But as the Roman Catholic Church struggles with the latest scandal involving the sexual abuse of minors, the efforts of the church-run psychiatric center and its self-reported success rate are under new scrutiny, with critics saying the facility has been too willing to let potentially dangerous priests return to the ministry in order to please church officials heavily invested in the priests' training and recovery.
"These centers, particularly one like St. Luke, do a big, big business with the church," said Gary R. Schoener, a Minneapolis psychologist who has closely studied the Maryland center and similar facilities. "It's the same problem consultants have - when you have one big customer, the tendency is to treat them nicely and have things go the way they want it to go."
Current and past officials with St. Luke dispute that suggestion. They say that far from being part of the problem in the roiling Catholic sexual abuse scandal, the center - with its blend of progressive art and drama therapy, drug treatment and exhaustive group and 12-step counseling sessions - is part of the solution.
An internal study of the more than 450 priests who underwent the center's six-month treatment program between 1985 and 1995 showed only three of the men relapsed - a conclusion based on reports from the men themselves, their church supervisors or law enforcement officials.
Center officials say few of the priests they treat are ever returned to their old duties or allowed to work again with young people.
"I never had pressure from any bishop to send a priest back and, in many cases, we had people who we thought were able to go back, and we had a hard time convincing any bishops to take them," said the Rev. Canice Connors, a past president of St. Luke.
The current church crisis, however, has focused new attention on St. Luke's role in advising the church on whether known sexual offenders should be returned to ministry. In several high-profile cases, church officials knew about sexual abuse allegations - and had priests evaluated or treated at St. Luke - but still shuttled them from parish to parish.
As those and other cases unfolded, they exposed rare fault lines between the church and the psychiatric facilities it has relied on for years.
The staff at the Institute of Living, reacting to a suggestion from New York Cardinal Edward Egan that the church relied on faulty psychiatric evaluations in reassigning priests accused of abuse, said recently that church leaders gave them limited background information on troubled priests and then ignored their treatment advice.
The head of the St. Luke Institute, in an interview last week, drew a sharp distinction between the center's role and the church's in placing priests who are known sexual offenders. The Rev. Stephen J. Rossetti said his facility can only make a recommendation about a priest's future - it is up to the church to decide what happens after that.
But Rossetti, who said he could not talk about Geoghan or other cases, signaled that St. Luke continues its close, cordial relationship with the church.
"There's the impression that people are being given, that [priests accused of sexual abuse] are all going back" to their parishes, he said. "That's just not been my impression.
"What I've been seeing is the bishops take it very, very seriously. They send them to treatment and, the majority of times, they're removed from ministry completely."
St. Luke's treatment regimen has been praised for years as one of the country's most rigorous programs for child abusers.
"St. Luke's has, in my estimation, an excellent staff, and I think their program was set on a very solid medical model," said A.W. Richard Sipe, a psychologist and former priest who was one of the first to study and write about the church's sex abuse problems.
The center expanded its counseling mission in 1983 to include clergy accused of sexual abuse, partly as a response to the case of Gilbert Gauthe, a Louisiana priest who was sentenced to 20 years in prison for sexually abusing at least 35 youths.
Peterson and St. Luke gained attention in subsequent years for bluntly drawing new attention to the problem of clergy sexual abuse.
A 1985 report Peterson co-wrote for the National Conference of Catholic Bishops warned that there is "no hope at this point in time for a cure." And, it noted, the "recidivism rate is so high with pedophilia ... that all controlled studies have shown that traditional outpatient psychiatric or psychological models alone do not work."
The church, particularly the Vatican, has not always looked favorably on St. Luke. This response appeared to be based at least partly on the fact that St. Luke's founder, Peterson, who was openly gay before becoming a priest, died of AIDS in 1987, one of the first such cases involving Catholic clergy to gain national attention.
