SIGNIFICANT CLINICAL/MEDICAL CONSIDERATIONS
The section entitled "Clinical/Medical Questions" posed many of the
importance questions which face an Ordinary in dealing with a cleric
who is alleged to have committed sexual abuse or a related act on
a Child or adolescent. The following considerations in this same area
expand on the problems which the alleged offense poses to the Ordinary.
It is intended that they provide essential information at the outset.
These considerations in no way respond to all of the pertinent questions.

SIGNIFICANT CLINICAL/MEDICAL CONSIDERATIONS
Pre-Intervention Strategy by the Ordinary
The Ordinary, rather than a subordinant or vicar, should confront
the cleric as soon as an allegation of a sexual offense is made about
the cleric. The Bishop- Priest relationship for instance, is a very
special one and should be utilized to the fullest both canonically
and psychologically, to intervene immediately if there is a suspicion
or allegation of sexual abuse by a priest.
Prior to speaking with the priest (or cleric) the Ordinary (usually
the bishop except in the case of religious clerics) should speak with
a priest-psychologist who is knowledgeable about this particular problem.
This should be done before the Bishop confronts or speaks with the
priest so that the bishop can obtain some "pointers" on the intervention
itself. The priest-psychologist can also assist the bishop in designing
some personalized strategies according to the nature of the allegations
made and the personality of the priest involved.
The Ordinary should make it clear to the priest before even stating
the allegations that it is vitally important that truthfulness exist
between them. The Ordinary should reassure the priest or cleric that
he will support him legally and financially and that he will also
help him to obtain evaluation and treatment for his problems. However
if the priest chooses not to be fully honest in the initial intervention,
the Ordinaty may still be obliged to be helpful but he could/should
let the priest know that he would be disturbed by the lack of truthfulness
in the initial interview.
This initial conversation between the Ordinary and the priest may
be one of the most important moments in the sequence of events that
will follow. It is assumed that most Ordinaries in the United States
have not had a great dealof experience with child abuse by the clergy
and for that reason they need some professional re-assurance for the
initial encounter with the accused. Each priest or cleric brings a
different set of problems and a different set of circumstances concerning
the sexual abuse. The initial intervention should be tailored accordingly.
What Are the Causes of Sexual Abuse by Roman Catholic Clergy
Once the priest or cleric admits to any type of sexual contact with
children or adolescents it is not appropriate for the Ordinary to
delve into the causes of this sexual abuse. This is best left to the
professionals who have had a good deal of experience in this area
and who understand Rornan Catholic clergy.
Nevertheless it is important that the Ordinary have some idea as to
what these causes are so that an appropriate place can be chosen for
the evaluation and treatment of the priest.
A concrete example best: illustrates the question: A 32 year old priest
had been seen by a psychiatrist in private out-patient therapy for
2 [two and a half] years which included the administration of psytropic
medications. For over a three year period this priest had inappropriately
committed sexual crimes in a public granmar school yard in three different
locales. He was on his way to jail. He had been evaluated by two "excellent"
mental health centers which stated that the inappropriate sexual behavior
was due to early childhood experiences that required intense psychotherapy
and perhaps group therapy.
When the priest was sent to another evaluation center with the capability
of looking at medical, neurological and substance abuse problems as
well as psychiatric and psychological problems, it was found that
the priest hadbeen drinking over one quart of bourbon a day over the
past five years but was unable to admit to having an alcohol problem.
In such a case it would have been inappropriate to have this priest
continue to see the private psychiatrist. Rather alcoholism, the primary
disorder, would have to be treated and then the inappropriate sexual
behaviors evaluated after the patient had been sober for a number
of months.
Statistically, at least in regard to adolescent sexual abuse by priests,
drugs and alcohol are the primary complicating problem or "mitigating"
factor that the treatment professionals must deal with. Even though
alcohol or drug abuse is present it does not mean that the sexual
problem will necessarily disappear following treatment. There is however,
a greater likelihood that the individual will be able to exert control
and prudence if he is sober and is monitored over a prolonged period
of time. Naturally treatment should be given for the sexual issues
as well as the substance abuse issues.
Further, there are a number of rarer or more unusual disorders that
can cause unusual behavior over a prolonged period of time. These
include such disorders as manic-depressive illness, frontal lobe dysfunction,
temporal lobe epilepsy, brain tumors etc. These problems will never
come to light if a priest of cleric is evaluated at a center that
looks only at the psychological dynamics of the patients family, his
adult and religious life as the source of all problems, using the
sane model for treatment. Refer again to the 32 year old priest with
two competent evaluation, neither of which uncovered the problem of
alcohol abuse.
How Soon Should the Evaluation Take Place
IMMEDIATELY. As soon as the Ordinary has ascertained that there is
sometruth to the allegations of sexual abuse by a cleric, arrangements
should be made the same day or the following day at the latest for
the priest s transfer to an evaluation center. The Ordinary may be
familiar with a competent evaluation center or may have discussed
such a center with the priest-psychologist.
It is especially important to understand that evaluation centers may
be located in states having reporting laws which might prove problematic
for the Ordinary. For examples some states have enacted legislation
that does not extend privilege of communication between a patient
and his psychologist or psychiatrist to cases involving child abuse,
including sexual abuse of children. In Massachusetts a therapist,
no matter what his training, must report the incident to the local
authorities if there is any indication that the incident occurred
within the state of Massachusetts. It is also possible that this extends
to people who were involved with other adults who were involved with
the incident in the state of Massachusetts. For this reason this state
would be a hazardous area to send a priest for evaluation because
of the stringency and extent of the reporting laws. Almost all states
require and suspend the privileged communication between mental health
professionals and the child if the child is the patient. A sexually
or physically abused child seen by such a mental health professional
must be reported in all 50 states along with the names of the persons
offered by the child.
The point here is that the Ordinary should determine the reporting
laws in the states of possible evaluation centers. It would be wise
to consult with attorneys knowledgeable of these issues prior to sending
the priest for evaluation.
The nature of the disorder dictates why the evaluation should be immediate.
We are dealing with compulsive sexual habits which the priest may
temporarily suspend in the face of legal or canonical pressure, but
not in all instances. There are many examples wherein sexual abuse
took place very soon after thethe confrontation between the priest
and his Ordinary had taken place. The priest must clearly be seen
as one suffering from a psychiatric disorder that is beyond his ability
to control. For this reason...the compulsion of the disorder... evaluation
of the disorder and the separation from temptation should be immediate
and stated as such to the priest by the Ordinary without the Ordinary
experiencing any feelings of misplaced guilt or lack of charity. This
will emphasize to the priest the importance of his being truthful
both to the bishop and to the evaluating mental health professionals.

