible and effective vocational helpers. Renowned therapists themselves identify lack of humility as not only inimical to successful therapy, but also responsible for their worst therapeutic failures (Kottler & Carlson, 2002). Indeed, thinking of ourselves as purveyors of steadfast truths about life and how to best live it can have catastrophic circumstances: for instance, when we deny, ignore, or invalidate our clients’ own truths, we risk threatening the integrity of their very selves (Rowe, 1994). Thus, because so much of what we do is so (let us settle on) nebulous, I believe it is imperative that we continually, actively reflect on our profession’s professed tenets, never blindly following them, while always keeping in mind the limitations of those tenets we have settled on and chosen to abide by.

In the introduction to his no-hold-barred book on the evils of psychotherapy, aptly titled Against Therapy, ex-psychoanalyst Jeffrey Masson (1994) specifies: “The fact that some psychotherapists are decent, warm, compassionate human beings, who sometimes help the people who come to them, does not shelter the profession itself or the practice of that profession from the criticism I make in this book. It only means that they function in this manner in spite of being psychotherapists, and not because of it” (p. 41). While I do not share many of Masson’s conclusions regarding the ethics of psychotherapy, I do agree with him on one point: that those psychologists best suited to help clients are probably those who do not take their profession—in its current state, at least—all that seriously. Some authors (e.g., Engelhardt, 2004) have even gone so far as to suggest that psychologists should, for their clients’ sake and benefit, pretend as if what they know to be true about human behavior (and, more precisely, misbehavior) is not true at all!

While I do not believe that clinical psychology ultimately amounts to a science (although particular helping strategies can certainly be studied scientifically), but more of a philosophically flavored art, many of my colleagues would respectfully disagree. However, even if we were to agree to call what we do science, the philosophy underlying what we do could still not be denied. As philosopher Daniel Dennett (1995) reminds (actual) men and women of science, “[scientists] sometimes deceive themselves into thinking that philosophical ideas are only, at best, decorations or parasitic commentaries on the hard, objective triumphs of science, and that they themselves are immune to the confusions that philosophers devote their lives to dissolving. But there is no such thing as philosophy-free science; there is only science whose philosophical baggage is taken on board without examination” (p. 21; emphasis added). And so, regardless of whether we believe we are “mental health scientists” or simply life coaches, the philosophy of psychology cannot be denied. In fact, it is essential it be ascertained.

But, why bother thinking about the philosophy underlying clinical psychology (or any other human endeavor, for that matter)? Since I could not possibly say it any better if I tried even really hard, I call upon philosopher Bertrand Russell to tell us why:

Because “[the] man who has no tincture of philosophy goes through life imprisoned in the prejudices derived from common sense, from the habitual beliefs of his age or his nation, and from convictions which have grown up in his mind without the cooperation or consent of his deliberate reason. To such a man the world tends to become definite, finite, obvious; common objects rouse no questions, and unfamiliar possibilities are contemptuously rejected. As soon as we begin to philosophize, on the contrary, we find […] that even the most everyday things lead to problems to which only very incomplete answers can be given. Philosophy, though unable to tell us with certainty what is the true answer to the doubts which it raises, is able to suggest many possibilities which enlarge our thoughts and free them from the tyranny of custom. Thus, while diminishing our feeling of certainty as to what things are, it greatly increases our knowledge as to what they may be; it removes the somewhat arrogant dogmatism of those who have never travelled into the region of liberating doubt, and it keeps alive our sense of wonder by showing familiar things in an unfamiliar aspect.” (1912, p. 91)

Psychotherapy is one such “common object,” which, once prodded with the rod of philosophy, quickly reveals itself (for many, at least) to be something somewhat different from what it is normally made out to be. I will later discuss how the common object of “mental illness” meets a similar fate as psychotherapy when handled using philosophy.

The psychoanalytically minded among you will no doubt attempt to discount my cantankerous attitude toward clinical psychology by postulating potential biographical causes that may have brought it about in the first place. Perhaps I have time and again been hurt and disappointed by objects I thought I could count on, I can no longer trust those that presently inspire affection in me. Even if that interpretation were true, the “etiology” of a belief system, as psychologist William James (1901) takes great care to explain in his seminal qualitative study of the religious experience, has absolutely no bearing on its accuracy. After all, what belief claims no psycho-historical causes or reasons whatsoever as precursors (beyond a probable epistemic desire “to know,” that is)? For instance, some historians have, according to astronomer Carl Sagan, said of Isaac Newton that he “rejected the philosophical position of Descartes because it might challenge conventional religion and lead to social chaos and atheism” (1996, p. 258). But how “Newton was buffeted by intellectual currents of his time […] has little bearing on the truth of his propositions.” Sagan goes on to describe a similar attempt to discredit aimed at Charles Darwin, one that commits the added mistake of confusing cause and effect. Having said all of this, there is some validity in the hypothesis that my suspicions are at least partly grounded in my past. As a child, I was asked to assume the truth behind countless religious postulates regarding how the world works and how to best direct human behavior; when I started to think, I noticed none of them—to my satisfaction, at least—did the explanatory or regulatory job they were specifically fashioned to do. This left a sour taste in my mouth: I felt misled by authority figures I trusted.

It is then that I learned the power of independent, critical thinking in shaping my own understanding of the world. (I appreciate the value of suspending thought and just having faith, but I cannot endorse faith as a standalone life philosophy. Since any belief can be accepted as true based on faith alone, all faith-based beliefs are consequently equally true. In other words, faith alone cannot make the probably true rise above the probably not true. You need reason for that.) Historically, no knowledge (except when resting on faith) has ever deserved the qualifier of “ultimate.” After all, knowledge builds upon itself away from non-adequate accounts, arguably ad infinitum (an observation made by the philosopher of science Thomas Kuhn, in his seminal book on the titular structure of scientific revolutions.). In fact, during my very first year of university, my History of Psychology professor likened the idea of “facts” to a modern fiction, in so far as facts are final and should not technically evolve. And so, I do not see the value in assuming that what I hold to be true now will necessarily be true 50 or 100 years from now.

Some of you may be thinking at this point: “Why believe in anything if it is just a stopover on our way to Truth?” First of all, what we currently hold to be true may not necessarily be a stopover at all, but actually the final destination. However, only time will be able to tell us this (not in a decisive sense, to be sure, but in a probabilistic sense, i.e., in the progressive accumulation of evidential weight). In fact, all knowledge, be it in Science (or Philosophy), is tentative to some degree, being only one body of counter-evidence (or counter-arguments) away from modification or downright withdrawal. Second, there are presumably units of knowledge that stand closer to the final destination than others, or at least stand a better chance of leading us toward it as opposed to some epistemological dead-end. Thus, I am not advocating that we not hold on to present-day knowledge. After all, without intellectual markers to situate us, we would flounder about the world directionless. What I mean to say is: we should simply hold on to this knowledge with a loose grip (a move which can also make it easier to reach for the next epistemic monkey bar). (For simplicity’s sake, I will continue to use the terms “fact” and “truth” [and all variants thereof], but in the tentative, “as can presently best be understood” sense of the words. With one exception: when “truth” is capitalized, it is meant to evoke ultimate Truth, that which scientific revolutions rotate toward.)

Chapter I – In the Company of Ideas

In writing about ideas, I have continued to learn more about my receptivity toward them. As briefly mentioned above, however, my reluctance to accept everything I am told as automatically true is a part of me I have already been aware of for some time now. What has been more of a revelation is how I as an individual engage with immaterial (but still very real) perceptions like ideas. I have to admit: relationships with ideas can be tricky. You may fall immediately in love with one or it may grow on you in time. Once you have selected a suitable idea for possible “appropriation,” you give yourself to it completely: it is yours, you are its. Eventually, you may reluctantly come to think you can somehow make it better, only to find out it stubbornly resists change. Frustrated, you may begin to seek out or simply let yourself be seduced by a more attractive idea. However heart-breaking the thought, you may decide to ditch your previous idea, because—as you repeatedly tell yourself as if to assuage some kind of doubt—“This new one is it.” Come to think of it, idea selection bears a striking resemblance to mate selection!

For this reason, I have learned to be more cautious when considering adopting ideas. That is not to say I have not also had to learn how to be more tolerant of uncertainty when ideas are being considered (or dated, if you will). Greenberg (2010) counsels: “[When] it comes to important and complex questions, the best approach is to leave yourself in doubt for as long as possible, to live with inner conflict rather than to end it, to withstand yourself rather than to become someone different, to understand you arrived at an important juncture rather than strike out down a road simply for the sake of getting on with life” (p. 7). Adopting a hopeful view of this emotionally arduous fact-finding process, physicists Laurence Krauss even predicts “[lack] of comfort means we are on the threshold of new insights” (2012, p. xv). And so, I never abandon an ostensibly sound idea that has managed past my skeptical defenses without giving my relationship with it every chance it deserves, however trying what lies ahead. I remain attuned to counter-arguments opposed to my idea. I evaluate their cogency. I revise my own arguments in support of my idea to address the counter-arguments. If an idea repeatedly fails to stand its own during challenges or keeps resisting improvement, I (I must admit, halfheartedly) abandon it, perhaps even for the very idea that brought about its downfall.

