Confronting Child Sexual Abuse

Front matter

Knowledge to Action

ANNE M. NURSE

KNOWLEDGE TO ACTION

Chapter Six: Preventing Abuse in Organizations and Workplaces

Chapter Seven: Child Sexual Abuse Prevention Training Chapter Eight: Looking to the Future Acknowledgments

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181 207 235 275 277 iv MEMBER INSTITUTION ACKNOWLEDGMENTS

Member Institution Acknowledgments

Lever Press is a joint venture. This work was made possible by the generous support of Lever Press member libraries from the following institutions:

Adrian College

Agnes Scott College

Allegheny College

Amherst College

Bard College

Berea College

Bowdoin College

Carleton College

Claremont Graduate University

Claremont McKenna College

Clark Atlanta University

Coe College

The College of Wooster

Knox College

Lafayette College Library Lake Forest College Macalester College Middlebury College

MEMBER INSTITUTION ACKNOWLEDGMENTS vi

Morehouse College

Oberlin College

Pitzer College

Pomona College

Rollins College

Santa Clara University

Scripps College

Sewanee: The University of the South

Skidmore College

Smith College

Spelman College

St. Lawrence University

St. Olaf College Susquehanna University Swarthmore College Trinity University Union College University of Puget Sound Ursinus College Vassar College Washington and Lee University Whitman College Willamette University Williams College

MEMBER INSTITUTION ACKNOWLEDGMENTS

On a beautiful Saturday in the fall of 2013, 1 woke up angry. My alarm had gone off at a painfully early hour so that 1 could drive to a neighboring town for a training session. 1 suppose it was my own fault that | had to get up. In a moment of maternal guilt, 1 had signed up to drive a field trip for my eight-year-old son’s class. That was clearly the wrong move. A few days later, the school called to let me know that | was ineligible to drive because 1 was not “certified,” meaning that 1 had not attended a required three-hour training course about child sexual abuse (CSA), nor had 1 taken a required background check. These demands seemed ridiculous to me, and | was particularly galled because my child was attending a Catholic school. Having followed the unfolding of the priest sex scandal in the early 2000s, | felt that 1 was paying for the “sins of the fathers.” Shouldn’t they be the ones getting up early to attend a training and not me?

Of course, the training was not the first time 1 had thought about CSA. As the mother of three children, sexual abuse was on my list of fears. This was partly because close friends had shared the anguish they had experienced as a result of being abused as children. 1 had also thought about CSA because | am a Catholic. 1 felt outraged about my church’s response to the widespread abuse of children by priests and sadness for the many victims. Strangely, however, | had not thought much about CSA in my professional role as a criminologist. For over twenty-five years, | had studied juvenile prisons and their impact on individuals and society, interviewing hundreds of incarcerated and paroled young men. | had also taught for years in a maximum-security juvenile facility. This work put me in contact with youth who were incarcerated for sex crimes against children, yet l had not studied or thought too deeply about the issue. Perhaps this was because | found it to be an upsetting topic and just wanted to avoid it.

Due to my inattention to CSA, l arrived at the prevention training program that morning with little idea of what to expect. 1 chatted somewhat awkwardly with the other participants while we waited for a cup of tepid coffee. Like me, most were parents wanting to volunteer in their children’s classrooms, although | also met coaches and teachers. We found common ground in our annoyance about being forced to attend the training. Finally, we were instructed to assemble on folding chairs. We spent the next couple of hours watching videos about CSA and having directed discussions. 1 would like to say that the session was outstanding, but that would be an overstatement. At the same time, it was much more interesting and emotional than | expected and, by the time 1 walked out the door, l had settled on a new direction for my research. The session made me realize that not only was CSA affecting thousands of our nation’s children and families, it was a topic rife with misconceptions and fear. 1 suddenly saw that my own anxiety about my children’s safety and my seeming unwillingness to think sociologically about CSA offenders offered a personal challenge. Could 1 step back from such an emotional topic and think clearly about CSA, its effects, and the policies we put in place to stem it?

The training session sent me on a frenzied odyssey of discovery. Right after my return home, | started reading the academic literature to see whether anyone had conducted an evaluation assessing the efficacy of adult prevention training. Even though over two million Americans had participated in the particular program | attended, there had been no scientific study of its effects. l asked the bishop of my diocese if 1 could conduct such a study, and he eventually approved my request. For the next two years, 1 explored participants’ base level of knowledge about CSA, whether the training taught them new information, and whether they retained that information over time. | also investigated whether the training increased protective behaviors. After publishing the results of my evaluation, 1 moved on to read other researchers’ work on a wide range of topics related to CSA. These included the psychology of offenders, the impact of abuse on victims, and the effect of different public policies on the prevalence of CSA.

