1. www.glencairnmft.com
glencairn@mdofficemail.com
Practical, competent and valid talk therapy

2. WORKING WITH THE SEX
OFFENDER IN DENIAL
Susan G. Smith, PHD, LMFT
& Garnie Nickell, MA, LPCC

3. Denial is not a river in Egypt.
Treatment resistance is largely the product
of processes of denial. (Schneider & Wright 2004)

4. Webster’s defines denial
as a statement saying that
something is not true or real; in
psychology denial is a condition
where someone will not admit that
something sad and painful is true or
real; or the act of not allowing
someone to have something.

5. Science . . . .
is based on
personal
experience, or on
the experience of
others, reliably
reported.
- Werner
Heisenberg

6. Denial is defined in the ATSA treatment
manual as “the failure of sexual abusers to
accept responsibility for their offenses.”
Association for the Treatment of Sexual Abusers (ATSA; Practice
Standards and Guidelines 2001)
It is characterized as an obstacle to treatment progress
and to compliance with treatment requirements.

7. While a person is responsible for
acting in the world,
s/he is not necessarily responsible
for the cognitive, affective,
and behavioral deficits
that realistically constrain
the range of options
to pursue valued goals.
(Levenson & D’Amora 2005)

8. Truth dwells in the deeps.
- Niels Bohr

9. Anna Salter
emphasized in her classic guide Treating Child Sex
Offenders and Victims: A Practical Guide (1988)
that “offenders must take responsibility for child
sexual abuse without minimizing, externalizing
or projecting blame onto others.” Salter also
categorized denial as physical
denial, psychological denial, and minimization of
the extent and seriousness of the sexually
offensive behavior.

10. The research does not convincingly
demonstrate that denial is a risk factor for
reoffending, nor that targeting denial in
treatment is associated with improved
treatment outcomes. (Yates 2009)
Treatment must be concerned with
responsivity – defined as the interaction
between the individual and the treatment.
The therapeutic relationship is the best
predictor of treatment success.

11. Why do people deny?
Freud’s Theory of Defense Mechanism
A reality-distorting strategy unconsciously
adopted to protect the ego from anxiety.

12. The relationship between anxiety and defense:
Neurotic anxiety
• Anxiety about our impulses
signals the need for their
repression
• We want things we do not
get; we fear our wants
• Anxiety plays a functional
role signaling the ego to
take action (repress
thoughts and feelings)
before being overwhelmed
Moral anxiety
• Experienced as guilt or
shame
• Fear of (internal)
punishment for failure to
adhere to our own moral
standards of conduct
• When impulsive behavior
gets us into trouble, we
begin to fear our own
instincts

13. Freud’s six types of defensiveness
• Repression where unacceptable impulses and thoughts
are pushed out of our awareness.
• Projection places what may be unacceptable in one’s
own mind into the mind of another.
• Displacement redirects emotional responses onto a
less dangerous substitute.
• Reaction formation converts a feeling into its opposite.
• Regression makes us retreat to an earlier, less
threatening age or stage.
• Rationalization invents a reason for bad behavior.

14. Depersonalization or the
denial of planning, sexual
deviancy, and relapse risk.
Even after an offender has acknowledged
responsibility for an offense, s/he may not
be psychologically prepared to admit s/he
is the type of person who could do
something like that.

15. Being decent comes down to being
brave. -Sakyong Mipham Rinpoche

16. The following factors
related to psychological
problems were found to
have no relationship to
recidivism. (Yates 2009)
• Self-esteem
• Anxiety
• Loneliness
• Negative mood
• Motivation for
treatment
• Lack of victim empathy
• Lack of remorse
• Denial

17. ALL OUR SCIENCE, MEASURED AGAINST
REALITY, IS PRIMITIVE AND CHILDLIKE.
- ALBERT EINSTEIN

18. Rehabilitation interventions are
directed at areas of deficit or
dysfunction. (Ward & Salmon 2009)
A major aim of therapeutic interventions with
offenders is to provide them with an array of
skills to effectively manage undesired states or
to pursue desirable ones in socially acceptable
and personally meaningful ways.