An example: my earliest memory of me participating in a college class—Introduction to Sociology—sees me arguing against the idea of ethnocentrism by appealing to a universal moral standard. However much I enjoyed the thought of absolute moral judgments, I eventually came to question their existence. (While it may sound contradictory, I do not, in any way, advocate normative moral relativism, whereby any behavior should be tolerated simply because there exist no objective behavioral standards in Nature.)

While learning to live and getting acquainted with ideas, I have also learned a great many things about them. First off, just because an idea sounds counterintuitive does not mean that it is somehow going against Truth. On the subject of moral behavior, Russell once commented: “[Conscience] is a most fallacious guide, since it consists of vague reminiscences of precepts heard in early youth, so that it is never wiser than its possessor’s nurse or mother” (1901, p. 74). Likewise, intuition is no more informative in guiding beliefs. Because intuition rests on knowledge of what Truth should be, as perhaps outlined by prior education, it does not necessarily orient us toward that which is definitely True. Experience is, in turn, no more reliable a guide. Speaking of clinical experience, self-avowed Freud basher Frederick Crews (1995) concludes: “Standing alone, [it] is not a probative tool but an inducement to complacency and tunnel vision” (p. 7). Moreover, I have learned that while I will not assume the truth of the status quo, I will always remain open to it being true (or at the very least a right step toward True).

However demanding thinking about ideas may be, writing about them poses different sets of challenges. Whereas there is no end to thinking (you can keep doing it for as long as you want or possibly can), there is one to writing (provided you want to share your writings at some point). Since I rarely write about ideas I am completely done thinking about, this final quality to writing can be problematic. Further, the very attempt to translate shapeless ideas into definite symbols may change one’s understanding of them. Screenwriter Charlie Kauffman, in a 2008 interview for the Writers Guild of America, explains: “Part of the thing that happens when you’re writing, especially when you’re writing one piece over an extended period of time, is that you have an evolving understanding of the world and an evolving understanding of the piece. And so, if you’re trying to be truthful, you start out with one idea, and as you become more familiar with it, or explore different aspects of the idea, different things become revealed to you, and you have to incorporate that. That becomes a bit of a hindrance when you’re writing, but I guess that’s the way I like to write.” And that is the way I like it too.

Chapter II – In the Company of Ideas that are (Probably) True

I have thus far discussed Truth with no mention of its nature, and so will say a little bit about it now. Jeff Winger, the self-assured protagonist from the television series Community, puts it this way: “The biggest truths aren’t original. The truth is ketchup. It’s Jim Belushi. Its job isn’t to blow our minds. It’s to be within reach” (2010, E14/S1). I agree with Winger’s first statement: many observations are self-evident (i.e., very unlikely of ever being discounted by any new evidence), truisms that barely need stating. That being said, I disagree with his subsequent statement: truths are not always necessarily easily discernable. As Algernon replies to Jack in The Importance of Being Earnest, “[the] truth is rarely pure and never simple” (Wilde, 1899/1990, p. 6). Presuming that Truth exists independently of human perception, it may then not always be easily apprehensible by the mind. Because Truth does not exist for us, its job cannot possibly be to exist in such a way as to always be ascertainable, as if tailored for our intellect. In fact, Truth holds no purpose; it just is, and what it is cannot, unfortunately, always be within reach. Discerning Truth, instead, oftentimes requires painstaking effort. It is us that must adapt ourselves to it, not vice-versa. As Krauss remarks, it is sometimes necessary that “we expand our horizons because nature is more imaginative than we are” (2012, p. 77). Miss Giddens, in The Innocents, is even warned by her employer that the “truth is seldom understood by any but imaginative persons” (Clayton, 1961).

Presuming there are things to know about our universe, what are the best ways to discern them? I have talked about how I prefer not to rely on potential indicators like authority, intuition or experience. Other classic aids are Science, Reason, and Faith. (I make a distinction between Science and Reason for reasons that will become clear shortly.)

As many of you already know, Science only concerns itself with that which can be falsified (i.e., determined to be untrue via observation or experimental testing). For example, Science can readily assess the statement “tortoises are faster than hares,” because its opposite can easily be measured. In this way, the investigative scope of Science is fairly limited. Although Reason is inherently part of the scientific process, Reason can also be used on its own to assess statements that cannot be falsified. For example, although the statement “Life is actually a dream” cannot possibly be proven to be untrue, Reason can show it to be very improbable (for a compelling argument, see Russell, 1912). (The latter statement is presumably either True or False; it is just that we cannot “know” the answer scientifically, but merely approximate it logically.) In fact, Reason is the primary tool of Philosophy, and so is used to answer questions stemming from every one of its branches, questions that Reason via Science oftentimes cannot touch (or touch as persuasively) because of its strict falsifiability requirement (see Klemke, Kline, & Hollinger, 1994 for more on the difference between questions “fit for Science” and questions “fit for Philosophy”). For example, while Science can effectively judge secondary religious beliefs (e.g., “The Earth is 6,000 years old”), only Philosophy can unrestrictedly tackle the primary belief in a deity itself (Piggliucci, 2009). In this way, the investigative scope of Reason is fairly large, if not unlimited. Like Reason, Faith can technically assess any variety of statements, falsifiable or not. For example, one could take it on Faith that tortoises are faster (or slower) than hares, or that life is actually (or not actually) a dream. In this way, the investigative scope of Faith is as large and potentially unlimited as that of Reason. (One might even say that Faith is superior to Reason when trying to find out what is true: whereas Reason can only show an un-falsifiable statement to be probably true or false, Faith can claim it to be conclusively True or False. Unfortunately, as we shall see, Faith can also show it to be both True and False, which most of us do not consider a helpful conclusion, or a conclusion at all…)

While both Reason and Faith boast equally impressive scopes of enquiry, they are by no means equal aids when it comes to actually making out Truth. Reason (whether applied within the realm of Science or Philosophy) remains most helpful because it can show certain statements to be very probably false or truer than others. In other words, it may organize statements alongside a continuum of Truth. Faith, on the other hand, can accept anything as definitively True. For example, one person could take it on faith that “God created the universe,” and another could take it on faith that “A giant, impossibly pink and fluffy bunny-rabbit created the universe.” From a Faith-based perspective, both people would be right, which is unlikely given both aforementioned beliefs cannot be true at the same time (unless, I suppose, God is an enormous, colorfully furred rodent). Statistically speaking, then, Faith is too liberal; in other words, it is associated with too great a risk of false positives. To be fair, some claim that Faith’s purpose is not to know Truth. Nevertheless, those who adopt beliefs based on Faith assume it has oriented them toward an accurate belief. Funnily enough, even people who insist Faith is sufficient when selecting beliefs (e.g., “God created the universe”) will admit that some faith-based beliefs (e.g., “A giant, impossibly pink and fluffy bunny-rabbit created the universe”) just do not make sense. Thus, while they ultimately do value Reason, they just do not think Reason is necessary to support their own beliefs. That is why the smarter among those who initially adopt a belief based on Faith alone ultimately succumb and resort to Reason to validate these. Take, for example, the numerous logical arguments (e.g., Rachels, 2002) for the existence of God, usually taken on Faith alone. The battle over whether these arguments are cogent is here waged in the realm of Reason, because Faith is, as we have seen, always insufficient, and Science is, in this particular case, out of its element (“God exists” is a non-falsifiable statement). (Note, however, that if one appends “and can interact with the physical world” to “God exists,” the latter statement suddenly becomes falsifiable, and, thus, amenable to scientific enquiry; see Stenger, 2009.)

For this very reason are common religious arguments against the trustworthiness of Science—postulating, say, that “Science can be wrong”—embody not a criticism at all, but merely a restatement of its strength, of the reason why it can be so useful. Because Science can reject hypotheses as being inadequate, but never accept any of them as definitively true, Science naturally promotes progress and movement toward Truth. Reason outside of Science, as in Philosophy, can also evolve by way of argumentation. Faith, on the other hand, is inert, deprived of any inbuilt mechanism allowing it to advance away from Error toward Knowledge. To illustrate my point, compare the number of times Science has revised its understanding of nature in the last few centuries to the number of times Religion has revised its understanding of nature in the last two millennia. Close to 2,000 years after the birth of their religion, Christians have only recently begun to seriously consider the possibility that hell, a major element of their belief system, does not exist (Bell, 2011). Science, on the other hand, has not only questioned but also revised its conceptualization of light, one of its own conceptual obsessions, at least three times in the last 350 years: first came particle theory, then wave theory, followed by wave-particle duality (Hawking & Mlodinow, 2010). (Although one can certainly substitute, without resorting to Reason, one faith-based belief with another faith-based belief, it remains impossible to tell, based on Faith alone, whether the new belief is any truer or “falser” than the old one. In other words, trying to understand the world using Faith alone is akin to running a marathon on a treadmill. Whatever you do, you are never behind, never ahead; or at the very least, there is no possible way to know.)

