This article was downloaded by: [Erciyes University]

On: 29 December 2014, At: 00:08

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Child Sexual Abuse

Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/wcsa20

Denying Denial in Children with Sexual

Behavior Problems
a
Barbara Reicher
a
Private Practice
Published online: 27 Jan 2013.

To cite this article: Barbara Reicher (2013) Denying Denial in Children with Sexual Behavior Problems,
Journal of Child Sexual Abuse, 22:1, 32-51, DOI: 10.1080/10538712.2013.735356

To link to this article: http://dx.doi.org/10.1080/10538712.2013.735356

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
 Journal of Child Sexual Abuse, 22:32–51, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1053-8712 print/1547-0679 online
DOI: 10.1080/10538712.2013.735356

Denying Denial in Children with Sexual

Behavior Problems

BARBARA REICHER
Private Practice

Denial in some form is almost always present in the assessment

Downloaded by [Erciyes University] at 00:08 29 December 2014

and therapy of children with sexual behavior problems. Although

it can be a major element in the therapeutic interaction, denial
has received scant attention, both in teaching programs and pro-
fessional literature. It is as if the clinical community is “denying
denial.” Despite its seemingly resistant nature, denial can be used
to produce impressive inroads in data collection and in develop-
ing insight. This article offers an in-depth look at the construct of
denial, especially its expression among children with sexual behav-
ior problems. It will be argued that a more informed understanding
of denial dynamics can creatively inform and direct treatment
of children and adolescents with sexual behavior problems and
considerably improve treatment outcome.

KEYWORDS denial, resistance, child sexual behavior problems,

juvenile sexual offending

INTRODUCTION

Denial tends to go part and parcel with sexual offending (Barbaree, 1991;
Conte, 1985; Marshall & Barbaree, 1990; Marshall & Eccles, 1991; Pithers,
1990; Stevenson, Castillo, & Sefarbi, 1989). Though it is a complex phe-
nomenon with numerous definitions, many sexual offender treatment models
attempt to simplify denial into a dichotomy of truth and falsehood. When this
is taken to the extreme, deniers are “denied” access to therapy due to their
disavowal of offense issues (Langevin & Lang, 1985; Schwartz, 1995). A vari-
ation on this approach deems denial a counterindication to therapy in that

Submitted 8 October 2011; revised 19 December 2011; accepted 19 December 2011.

Address correspondence to Barbara Reicher, E-mail: reicherbarbara@gmail.com

32
 Denying Denial 33

it implies that the client rejects the need for help. Other writers pinpoint
the need for therapists to actively (and sometimes aggressively) confront
the abuser’s denial (Salter, 1988; Sharp, 2000; Wyre, 1989), which can often
play out like a he-said, she-said scenario, creating two diametrically opposed
camps rather than a therapeutic alliance.
Conventionally, therapy deals with what the client brings to a session,
and therefore the denial of offensive behavior becomes a clinical conun-
drum. For example, the delineation between facts and subjective truths in
children with sexual behavioral problems (SBP) may be unclear. As a result,
therapists may find themselves vacillating between face value acceptance of
what the client says to taking on a more investigative role. Considerations
about the therapy being compromised may result from the therapist’s sense
of doubt regarding the veracity of what the client brings up in treat-
Downloaded by [Erciyes University] at 00:08 29 December 2014

ment. Lastly, the compatibility between the client’s accountability and his
or her claim that no offense was committed can pose a difficult therapeutic
dilemma.
The sexual offender literature is also sparse in regard to analyzing the
complexities of denial (Laflen & Sturm, 1994). This is even more prevalent
in the literature on children and youth with SBP. Similar to the situation
with adults, some form of denial tends to constitute the basis of the initial
encounter an assessor or therapist has with these children and adolescents.
It often becomes a major element in the therapeutic discourse. However,
despite its empirical presence, denial still tends to only be mentioned in
passing in the literature and a broader discussion of ways to cope with this
mechanism is generally lacking.
This article is a modest attempt to enrich therapeutic understanding of
denial in children and adolescents who sexually offend. To counter the ten-
dency to deny denial, its multifaceted manifestations will be spotlighted as
will the various conceptualizations that exist regarding denial and its ther-
apeutic management. A number of vignettes detailing interactions between
therapist and client from my clinical experience as therapist and supervisor
will be used as illustration. The construct of denial will be explored from
both psychodynamic and cognitive-behavioral models.

Defining Denial
DENIAL AS A DEFENSE MECHANISM
Psychodynamically, denial is considered a primitive defense mechanism
employed from infancy. Its goal is to aid adaptation by reducing anxiety and
bolstering self-esteem (Cramer, 2006). Denial is “the conscious or uncon-
scious repudiation of part or all of the total available meanings of an event
to allay fear, anxiety or other unpleasurable affects” (Weisman & Hatchett,
1961, p. 232). In its simplest form, it is a mental operation enabling the
 34 B. Reicher

withdrawal of attention from internal or external stimuli that could cause

disturbing feelings. Denial may show other manifestations in which at least
partial attention may be given to the disturbing inner or outer reality, such
as negation (“that’s not how it happened”), misperceptions and misinter-
pretations of events, minimization (making light of or even ridiculing an
event’s significance), and reversal (distorting an event into its opposite).
Common to all is a way of dealing with something upsetting by “changing
its psychological size” (Cramer, 2006, p. 45).

DENIAL AS A COPING STRATEGY

Psychological disequilibrium can arouse both defense mechanisms and cop-
ing strategies and both are geared toward adaptation. However, while
Downloaded by [Erciyes University] at 00:08 29 December 2014

defenses are considered by and large unconscious, coping strategies are

conscious means of reducing anxiety and managing problematic situations.
Children learn to cope by example and as part of the socialization process.
As such, their strategies are proactive attempts to change a problem situ-
ation while the focus of their use of defenses is on making a change in
their internal state. Laflen and Sturm (1994) conceive of denial in offenders
and their families as a fundamentally narcissistic coping mechanism aimed
at maintaining self-esteem and reinstating equilibrium.

Categories of Denial

Though knowing the truth, he may act as if it did not exist.

