A California law about reporting child porn puts psychotherapists in a bind

12-27-2014 California:

A middle-aged man feels a spark with a co-worker that he hasn’t felt in years with his wife and wants to start an affair. He remains faithful. A teenager longs to lash out in rage against her parents. She instead composes an angry song. A new mom in the throes of severe sleep deprivation and exhaustion feels a sudden urge to smother her child. She does not do so. A man feels aroused by sexual images of children. He never acts on those desires.

Our desires need not compel us to act. We are free to choose our own course of action. These truths may be among the most liberating that my psychotherapy patients learn in treatment.

Beginning next month, however, I will be hampered in my ability to hear the full range of my patients’ desires and to assure them that they can discuss these feelings without fear. Under an amendment to California’s Child Abuse and Neglect Reporting Act, psychotherapists and psychiatrists will be required to report to the authorities any patient who “downloads, streams, or accesses images of any person under the age of 18 engaged in an act of obscene sexual conduct.” In the same way that I am required to break confidentiality to report child abuse, I will be mandated to report consumption of child pornography.

California is often a bellwether state when it comes to issues of psychotherapy and the law. The state’s recent, highly commendable decision to bar the practice of “gay conversion therapy” on minors has already been copied by New Jersey and the District. The child porn reporting requirement could likewise begin to serve as a national standard.

On the face of it, the amendment may seem like a helpful addition to the reporting mandates for psychotherapists and psychiatrists. Child pornography is, after all, a damaging and illegal practice. As a society we surely want to decrease its production, distribution and consumption.

On closer inspection, however, the law falls short on three fronts: First, it will not protect children from either the production or distribution of child pornography, which is its intent. Second, it violates therapist-patient confidentiality and decreases the likelihood that people will get the psychological help they need to stop accessing child pornography; if the goal is to undercut production by reducing demand, the law will likely have the opposite effect. And, third, it conflates desire with action.

There is little evidence to suggest that consuming child pornography causes individuals to commit sexual abuse. While it’s true that individuals who commit sexual abuse are more likely than others to have consumed child pornography, this is a clear case of correlation and not causality. Given the ease and privacy with which people can access sexual images of children and teenagers, data on consumers of child pornography are neither complete nor reliable. The majority of the evidence we have comes from those convicted of what is termed a “hands-on” sex offense against a child.

In contrast, a 2009 study by Swiss psychiatrist Frank Urbaniok and colleagues was unique in that it included a large number of consumers of child pornography who had never committed a hands-on sexual offense against a child. The study found that “previous hands-on sex offenses are a relevant risk factor for future hands-on sex offenses among child pornography users, just as they are among sex offenders in general. The consumption of child pornographic material alone does not seem to predict hands-on sex offenses.” In fact, this research found that less than half of 1 percent of child pornography viewers without a prior hands-on child sex offense went on to commit a hands-on child sex offense.

For many years, psychotherapists and psychiatrists have been required to break patient confidentiality only when we believe a minor or dependent adult is in imminent danger of serious abuse or neglect, or a life is imminently at risk. As a psychotherapist, I am not required to report any other illegal activity that a patient may report to me, including drug abuse, drinking while driving, stealing, sexual assault, assault or even a murder that has been committed. This has allowed psychotherapists and psychiatrists to help patients discontinue illegal or potentially harmful behaviors. And it has enabled patients to speak freely about their thoughts, feelings and desires without fear of exposure. Thoughts and feelings are not equivalent to actions. One of the desired outcomes of psychotherapy is that patients will understand precisely this distinction.

People are motivated to come to psychotherapy because the expression of their deepest desires and fears will be met with a commitment to help, not judgment or censure. Laws such as California’s may cause patients to think twice before embarking on psychotherapy, depriving them of the help that they need. The solution to the problem of child pornography is to enforce existing laws regarding its production, distribution and consumption, not to violate therapist-patient confidentiality. ..Source.. by Leslie C. Bell who is a sociologist and psychotherapist in private practice in Berkeley, Calif.