As you may have guessed, I favor Reason (in the form of Science or Philosophy) when attempting to understand the world around me. I will now discuss some of the products of my reasoning over the last few years, in regards, specifically, to psychology.

Chapter III – In the Company of Ideas in Psychology (Part I)

We saw earlier that “etiology” can never determine the accuracy of a belief, because every belief has causes. I argue that in some cases, neither do its consequences. (Note that James, an ardent pragmatist, would have disagreed with this.) When determining whether a belief is true or not, I believe the effects of maintaining that belief have absolutely no bearing on its truth-value, since some truths presumably exist independently of the effects of believing in them. For example, it is not unreasonable to assume that dogs probably exist regardless of whether believing in dogs is helpful or harmful to humans. Now, that may sound silly, but many people express beliefs that, when translated using canines, sound a little bit like this: dogs must exist because dogs make humans less lonely. For example, some defend the existence of God by claiming that without belief in Him, society as we know it would crumble into chaos. But the effect of not believing in God has absolutely no bearing on whether He actually exists. Such people are confounding two debates: the existence of God, and the effects of believing in someone like Him. In short, there is a difference between the veracity and the utility of an idea, two characteristics that are often confused when attempting to demonstrate the former.

Many psychologists commit such a logical mistake when defending their own ideological beliefs (namely, their preferred therapeutic approach). To be precise, they commonly interpret the proven efficacy of a given therapeutic technique as indicating the truth of its underlying premises and postulated entities. If their brand of therapy happens to have more positive outcomes then other brands of therapy, then that must mean their approach is based on fact, and that they are justified in using it when helping clients. In doing so, many therapists “draw hasty conclusions between symptom abatement and interpretation” (Crews, 1995, p. 117). As we have seen, that habit is misguided.

Other psychologists commit a similar mistake when interpreting the finding that all therapeutic approaches are actually equally effective in relieving life difficulties (dubbed the Dodo-Bird Verdict), and that therapeutic approach actually plays only a small role in achieving this outcome, as indicating that all approaches are equally (or unequally) valid. In other words, psychotherapy is really a free for all: simply pick the one you happen to like best or borrow from here and there. To be sure, the Dodo-Bird Verdict has been the mark of much debate, but let us assume for a moment that this is in fact true, that all forms of therapy are equally effective in relieving life difficulties. Does that mean that we, as professional helpers, are warranted in using or sampling from any one of them to help our clients? Provided one values Truth over Deception, not at all. The Dodo Bird Verdict only extends to therapeutic outcome (or value), not therapeutic veracity. (I regret to inform those of you who advocate therapeutic eclecticism so as to avoid thinking about the philosophy underlying each and all therapeutic approaches, that the best eclectic therapists will only borrow from approaches that share the same core philosophical assumptions, but who suggest different strategies based on these [Neimeyer, 1995].)

As I alluded to earlier, an idea should ideally be evaluated via itself, and not via ourselves; otherwise, we are simply evaluating the effect of believing in this idea, as opposed to the idea itself. That is what the Dodo Bird Verdict amounts to: a conclusion as to the effect of an idea, as embodied by a particular approach, not a conclusion as to the legitimacy of this idea, or the approach itself. Even Wampold and his colleagues (1997), who assessed and confirmed the Dodo Bird Verdict, take care to mention in the title to their article that “all must have prizes” only “empirically.” (By empirically, I interpret the authors as meaning, “as far as observable effects are concerned.”) That is, from a wider truth-seeking perspective, all do not necessarily get to take those prizes home. Thus, the actual soundness of a given therapeutic technique cannot be determined via its efficacy, but via the accuracy of its premises and the entities that those premises engage.

Now, whether Efficacy should trump Truth in therapeutic settings is for you to decide. To be sure, therapy is meant to be helpful, but it is also expected to be truthful (i.e., based on the best knowledge available). To help me demonstrate, consider the following: if a given lie-spewing cult helps make people happy, does that make it a reasonable way of helping people? If you have answered in the negative, then you have no business conducting whichever brand of therapy you favor based solely on the fact that it has been proven to or may possibly be effective. You are only justified in conducting it if you have critically assessed the theory behind your approach to see if it stands up to Reason. For example, if you are a psychodynamic therapist, you must believe in and be able to defend the statement: “nothing in reality is ever what it seems.” (You would think that, as a skeptic, I would admire psychodynamic theory; unfortunately, such theory advocates a fanatical sort of skepticism, where no clear paths toward reliable insights are laid out except those paved by “experts.”) Further, one should be able to explain why, despite the fact that no “distinctly psychoanalytic notion has received independent experimental or epidemiological support—not repression, not the Oedipal or castration complex, not the theory of compromise formation, nor any other concept or hypothesis” (Crews, 1995, p. 298), one is still justified in speaking of these as if they were real. Cognitive psychotherapy may enjoy a better reputation nowadays and put forth and into play self-evident truths like the existence of thoughts, but that by no means exempts it from critical philosophical consideration. Likewise, if you are a second-wave cognitive-behavioral (CB) therapist, you must believe in and be able to defend the statement: “reality exists and has been decisively and irrevocably quantified.” After all, without a discernable (and already discerned) reality, there can be no such things as cognitive distortions of said-reality, and there remains nothing with which to realign a client’s mistaken subjectivity. (Third-wave CB therapists overcome this philosophical hurdle by embracing human subjectivity, even its unpleasant manifestations, without seeking to modify it.) If you cannot defend either of these arguments via non-fallacious means, yet are still conducting either brand of therapy, then fortunately for you: you have some thinking to do!

Arguing against a pragmatic view of religion, Russell (1901) confessed: “I can respect the men who argue that religion is true and therefore ought to be believed, but I can only feel profound moral reprobation for those who say that religion ought to be believed because it is useful, and that to ask whether it is true is a waste of time” (p. 197). Likewise, I can respect the men (and women) who argue that their brand of psychotherapy rests on sound philosophical premises and therefore ought to be practiced, but I can only feel profound moral reprobation for those who say that their brand of psychotherapy ought to be administered simply because it is useful.

Chapter IV – In the Company of Ideas in Psychology (Part II)

Another idea I have become quite infatuated with is the idea that mental illness does not exist. I am not going to concern myself here with the reasons why I believe this idea to be cogent, but with a common mistake people make when trying to prove me wrong. People often tell me mental illness must exist since diagnoses give people comfort. That is yet another example of mistaking value for veracity. I am not concerned with the effects of believing in mental illness, but whether it actually exists or not. Because I have concluded, by weighing the arguments I have come across until now, that it does not, I believe it would be irresponsible—not to mention disingenuous—for me to pretend as if it does, simply to assuage my clients’ distress. (Should you be curious, the effects of labeling are both positive [e.g., Angermeyer & Matschinger, 2005; Deacon & Baird, 2009; Hayne, 2003; Laegsgaard, 2010; Murrie, 2005; Murrie et al., 2007; Wright et al., 2007] and negative [e.g., Angermeyer & Matschinger, 2003, 2005; Deacon & Baird, 2009; Hayne, 2003; Kleim et al., 2008; Lloyd et al., 2010; Schomerus et al., 2010].)

Let us say I were to conclude that mental illness does, in fact, exist. Should, then, I resort to psychiatric diagnoses when explaining my clients’ experiences to them? I should think so. Unlike me, however, many of my clinical colleagues have actually come to the conclusion (or simply accept) that mental illness is real, yet somehow still debate whether to communicate their diagnoses to their clients. That is, to put it bluntly, pure hypocrisy. (A laughable type of hypocrisy, since many of those same people will tell me I am being irresponsible for not telling my clients that they have a given mental illness, an illness that I, unlike them, do not even believe in!) Currently, the debate surrounding diagnostic labels concerns whether we should use them, not whether they embody something real. Under the pretense that diagnoses of mental illness may cause stigma, some clinicians decide not to report them to patients, opting for less reductionist, more humanistic terms instead. This anxiety surrounding labels has led to many psychologists becoming two-faced, speaking the language of humanism with clients, while thinking about and discussing clients with their colleagues using the language of psychiatric reductionism.

