Social Work: Discussion part 2

O R I G I N A L P A P E R

No Easy Answers: Ethical Challenges Working with Sex Offenders

Melissa D. Grady • Kimberly Strom-Gottfried

Published online: 18 April 2010

� Springer Science+Business Media, LLC 2010

Abstract Therapeutic practice with sex offenders and

similarly ostracized populations presents unique personal,

clinical, and professional challenges for clinicians. This

article examines four areas of difficulty—treatment effi-

cacy, clinical competence, boundary maintenance, and

stigmatizing policies—and reviews ethical and clinical

standards for addressing these challenges. Specific recom-

mendations for competent practice, supervision, research,

and advocacy are given.

Keywords Clinical practice � Sex offenders � Ethical dilemmas

Clinical social workers face challenging clinical and ethical

scenarios day in and day out as they attempt to reconcile

complex cases with a demanding but shrinking service

environment (Strom-Gottfried 2007). Working with stig-

matized populations creates even greater challenges for

social workers when negative attitudes on the part of the

worker, society, or both, threaten to compromise effective

practice. Beyond the specter of personal reactions, service

to sex offenders takes place in a climate of diminished

resources and inhospitable, even punitive, conditions

(LaFond 2005). Sex offenders present unique ethical and

clinical dilemmas because of the characteristics of the

population and given the societal views and policies that

impact practice outcomes.

Social workers most commonly encounter sex offenders

in mental health and correctional settings. Although some

sex offenders may voluntarily seek service, most are com-

pelled to attend counseling as a condition of their sentencing

within the court system (LaFond 2005). The population of

sex offenders in treatment is predominantly male and the

offenses involved may range from statutory rape charges

following consensual sexual contact with a peer to pedo-

philia, sadism, and other violent crimes (Center for Sex

Offender Management [CSOM] 1999; Snyder 2000).

However, research has shown that sex offenses are often

unreported, and therefore it is not only difficult to accurately

calculate the number and types of crimes committed but

equally difficult to create an accurate picture of who is

committing sexual offenses (U.S. Department of Justice

2002). Given the under reporting of sexual assault as well as

the broad scope of the term sex offender, ‘‘we cannot be

certain that a single constellation of symptoms was or is

common to all ‘sexual psychopaths’’’ (Wood et al. 2000,

p. 25). Individual offenders within this group are distin-

guished by factors such as the types of victims they chose,

the number of times they have offended, and the level of

violence used. In light of these differences, both researchers

and treatment providers have made numerous calls to dis-

tinguish among the various categories of offenders (Lösel

and Schmucker 2005; Miner 1997), which has further added

to the complexity of understanding this population as well

as the struggle to offer effective treatment. Some ethical

challenges are unique to working with sex offenders, such as

the content discussed in treatment, and the distinctive poli-

cies and restrictions directed at that group. Other practice

challenges are common to practice with any stigmatized or

marginalized population, such as recruiting clients, prepar-

ing and retaining qualified workers, addressing social

isolation, and securing funding for research.

M. D. Grady (&) � K. Strom-Gottfried School of Social Work, University of North Carolina at Chapel

Hill, 325 Pittsboro Street, CB 3550, Chapel Hill,

NC 27599-3550, USA

e-mail: [email protected]

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Clin Soc Work J (2011) 39:18–27

DOI 10.1007/s10615-010-0270-9

The aim of this paper is to identify and address four dis-

tinctive challenges in practice with sex offenders, and to

translate ethical and clinical standards to assist social

workers in this complex and multifaceted area of practice.

Practice guidelines are drawn from the extant research in the

field and ethical standards are drawn from the code of ethics

of the National Association of Social Workers. The discus-

sion also employs core bioethical principles, including:

(1) respect for autonomy (a norm of respecting the

decision-making capacities of autonomous persons);

(2) nonmaleficence (a norm of avoiding the causation

of harm); (3) beneficence (a group of norms for

providing benefits and balancing benefits against

risks and costs; and (4) justice (a group of norms for

distributing benefits, risks and costs fairly). (Beau-

champ and Childress 2001, p. 12)

The literature on practice with sex offenders and simi-

larly ostracized populations reveals four common dilem-

mas: establishing treatment efficacy, ensuring clinical

competence, maintaining professional boundaries, and

navigating counter-therapeutic social policies. At the heart

of these dilemmas is ambiguity and ambivalence about the

proper societal response to people whose behaviors so

grossly violate social norms (LaFond 2005; Wood et al.

