The common fantasy among therapists is to be handed a client for whom the diagnosis is a solvable mystery and whose recovery can serve as a life affirming symbol of what is right in the world. The dream is to rescue the innocent but suffering client from a severe but solvable problem, and to be rewarded as you find the good within and help it to grow. The more realistic hope is that you find a good partner in therapy, that the client comes to you with a desire to work on an issue and has recognized you as an ally in that task. In this view, you are building a relationship that is focused on health and life, and that you and the client both know what you want to do, and have a strong idea about how it is to be done.
I, on the other hand, have been assigned a sex offender.
The dilemma is not “do I work with this person?” I don’t have much of a choice on the matter. I’m an intern and have to take the cases I’m assigned. In addition, not treating this person in unethical because at some point the judge will order his discharge, and to let him loose without treatment puts more people in danger. The dilemma, instead, is “how do I work with this person?” Study after study has shown that a necessary part of therapy is the building of the therapeutic alliance, the creation of the empathetic partnership with the client, and my own personal therapy style relies heavily on inserting myself into the world of the client, accepting their experience of the world, and offering them the insight that extends from the insight of my perspective. But as anyone who knows me well will tell you, I have spent a lot of time active in rape prevention and recovery, trying to help in any way I can to counteract the damage done by sexual abusers. I have been motivated by the multitude of close and intimate relations who have suffered under such abusers, and my empathy and sympathy remains towards them. So the paradox becomes: In order to protect people from becoming future victims of his abuse, I have to find a way to ally myself with the perpetrator.
Rationalizing this really isn’t getting me too far. I’ve tried to tell myself that in many ways he was set up to fail, and when he did he really fucked up. There is some truth to that: our society sends out a lot of messages that actually supports the abusive behaviors, which, when handed to a kid with traumatic brain injury can really confuse a moral compass. On the other hand, I can’t minimize the damage he’s done, I’ve known too many victims, and I’ve heard too many horror stories of therapists who treat sex offenders becoming brainwashed through their own empathy.
For now, I find myself in a situation that is less like therapy, and more like a chess game. He’s trying to manipulate me into letting him coast his way out, and so I’m trying to maneuver him into accepting his responsibility. I know he’s not being completely honest with me, and I think he sees I’m phoning in the alliance at this point. I know what goals need to be reached, and I have some plans in mind to get there. But this would be so much easier if he would just turn to me and say “I fucked up. Please help me so I don’t do it again,” because then we would at least have a common goal for the alliance.
But that may not be likely for a while.