This is all plain silly. If mental illness exists, it follows that patients should always be diagnosed with whichever illness they appear to suffer from! If mental illness is just like any other illness, then it does not matter in the least bit whether learning that one is mentally ill will impose emotional hardships. After all, have you ever heard of a doctor debate whether he should label his patient as having HIV, because he may be discriminated against on account of his infection? Of course not! Diagnoses of physical illness may be hard to take, but we still give them, because they accurately represent what is happening to a patient. And so, if psychiatric diagnoses are the same as medical diagnoses, it follows we should always give them to patients, even if learning that one is mentally ill will hurt.

Chapter V – In the Company of Ideas in Psychology (Part III)

I have argued that psychotherapy should be based on fact. Yet, at the same time, I implied earlier that psychotherapy is a predominantly value-based endeavor (compared, that is, to medical intervention, which, to be sure, also involves value-based decisions, but not to the central extent found in psychotherapy) that rallies rhetorical, relational, and experiential processes (as opposed to medicine’s use of basic speech and physical instruments*) in service of its moral aims, which center around existential-humanistic matters like “what people do” and “what people ought to do” (as opposed to physicalist matters like “what the body has,” in the case of medicine). Values, of course, are not scientific entities, nature being morally uniform. This begs the question: if we are willing to tolerate the application of values in psychotherapy, why not also enlist other fictional constructions, such as psychodynamic or psychiatric entities like the unconscious or mental illness? More succinctly, can psychotherapy ever truly be based only on fact?

The goal of psychotherapy is typically to increase psychological wellbeing. (I use the term “wellbeing” here instead of “health,” so as to avoid any unnecessary confusion between the two, broad concepts of “optimal behavior” and “optimal body.”) This goal involves the following value-statement: wellbeing is more desirable than its opposite. This statement, however, is not grounded in science and thus should not be considered formal fact. As evinced by the existence of natural disasters and the mere potential for violent behavior, nature does not always have our best interest at heart: it could not care less whether we survive and thrive within its confines, or simply suffer our way through life, only to die a meaningless death in the end. Values come into play not only in regards to the goal of psychotherapy, but also in regards to the pursuit of that goal. A correctional psychologist attempting to rehabilitate a violent offender who is quick to anger, for example, might encourage him to learn to cope with his anger without resorting to violence, because doing so will help him lead a more satisfying life, by, say, not scaring away potential resources. But nature, again, does not care whether we better ourselves or not, whether we behave in such a way as to foster or undermine our wellbeing.

The decision, in therapy, that we ought to behave in certain ways, and that we ought to replace certain behaviors with others, will forever be determined by fictional entities (i.e., values). That is, and will forever remain, the nature of therapy. We cannot do anything about that. That being said, it remains possible to favor certain behaviors over others, and to replace those behaviors we do not favor with behaviors we do consider favorable, in ways that are based in objective reality, i.e., in observable phenomena. (Indeed, although “normative judgments cannot properly be regarded as either true or false [,] accepting or rejecting an evaluative judgment [can] depend on judgments that are themselves straightforwardly nonnormative”; Frankfurt, 2006, p. 28-29, italics in original.)

For example, if we wish to help a client increase his wellbeing, we can use observation to tell us which behaviors generally increase wellbeing, and do so consistently, lastingly, and with the least number of harmful consequences. We can also rely on observation to determine the best strategies to use when replacing behaviors that decrease wellbeing with others that increase it. Note here that nowhere in nature is it prescribed that life should be pleasant, but science can still be helpful in telling us how to best accomplish this goal. (On a related note: although the selection of adaptive behaviors, and the elimination of maladaptive in favor of adaptive behaviors, can be based on scientific inquiry, the recommendation that clients live and that therapists practice according to empirically derived knowledge will always be value-based. In the words of philosopher David Hume, 1739, just because a behavior is related to increased wellbeing, or just because a therapeutic strategy is helpful in replacing behaviors that decrease wellbeing with behaviors that increase wellbeing, does not mean that it ought to be enacted.)

Thus, we would be warranted in urging a habitual substance abuser to consider substituting his behavior with another, more happiness-friendly behavior, not because this is what nature intends for that individual to do, but because objective observation tells us that using certain quantities of drugs and alcohol, while creating legitimately pleasant states of mind in an of themselves, increases wellbeing with only relative efficacy (pleasant emotions may be interrupted by unpleasant physical symptoms, or other sources of pleasure may be compromised, like one’s profession), reliability (unpleasant emotional experiences may sometimes, inadvertently and unexpectedly, become more salient), durability (pleasant emotions are fleeting), and sustainability (pleasant emotions may become hollow or require more intense consumption to come about at the same level of potency). Using certain quantities of drugs and alcohol also entails potentially detrimental consequences to others (like family and friends). Moreover, we would be warranted in suggesting to the habitual substance abuser certain change strategies over others, because observation tells us that some strategies neutralize cravings better than others.

Further, misbehaviors targeted for substitution in psychotherapy can always be described and explained in factual, or at very least parsimonious and transparent, ways. Thus we would be mistaken to describe habitual substance misuse as an id-motivated regression to the oral stage of psychosexual development, or as a chronic mental illness, because these concepts, while accurately reflecting the existence of particular behaviors, rely heavily on allegory (which often entails the creation of extraneous entities) to describe and explain these behaviors, and also fail to wear their moral loading on their sleeve (unlike, say, the expression “life difficulty,” which openly acknowledges its value-based underpinnings).

Conclusion

I have discussed en long et en large what I have learned about myself over the past fours years contributing to A Heck of a Kerfuffle.com, while focusing specifically on the topic of ideas in the field of psychology. I have, however, purposefully omitted one particular detail surrounding ideas that I now wish to consider with you: ideas are meaningless if they cannot be (and have not been) shared. We have now set foot upon the final, most agonizing step of the writing process: bidding one’s work farewell. Allowing a work to venture into a public sphere is, for two reasons, quite unnerving. First, writers no longer exert power over their creation for it does not belong to them anymore; it is out there, in the reader’s mind, becoming something “more,” a mix of the writer’s associations and the associations they, in turn, trigger in the reader. Second, allowing others to read our work demands we open ourselves up to criticism, make ourselves vulnerable in a way. However nerve-racking it is at times to conceive of and raise an idea, helping it grow into a full-fledged and freestanding essay, then free it into the world to fend for itself, it remains an exciting, stimulating process. I would go so far as to say it is addictive. In this spirit, many thanks to those of you who have taken the time to visit and rummage your way through my blog in the past four years. I am also grateful for the constructive feedback some of you have sent me via electronic mail. And on this note, to one more Kerfuffle of a year!

Footnote

* To be sure, clinical psychologists boast an arsenal of instruments at their disposal, mainly for diagnostic purposes. However, diagnostic tests in psychology do not allow psychologists to “diagnose” in the typical, medical sense of the word.

For the most part, diagnostic tests in psychology (e.g., the Beck Depression Inventory; BDI) identify a series of behaviors that are statistically correlated with one other; dub these behaviors “symptoms” individually and “disease” collectively; determine whether any of the testee’s behaviors match any of the behaviors defined as symptoms; and, given a pre-determined number of positive responses, allow the tester to conclude that the testee suffers from a disease. “To logicians,” Greenberg quips while discussing the flaws inherent in such a system of diagnosis, “this is known as assuming your conclusion as your premise, or begging the question” (2010, p. 129). Conversely, diagnostic tests in medicine, which do not involve circular logic, find evidence of disease independently of symptoms: “A good doctor would never conclude that a person with a sore throat and fever necessarily has a streptococcal infection, and a good scientist would not say that the disease of strep throat is constituted solely by a sore throat and fever. Both would insist that a bacteria must be present to complete the diagnosis” (p. 63). At present, the bacteria equivalent of depression (i.e., a definition of depression that does not include a description of what it is like to experience depression) does not exist, to say nothing of a diagnostic test that can accurately tell if a person has fallen ill with this entity.

As hinted by Greenberg, underlying, for instance, the BDI’s circular logic is confusion regarding the difference between disease and symptoms. In medicine, “the symptoms of the disease are only the signs of the disease, not the disease itself. In psychiatry, the symptoms constitute the disease and the disease comprises the symptoms” (Greenberg, 2010, p. 63-64). This confusion was earlier echoed by psychiatrist Thomas Szasz, who pointed out: “The term pneumococcal pneumonia identifies the organ affected, the lungs, and the cause of the illness, infection with the pneumococcus. Pneumococcal pneumonia is an example of pathology-driven diagnosis. Diagnoses driven by other motives [Szasz here refers to the diagnoses and motives of psychiatrists] generate different diagnostic constructions, and lead to different conceptions of disease” (1974/2010, p. 277). Tellingly, the problem surrounding the proper usage of the terms “disease” and “symptoms” in mental health is even acknowledged by the authors of the Research Agenda for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V; Kupfer, First, & Regier, 2002): having conceded that “the field of psychiatry has thus far failed to identify a single neurobiological phenotypic marker or gene that is useful in making a diagnosis of a major psychiatric disorder” (p. 33), the authors go on to predict that “[once] it is possible to define a mental disorder based on the identification of its underlying pathology [a prediction that is based on the convenient reasoning that “proof must be coming,” which, incidentally, also begs the question: why are we speaking as if the proof already existed?], then it would surely make sense to follow the course of other medical conditions and have the presence of disorder be based solely on pathology and not on the effect this pathology exerts on the individual’s functioning” (p. 208).