2000). Policy makers, funding sources, clinicians, and even

clients themselves may question the value of therapeutic

interventions for sex offenders. When examined alongside

the array of other disorders and conditions vying for

societal empathy and resources, it is easy to understand the

limited financial support, punitive policies and, scarce

resources directed at this population. Nevertheless, effec-

tive, accessible, and ethical therapeutic resources are

required because sweeping, lifelong confinement is

impractical, costly, and at odds with long-held societal

values of redemption and liberty (Ward 2007; Wetterling

2007). Further, current punitive community-based policies

are part of the milieu of the treatment landscape (Levenson

et al. 2007; Sandler et al. 2008), which adds to the com-

plexity of the challenges faced by treatment providers and

their clients. It is against this backdrop that clinicians must

craft effective and ethical pathways to facilitate change.

Lack of Empirically Supported Treatments

Arguably the most critical ethical issue in the treatment of

sex offenders is the limited knowledge about what works.

The knowledge base is not well-evolved because of scarce

funds for research, limited interest among researchers, and

the divergent and complex nature of the variables influ-

encing offenders’ behavior. Social workers are mandated

by the National Association of Social Workers’ (NASW)

Code of Ethics to ‘‘base practice on recognized knowledge,

including empirically based knowledge’’ (NASW 2008,

p. 1), yet the field struggles to find treatments that dem-

onstrate consistent effects such as reductions in recidivism

rates of sex offenders (CSOM 2001; LaFond 2005; Mar-

ques et al. 2005). Moreover, the soundness of the literature

has been called into question in numerous critiques of the

rigor of the available studies (CSOM 2001); the lack of

consistent formulation of the constructs being measured,

such as recidivism (CSOM 2001; Zgoba and Simon 2005);

and the lack of randomized controlled trials (Marques et al.

2005). As mentioned previously, the broad category of sex

offender is a heterogeneous population for which a ‘‘one

size fits all’’ approach is regarded as ineffective (Lösel and

Schmucker 2005; Miner 1997).

Ethical challenges arise from the clients’ perspective as

well. Compelling individuals to treatments with poorly

established efficacy violates ethical principles such as

beneficence and nonmaleficence. Services without demon-

strable positive effects waste scarce resources, create the

illusion of change where none exists and potentially subject

consumers to harmful treatment. While many practice areas

in social work do not have a firmly established evidence-

base, in the field of sex offender treatment, there is a growing

body of evidence which indicates that the current standard of

practice is actually ineffective (Marques et al. 2005; Zgoba

and Simon 2005), yet these practices continue.

In the world of evidence-based practice, it is critical that

social workers continue to research effective treatments

and contribute to the limited body of knowledge regarding

what works because finding effective prevention and

treatment strategies is essential to reducing the incidence of

sexual assault. Indeed, social workers are mandated by

their code of ethics to ‘‘contribute to the knowledge base of

the profession’’ (NASW 2008, p. 1). However, little

funding is available for sex offender treatment, let alone

research on these limited treatment programs. For clini-

cians and researchers to better understand how to develop

effective interventions, more resources must be devoted to

understanding this population’s treatment needs. Success-

ful advocacy for such changes would include creation of

demonstrably effective programs, cost-benefit projections

that indicate the financial advantages of proactive thera-

peutic interventions, and public education to support such

expenditures and interventions.

Ensuring Competence in Clinicians

Beyond concerns about the adequacy of therapy, questions

exist about the adequacy of the workforce involved in sex

offender treatment. The number of properly trained and

supervised professionals is insufficient for the needs and

Clin Soc Work J (2011) 39:18–27 19

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size of this population (Pais 2001). Many areas of social

work practice lack competent practitioners due to the

specialized nature of their work. Yet, within the sex

offender community, the paucity of qualified professionals

may be due in part to fears about what assumptions will be

made about the clinician (Van Deusen and Way 2006),

which is not always the case with other sub-specialties in

social work. Clinicians report that they are labeled nega-

tively by association because of the stigma attached to sex

offenders, and thus, fewer professionals choose to work

with this population (Van Deusen and Way 2006). One

practicing clinician described her work with this population

as a ‘‘party stopper.’’ When others hear that someone works

with this population, many assumptions are made about

his/her ‘‘own issues.’’ As an example, one acquaintance

said to the worker above, ‘‘Why would you ever work with

them?’’ implying that something was wrong with the

worker as indicated by her choice to work with this pop-

ulation. The resulting cycle of ever fewer people treating

sex offenders further limits opportunities to educate and

socialize new professionals into the subfield through

internships, supervision, and other mechanisms.