In terms of policy, 1 learned that the legal system, as well as most organizations, have made significant changes regarding CSA punishment and prevention over the last thirty years. This makes it a particularly appropriate moment for us to step back and think critically about our CSA prevention efforts. Although recent high-profile cases of serial abuse in various organizations (like USA Gymnastics) may make it difficult to believe, the official rate of CSA has been on the decline for more than thirty years.’ Perhaps this means that our policies have been working. Or it may mean that some policies are working while others are useless or even harmful. Even more distressing, it is possible that the rate is declining for some reason that has nothing to do with our efforts. Because CSA prevention efforts are expensive, time consuming, and have an impact on many people’s lives (not to mention on our ability to sleep in on a Saturday morning), it is in all of our best interest to figure out the truth. This book is intended for readers who want to learn more about both CSA and the efficacy of prevention.

1. David Finkelhor, Kei Saito, and Lisa Jones, “Updated Trends in Child Maltreatment, 2018” (University of New Hampshire: Crimes against Children Research Center, 2020), http://www.unh.edu/ccrc/pdf/CV203%20-%20 Updated%2otrends%202018_ks_df.pdf.

A NOTE ABOUT LANGUAGE

As | was writing this book, | thought a lot about language and its impact. An experiment conducted by social psychologists many years ago illustrates the importance of word choice. The researchers showed participants a film of a car crash and then, a week later, they asked half of the group to recall the film; had there been broken glass when the two cars “smashed” into each other? The other half of participants were asked the same question, except the cars were described as “colliding” rather than “smashing.” The people in the smash group were more likely to recall broken glass than the people in the collision group. The funny part is that both groups had seen the same film, and there wasn’t any broken glass at all.’ It appears that language is so powerful it can induce memory. “Smashed” is such a strong word it practically screams “broken glass!”

Words are particularly important with an emotional and upsetting topic like CSA. What should the people who commit CSA be called? And what should we call the children who experience that abuse? Starting first with those who commit CSA, the Urban Institute, a well-respected research think tank, argues that we should avoid words like felon and offender, especially when we are talking about people who have served their time and have returned to their communities. The Urban Institute’s reasoning is that, no matter how horrible a crime a person has committed, they are still human. Terms like offender suggest that people’s only identity is criminal, so they recommend the use of “people first” language. For example,

2. Elizabeth F. Loftus and John C. Palmer, “Reconstruction of Automobile Destruction: An Example of the Interaction between Language and Memory,” Journal of Verbal Learning and Verbal Behavior 13, no. 5 (October 1974): 585-89.

3. Cameron Okeke and Nancy G. La Vigne, “Restoring Humanity: Changing the Way We Talk about People Touched by the Criminal Justice System,” Urban Institute, November 29, 2018, https://www.urban.org/urban-wire/restoringhumanity-changing-way-we-talk-about-people-touched-criminal-justicesystem.

we can say “people with a felony” or “people who have committed CSA.” This kind of “people first” recommendation is not new. People with disabilities, for example, have long argued against being called “the disabled” for similar reasons. In this text, 1 generally try to follow the Urban Institute’s recommendations when discussing people who have served their time. 1 use the term offender when referring to a person who is actively committing abuse or who is serving time in prison for CSA.

Turning to children who suffer abuse, there is also debate. Some use the term victim while others prefer survivor. The advocacy group Rape, Abuse, and Incest National Network (RAINN) cautions that individual preference is important, and that it is best to ask people what terminology they prefer.‘ This is obviously not an option in this book since | rarely refer to particular individuals. RAINN itself uses the term victim when they are talking about someone who has recently suffered abuse and the term survivor for people who have been engaged in the recovery process for some period of time. Another option is people-first language, like people who have suffered CSA. The reasoning behind the use of this more cumbersome term is the same as discussed above: people who have suffered CSA are much more than the abuse they have experienced. In this text, 1 try to follow RAINN’s suggestion and use victim if l am talking about abuse and its immediate aftermath and survivor when time has passed.