—Fenichel (1945, p. 145)

Denial can also be categorized into two broad and sometimes overlap-
ping categories. The perceptual system is dominant in some of the previously
mentioned mental operations in that reality is not seen or heard (“turning a
blind eye”), avoidance is implemented (“turning one’s back”), and what is
perceived can be distorted. The other category of denial relates more to
cognition and fantasy construction. An individual creates a potent fantasy
or narrative of events that includes both an account of what transpired as
well as the narrator’s psychological perspective on what happened (Laszlo,
2008). This narrative is generally geared to reflect positively on the subject.
This fantasy or narrative can overshadow reality and even becomes a par-
tial replacement for certain portions of personal experience. The following
vignette is an example of a denial narrative heard in my clinical practice.

Several irate parents complained about an 8-year-old boy who kissed and
fondled their children on numerous occasions. On being presented with
these complaints, the parents of this child were convinced that there
 Denying Denial 35

must be some misunderstanding as their child is a “very good boy—

disciplined, good natured, and very innocent.” They refused to hear any
details of the problematic events and discounted all of the other children’s
narratives or symptoms. The little boy himself echoed his parents’ stance
claiming he was just playing with his friends and anything they did was
fun and mutual. It took many therapy sessions before the parents and
child were able to think outside of their “good” fantasy and cope with
the harder facts that challenged it.

Spectrums of Denial
Denial can also be conceived of as a continuum. Along these lines, the
literature on sexual offenders has put forward many specific typologies.
Schneider and Wright (2004) used categories of denial identified in various
Downloaded by [Erciyes University] at 00:08 29 December 2014

typologies (see Schneider & Wright, 2004, Table 1) to create their own self-
report measure that they proceeded to empirically test using factor analysis.
They identified seven categories of denial: denial of offense, denial of victim
impact, denial of extent of abuse, denial of responsibility, denial of planning,
denial of sexual deviancy, and denial of relapse potential. To illustrate the
different aspects of denial, the following vignette is taken from a group ther-
apy session that I led for adolescents with sexually offensive behavior. The
participant “O.” demonstrated various levels of denial in different contexts.

O., a 16-year-old boy, did not deny his multiple sexual offenses against
younger boys in therapy. More to the point, he appeared to get some kind
of exhibitionistic satisfaction from recounting his behavior. However, he
was committed to working on his problem and was very cooperative
in the group treatment. After a year of group sessions, he recounted to
the group that he had “befriended” a 10-year-old boy who shared with
him many common interests. Both the therapists and the group began
confronting O. with the implications of this “friendship.” O. was in total
denial of the manipulative nature of his behavior, and only after much
group effort could he realize the relapse potential of being in contact
with a younger boy.

Is Denial Conscious or Unconscious?

Each of us is aware in ourselves of the workings of denial, of our need

to be innocent of a troubling recognition.
—Bollas (as cited in Cohen, 2001, p. 7)

This quote relates to the paradox inherent in denial: to know and not
to know. Denial can never be absolute as at least some information is
registered in order for it to be disavowed. From a neurological point of
 36 B. Reicher

view, this situation is known as “blindsight” whereby a part of the mind is

aware of what it is doing while another part that seemingly knows remains
oblivious (Cohen, 2001). Emotionally, there is always some awareness of
uncomfortable affect before denial is implemented. In addition to this, denial
often emerges out of a specific social context. In the case of children who
sexually offend, their need to keep up a normative appearance, avoid pun-
ishment or criticism, and prevent loss of status are often potent motivators for
denial.
The time lag between social consciousness and the use of denial can
vary: it can depend on external stimuli (e.g., the child being confronted
with an official complaint) or the child’s internal image of social responses.
Therefore, it is not always clear if the denial is situational (a response after
the offending behavior) or dispositional (the denial facilitates the offending
Downloaded by [Erciyes University] at 00:08 29 December 2014

behavior; Maruna & Mann, 2006).

Cognitive Processes That Form the Scaffolding for Denial

Denial is like a jury giving a verdict without hearing the evidence.

—Dorpat (1983, p. 51)

Cognitive psychology views denial as an idiosyncratic way of processing

information. The mind receives a multitude of stimuli. Of necessity, it must
select perceptions, filter input, and determine how to allocate the attention
span. Information that is too anxiety-provoking can be isolated by any of
the different types of denial (e.g., disavowal, reinterpretation, minimization,
rationalization).

COGNITIVE DECONSTRUCTION AND ATTACK ON LINKING

Baumeister (1991) developed the concept of cognitive deconstruction
whereby an individual diminishes his or her thought processes and aware-
ness to a level of less meaning and integration. Thinking becomes concrete
and short-term and affect is limited so that there is little room for inter-
pretation. This is similar to Bion’s (1967) conceptualization of “attack on
linking” whereby connections between thoughts become nonexistent and
one’s experience becomes fragmented and inconstant. Two brief vignettes
from my private practice can illustrate the effects of these cognitive processes
in denial:

A., a 13-year-old boy with social difficulties, heard his peers discussing
sex. This caused him to feel that, once again, he was left out and “not nor-
mal.” He had full sexual relations with his 6-year-old sister and repeated
 Denying Denial 37

this behavior several times over a period of 6 months. Eventually the sis-
ter accidentally disclosed the abuse to her kindergarten teacher. A. loved
his sister dearly and, though he was secretive about the sexual contact,
he denied that he did anything wrong and that she could be hurt by his
actions. He was negativistic toward the therapy and, though very bright,
his therapeutic dialogue was lame and piecemeal, leaving the therapist
with a disjointed sense of whom this child was.

Z., a 16-year-old youth exploited the fact that a 14-year-old girl with
low-normal intelligence was flirting with him. He cajoled her into an iso-
lated area and urged her to perform oral sex on him. This youth came
from a disadvantaged background characterized by neglect and physi-
cal and financial hardship. His dominant experience of his parents and
other authority figures was of disappointment. Z. developed an attitude
Downloaded by [Erciyes University] at 00:08 29 December 2014

of pseudomaturity whereby he felt he could manage on his own without

needing anyone’s help or advice. This youth denied initiating the offen-
sive behavior and insisted that the girl was responsible for the results.
Though very intelligent and “streetwise,” this boy’s presentation of events
was blatantly simplified, lacking in logic, and barely camouflaging his
anger and anxiety.

