Josh Duggar admitted to past inappropriate behavior with minors. Treatment in this area is complex, controversial.

Joshua Duggar, the eldest sibling in the former TLC reality show “19 Kids and Counting,” was indicted last week on charges of receiving and possessing child pornography, some of which allegedly shows the sexual abuse of girls as young as 12 years old.

While Duggar has pleaded not guilty to the current charges, he has previously admitted to “wrongdoing” and acting “inexcusably” after a police report surfaced in 2015 accusing him of molesting several young girls while he was a teenager. His parents said four of the victims were his sisters. Two of them opened up about the abuse. 

Duggar said he received counseling and his wife Anna said the counseling had “changed his life.”

Experts say treatment exists for people who have a history of sexual offenses, but the path to changing behavior is complex and seeped in controversy. 

Camille Cooper, vice president of public policy at the Rape, Abuse & Incest National Network, explains that there is not a “cure” for sex offending because it “is not a disease, it’s criminal behavior,” but that “every sex offender should have access to treatment.” 

Controversy around treatment 

Counseling and treatment for sexual offenders, especially those who abuse children, is heavily debated. One reason for this is the recidivism rate, says Jenny Coleman, director of Stop It Now!, an organization focused on preventing child sexual abuse. The recidivism rate is hard to determine for child sexual abusers because there is a low rate of disclosure, meaning offenders are reticent to report if they re-offend. 

“While there are many studies on recidivism rates, they generally only measure re-arrest rates, not re-offending rates,” Cooper adds. “So far, no treatment approach has come anywhere close to ‘solving’ the problem.” 

It’s also controversial because of the individuals themselves.

“As a society, we tend to have … negative feelings about people who do these terrible things to kids, as we should. And because of that I think sometimes we’re short-sighted in terms of what should be provided to try and get them help,” said Whitney Gabriel, a board member with the Child Molestation Research & Prevention Institute.

Can abusers be reformed?

Experts say an abuser has to desire reform. 

“Somebody needs to want to make a change or want to accept help and support and recognizes the need for it,” Coleman says.

Coleman says it is “absolutely possible to provide effective treatment” for abusers, but there are a few factors to consider, including ensuring the individual has an accurate diagnosis and understanding what’s motivating the behavior.

“What’s important to understand is that the causes behind somebody’s sexual harmful behaviors differs,” she says. “There could be a sexual interest, primarily in youth or varying ages and gender. There could also be addiction issues. There could be other psychiatric disability issues.”

The effectiveness of treatment can also depend on the individual’s environment and support system. 

“The risk of harm is greatly reduced when somebody who is at risk has a community, has support,” Coleman says. “When we’re talking about sexual abuse – when somebody feels isolated, when they feel alone… that people just think of them as a bad person – that just kind of fuels the fire.”

What does treatment entail? 

“For an individual whose sexual behavior was driven by a sexual interest in prepubescent children, effective treatment cannot focus on changing this interest, but on managing these sexual urges and fantasies and assisting the client in finding a healthy expression for sexuality,” according to the executive board of the New York chapter of the Association for the Treatment of Sexual Abusers.

Coleman said there are different approaches, including cognitive behavioral treatment and a “variety of other kinds of psychological treatment” as well as treatment models like The Good Lives Model of Offender Rehabilitation, a strengths-based approach to offender rehabilitation. 

Cooper says the most widely used treatment is cognitive behavioral therapy, relapse prevention or the Risk-Need-Responsivity model,.

According to the Association for the Treatment of Sexual Abusers, the Risk-Need-Responsivity model “has been specifically applied to the treatment of sexual offense behavior and has also demonstrated increased reductions in sexual offense recidivism.”

“Many people believe that people who commit crimes are not deserving of rehabilitation,” according to the New York chapter of the Association for the Treatment of Sexual Abusers. However “our best research indicates that person-centered and strengths-based approaches to treatment are the most effective, although it can be counterintuitive to treat someone with respect when he or she has engaged in sexually harmful behavior to a child.” 

Gabriel says it’s important to keep potential victims at front of mind. Providing effective treatment is “the best thing we could do in terms of prevention and keeping other kids safe.”

If you are a survivor of sexual assault, RAINN offers support through the National Sexual Assault Hotline (800.656.HOPE & online.rainn.org). 

Josh Duggar apologized after allegations came to light that he sexually abused young girls when he was a teenager. Mara Montalbano (@maramontalbano) has the story.

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