On top of rendering diagnostic tests in psychology (not to mention the DSM itself) utterly useless by reducing them to complicated labeling machines (as opposed to the explanatory instruments these tests are modeled after), the confounding of disease and symptom in psychology often leads to improper use of language (which Szasz would likely qualify, depending on the speaker’s intentions, as base rhetoric). For instance, psychologists will often utter nonsensical diagnostic statements like “Martha is delusional because she has schizophrenia.” Given schizophrenia includes delusional beliefs in its definition, this statement amounts to a tautology, redundantly stating the same idea twice, only in different words. Conversely, a similarly structured statement in medicine makes perfect sense: “Martha has a throbbing headache because she has a tumor lodged in her brain.” A tumor is not a headache, and so it is acceptable to say that one is responsible for Mary’s headache.

References

Coming soon.

I was recently invited to address, as a guest speaker, a graduate seminar on clinical issues in forensic psychology. The aim of my lecture, I was informed by the inviting professor, would be to familiarize her students with the principles and practices underlying sexual offender rehabilitation. I agreed with a mix of excitement and reluctance. Excitement at the prospect of sharing with students my passion for my area of practice. Reluctance because reactions often tend to be disapproving: typical responses have ranged from, “All sexual offenders deserve is a bullet to the head,” to the comparatively more moderate (but only comparatively), “How about we just throw away the keys?” A particularly memorable response by a student of social work (a field typically attuned, much more so than psychology at least, to the needs of social outcasts) was: “Fine. Go ahead and be the Robin Hood of sexual offenders if you want to. They’re not worth my time.” (To this day, I still struggle to grasp what exactly this student meant by “Robin Hood of sexual offenders.” I understand the sentiment: in choosing to offer psychotherapy to sexual offenders, I am upholding their right to such services. But what exactly am I stealing from the law-abiding community and giving to sexual offenders?)

Students from the seminar I would be addressing were asked to provide me, in writing and in advance, with some of their questions regarding sexual offender rehabilitation. This would mainly help me gage where in their reflection students were at, but also give me time to come up with replies to any “out-of-left-field” comments. It would, additionally, provide a springboard for discussion during class. In case there would not be enough time, over the course of my lecture, to address all the questions sent to me, I prepared a document, which I handed to students at the end of class, providing answers to each of their questions. Following are the questions—in the end, all of them thoughtful—students posed to me, along with my answers. I reproduce them here as a resource for anyone curious to learn more about the “whys” and “hows” of providing psychotherapeutic services to sexual offender clients.

Q1: It seems that many sexual offenders deny any responsibility for their actions, or confidently justify them. How does a clinician work with that kind of person?

Sexual offenders display varying degrees of resistance* to change and to attempts from others to bring about change in them. In my experience, many individuals convicted of a sexual offense understand they have committed a destructive act and are motivated to behave in such a way as to reduce their risk of re-offending. When resistance is present, however, it can manifest itself in different forms: for instance, a) individuals can altogether deny** they committed a sexual offense, b) individuals can acknowledge some aspects of the allegations made against them, yet contest others, c) individuals can fully accept their guilt, but still hesitate or refuse to find ways to reduce their risk of re-offense.

In working with sexual offenders (or any type of client, really), it is important to remember that resistance is an expected part of the change process, which can be divided into five general stages: precontemplation, contemplation, preparation, action, and maintenance (Miller & Rollnick, 2013; Mitchell, 2012). Individuals in earlier stages of change are more likely to demonstrate resistance (in the form, for example, of denial), and with greater intensity, than individuals in later stages. Since resistance is as much a relational matter as it is an internal one, it is important, in order to avoid sparking or compounding resistance in clients, to tailor one’s interventions to the stage of change they currently are at: namely, individuals at earlier stages of change will benefit from interventions that seek to instigate change (by, namely, shifting their focus from stated problems to possible solutions), whereas individuals at later stages of change will benefit from interventions that help them maintain their commitment to change.

Regarding, specifically, denial in sexual offenders, it is important to remember that this cognitive stance does not generally increase risk of sexual recidivism (Hanson & Bussière, 1998; Hanson & Morton-Bourgon, 2004). (Note, however, that this finding does not apply to individuals who committed intra-familial offenses; Nunes, Hanson, Firestone, & Moulden, 2007.) As such, it is not necessary to target denial in the context of sexual offender therapy. (Even when denial is associated with an increased risk of recidivism, it could prove counterproductive to work toward getting a client to admit to his crimes, especially at the onset of therapy. This will likely serve to increase initial resistance and effectively limit any possibility of progress, not only in regards to taking responsibility, but also to other possibly worthwhile targets.) To put it another way, even though denial may spring from an inner resistance to the idea of pro-social change, it does not necessarily need to be eliminated for actual pro-social change to come about.

It is possible to work on many criminogenic needs (i.e., experiences that can change over time and that are, unlike “non-criminogenic needs,” related to re-offending) without getting clients to admit to their crimes (Marshall, Marshall, Serran, & Fernandez, 2006). With deniers, it is recommended practice for therapists to help clients find which (cognitive, emotional, behavioral, situational) experiences led to their alleged false accusations, with the intention of avoiding these experiences (and any false accusations these may lead to) in the future. Generally, clients will, in the midst of such an exploration, identify experiences that happen to be (if they truly are guilty) criminogenic: for example, “We agreed on a safe word. She says we didn’t, but we did. I wasn’t raping her for real. I’m no sicko. Whatever she says, that’s the God’s honest truth.” In this example, working on diversifying the client’s sexual interests (or, in instances where preferred sexual stimuli are problematic and exclusive, on mourning one’s sexuality) will be worthwhile for the client, whether his innocence is factual or not. Should the client really be innocent, avoiding situations where misunderstandings about consent are more likely to occur (e.g., S&M play) will help him reduce his risk of once again falling victim to false allegations. Should he really be guilty, avoiding situations where another person willingly hands power over to him (thinking he is worthy of his or her trust) will help him reduce the risk of once again mishandling that power over the course of such a situation.

Q2: Does sexual offending have a strong biological component similar to other forms of psychopathology such as bipolar disorder or schizophrenia? For example, if someone is a sexual offender, are their children more likely to engage in the same behavior when they get older? If so, what is the treatment prognosis?

This is an interesting question, one I believe will be best answered by acknowledging and addressing the different assumptions that seem to underlie the question.

Assumption #1: Sexual offending is a form of psychopathology.

Assuming that psychological processes can be pathological (see Assumption #5), sexual offending may or may not involve mental illness. The tendency to commit sexual offences is not, in and of itself, considered a mental illness. In this sense, sexual offending cannot be considered (again, in and of itself) a form of psychopathology. One could say, however, that the tendency to commit sexual offences involves psychopathological processes, in the form, namely, of deviant sexual interests (e.g., pedophilia). It is important to keep in mind, however, that not all sexual offenses are motivated by unusual sexual interests (Langevin, Lang, & Curnoe, 1998).*** (Likewise, not all individuals who exhibit unusual sexual interests commit sexual offenses; Hall, Hirschman, & Oliver, 1995; Williams, Cooper, Howell, Yuille, & Paulhus, 2009.)

Assumption #2: Sexual offending and other behaviors generally considered to be inappropriate (e.g., bipolar and schizophrenic modes of behavior) are more biologically determined than behaviors generally considered to be appropriate (e.g., prosocial, “unipolar,” and “uni-phrenic” modes of behavior).

It is important to keep in mind that all modes of behaving, whether considered appropriate or inappropriate by society, are founded in biology. While there is a tendency in the literature to only summon biological explanations when discussing inappropriate behavior, and to assume that appropriate behaviors come about spontaneously, as if materializing out of God’s breath itself, there is no reason to believe that appropriate behaviors are not similarly governed by biological rules and processes. For this reason, I find the following question equally fascinating: “Does non-criminal behavior have a strong biological component similar to other forms of psychological functioning, such as bipolar or schizophrenic behavior?” It is also important to remind ourselves that the exact role of biology (to say nothing of whether the processes involved can best be described as “disordered” or “pathological”) in behaviors commonly referred to as mental illness has been greatly overstated. The American Psychiatric Association itself, in its research agenda for the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders, rather candidly admitted that “the field of psychiatry has thus far failed to identify a single neurobiological phenotypic marker or gene that is useful in making a diagnosis of a major psychiatric disorder” (Kupfer, First, & Regier, 2002, p. 33). So premature are, namely, neuropsychologists’ conclusions regarding the neurological underpinnings of behaviors referred to as mental illness, that certain critics of psychology (e.g., Bentall, 2004; Greenberg, 2010) have likened modern neuropsychology to phrenology.

