Hypnotherapy and Sexual Offenders: The First Steps Towards Empathy and Healing.

People who commit sexual offenses are severely ostracized and isolated in today's society. In the prison systems, as self-reported by numerous offenders I counseled, a sexual offense is recognized as the lowest form of criminal activity, apparently lower than a serial killer, murderer, shoplifter, bank robber, etc. In fact, every offender I have treated in the past seven years has reported that they lied in prison or jail about the crime they committed for fear of death. Research has established that, among criminals, sexual offenders are best at denial. Marshall (1990) estimated that 80% of offenders initially deny. Most experts, in the field, would agree that successful treatment of sex offenders begins with disclosure. We must ask ourselves how does treatment ever begin when disclosure may result in the loss of life? Contrary to what is commonly assumed, sexual offenders who deny their offenses are no higher risk than offenders who admit (Hanson & Bussiere, 1996).

Empathy is the capacity to understand and identify with another's perspective (Cronback, 1955) and the capacity to experience the same emotions as another (Clore & Jeffrey, 1972). As sexual offender therapists, our primary treatment goal is for the offender to develop victim empathy with approximately 94% of all treatment programs employing "empathy-enhancing interventions" (Knopp, Freeman-Longo, & Stevenson, 1992). We must now ask ourselves how can an offender have empathy for something he can't disclose? Although the research states that there is no cure for sexually deviant behavior, other than maintenance and prevention, I have found that utilizing traditional Cognitive Behavioral Therapy (CBT) in conjunction with Heart-Centered Hypnotherapy (HCH) (see Zimberoff & Hartman, 1998, for a thorough description of the model) has increased offender's empathetic response to their victims.

The sex offender treatment program

I worked as an independent contractor for incarcerated sexual offenders on lifetime probation. The subjects used in this article were my clients and signed a consent form allowing me to paraphrase their experiences with CBT and HCH. All information gathered is by self-report. The program these offenders participated in consisted of weekly 100 minute groups, a one-time comprehensive psychophysiological evaluation, weekly meetings with probation officers, spontaneous visits by surveillance officers, periodic 6 month polygraphs (i.e., lie detector tests), and a yearly Plethysmograph which involves measuring changes in penile dimensions during presentations of audiovisual stimuli (Bancroft, Jones, & Pullan, 1966) or Abel Screen to determine the level of deviant sexual interest via visual reaction time (Abel et al, 1990).

Primary Group

The program consisted of three group levels. Primary group lasts approximately 2 years with a majority of the lessons learned via a CBT workbook. The focus is on admittance of present assault, complete disclosure of deviant sexual activity, invitation towards responsibility vs. denial, acceptance of self as a sexual offender. Offenders were taught The Sexual Abuse Cycle (S.O.C.) (Ryan & Lane, 1997), see Figure 1, Responsible Language (i.e., "I raped, assaulted, or groped" vs. "I touched, fondled, or molested"), Minimal Arousal Conditioning (i.e., ammonia/ aversion therapy), as well as Situational Analysis of daily behaviors.

[Figure 1 ILLUSTRATION OMITTED]

Intermediate Group

The next level of group was Intermediate. This group is for offenders who violate terms of probation, who have difficulty grasping workbook material (i.e., the cycle, responsible language), who use defense mechanisms (i.e., denial, rationalization, minimization, justification), and who continue deviant sexual behaviors (i.e., masturbation to deviant fantasies). The information about their sexual deviancy is gained through periodic psychological assessments and not self-report. It is not uncommon for this group to be comprised of Personality Disorders.

Maintenance Group

Maintenance Group can be obtained anywhere from 2-5 years in treatment. This is for offenders who grasp and utilize a working knowledge of CBT, as it relates to their sexually deviant behavior. These offenders do not have distressed polygraphs (i.e., "no unresolved emotional responses", a polygraph term for telling the truth about their sexual history), and have age-appropriate arousal as measured consistently by phallometric assessments. Offenders at this level confront themselves when they are behaving in the sexual abuse cycle and most likely create a life preventing themselves from high risk situations or relapse. This includes relationships, jobs, social activities, family, and support groups.

