An Encomium for Jonathan Lear....and Other Books

I did not mean to leave so large a gap on here, having posted nothing since March. I have several times gestured wanly in the direction of my laptop and the piles of books which sit uneasily near it at all angles and with varying degrees of instability, and on at least two occasions sat down to draft posts (one of which is nearly done and will focus on 3 or 4 books on mentalization I have been wrestling with this year). But for reasons I will not bore you with, my energy this year has been reduced and taken up with other things, and thus every time I sat down to write something the desire vanished almost instantly--until now. 

Anyway, in no especial order, here are some thoughts on books that you might find beneficial, edifying, and even enjoyable to some degree. 

Jonathan Lear: 

I begin with Jonathan Lear, whose death in September occasioned grateful commentary as well as mourning and melancholia in the worlds of academic philosophy and clinical psychoanalysis. I read his Imagining the End: Mourning and Ethical Life in early 2023 and before that his Freud, published in the Routledge Philosophers Series. It is, I submit, the best philosophical treatment of Freud since Ricoeur's 1977 landmark book Freud and Philosophy: An Essay on Interpretation. 

Therapeutic Action: An Earnest Plea for Irony (2003) is a languid book that showcases Lear as a philosopher asking question after question in service of, and search for, an answer to his central question, which is: what is the therapeutic action of psychoanalytic treatment? Since this book was published more than two decades ago, there has been an increasing body of literature investigating this question and not just in psychoanalytic circles either. It remains a question that continues to fascinate me and will be the focus of some attention in my next book: what is the action of psychotherapy that provokes change by and in and with the patient? 

Lear's contribution to this is based on a wonderful and close re-reading not just of Freud but also of Lear's own mentor, Hans Loewald. He begins by reminding all of us that "therapeutic action does not describe a process, like getting a tattoo, which has a fixed end point. Once you've gotten a tattoo, you've got a tattoo; indeed once you've had an analysis, you've had an analysis, but therapeutic action goes on and on. Analysis has a termination: therapeutic action does not. Ideally one continues one's own process of therapeutic action as a lifetime project" (p.33). In this Lear very much reminds me of one of Adam Phillips's aphorisms that "the cure can only begin once the treatment has ended." 

Later on Lear briefly discusses termination in treatment, and the need to have that firmly in mind as a clinician from the moment treatment begins. (My first supervisor taught me that in introducing the question of goals, he often used the question "What would done look like?" as a way to get the new patient thinking about how their life would have to be changed for them to feel justified in letting treatment be done, be finished.) Lear compares this to good parenting, saying that both, to be healthy, have to consist in a progressive withdrawal because "psychoanalysis is aimed at promoting a person's freedom [and] part of the freedom is freedom from the need to keep coming to the analyst" (p.56), a key principle both Erich Fromm and D.W. Winnicott have previously articulated. 

Lear's compatability with the thought of other clinicians shows up in numerous points in the rest of the book. When he turns to a discussion about whether a psyche can be said to have a "core," he notes, in a vein that strikes me as very similar to Philip Bromberg's incredibly rich and important book, that "the core is the elementary capacity of the psyche to hold itself together" without resorting to a ruthless superego-induced attempt at purging or synthesizing (p.118).

He returns to this issue at the end of his third chapter, "Internalization," where he seems to nod clearly in the direction of mentalization (as Fonagy and Bateman have famously called it) or the creation of a "psychoanalytic mind" (as Fred Busch has called it) by saying that "while superego internalizations may well occur at various levels of sophistication and primitiveness, even in the termination phase of the analysis, one is also fostering the internalization of a capacity for analyzing these unconscious forms of internalization." In other words, if the analyst has been internalized as a good object (a "benign superego figure" in Lear's phrase) then ipso facto the patient will have also internalized the analyst's mentalizing capacity for use after the analysis has ended, and such a process "properly constitutes the therapeutic action of psychoanalysis" (p.133).

The next chapter, "Love as a Drive," contains some fascinating reflections that could too easily be dismissed as insider baseball, or as reviving old controversies nobody has cared about for decades, but in line with Bettelheim and Laplanche (on whose Freud and the Sexual see below) Lear insists that swapping out "instinct" for "drive" in translating Freud's German is misleading and unhelpful. Lear insists, with ample documentation from Freud, that this is a bigger issue for him than any of his biographers or scholars and clinicians after him have been willing to allow, and that it remains a great unsolved issue: the drives, especially of sex and death, have been rather quickly and quietly bundled off the stage so as to allow our genteel and ever so much more socially respectable conversations about developmental, relational, and now traumatic challenges to take over the entire show. 

In the context of this discussion, Lear calmly revisits the old polemics--from enemies and defenders of Freud alike--about the role the "sexual" drive occupies in Freud's writings, noting that both sides miss a crucial philosophical point that Lear explicates: his understanding is not focused on copulation and he denies that the sexual drive and the sexual object have a more intimate connection than they actually do. To this extent, then, Freud is not saying--Lear argues--that at our most sexual we are also at our most animalistic. Au contraire: human sexuality has so many features, expressions, and pecularities that it is here more than anywhere else that we are not like other animals. In Lear's by-now familiar refrain, "human sexuality makes us all candidates for irony" (p.156).

Additionally, drawing on Plato, Freud noted in 1924 ("The Resistances of Psycho-Analysis: SE 19: 213-224) that when psychoanalysis refers to sexuality, it "had far more resemblance to the all-inclusive and all-embracing love of Plato's Symposium." Lear the philosopher leaps on this and spends the rest of the chapter wondering aloud about why Freud, having said this, then spent the rest of his life running away from serious sustained reflection on love as a drive. In doing so, Lear charges, Freud fails to develop a crucial line of reflection that would have a direct bearing on therapeutic action. We cannot, Lear implies, understand efficacious therapeutic action except as being a process motivated by love (as Freud first conceded in that off-hand comment to Jung in a letter of December 1906). 

What might this love look like and how might it be a driver (if not the driver) of therapeutic action? What might a "loving" treatment result in? Lear suggests--but does not really develop the thought--at a couple of points that loving therapeutic action will result in the analysand's enlarged capacity for "greater psychological complexity" (p.170). (Once again there are clear echoes of this in others, including Phillips, Busch, Bion, and many others.) But the analyst does not impose this on the patient, or demand that he develop or "perform" complexity. The analyst merely provides a place to do so without getting pushy about it. Indeed, Lear defends fairly traditional understandings of neutrality at this point, saying that "the analyst's holding herself in this 'neutral' position is itself an act of love."

Towards the end of this chapter and nearing the end of the book, Lear asks a question that I have not seen anyone else do: is the fear Freud had about discussing a "love drive," a fear that virtually every clinician since him has replicated and never challenged, born out of a philosophically impoverished understanding of what "science" is and does? (Contemporary psychology's ignorance of the philosophy of science remains a constant source of serious vexation to me.) "One reason Freud's theory of love has been ignored is that it seems ridiculous to take seriously the idea that love is really a basic principle of nature. Surely we need to turn to natural scientists to find out what the basic principles of nature are. But what if we think about second nature?" (p.172). 

At this point Lear the philosopher emerges to the fore again, and he reminds us of our need to return to moral philosophy in Plato and especially Aristotle, but also in our own time the works of such as Bernard Williams and Alasdair MacIntyre. The development of our second, more properly human nature--our nature as philosophers, one might say, over and above our animal nature--cannot avoid questions of "character, personality, and psychological structure" (p.173). These can only have a chance of developing well if they do so in the context of relationships motivated by love that abjure moralizing while insisting on asking what Lear terms the ethical question: "How shall I live?" (174). 

Analysts, finally, cannot avoid such questions, either in themselves, or in their work with patients. In pursuing such questions with love they propel the therapy forward to successful action, defined as "structural change" understood not as a "once-and-for-all achievement" but instead a "perpetual undermining of rigidifying and thereby alienating pretenses" incapable of ironic reflection on oneself (p.177). 