Assumption #3: The level to which a behavior is biologically determined will determine the likelihood at which it can be altered.

This is an interesting assumption that I am not certain science, in its current state, can corroborate. There is, however, a variation that can be addressed: biologically determined behaviors are necessarily resistant to intervention. This assumption starts crumbling to pieces if we conceptualize all human behavior as being (at least in part) biologically determined. Yes, behaviors like heterosexuality and religious belief, both of which presumably involve some biological processes, are very resistant to change. Yet, other behaviors, like vocational interests and emotional infatuations, both of which also presumably involve some biological processes, are known to be amenable to change (often without intervention).

Practically speaking, clinical psychologists working with sexual offenders do not ask, “How much is my client’s behavior due to biology?” when attempting to assess their amenability to change. Rather, they ask, “How likely is my client to re-offend in the future?” Indeed, amenability to change appears related to sexual offenders’ risk of sexual recidivism. (That is not to say, of course, that one’s level of risk is not, to some extent, rooted in biology.) More precisely, higher-risk offenders will benefit from rehabilitation more so than lower risk offenders; for low-risk offenders, rehabilitation may even increase risk of recidivism. (Although these findings are generally discussed in regards to “general” offenders [Andrews & Bonta, 2010], they seem to extend to sexual offenders as well [Lovins, Lowenkamp, & Latessa, 2009].) Regarding those sexual offenders who express inappropriate sexual interests, some behavioral methods exist (e.g., covert association, directed masturbation, masturbatory reconditioning, verbal satiation) to extinguish such interests and to reinforce more appropriate ones. These methods, however, possess varying degrees of empirical support (Marshall, Anderson, & Fernandez, 1999).

Assumption #4: Sexual offending behavior can be passed down from one generation to the next via genetic transmission.

In actuality, many dispositional and environmental factors (not to mention social norms) combine to create a moment between two individuals that comes to be described as sexual offending. While certain traits or tendencies involved in sexual offending (e.g., sexual interest in children) can be believed to be passed down from generation to generation, it is hard to conceptualize how sexual offending as a whole could be transmitted from one generation to the next, as if constituting some unique physical entity singly represented in one’s biology by a specific set of genes. Regarding inadequate sexual interest specifically, research suggests that sexual interest in children is mainly determined by one’s environment (Alanko, Salo, Mokros, & Santtila, 2013), a finding similar to that for adequate sexual interest (e.g., homosexuality; Santtila, Sandnabba, Harlaar, Varjonen, Alanko, & von der Pahlen, 2007). That is not to say, of course, that biology (simply in a form other than genetics) is not involved somehow, or that sexual offenders with pedophilic interests experience any sense of choice in their desire to engage in sexual activity with children (similarly to individuals with teleiophilic interests).

Assumption #5: Behavior can be “pathological.”

The idea that mental illness is real represents the most commonly made assumption in the entire field of clinical psychology, not to mention psychiatry. While it may appear to be self-evident, there are a number of philosophical and scientific objections to the notion that mental illness exists. (That is not to say, of course, that the behaviors referred to as mental illness do not exist [although the means via which these behaviors are categorized may be flawed] or that they are necessarily the product of human volition.) Interestingly, most of these objections, leveled by psychologists and psychiatrists alike, have and continue to come from within our field. (Arguments range from “mental illness is a metaphor” to “unlike physical illness categories, mental illness categories circularly mistake description for explanation.”) Entire books have been filled with these objections, and so I cannot hope to do justice to any of them in the space of a few short paragraphs. For those interested in finding out more on the subject, I have taken care to list a few seminal titles in the “Suggested Readings” section of this document, books that have greatly influenced my philosophy as a professional helper. Mainly, my philosophy manifests itself linguistically: I make special efforts to avoid using medical language when describing and explaining human misbehavior, preferring instead to use humanistic language, which possesses the dual advantages of a) being more parsimonious than its alternatives (i.e., not only medical, but also religious and romantic language) and of b) acknowledging the human experiences that exist behind many of the behaviors psychiatry dismisses as symptoms.

Assumption #6: Inappropriate behaviors can be “cured” with “treatment,” and have different “prognoses.”

This assumption flows from the previous one. If misbehaviors can be diseases, then they can also be “cured” with “treatment,” and have different “prognoses.” If misbehaviors are simply misbehaviors, however, medical terminology like “cured,” “treatment, and “prognosis” is inappropriate to describe the actions of those who seek to alter the misbehaviors in question, as well as to describe the course these misbehaviors adopt across time (with or without the influence of the actions of those who seek to alter them). Let me elaborate: Much in the same way what we refer to as mental illness has very little to do with physical illness, what we refer to as psychological treatment has very little to do with medical treatment (rendering the usage of the term “illness” or “treatment” in both instances misleading). What we describe as treatment in psychology is, in actuality, a relational enterprise (Szasz, 1988) that shares more in common with conventional forms of communication than it does with medical intervention: words and other symbols, combined with our ability to reason and reflect, are harnessed in the service of deciphering life challenges and developing the skills needed to overcome them.

How effective are psychological interventions at getting individuals to stop committing sexual offenses? Research has shown that psychological interventions are able to effectively reduce risk of sexual recidivism. To be effective, however, interventions must be based on what is known as the Risk-Need-Responsivity (R-N-R; Andrews & Bonta, 2010) model of offender rehabilitation: in other words, level of risk, criminogenic needs, and level of receptivity to intervention must all be taken into account when attempting to help sexual offender clients commit to a pro-social lifestyle (Hanson, Bourgon, Helmus, & Hodgson, 2009). Interventions should also abide by contemporary, empirically supported (e.g. cognitive-behavioral) principles (Andrews & Bonta, 2010; Hanson, Gordon, Harris, Marques, Murphy, Quinsey, & Seto, 2002).

Q3: Based on your experience, what do you feel are the greatest barriers to successful treatment for sexual offenders? Are the barriers related more so to external factors such as stigma and lack of access to adequate resources or are they related more so to factors involving the offender’s personality/mental health?

There are many forces, internal and external, that conspire to thwart a sexual offender’s efforts to lead a pro-social life, even when the person in question is highly motivated to do so. Fear and anger from the community (e.g., strangers, family, policy-makers, case management team members), compounded by poor knowledge of the literature on sexual offending (embodied in the form of the uniquely American notion of the mythical sexual predator), often lead to measures being taken that poorly balance a) the community’s legitimate needs for protection from harm and for revenge with b) the offender’s need to live a pro-social life (and, thus, become less of a danger to the community). In fact, while many of these measures successfully satisfy our needs as a community, they do so at the expense of offenders’ rehabilitative process, by self-defeatingly limiting these individuals’ ability to access pro-social experiences and even exacerbating particular risk factors (e.g., social rejection). In sum, we owe it to ourselves and to the sexual offenders in our communities to find a middle ground, one that takes into account our needs for protection from harm and for revenge, without producing the very circumstances we wish to avoid (i.e., by thwarting sexual offenders’ efforts to become pro-social).

Permit me a brief tangent. Certainly, fear and anger are legitimate responses to sexual offending. It is essential to our humanity, however, that we do not debase ourselves in moments of despair by acquiescing to our basest instincts and by letting these animalistic drives guide our behavior as we attempt to regain control over the situation. To summon compassion for sexual offenders is a challenging endeavor, I concede. If we are to pride ourselves as compassionate beings, however, we owe it to ourselves to attempt to offer compassion to those who ignite our ire. To put it bluntly, if we are only able to feel compassionate toward starving orphans or three-legged dogs, then the very concept of compassion becomes rather hollow and meaningless, to say nothing of our impression of ourselves as benevolent individuals.****

To those who can never see themselves mustering any compassion whatsoever for rapists or child molesters, it is important to remember that, even if we harden our hearts to the personal challenges of sexual offenders, the cost of overly restrictive offender management initiatives to the rest of us “law-abiding folks” remains potentially damaging (as mentioned previously) and should still be opposed, if only for our own sake.

A more internal barrier to change in sexual offenders is shame. Most sexual offenders understand that they have committed a destructive act, a realization that naturally produces shameful feelings in them. Some individuals seek to protect themselves from this uncomfortable emotional experience by resorting to less-than-ideal strategies, like “cognitive distortions” or, more appropriately and less presumptuously, problem thoughts (e.g., minimization, victim-blaming). While it may be tempting (especially to the strict cognitive-behavioral therapist) to immediately seek to replace problem thoughts with less damaging alternatives, this can be a mistake. It is important to understand that problem thoughts often represent defenses, and that defenses are, by their nature, protective. As such, it will often prove quite fruitless to try to eliminate problem thoughts when the experiences clients are seeking to defend themselves against (via these thoughts) remain threatening to them. For this reason, when problem thoughts are defensive, it is best to focus on, say, emotion management, before attempting “cognitive restructuring.”