Heart-Centered Hypnotherapy in Group

The information about HCH was gained from clients in the Intermediate Group level. I chose to use HCH in the group setting and in individual sessions when it became apparent that these Personality Disordered or Characterologically Disordered Offenders had not integrated CBT into their being/person after over 5 years of treatment. Something had to be done besides situational analysis or behavioral reconditioning because it wasn't working. If I continued with CBT alone, these men might experience more disconnection and isolation and less empathy, compassion, and love. This might reinforce their self-definition as "just an offender", and therefore reduce the likelihood of experiencing a sense of personal power.

One night I began HCH with Joe who is a twenty-something pedophile. This person had been through Primary group twice and had been unable to move beyond intermediate group. He has a history of distressed polygraphs and utilizes cognitive distortions and manipulation of his environment (i.e., therapist, psychologist, probation officer, group members) to get his needs met (i.e., strong need for control). Joe came into group and during check-in disclosed that he lost his job after he informed his boss about his sexual offense (this is a requirement of the program). Joe began to act in the "cycle" by blaming the world and everybody in it for his job loss. He was rageful at his boss, his probation officer, and the program for having to disclose his "private life to the public." It is important to note that this particular client, according to phallometric assessment, was responding at 100% to pre-pubescent females, the age range of his victim. This means he was still sexually aroused to his victim and therefore could not respond to her or to others in his life in an empathetic way. He was considered extremely dangerous.

As he continued to rage, CBT therapy would do a behavioral analysis (see Table 1). This includes identifying the situation, thinking errors, mistaken beliefs, feelings, and payoff/benefit to reinforce his victim posturing. This client cognitively stated his payoff was to believe the world is unfair, that he would never be anything more than a sex offender, and that he would always fail. The treatment direction could have included more CBT; however, it wasn't working. I decided to pursue the feeling section of the behavioral analysis through HCH techniques to allow a different experience for him.

Table 1

CBT: Situational Analysis

Situation   Thinking   Mistaken   Feelings  (Mis)  Payoff
             Error     Belief

Joe began to experience the part of himself that felt angry at his boss and I increased the angry feeling, by counting from 1 up to 5. He then voiced, "I hate you for firing me, I'm angry at you for firing me, and I resent you for firing me." He continued with "You didn't even give me a chance, this is part of my treatment, I am working at being honest." He then connected to the part of himself that experiences sorrow for assaulting his victim. He began to cry and stated he felt sad and hurt for his victim. He again voiced, "I'm sorry (victim's name)for abusing you" over and over. Next came the Collapsing Anchors intervention (i.e., a technique designed to merge two templates to gain sensate understanding) where I encouraged him to connect with his heart center and listen for the message. Anchoring is the process of associating an internal response (thought, feeling, physiology) with some external stimulus or trigger, similar to classical conditioning. An anchor is any stimulus that evokes a consistent emotional response pattern from a person (Zimberoff & Hartman, 1998). After a few minutes, Joe spoke out his new mantra, "I lost my job at ... and it is a direct result of my abusive behavior with ...." Joe described his experience as "absolutely the most vulnerable and out of my head I ever was in a therapy session." He also reported, "it was the first time I was truly able to feel for my victim and get it in my body." His current therapist reports, "he has generalized this experience to many others. It is not uncommon for him to say, without prompting, I don't get to do ... as a direct result of sexually assaulting ... ." She further states that this experience has noticeably connected him to empathy, and he will enter Maintenance group by the end of this year.