For this rich and important book, and for his others, it is certain that Jonathan Lear's memory will remain a blessing.  

Memory of and Desire for more Bion?

We seem to be entering an era in which books about W.R. Bion, who died in 1979, are emerging at an ever increasing pace. I know for many of us he has been a difficult read, and our feelings about him are suitably ambivalent. His claim that each session should unfold with the clinician refraining from "memory and desire" has often been seen as a problematic counsel of perfection, but there are very solid reasons for striving to do this as I have learned the hard way more than once. In fact, I would say that mistakes I have made in a recent case are almost entirely because I failed to refrain from memory and desire and instead been too keen to demand the patient discuss certain things he is manifestly not ready to discuss. Pacing remains a crucial technique still in need of refinement.

Beyond his reflections on attention, memory, and desire, I have long found Bion enormously useful for his two essays on the psychotic mind. Using Bion, I built my chapter, "Men and Schizophrenia," which I was asked to write for the forthcoming Oxford Textbook of Men's Mental Health, part of the Oxford University Press imprint Textbooks in Psychiatry. The better known of Bion's essays, "Attacks on Linking" (1959), I now believe, is really the second part of, or a continuation of, his 1957 essay “Differentiation of the Psychotic from the Non-Psychotic Personalities.” The two really must be read together, and both are to be found in several places, but conveniently reprinted together in E.B. Spillius, ed., Melanie Klein Today: Developments in Theory and Practice, Vol. 1 (Routledge, 1988). 

But now we have new books on Bion, and in this case Donald Meltzer as well, with whom I was completely unfamiliar prior to reading Avner Bergstein, Bion and Meltzer's Expeditions into Unmapped Mental Life (Routledge, 2019). This is a very useful introduction to the two authors in the title, rendering Bion especially much more accessible than he was himself in some of his writings. The chapters on obsessionality, as well as on the psychotic personality, render Bion's thinking on both topics lucid and accessible without any dilution of their explanatory power. 

The final chapter, "The Ineffable," looks briefly at Bion's familiarity with both Christian and Jewish mysticism before arguing that "Bion seems to present us with non-religious mysticism": p.172), a judgment I would agree with. Part of what Bion appears to have taken from both of these mystical traditions is captured in his famously misunderstood phrase about refraining from memory and desire: "The psychoanalytic attitude, much like the mystical one, is a deliberate conscious act of discipline which depends on an active suspension of memory and desire" in order to exercise an "act of faith" that "truth exists" and can be discovered in the clinical encounter (p.166). 

Psychosis and Schizophrenia: 

While on the topic of psychosis, I must mention the following books which I have found not merely edifying but actively encouraging in what is so often a bleak landscape of poor and inadequate treatment and resources for psychotic patients: David Garfield and Daniel Mackler, eds., Beyond Medication: Therapeutic Engagement and the Recovery from Psychosis offers a number of essays from scholars and clinicians around the world looking at a range of options, while Therapeutic Communities for Psychosis, John Gale et al., eds., is looking at non-medical, quasi-institutional, but voluntary and community-based outpatient options for residence and care. 

Perhaps the best known (relatively speaking) example of this are the Soteria houses, which have fascinated me for some time. Only in September did I get around to finally reading Soteria: Through Madness to Deliverance. I find that I read all such books with a mixture of awe and respect for what was attempted but also some regret and amazement at how poorly supported such initiatives seem to be--and also with a wish that we might continue to build such places for there is a long track record and very impressive evidence base that they work. (See below for the evidence.)

I have a number of must-read books I recommend to other clinicians when they consult with me about working with psychotic and schizophrenic patients, starting with Michael Garrett and Andrew Lotterman's books. To that I will now insist on adding a third which, despite being the oldest of the three, is still incredibly relevant, timely, and useful: Michael Robbins, Experiences of Schizophrenia: An Integration of the Personal, Scientific, and Therapeutic.

Finally for books in this category we come to Courtenay Harding, Recovery from Schizophrenia: Evidence, History, and Hope. Please, please, please buy this book! I get nothing for saying that, and have never met the author, but I will hope for some small satisfaction that by encouraging a wide reading of this book then perhaps the long-standing, deceptive, indolent, and destructive narrative about schizophrenia that I first encountered in 1991 as an undergraduate, and which seems still to be propagated today to the detriment of many, may eventually die an overdue death. That narrative, of course, is the one that tells patients and their families that schizophrenia is a lifelong sentence of suffering for which there is no cure and which can, at best, be only partially ameliorated by neuroleptic medications (with notorious, intolerable, and sometimes irreversible side-effects). The fatalism and hopelessness in this narrative is just crushing to patients and their families, but it is infuriating to those of us who know that with the right treatment patients can and do get better!

That is not just an anecdotal claim based on a tiny, non-representative sample of one clinician, but has been backed up by empirical studies of hundreds of patients in different countries going back 75 years. It is to Harding's everylasting credit that she has tracked down patient records and long-forgotten studies of schizophrenic patients, including some of the most rigorous longitudinal studies we have of any psychiatric population, and published them in one place. In rendering so important a service to scholarship and patients alike, she has allowed us to see that, with multi-modal treatment, many patients have recovered. That is, three-quarters of a century ago now we already knew that merely medicating a patient is far from sufficient. Medication might be useful, but so too is intensive psychotherapy (see, e.g., Frieda Fromm-Reichmann's practice, or Harry Stack Sullivan) combined with vocational counseling, social supports, access to supportive, low-cost, outpatient housing, and a team of people (psychiatrists, nurses, therapists, social workers, dieticians, and others); but who today is willing to fund such treatments? 

How to Listen:

Salman Akhtar's short book, Psychoanalytic Listening: Methods, Limits, and Innovations is a wonderful addition to the literature, filling a gap that goes back at least thirty years. 

My debts to, gratitude and affection for, and frequent quotation of Nina Coltart are no secret. I have long maintained that nobody, in my experience, has surpassed her cogent description of therapeutic listening as a process of: 

sharply focusing, and scanning; complex involvement in feelings, and cool observation of them; close attention to the patient, and close attention to ourselves; distinguishing our own true feelings from subtle projections into us; communicating insight clearly, yet not imposing it; drawing constantly on resources of knowledge, yet being ready to know nothing for long periods; willing the best for our patients and ourselves, yet abandoning memory and desire; a kind of tolerant steadiness which holds us while we make innumerable, minute moral decisions, yet steering clear of being judgmental (Slouching Toward Bethlehem, 119). 

A little later in that unforgettable book she returns to all that is going on when the clinician is listening therapeutically:  

the need for consistent scanning and judging, not only of what the other person says, but of what we are about to say, and are saying; and with this scanning, the need for rapid continuous thinking, which may be only half-conscious; the need for repeated moral and technical decision-making; and yet if it is to convey truth, and more importantly, authenticity, in our style of speech we must also master intuitive, unlaboured spontaneity. This is an extremely demanding and complex requirement...[and]...it depends, for success...on...the combination of unselfconscious self-forgetfulness with deep self-confidence (Ibid., 145). 

Since reading this description of listening more than 30 years ago, I have found nobody who unpacked these dense descriptions until Akhtar's book, which is a gem. I now regard it as required reading for my students. 

It is not especially long, and it is written in clear, cogent, accessible prose with good but not overwhelming use of clinical illustrations. In addition, there is a commendable modesty in the author, who freely and frequently confesses his own errors about listening in the wrong way, or tolerating silence when speech was called for, or vice versa. He also notes, with admirable restraint, the difficult circumstances under which listening might and even should be refused--not least when outside of clinical contexts, when psychotherapeutic listening could be used manipulatively or destructively (he gives examples of doing this early in his marriage and watching how frustrating his family members found his doing so). 

