1. Priests and sex abuse

2. Treating pedophiles

3. Does it work?

4. Is he safe?

The Rev. Paul Shanley, left, is led for an extradition hearing into a courtroom by a San Diego County Sheriff's deputy Friday, May 3, 2002. Shanley, who is at the epicenter of the clergy sex abuse scandal in the Roman Catholic Church, agreed to return to Massachusetts to face charges that he repeatedly molested a boy in the 1980s. Photo courtesy Bob Grieser, AP/Wide World Photos.

On May 7, former Boston priest Ronald Paquin was arrested and charged with rape of a child under 16. On the same day, bail was set at $750,000 for Rev. Paul Shanley, who faces three counts of child rape. One of Shanley's accusers, now 24, said the priest had sex with him between 1983 and 1989. Shanley has not commented publicly on the charges (see "Priest Accused..." in the bibliography).

The crime is sexual abuse, but the mental condition behind it is called pedophilia, a sexual attraction to prepubescent children. The Boston Archdiocese has been at the center of the scandal, with "scores" of priests and former priests now standing accused of pedophilia (see "Priest Abuse..." in the bibliography).

As the Vatican and U.S. society both try to come to grips with pedophilia, the public seems to believe that most of those convicted will repeat their crimes; with such an intense compulsion, some must be locked away forever. This is expensive. And while some argue that continuing to punish offenders after they serve their prison time infringes civil rights, others say releasing incorrigible predators endangers innocent children.

By 2000, the impression that sex offenders are untreatable prompted 16 states to pass "sexually violent person" laws permitting lifetime civil commitment for untreatable sex criminals.

Statistical woes abound
An alarming number of children are victimized by pedophiles. A 1989 study estimated that 3 to 6 percent of boys, and 12 to 28 percent of girls, are subject to some form of sexual abuse (see "Psychological Assessment ..." in the bibliography).

We don't need to stress how harmful this is, but it's worth noting that some of the abused become abusers themselves.

And while convicted sex criminals deserve punishment, is it true that treatment usually fails to prevent further sex crimes? While the public may believe treatment doesn't work, the truth is more complex. So what type of treatment is most promising? And how do we know it's safe to release a particular pedophile?

Three phases of treatment
Treatment of pedophiles has changed over the years (see "Psychological Assessment..." in the bibliography). The first treatments, begun in the 1930s, were based on insight-oriented, psychoanalytic (Freudian) or humanistic principles. In hindsight, studies of treatment effectiveness were scientifically dubious: diagnoses, treatments and followups were poorly described, and the comparison groups questionable. Even given these limitations, the benefits were generally minor or non-existent.

Courtesy New York State Historical Archives.

During the 1950s, the psychology based on the theories of B.F. Skinner inspired a switch to behaviorist treatment of sex offenders. The classic treatment was showing pictures of children to pedophiles, then giving electric shocks in an effort to link negative emotions to the sexually arousing stimulus. Perhaps because there was no effort to understand why the men (almost all pedophiles are male) were aroused by children, the treatments failed to reduce recidivism -- repeat offenses.

Cognitive-behavioral treatment, today's preferred technique, arose from the ashes of the preceding two treatments. Essentially, the cognitive side of treatment helps the offender acknowledge the deviant behavior, understand its harm and ideally its origin, and devise strategies to change it. Behaviorist techniques may include imagining going to prison after having sex with a child. "If you are going to try something that's been proven to work, this is the mode to try," says Joseph Plaud, a clinical psychologist who treats sex offenders and directs the Cambridge (Mass.) Center for Behavioral Studies.

Treatment. How's it done?

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