Clearly, the nature of practice with offenders and the

small pool of clinicians in this field underscore concerns

about burnout and professional impairment. With a limited

number of qualified supervisors, the paucity of supportive

colleagues willing to offer a listening ear, and the stigma

attached to the work itself, it is small wonder that some

social workers experience professional isolation (Pais

2001; Van Deusen and Way 2006). The implications of

such isolation, coupled with exposure to traumatic mate-

rial, have been well documented, including callousness,

suspicion, hypervigilance, and vulnerability (Ennis and

Horne 2003; McCann and Pearlman 1990; Pais 2001;

Thorpe et al. 2001). Not surprisingly, the quality of some

clinicians’ work has been shown to suffer as a result of

these negative effects. Thorpe et al. (2001) found that ‘‘the

greater the negative emotional impact of sex offender

work, the more deleterious the effect on professional per-

formance’’ (p. 201). The cumulative effect of hearing about

sexual victimization can result in clinician burnout,

‘‘compassion fatigue’’ or even vicarious traumatization

(McCann and Pearlman 1990), which has the potential to

erode professionalism ranging from diminished concern for

the client to malicious acts (Maule 2007; Thorpe et al.

2001). While social workers from many subspecialties

need to be cognizant of such issues as compassion fatigue,

the very nature of the types of crimes that are involved in

practice with offenders highlights the need for clinicians to

be self-aware and assess for signs of vicarious traumati-

zation or secondary traumatic stress (Trippany et al. 2004).

While workforce development is the responsibility of

educators, professional associations and advocacy groups,

personal development is an individual ethical responsibil-

ity. The NASW Code of Ethics stipulates that social

workers should ‘‘provide services in substantive areas or

use intervention techniques or approaches that are new to

them only after engaging in appropriate study, training,

consultation, and supervision from people who are com-

petent in those interventions or techniques’’ (2008, 1.04b)

and ‘‘seek the advice and counsel of colleagues whenever

such consultation is in the best interests of the client (2008,

2.05a). Professional competence and well-being is also

essential to meet the ethical principle of nonmaleficence,

assuring that clients are not harmed because of workers’

incapacity.

To reduce the risk of a clinician’s professional capacities

being detrimentally affected by his or her practice, it is

imperative that social workers connect with other profes-

sionals who do similar work. Studies have shown that when

clinicians who work with sex offenders are involved in

professional peer support, which includes supervision,

there is a reduction in their measured levels of distress

(Ennis and Horne 2003; Pais 2001). Yet, for many social

workers who work with offenders, it is a challenge to find a

colleague who also works with sex offenders, who is in the

same geographic area, and who would constitute an

appropriate consultant. Given this limited pool of col-

leagues, professionals who work with offenders may use

e-mail lists to stay connected to other professionals work-

ing with sex offenders (Ennis and Horne 2003). However,

it is unclear whether this mechanism appropriately safe-

guards case information, and whether this type of informal,

unstructured contact is sufficient to ensure individual

growth, professional competence, and personal well-being.

Maintaining Boundaries

Maintaining professional boundaries is critical in every

social work relationship (NASW 2008) though it takes on

added significance in work with sex offenders. For exam-

ple, given the sexual content of the information that is

shared between the therapist and the client, such disclo-

sures are intensely personal, intimate, and obviously sex-

ual. For most people, topics related to sex and sexual

encounters evoke strong feelings, including arousal (Maule

2007; Pope et al. 1993). Such countertransference reactions

may lay the foundation for boundary violations to take

place. As with other marginalized or challenging client

populations, managing countertransference may be more

difficult for the therapist to maintain (for a more extensive

review see Gabbard and Wilkinson 2000; Phillips 2003).

While sexual trauma is pervasive throughout the mental

health field, every case a clinician encounters when

working with sexual offenders involves sexual trauma.

20 Clin Soc Work J (2011) 39:18–27

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As such, Pais (2001) has identified specific areas within

clinical work with sex offenders where a clinician’s emo-

tions and personal judgments may interfere negatively with

his or her professional judgment and objectivity, possibly

leading to boundary violations.

One of these areas includes the therapist’s own beliefs

about sexuality. The clinician’s comfort level with dis-

cussing sexuality or personal beliefs regarding what con-

stitutes healthy sexuality may affect his or her ability to

display genuine curiosity and empathy when talking with

clients (Hepworth et al. 2010). For example, one profes-

sional who attended a training conducted by one of the

authors asked during the training if there were programs

where offenders who had committed crimes against victims

of the same gender received separate or more ‘‘intensive

therapy’’ because their crimes were ‘‘worse’’ than those

that were ‘‘heterosexual in nature.’’ This professional’s

beliefs about homosexuality have the potential to nega-

tively interfere with her work with clients, possibly creat-

ing more shame and limiting a client’s willingness to fully

and frankly discuss his/her crime.