Individual Heart-Centered Hypnotherapy

Early applications of hypnosis for the treatment of sexual dysfunctions can be seen in the work of Erickson (1935). His indirect imagination techniques focused the clinical attention upon the symptoms, which were viewed as an expression of some personality problem. Somewhat later, van Pelt (1958) focused his approach upon helping the patient uncover past traumatic events which he believed were producing anxiety and consequent dysfunction. Through the direct suggestions of "new ideas" he believed he could eliminate the anxiety-producing dysfunction. This brings me to the sessions I did with Sam, who is a sixty-something pedophile. Sam has an abusive past history with his mother, the church, and turbulent adolescent years filled with ridicule. Sam always gave accurate phallometric readings, yet has difficult answering to authority figures about inappropriate behavior (i.e., manipulating support networks without disclosing the offense, beginning age-appropriate relationships based on objectivication or deviant fantasy). When confronted, CBT would have Sam describe his operation in the Sex Offense Cycle (S.O.C.). CBT would begin by pointing out victim posture (i.e., poor me), anticipated rejection (i.e., expect rejection) and social and emotional isolation (i.e., Nobody has problems like me) (See Figure 1). Sam has always been able to point out his cycle, yet his behavior was not changing. He continued to regress to a child-like position when confronted, refused eye contact, and stared at the floor. He described himself in those moments as "paralyzed." CBT aided discovery that Sam was behaviorally operating with thinking errors, and mistaken beliefs out of fear, yet the depths of his feelings were not being explored and that seemed to be where the dysfunction was lodged.

During a session, we focused on the anxiety Sam felt when confronted about his behaviors. He became angry and that took us to early childhood memories of perceived abuse by his mother. He described "being yelled at and abused and not knowing how to say stop." More anger release occurred as he gave voice to the child parts of himself that had been "paralyzed and trapped." Sam reports he realized he "cannot change what she (Mom) is or what happened. I choose to not blame how I lived my life because of what I perceived she did to me. The anger work helped me to let go of my blaming cycle, give voice to my true feelings and ultimately helped me move on." At our next session, I reviewed the Behavioral Analysis of CBT with Sam about a current misbehavior. He identified his mistaken beliefs and thinking errors about his mother and came to the conclusion that "my mother's abuse of me did not cause my pedophilia." Both CBT and HCH were necessary in first identifying the cycle behavior, uncovering the traumatic past experience emotionally, and understanding his present behavior intellectually. He was able to create a more balanced mind/body connection about dysfunctional behaviors.

Recidivism 

It is important to note that three of the developmental history variables significantly predict sexual offense recidivism: negative relationship with mother, juvenile delinquency, and an aggregate measure of general problems in the family of origin (non-sexual abuse, family disruptions) (Hanson & Bussiere, 1996). The following case study depicts an example of recidivism potential. Tom, a late twenty-something male sexually assaulted a nine year old boy. He opted for a plea bargain which gave him minimal jail time and life-time probation. He has recently reported, after being terminated from group, that "sometimes I think I would have preferred to spend the 6 years in jail vs. going over and over my deviant problems." Tom is a socially well-adapted, intelligent, and personable man. Tom mastered the workbook and CBT. He identified his mistaken beliefs, thinking errors, and payoff (i.e., to not accept himself as a sexual perpetrator). Unfortunately, he began to regress. He missed groups, was behind on his periodic polygraph and phallometric assessments, created an outstanding balance for therapy services, and when confronted would make false promises about change.

Tom finally disclosed the depths of his shame (i.e., socially and emotionally isolating by attaining employment where there was no direct contact with people). Each CBT situational analysis and cycle assignment (i.e., identify daily situations when you are in the cycle, write down, report in group) resulted in the same payoff: avoidance and isolation. Proceeding with HCH, it became apparent that his shame presently manifested about not accepting his sexual deviant self and also connected back to his volatile relationship with mother. He described himself as always feeling "like a piece of crap." This led to uncovering the past traumatic experiences of verbal abuse where he was told "I was no good, worthless, and would never amount to anything." He released and voiced his anger that was repressed and invalidated, and experienced the shame of his existence. Tom reported he "embraced the painful feelings of his childhood, expressed them, and verbalized what was truly inside of me. Getting those feelings out produced a sense of relief" I then included the Extinguishing intervention which lead to his new decision "This is the package, I am me, and I am okay."

We then connected his feeling of shame to his sexually deviant behavior. Since he had done the powerful work of accepting himself, he was able to take responsibility for his sexual deviancy, breaking his denying patterns and ultimately forgiving himself. He reported "I felt more connected to my spirit and experienced a level of self-forgiveness I never thought I could attain." He summed up his HCH experience as: "I can say what is on my mind and in my heart, I am more in tune with my true self, I experience the intensity of feelings more, and it's still scary to go to emotional places, yet at the end of the session I feel relieved and can take responsibility for my actions and my life." Tom has since returned to group, caught up on all testing, paid his balance, attained a social interactive job and has improved his relationship with mother. Again, the combination of CBT and HCH continues to make a case for internalizing responsibility in the population of incarcerated sexual offenders.