FAULTY SCHEMAS
Schemas are cognitive abbreviations of details that can facilitate the pro-
cessing of information, fill in gaps in knowledge, and offer interpretations
(Taylor, Peplau, & Sears, 2000). Schemas are cognitive manifestations of pre-
existing belief systems or assumptions and their use is not necessarily fully
conscious. Children with sexual behavior problems, like adult sexual offend-
ers, can be guided by schemas that color their interactions in an improper
light. As such, denial that relies heavily on a faulty schema can be automatic
and semiconscious and not necessarily an attempt to avoid social disapproval
(Barbaree, 1991; Marshall & Eccles, 1991). Furthermore, when cognitive dis-
sonance is caused by a discrepancy between one’s belief system and other
information, the schema can be maintained by altering one’s perceptions and
memories to create consistency. The following vignette helps to illustrate
these clinical issues.

A 15-year-old religious Jewish youth was referred to me for a consultation

because of sexually offensive behavior that he presented with an idiosyn-
cratic rationale. This youth had various degrees of sexual relations with
same-sex peers in the yeshiva (religious residential learning institution)
he attended. This youth was aware that religious law forbids masturba-
tion as well as sexual relations with women before marriage. In his mind,
he could therefore justify his sexual behavior by interpreting his actions
as a physiological response in the framework of mutual relations, thereby
not directly breaking any taboos.
 38 B. Reicher

Emotional Elements in Denial

Denial is there for a purpose. It is the glue that holds an already shat-
tered self-esteem together. And it is the tactic through which otherwise
overwhelming anxiety can be contained.
—Wallace (1977, p. 18)

Emotionally, the disavowal of the meaning of an event can greatly miti-

gate the denier’s unpleasant affect (Weisman & Hachett, 1961). Interactive
responses such as shame, distrust, or disbelief can be avoided. Denial
is also self-focused: it can protect the self-image by blocking images or
thoughts of personal badness, lack of control, or deviancy. Denial, as it
were, screens out harsh realities that can prevent the ego from being
Downloaded by [Erciyes University] at 00:08 29 December 2014

overwhelmed.
Clinical practice has shown that as denial is worked through in the
therapeutic process, many children with SBP begin to show depressive affect.
The loss of denial heralds insight but also the coming to grips with the
inner and outer consequences of their offensive behavior. As such, denial
should be treated as a major defense, often protecting a fragile ego. The
following vignette provides a salient example of the emotional ramifications
of conceding on denial.

C., an 8-year-old boy, watched as his friend stripped his 4-year-old sister
and proceeded to touch her genitals. C. was both scared and mesmer-
ized by this scene and eventually also began touching the little girl. The
boys were caught in the act when C.’s parents happened to enter the
room. While at first attempting to deny any wrongdoing, C. soon admit-
ted to everything that he had done. His parents’ reaction was strong and
harsh. C.’s father slapped his son, leaving a bruise on his face. C. was
not allowed out of the house for 4 weeks except to attend school and
he was forbidden to watch any television or use the computer. Soon
thereafter, C. developed encopresis and became withdrawn, effectively
isolating himself socially.

Microgenesis of Denial
A step-by-step breakdown of the unfolding of denial commences with a
disturbing trigger that pains or otherwise holds the potential for negatively
impacting the child. The ensuing emotional disequilibrium causes the child
to arrest his usual thought processes by blocking information and responses
that could help him manage the perceived danger or threat. The stage of
cognitive arrest necessarily preempts making a more balanced assessment
of the situation. Screen behavior, similar to a “cover story,” is the next step
intended to round out the rough edges caused by the cognitive arrest.
 Denying Denial 39

Screen behavior can consist of rationalizations, ideas, fantasies, and

actual behavior that often stand in sharp contrast to the negated cogni-
tions (Dorpat, 1983). Maruna and Mann (2006) point out that denial can
also commence before the actual offense. A process of cognitive arrest and
screen behaviors can precede the actual disturbing event as, for example,
in making excuses to facilitate the offense. As such, denial can serve both a
maintenance and causal role toward sexual behavior problems. In the follow-
ing vignette, it became evident that a client’s denial of his sexually offensive
behavior preceded the actual offensive acts.

A 14-year-old adolescent boy routinely babysat an 8-year-old female

neighbor. He began to plan a way to exploit this time alone with the
younger child to satisfy his sexual curiosity. In the assessment process,
Downloaded by [Erciyes University] at 00:08 29 December 2014

he could describe how he had already begun denying many aspects of

his offensive behavior in the planning stage in order to feed into his need
for sexual release.

Denial Developmentally

Denial functions through the disavowal of whole percepts and the

substitution of a wish-fulfilling fantasy.
—Lichtenberg and Slap (1972, p. 781)

A child’s development is a work in progress, plastic and always trans-

forming but also predictable in many ways. Cognitive, emotional, behavioral,
and sexual stages of development interact and dovetail both in normal path-
ways and more pathological ones. As such, sexual behavior problems, in
general, and denial, in particular, must first and foremost be viewed as a
derailment of a child’s normal developmental course. A minority of cases,
especially among older children, can manifest a more entrenched behavioral
pattern similar to that of adult sex offenders. However, even in these cases,
proper assessment and treatment should never lose sight of developmental
factors.
Anna Freud (1936) spotlighted the double function of psychological
defenses as both protective and adaptive mechanisms. Specifically, denial as
a prominent defense is normative when manifested from infancy to around
age 7. In the first years of life, Sigmund Freud (as cited in Cramer, 2006)
noted that babies can erect a “stimulus barrier,” which prevents them from
being overwhelmed by external sensations. This can be expressed physi-
ologically by such responses as falling asleep and gaze avoidance. As the
infant matures, his or her mental operations become more fine-tuned and
attention can selectively be withdrawn from outer stimuli.
 40 B. Reicher