In keeping with Coltart, he writes appreciatively on types of and purposes for silence, and he recognizes the degree of "faith" (also a concept Coltart explored in a non-theistic way) required to sit and wait, confident that if something is important, it will show up, and not once but repeatedly. Finally, he has some throwaway comments on several topics, including supervision ("supervision is more than teaching and less than treatment" he quotes A.J. Solnit's 1970 article in the International Journal of Psychoanalysis as saying). 

Laplanche, Freud and the Sexual. 

I have not read Laplanche nearly enough, and so on my last research trip to the library of the Cincinatti Psychoanalytic Institute, with less than an hour before I was to leave, I pulled all his books off the shelf, and slightly manically tore through them to decide which I really needed to read in a ranked order of urgency or importance. Apparently (this was 18 months ago now at least) I decided it was going to be Freud and the Sexual at the top of my list. Having just finished it, I must say frankly that I'm not sure what I saw in it. The book is a collection of articles on several topics, many of which feel quite like unfinished first drafts; much space is given to arcane arguments with translators of Freud from German into French and English; and when Laplanche finally turns to the topic of the sexual, his main insight seems to be confined to insisting that we should stop fighting over whether "instinct" or "drive" is the best translation for Freud's Urtriebe and recognize the utility of both terms in English.

On Buddhism and Philosophy:

Todd McGowan, Embracing Alienation: Why We Shouldn't Try to Find Ourselves is a new book that I read in January as presidential transition was taking place and a sense of alienation was mounting. 

I came upon McGowan close to a decade ago now in reading his book on the death drive. Enjoying What We Don't Have is one of the richest and most rewarding reflections on the death drive I have read in English. 

His new book on alienation makes the simple point in several places that by abandoning quests to find ourselves, or our "true" selves, we stop wasting time and energy that could be better put to projects of solidarity with each other in challenging the myriad instances of injustice in the world today. Embracing our alienation, in other words, has an "emancipatory quality" (p.7). In this way, then, McGowan manages to avoid the problem of a paralyzing despair at being alienated, and to avoid the temptation to fantasize about some prelapsarian paradise from which we are estranged but which we should struggle to find out way back to. There is no such paradise, McGowan says, and a good thing too.

The "alien" that we need to embrace is not some vague existential angst or a sense of estrangement we have from scrolling on social media and reading about all the horrors of strangers being snatched off the streets by fifth-rate opéra bouffe thugs in masks. The alien, rather, is within: it is our unconscious mind. As Freud first argued, and McGowan heartily agrees, each of us is alienated from ourselves. Our minds are divided and we live in a state of perpetual psychic alienation. If we stop fixating on "solving" this problem, and instead learn to forget our alienated selves, we will not only have more time and energy to work toward a better world, but we will also discover freedom and even some measure of happiness by focusing on helping others instead of chasing after our own "identity." 

And that word, in McGowan's hands, is clearly (and rightly) to be regarded as a bogus, deceptive, self-indulgent idol of our time, perhaps more than ever thanks in part to social media. Being preoccupied with finding and then defending our true "identity," McGowan shows through a close reading of Hegel, is actually a form of slavery we must emancipate ourselves from by learning self-forgetfulness. In doing so, he says in conclusion, "becoming reconciled to one's alienation is not a way of accepting oppression as inevitable" (p.148). McGowan's welcome book, then, is not a counsel of despair or an example of pietism or quietism, but instead a call for a new kind of politics. 

McGowan's theme of forgetting ourselves is also treated in several of Mark Epstein's books, which I have read over the past year, but these deserve a post of their own, so before Christmas I hope to offer some thoughts on Advice Not Given: A Guide to Getting Over Yourself and at least two other of his books. I have been propelled into an unexpected exploration of Buddhism and psychotherapy because of Nina Coltart's own immersion in that tradition as seen in her wonderful concept of "bare attention," an ascetical discipline (so I would say) we must all cultivate moment by moment and hour by hour with each patient. More on that anon. 

On So-Called Conversion Therapy: An Interview with Lucas F.W. Wilson

In the late 1990s, I had finished an MA in moral philosophy ("ethics") and was casting about for ideas for a doctoral dissertation. As a student at a Catholic university in Ottawa, I had for several years been fascinated by the literature on "conversion therapy" or "reparative therapy" of the so-called disorder of homosexuality. I pitched to one professor, who had directed my MA thesis, the prospect of writing on the ethics of Christian clinicians continuing to promote and practice "conversion therapy" when there was an increasing body of empirical literature emerging at that point showing not just the total lack of efficacy of such therapy, but the active harm it was doing to patients. My professor thought the topic eminently suitable for a dissertation, but in the end my life went off in several other directions and I never wrote on the topic even after reading a great deal in the area. So it remains something of interest to me.

Along comes Lucas Wilson to have compiled a book on the topic which is marvellously well done, and deserving of a place on every bibliography devoted to conversion therapy and other ideologically driven destructive pseudo-treatments:  Shame-Sex Attraction: Survivors' Stories of Conversion Therapy (Jessica Kingsley Publishers, 2025), 192pp. 

I contacted him by e-mail to ask for an interview about the book. Here are his thoughts.

AD: Tell us about your background

LFWW: I grew up in a home with a dad who was an agnostic and a mom who, as I say now, was haunted by her Baptist demons. We were not a Christian family by any means, even if we went to church in the early years of my life. In fact, by grade three or so, my family—like all good Canadian families—went to the cottage rather than church. But when I was just about to enter high school, I became interested in questions of faith, and by the time I was in grade nine, I became a zealous evangelical and remained so for just over ten years (until I deconverted around age 27). When it came time to choose which college I would attend, I chose to study at the world’s largest evangelical college: Liberty University, Jerry Falwell’s school, located in Lynchburg, Virginia. It was there, on campus, that I underwent four years of conversion therapy—that which is now commonly referred to as conversion practices. 

After leaving Liberty, I went on to graduate school and received a proper education. Most of my academic training was in literature, but as time went on, I became increasingly interdisciplinary, working in the fields of religious studies, history, and creative writing. My work has largely centered on the Holocaust, but given the rise in anti-queer and anti-trans violence, public policy, and legislation, I redirected my attention on a main catalyst of homophobia and transphobia today: white Christian nationalism.

AD: Your other recent publications seem to be in the field of Holocaust studies . Tell us a bit about those works and what, if any, connections exist in your mind between them and this new book on so-called conversion therapy.

LFWW: Both the Holocaust and conversion therapy are inextricably connected to Christianity. The Holocaust never would have happened, as it did at least, had it not been for Christianity. Both the Christian scriptures and Christian theology laid the seedbed for the Holocaust—so much of the hatred against Jews that was in circulation before and during (and after) the Shoah was a function of Christian antisemitism. As for conversion therapy, efforts to change individuals’ nonnormative sexualities and genders were enthusiastically supported and promoted by Christians since at least the 1970s; although conversion therapy began in secular contexts, it became something that has occurred disproportionately in conservative Christian contexts. Christianity has played a significant role in both of these sustained attacks on minority groups, and my research on these topics addresses the ways by which Christianity has so easily lent itself to such hatred. 

Of course, there are also many differences between these two areas of research, but despite these differences, my work in these two areas shares a number of theoretical and methodological similarities. Not only do I employ feminist and queer theories of affect, memory, and trauma in almost all my work, but I also approach my research subjects largely by way of oral history, archival collections, and literature. As my approaches to both areas of research overlap significantly, my goal is always the same: to center and amplify marginalized voices in order to better understand underrepresented individuals and groups, especially those in politicized religious contexts.

AD: What led you to write this book in particular on conversion therapy? 

LFWW: I’ve been writing and speaking about conversion therapy for a few years now. Because of this work, in concert with my involvement in the fight against conversion practices in Canada, I was invited by the fabulous Alex DiFrancesco (who became my editor) to edit Shame-Sex Attraction, an anthology of stories about conversion practices as told by survivors themselves. We thought it was important for all the stories in the collection to be written by survivors themselves; representation of conversion therapy has not always centered survivors, and we wanted to make sure that this collection elevated their voices. So, we only included survivors in Shame-Sex Attraction. 

