I do not think there is a more essential task for our field than charting our course for the future and deciding for ourselves what roles we would like to play, and how we would like to contribute to finding solutions to the problems of our time. To not take the time to reflect on who we are, where we have been, who we would like to be, and where we would like to go, is to virtually assure that our input will be diminished and that we will forever be "reacting" to one crisis or another, never feeling in control of our destiny. So it is with great pleasure and a keen sense of responsibility that my discussion of "The Challenges That Lie Ahead" focuses on three proactive steps that I recommend that the field take to ensure our viability in the next century:
Sex Abuse as a Public Health Problem
The first step involves defining sexual abuse as a public health problem, and our work with perpetrators as critical to finding a solution to the problem. Historically, public health has been devoted to the elimination of disease and illness associated with physical causes; however, since World War II there has been growing awareness of the need for public health to expand its focus to include issues of mental health and to examine the social influences on behavior that affect the physical health of people.
The problem is that our work with sexual perpetrators is not of commonly perceived by the public, professionals devoted to the study of public health, or in some cases even by our own colleagues who treat victims of violence, as being directly involved with, or contributing to finding solutions to these problems. Instead, our work is often viewed with skepticism. Worse, it is sometimes viewed as contributing to the problem by protecting the perpetrators of these crimes from the appropriate legal consequences for their behavior. We cannot afford to either be perceived in this manner, or work in isolation of other professionals devoted to addressing public health problems.
So, I am suggesting that we need a public image overhaul; not simply by demanding it, we are going to have to earn it, and it may take some time. Furthermore, it will not be an entirely painless process because it will demand some change on our part and an increased willingness to examine our fundamental philosophic and conceptual premises, to seriously consider the validity of some of the criticism that has been leveled at us, to not define our mission and goals in isolation of other professions or the public at large, and to be fully accountable for that we do, as well as what we do not do.
Reframing The Problem of Sexual Abuse
The second step that I recommend involves effecting conceptual model shifts with regard to how we view the nature, etiology, and amelioration of sexual perpetration. Change in this realm must involve not only reconsideration of what we believe to be true about sex offenders, but more fundamentally how we approach the understanding of their behavior. What I mean is that we have for too long regarded sex offenders as engaging in "aberrant" behavior which relates to a generally idiosyncratic process, as opposed to examining how the behavior of certain groups of people relates to the more basic needs of all people. Instead of focusing so intently on how different sex offenders are, we need to examine how similar they are to the rest of us, and how their issues are really the issues of our society. To state this even more provocatively, they are too often the bearers of a message that we do not like to hear: our society espouses values and masks problems which contribute to a propensity for certain of its members to engage in acts of interpersonal violence.
I am not suggesting that the behavior of sex offenders is not "bad" or "objectionable," or that they as individuals should not be held fully accountable for their perpetrating, but address the underlying societal problems which give rise and shape to the behavior of individuals who exploit others.
I am suggesting that we would benefit from examining sexual aggression from theoretical frameworks which emphasize the environmentally adaptive aspects of aggressive behavior. In particular, I have been struck by how some of the newer psychosocial theories of human behavior, such as evolutionary psychology and environmental psychology, lend themselves to a fresh understanding of the motivators of sexual behavior. I must admit that my thinking in this realm has also been very influenced by having treated a large number of inner city youths over the past several years.
Contrary to expectation, I have not found these youths to be highly psychopathic individuals who are devoid of the capacity to attach, but instead youths who have been forced by environmental circumstances to deny their inner pain and develop a tough outer facade in order to survive. Their treatment does not depend so much on confronting their bad behavior or de-conditioning their deviant sexual arousal, as it does on providing them with positive male mentoring and instilling in them a belief in themselves and a sense of optimism about their futures. In short, these youths do not strike me as being different from the rest of us in their needs and wishes, but highly distinct in the amount of trauma and pain that what we fail to do is adequately identify and which they have had to endure, and the degree of difficulty they have encountered in attempting to access society's resources and share in our country's vast wealth.
Working with these youths has convinced me that many were actually Post Traumatic Stress Disorder victims as young children, but never diagnosed and treated as such. It was not until they reached adolescence and began to externalize the effects of their trauma and act out, that we even acknowledged that they had problems. However, once identified these youths were not labeled as trauma victims, but as "criminals" with the implication that they are simply "bad kids" who come from "bad families" and that the solution to the problem is punishment and confinement. One of our field's greatest challenges is to reframe human behavior, including sexual misbehavior, as deriving from larger social system contingencies, and to become instruments of social change rather than those who simply strive to become more adept at treating dysfunctional individuals efficacy of our efforts. I do agree that salient concerns include better understanding the etiologies of sexual offending behaviors, risk profiling and typological classification, and examining the impact of notification and registry policy changes. What I would like to add to the discussion on research is my belief that research, in order to be of maximal benefit to the field, requires a set of guiding principles. I would like to suggest four such principles.
The first is that research should primarily have a utilitarian function. Research priorities should reflect the delineation of public health problems and issues. In our case, research must advance our understanding of the nature and origin of sexual behavior problems and their amelioration.
Secondly, research should be institutionally driven in accordance with public health policy. It should not be the domain of the individual researcher and his or her esoteric interests. We should encourage agencies devoted to addressing issues of public health to join in the macro-system planning of large-scale research initiatives. Teams of researchers, across disciplines, should be invited to explore discrete, but interrelated aspects of these problems.
Third, research should be disseminated in multiple formats and at multiple forums in order to be of maximal benefit. It is unfortunate that most research conducted today ends up published in obscure journals where it is seldom read by most practitioners in the field, let alone other professionals, or the lay public. In order to be useful, research must be accessible and comprehensible.
Fourth, in order to truly achieve accountability in the field, clinical practice should follow, not precede, empirically validated theory. Until that happens, we will justifiably be subject to the criticism that our clinical efforts and public policy recommendations are guided as much by self-interest as public interest.
In conclusion, I believe that we as a field are capable of achieving these goals, and that in their achievement we will become an even stronger voice in helping shape the worse in which we live. Our success in achieving these goals, and in strengthening the degree of public support for our work, depends in large part on our own resolve and determination, our willingness to listen to our critics as well as our supporters, our willingness to work cooperatively with one another and those outside of the field in the pursuit of the common good and the welfare of all, not just a few, and our commitment to respecting the dignity of all people including the clients with whom we work and the communities that we serve.
[The above comments and insights offered by Dr. Hunter were adapted from his plenary address to the fifteenth annual conference of the Association for Treatment of Sexual Abusers, Chicago, November 1996 ed.]