PIAGET AND COGNITIVE DEVELOPMENT

The developing child is self-centered and views the world from a distinctly
subjective vantage point. Piaget (1952) outlined the child’s cognitive devel-
opment on the axis of assimilation to accommodation. In the former, the
child uses and at times transforms the environment so that it will fit his or
her way of relating to things (cognitive structures). In the latter, the child
changes his or her cognitive structures so as to be able to receive from the
environment. As such, a young child in the stage of preoperational thought
(0–7 years) can focus on a limited amount of stimuli (termed “centration”),
can confuse reality with magical thinking, and will judge things that happen
in his or her life more by their results than by anyone’s intentions. From
age 7–12, the period of concrete operations is manifest. A child’s thought
processes become more logical, based on the here and now, and the abil-
Downloaded by [Erciyes University] at 00:08 29 December 2014

ity to categorize and problem-solve begins to develop. The stage of formal

operations occurs in adolescence. The growing capacity for abstract think-
ing enables teens to mentally juggle multiple ideas and outcomes as well as
understand cause and effect.
As such, a child’s growing cognitive ability gradually enables more
sophisticated means for dealing with disturbing perceptions and affects.
A child can “improve” on reality by misperception, thereby transforming
a disturbing stimulus into something else, something less threatening. He or
she can employ such mental acrobatics as reversal, minimization, exaggera-
tion, and indifference. Freud (1923) offers a classic example of the universal
denial of pre-Oedipal boys who cannot manage the fact that the opposite
sex lacks penises. This perception is denied by claiming that girls do have
penises or that they will grow later. This denial eventually transforms into
castration anxiety (Cohen, 2001).
Young children’s reality-testing can be fluid and denial can be used or
abandoned in a similar fashion. In comparison, the denial of older children
is less concerned with disavowal of reality. More “mature” denial tends to be
characterized by interpreting a perception by means of an enhancing fantasy.
Traits of an individual can be maximized or minimized to fit a preconceived
image of the ideal object. For example, children in late latency or early
adolescence can deal with parental disappointment by fantasizing a “family
romance” whereby the child imagines himself born to ideal parents and
thereby psychologically distancing himself from his real parents (Cramer,
2006; Greenacre, 1958).

THE DEVELOPMENT OF THE SUPER EGO

“Young children possess no internal inhibitors against their impulses. . . . The
part which is later taken on by the super ego is played to begin with by an
external power by parental authority” (Freud, 1933). The super ego develops
 Denying Denial 41

in early childhood as a consequence of the child’s identification and imitation

of his or her parents and it is a hallmark of the Oedipal period (ages 3 to 6).
As an internal structure, the super ego functions to direct the child morally,
to limit inappropriate behavior, and to punish unacceptable behavior. Its for-
mation heralds a transformation from earlier periods of development when
the child was more self-directed and narcissistic (Milrod, 2002) to a much
more other-directed (object-directed) outlook. As such, the super ego helps
the child to regulate his or her behavior and self-esteem.
The super ego has the additional function of self-observation whereby it
measures the ego according to the standards of the ego ideal (Milrod, 2002).
In adolescence, when the teenager is reexamining his earlier identifications,
both the ego and the super ego can be weakened: as the teenager questions
his or her identity, the power and certainty of the super ego can become
Downloaded by [Erciyes University] at 00:08 29 December 2014

less stable. It is in this developmental period that the ego ideal can become
particularly salient, as its standards can be derived from many (extrafamilial)
sources. This can be seen, for example, in adolescent aspirations such as
hero-worship and strong group identification, etc. In order to illustrate indi-
vidual and group dynamics in adolescence, an example vignette was taken
from a consultation I made for social services after several teenagers banded
together to commit sexually offenses against a female peer.

A group of four 14-year-old boys had no trouble convincing a socially

withdrawn female classmate to perform oral sex on them during school
recess. In individual assessments, it was apparent that each boy was in
ad hoc denial of the seriousness of the offense. It is likely that not one
of the boys would have been able to commit the offense on his own as
they each described their behavior as being supported and reinforced by
the active presence of the others. Furthermore, none of them had the ego
strengths to make such a decision alone, nor the ability to be in such an
“intimate” situation with their female classmate. After the offense, each
was able to morally condemn his actions. The combination of a distorted
ego ideal of hypermasculinity and a strong group identification that pre-
empted self-analysis were among the factors facilitating the victimizing
behavior.

Pathological Denial in Children

I would suggest that a thought becomes thinkable often by a very slow

gradual process, a process which cannot be rushed.
—Alvarez (1992, p. 153)

Children and teens with problematic sexual behavior can be vehement

in the denial of their offenses, often leaving the therapist/assessor unclear
as to the causation of the expressed denial or degree of pathology it may
 42 B. Reicher

represent. As opposed to adults, a child’s reality testing is just in the pro-

cess of crystallization, and this, too, factors into the use and misuse of
denial.
Play is often a vehicle for the child to examine reality by trying out
different options while allowing direct expression of the child’s inner world.
As such, play can facilitate the enactment of fantasies and idealized situations
that can also allow the child a timeout, an alternative reality. Symbolic play
that attributes very personal meanings to everyday objects develops around
age 2 and is considered the forerunner of teen daydreams and idealization
(Cramer, 2006).
From toddlerhood to early latency, children can combine fantasy with
reality. However, by late adolescence, such perceptual denial is expected
to be a vestige of the past. Two studies (Hart & Chmiel, 1992; Matsuba &
Downloaded by [Erciyes University] at 00:08 29 December 2014

Walker as cited in Cramer, 2006) found that preadolescents’ and adolescents’

use of immature defenses like denial was related to poorer levels of moral
reasoning.
Stress and trauma call forth defenses like denial in order to prevent
stimulus overload. Several longitudinal studies have shown that traumatized
or highly distressed children can become so dependent on denial that it
eventually becomes a personality trait (Cramer & Block, 1998; Haan, Millsap,
& Hartka, 1986). It is normal for young children to deny aggressive feelings
they might have toward their caretaker so as not to arouse the fear of object
loss (Rubinfine, 1962). However, the aggressive feelings of deprived children
are often denied by transforming them into feelings of omnipotence with
subsequent fantasies of controlling others (Cramer, 2006).
Alvarez (1992) offers another take on the denial of traumatized children
in therapy. She speaks of the distressed child’s need to work through his
or her memories in a safe and hopeful atmosphere. In this way, denied
material is not strictly speaking avoidance but rather an attempt to correct the
context of disclosure by first building up the nonabused parts of the child’s
existence.
The following material from an intensive course of psychotherapy in my
private practice demonstrates a misguided attempt to deal with past abuse
by denial and sexual acting out. Ultimately, in the secure framework of ther-
apy, the client could make a transformation to consciously directed working
through of his distress.

