ABSTRACT
Treating the paraphiliac can be an interesting and rewarding challenge for the forensic psychiatrist because it leads to the reduction of sexual violence, reduces the likelihood of future victimization, and also gives the forensic psychiatrist a sense of meaningful accomplishment in dealing with a serious public health problem – child molestation, rape and other forms of paraphilic behavior. However, the therapist must be accepting of a number of consequences to working with sexually violent patients. First, our culture is exceedingly upset by sexual perpetrators and, by association, their therapist can be seen as in some way helping the offender by providing treatment (Brown 1999). The therapist must keep the focus of therapy on protection of the public by reducing the probability of re-offense. A second issue involves double agentry, in which the therapist has conflicted loyalties. In traditional psychotherapy the therapist works exclusively on the patient’s goals to accomplish the patient’s objective without the intrusion of the therapist’s opinion and prejudices into the therapy. Most sex offender patients, however, will be on probation or parole and an integral element of their lives is ongoing supervision by their probation/parole officer (English 1998; Grant 1999; Scourfield 1998; Wilson et al. 2000). It is inevitable that the therapist must come to terms with this dual alliance, since it is the responsibility of the probation/parole officer to know when the patient is at high risk to re-offend, is not compliant with therapy, or is not attending. The therapist must accept this dual agentry responsibility; indeed, that responsibility inevitably extends to protection of the general public when treating sex offenders.
