Is There Help?

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Patrick Velez walked into a fast-food restaurant in Pierce County and kidnapped two teenage female employees at knifepoint. He bound their wrists, taped their eyes and mouths shut, drove them to a secluded area. Then he raped one of the victims, who was 17.

Later convicted of the November 1981 crimes, Velez wound up spending eight years in sex-offender treatment, in and out of prison. He kept logs of his fantasies, took polygraph tests, underwent "arousal reconditioning" and learned how to have positive relationships.

By the time Velez left prison in 2000, officials still considered him a high-risk offender, but were encouraged by his progress. He had "done quite well in treatment," a therapist wrote in his prison records, and had demonstrated "good relapse-prevention knowledge."

Last month, prosecutors charged him with trying to strangle a woman after hiding in her car in a Costco parking lot in Tukwila. He had a "rape kit" -- knife, gloves and handcuffs -- along with condoms, lubricant, a douche bag and women's underwear in his car, police said.

While the Velez case is alarming, another treated sex offender, Terapon Adhahn, recently stirred outrage across Washington, prompting calls for a one-strike-you're-out-law. The Tacoma handyman is accused of graduating from incest to kidnapping, child rape and murder.

Velez and Adhahn offer glimpses into the conflicted world of sex-offender therapy. Despite inconsistent research findings on the subject, sex-offender treatment is not only a fixture in criminal justice, but also a burgeoning field, with the number of certified therapists more than doubling statewide in the last 10 years.

And while the overall climate for sex offenders has radically changed -- with longer sentences and more restrictions -- treatment has largely remained static, relying on the same cognitive-behavioral methods introduced in the 1980s.

"It's an ongoing question, there's no two ways about it," said Roxanne Lieb, director of the Washington State Institute of Public Policy, on the effectiveness of treatment. "Certainly, it's not a cure-all," she said.

Last year, Lieb's office released a study that found that Washington's prison treatment program for male sex offenders -- one of the largest in the nation -- had virtually no effect on reducing recidivism rates.

The study echoed a landmark 2005 study, in which researchers found that a California hospital program for confined sex offenders had no significant impact on curbing repeat crimes.

Both studies, however, have detractors who point to other studies showing that treatment works.

"There's pretty good evidence that if you pick out the right kind of people, who feel badly about what they've done, you can alter those patterns," Lieb said. "But if you have someone who's anti-social, who hates women or who is sexually attracted to little kids, no one knows anything about what to do about those three things."

'End goal is not a cure'

When Velez pleaded guilty to first-degree rape in 1982, he was a 19-year-old with entrenched sexual deviancies, court records show. He had peeped on neighbors as a child growing up in Tacoma. He burglarized homes to steal women's underwear.

As a teenager, he cruised for rape victims and once hid in the back seat of a woman's car, he told therapists. He had threatened the woman with scissors, but fled when she screamed and was never caught.

For the assault on the restaurant workers, which one therapist described as "brutal" and "extremely predatory," Velez received a 20-year suspended sentence. That required him to complete a now-defunct program at Western State Hospital for "sexual psychopaths."

Velez flunked out after five years. He got a second chance at treatment and flunked again, after fantasizing about raping his therapist.

He then went to prison in 1989, where he enrolled in the state's Sex Offender Treatment Program, based at the Twin Rivers Unit in the Monroe Correctional Complex.

Despite Lieb's study, prison officials are quick to defend the 200-bed, $1.8 million-a-year program. In fact, they want to expand it, with a second location in Eastern Washington.

"The study says what it says," said Sally Neiland, the treatment program's unit supervisor. "But being here every day, seeing men released, watching them graduate, hearing from them they have successful lives -- they report that wouldn't have happened without treatment."

Neiland could not discuss Velez, but said offenders in general spend about a year in treatment, learning to recognize stressors such as anger or boredom, and to change thought and behavior patterns.

Many undergo a process called "arousal reconditioning," in which a deviant fantasy is paired with a foul odor such as Limburger cheese, rotting meat or skunk urine. (Twin Rivers used to use ammonia capsules, but stopped when they learned the method can be harmful).

Offenders also learn how to manage emotions, develop social skills and empathize with victims, in part by listening to a Holocaust survivor.

"The end goal is not a cure," Neiland said. "It's to assist them in learning what situations lead them to offend and how to create intervention."

By the time Velez left prison, he had married a nurse educator he met at a hospital. He had begun attending Quaker meetings and taking classes in computer programming. He moved into his wife's rural Maple Valley home, where he did well under the terms of his two-year community supervision. It ended in 2002. The next five years are a mystery.

Velez, who is now in the Regional Justice Center jail, did not return a call for comment, nor did his wife.

"I wonder what was going on in his life, and how did he fail to use the tools that he was given?" Neiland said. "How did he unravel?"



Therapists often fooled

In Adhahn's case, treatment meant five years of court-ordered therapy after he pleaded guilty to incest for raping a teenage relative in 1990.

He fulfilled that by going to group therapy, much of it once a week, and submitting himself to polygraph and plethysmograph tests, the latter of which measures penile arousal to sexual material.

Toward the end of treatment, counselor Daniel DeWaelsche lauded Adhahn's progress.

"Terapon has demonstrated that he is using the skills and techniques, gleaned in sex-offender treatment, on a day-to-day basis to avoid recidivism," DeWaelsche wrote in 1997. "It has been a pleasure working with Terapon."

Ten years later, prosecutors say Adhahn kidnapped, raped and killed 12-year-old Zina Linnik, and raped two other girls, one of whom was abducted on her way to school.

DeWaelsche did not return a call for comment.

Experts say it's not uncommon for offenders to fool therapists, and that some people do well in treatment and deteriorate later.

Beyond that, answers become well-oiled bromides. Experts know that a subset of offenders -- psychopaths, predators and extreme deviants -- are more dangerous than others and may not do well in treatment. Of the more than a dozen violent predators released from the state's Special Commitment Center since 2001, more than half have had their releases revoked.

Experts also say most sex offenders rarely reoffend, a notation usually followed by a swift acknowledgement that all sex crimes are traumatic, no matter how rare. Then they say there are no simple answers.

More counselors are combining therapy with anti-depressants and anti-androgens, which reduce testosterone and are sometimes called "chemical castration." But anti-androgens can have severe side effects, and only a few offenders take them.

"The reality is this: Nothing beats intelligence," said Richard Packard, a clinical forensic psychologist on Bainbridge Island and past president of the Washington Association for the Treatment of Sexual Abusers.

But research and supervision are expensive, he said. "We spend no money on trying to understand how to do it better -- how to evaluate and treat sex offenders better."

Instead, many therapists find themselves cringing at the inevitable clamor that follows high-profile sex crimes.

"It's no big secret treatment doesn't work. You cannot rewire somebody's mind," said state Sen. Pam Roach, R-Auburn, a longtime supporter of tougher sentences and decreased funding for treatment.

House Republicans recently proposed GPS tracking for high-risk offenders and up to a year in prison for failing to register. Gov. Chris Gregoire has appointed a group to study the Adhahn case and propose any legislative changes by Oct. 4.

Spurred by outrage over the Adhahn charges, citizens lobbying for an improbable one-strike-you're-out law for sex offenders have rekindled their efforts.

"What is just? I'm not saying I have an answer, and I'm a psychologist," Packard said. "I mean, you do that to my kid, believe me, I'm going to be really mad."

But many sex offenders benefit from treatment, he said, and few are incarcerated forever. Then he asked the question of the ages: "So, what are we going to do about it?"