While some problem thoughts are meant to protect us from feelings stemming mainly from our past, others are meant to protect us from feelings stemming from our future (or, more accurately, what we imagine our future to be). “It is perfectly acceptable for adults to have sexual relationships with children” may represent one such thought. Given the inflammatory nature of such a statement, many therapists would be quick to attack it. Again, while it may be tempting to immediately argue with an offender about the legitimacy of his belief, such a conversation might be less than productive if the subjective purpose of his belief is to permit (in the face of doubts as to the feasibility of having a satisfactory relationship with an adult) for the possibility of having one’s needs for intimacy met in the future. In this instance, only once the offender becomes confident in his ability to meet his intimacy needs within the context of an adult relationship will he become open to replacing his problem thought with a more constructive one.

Even when an offender has learned how to “navigate” his shame without feeling threatened and defensive, shame can still weigh heavily on him and limit his ability to commit to a new, pro-social lifestyle: “Look at what I’ve done. I’m a piece of shit. Scum like me doesn’t deserve friends.” One way to render shame less incapacitating is to interpret such feelings as painful indicators of clients’ humanity, of the intactness of their moral compass. (After all, they wouldn’t be feeling shameful if they thought what they did was right.) This “re-framing” of shame can be transformative for clients, bringing into perspective a moral foundation upon which to build their new life. (Once a given client has made this realization, he would also be encouraged to think about what caused him to disregard his moral compass at the time of his offense, so as to help him prevent any further deviations from his moral center in the future.) In sum, even if shame is not, in and of itself, criminogenic, it is crucial that it be recognized and addressed in therapy with sexual offenders, in that it can give rise to and maintain behaviors that are criminogenic, not to mention keep pro-social behaviors at bay.

Q4: My question is in relation to the process of treatment. Is it particular personality traits that guide you to determine treatment? Do you begin treatment focusing on the urge/impulsivity issues and work your way from there? What factors determine your treatment method?

The first part of the rehabilitative process is to assess the sexual offender’s risk of re-offense. This process highlights a number of factors that serve to increase the individual’s risk of committing a new sexual offense over the course of several, pre-determined periods in the future. Some of these factors are considered static (or historical, and thus mostly unalterable through intervention; Hanson & Thornton, 2000), whereas others are considered dynamic (or changing in time, and thus alterable through intervention; Hanson, Harris, Scott, & Helmus, 2007). Rehabilitation targets those risk factors that are considered dynamic. (Since dynamic risk factors are synonymous with criminogenic needs, this approach at rehabilitation is known as the need model). There are two types of dynamic risk factors: acute dynamic factors change rapidly across time and risk bringing about a sexual re-offense in the immediate short term (e.g., access to potential victims), whereas stable dynamic factors change slowly across time and risk bringing about a sexual offense in the longer short term (e.g., hostility toward women). Unless acute dynamic risk factors are present, rehabilitation will focus on eliminating, or a the very least decreasing, the influence of stable dynamic risk factors.

It can also be helpful, during the course of therapy, to identify, along with the client, the positive experiences (e.g., autonomy, intimacy, belonging) he was attempting to create for himself prior to and during his sexual offence. (This approach is known as the Good Lives model; Yates, Prescott, & Ward, 2010.) These valued experiences are known as “primary goods.” After validating the innate legitimacy of these experiences, the therapist should help the client (among other objectives regarding what is known as the “Good Lives plan”) find methods of achieving these same experiences in the future, this time without moving toward or engaging in sexual offending. These methods (whether constructive or not) are known as “secondary goods.” Because dynamic risk factors promote the use of inappropriate secondary goods (in the form of sexual offending), can themselves represent inappropriate secondary goods (by virtue of their risk properties), and can prevent clients from meeting primary goods not already embedded in their offense chain (up to and during their sexual offense), work on primary and secondary goods is complimentary to work on dynamic risk factors.

Finally, the therapist should help the client identify the goals, in regard to future offending, that he set for himself prior to actually committing his offense, as well as the manner in which he went about achieving these goals. (This approach is known as the self-regulation model; Yates, Prescott, & Ward, 2010.) There are several goal-manner combinations, also known as “pathways” to sexual offending. Prior to his offense, the client may have a) wished to avoid offending, but failed to implement any strategies to accomplish this (“avoidant-passive pathway”), b) wished to avoid offending, but implemented ineffective strategies to accomplish this (“avoidant-active pathway”), c) wished to offend and done so impulsively (“approach-automatic pathway”), or d) wished to offend and done so in an involved and strategic manner (“approach-explicit pathway”). Notice that, in each of these scenarios, the client either regulated improperly (by not at all attempting to control his behavior, or by attempting to do so, but ineffectively) or regulated properly (by attempting to control his behavior, and doing so effectively) toward his stated goal, which was either pro- or anti-social. Thus, the nature of the therapeutic conversation will vary depending on where exactly the problem lies: the problem may lie in the client’s goals or in his ability to regulate toward these (or in both). If the client’s stated goals are problematic, then the therapist will want to gear the therapeutic conversation toward replacing the client’s intentions with less problematic ones. Likewise, if the client’s ability to regulate toward his goals is problematic, then the therapist will want to gear the therapeutic conversation toward improving self-regulation (by curbing passive or automatic tendencies, and/or by developing goal-directed decision-making). Because dynamic risk factors and primary/secondary goods interact with sexual offenders’ goals regarding future offending and with the manner in which they accomplish these goals, work on goal-selection and self-regulation is complimentary to work on dynamic risk factors and primary/secondary goods.

Q5: How does building a strong therapeutic alliance with sexual offenders differ from the average non-sexual offender and from the general population?

Psychotherapy with sexual offenders poses particular challenges to therapeutic alliance that are generally absent or less intensely present in therapy with non-sexual offenders or the general population. Challenges to therapeutic alliance in the context of sexual offender therapy usually originate in the following order, first from within the therapist, then from within the context inside which the therapeutic relationship must unfold, and subsequently from within the client: (1) Sexual offenders have committed crimes that can sometimes elicit intense emotions like disgust or anger in the therapist, emotions that, while entirely appropriate, can easily thwart one’s ability to relate (both internally and externally) constructively with clients. (2) While some sexual offenders volunteer for psychotherapy, therapy is most often mandated. Also, the same level of confidentiality afforded to clients in non-correctional therapy cannot, for security purposes, be afforded to clients in correctional therapy. As such, sexual offenders’ motivation to invest in therapy (and any component thereof) can be very low. (3) Given the shameful nature of their crimes, sexual offenders are likely to erect various defenses within therapy, to protect themselves from the therapist’s judgment, and, ultimately, their own. This defensive tendency is compounded by sexual offenders’ common inability to interact with others in constructive ways. (Interestingly, some practitioners conceive of sexual offending as mainly a relational problem, as opposed to a sexual one.) Since all of the aforementioned experiences tend to materialize at the onset of therapy, it is important to intervene, from the very first session on, in such a way as to prevent these states of mind from crystallizing and impacting, in counterproductive fashion, the course of therapy.

To develop therapeutic alliance with sexual offenders, it can be helpful to: a) trigger one’s ability to empathize by focusing not on the client’s crime, but on the person who committed the crime, their regrets, their fears and their hopes (however suppressed or otherwise protected these may be), all of which can be rallied in service of rehabilitation, b) earn the client’s collaboration by recognizing the fact that they must attend therapy, by being forthright about the limits imposed on confidentiality, by acknowledging their (possible) reluctance to attend therapy as a function of these contextual issues, and by together finding ways to make the therapeutic hour, despite its mandatory nature and its limited confidentiality, helpful to the client, c) validate the positive experiences (e.g., connection) the client was attempting to create for himself when he engaged toward a sexual offence, and explain that, while the manner in which he sought to achieve these experiences was less than ideal, the desired experiences themselves were wholly legitimate, d) adapt one’s interventions to the stage of change the client is currently at (i.e., precontemplation, contemplation, preparation, action, or maintenance). By instilling a humane climate endowed with patience, understanding, and non-judgment, most often these methods will help to strengthen the therapeutic alliance, and to increase clients’ motivation to commit toward change through therapy.

Q6: According to Conroy (2003), “females who perpetrate against children constitute a very small percentage of sex offender population” (p. 475). What types of sexual offenses are women most likely to commit? Has research identified why women sexually offend less, especially against children? What makes them different than men? How do their special needs that differ from the needs of male sexual offenders impact treatment?