The clinician’s level of sexual arousal is another reac-

tion that may occur with this population. The therapist

might be interested in or aroused by the sexual content that

is discussed during treatment of sex offenders, and shift the

focus of therapy to self-interests rather than maintaining a

focus on the client’s needs (Pais 2001; Pope et al. 1993).

Social workers who have experienced some form of

childhood maltreatment are particularly vulnerable to

troubling case reactions and other detrimental effects,

including disrupted cognitions about trust of and intimacy

with others (Van Deusen and Way 2006). Clinicians ‘‘who

have a past history of sexual abuse may experience intense

feelings in themselves and suppressing them would lead to

transference-countertransference problems’’ (Pais 2001,

p. 90), and in turn compromised boundaries, such as

breaching policies, failing to hold the client accountable, or

accepting gifts and favors (Maule 2007). One worker from

a prison-based program began allowing one of the inmates

to make phone calls on her cell phone and secretly brought

in items to the same inmate. Once discovered, the worker

lost her job and the inmate was transferred out of the

program. Taken to their extreme, these boundary crossings

can lead to the worker’s revictimization or retaliation by

the client (Maule 2007). Given that individuals within the

social work profession have higher rates of childhood

maltreatment than members of other professions (Black

et al. 1993), ethical practice requires competent supervision

to ensure the clinician carefully manages whatever emo-

tions arise when practicing with sex offenders.

Professional boundaries may also be challenged by the

practitioner’s characteristics and intentions. Many mental

health professionals enter the profession because they are

seeking a way to feel helpful and needed by others (Farber

et al. 2005; Maule 2007). Sex offenders as a group are an

ostracized and marginalized population (Ward 2007) and

this status may elevate clinicians’ perceptions of self-worth

given they are advancing the cause of this disenfranchised

group (Maule 2007). A further consideration is the extent

to which sex offenders are not only especially attuned to

others’ vulnerabilities but also highly effective at manip-

ulating others for personal gain (Andreason and Black

2006). As such, an offender may accurately read a worker’s

desire to be liked or to be an ally and flatter him or her with

additional physical or emotional attention, increasing the

risk of a boundary crossing (Maule 2007).

Finally, the settings in which sex offender treatment is

rendered may affect the clarity and permeability of pro-

fessional boundaries. Whereas settings such as correctional

institutions or residential treatment may appear to be rig-

idly structured, in fact, the worker-client boundaries may

be less clear than in other practice settings (e.g., an out-

patient group) because therapists and clients spend greater

amounts of time together and interact in more intimate

ways, such as over meals (Maule 2007; McGrath et al.

2003). These types of interactions may blur professional

roles and tasks as well as increase the sense of intimacy for

both the offender and the therapist. When these environ-

mental factors are paired with the individual and emotional

factors discussed, the combination places clinicians at a

greater risk of boundary transgressions.

Clear boundaries protect the interests of clients, placing

the therapeutic relationship as the worker’s foremost

responsibility. Understanding, establishing and enforcing

boundaries promotes the principles of autonomy and

beneficence. Ethical guidance for the management of

boundaries suggests that social workers be alert to conflicts

of interest ‘‘that interfere with the exercise of professional

discretion and impartial judgment,’’ and take steps to

ensure that clients’ interests are protected, setting ‘‘clear,

appropriate and culturally sensitive boundaries’’ (NASW

2008, 1.07). In practice, this caveat means the clinician

must maintain self-awareness to be alert to troubling

material and reactions, use supervision assertively and

forthrightly to examine issues as they arise, and place

primary emphasis on his or her professional role and

responsibilities so that all decisions are made in the service

of reaching the treatment goals.

Addressing Policies that Affect Practice

Social workers must always be conscious of how larger

systems affect clients and services. The policies that sur-

round sex offenders are clear examples of how current

policies affect clinical work and present a number of

Clin Soc Work J (2011) 39:18–27 21

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clinical and ethical dilemmas for clinicians who work with

this population.

Although several national laws are in place, such as

registration and notification laws, their execution differs

across the states (Levenson et al. 2007). (For a thorough

review of the relevant policies, see Grady 2009.) For

example, some states require sex offenders to personally

notify each household within a certain radius of their res-

idence whereas other states require individuals to be listed

on an open-access Web site (Scott and Gerbasi 2003).