Should the Alleged Offender See Anyone else Prior to Evaluation
The Ordinary may perceive, as he converses with the priest, that the
latter is not taking the allegations very seriously. If this is true
it is strongly urged that the Ordinary have the priest meet with competent
attorneys conversant in dealing with the issue (whether or not there
is an immediate legal threat). This should be arranged immediately.
The attorneys should outline in detail all of the possible consequences
in criminal law as well as the civil law liability of the priest and
the diocese. This will also be helpful to the evaluation center since
the priest will have a better appreciation of the significance and
consequences of his behavior, and perhaps even of the effect it may
have had on the victims.

What About Canonical Suspension
A suspension of the cleric, especially if he is a priest, should happen
in all cases. This makes a clear separation between the Ordinary and
the cleric. It is a statement that the man is not capable of carrying
out his sacred functions or ministry until an evaluation is completed
and a determination of his fitness for ministry is made.
How Long Does an Evaluation Take
Some mention should be made of the open ended nature of the evaluation.
Many times it takes a week or two for the evaluating center to arrive
at a good picture and feel for the total situation involved with the
priest as well as his diocese or religious community. Most centers
will do an evaluation in five days but usually will extend it in order
to better get to know the priest and his diocese/community.
Thus they are in a position to make a better recommendation to the
Ordinary when the evaluation is completed.

What Should an Adequate Evaluation Include
This is a very important question. In the final report the following
should be looked for as part of the evaluation from any competent
center.
a. Clear evaluation by the psychologist or psychiatrist who has had
experience in dealing with sex offenders of different types.
b. An evaluation by a chemical dependency counsellor or someone with
equivalent experience in substance abuse to make certain that the
person does not have a history of abuse of alcohol or drugs which
would be contributing to sexual problems.
c. A complete physical and neurological examination completed by an
internist or neurologist.
d. A electroencephelogram done both in the sleep state and with pharengel
leads.
e. A CT brain scan with and without contrast dye study to rule out
the possibility of intercerebral tumors or other cerebral pathology.
f. Blood and urine laboratory tests that rule out the presence of
alcohol and/or other illicit substances. The lab test should include
an evaluation of liver, kidney, endocrine, lung, heart, and other
vital functioning, all ofwhich may give clues as to the presence of
"mitigating: problems that must be explored.
g. Some neurological assessment including an intelligence test .which
will give an idea of the "functional" capacity of the patient.
h. Appropriate psychological tests including projective testing which
may give clues as to the stability of the character structure of the
priest or the pathology of the character structure.
This is not an exhautive but a basic list of tests which should be
completed on a priest who is accused of sexual offenses. In other
words, it is important to have an holistic approach to the problem
which helps to discover mitigating factors which will assist in moving
in the correct direction for the appropriate modality and treatment
facility.