My clinical experience is limited to working with male sexual offenders, and so I am not very familiar with the literature on female sexual offending. What I do know, however, is that there is very little research available, at present, on the subject of women who perpetrate sexual crimes. For this reason, there are very few guidelines regarding how to properly assess and reduce the risk of re-offense in female sexual offenders. Regarding differences between female and male sexual offenders, it appears that female sexual offenders re-offend less often (Cortoni, Hanson, & Coache, 2010), and that the factors involved in their re-offending are different (Sandler & Freeman, 2007). On a practical note, until more is known on the causes (or, at the very least, the correlates) of sexual offending in women, I would suggest using what is currently known about male sexual offending as a template when working with female sexual offenders, while, of course, carefully keeping in mind the empirical limitations of this template.

Notes

* I use the term “resistance” not in a psychoanalytically dismissive way, but to describe that aspect of consciousness that is opposed to change—an aspect that may exist on its own, or that may be counterbalanced with openness to change. (The experiential blend of opposition and openness to change is typically referred to as “ambivalence.”)

** For the purposes of this answer, I am using the term “denial” (or any derivative of the term, e.g., deny, denier) in its categorical, all-or-nothing sense. (Certain definitions of the term will accommodate partial acknowledgement of the subject of denial.)

*** This is also implied by the possibility of assigning a given sexual offender a score of “0” on the “Deviant Sexual Preference” row of the STABLE-2007, a measure of sex-offender specific criminogenic needs (see Fernandez, Harris, Hanson, & Sparks, 2012, for coding rules).

**** This tangent was brought to you by the philosophies of Viktor Frankl, psychiatrist and author of Man’s Search for Meaning (1946), and of Paul Gilbert, psychologist and founder of Compassion Focused Therapy (see Gilbert, 2009, for an outline of the approach).

References

Alanko, K., Salo, B., Mokros, A., & Santtila, P. (2013). Evidence for heritability of adult men’s sexual interest in youth under age 16 from a population-based extended twin design. The Journal of Sexual Medicine, 10, 1090–1099.

Andrews, D. A., & Bonta, J. (2010). The psychology of criminal conduct (5th edition). New Providence, NJ: LexisNexis.

Bentall, R. (2004). Madness explained: Psychosis and human nature. Toronto, ON: Penguin Books.

Conroy, M. A. (2003). Evaluation of sexual predators. In A. M. Goldstein & I. B. Weiner (Eds.), Handbook of Psychology, Volume 11: Forensic Psychology (pp. 463–484). Hoboken, NJ: John Wiley & Sons, Inc.

Cortoni, F., Hanson, R. K., & Coache, M.-E. (2010). The recidivism rates of female sexual offenders are low: A meta-analysis. Sexual Abuse: A Journal of Research and Treatment, 22, 387–401.

Fernandez, Y., Harris, A. J. R., Hanson, R. K., & Sparks, J. (2012). STABLE-2007 coding manual (revised 2012). Ottawa, ON: Public Safety Canada.

Frankl, V. E. (2006). The search for meaning. Boston, MA: Beacon Press. (Original work published 1946)

Gilbert, P. (2009). The compassionate mind: A new approach to life’s challenges. Oakland, CA: New Harbinger Publications.

Greenberg, G. (2010). Manufacturing depression: The secret history of a modern disease. Toronto, ON: Simon & Schuster.

Hall, G. C. N., Hirschman R., & Oliver, L. L. (1995). Sexual arousal and arousability to pedophilic stimuli in a community sample of normal men. Behavior Therapy, 26, 681–694.

Hanson, R. K., Bourgon, G., Helmus, L., & Hodgson S. (2009). A meta-analysis of the effectiveness of treatment for sexual offenders: Risk, need, and responsivity. Ottawa, ON: Corrections Research, Public Safety Canada.

Hanson, R. K., & Bussière, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348–362.

Hanson, R. K., Gordon, A., Harris, A. J. R., Marques, J. K., Murphy, W., Quinsey, V. L., & Seto, M. C. (2002). First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders. Sexual Abuse: A Journal of Research and Treatment, 14, 169–194.

Hanson, K. R., Harris, A. J. R., Scott, T.-L., & Helmus, L. (2007). Assessing the risk of sexual offenders on community supervision: The Dynamic Supervision Project. Ottawa, ON: Corrections Research, Public Safety Canada.

Hanson, K. R., & Morton-Bourgon, K. (2004). Predictors of sexual recidivism: An updated meta-analysis. Ottawa, ON: Public Safety and Emergency Preparedness Canada.

Hanson, R. K., & Thornton, D. (2000). Improving risk assessments for sex offenders: A comparison of three actuarial scales. Law and Human Behavior, 24, 119–136.

Kupfer, D. J., First, M. B., & Regier, D. A. (Eds.) (2002). A research agenda for DSM-V. Washington, DC: American Psychiatric Association.

Langevin, R., Lang, R. A., & Curnoe, S. (1998). The prevalence of sex offenders with deviant fantasies. Journal of Interpersonal Violence, 13, 315–327.

Lovins, B., Lowenkamp, C. T., & Latessa, E. J. (2009). Applying the risk principle to sex offenders: Can treatment make some sex offenders worse? The Prison Journal, 89, 344–357.

Marshall, W. L., Anderson, D., & Fernandez, Y. (1999). Cognitive behavioural treatment of sexual offenders. Toronto, ON: John Wiley & Sons, Ltd.

Marshall, W. L., Marshall, L. E., Serran, G. A., & Fernandez, Y. M (2006). Treating sexual offenders: An integrated approach. New York, NY: Routledge.

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd edition). New York, NY: The Guilford Press.

Mitchell, C. W. (2012). Effective techniques for dealing with highly resistant clients (2nd edition). Publisher: Author.

Nunes, K. L., Hanson, R. K., Firestone, P., Moulden, H. M., Greenberg, D. M., & Bradford, J. M. (2007). Denial predicts recidivism for some sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 19, 91–105.

Sandler, J. C., & Freeman, N. J. (2009). Female sex offender recidivism: A large-scale empirical analysis. Sexual Abuse: A Journal of Research and Treatment, 21, 455–473.

Santtila, P., Sandnabba, N. K., Harlaar, N., Varjonen, M., Alanko, K., & von der Pahlen, B (2007). Potential for homosexual response is prevalent and genetic. Biological Psychology, 77, 102–105.

Szasz, T. (1988). The myth of psychotherapy: Mental healing as religion, rhetoric, and repression. Garden City, NY: Syracuse University Press.

Williams, K. M., Cooper, B. S., Howell, T. M., Yuille, J. C., & Paulhus, D. L. (2009). Inferring sexually deviant behavior from corresponding fantasies: The role of personality and pornography consumption. Criminal Justice and Behavior, 36, 198–222.

Yates, P. M., Prescott, D., & Ward, T. (2010). Applying the Good Lives and Self-Regulation models to sex offender treatment: A practical guide for clinicians. Brandon, VT: The Safer Society Press.

Suggested Readings

Note: This section appeared as an appendix to the Q&A handout.

i) General readings in offender psychology

Making Good: How Ex-Convicts Reform and Rebuild Their Lives (Maruna, 2000)
The Psychology of Criminal Conduct (Andrews & Bonta, 2010)
Rehabilitation (Ward & Maruna, 2007)
The Criminal Recidivism Process (Zamble & Quinsey, 2001)

ii) Sexual offender assessment and rehabilitation

Applying the Good Lives and Self-Regulation Models to Sex Offender Treatment: A
Practical Guide for Clinicians (Yates, Prescott, & Ward, 2010)
Cognitive-Behavioral Treatment of Sex Offenders (Marshall, Anderson, & Fernandez, 2006)
Desistance from Sexual Offending: Alternatives to Throwing Away the Keys (Laws & Ward, 2011)
Rehabilitating Sexual Offenders: A Strength-Based Approach (Marshall, Marshall, & Serran, 2011)
Sexual Deviance: Issues and Controversies (Ward, Laws, & Hudson, 2002)
Sexual Deviance: Theory, Assessment, and Treatment (Laws & O’Donohue, 2008)
Treating Sex Offenders: An Integrated Approach (Marshall, Marshall, Serran, & Fernandez, 2006)

iii) Issues in clinical psychology

This is only a sample of titles from a wide and varied body of literature critically evaluating some of psychology and psychiatry’s most popular assumptions:

The Cult of Personality Testing: How Personality Tests Are Leading Us to Miseducate Our Children, Mismanage Our Companies, and Misunderstand Ourselves (Paul, 2004)
Doctoring the Mind: Why Psychiatric Treatments Fail (Bentall, 2010)
House of Cards: Psychology and Psychotherapy Built on Myth (Dawes, 1996)
Madness Explained: Psychosis and Human Nature (Bentall, 2004)
Manufacturing Depression: The Secret History of a Modern Disease (Greenberg, 2010)
The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (Szasz, 1974)
The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric, and Repression (Szasz, 1988)

iv) General readings in clinical psychology

Effective Techniques for Dealing with Highly Resistant Clients (Mitchell, 2012)
Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013)

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