19. The primary vehicle for assessing and modifying
offenders’ cognitions is likely to be found in
the explanations provided by offenders
to account for their offenses.
(Schneider & Wright 2004)

20. A key distinction in determining
whether the offender will view treatment as
helpful or as a punishment
lies within the practitioner’s skill level.
(Prescott & Levenson 2010)
The process of change is difficult for most of us but
especially difficult for those who have offended others
sexually because it requires looking at our shadow side.
Will they feel coerced or invited?

21. The universe can be best pictured . . .
as consisting of pure thought.
- Sir James Jeans

22. Treatment or Punishment?
Problem reduction and well-being
enhancement versus the infliction of pain
as retribution for crimes committed.

23. Failure and deprivation are the best
educators and purifiers.
- Albert Einstein

24. Treatment providers cannot avoid
confronting the ethical challenge
created by the institution of
punishment within
the criminal justice system.

25. The issue of justifying punishment
arises in part because harms inflicted
on offenders may cause them
significant suffering and set back their
core interests, and also result in
marked hardships to family, friends,
and even the broader community.
(Ward & Salmon 2009)

26. Sex offender treatment is not punishment but
services are delivered within a punishment
context. As service providers,
we have to consider both.
Rehabilitation revolves
around skill
acquisition, well-being
enhancement, and
building a better life in
the future.
Punishment is
embedded in
accountability for past
actions and moral
questions of right and
wrong.

27. Science is the attempt to make the chaotic
diversity of our sense-experience correspond to
a logically uniform system of thought. . . The
sense-experiences are the given subject matter.
But the theory that shall interpret them is man-
made. It is. . .hypothetical, never completely
final, always subject to question and doubt.
- Albert Einstein

28. Because of the correctional context of
sex offender treatment,
it is not possible to insulate the role of program
deliverers or treatment providers from ethical
issues associated with punishment.
It is worthwhile for practitioners to have some
general familiarity with the different theories of
punishment and their clinical and ethical
implications. (Ward & Salmon, 2009)

29. Punishment elements
express censure and are intended
to be harmful, resulting in a
burden being placed on the
offender that directly causes
suffering, pain, and deprivation.
Assumptions about punishment
are reflected in the specific
policies and practices embedded
in the criminal justice system and
directly shape the professional
tasks constituting the roles of
correctional practitioners.
Treatment providers
have an ethical obligation to do
no harm and to seek to end
unjustified harms to offenders.
Failure would arguably make us
complicit in unacceptable
practices (Lazarus, 2004).
In a real sense, good
psychological practice is partly
determined by policies
underpinned by punishment
assumptions including decisions
on intervention
priorities, sequencing, and timing.
Punishment within the criminal justice system
must be unpacked to help clinicians skillfully
traverse ethical dilemmas.

30. Retribution theories
Retribution theories:
• Backward looking
• Fact that punishment does not
reduce crime not of major
concern; fitting to punish to
balance the moral ledger
• Failure to hold offenders
accountable is unacceptable
• Offenders are viewed as morally
deficient
• Victim’s rights and community
views are given priority
• Punishment will result in
acceptance of responsibility
Practice implications:
• Fails to satisfactorily unpack
the notion of just deserts
• May be threats to offenders’
human rights
• Impulsivity characterized as
failure of will rather than self-
regulation impairment
• Difficulty discriminating
between crimes and private
wrongs
• Restricted funding for
treatment and reintegration
programs

31. America is the land of the second
chance and when the gates of the
prison open, the path ahead should
lead to a better life.
-
George W. Bush, 43rd US President

32. Consequential theories
Consequential theories:
• Forward looking
• Focused on crime
prevention
• Goal is to reduce crime
• To deter, incapacitate, or
reform offenders is seen as
the most effective way to
reduce the crime rate
• Character reform
Practice implications:
• Reliably measure dynamic
and static risk factors
• Treatment is a means to
ensure community safety
• Looking for causal factors
generating behavior
• Extended supervision ,
geographical restrictions,
and community notification
• Interventions focus on
offender and do not include
families and the community

33. Problems with
consequential theories
• It is logically possible to
countenance the
punishment of innocent
people if the overall effect
may result in the reduction
of crime.
• Neglects the community’s
obligation to offenders to
provide and resource
reintegration initiatives.
• The impact of hard
treatments on offenders
and their families is rarely
considered.
• A desire to protect the
community can lead to the
lack of concern for the
human dignity and intrinsic
self-worth of offenders.
• May result in confrontation
rather than dialogue.