Fifteen-year-old T. had sexual relations with his 10-year-old male cousin

on numerous occasions. The abuse began as an anniversary reaction:
T. himself had been sexually abused by a babysitter when he was his
cousin’s age. The original abuse was for T. a morbid secret and he even-
tually “forgot” it. As he became more involved in his therapy and felt
better about himself, T. could handle several parts of the past he had
previously denied, including his experience of sexual abuse.
 Denying Denial 43

CLINICAL IMPLICATIONS
Therapeutic Tools and Approaches

Although it would be a mistake to reinforce biased views or to excuse

dishonesty, it may be just as harmful to attack these excuses and
explanations without appreciating their meaning to the offender.
—Schneider & Wright (2004, p. 16)

Children and adolescents with SBP who display various forms of denial
pose a major therapeutic challenge. Denial is a complex phenomenon that
needs to be approached through a broad lens rather than a simplistic,
truth–deceit dichotomy (Schneider & Wright, 2004). Cognitive-behavioral and
psychodynamic theories can contribute to this wider approach in that they
Downloaded by [Erciyes University] at 00:08 29 December 2014

offer complementary views of denial. Denial is often a combination of social

defiance and distorted thinking as well as unconscious ego protective mech-
anisms (Cramer, 2006). As such, an understanding of the type of denial
manifested and its underlying purpose can offer a wealth of clinical under-
standing. Furthermore, an analysis of a child’s denial has the potential to
indicate the most effective mode of treatment.
Attentive and nonjudgmental listening to a child’s account of his or her
offensive behavior instills a sense of empathy and trust. This is compatible
with therapeutic principles and invites the child client to entrust us with
the way he or she recalls his or her actions and makes meaning of them.
Premature attempts to confront the denial critically can cause a shutdown
of this source of rich material and can derail the nascent treatment (Alvarez,
1992). It is of the utmost importance to reach an understanding of the child’s
take on his or her sexual behavior problems. From this, the cognitions that
scaffold his or her denial can become evident.
Therapists/assessors would do well to encourage and pursue their own
therapeutic curiosity about the denial and not relate to it as a technical
obstacle. A child denies not only for such self-evident reasons as to avoid
punishment but also to sustain a semblance of self-esteem. The denial can
also serve multiple needs, such as avoiding the psychological pain of rela-
tional difficulties and a sense of emptiness that may be at the root of the
offensive behavior (Cramer, 2006).
Paradoxically, when children deny their problematic sexual behavior,
they are in effect manifesting signs of an active super ego. Their denial is an
indication of their awareness that they did something wrong. This can be an
excellent starting point for therapy, and it bodes well prognostically (Hanson
& Morton-Bourgon, 2005).
The Association for the Treatment of Sexual Abusers (ATSA) Task Force
Report on Children with Sexual Behavior Problems (Chaffin et al., 2008)
related to children’s denial from a developmental standpoint. The ATSA
Task Force took the stand that since young children do not have the
 44 B. Reicher

cognitive wherewithal for the sophisticated manipulation needed to plan sex-

ual offenses, the therapy should focus more on establishing rules and less
on abstract insights aimed at correcting cognitive distortions. Friedrich (2007)
also advocated a therapeutic approach that relates to attachment deficits by,
among other tools, modeling empathy.
Several short-term cognitive behavioral therapy-based group therapy
programs for children with sexual behavioral problems have been researched
(Bonner, Walker, & Berliner, 1999; Carpentier, Silovsky, & Chaffin, 2006;
Gagnon, Begin, & Tremblay, 2004). (For further discussion of cognitive-
behavioral therapy with children with sexual behavior problems, see
Rasmussen, 2013, this issue.) In keeping with younger children’s devel-
opmental capabilities, these groups teach the children normative sexual
behavior, proper physical rules and boundaries, and impulse control skills.
Downloaded by [Erciyes University] at 00:08 29 December 2014

Parents and caregivers are also involved in the therapy in an attempt to

enhance their skill in the monitoring and supervising of their children (Cohen
& Mannarino, 1996, 1997).
Several writers are presenting approaches that, though initially aimed
at an adult population, can be suitable for adolescents with SBP. These
approaches tap into the adolescent’s budding cognitive ability to use
abstract thinking as well as acknowledging the teen’s identity issues. (See
Rasmussen’s [2013] discussion of holistic treatment models for sexually
abusive youth in the conclusion of this special issue.)
Motivational interviewing (Mann & Rolnick, 1996; Miller & Rollnick,
2002) is a client-centered and directive method of communication. It builds
on the individual’s intrinsic motivation to arrive at his or her own needs and
solutions by working through different levels of ambivalence. Through such
techniques as reflective listening and enhancing ambivalence by exploring
personal desires and options, the client is guided to make more informed
choices. The empathic outlook and broad discussions of alternatives in
this approach facilitate self-efficacy and personal motivation to change.
Motivational interviewing facilitates open discussions and deeper introspec-
tion that can help many denying sexually abusive adolescents to get beyond
an outlook limited by denial (Prescott & Levenson, 2011).
Jenkins (1993) does not advocate confronting denial directly, rather
“inviting” the adult sex offender to take responsibility by examining the inter-
active aspects and personal impact of what has occurred. In this approach,
the disadvantages of offending behavior are addressed by discussing other
people’s concerns about the client as well as challenging the client to live
with integrity. This approach, although formulated for adults, suits some of
the core developmental issues of adolescence. Most teens, including those
with SBP, are deliberating about their emerging identities and questioning
themselves as to what kind of person they want to be. Socially, teens are
very preoccupied with their group affiliations and status. Inviting a juvenile
with SBP to take responsibility, when reframed by personal integrity and
belonging, can provide a powerful therapeutic alternative to denial.
 Denying Denial 45