AD: In your introduction you not only argue that conversion therapies are ineffective, fraudulent, and harmful, but also practices that are motivated by "genocidal intentions."  Some, I expect, might question such language. Can you elaborate on what you meant?

LFWW: This language and argument is original to two rockstar academics whose work I love: Christine M. Robinson and Sue E. Spivey. Though I can’t take credit for this language or argument, I draw upon both Robinson and Spivey’s research in almost all the work I do on conversion therapy, including in the introduction of Shame-Sex Attraction. Put simply, conversion therapists’ desire is for queers not to exist. Indeed, their goal is to eradicate any and all queer and trans representation, vitality, and life. That is, if conversion therapists could have their way, they want to see an end to me, LGBTQ2S+ communities, and queer and trans culture totally and completely. Such a desire is, definitionally, motivated by genocidal intentions. Although some supporters and practitioners of conversion therapy would not want us physically dead—though I am sure many do—genocide does not always aim to physically eliminate people. As has been well-established (especially in regard to Indigenous folks in North America), genocide can also be cultural.

AD: In your introduction especially you give a good overview of the literature on conversion therapies and the awareness of the harms these practices cause, noting that most of the practices still endure today "especially in religious spaces." You hint at some diversity here, but do not go into detail. Are there, to your knowledge, any religious traditions that refuse to engage in conversion treatments or have denounced them?

Yes! There are a number of religious traditions that are not complicit in conversion practices and that actively advocate against the harmful efforts to change queer and trans folx’s sexualities and genders. These are mostly more progressive mainline Christian and Reform Jewish congregations. The sad reality is, however, that many conservative religious traditions continue in their attempts to change queer folx’s genders and sexualities, despite these progressive religious traditions doing the good work they do. 

AD: In looking at national data of those forced to undergo conversion practices, you highlight that "specific minority populations" (p.17) undergo such practices at much higher rates. Any thoughts on why this might be the case?

LFWW: There are a number of complicating factors as to why minority populations are disproportionately targeted. Insofar as many of these folx face increased barriers to education, appropriate healthcare, and other resources, they are more vulnerable to conversion practices. If we think of trans folx specifically, there are numerous challenges they face in regards to receiving proper gender-affirming care. Many trans and nonbinary folx are moreover pushed into conversion therapy in religious contexts because their gender expressions do not allow them to pass; when these individuals were raised in religious families and communities, they were not always able to hide their non-normative genders and were thus more prone to conversion practices. 

AD: You note that "in 1952, homosexuality was listed as a mental illness in the first edition of the...DSM" (p.19). Numerous scholars (Robert Corber, Craig Loftin, Dagmar Herzog, inter alia) have suggested that these clinical decisions were not really driven by science but instead by the politics of the Cold War. What are your thoughts on that?

LFWW: No doubt, there were political factors that shaped the classification of homosexuality as a mental illness in the DSM. There were also social factors like the diffuse cultural homophobia that was in cultural circulation at the time, which made it seem obvious or natural that homosexuality was an illness. But with Alfred Kinsey’s early work in the 1940s, there was already research to suggest that homosexuality was not a mental illness. Shortly after the DSM came out, Kinsey’s next study, along with the work of Evelyn Hooker and others, further refuted this pathologization of homosexuality; however, it was not until 1973 that homosexuality was removed from the DSM. Indeed motivated by political and social politics of the time, this declassification of homosexuality came 21 years too late.

AD: You note that in the 1970s, when "Christian ministries emerged for queer individuals to become straight" (p.20) they were focused on the "transformative power of Jesus" and thus "did not draw on psychological 'explanations' of homosexuality until the 1980s." Have you looked at those programs from the 70s? I'm very curious as to what they consisted of. I'm equally wondering about your thoughts on why they made the turn to psychological explanations in the following decade? What might have motivated that?

LFWW: I have looked at the 1970s programs, albeit only briefly (there has not been an abundance of research on this subject and most of my research has centered on the later aspects of conversion practices). I am familiar with Chris Babits’ work that has focused on Kent Philpott, an early conversion therapist who relied heavily on the curative powers of the Holy Spirit and exorcisms throughout the 1970s. Like Philpott, the early conversion-therapy programs relied heavily upon prayer and faith, and both prayer and faith remained main aspects of conversion practices for many years. 

However, as I explain in the book, by the 1980s they were incorporating so-called psychological explanations for queerness into their teachings. I think the main reason for this was the symbiotic relationship ex-gay ministries and ex-gay “researchers” that the two groups formed. The ministries gained ostensible legitimacy because they had supposed psychological “research” to back up their claims, and the “researchers” (a dubious term to use in regards to these folks) got paid for their books, seminars, and conferences for which the ministries were paying. This is certainly a large reason for what motivated the psychological turn. 

AD: I've edited international scholarly collections and one hallmark is often an enormous diversity in individual chapters, but what I find striking in yours is a certain "uniformity" in that all the chapters resist being tied up in a neat, nice little bow at the end, allowing the reader to go away with a comforting ending. Was that an explicit editorial direction you gave to contributors?

LFWW: This was an explicit editorial direction, yes. I wanted readers to have to sit in the discomfort of what it is like to undergo conversion therapy. Obviously, this is a second-hand discomfort, and most folks (thankfully) will never know the depths of what it was like to be subjected to such dehumanizing practices. However, the endings were to disable readers from feeling some sort of narrative resolution or a sense that all was well for the authors after their time in conversion therapy. I think that we as humans (if I may make such a broad claim about all humanity) desire a sense of resolution when reading or listening to stories and that we often crave a happy ending. The stories’ endings in the collection, as abrupt and unresolved as they are, pointed to how, for survivors, our experiences were quite rough for quite some time. Although we eventually were able to come to terms with what happened to us, for a long time we had really unresolved and difficult times piecing ourselves back together. The stories’ endings gave voice to this, even if indirectly or in a small way. 

AD: The cumulative effect of such abrupt endings is, for me at least, a sharp awareness of the ongoing suffering of those who endured conversion therapies. This, in turn, gives rise to two questions: what do you find people need to recover from conversion "therapies"? Are there common things that many or even most people find helpful?

LFWW: In a Canadian study of conversion practices from a few years ago, that which was most helpful for survivors to recover and come to terms with their experience was friendships with affirming people, followed closely by friendships with 2SLGBTQ+ individuals. In other words, community is wildly important. Of course, therapy is always a good idea (for survivors and non-survivors alike), but not everyone can afford it. However, friendships are free, and a supportive community is of utmost importance to heal. 

AD: You note that your contributors are from North America and Australia, and mostly experienced conversion treatments in Christian contexts. Are there researchers out there you are aware of looking at conversion practices in the global south--Africa especially? (Some churches in Nigeria and Uganda have been especially virulent in their homophobia and promotion of the idea of "converting" from such a "sinful lifestyle".) And are there conversion practices in Islamic and other religious traditions that you know of?

LFWW: Yes, there are researchers who are doing work on conversion practices in the Global South; however, the majority of research focuses on such practices in the West. I think this is a major issue because conversion practices are ubiquitous and happen everywhere. Wherever there is religion, there are conversion practices (including in Muslim contexts). Though I hope the research on conversion practices in the West continues, I am even more eager to see the body of research on conversion practices in the Global South grow—not to mention research specifically on conversion practices in Muslim contexts. 

AD: Sum up your hopes for the book.

LFWW: I would love (and I mean love) for this book to change the minds of conversion practitioners and those who endorse conversion practices—to show them how death-dealing it is to try to change others’ sexualities and genders. I want to show them the immense psychological, emotional, and spiritual harm such practices cause. But I also know that the vast majority of conversion practitioners and their supporters will never read this collection, and even if they did, it would likely not change their minds—these folks do not have the ears to hear or the eyes to see that what they are doing and/or supporting is wrong. As such, I know this desire for them to change their minds after reading this work is a pipedream. 