34. Shifting Paradigms
It is important to pay attention to the rights of
all stakeholders in the criminal justice system
including offenders because of their equal
moral status; thus communication theories of
punishment have a relationship focus.
(Ward & Salmon, 2009)
From this perspective, offenders are viewed as
one of us.

35. Communication theory
A hybrid theory of Anthony Duff (2002)
Communication theory:
• Forward and backward looking
• Punishment seeks to persuade
rather than force offenders to
take responsibility for crimes
• Offenders viewed as valued
members of the community
• Repair individual, relational and
social harm caused by the offense
• Wipe slate clean and obtain
redemption with dignity
• Community obliged to facilitate
reintegration
Practice implications:
• Engage in process of intense self-
reflection and self-censure
• Remorse and self-blame will
motivate to acquire skills to
achieve in lawful ways
• Realization they have caused
people to suffer will lead to firm
resolution to not do this again
• Apology and restitution
• Better lives mean safer
communities
• Strength-based community
oriented treatment approach

36. It is better to conquer yourself than to win a
thousand battles. Then the victory is yours. It
cannot be taken from you, not be angels or by
demons, heaven or hell. -Buddha

37. THE SECOND CHANCE ACT of 2007
formalizes President Bush’s Prisoner Re-entry Initiative (PRI)
• Ensures returning
prisoners have
opportunities to
transform their life and
build safer communities.
• Helps offenders break the
cycle and start a new life
as a productive member
of society through
individualized case plans
and services.
• Develops programs that
encourage offenders
toward safe, healthy, and
responsible family and
parent-child relations.

38. “I might have did it . . . ,” “Maybe I did it . . . ,” “I
don’t remember. . .but let’s just say I did,” are not
admissions but they are stepping stones suggesting
that further discussion is needed.

39. Although many have focused on denial as a black and white
construct, a large number of clinicians and scholars have
acknowledged that denial is not an all-or-nothing phenomenon
but rather a complex, multifaceted thought process.

40. Accountability and denial
as treatment obstacle or treatment target?
(Schneider & Wright)
Denial as a dichotomous variable
• Disavowal of having committed an
offense (full denial, absolute
denial, or categorical denial). A
person is either in or out of denial.
• Assumes denial results from
deliberate attempts to avoid blame
by deceiving
• Indicates poor treatment amenability
• Offenders have to admit they
engaged in inappropriate sexual
behavior before entering treatment.
• Otherwise clinicians are reinforcing
the illusion that offenders can benefit
from treatment without taking
responsibility for their offense.
Denial as continuous variable
• Refers to a broader range of
explanations provided by offenders
to justify or minimize offense-related
behavior.
• Likely to be grounded in cognitive
distortions.
• Requiring offender to be out of denial
before starting treatment is like
requiring them to cure themselves.
• Practice of not treating or dismissing
deniers from treatment increases risk
to the community by preventing
participation in treatment programs
that lower recidivism.

41. Types of Denial
Schneider & Wright 2004
Denial is a multifaceted
construct:
• Denial of the offense
• Denial of harm to the victim
• Denial of the extent of the
abusive behavior
• Denial of responsibility,
intent, or premeditation
• Denial of receiving sexual
pleasure
• Denial of relapse potential
Deeply ingrained forms of denial:
• Planning
• Grooming
• Deviant arousal
• Fantasizing
• Sexual gratification
• Need for help
• Future risk of harming
someone else

42.  For incest offenders, denial was associated
with increased sexual recidivism. Effect
sizes were extremely small suggesting it
could be a minor risk factor. Denial was
not associated with increased recidivism
for offenders with unrelated victims. (Nunes
et. al. 2007)
 Child molesters tend to admit more
frequently than rapists. (Nugent & Kroner
1996)