PSYCHOLOGICAL PROCESSES THAT CAN IMPACT OUR UNDERSTANDING OF CHILD SEXUAL ABUSE

In this section, | briefly introduce two psychological mechanisms that may be impactful while reading this book. The first, confirmation bias, threatens the ability to accept information that

4. RAINN, “Key Terms and Phrases,” RAINN, 20109, https://www.rainn.org/ articles/key-terms-and-phrases.

Logical Fallacies in the Lab CONFIRMATION BIAS

FAVOURING EVIDENCE THAT SUPPORTS YOUR PRE-EXISTING BELIEFS WHILE IGNORING EVIDENCE THAT DOESN'T.

I DID SIX WELL, EXPERIMENTS LET'S ONLY BUT ONLY ONE | SUBMIT THAT

SUPPORTED OURA EXPERIMENT HYPOTHESIS.

Figure 1. Confirmation Bias. Source: The Upturned Microscope by Nik Papageorgiou. May 2017. https://theupturnedmicroscope.com/comic/ logical-fallacies-confirmation-bias/ contradicts preexisting beliefs. The second, defensive attribution, leads people to distance themselves from victims. 1 found it was useful to know about both of these psychological phenomenon as l learned about CSA.

Warren Buffett has been quoted as saying that “what the human being is best at doing is interpreting all new information so that their prior conclusions remain intact.” This is a succinct definition of confirmation bias. Confirmation bias is the human tendency to look for (or notice, or weigh more heavily) information that

5. Tomas Chamorro-Premuzic, “How the Web Distorts Reality and Impairs our Judgement Skills,” Guardian, May 13, 2014, https://www.theguardian.com/ media-network/media-network-blog/201 4/may/13/internet-confirmation-bias.

supports our previously held beliefs. It also leads us to ignore (or fail to notice, or underweigh) information that contradicts those beliefs. It is hard to notice when we engage in confirmation bias because it is usually unconscious.°

There has been a significant amount of research conducted on confirmation bias. In one experiment, people were asked to read a detailed crime scenario and determine the guilt or innocence of the suspect. Once they had made their initial decision, they were allowed to request additional information from a list of twenty options. For example, they could ask for an interview of a particular witness. The investigation options were crafted so that half looked like they would provide incriminating evidence, and the other half looked like they would provide exculpatory evidence. As you might expect from the definition of confirmation bias, the people who thought the suspect was guilty requested investigations that would help support that position. It was the opposite for those who thought the suspect was innocent.’ This shows that people prefer to confirm their beliefs than to consider evidence that does not support those beliefs.

How might confirmation bias affect our thinking about CSA? It makes our attitudes about offenders and victims difficult to change, regardless of what they are. As 1 was writing this book, l sometimes struggled when | found evidence that went against something | had always believed. The box below includes some tricks that 1 found useful for working against my mind’s desire to confirm preexisting beliefs.

6. Raymond S Nickerson, “Confirmation Bias: A Ubiquitous Phenomenon in Many Guises,” Review of General Psychology 2, no. 2 (1998): 175-220, http://psy2. ucsd.edu/~mckenzie/nickersonConfirmationBias.pdf.

7. Eric Rassin, Anita Eerland, and Ilse Kuijpers, “Let’s Find the Evidence: An Analogue Study of Confirmation Bias in Criminal Investigations,” Journal of Investigative Psychology and Offender Profiling 7 (2010): 231-46, https://www. researchgate.net/publication/230268983_Let’s_Find_the_Evidence_An_Ana logue_Study_of_Confirmation_Bias_in_Criminal_Investigations.

Combatting Confirmation Bias

An article in Psychology Today’ provides a set of questions to ask after receiving new information. The questions might even be useful while reading this book.

1. Which parts did 1 automatically agree with?

2. Which parts did l ignore or skim over without realizing?

3. How did l react to the points | agreed or disagreed with?

4. Did what | read/hear confirm any ideas | already had? Why?

5. What if 1 thought the opposite of those ideas?

Confirmation bias is one important psychological mechanism that can affect our views of CSA. Defensive attribution is another. It is a common tool that our minds use to try and calm us about scary topics. lt involves minimizing our own perceived level of risk by attributing blame to victims. For example, researchers looked at how people react to the thought of a car accident. They told study participants a story about a responsible young man who had recently bought a used car. He parked it on hill and it later rolled away. While the young man might have failed to engage the parking brake, the car’s brakes were also later found to be very rusted.