In either case, I hope that survivors of conversion practices find this book and that they see themselves in its pages. I hope this book offers them solace in that they are part of a group that has persisted despite countless attempts to erase us. And I hope this book reminds them that they are nothing short of beautiful, strong, and resilient—that they are in fact survivors.

AD: Having finished this book, what are you at work on now?

I am currently working on another edited collection, this one about queer experiences at Christian colleges, universities, and seminaries. I am accepting submissions until April 15, so if anyone is interested in submitting a story, I invite them to e-mail me!

Notes from Christmastide Reading: Schizophrenia, Case Formulation, Ogden, Self-Supervision, and Dead Analysts

The only time I can permit myself not to work is when I am traveling. If I am on my academic Christmas break, then I must be reading, writing, and editing. Herewith a few notes on some new, and new-to-me, books that I have recently finished over the break.

On Schizophrenia:

This is a very workmanlike little book that I immediately decided to adopt for my students in my psychopathology course. We do a special extended unit on psychotic illnesses, and I've not hitherto found a suitable book for this part of the course, making do with several articles.

I would quibble with the author for her bias that only the "medically qualified, Psychistry-trained Psychoanalyst" (titles she always capitalizes) is really equipped to handle schizophrenia--a clunky, snobby phrase used several times in a short book. I have no medical training but have nonetheless worked with cases of schizophrenia for years now. To her credit, she is aware that those with psychoanalytic training, which I do have, are also able to handle schizophrenic patients. 

Case Formulation/Conceptualization:

A supervisor of mine lamented for years that the art of case conceptualization had largely been lost, and I rather agree that in many cases it has. It is important, if only in the clinician's mind, to be able to have a relatively coherent, but dynamically flexible, succinct vision of who the patient is, what the presenting issues are, how they are bound up with personality structure and personal history, and what goals and direction treatment is taking, including its transference and counter-transference manifestations. The lack of all this immediately puts the clinician at risk for what I call therapeutic drift. 

To prevent that along comes the psychiatrist and psychoanalyst Mardi Horowitz with a handy little book suitable for students and trainees: Formulation As a Basis for Planning Psychotherapy Treatment. This is a very short workmanlike little book that would be suitable for students and trainees early on. 

André Green and Dead Parents:

Despite being once fluent in the language, I have read little of French psychoanalysis in that lovely language. Indeed, apart from the notorious (and largely unreadable) Lacan, I have had only some knowledge of a tiny number of figures such as Françoise Dolto, Élisabeth Roudinesco (author of several useful biographies, including of Freud and Lacan, and of the very valuable little book Why Psychoanalysis?), and André Green. But my ignorance of Green is slightly less deep after reading not just his most famous essay "The Dead Mother" (found in this collection) but also a book of essays devoted to that theme, The Dead Mother: The Work of André Green, ed. Gregorio Kohon. Among the virtues of this collection are essays by three of my favourite analytic writers today, Adam Phillips, Christopher Bollas, and Thomas Ogden. 

Green's concept of the dead mother has been helpful in understanding early struggles of several of my own patients. It was also very helpful in my own psychoanalysis to understand not just the emotional deadness of my mother but my father too because of several miscarriages prior to my birth, and other sudden family deaths, especially of my father's hugely idealized older brother when I was a small child. 

Thomas Ogden on Not Being Alive:

The theme of aliveness is one found in many of Ogden's writings (which, on this theme at least, bear striking similarities to Adam Phillips, as I showed here), including the essay published in 1999 in the above-noted collection. He has returned to it in his latest book, released just a few weeks ago: What Alive Means: Psychoanalytic Explorations. 

Having written many appreciative, almost fulsome, essays on Ogden, having recommended him more times than I can count to students and interns, and having bought all his other books (save for his novels), I think I am allowed at least one occasion to remark that this newest book of his is a dud. It says little he has not said elsewhere (always a danger as an author ages and his opera omnia becomes every larger, stretching back several decades), and most of this book is a rather diffident series of short commentaries on Winnicott's writings. My love of Winnicott, too, is second to none; but at some point this ground has been gone over so much by Ogden himself (to say nothing of others) that the freshness and, well, sense of aliveness that so marks Ogden's previous books, which I found exhilarating to read, is absent here, alas. Those new to Winnicott and Ogden alike might well find something useful or nourishing here, but I was quickly bored and disappointed. 

Self-Analysis and -Supervision: 

Freud, of course, first discussed and attempted to practice self-analysis and other authors, including Karen Horney, have written at length on the topic. There is some interesting recent research (which so often lags behind demonstrating what psychoanalytic clinicians have known for decades) on the reflective capacity of the clinician being a key component to the success or failure of treatment. Such a capacity is just what self-analysis and -supervision should be focused on. 

Marc Lubin and Jed Yalof have a new publication Self-Supervision Psychodynamic Strategies which offers some useful tips to clinicians. It is not a long or complicated book, making itself accessible to those new to this topic and trying to sort out some of the challenges of engaging in a self-supervision. 

Self-analysis and -supervision show up in Fred Busch's latest book How Does Analysis Cure: Essays on Psychoanalytic Method, Psychoanalytic Organizations, and Psychoanalysis. 

I have been a fan of Busch's earlier book Creating a Psychoanalytic Mind, as I showed here and here. So I hope it will not be thought an impertinence on my part to say that this new book is a bit of a mess, and only parts of it can be recommended. (The entire second and last section of the book has an infelicitous feel as Busch complains--almost gossips in public--about some rough handling by callow editors at psychoanlytic journals, and problems within psychoanalytic institutes, none of which are at all new or any great surprise to those of us paying attention since, say, 1941 or thereabouts. I am not at all clear how airing all this in public does anything to solve the problems or increase the esteem in which already battered and often justly ridiculed institutes, hidebound places of orthodoxies where none should be found, are held.) 

If we overlook the final section of Busch's book, we have some rich reflections, including the first chapter ("How Analysis Cures"--the short answer is mentalization, a word that Busch seems at pains to avoid for some reason), and the chapter on silence, as well as a chapter on self-analysis. Here, too, however, my complaint about several of these chapters is that they are too short and say too little. One has the distinct impression of an author losing steam from the beginning of this book. 

One thing that is clear in treatments of self-analysis and self-supervision is that these two are never to be exclusive substitutes for an actual personal psychoanalysis and work with a supervisor. One of the many things I admire about both Glenn Gabbard and Nina Coltart is how, even late in life, after decades of practice, they both flatly and humbly admitted, in an almost off-handed way, that with certain cases they sought out supervisors because the clinical issues were very tricky. This is something we must all consider doing when needed. 

Mechanisms of Change in Psychotherapy:

These two new books belong in the curricula of teaching institutes and graduate programs, for they contain a wealth of research, much of it quite sobering. 

I work with personality disorders, including borderline personalities as well as obsessional and compulsive personalities, about which see here for some invaluable resources. Despite being in the second-largest city in the state of Indiana, I seem to be among a very tiny handful of clinicians who treat these issues, which are, so far as I can tell, rarely discussed in the standard graduate training program in this country. (Every clinician's website I'm on seems to say the same thing: "I specialize in depression, anxiety, and trauma!" But how can it be a specialization when everybody is doing it?) So I picked up Understanding Mechanisms of Change in Psychotherapies for Personality Disorders by Ueli Kramer, Kenneth N. Levy, and Shelley McMain with great interest, and it would lend itself to incorporation into training programs.

This question of what mechanisms of change are in psychotherapy is a fascinating one in part because answering it raises some very formidable challenges to the empirical researcher. Those questions are given very substantial treatment in an enormously valuable collection edited by Louis Castonguay and Clara Hill, Becoming Better Psychotherapists: Advancing Training and Supervision. 