‘‘These laws are designed to keep law enforcement officials

appraised of the whereabouts of convicted sex offenders. If

a sex crime is committed, the police have a pool of ready

suspects’’ (Simon 2000, p. 300). However, some in the field

have raised questions regarding the unintended conse-

quences of such laws, such as acting as barriers to com-

munity integration after an offender had completed

treatment or mandated incarceration, as well as their effi-

cacy in preventing additional crimes (Wetterling 2007).

Offender registries defy ethical principle of justice. The

principle of justice states that ‘‘equals must be treated

equally and unequals must be treated unequally’’ (Beau-

champ and Childress 2001, p. 227). Yet, given the grave

inconsistencies in the categorization of sex offenders and

regional variations in the restriction of their liberties, the

result is a ‘‘serious priority problem as well as a challenge

to the moral system that aims for a coherent framework of

principles’’ (Beauchamp and Childress 2001, p. 229).

Further challenges arise when the policies are evaluated

using the ethical principles of beneficence and nonmalefi-

cence. Human Rights Watch (HRW; 2007) published an

evaluation of sex offender policies that yielded two sig-

nificant findings: current registry laws have not led to a

reduction in the number of sex crimes against children,

and, as a result of being placed on the registry, sex

offenders are at increased risk of violence directed against

them and their family members. The first finding has been

supported by other studies that found ‘‘marginal support at

best’’ for the contention that community notification laws

were associated with ‘‘protective actions against sex

offenses’’ (Caputo and Brodsky 2003, p. 250). In a study

with more than 33,000 sex offenders that was conducted

over a 20-year period in the New York State Department of

Correctional Services, the 1996 enactment of sex offender

and registration laws (SORNA) showed no significant

impact on overall rates of sexual offending, rape, and child

molestation (Sandler et al. 2008). This lack of efficacy was

true for all levels of sexual offenders, regardless of whether

they had only a sexual offense conviction or if they had a

sexual conviction in tandem with nonsexual convictions.

The authors concluded that the primary reason for this

finding was that over 95% of all sexual crimes are com-

mitted by first time offenders; therefore, laws such as

SORNA do not address the individuals most at risk of

committing sex crimes.

Another reason for the lack of efficacy of this law may be

because SORNA was designed to prevent strangers from

having access to children. However, in as many as 97% of the

child molestation cases of children between birth and

11 years, the perpetrator was either someone from the family

or someone that the family knew (Snyder 2000). Given these

statistics, the current structure of the law does not target the

population most at risk of molesting a child. Further, laws

that constrain sex-offender liberties, such as prohibiting

movement within a particular radius of a daycare facility,

play ground, school, or other youth gathering place, do not

prohibit sex offenders from returning to their families or

cohabiting in households with young children. In fact in a

recent study in Minnesota, of the 224 offenders included,

only 27 (12%) established contact with their victim(s) within

one mile of the offenders’ home and not one established

contact near a school, park, or playground (Minnesota

Department of Correction 2007). Of the 16 juvenile victims

with whom contact was established within one mile of the

offender’s home, none of these relationships were cultivated

near a school, park or playground. Instead, nearly two-thirds

victimized family members or gained access to their victims

through another adult, such as a spouse, girlfriend, co-

worker, friend, or acquaintance. These studies challenge

presumptions on which sex offender restrictions are based:

they may fail to prevent harm through further criminal

activity, may divert resources and attention from more

fruitful areas, and in fact may create a false sense of security

when other methods of assault prevention would have

greater efficacy. While the restriction of liberties is war-

ranted in certain circumstances (Beauchamp and Childress

2001), current policies fail to meet the standards of nonma-

leficence, justice and beneficence.

The second finding from the HRW (2007) study was that

registered sex offenders experienced harassment, ostra-

cism, and various forms of violence against themselves and

their family members. Similar findings have been reported

elsewhere (Levenson et al. 2007; Malesky and Keim 2001),

with one study showing that 62% of the 239 offenders

reported that registry laws have made their recovery more

difficult because the laws have added multiple layers of

stress and difficulty to their community re-entry (Levenson

et al. 2007). An example of a community response to sex

offenders took place in a southeast rural county on Hal-

loween. The county sheriff gave orders that every regis-

tered sex offender, regardless of their history, were to be

rounded up and temporarily housed in a church basement

for the duration of the Halloween night. As a result, every

parole and probation officer was responsible for ensuring

that each individual on his/her caseload was accounted for

in the basement that evening.