Relapse Prediction variables

Dr. Gene Abel (1997), in the Abel Screening News, cited 20 Relapse Prediction variables (see Table 2) that work in conjunction with Hanson's (1996) study. The largest single predictor of sexual offense recidivism was a sexual preference for children as measured by phallometric methods (Hanson & Bussiere, 1996). Sexual preference for boys was also a significant risk predictor (Hanson & Bussiere, 1996). The next two clients both assaulted males in the 2-4 pre-pubescent, 8-10 young male, and 14-17 adolescent male categories. According to the research, these two clients embody variables that make them higher risks for recidivism. Todd is an early forty-something adult male pedophile who assaulted boys ages 8-14. Steven is a late twenty-something adult male pedophile who assaulted boys age 2-10. I chose these two clients because they fit the profile for what HCH calls integrating disowned parts of self (soul retrieval). When people separate from their conscious awareness at times of trauma, the consciousness floats adrift, separate from the body. The trauma is not processed during the freeze response, causing Dissociative Disorder or Posttraumatic Stress Disorder (PTSD) (Zimberoff & Hartman, 1998).

Table 2

Relapse Prediction Variables

Sexual interest in children by VRT    Female child victim
Deviant sexual preference             Single
Prior sex offense                     Related child victim
Stranger victim                       Male and female child victims
Sexual interest in boys               Married
Male child victim                     Exhibitionism
Prior offense                         Admission to corrections
Age                                   Deviant sexual attitudes
Early onset of sex offending          Low intelligence
Diverse sex crimes                    Adult male victim

During one of my groups, a member came in and I could feel his grief, sadness, and anger. He was 22, was convicted of rape, with a history of Domestic Violence. He immediately began to tear up as he talked about how he hated his manipulative, abusive ways with women. He became extremely angry and immediately dissociated. I asked him to use his voice to get reconnected to his feelings and his body. He began with "I resent who I am, I hate myself, I am mean, manipulative, and abusive, and I rape women." This lead us back to uncovering traumatic childhood events that he separated from.

So we began the process of Energetic Psychodrama (Zimberoff & Hartman, 1999) (i.e., externalizing and role-playing internal beliefs and decisions to create new, adult, healthy decisions and beliefs) where he confronted those people (i.e., brother and father) who he perceived taught him how to manipulate, lie, and abuse women/people. Sexual offenders can be highly dissociative and he was no different. In order to combat the dissociation, I instructed him to keep his energy connected to his body through physical activity. At this point, he collapsed into the fetal position and I invited Todd to role-play his new nurturing parent.

Todd began to connect with this man (i.e., rocking him) and validated his existence and experience. This led to new decisions, reframing unwanted behaviors and the creation of his adult nurturing self. Todd's connection with the experience increased and he voiced "I just want to know if I have a purpose, that I'm not just a sex offender." He further went on to say "I wanted this as a child, I miss this nurturance, I never got it. This is all so related to my offense, how I wanted the attention, wanted a friend, wanted someone to care for me." He described how at age 11 or 12 he felt abandoned and different from others. He reported "I escaped via music, making a decision to not feel, and began seeking refuge and comfort in pornography of adolescent boys." Ideomotor Signals (yes/no), a Neuro Linguistic Programming (NLP) technique (Bandler & Grinder, 1982), was used to discover, subconsciously, if a part of him left or split off at that time. He looked around the scene and said "I'm flying around watching it." We then reconnected the dissociated part through kinesthetic body memories. Individuals commonly recover these memories or forgotten information through hypnosis. "Breaking through the limitations of conscious attitudes to free unconscious potentials for problem-solving often involves accessing state-dependent memories that remain cloaked (dissociated) under a traumatic amnesia" (Rossi & Cheek, 1988).