Particularly alarming are the several chapters devoted to exposing how little research we have on what constitutes good and useful supervision. Supervision, of course, is a standard requirement for graduation and licensing nearly everywhere, but who trains the trainers, and then who evaluates that training and those trainers? Few do, it seems. If we are to have better psychotherapists--and God knows we have nowhere to go but up on this score, as the hugely depressing, almost disgusting, data revealed by Francis Martin in Therapy Thieves has shown--then we need to train not just them but also their supervisors. But trained in what, and how, and by whom? Once again these are formidable questions without easy or quick answers. But they are crucial questions we need to be asking, and this book does so in unspairing and unsentimental ways, which we must be thankful for. 

Let me--feeling slightly sadistic--close by recommending you pick up Martin's book. He's done the heavy lifting of surveying thousands of clinicians in the United States to ferret out all the rubbish, all the chicanery, that gets passed off under the guise of "therapy." I was aware of just a handful of woo-woo examples--chakra therapy, singing bowls--but there are hundreds more, each more absurd than the last. Perhaps especially sobering is that regulating psychotherapy does little to control the growth of this nonsense. Once a clinician has a license, there seems in most if not all jurisdictions to be a tacit acceptance that whatever they want to do they can. Complaints against a license are common in custody cases, and of course for reasons of violating sexual boundaries or breaking confidentiality. But when was a clinican last challenged or brought before a disciplinary hearing for practicing (just to pick four random examples from thousands Martin has documented) bright light therapy, Shifaa soul counseling, Reiki womb therapy, or equine ecosomatics? One scarcely knows whether to laugh or throw up. 

This notion of being "evidence-based" smuggles in all sorts of covert philosophical and hermeneutical assumptions ("evidence" is never self-evident, but only ever a result of a process of interpretation which is personal and inescapable), and the refusal to recognize this is very vexing to me. So, having finished Stephen Toulmin's helpful Return to Reason over Christmas (which criticizes clinical psychology’s habit of wanting to base studies of the mind on Newtonian physics whence some wish to derive universal “laws” to the total exclusion of the case study method), my reading this spring will continue to mine the hermeneutical literature, starting with Richard Rorty's landmark book Philosophy and the Mirror of Nature; and then Paul Ricoeur's Hermeneutics and the Human Sciences: Essays on Language, Action and Interpretation. I've been reading Ricoeur off and on for more than twenty years, but never in a sustained and systematic way, as I hope to continue to do. 

On Working Clinically with Sexual Offenders: An Interview with Dr James Cates

When I was first introduced to Dr James Cates about five years ago, it was in a lecture in which he talked about the unique challenges of doing clinical work with the abundant Amish population (third largest in the country) in northern Indiana. I was fascinated by this work in part because it focused on sexual abuse inside a religious community, and I had myself just finished a book on sexual abuse inside the Catholic Church. 

About a year later, I had the great good fortune to read his elegantly written and fascinating book, Serpent in the Garden: Amish Sexuality in a Changing World, about which I interviewed him here. 

I brought him to one of my classes this past semester to lecture on working with the Amish and it was then I learned his newest book was about to make its appearance in print. I eagerly ordered and read Offenders and the Sexual Abuse of Children (Routledge, 2024), and then asked him for an interview about it. His thoughts are below.  

AD: Tell us about your background

James Cates: I graduated with a master’s degree in clinical psychology from George Mason University in Fairfax, Virginia. Jobs were sparse, so I did a nationwide search, and wound up employed in Fort Wayne, Indiana. I planned to stay a couple of years and move back to Virginia.

That was 1982. I’m still in Fort Wayne, looking for the right job to move back. 

Meanwhile, I received my doctorate in clinical rehabilitation psychology in 1993, became a board-certified clinical psychologist, and moved into private practice. Somewhere along the line I began teaching part-time at Purdue University-Fort Wayne, first undergraduate, and more recently in the mental health counseling program. I became involved with the Amish, a culture that I love dearly and respect deeply. I am now semi-retired, and continue to write and to do psychological testing and consultation. 

AD: Your previous books marked you out as the leading scholar-clinician on Amish psychology, so a book on sexual offenders might seem a significant new direction to move in. Are there any connections between these worlds?

JC: Sadly, more connections exist between the Amish and sexual offending than would be preferred. All three of my books on their culture include chapters that address sexual abuse: Serving the Amish: A Cultural Guide for Professionals; Serpent in the Garden: Amish Sexuality in a Changing World; and Dancing on the Devil’s Playground: The Amish Negotiate with Modernity. And mainstream media has picked up the storyline of hidden sexual abuse among the Amish, as among so many groups today, as a social ill in desperate need of change. 

I credit my work with the Amish for helping to broaden my perspective on sexual offending. Their culture is collective, emphasizing a communal and cooperative lifestyle, so that very few actions occur outside public awareness. Their culture also emphasizes forgiveness as a Christ-like virtue, so that sins are to be forgiven and forgotten. Consulting with both social service personnel and Amish ministers on how to handle issues of sexual abuse within the church, and counseling with Amish victims of sexual abuse and those who have sexually offended has given me an appreciation for the interwoven complexities of this behavior, and its impact on the family and community. This fallout is too often obscured as the justice system grinds into gear in mainstream culture.  

AD: The first part of your book helpfully situates what is to come in its social and historical context, especially in the anglophone world. As you survey this history, are there 2 or 3 outstanding factors you unearthed to help explain shifting perspectives on sexual offenses? 

JC: The idea that history is written by the victors is most recently attributed to Winston Churchill. That is so true when considering perspective on sexual offenses. With the caveat that I am neither a historian by training, nor am I an amateur historian, these are my thoughts.

The anglophone response to sexual abuse through the 19th and earlier 20th centuries was dictated by class and caste systems far more than an advocacy to protect all children. As horrible an indictment as that sounds, it fits within the broader disinterest in the rights and well-being of those of lower socioeconomic status. In this country, the status of African-Americans is the most obvious example. As the Civil War became a cause to end slavery, even many who were fervent abolitionists failed to perceive people of color as equal to whites. And these attitudes continued to be codified in law well into the mid-20th century. The backlash to these prejudices became an embrace of equality, and demand that the rights of all people be respected. One of the lasting legacies of this principled backlash has been a strong advocacy for the safety of children. Unfortunately, those who sexually offend then become pariahs in their own right. 

Another rarely considered historical factor was political necessity in the early years of gay rights. That portion of the nascent movement driven by gay men was enmeshed with men attracted to young boys. This uneasy truce lasted until it became clear that an alliance between men attracted to men and men attracted to boys was a detriment to social and political ambitions for the former, who acted to distance themselves from those who would now be termed minor-attracted. While the gay movement did not actively denigrate those who were minor-attracted, the implication was clear: we do not support that type of sexual activity. In that implication, one denigrated sexual minority made a case for its own worth by keeping its distance from another. (And in fairness, at the time those advocating same-sex attraction to boys were also advocating for the freedom to act on their sexual desires, a much different social and political agenda than those currently seeking status as minor-attracted.)   

AD: One of the themes in the background of your book seems to be how much we like to paint sexual offenders as bright red grotesques, whose features and causes we confidently feel we can immediately identify, but you note "there appear to be too many variables that contribute to the ultimate behavior to reliably predict patterns of sexual offending" (p.23). Later you note that when it comes to the risk of recidivism for sexual offenses "nothing even approaching a definitive response exists" (p36). Given the enormous publicity that attends sexual offenses, one might expect this to be a heavily researched area. What helps to explain the many lacunae in the clinical literature on these topics? 

