Treating Mentally Ill Pedophiles with RESPECT_(TM)

Editors note: The purpose of this article is to provide an overview of a very interesting new group therapy approach to treating pedophiles who are mentally retarded, have mental illness, and/or have physical handicaps. It is my hope that reading this will whet your appetite for more information about this treatment approach. If you should find yourself hungering for more information once you finish reading this, a more thorough description and explanation of the treatment program can be found in an upcoming article by Tom Keating, the originator of the program. You can also contact Tom directly at the address and/or telephone number included at the end of this article.

The RESPECT _(TM) SYSTEM is a 7-step treatment system that relies on concrete, repetitive interventions involving kinesthetic actions that can be activated with one word. The system addresses issues of denial, empathy for the victim, and low self-esteem through group interaction. It also helps the client incorporate a plan that helps him dynamically evaluate changes in behavior as progress and skills are learned. The client gradually develops an internalized system of responsible behavioral choices that eventually empower him to trust himself to behave appropriately out in the community. The name for the system, RESPECT, is an acronym that represents each step a client must take in his profound and powerful struggle to transcend the scars of his life on the journey back to trust in himself, and trust received from the community.

When a new member first joins the group, he is given a R-E-S-P-E-C-T card to carry in his wallet. The card identifies each of the program steps by name, and the print is raised so it provides tactile feedback. The new member can also choose to purchase a laminated R-E-S-P-E-C-T card for $7.00. As he completes each step, he is refunded $1.00. In that way by the time he completes the final step he has earned back his original $7.00. This provides the client with concrete feedback on his progress and makes the point that he has invested in his own future by progressing through each step of the program. The card also indicates membership in a common group. He now belongs somewhere where he is no longer alone with his problems.

When an individual first enters the sex offender group the last thing he expects to get is respect. But since we are trying to teach respect for others, we must also show respect, especially for members of the group. Therefore, when an individual fir st enters the sex offender group, one of the first things the therapist does is stand in front of him and say, "I'm now going to give you respect. You can choose or not choose to participate. The choice is yours."

The leader then bows to each man in the group, and each man can choose or not choose to return the gesture. This ritual provides concrete, visual, and kinesthetic experiences related to being respected, and giving respect. Eye contact is necessary. The bow, borrowed from kung fu, is accompanied by unique set of words, "Ko-day, Ko-da, Ko-dee. Thank you," which add to the impact of the act and help make it special. Participation in the bowing ritual makes a person vulnerable in a s afe place and in a safe way. Allowing yourself to be vulnerable, if only for a moment, helps develop trust in the group.

A comment I have often heard goes something like this, "I saw the kid. She was looking at me, and I remembered the bow. I walked away. I showed her respect." After each individual bows, the whole group participates and gives the group and the indiv idual who led the ritual respect.

Perpetrators minimize, avoid discussion, evade, believe their victims seduced them, are victimized by their own delusional system, and have extreme difficulty verbally admitting their offenses. In short, they are heavily into denial. The first step i n the RESPECT_(TM) stairway is Reality. Perpetrators are encouraged to take responsibility for their behavior.

At the beginning of each group session the group picks a leader. If no one volunteers, the therapist becomes the leader and leads the discussion about what reality means. Leadership is a position of responsibility and carries with it a certain amount of self-worth.

The leader sets an example and has to state why, specifically, he is in the group. He is required to describe his offense, in detail, and own it. He cannot use words that suggest innocence. People in these groups have experienced little but powerles sness throughout their whole life. The position of leader provides them with perhaps one of the first opportunities they have ever had to be noticed and recognized as someone of worth. A possible chance for these men to be a step above others can often crack the denial of offense.

Empathy is concerned with aligning one's state of mind with another's in order to commune rather than communicate, and in order to expand the interactive repertoire between the participants rather than transmit knowledge of one to anot her.

We explore sexual abuse always in the context of the client's victim. Sometimes there is an epiphany. "Oh, yeah. Wow. That's how the kid felt." We introduce role-play at this step. It is not unusual for a client's own sexual abuse to surface when exploring the concept of empathy.

The Self-esteem step is a step of celebration. Group members who are new to this step celebrate their courage for taking the first two steps in the program. On this step, we build on an individual's strengths in order to move on up t he stairway to recovery.

This is also the step where we try to activate and stimulate as many of the senses and the seven intelligences as possible in the hopes of accelerating learning. Classical music is played. Flowers are placed on a table along with different kinds of f ruits, cake, coffee, soda, and so on. We surround the group with soothing sounds and attractive smells, colors, and tastes. We make the member's attainment of this step memorable, enjoyable, and something to be proud of.