43. Denial decreases over the course of treatment.
(Barbaree 1991; Marshall et al 2001)

44. Denial is best viewed as a source of rich clinical
information about the offender’s view of the world
rather than as an obstacle that interferes with
treatment. (Schneider & Wright 2004)

45. Clinical approaches for addressing denial
and treatment resistance (Deming 2013)
The INSOMM Approach
• Motivation based
• Future focused
• “Good Lives” Model
• Address shame
• Address fear of
consequences
• Process the value and
purpose of taking
responsibility and its role in
treatment

46. Let us get down to the bedrock facts.
The beginning of every act of
knowing, and therefore the starting
point of every science, must be in our
own personal experience.
- Max Planck

47. Myth or fact?
• Denial and minimization are
efficient predictors of recidivism.
• Greater denial / minimization is
associated with lower motivation
and more negative perceptions of
treatment.
• Denial increases over the course
of treatment.
• Denial is better related to internal
processes of anxiety than to the
external process of deception.
• Only sex offenders minimize and
deny harmful behavior.
• The only way for a sex offender to
get the help they need is for them
to take responsibility for what
they did.
• Denial in treatment has been
upheld by the courts as a reason
to revoke probation.
• Denial is related to punishment
models of accountability.
• Clinicians can ethically treat sex
offenders without considering
the ethics of punishment.
• Offenders who complete
treatment have lower recidivism
rates than those who do not.
• More justifications and less
treatment rejection can reflect
acknowledgment of personal /
psychological problems.

48. It is the very essence of our striving for
understanding that, on the one hand, it
attempts to encompass the great and complex
variety of man’s experience, and on the other, it
looks for simplicity and economy in the basic
assumptions. The belief that those two
objectives can exist side by side is, in the
primitive view of our scientific knowledge, a
matter of faith.
-Albert Einstein

49. References:
Deming, Adam (January 29, 2013). Working effectively with the
treatment resistant sex offender. ACA Houston, Texas.
Freeman, James, Palk, Gavan, & Davey, Jeremy (2010). Sex offenders in
denial: A study into a group of forensic psychologists’ attitudes
regarding the corresponding impact upon risk assessment
calculations and parole eligibility. The Journal of Forensic Psychiatry
& Psychology, 21:1, 39-51. Routledge.
Glaser, Bill (2010). Sex offender programmes: New technology coping
with old ethics. Journal of Sexual Aggression, 16:3, 261-274.
Routledge.
Jung, Sandy & Nunes, Kevin (2012). Denial and its relationship with treatment
perceptions among sex offenders. The Journal of Forensic Psychiatry
& Psychology, 23:4, 485-496. Routledge.
Levenson, Jill & D’Amora, David (2005). An ethical paradigm for sex offender
treatment: Response to Glaser. Western Criminology Review, 6:1,
145-153.

50. Nugent, Patricia M. & Kroner, Daryl G. (1996). Denial, response styles, and
admittance of offenses among child molesters and rapists. Journal
of Interpersonal Violence, 11:4, 475-486. Sage.
Nunes, Kevin, Hanson, Karl, Firestone, Philip, Moulden, Heather, Greenberg,
David, & Bradford, John (2007). Denial predicts recidivism for some
sexual offenders. Sex Abuse, 19:91-105. Springer.
Prescott, David & Levenson, Jill ( 2010). Sex offender treatment is not
punishment. Journal of Sexual Aggression , 16:3, 275-285.
Routledge.
Schneider, Sandra & Wright, Robert (2004) Understanding denial in sex
offenders. A review of cognitive and motivational processes to
avoid responsibility. Trauma, Violence & Abuse, 5:1, 3-20. Sage.
Ward, Tony & Salmon, Karen (2009). The ethics of punishment:
Correctional practice implications. Aggression and Violent
Behavior, 14:4, 239-247.
Yates, Pamela M. (2009). Is sexual offender denial related to sex offense
risk and recidivism? A review and treatment implications.
Psychology, Crime & Law, 15:2-3, 183-199. Routledge.

51. I can treat others with
kindness, gentleness, and
without judgment, starting with
myself!