JC: The problems in predicting the behavior that leads to sexual offending are myriad. A parallel example from several years ago in the area of substance use exemplifies the dilemma. At that time, studies repeatedly found that among 18–25-year-olds, over 50% were binge drinking on a regular basis. The first problem with this statistic is that by definition, if an 18–25-year-old was not binge drinking, they were abnormal, since they were in the minority. The second problem with this definition became the criteria for binge drinking. As studies began refining the definition of “binge drinking,” using differing criteria for the number of drinks consumed at one time, or within a certain time period, the percentage of those identified as binge drinkers began to vary too. Alcohol use was not significantly changing. The way research defined it was. 

When research looks at sexual offending, the same problem with definitions applies. What is the age of the victim? Legally, a “sex offender” label applies to someone who has sex with a five-year-old, or someone a week younger than the legal age of consent. Do the same dynamics of sexual, emotional, and romantic interest apply to these two individuals? What is the age range of interest for someone who has sexually offended? How often, or under what circumstances do the sexual offenses occur? Do we apply the same criteria to the uncle who molests his niece on two occasions, and the serial offender who has sexually offended against both genders multiple times?  Is there an element of power and control, or do they exhibit a romantic or regressive emotional interest in the younger partner? Not only is this a complex topic, but we do little to encourage those who have sexually offended to be open and honest about their sexual and psychological experiences. 

Research on recidivism in sexual offending is hampered by the shame, guilt, and risks that attend honesty. Consider a standard field research protocol. Participants must be known to have sexually offended. There is no potential to circulate a call for participants, such as can occur at a local 12-step meeting for those struggling with substance abuse who might like to give back to the community. There is no potential to ask counselors to share with clients who would qualify as participants. No, the only participants available are those who have been charged and convicted of a sexual offense. And the majority of these (now) criminals have no incentive to be honest about their behavior, beyond the behaviors for which they have been convicted. If they are, they run the risk of having even more charges added, and facing lengthier sentences. The individual struggling with alcohol or drug abuse, including illicit drugs, can share stories of past use with impunity. Not so the individual who has sexually offended.

The most accessible participants then, are those who have served a period of incarceration and are released. And the most easily obtained outcome measure is recidivism. Have they been arrested post-release for a sexual offense? And again, there is no incentive to be honest if they have not been caught. For the probationer who relapses and watches child pornography but escapes detection, there is no incentive to share that fact. We are then left with no understanding of the emotional and psychological forces that become overwhelming and lead to the decision to risk prison once again in order to fulfill this sexual need. The probationer who shares with a counselor that they have used alcohol, violating the rules of their release, faces minimal expectation that the counselor will report them. But the probationer who shares with a counselor that they have sexually offended, violating the rules of their release? A report is almost inevitable. 

And there is a need – clearly, there is a need – to protect potential victims of sexual offending. But in acknowledging that need, we fail to take into consideration the vague definition that the outcome measure “recidivism” must inevitably become. As another example, studies vary in the types of crimes they define as recidivism. Any violent crime? Or only a sexual crime? If a defendant is initially charged with a sexual crime, but it is reduced by plea bargain to a misdemeanor battery with no sexual component, is that recidivism? These are the types of decisions about definitions that vary from study to study, and complicate meta-analyses.  

AD: One of the (to my mind) peculiarities in treatment of adolescent vs. adult offenders is, as you note, offering the former a "rehabilitative model rather than a punitive one" (p.38). The latter model, when applied to adults (who are often related to their victims), often causes even further unintended hardship (as you note on p.78) and suffering by imprisoning the offender, causing a loss of income to the family and other problems. Is there any argument to be made about adopting a more rehabilitative model across the board for all offenders? What is the evidence we have about rehabilitation and its efficacy? 

The question goes to the broader issue of American attitudes toward rehabilitation. The statistic is hard to pin down, but we rank among the highest per capita incarceration rates among developed countries. We are more comfortable locking away those who offend than finding ways to manage them within the community. 

Restorative justice, the concept that accountability and reparation are more important than retribution and punishment, is beginning to make inroads into the justice system. We see it in the formation of drug courts and mental health courts, designed to treat substance abuse and mental illness primarily as disorders, rather than crimes to be adjudicated. Still, the emphasis on protection for the community means that rehabilitative models for those who sexually offend are slower to develop and slower to be implemented than for other populations. 

Rehabilitation for a particular population will relate to that population’s standing. Those who engage in criminal behavior are placed at the intersection of politics and science. There is a grim reality to the frequency with which Americans incarcerate those who commit crimes. Reducing the number of people likely to commit crimes who are on the streets does indeed contribute to a lower crime rate. So, at some point the issue becomes philosophical: to what extent is the drug dealer/drug user/burglar/child pornographer/etc. deserving of rehabilitation and a return to mainstream society? Only the to extent that we believe that a given population deserves rehabilitation do we begin to emphasize rehabilitation for them. And only to the extent we emphasize rehabilitation is it funded, analyzed, refined, and measured for its efficacy. 

An argument for extending rehabilitation? For those of us who argue for the worth of the individual over the erosion of civil rights and the staggering costs of incarceration, it is well worth it. For those of us who argue for the safety of the community over the worth of the individual? Rehabilitation is secondary to confinement.  And the argument is obviously not that black-and-white. Argue within the shades of gray and it becomes a tumultuous argument, indeed. 

AD: I thought my cynicism about the legal system was approaching bedrock level, but I confess it fell still further as I watched you judiciously sift and sort through the evidence for geographical restrictions on offenders, state-mandated offender registries, and similar tools of social control. Given that, as you show, we have virtually no empirical evidence for their utility, how are we to explain their ubiquity today--are they simply the perverse fruits of moral panic, a kind of "quarantining" or ghettoization of undesirables we see throughout human history going back to biblical leper colonies? 

JC: The high-profile kidnapping, sexual assault, and murder of several children resulted in federal laws that have shaped social control of those convicted of sexual offending. To some extent, it was a perfect storm of events: the public was clamoring for a sense of safety due to multiple events on the world stage that led to unrest and feelings of unease; the media hyped stories of child abduction and murder in an endless loop as the public became increasingly interested, and the media fed that interest; and social science had little or nothing in the way of evidence to support or refute proposed legislation. 

Once legislation was in place, research was playing catch-up to determine how effective it might be. Laws continued to be modified, expectations for registries continued to evolve, and research needed to change to match current expectations. By the time research was demonstrating that registries had no deterrent effect and geographic limitations were ineffective, both of these safeguards were entrenched in the public psyche as “deterrent measures.” For legislators it was no longer a matter of what might be effective. It was a matter of public demand. 

A demonstration of just how little evidence-based practice impacts social policy can be seen by placing gun ownership and sexual offending side by side. Mass shootings have become a norm in the United States – including in schools - but no one is seriously considering gun control, despite the evidence that gun control would work to reduce senseless deaths. Meanwhile, registries and geographic limitations on habitation do nothing to reduce sex offending, but we cling to them like a drowning man to a life preserver.

AD: At the end of ch.9 you note that "the necessary, fundamental change is a better understanding of a person who sexually offends." This seems so simple as to be almost startling, but I think it true. And yet I know from my students that the one population they all say they would struggle the most to work with, some of them expressing horror at the very thought, is that of sexual offenders. What are some of the most startling or surprising insights for you working with sexual offenders--what have you learned from them?

JC: Let me start the answer to this question indirectly, and wind my way back. It strikes me as a political rather than a clinical statement that as a 68-year-old male, in my state of residence I can carry on a romantic/sexual affair with a 16-year-old, and not only be within the boundaries of the law, but there is no preponderance of research explaining what might be the hell wrong with me. And yet social science churns out article after article detailing the problems of a 20-year-old who deigns to fall madly in love with a 15-year-old. 

Now, a couple of quick clarifications to the paragraph above. I have no interest in a romantic or sexual liaison with a 16-year-old. Rather, my point is that empirical research does not bother to extensively study age differences in romantic interest across the lifespan; only between adults and children. And the example I use is one of the narrower age gaps that can occur that result in arrest, charge, and conviction leading to the label of “sex offender.” Obviously, 20-year-olds (and older) are also sexually abusing much younger children, a clinical problem in desperate need of research. 