Marshall, Thornton, Marshall, Fernandez, and Mann (2001) developed a

treatment model specifically for adult sex offenders in denial. The group
therapy process is similar to many conventional sex offender treatment
approaches (see Rasmussen, 2013, this issue, for a discussion of sex-offender
specific cognitive-behavioral therapy) except that the clients are not required
to give an account of their offenses. The therapeutic goal is presented as dis-
covering the pathways and events that led to their being “falsely” accused
of sexual offending so as to assure that such a situation will never occur
again. Many adolescents who have sexually offended are resistant to giv-
ing an account of their offenses, both in the assessment stage and in actual
treatment. Clinical experience has shown that this resistance often expresses
the youth’s denial of having done anything wrong, and, therefore, describ-
ing their actions is liable to hurt this effort. In addition, many teenagers
Downloaded by [Erciyes University] at 00:08 29 December 2014

are automatically reticent about collaborating with authority figures, and

their silence expresses much passive aggression. Marshall and colleagues’
treatment model can bypass these adolescent dynamics by reframing the
recounting of the offense in the youth’s terms of being “falsely” accused. This
eliminates the need to enter into a power struggle of telling/not telling and
presents collaboration in such a light that it “pays” for each group member
to do his or her share of telling.
Many treatment programs for teens with SBP put great emphasis on the
individual recounting his or her sexual misconduct (see Rasmussen, 2013,
this issue, about traditional versus contemporary treatment models for sex-
ually abusive youth). Teens having difficulties giving a coherent and candid
account may be barred from treatment programs. Another common outcome
is that much therapeutic time and effort is invested in cajoling the client to
supply details of his or her offenses at the expense of dealing with other
relevant issues (Schneider & Wright, 2004). Starting from the alleged abuse
and working backward can both allow time for the therapeutic alliance to
become more consolidated as well as presenting the problematic behavior
in more manageable terms as a process to be learned from. This is also com-
patible with the emergence of formal operations in adolescence that enable
analyzing causes and consequences. Therapy that deals in “damage control”
and insight by means of hindsight can be more palatable for teens and it
has the potential to trump denial mechanisms. An example of this is the
following:

Z., the 16-year-old mentioned previously, began his assessment process

with a negativistic attitude. The assessment was court ordered, and this
fed into his difficulty in accepting authority. His blatant cognitive distor-
tions concerning his sexually offensive behavior (e.g., “The girl [victim]
went with me willingly”) added to his protest against the need for any
kind of therapeutic intervention. The assessor began communicating with
this adolescent around his dislike of the situation he was “forced” into.
 46 B. Reicher

TABLE 1 Therapist–Client Interaction

Person Type of Technique From

Speaking Statement Motivational Interviewing

Therapist I understand that the Abuse Council referred Open question

you for a risk assessment. Can you tell me
about that?
Z. This is all a big mistake and a waste of time Blatant resistance
and money for me. I’ll meet with you just
this once to get this over with.
Therapist I see that you’re making a big effort to be Affirmation
here today.
Z. Yes, that’s true. How long will we have to Less resistance; subtle
speak? change from declaration
that he’ll meet only once
Therapist That’s a relevant question. We’ll meet several Shifting focus; complex
Downloaded by [Erciyes University] at 00:08 29 December 2014

times depending on how much we cover reflection

in each session. For now, it must be very
frustrating to feel that you are being made
to come to these assessment meetings.
Z. Damn straight. No offense to you, but Splitting resistance from
I know what I need and this is not it. therapist to assessment
Therapist On the one hand, doing this assessment can Double-sided reflection
help you see what happened and why you
acted as you did; on the other, you’re
concerned that the assessment report may
present you in a criminal light to the
Abuse Council.

This was explored in a nonjudgmental and empathic way, allowing him

to ventilate his feelings. Using some techniques from motivational inter-
viewing, the assessor chose to reflect back and validate what the youth
said both as statements and in question form. See Table 1.

In this account, the assessor (myself) tried to introduce ambivalence

as a situational factor in keeping with both motivational interviewing and
Marshall and colleague’s (2001) approach. The assessor framed the assess-
ment as something that the youth did not want to do on one level, while
on another it was actually an act that could save him from a criminal record
and a label as a sexual offender. In order to implement the assessment in a
way that would be most helpful for the teen, they had to at least run through
the events and interactions leading up to the “alleged” sexual behavior. Z.
did not enjoy the assessment process, and it was very difficult for him to
share his world with the adult assessor. Nonetheless, these interventions
were conducive in lowering Z.’s level of denial, and he had a somewhat cor-
rective experience whereby he ultimately benefited from collaboration with
the authorities. See Table 2.
The therapist’s interventions helped Z. become more aware of his prob-
lematic behavior. In terms of the motivational interviewing model this is
 Denying Denial 47

TABLE 2 Therapist–Client Interaction

Person Type of Technique From

Speaking Statement Motivational Interviewing

Z. They think I forced that girl to have sex. Cognitive distortion

It didn’t go down like that at all. It was all (blaming the victim)
her idea.
Therapist So she suggested going behind the building Summary
during recess to have sex and she seemed
okay with that.
Therapist It doesn’t seem a big deal to you and Double-sided reflection
therefore there’s no need to discuss it. Yet,
your mother is very upset and the school
staff and regional social worker see this as
something that must be reported to the
Abuse Council.
Downloaded by [Erciyes University] at 00:08 29 December 2014

Z. Look—I’m willing to accept the girl maybe The beginning of change

changed her mind about the sex. Maybe talk—less minimization
she thought it meant we’re a couple now and an awareness of
and got disappointed. the victim

termed movement from the precontemplation to the contemplation level of

change. Continuous use of these types of interventions could potentially help
Z. arrive at more advanced stages of change (planning [intent to change] and
action and maintenance [working on goals]).

Acted-Out Denial
It has been the author’s experience, both as a clinician and as a supervi-
sor of other clinicians in this field, that a certain percentage of youth with
sexually abusive behavior reoffend during treatment. Such an occurrence is
difficult to contain as a therapist: it arouses strong emotions such as anger
and frustration at the client for victimizing another person and doubt about
the effectiveness of the therapy. However, because this type of therapeutic
crisis has the potential to occur, it is important to analyze its meaning. The
reoffense sends a very concrete message that there is no room for denial.
The subtext may be for the therapist to treat the denial in another fashion, to
revisit the causality of the SBP, and/or to alert the milieu as to the need for
the offending youth to be more closely supervised. Although at a huge price
of another person’s victimization, such a crisis of reoffending may become
a therapeutic breakthrough. The offending youth has broken through his or
her own denial.