The group discusses the individual's personal strengths, and he is told that he can succeed at things. The member can see, hear, smell, and taste success. Isolation is broken down for socially acceptable reasons. Other members still on the Reality s tep or Empathy step may develop the desire to move up the stairway in order to achieve this step themselves. If this person can do it, why not them?

Before the group ends for the day, I have the person who has just attained this step of Self-esteem bend over and really smell the flowers up close. The sense of smell is a powerful reinforcer. It is non-verbal and immediate. After the client smells the flowers I ask if he wants to take them back to where he lives. Most often the client will say, "No. They'll think I'm crazy." This demonstrates another aspect of this step -- increased cognitive dissonance. Cognitive dissonance serves several pur poses in this system. It makes experiences memorable, for one thing. It can also shake a person up and make him look at his life and actions from a different perspective. Complacency is the enemy of progress when working with this clientele.

There is also work to be done on this step. This is, for example, the opportunity to explore the first time they started feeling guilty when something, supposedly good and enjoyable, was happening. We eventually try to explore forgiveness of self, an d moving on. Without self-forgiveness there can be no hope. Without hope there can only be recidivism.

The fourth step of the RESPECT_(TM) System is to develop a Plan of how to deal with thoughts of abusing children. Clients develop their own individualized plans, but the first step in each plan begins with the thought of a child. A notebook is provided the client, with a RESPECT card placed on its cover. In the notebook the client writes his plan. After writing his plan, a time is chosen for the client to present his plan to the group for their discussion a nd approval. At this point the plan is written on the blackboard for all to see. Some plans involve such simple actions as snapping an elastic band that is worn on the client's wrist whenever thoughts of a child come into the client's mind. Other clien ts have ammonia tabs that they snap under their nose at the first thought of a child. Other plans have been more elaborate or creative.

At least one plan is Evaluated, in depth, weekly. Sometimes plans are added to in group discussion. When Bob has a thought of a child he thinks about the dentist. As an added cue, we have added the sound of drills to his mental imag e of the dentist. "I don't even look at kids anymore," he says. Less is sometimes more, however. The less complicated, and intrusive, the more effective a plan can be.

At the end of each session everyone is reminded to use their plan. Repetition is crucial. New habits are formed by performing rituals such as the Respect Bow.

It is important for the therapist not to threaten or coerce participation in the group. Always allow the client to make choices. The perpetrator needs to know he is in control of his life. That way, when he eventually makes his way up to the trust s tep, he will have had the opportunity to practice the skills he will need in his community to make responsible decisions and take responsible actions. The therapist's role is primarily to offer the perpetrator opportunities to take control of his life.

At this step we try to create concrete experiences that symbolize the client's past offending behavior. Clients are asked to bring in tools that they use on a daily basis to help make this step personally meaningful. For example, dirt might be dumped on the floor, symbolizing the client's past behavior. Broken glass might be mixed in with it, symbolizing a child's pain that result from such behavior. Then the client might be asked to take a broom and dust pan that he uses on a daily basis and clean up the mess he has made with his own hands.

The individual is allowed to choose or not choose to clean the floor. If he does clean up, he goes to the sink or bathroom and washes his hands with soap and comes back to the group. He then gets to discuss what this exercise meant to him and what ha s to be done to move to the trust step. If he refuses to participate he doesn't move to the next step. This step, like all of the other steps, can cause significant anxiety and discomfort.

Trust is the ultimate step on the RESPECT stairway. The client on the Trust step describes to the other members of the group who are still climbing the stairway what it is like to be living with Empathy, using his Plan, making Choices , and earning the Trust of himself and of others in his community on a daily basis.

It is possible to lose the Trust step and be moved back down the stairway. However, losing this step frequently proves to be a powerful motivator for clients not to reoffend. Perpetrators who reach the Trust step also should have learned that the les sons of the RESPECT_(TM) System are only useful if they are used on a daily basis. Clients who reach this step are told that there is never a cure for pedophilia. There is only trust that is earned and reearned one day at a time .

Thomas P. Keating II, MA, LCSW, RT. 978-343-6957. Tom is a senior clinician in the BUDD Program at the Lipton Center, 255 Main, Fitchburg, MA USA 01420. He works with mentally retarded, emotionally disturbed and physically handicapped adults in a day treatment facility. Illustrations by Sue Donahue, Worcester, MA.

Keating, T.P. (In press). RESPECT_(TM): A 7 step system to treat pedophiles who are mentally retarded, have mental illness, and physical handicaps. Journal of Psychology and Human Sexuality.

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