After setting up the story, the researchers divided the study participants into four groups and each group heard a different ending. In one, the car rolled a short distance, suffering only minimal damage. In the second, the car rolled all the way down a hill and hit a stump, totaling the car. In the third, the car rolled all the way down the hill and hit a grocery store, causing minimal damage to the car and to the store. Finally, in the fourth, the car hit the grocery store and was totaled. The impact also caused minor injuries to a child who was in the store, as well as significant injuries

8. F. Diane Barth, “How Confirmation Bias Affects You Every Single Day,” Psychology Today (blog), December 3 1, 2017, https://www.psychologytoday.com/us/ blog/the-couch/201712/how-confirmation-bias-affects-you-every-single-day.

to the grocer. The researchers found that the greater the damage incurred, the more likely the study participants were to blame the young man. They did not want to believe that the brakes in their own car might rust and cause major damage, so they preferred to believe the young man had failed to set the brake. People’s tendency toward defensive attribution gets stronger as possible negative outcomes get scarier.°

It is easy to understand why people engage in defensive attribution when they hear about cases of CSA. None of us wants to believe that abuse could happen to someone we love. As a result, when 1 read about a teacher who molests a child over several months, | might say, “My kid would have told me if his teacher had touched him in that way.” Similarly, if there is a report on television about a child who was abused by his neighbor, | could say, “I never would have let my child play over at that person’s house.” While defensive attribution functions to make us feel better, it can also cloud our judgement about the reality of CSA and our own risk level.

FRAMING AND CHILD SEXUAL ABUSE

One of the ways that people receive and interpret knowledge about CSA involves “framing.” A “frame” refers to the way people define, construct, and interpret events. It might be helpful to think about frames in terms of jigsaw puzzles. When doing a puzzle, one does not try to fit pieces together randomly. If you are like me, you start by looking for edge pieces. While 1 am certainly aware that there are other distinguishing features of the puzzle pieces, | force my brain to concentrate on seeing edges. After 1 have the edges done, | often focus on particular colors—or | look for the shape of a piece 1 need. These strategies are like frames: they highlight particular aspects of reality to make a huge amount of information

9. Elaine Walster, “Assignment of Responsibility for an Accident,” Journal of Personality and Social Psychology 3, no. 1 (1966): 73-79, http://www.elainehatfield. com/uploads/3/4/5/2/34523593/12._hatfield_1966.pdf.

manageable and coherent. It’s similar when telling a story; there are a million details that could be included but the story is shaped to emphasize particular themes or frames. Below are two examples.

Examples of Frames

Example One: The media is going to run a story about illegal drug use. One frame could portray drug use as a public health problem, suggesting that users are victims who need medical help. Alternately, the media could frame the issue as a criminal justice problem. In that case, they would portray users as law breakers who should be locked up.

Example Two: Laws about same-sex marriage were changed recently in the United States. In the run-up to the change, many media outlets published stories about the topic. One frame envisioned same-sex marriage as a threat to heterosexual marriage. This frame suggested that the solution was to continue to define marriage as between one man and a woman. Another frame, however, portrayed same-sex marriage as an issue of equal rights. This frame pointed toward legalization as the proper solution."

In the examples in the box, frames provide parameters for thinking about drug use and same-sex marriage. The frames also lead us to favor particular solutions.” It is important to understand framing

10. David L. Altheide and R. Sam Michalowski, “Fear in the News: A Discourse of Control,” Sociological Quarterly 40, no. 3 (1999): 475-503, https://scholar. google.com/scholar?hl=en&as_sdt=0%2C36&q=Feartin+the+News%3A+A+Dis course+of+Control&btnG=.

11. Deirdre M. Warren and Katrina R. Bloch, “Framing Same-Sex Marriage: Media Constructions of California’s Proposition 8,” Social Science Journal 51, no. 4 (2014): 503-13.

12. Altheide and Michalowski, “Fear in the News,” https://scholar.google.com/ scholar?hl=en&as_sdt=0%2C 3 6&q=Fear+in+the+News%3A+A+Discourse+of+ Control&btnG= in relation to CSA. In chapter 1, 1 discuss how the media and various social movements frame CSA and show that their choices have a serious impact on our understanding of victims, offenders, and solutions. In chapters 4 and 5, | discuss how politicians frame CSA to support particular policies and laws. Chapter 7 covers how various organizations (like the Catholic Church) frame CSA in their prevention training. Finally, 1 employ frames myself throughout this book. While reading, think about how | am framing CSA and how that might impact your opinions.