The Therapist’s Denial

Denial has a strong interactional component. As a communication, it impacts
others and can set off a series of actions and reactions. This is often seen
 48 B. Reicher

in families of children with SBP, but that is beyond the scope of the present
article (see Abu-Baker, 2013, this issue, for ways in which denial manifests
in dysfunctional families affected by sexual abuse of one of the children).
Therapists, too, are not immune to the looplike effect of denial. This can
play out as the therapist denying denial.
Therapists facing a youth who has abused a fellow youth can be over-
whelmed by the youth’s actions. With children and adolescents especially
there can be a huge discrepancy between how the youth presents in therapy
and the severity of his or her abusive actions. There can be a basic cognitive
dissonance between a naïve young child and reports of actions including
elements of adult sexuality or aggression. Such an onslaught of disparate
material can cause therapists to mentally minimize the extent of the offense
or inadvertently aid the youth in not fully verbalizing his or her actions. Some
Downloaded by [Erciyes University] at 00:08 29 December 2014

therapists overidentify with the abusive (and often abused) youth, which can
lead to accepting denial at face value (Benedek, 1985). In such scenarios, the
therapist is, for various reasons, “infected” as it were with the youth’s denial
and the therapy can be compromised as a result.

SUMMARY

This article offers a broad analysis of denial, with a specific emphasis on

its manifestations among children and adolescents with SBP. The tendency
among professionals and laypeople is to deny denial, and a case is made
to strongly advocate against this. Denial is inherent to sexual abuse, and
far from constituting an obstacle can actually be used to therapeutic advan-
tage. Denial is a rich source of information about the client (e.g., cognitive
processes, value system, and emotional dynamics). When viewed as a chal-
lenge rather than an obstacle, denial can inform intervention decisions and
therapeutic strategy.

REFERENCES

Abu-Baker, K. (2013). Arab parents’ reactions to child sexual abuse: A review

of clinical records. Journal of Child Sexual Abuse, 22(1), 52–71. doi:10.1080/
10538712.2013.744378
Alvarez, A. (1992). Child sexual abuse: The need to remember and the need to
forget. In Live company: Psychoanalytic psychotherapy with autistic, borderline,
deprived and abused children (pp. 151–162). London, England: Routledge.
Barbaree, H. E. (1991). Denial and minimization among sex offenders: Assessment
and treatment outcome. Forum on Corrections Research, 3, 30–33.
Baumeister, R. E. (1991). Escaping the self . New York, NY: Basic Books.
Benedek, E. D. (1985). Children and disaster: Emerging issues. Psychiatric Annals,
15(3), 168–175.
 Denying Denial 49

Bion, W. (1967). Second thoughts: Selected papers on psycho-analysis. New York, NY:
Aronson.
Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Final report on children with
sexual behavior problems: Assessment and treatment. Washington, DC: Office
of Child Abuse and Neglect, Department of Health and Human Services.
Carpentier, M. Y., Silovsky, J. F., & Chaffin, M. (2006). Randomized trial of
treatment for children with sexual behavior problems: Ten-year follow-up.
Journal of Consulting and Clinical Psychology, 74, 482–488. doi:10.1037/0022-
000.X.74.3.482
Chaffin, M., Berliner, L., Block, R., Cavanaugh Johnson, T., Friedrich, W. N.,
Louis, D. G., . . . Madden, C. (2008). Report of the ATSA task force on
children with sexual behavior problems. Child Maltreatment, 13, 199–218.
doi:10.1177/1077559507306718
Cohen, J. A., & Mannarino, A. P. (1996). A treatment study for sexually abused
Downloaded by [Erciyes University] at 00:08 29 December 2014

preschool children: Initial findings. Journal of American Academy of Child and

Adolescent Psychiatry, 35, 42–50. doi:10.1097/00004583-19960100-00011
Cohen, J. A., & Mannarino, A. P. (1997). A treatment study for sexually
abused preschool children: Outcome during one year follow-up. Journal
of American Academy of Child & Adolescent Psychiatry, 36, 1228–1235.
doi:10.1097/00004583-199709000-0015
Cohen, S. (2001). States of denial: Knowing about atrocities and suffering.
Cambridge, England: Polity Press.
Conte, J. R. (1985). Clinical dimensions of adult sexual abuse of children. Behavioral
Sciences & the Law, 3, 341–354.
Cramer, P. (2006). Protecting the self . New York, NY: Guilford Press.
Cramer, P., & Block, J. (1998). Preschool antecedents of defense mechanism use
in young adults. Journal of Personality and Social Psychology, 74(1), 159–169.
doi:10.1037/0022-3514.74.1.159
Dorpat, T. L. (1983). The cognitive arrest hypothesis of denial. International Journal
of Psycho-Analysis, 64, 47–58.
Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York, NY: Norton
Press.
Freud, A. (1936). The ego and the mechanisms of defense. New York, NY:
International Universities Press.
Freud, S. (1923). The ego and the id. In The standard edition of the complete psycho-
logical works of Sigmund Freud (Vol. 19, pp. 12–66). London, England: Hogarth
Press.
Freud, S. (1933). New introductory lectures on psycho-analysis. London, England:
Hogarth Press.
Friedrich, W. N. (2007). Children with sexual behavior problems: Family-based
attachment-focused therapy. New York, NY: W.W. Norton & Company.
Gagnon, M. M., Begin, H., & Tremblay, C. (2004). Treatment programs for children
with sexual behavior problems: A status report. International Journal of Child
and Family Welfare, 1, 44–59.
Greenacre, P. (1958). The family romance of the artist. Psychoanalytic Study of the
Child, 13(9), 13–35.
 50 B. Reicher