He describes his purpose as "facing his deviancy, his feelings and being forgiving of self and others." He further went on to say that "As an offender, I know I needed to feel more and I wanted to. This experience has allowed me to feel open and connect to an understanding of why I became a sexual offender." HCH connected a hidden memory that Todd dissociated from, due to the unacceptability or incongruity of the memory with conscious beliefs, values, and ideals (Zimberoff & Hartman, 1998). Dissociation appears elusive to recognize and confront in verbal cognitive therapy, yet it is simple to identify and work around in experiential therapy (Zimberoff & Hartman, 1998).

Minimal Arousal Conditioning

Minimal Arousal Conditioning (MAC), a CBT approach, systematically applies the essentials of behavior modification. It is one of the most efficient conditioning techniques to control deviant arousal, deviant fantasy, and the excitement associated with deviant themes. While many control methods require the individual to take action to control arousal, MAC seems to trigger a conditioned anxiety response which usually inhibits arousal (for a more detailed description see Jensen & Laws, 1995). Steven, a 29 year old male, was in Intermediate Group and seemed to understand the concepts of CBT. What was missing was a reduction in deviant arousal and increase in appropriate arousal. We discovered, during MAC work, he would allow himself to become aroused to his deviant script, experience the excitement, and then perform the ammonia aversion technique. This hindered change in deviant arousal patterns and actually generalized his deviant attraction, so I decided to pursue HCH and uncover the subconscious reasons why this continued to occur. CBT would argue that it occurs because he is sexually deviant and continue with Behavior reconditioning techniques. My experience is that these techniques are essential but not sufficient alone.

Steven said that "feeling lonely sums up most of my life, it was the heart of all my growing up." He described a childhood situation where he remembered feeling "ignored and that nobody cared about me, so I went upstairs searching for something to do. I decided to try on my sister's underwear and looked at myself in the mirror and I became aroused." During our work, Steven connected his creation of deviant patterns to avoid boredom and feelings of loneliness. We used the Collapsing Anchors technique about that fantasy, and according to his selfreport, he was unable to fantasize about that after the session.

Steven continued to divulge the depth of his deviant sexual fantasies during our sessions. It became apparent that he was emotionally disconnected from his self-hatred, rage at family of origin, and loneliness. At some point, I realized that in order for Steven to begin emotional connection, he needed Ego Strengthening. John Hartland popularized the concept of ego-strengthening (1971), by using generalized supportive suggestions to increase the client's confidence and minimize anxiety. He further went on to say that few clients would let go of their symptoms before they felt confident and strong enough to function without them. Steven described his experience as "feeling the most connected to since I visualized myself as being confident, which made it easier for me to find, create, and feel successful as a person. I realized I wasn't just an offender."

Next, Steven delved into his subconscious and integrated the disowned parts of himself that split during his traumatic childhood years. We reached the depth of his rage (i.e., loneliness) as he allowed himself to discuss the pain and anguish of his father's emotionally and verbally abusive relationship (i.e., almost drowning as his father watched unconcerned), the violation of being sexually abused by family members, and the shame for his deviant fantasy structure developing. He began to reclaim parts of himself and become whole. And importantly, he remembers "forgiving myself, accepting responsibility for my sexual deviancy, and being forgiven and comforted by Jesus." Steven generalized his progress to employment, group work, supervision with probation officer and his marriage. It is important to note that Steven continues to have deviant arousal, yet he reports, "I'm still making good decisions, even with my deviant arousal." It seems evident that HCH helped resolve painful past memories and created a strengthened ego, while CBT provided the baseline for understanding the concepts and intricacies of sexual deviancy.

Conclusion

Most research on sexual offenders comes from traditional CBT methods, which has provided treatment professionals with guidelines for creating successful programs and interventions. Research suggests offenders typically attempt to dissimulate information so the reliability of this information may be threatened. It is important to note, a comprehensive evaluation, including current polygraph data and phallometric assessments, are vital to develop treatment strategies.

Empathy, as described earlier, is the capacity to experience the same emotions as another (Clore & Jeffrey, 1972). HCH works with Personality Disordered sexual offenders, at the Intermediate Level. In each case study, subjects were able to connect in their present treatment, on a subconscious level, to early childhood patterns reinforcing sexual deviancy. Also, each subject was able to take a more active role in being 100% responsible for their offending behavior. Many noted an increased sense of empathy for self and others, as well as released barriers holding self-defeating thinking errors or mistaken beliefs. HCH promoted disclosure on a feeling level, improved self-esteem, manifested treatment participation, and highlighted the mind/body connection. HCH seems to be a non-threatening form of therapy, yet powerful in working with the subconscious mind and appears to combine well with CBT. I honor, value, and respect the effectiveness of both modalities with the sexual offender population.