22 Clin Soc Work J (2011) 39:18–27

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Typically, punitive and extreme sex-offender laws have

been passed quickly in response to the community’s

emotional outcry following particularly heinous and

highly-publicized crimes (‘‘House,’’ 2008). For example, in

February 2008, a 6-year-old boy was raped in a city library

in Massachusetts. In response to the crime, this community

began implementing restrictions for all registered sex

offenders that would limit their access to or being within

certain proximity of some public spaces (Zezima 2008).

One example of the impact of the punitive and restric-

tive nature of the laws involves a man who was released

from prison after he completed his full sentence for a rape

conviction. While in prison, he completed a sex offender

specific treatment program and continued his treatment in

the community post-release. Upon his release from prison,

he was fortunate to find a job working at a local factory in a

mid-size city. It took him approximately 10–15 min to get

to work each day, until the state passed a premises law that

mandated he could no longer be within 300 feet of any

place of business where children might be, which includes

any McDonald’s with a play area, schools, churches with a

daycare center or malls, among others. While he did not

enter any of these locations on his commute, he did pass by

them while driving in his car. After the passage of the

premises law, his commute increased to over an hour, as he

had to take alternative routes to avoid being within the

restricted vicinities of such businesses. If he was pulled

over for a traffic or any other non-criminal violation, such

as a broken tail light, he could return to jail for being within

300 feet of a restricted locality, even if he never got out of

his car.

This state is not unique in taking such measures; many

jurisdictions restrict sex offender’s access to public places

such as bus stops, community swimming pools, and parks

(‘‘House,’’ 2008; Zezima 2008). Although these policies

and other sex offender laws have been challenged as vio-

lations of the offender’s constitutional rights, restrictive

policies and regulations are rarely overturned (Janus 2000;

LaFond 2005; Scott and Gerbasi 2003; Zezima 2008).

Clearly such regulations fulfill societal intentions in

restricting offenders’ freedom of movement and autonomy

(Beauchamp and Childress 2001). Whether or not these

laws achieve desired security, they clearly stymie thera-

pists’ ability to support their clients’ progress towards

successful reintegration.

Clinicians’ therapeutic work with clients is often

focused on increasing skills such as assertiveness, conflict

resolution, and other social skills (McGrath et al. 2003).

Yet, the current laws create a climate of shame and intense

negativity, often driving former offenders into isolation and

depression, and constraining them from putting into prac-

tice the skills they have worked hard to develop. In fact,

Wetterling (2007) stated that current laws make ‘‘it nearly

impossible to rehabilitate those people and reintegrate them

safely into their communities—and that may actually

increase the risk that they’ll repeat their crime’’ (p. 33A).

Clinicians are often caught in the dilemma of helping

offenders to succeed in a society that will not allow them to

achieve success, and may actively conspire against suc-

cessful reintegration. Thus, the clinician must struggle to

find ways to help his or her clients practice their new skills

in a society that does not want the offender, and takes

active steps to ostracize and humiliate offenders, which in

turn leads to former offenders experiencing further isola-

tion and a loss of hope.

An example of a case where there was a loss of hope and

further isolation comes from a man who had been convicted

of indecent liberties with a child. He had children of his own,

none of whom were his victim. Although he did not live with

his children, he remained active in their lives under guide-

lines set by the judge and his therapist. He regularly attended

treatment sessions with a qualified sex offender therapist

with whom he had a strong therapeutic alliance. The man’s

daughter was to receive an award at school, and the principal

contacted him and asked him if he would attend the cere-

mony, as she felt it was important for his daughter to have

both parents present. The principal was aware of his con-

viction, and stated that she would take responsibility for him

while he was in the building, as is required under state law. In

addition, he discussed this situation with his therapist who

was also in contact with the principal, and they reviewed his

relapse prevention plan and rehearsed in therapy coping

strategies he had learned to address any of the potential

triggers that might arise during the visit to the school. The

therapist encouraged him to attend, as he had made signifi-

cant progress and felt that the ceremony was an opportunity

for him to have a ‘‘normal’’ life experience with his daughter.

In an effort to ensure he would not be breaking any of his

probation requirements, he contacted his probation officer,

who then contacted the sheriff, as he was unsure how to

advise the individual in question. Both individuals spoke

with the principal who repeated her position, which was that

state law allowed a registered sex offender to enter onto

school premises if s/he notifies the administration and is

supervised while on school grounds. However, the sheriff

wanted further assurances and requested that the father

petition the school board for permission, whose meetings are

all held publicly. The shame and frustration he experienced

during this process, and his fears that he would be arrested led

him to the decision not to expose his children to more public

scrutiny and he did not attend his daughter’s award

ceremony.