Does a story’s frame really affect our thoughts? Research suggests that the answer is yes, but it turns out that it is not a straightforward process. People are not just robots, blindly taking in what they are handed. Frames direct feelings, but people also react to stories based on many other factors, including their own previous experiences, the experiences of people they know, and information obtained from other sources.

To test how framing affects thinking, researchers presented undergraduates at a state university with one of four versions of a news story. The story was about anticipated budget cuts, some of which would impact state universities (including their own). One version of the story did not have a strong frame, it just contained basic facts about budget cuts. The second version employed a “conflict frame” that focused on two grassroots organizations that disagreed with each other about whether the budget cuts were necessary or advisable. The human-interest framing of the story focused on a high-level state employee who was retiring from his job because he was frustrated with figuring out how to equitably distribute limited money to the universities. The final frame, the “consequences frame,” explicitly stated that state university tuition would need to be increased because of budget cuts. After the students were presented with one of the four stories, they were asked to list the thoughts and feelings they experienced while reading.”

13. Vincent Price, David Tewskbury, and Elizabeth Powers, “Switching Trains

The study showed that the way stories are framed affects how people interpret information. For example, the students who read the story that emphasized consequences were more likely to think about tuition increases. Those who read the story with the conflict frame tended to think about politics or interest groups. At the same time, the students were also able to think outside their story’s frames. For example, some members of the human-interest group thought about the possibility of tuition increases even though it was not emphasized in what they read. Surprisingly, those who read the story that lacked a strong frame were even more likely than other groups to think about tuition increases. This suggests that frames can push people toward thinking in particular directions as well as distract them from thoughts they would have in the absence of the frame.

Another interesting finding from the study involved how students’ personal characteristics affected their interpretation of the state budget story. Both residency status (whether the student was from within the state or out of it) and social class made a difference in what students thought about as they read the stories. This indicates that reactions to frames are at least partly shaped by who we are and our own particular interests. Finally, the experiment showed that frames affect support for particular policies. Specifically, the students in the consequences condition were more likely than those in other groups to support placing a limit on tuition increases."

of Thought: The Impact of News Frames on Readers’ Cognitive Responses,” Communication Research 24, no. 5 (1997): 481-506, https://www.researchgate.net/ publication/247687811_Switching_Trains_of_ThoughtThe_Impact_of_News Frames_on_Readers’_Cognitive_Responses.

14. Price, Tewskbury, and Powers, “Switching Trains of Thought,” 481-506, https://www.researchgate.net/publication/247687811_Switching_Trains_of_ ThoughtThe_Impact_of_News_Frames_on_Readers’_Cognitive_Responses.

THE ORGANIZATION OF THE BOOK

As described, this book is designed to provide information and spark discussion about CSA, allowing readers to take an active role in policy discussions. The first section focuses on knowledge about CSA. We start with an examination of common beliefs and attitudes. What do people know about CSA and how do they interpret that knowledge? It turns out that social forces, including the media and social movements, are important players in shaping perceptions. Sociologists sometimes call this process the “social construction of knowledge,” to highlight that our understanding of issues like CSA is not developed in isolation. Instead, people rely on others for information, and their framing of that information influences how it is interpreted. Chapter 1 of this book explores how knowledge about CSA has been constructed across time in the United States. While 1 discuss particular historical moments when public attention has been focused on CSA, | also talk about general trends in public and media discourse.

The next two chapters present a summary of what research has revealed about CSA. Researchers from a wide variety of fields have worked to understand the how, what, who, where, and why of CSA. It turns out that some of their findings match common beliefs, but others do not. Chapter 2 focuses on how researchers define CSA and their estimates of its prevalence. It also summarizes what the general public knows about the harms that abuse causes to victims, their families, and their communities. Chapter 3 looks at the research findings about the characteristics of victims and offenders and describes what is known about the causes of CSA.

In the second section of the book, 1 look at CSA prevention, starting with the approach of the criminal justice system. This system is primarily focused on preventing identified offenders from abusing children anymore. Chapter 4 considers how the criminal justice system responds in the wake of an CSA allegation. How are cases investigated, prosecuted, and sentenced? Chapter 5 considers legal measures applied to known offenders who live in the community. These include sex-offender registries, restrictions on housing, and civil confinement. Both chapters take a deep dive into the research that evaluates whether or not particular criminal justice measures work to prevent CSA. They also ask if there have been unintended consequences associated with those measures.