How To Choose an Appropriate Treatment Center
This is a most difficult and at the same time important question for
the Ordinary. He may have a center where he has been pleased with
the treatment of priests with other problems. However the "favorite
treatment center" may not be the appropriate center for clerics with
sexual problems, especially if the problem is pedophilia.
The following is a partial list of appropriate questions to be answered.

a. Have the therapists and other professionals of the center had significant
past experience in dealing with sexual abuse/sexual offenders/pedophiles.
Will the priest be supervised by professionals with such experience?

b. What kinds of physical and environmental restrictions will be placed
while the priest is in therapy. Will he be allowed use of a car at
any times? Will there be non-supervised periods in a 24 hour period
each day? Will he be allowed to go out to dinner, entertainments,
churches where he might encounterchildren in the course of his treatment
program.
c. Will he be allowed to consume alcohol of any kind. No sex offender
should ever be allowed use of alcohol or drugs in a recreational or
social setting because of the possibility of relaxing inhibitions
or relapse of sexual acts. Total abstinance is a must in order for
there to be hope for abstinance and control of the sexual problem.

d. What are the criteria used to determine the fitness of the priest
for discharge, possible return to ministry. How are these criteria
tested during the treatment program.

e. What self-help group will the priest be required to attend while
in the treatment program as well as after he leaves. It is essential
that there be some form of mandatory self-help group such as AA or
a sex offender group for the rest of this person s life. This should
be started during in-patient treatment and encouraged, to the degree
that the patient is taken to the group if necessary.

f. What concrete follow-up plans are made for the patient after treatment
is concluded. Does he return on a period basis for an aftercare program.
What kind of aftercare programs are set up in the diocese if the priest
is to return to function there. What are the guidelines that will
be given to the Ordinary with reference to future functioning in the
diocese.

All of these plus many more questions must be answered. Every treatment
center is not the same nor do all have the same treatment philosophy.
It must be stated unequivocally that a pure psychoanalytic or psychodynamically
based program is inadequate for the treatment of sex offenders. There
must be a multi-disciplinary and multi-dimensional approach to the
treatment of these very special people and it is essential that the
Ordinary find out exactlywhat is offered in and by the different treatment
programs and centers before a decision is made to place the priest
in a center for a prolonged period of time.
Can the Priest Ever Return to Ministry in the Diocese

Individual factors, the extent of the sexual abuse, the extent of
the notoriety involved and the extent of knowedge of the problem are
but some of the factors that go into this question.
The treatment center chosen should be one that works on a "family
model" approach. This means that members of the religious family involved
with the priest prior to treatment should be involved in the treatment
and in the post treatment plans. There should be close communication
and coordination with the diocese or religious community so that when
this question arises during in-patient treatment, it can be answered
directly and specifically and the treatment program moved in such
a way as to assist the priest in looking at his fitness for ministry
or finding new ministries or occupations.
It is inadequate to treat a sex offender in the diocese on a private
psycho therapy model. It should be emphasized that in-patient treatment,
preferably with peers, is the most preferable mode and the one which
will have the best results.
What About the Families of the Victims
This is a very delicate area. While the welfare of the priest-offender
is considered very important to the church officials, the welfare
both at the time of the abuse and well into the future, of the victims
is most important and should be given a priority by Ordinaries. The
effects of sexual abuse of children by adults are long lasting and
go well into adulthood. This is well documented though it may well
be difficult to predict the extent of theeffects in particular cases.
We are speaking not only of psychological effects but also the spiritual
effects since the perpetrators of the abuse are priests or clerics.
This will no doubt have a profound effect on the faith life of the
victims, their families and others in the community.

A rather direct approach should be made to the family (in conjunction
with consultation with competent civil attorneys). Psychological help
and other needed assistance should be offered to the victims and their
families. If the family seems disposed to such a move, there should
be some form of healing, if possible, between the priest and the family,
possibly in terms of monitored communication or perhaps even a family
meeting with the priest at some point when the priest, Ordinary and
family are disposed to it.
We have been rather ignorant of the effects of sexual abuse of children
by Catholic clergy over the years.because it has never been investigated
or studied in a systematic manner. However from a professional viewpoint,
enough adult persons who have been in therapy in the past several
years have discussed abuse by priests that it seems clear that such
abuse has a profound effect even when it does not come to the attention
of parents, familiy members or the civil or church authorities.

The extent and degree of the sexual abuse, the age of the child at
the time of outset of the abuse, when it was discovered and finished,
the manner in which it was discovered, any other dimensions of relationship
of the priest with the family... these are all factors involved in
treating the victims and their families. Special mental health professionals,
trained and competent in this particular area, should be called on
by the Ordinary to provide help and support as soon as is feasible.
This is also a healthy preventive measure with respect to civil litigation
since most families are eager to help their children and themselves
in these embarrassing and complex psychosocial problems.

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