Haan, N., Millsap, R., & Hartka, E. (1986). As time goes by: Change and sta-
bility in personality over fifty years. Psychology and Aging, 1, 220–232.
doi:10.1037/0882-7974.1.3.220
Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent
sexual offenders: A meta-analysis of recidivisim studies. Journal of Consulting
and Clinical Psychology, 73, 1154–1163. doi:10.1037/0022-006X.73.6.1154
Hart, D., & Chmiel, S. (1992). Influence of defense mechanisms on moral judgment
development: A longitudinal study. Developmental Psychology, 28, 722–730.
doi:10.10 37/0012-1649.28.4.722
Jenkins, A. (1993). Invitations to responsibility: The therapeutic engagement of men
who are violent and abusive. Adelaide, Australia: Dulwich Center.
Laflen, B., & Sturm, W. R., Jr. (1994). Understanding and working with
denial in sexual offenders. Journal of Child Sexual Abuse, 3, 19–36.
doi:10.1300/Jo70v03n04_02
Downloaded by [Erciyes University] at 00:08 29 December 2014

Langevin, R., & Lang R. A. (1985). Psychological treatment of pedophiles. Behavioral

Sciences and the Law, 3, 403–419. doi:10/1002/bsl.2370060207
Laszlo, J. (2008). The science of stories: An introduction to narrative psychology. New
York, NY: Routledge.
Lichtenberg, J. D., & Slap, J. W. (1972). On the defense mechanism: A survey and
synthesis. Journal of the American Psychoanalytic Association, 20, 776–792.
doi:10.1177/0003065 17202000404
Mann, R. E., & Rolnick, S. (1996). Motivational interviewing with a sex offender
who believed he was innocent. Behavioral and Cognitive Psychotherapy, 24(2),
127–134. doi:10.1017/ 1352465800017392
Marshall, W. L., & Barbaree, H. E. (1990). Outcome of comprehensive cognitive-
behavioral treatment programs. In W. L. Marshall, D. R. Laws, & H. E.
Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of
the offender (pp. 363–385). New York, NY: Plenum.
Marshall, W. L., & Eccles, A. (1991). Issues in clinical practice with sex offenders.
Journal of Interpersonal Violence, 6, 68–93. doi:10.1177/088626091006001006
Marshall, W. L., Thornton, D., Marshall, L. E., Fernandez, Y. M., & Mann, R.
(2001). Treatment of sexual offenders who are in categorical denial: A pilot
project. Sexual Abuse: A Journal of Research and Treatment, 13, 205–215.
doi:10.1023/A:1026652321327
Maruna, S., & Mann, R. E. (2006). A fundamental attribution error? Rethinking
cognitive distortions. Legal and Criminological Psychology, 11(2), 155–177.
doi:10.1177/1524 838003259320
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Helping people change
(3rd ed.). New York, NY: Guilford.
Milrod, D. (2002). The superego: Its formation, structure, and functioning.
Psychoanalytic Study of the Child, 57, 131–150.
Piaget, J. (1952). The origins of intelligence in children. New York, NY: International
University Press.
Pithers, W. D. (1990). Relapse prevention with sexual aggressors: A method for main-
taining therapeutic gain and enhancing extern supervision. In W. L. Marshall, D.
R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories,
and treatment of the offender (pp. 343–361). New York, NY: Plenum.
 Denying Denial 51

Prescott, D. S., & Levenson, J. S. (2011). Sex offender treatment is not punishment.
Journal of Sexual Aggression, 16, 275–285. doi:10.1080/13552600.2010.483819
Rasmussen, L. A. (2013). Young people who sexually abuse: A historical per-
spective and future directions. Journal of Child Sexual Abuse, 22(1), 119–141.
doi:10.1080/10538712.2013.744646
Rubenfine, D. (1962). Maternal stimulation, psychic structure, and early object
relations. Psychoanalytic Study of the Child, 17, 265–282.
Salter, A. C. (1988). Treating child sex offenders and victims: A practical guide.
Newbury Park, CA: Sage.
Schneider, S. L., & Wright, R. C. (2004). Understanding denial in sexual offenders: A
review of cognitive and motivational processes to avoid responsibility. Trauma,
Violence, and Abuse, 5(1), 3–20. doi:10.1177/1524838003259320
Schwartz, B. K. (1995). Decision making with incarcerated sex offenders. In B. K.
Schwartz & H. R. Cellini (Eds.), The sex offender: Corrections, treatment, and
Downloaded by [Erciyes University] at 00:08 29 December 2014

legal practice (pp. 8.1–8.18). Kingston, NJ: Civic Research Institute.

Sharp, B. D. (2000). Changing criminal thinking: A treatment program. Lanham,
MD: American Correctional Association.
Stevenson, H. C., Castillo, E., & Sefarbi, R. (1989). Treatment of denial in adolescent
sex offenders and their families. Journal of Offender Counseling, Services, and
Rehabilitation, 14(1), 37–50. doi:10.1300/5264v14n01-05
Taylor, S. E., Peplau, L. A., & Sears, D. O. (2000). Social psychology. Englewood, NJ:
Prentice Hall.
Wallace, J. (1977). Between Scylla and Charybdis: Issues in alcoholism therapy.
Alcohol, Health and Research World, 1(4), 15–22.
Weisman, A., & Hachett, T. (1961). Predilection to death: Death and dying as a
psychiatric problem. Psychosomatic Medicine, 23, 232–256.
Wyre, R. (1989). Working with the pedophile. In M. Farrell (Ed.), Understanding the
pedophile (pp. 17–23). London, England: ISTD/Portman Clinic.

AUTHOR NOTE

Barbara Reicher received a BSW from Tel Aviv University, Israel, and an
MSW degree from Bar Ilan University, Israel. She did advanced training in
family therapy and is certified as a family therapist and supervisor in Israel.
She was trained as a researcher in Expressed Emotion (a qualitative research
format) in the Mental Research Center, London, England, and researched that
subject with Nigerian schizophrenics. She has done brief training in TF-CBT
and PCIT.In the past 15 years, Ms. Reicher’s main professional and research
interests are in the field of child sexual abuse. She has taken part in sev-
eral national think tanks in Israel to discuss treatment strategies and advise
government agencies as to effective interventions. She is presently working
on two research projects. One is a qualitative research designed to under-
stand the traumatic bond between children who sexually offend and their
child victims. The second project is to examine the clinical sensitivity of the
Wartegg psychological test to detecting sexual abuse and sexual offending
in children.