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Book Reviews   |    
Treating Sex Offenders: A Guide to Clinical Practice With Adults, Clerics, Children, and Adolescents, Second Edition
Reviewed by Fabian M. Saleh, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.8.949
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by William E. Prendergast, Ph.D.; New York, Haworth Press, Inc., 2004, 331 pages, $49.95

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Dr. Prendergast, the author of Treating Sex Offenders: A Guide to Clinical Practice With Adults, Clerics, Children, and Adolescents, is certified as a sex therapist by the American Association of Sex Educators, Counselors, and Therapists and holds a diplomate as a certified sex therapist and clinical supervisor of the American Board of Sexology. He also is the recipient of a distinguished service award of the New Jersey Child Assault Prevention Project for his contributions to the treatment of sex offenders and the training of other professionals in the specialized techniques of treating sex offenders in correctional institutions and outpatient clinics.

Although Dr. Prendergast provides some insightful observations and offers a few ideas about how to conduct therapy with sex offenders, I have strong reservations about the value and clinical usefulness of this book. I am troubled by the author's use of psychiatric phenomena and syndromes that are not recognized in the field—for example, delusional regression, fear-of-failure syndrome, and small-penis complex—and by his psychodynamic-like formulations and proposed treatment plans. Reading through this book, I felt that some of the proposed treatment methods were akin to exorcism, as illustrated by this excerpt: "For some sexually assaultive personalities, none of the standard methods of ventilating their rage are effective. Their resistance is so great that special methods must be employed to achieve this important goal. One of the methods that we have used successfully, Now Therapy [italics in original], involves marathon therapy sessions and specialized badgering techniques. What occurs as a result is a regression to earlier age levels and actual reliving of past traumatic experiences. This regression is frequently accompanied by hysterical conversion-reactions that result in bleeding, pain, bruises, and physical symptomatology that, when examined by medical personnel, may bring a diagnosis that the trauma just occurred in the last hour or so."

Regrettably, the case vignettes in this volume are more confusing than enlightening and raise questions about the author's knowledge and understanding of the phenomenology and etiology of psychiatric ailments, as illustrated by this passage: "One night, he [Rudy, Dr. Prendergast's patient] awoke to one of his parents' regular Friday night arguments. He leaned over toward the adjoining wall to listen and soon realized that they were discussing him, specifically a meeting his mother had at his school with his teacher… . Apparently, from what he could glean, he was considered a severely emotionally disturbed child, and they were discussing putting him in a boy's school. His father's reaction shocked Rudy. He heard him say, 'If only that damned rubber didn't break, we wouldn't be going through all these problems. I told you you should have an abortion.' Needless to say, Rudy was shocked, angry, and depressed, all at the same time. From that day on, he withdrew from the world and created a world of his own. His catatonic-schizophrenia was born."

Certainly, it is not clear whether this troubled young man actually had or was developing schizophrenia. What is disconcerting about this case and the many similar cases was Dr. Prendergast's reductionistic explanation of multifactorial syndromes and complex behaviors as seen, for example, among patients with paraphilias and comorbid mental illness. This author seems to be perpetuating the ancient myth that mental illness is caused by adverse life circumstances rather than stemming from complex interwoven biological and environmental factors.

In conclusion, I do not recommend this book to the practicing clinician, aspiring therapist, or anyone else who wants to become a competent, thoughtful, and humble therapist of children and adults who sexually offend.

Dr. Saleh is director of the sexual disorders clinic at UMass Memorial Medical Center and assistant professor of psychiatry at the University of Massachusetts Medical School in Worcester.




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