The efficacy of CBT in the treatment and prevention of sexual offense is indisputable. Although current literature does not yet reflect the efficacy of hypnotherapy with sexual offenders, I believe this article is a step pointing out the importance for combining CBT, and other traditional modalities, with HCH. It may be that the most successful treatment (i.e., prevention, maintenance, responsibility, empathy) for an offender is the combination of these two modalities.

References

Abel, G. G. (1997) The Abel Screening News. Stopping Sexual Violence--particularly against children.

Abel, G. G., Becker, J.V., Cunningham-Rathner, J., Mittelman, M. S., & Rouleau, J.-L. (1989). A non-invasive, physiologic measure of adult sexual preference. Paper presented at the annual meeting of the International Academy of Sex Research, Sigtuna, Sweden, Aug.

Abel, G. G., Rouleau, J. L., Lawry, S. S., Barrett, D. H., & Camp, N. L. (1990). A non-invasive, physiologic measure of adult sexual preference. Paper presented at the annual meeting of the International Academy of Sex Research, Sigtuna, Sweden, Aug.

Bancroft, J., Jones, H., & Pullan, G. (1966). A simple transducer for measuring penile erection, with comments on its use in the treatment of sexual offenders. Behavior Research & Therapy, 4, 239-241.

Bandler, R. & Grinder, J. (1982). Reframing: Neuro-Linguistic Programming and the Transformation of Meaning. Moab, Utah: Real People Press, p. 45-103.

Burte, J. M. & Araoz, D. L. (1994). Cognitive hypnotherapy with sexual disorders. Journal of Cognitive Psychotherapy: An International Quarterly, Vol. 8, 4.

Clore, G. L., & Jeffrey, K. M. (1972). Emotional role playing, attitude change, and attraction toward a disabled person. Journal of Personality and Social Psychology, 23, 105-111.

Cronbach, L. J. (1995). Processes affecting scores on "understanding of others" and "assumed similarity." Psychological Bulletin, 52, 177-193.

Erickson, M. H. (1935). A study of experimental neurosis hypnotically induced in a case of ejaculatio precox. British Journal of Medical Psychology, 15, 35-50.

Hanson, R. K. & Bussiere, M. T (1996). Predictors of Sexual Offender Recidivism: A Meta-Analysis. Canada: Public Works and Government Services.

Hartland, J. (1971). Further observations on the use of "ego-strengthening" techniques. American Journal of Clinical Hypnosis, 14, 1-8.

Knopp, F. H., Freeman-Longo, R., & Stevenson, W. (1992). Nationwide Survey of Juvenile and Adult Sex Offender Treatment Programs. Orwell, VT: Safer Society Press.

Jensen, S. H. & Laws, R. (1995). Minimal Arousal Conditioning. The Association for the Treatment of Sexual Abusers: Pre-Conference Workshop. New Orleans.

Marshall, W. L. (1990). Sexual aggressive in the community. Paper presented at the 3rd Symposium on Violence and Aggression, Saskatoon, Saskatchewan.

Rossi, E. L. & Cheek, D. (1988). Mind-Body Therapy: Ideodynamic Healing in Hypnosis. New York: W. W. Norton.

Ryan, G. & Lane, S. (1997). Juvenile Sexual Offending: Causes, Consequences, and Correction. 77-122.

Van Pelt, S. J. (1958). Secrets of Hypnotism. North Hollywood, CA. (New Edition, 1974).

Zimberoff, D. & Hartman, D. (1998). The heart-centered hypnotherapy modality defined. Journal of Heart-Centered Therapies, 1,1, pp. 3-49.

Zimberoff, D. & Hartman, D. (1999). Heart-Centered Energetic Psychodrama. Journal of Heart-Centered Therapies, 2,1, pp. 77--98.

Lisa Conney, M.C. 39 Rogue Morres Court, #3, Mill Valley, CA 94941 USA.