The criminal justice system is not the only group working on CSA prevention. Child-serving organizations—such as day-care centers, schools, nonprofits, and churches—have also put measures in place to reduce CSA. Unlike the criminal justice system, however, these organizations’ primary goal is to stop abuse before it starts. Chapter 6 looks at how organizations have tried to achieve this through mandatory background checks, employee/volunteer screening tests, and rules about how adults should interact with children. Chapter 7 focuses on the prevention training organizations provide, both for adults (like the session 1 attended through the Catholic Church) and for children. What is learned in these programs? Are they an effective way to prevent abuse?

The final chapter of the book pulls together the contents of the earlier chapters to look to the future. Given what is known about CSA, what is the best course of action for the legal system, organizations, and families? The chapter is organized into approaches that work, those that don’t, and those that hold promise. While l have included a number of suggestions for large-scale change, l also present ideas for individuals who want to get involved in prevention efforts.

WHY ARE THERE SO MANY FOOTNOTES AND LINKS IN THIS BOOK?

One of the goals of this book is to be transparent about the sources of the information 1 use when | draw conclusions. | also want to help readers obtain original sources whenever possible. For this reason, | have put a clickable link in the footnotes when a referenced source is freely available to the public. Unfortunately, much academic research is held behind paywalls and is not free unless one has a university affiliation. 1 do not provide links for these paywall sources. If you are interested in finding one of the unlinked sources, you should first try Google Scholar (https:// scholar.google.com/). Many sources become publicly accessible after a set period of time, and it is always worth checking to see if the one you are looking for has become available recently. The local public library is another way to access sources; many give their patrons access to academic databases. It should also be noted that sources sometime move or become unavailable to the public so not all the links 1 provide may work.

l conclude each chapter with a few suggestions for further reading. Sometimes 1 have referenced the books in the chapter, but other times they are about topics that are not covered. For example, human trafficking is related to CSA, but it is not a focus in the text. Instead, I have suggested reading for people who would like to learn more. Most of the recommended books will be available through the public library. Used and new copies are also for sale through major online booksellers.

A NOTE TO SURVIVORS OF CHILD SEXUAL ABUSE

Many people who pick up this book will have a deep understanding of the pain caused by CSA because they have experienced it themselves or they love someone who has been abused. Over the course of this project, 1 had the opportunity to talk with a lot of survivors. With their help, 1 learned how devastating such an experience can be, and | also learned how, with tremendous strength and bravery, many people who have experienced CSA refuse to let it define them.

If reading this book causes you to become uncomfortable, upset, or depressed, please reach out for help. Here are links to a couple of resources:

1. RAINN has a website with a lot of resources at https://www. rainn.org/about-rainn, or you can call 800-656-HOPE (4673) to be routed to your local sexual assault helpline.

2. Stop It Now! has a webpage with links to all sorts of support services. Some are for specialized groups (like men who were abused as children or partners of people who were abused as children): https://www.stopitnow.org/help-guidance.

There are also some outstanding books about healing from CSA. 1 list just a couple here:

1. Mike Lew, Victims No Longer: The Classic Guide for Men Recovering from Sexual Child Abuse (New York: Harper Perennial, 2004).

2. Wendy Maltz, The Sexual Healing Journey: A Guide for Survivors of Sexual Abuse (New York: William Morrow Paperbacks, 2012).

A NOTE TO ANYONE WHO HAS COMMITTED OR IS THINKING ABOUT COMMITTING CHILD SEXUAL ABUSE

Our society does not make it easy for people to seek help if they have sexual impulses toward children, but it can be done. If you are engaging in, or thinking about engaging in, sexual contact with a child, you can contact a therapist in your area who specializes in sexual issues. You need to know that disclosure laws vary by state and, in many areas, therapists are required to report past or planned CSA to authorities. It may be possible, however, to enter treatment for sexual thoughts about children without revealing any past or planned activity. There is a website that summarizes state laws on mandatory reporting. You can find it here: https:// www.childwelfare.gov/topics/systemwide/laws-policies/state/. Further, the American Psychological Association provides a listing of therapists by specialty and location at https://locator.apa.org/.