A societal tension exists on how to ensure public safety

while safeguarding the rights of individuals, the principle of

justice (Beauchamp and Childress 2001). For example, there

have been numerous debates nationally about whether a

Clin Soc Work J (2011) 39:18–27 23

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registered sex offender has the right to attend an organized

religious group service when there is a daycare on site (The

Associated Press 2007). Many of the individuals involved in

these cases state that reconnecting back with their religion is

an important component of their rehabilitation, however,

many are being arrested for attending these services as the

laws are designed to protect citizens from predatory behav-

iors (Caputo and Brodsky 2003; ‘‘Lee County,’’ 2009; The

Associated Press 2007). Some quarters have called for a

general human rights perspective that ‘‘is concerned about

ensuring equal treatment and consideration of offenders in

conjunction with ensuring the safety of members of the

community’’ (Ward 2007, p. 192). This perspective would

require that members of society could ‘‘grasp that offenders

can be human-right violators, duty bearers and also human

rights holders all at the same time’’ (Ward 2007, p. 199).

Some researchers and practitioners have suggested that the

current policies counter any progress that the sex offender

may have achieved in treatment. Ward et al. (2007) have

argued that ‘‘effective rehabilitation cannot occur in a con-

text in which only the appreciation of others’ rights is

acknowledged’’ (p. 197).

Out of one outpatient group alone, several examples

exist regarding the challenges faced by offenders hoping to

reintegrate into society and the challenges faced by this

unique group regarding their rehabilitation. One man in the

group enrolled in an on-line college course that was offered

by a university across the country. When the university

found out that he was a registered sex offender, university

officials revoked his enrollment even though it was an on-

line course and he would never physically be on their

campus. In a similar situation, a woman who was placed on

the registry as a juvenile, now 5 years later and after no

other convictions, sought enrollment in a community col-

lege’s technical program. She was denied enrollment by the

community college because of her status as a registered sex

offender and unable to participate in this program.

The premises laws discussed above have created many

consequences that may not have been thoroughly considered

by the supporters of such policies. Several of the group

members have struggled with finding a substance abuse

support group that does not meet in a church, as the vast

majority of these groups, such as Alcoholics Anonymous and

Narcotics Anonymous meet in churches or other religious

centers. In the state where this group meets, if the congre-

gation has a day care center or a location where children

gather, sex offenders are prohibited from being within 300

feet of the building, even if the day care center does not

operate during the hours of the meetings. As a result, such

treatment programs due to their locality make attendance

illegal for an offender who may want to engage in this form

of on-going substance abuse treatment. Another man from

the group has struggled to find a church where he and his

pregnant fiancé can be married due to the same struggles as

described above. They are planning a Saturday afternoon

wedding when the Sunday school would not be operating, yet

he is banned from walking into the church because the church

offers a site where children congregate. In an ironic twist, in

the county where this group meets, the office where

offenders must register is within 300 feet of a restricted

locality, i.e., a daycare center or a school. The individuals

discuss the amount of stress they experienced when they

went to register as they feared that a law enforcement agent

might accuse them of being there for another reason and they

could go back to jail as they attempted to register. For the

clinicians of this group, they often struggle to identify how to

support the members’ use of the skills they have acquired and

practiced in treatment in such an environment. As one of the

clinicians said, ‘‘The ones [sex offenders] in prison have it

easier than those on the outside. At least in prison, everyone

has the same rules regardless of their crime.’’

All sexual assault survivors deserve protection from fair

laws that effectively punish offenders. Instead, the current

distribution of resources addresses just 4% of all sex crimes

(Sandler et al. 2008), leaving few resources to improve

treatment, address prevention, and investigate and prevent

the complex issues related to sexual abuse within families.

In addition to being ineffective, such resource distribution

fails from a utilitarian perspective. Many argue that under

utilitarianism, society’s interest can ‘‘override individual

interests and rights’’ and that such action ‘‘can be under-

taken, and ought to be undertaken, if its likely benefit to

society outweighs its danger to the individual subjects’’

(Beauchamp and Childress 2001, p. 166). Yet, what is the

social worker’s role when the policies neither benefit

society nor support rights and privileges of individuals?

The NASW Code of Ethics (2008) affirms social workers’

responsibilities in addressing systemic injustice and errant

policies and also mandates that workers serve as advocates

for ‘‘living conditions conducive to the fulfillment of basic

human needs’’ (6.01). To fulfill this mandate, social workers

should engage in social and political action that seeks to

ensure that all people have equal access to the resources,

employment, services, and opportunities required to meet

basic human needs and to develop fully. Social workers

should be aware of the impact that the political arena has on

practice, and should advocate for changes in policy and

legislation that will improve social conditions and promote

social justice for all (NASW 2008, 6.04a).