This ambivalence apparently figured in the Vatican's opposition in 1993 to an American bishop's efforts to oust a suspected abuser from his diocese. The Signatura, the Vatican's supreme court, ruled against Bishop Donald Wuerl of Pittsburgh, appearing to side with a canon lawyer for the accused priest, Anthony Cipolla.
"St. Luke's Institute, a clinic founded by a priest who is openly homosexual and based on a mixed doctrine of Freudian pan-sexualism and behaviorism, is surely not a suitable institution apt to judge rightly about the beliefs and the lifestyle of a Catholic priest," said the brief, first published in The Pittsburgh Post-Gazette. The Vatican court reversed itself two years later and supported the decision to remove Cipolla.
At St. Luke, priests undergo a range of assessments and follow-up treatments, at a cost to the church of about $300 a day.
Rossetti, who would not allow a reporter to visit the Silver Spring facility, said sexual offenders make up only about a quarter of the center's clients - about 18 of the center's 70 beds.
That device, called a penile plethysmograph, is one of the most controversial parts of St. Luke's approach, and some priests subjected to it call the experience humiliating.
Dr. Fred S. Berlin, founder of the Baltimore-based National Institute for the Study, Prevention and Treatment of Sexual Trauma, said the arousal measurements, as well as sometimes confrontational counseling sessions, are important components of the program.
"The idea is not for these guys in treatment to be comfortable," said Berlin, who worked with St. Luke as it began its sexual offender program in the early 1980s. "St. Luke's is very much focused on what the primary objective should be - that the behavior is not acceptable."
If a patient is admitted to the full, six-month program, his treatment typically begins with a dose of the drug Depo-Provera to weaken the sex drive. In group and individual therapy sessions, priests undergo art and drama therapy to help them better express their feelings. They are instructed to keep a detailed sexual history diary.
In group therapy sessions, they are confronted by other priests who challenge the most common denials or protests - that the offenders' actions weren't really abusive, that the child involved didn't mind.
The goals of the program are straightforward: Priests are expected to acknowledge their sexual problems, accept responsibility for their actions and learn how to prevent relapses.
No one at St. Luke talks about a cure, and priests finish the program with the understanding that they will face long-term monitoring. Connors said priests typically report back every six months for five years.
Other psychologists say that is at least one factor allowing the center to claim a recidivism rate of less than 10 percent.
"They've got such a closely supervised program once they get out, so there's less opportunity to offend," said Thomas G. Plante, a California psychologist and editor of a 1999 academic study of priestly sexual abuse.
Schoener, however, questions whether the reports of relapses - which have never been subjected to an outside review - are complete. Sexual offenders in the general populace typically have higher repeat rates.
"To believe that whatever measure they are using is catching every victim is absurd," he said.
Schoener and others say that St. Luke suffers most from its close ties to the church. In reviewing St. Luke and two other facilities seven years ago at the request of the archbishop for St. Paul and Minneapolis, Schoener said the clinical reports by St. Luke's professional staff were solid. But he criticized the center for relying too heavily on the church for initial investigations and follow-up monitoring.
Sipe, the psychologist and sex abuse expert, said St. Luke has to overcome the cloistered "clergy culture" in which it operates. That is echoed by the Rev. James J. Gill, who said the institute offers less of a real-world treatment environment than some secular treatment facilities.
"If a bishop feels he has to send a man to a place where only priests and nuns and brothers are, a Catholic ghetto, they send him to the St. Luke Institute," said Gill, a psychologist and consultant at the Institute of Living.
Rossetti, St. Luke's president, counters that its religious affiliation can be beneficial. Priests at his facility aren't given any special respect or the benefit of the doubt because of their profession, he said.
What is missing, he said, is more aggressive secular involvement from criminal and child welfare investigators, who often decline to review allegations of priest sexual abuse because the claims typically are raised years after the abuse occurs.
"What professional, secular organization is going to do a criminal investigation?" he said. "And they don't - the bishop ends up becoming judge and jury and parole officer, and that is unfortunate."