The point however, is that between the black-and-white of inappropriate sexual acting out and sexually permissible behavior there is a wide, gray area that becomes codified in laws that may not be an accurate representation of how clinically disordered a person is. 

I give two brief examples in the book. Fleshing these out a bit gives a better sense of just how different the dynamics between two people who become “sex offenders” can be. 

One was a case in which I testified for the prosecution. This was an approximately 40-year-old man who had a history of arrests for various offenses. His apartment was filled with toys and games he used to entice children from the neighborhood. By the time he was arrested he had multiple victims, and from all potential observation, no remorse for his behavior. He appeared to exhibit an Antisocial Personality Disorder – that is, a lack of conscience or ability to empathize with others, and a willingness to disregard their rights. In his case, rehabilitation was far less of a concern than safety for the community. His is one extreme of those who sexually offend. He also had charges for various non-sexual felonies. His sexual offending was part of a larger pattern of disregarding the rights of others. 

At the other extreme was a young man with a severe addiction to marijuana. He began sexually abusing his young daughter. He hated himself for doing so, and after one incident said to her, “If I do this again, tell mommy.” He sexually abused her again, and in turn, his daughter told her mother. He did not contest the charges. While he waited for the justice system to proceed (it took 14 months for his sentencing hearing), he lived on house arrest with his parents. He found a job, and made voluntary child support payments on a biweekly basis. Despite his cooperation and behavior, he was given a sentence of 12 years. In counseling him as he waited for sentencing, and staying in touch with him during the time he has been in prison, it is clear to me that he is not attracted to children. The incidents with his daughter arose from a combination of reduced inhibitions due to drug use, tensions with his wife (the girl’s mother), and feelings of helplessness in his larger environment. 

In these two vignettes, from a legal perspective, the behavior is the same. A child under the age of 14 was touched for the purpose of sexual gratification. From a clinical perspective, they could not be more disparate. Regardless of the presenting problem, it is a profound reminder for those of us in the mental health field: there are multiple reasons for a behavior to occur. 

And the most surprising observations? Very few of my clients fail to offer me insights in some way. Sometimes, they are insights that leave me grieving the human condition. Sometimes, they are insights that leave me breathless with what the human condition can overcome. The most startling among those who sexually offend has been the integrity they can demonstrate. Knowing full well that they are now pariahs, despised by so many, relegated to wear the scarlet letter of the registry upon their release from incarceration, they carry on with a dignity and purpose that belies their pariah status. There are several that I am proud to call my friends.  

AD: Your historicizing tendencies in this book are never so powerful and disturbing as when you show that many of the treatments previously used to "treat" today's offenders were the self-same ones used not so long ago to try to "convert" mostly gay men into heterosexuality. Are there, in fact, any treatments we have today that are (a) not connected to those abuses and (b) effective? 

JC: Visualize a map of empirical study of effective treatments for sexual offending. There is a broad, well-traveled road that runs through the middle of the map. That is the history of Sexual Orientation Change Efforts (SOCE), as they are now called, the historical efforts to convert sexual minorities to heterosexuality. At some point, that road begins to narrow, and eventually becomes a minor path. But branching away from it is a path that broadens into its own road. And these are the efforts to create change among those who sexually offend. Same journey; different destination. 

Now, staying with that visual, imagine side trails leaving the main road, both from the original highway and the new branch. These are much narrower, and almost all of them dead-end. That is the history of alternative treatment efforts, for both SOCE and for sexual offending. Without sufficient funding or willingness on the part of the larger mental health community to explore them, they may hold potential, but the destination is a therapeutic dead end. 

In brief answer to your questions then, (a) no, nearly all of the interventions in use today have their genesis in SOCE approaches, and (b) their efficacy is based on outcome measures, and the inefficacy of those measures is discussed above.  

I devote a single chapter to the evolution of mental health treatment. The topic is worthy of an entire book itself. My hope is that the chapter spurs a healthy debate on the efficacy of treatment, and that the community of current mental health practitioners implementing and researching these treatments are called to critically analyze their approaches.   

AD: Your chapter on minor-attracted persons is perhaps the one where we see most acutely the limitations and short-comings of our research, knowledge, and clinical practice. Where would you like to see the research go? What future directions and changes do we need to investigate? 

Minor-Attracted People (MAPs) are a paradox. They again demonstrate the intersection of the clinical and political. Allyn Walker wrote extensively about MAPs in their book A Long, Dark Shadow: Minor-Attracted People and Their Pursuit of Dignity, only to be pressured to resign from their position as faculty at Old Dominion University because of it. On the one hand, there is increasing urgency to recognize the right of MAPs to express themselves as romantic and sexual human beings. On the other hand, there is the ongoing urgency to protect vulnerable children from any more exposure to adult romantic and sexual encounters than a socially toxic environment already allows. 

The fear is the “slippery slope” of acceptance. It took time, but from riots by street people outside the Stonewall Inn in 1969, gay liberation brought us to Obergefell vs. Hodges in 2015, the Supreme Court decision legalizing same-sex marriage. Some fear that embracing MAPs as a legitimate sexual orientation is an ultimate invitation to act on that desire, protests to the contrary notwithstanding. They point to the slow history of acceptance of same-sex couples as an example of how that can occur. 

It is here that social scientific research can be most helpful. Is minor-attraction a sexual orientation? Are there different manifestations of minor attraction? How often does minor-attraction as a sexual orientation coexist with other sexual orientations? If minor-attraction is only one of many reasons that individuals may desire to become sexually involved with a child, what clinical/emotional/psychological factors and traits contribute to minor-attraction as opposed to other reasons for focusing on children? And if a MAP chooses to embrace that attraction but remain abstinent from acting on the desires, what are the most effective means of assisting them in doing so?  

AD: Sum up your hopes for this book? Who should read it? 

JC: Bear with me for a moment – my dad was a Baptist minister, and some of those lessons linger. One of those lessons was the story of Elijah the prophet on the mountainside. God sent a message, but first he sent an earthquake, a huge wind, and a fire. The message wasn’t in any of these. And then, God sent the soft whisper of a voice. That has been an important lesson for me.

So much of what is written about sexual offending advocates for the victim and rails against those who offend. Less often, but still in print are those writings that advocate for those who offend and rail against the system. Offenders and the Sexual Abuse of Children is, unapologetically, an indictment of the mental health, social service, and justice systems as they attempt to protect victims and treat those who offend. But I strive to maintain a balanced perspective. The system is not in need of repair because of indifference. On the contrary, there is a desperate desire to protect the community and potential victims. My voice may rise above a whisper in these pages, but I strive to avoid the drama of frustration and anger that so often pervades these emotional arguments. 

I encourage anyone in the fields of mental health, social services, or criminal justice who work with those who sexually offend or their victims to read this book. I also encourage those who volunteer with organizations that support those who offend, their victims, or their families to read this book. And for those who have offended and their families, some may find this book of interest as well. As much as possible, I have stayed away from jargon, and maintain a readable style. 

AD: What are you at work on next? 

Back to the Amish, at least for a time! Several years ago, I was part of a program that offered psychoeducational classes for Amish youth arrested for drug and alcohol offenses in the Elkhart-LaGrange settlement of northern Indiana (the third largest Amish settlement). Over the 14 years the program ran, we collected data on almost 1000 participants. That data is ready for analysis, and I am working with several other professionals to begin that process.

I am also co-authoring another book on the Amish. This book examines the strengths and weaknesses of Amish culture, particularly as their social fabric comes under criticism from ex-Amish, the media, and the larger culture.  

And the response to Offenders and the Sexual Abuse of Children will guide my decisions about further work (article, book, etc.) in this area.  

Thank you so much, Dr. DeVille, for the opportunity to share on this blog! Always fulfilling to work with you as a colleague and a friend.