As with other elements of practice with sex offenders,

achieving these aspirations is not easy. Although clinicians

are uniquely qualified to speak to the ineffectuality and

paradoxical effects of sex offender policies, clinicians who

do so will likely experience derision and indifference that

makes their efforts a difficult uphill climb. Affiliation with

other professionals who share a concern for fairness and

24 Clin Soc Work J (2011) 39:18–27

123

justice for sex offenders, data to support rational policy

modifications, and the leverage of professional organiza-

tions such as the Association for the Treatment of Sexual

Abusers (ATSA; 2001) will help advance the reach of

individual worker’s efforts and their likelihood of success.

Recommendations and Conclusion

Given the many challenges to working clinically and eth-

ically with sex offenders, social workers can take several

steps to ensure their work meets the profession’s ethical

standards. These concrete actions fall into four categories:

competence, supervision, research, and advocacy.

Competence

Competent practice with sex offenders and other stigma-

tized groups requires assertive efforts to find and acquire

adequate instruction and supervision, and to use the

available literature and on-line resources. Self-care is also

imperative for competent practice. When working in this

subfield, self-care may mean diversifying caseloads to

include those convicted of nonsexual offensives, and

diversifying roles to include supervision, teaching, advo-

cacy, and consultation in addition to direct clinical prac-

tice. Therapy and other forms of personal growth work can

assist in securing support for the emotional toll of work

with sex offenders, and in addressing countertransference

and personal reactions to clinical material. Clinicians with

expertise in this subfield should consider training social

work interns, mentoring new professionals, and collabo-

rating in the creation of workshops, courses, and certificate

programs to develop the pool of competent providers.

Supervision

All professionals must be in consistent supervision with

other colleagues to monitor boundaries, countertransfer-

ence issues, including vicarious traumatization and poten-

tial burn out. At the outset of the supervisory relationship, a

contract should establish expectations of honesty and

openness, trust, respect, and accountability (Haynes et al.

2003). Supervisors who are uncomfortable or unprepared

to deal with the needs of supervisees working with sex

offenders should decline the role to ensure that supervision

is competently rendered.

Research

Additional, rigorous research is needed in all areas of this

subfield, but the most critical areas include effective

treatments, the impact of policy on sex offenders’

rehabilitation, and how to prevent development of sex

offending behaviors. Public education and political action

are needed to spur funding and interest for rigorous

research. Because no lobby is eager to take up the sex

offender cause, the professionals who work with these

individuals must advocate for consideration of their needs.

Such advocacy can be done through professional organi-

zations, coalitions that share similar concerns such as abuse

prevention groups, or individual civic engagement.

Advocacy

Advocacy for sex offenders must extend beyond securing

support for research, even though the challenges in policy

change remain the same. In carrying out their obligations

for seeking social justice, social workers must draw on

moral courage and act based on principle (Kidder 2005). In

practice, advocacy may mean speaking out against unjust

policies, taking public positions that challenge societal

views, and acknowledging the limits of the current

knowledge base about treatment and recidivism. Further,

advocacy may involve lobbying for improved professional

standards and credentials for this form of practice, man-

dated therapy for all incarcerated sex offenders, and

increased funding for service provision.

Social workers working with sex offenders wear several

hats. They must work for social justice for all, which means

looking at how current policies affect the rights of all

members of the society. At the same time, social workers

must provide competent and effective treatment to sex

offenders and advocate for them in the wider community so

ex-offenders have the opportunity to be successful. It is

challenging for any former offender to succeed in society,

but the challenge is greater for sex offenders with a felony

charge on their record, with limited support within mental

health systems, and with local communities demonstrating

increasing levels of fear of having these individuals within

their boundaries. Social workers have an important role to

play in all levels of practice to make an impact on the lives

of the individual offenders, the lives of potential future

victims, and for the well-being of the society at large.

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Author Biographies

Melissa D. Grady PhD, MSW, LCSW is a Clinical Assistant Professor at the University of North Carolina at Chapel Hill’s School

of Social Work where he teaches in the direct practice concentration.

Kim Strom-Gottfried Ph.D., MSW is the Smith P. Theimann Distinguished Professor for Ethics and Professional Practice at the

University of North Carolina at Chapel Hill’s School of Social Work

where he teaches in the direct practice concentration.

Clin Soc Work J (2011) 39:18–27 27

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