Treatment of adult sexual offenders: a therapeutic cognitive-behavioural model of intervention

Recent research indicates that, of the various forms of treatment available to sexual offenders, cognitive-behavioural methods are likely to have the greatest impact in reducing rates of sexual re-offending. Cognitive-behavioural treatment typically targets attitudes that support sexual offending, anger management, victim empathy, deviant sexual arousal, and relapse prevention. More recently, treatment has targeted cognitive processes more generally, management of other emotional states in addition to anger, intimacy deficits, and risk self-management (Marshall, Anderson, & Fernandez, 1999; Yates, Goguen, Nicholaichuk, Williams, & Long, 2000). This article describes the components of cognitive-behavioural treatment with sexual offenders, including recent developments, assessment, treatment methods, and the importance of therapist characteristics on the therapeutic process and on treatment outcome.     

Factors Affecting Attitudes Toward Juvenile Sex Offenders

ABSTRACT

This study investigated attitudes toward juvenile sex offenders and factors influencing those attitudes. Additionally, the influences of perpetrator characteristics such as age, gender, and ethnicity on societal attitudes towards intervention requirements were also investigated. Overall, attitudes toward juvenile sex offenders and their treatment amenability were negative. No differences in attitudes toward juvenile sex offenders were found between those who had been victims of sexual abuse and those that had not. Sex offenses committed by juvenile female sex offenders were viewed to be more serious and require more intervention than those committed by juvenile male sex offenders.     

An Exploration of Differences Between Small Samples of Female Sex Offenders With Prepubescent Versus Postpubescent Victims

The general consensus among researchers is that the prevalence of sexual paraphilias among female sexual offenders is low relative to male sexual offenders (Cortoni & Gannon, 2013). In addition, there is very limited information about gender specific paraphilic behaviors and characteristics pertaining to females who commit sexual assaults (Pflugradt & Allen, 2014). This study examined the characteristics of female, solo sexual offenders who sexually assaulted prepubescent (n = 14) and postpubescent (n = 15) children. A content analysis was utilized to examine their psychological characteristics. Nonparametric analysis indicated that significantly more offenders with prepubescent victims had multiple paraphilias, poor cognitive problem-solving, noncompliance with supervision, and negative social influences. Limitations and future research directions are discussed.     

Multisystemic Treatment of Juvenile Sexual Offenders

Abstract

Multisystemic therapy (MST)is an ecologically-based treatment model that has proven effective with violent and chronic juvenile offenders and that holds promise with juvenile sexual offenders. This article describes the empirical underpinnings, theoretical foundation, and clinical features of MST and provides a brief review of MST outcome studies with juvenile sexual offenders. The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In two randomized trials with juvenile sexual offenders, MST has had positive effects on key social-ecological factors (e.g., family affective relations, peer relations, school performance) associated with sexual offending and has demonstrated long-term reductions in criminal activity and incarceration. The success of MST can be attributed primarily to (a) the match between MST intervention foci and empirically identified correlates/causes of sexual offending in youths and (b) the flexible use of well-validated intervention strategies in the natural environment.     

Collaborative Treatment for Sexual Behavior Problems in an Adolescent Residential Center

Abstract

Many residential treatment and sex offender programs for adolescents historically have used coercion-based interventions. Treatment programs employing coercive techniques often replicate the same destructive and intrusive behaviors they seek to eliminate. Tension between departments coupled with poor communication and discomfort around sexual behavior issues within the staff of residential treatment centers are more likely to inhibit the progress of the youths they serve.

Collaboration among residential, educational, and clinical components enables staff to work in a direct, genuine, and respectful fashion with students who have histories of sexually abusive behavior. It further assists in maintaining a safe and predictable environment for these students. Finally, it helps students eliminate destructive behaviors by directly and consistently addressing four key areas: sexually abusive behavior, antisocial attitudes, social/emotional functioning, and overall self-care. It is not the author's intention to hold Bennington School, Inc.up as a model residential treatment program or to criticize other residential facilities. Rather, it is hoped that what is working in Bennington may be helpful to others.

Many who have worked on the front lines of residential treatment with sexually abusive adolescents have received training in elements specific to sexually abusive behavior. The origins of treatment for youth who have sexually abused were noteworthy for their lack of offense-specific interventions (National Adolescent Perpetration Network, 1993). However, a wealth of literature soon emerged addressing the need for assessment and treatment techniques specific to this population (Perry & Orchard, 1992; Barbaree, Marshall & Hudson, 1993). Much of this literature made assumptions regarding high levels of chronicity (Perry & Orchard,1992) while other contributions stressed the role of denial and minimization (Barbaree & Cortoni, 1993). As a result, while many issue-specific forms of assessment and treatment were developed, they often did not take into account other developmental needs and issues in the lives of sexually abusive youths (Lane, 1997).

Concurrent with this emerging research was a substantial increase in the number of treatment programs for juvenile sex offenders (National Adolescent Perpetration Network, 1993). In this context, it is not surprising that many treatment programs relied heavily on treatment targeting denial, minimization, and perceived sexual deviance without taking into account other treatment needs of youths. Although a recent literature review of adolescent residential programs (Curwen, 2000) notes a trend away from shame-based approaches, there appears to be less clarity on specific criteria on which to base residential treatment of adolescents who have sexually abused (Curwen, 2000).

Finally, recent research shows that among adult populations, accepting responsibility for abusive behavior in treatment is more likely to result from a warm, genuine, and empathic treatment style (Marshall, Fernandez, & Anderson, 1999). Group therapy participation, similarly, results from encouragement, open questions, and nonconfrontational challenge. The emerging themes of recent trends and research should inspire those at the front lines of residential treatment to reconsider not just basic treatment approaches, but the most minute elements of their interactions with youths.     

Evaluating community-based treatment programmes for men who sexually abuse children

The currently dominant multi-factorial explanations of sex offending have been reflected in the widespread adoption of cognitive-behavioural groupwork methods where treatment foci are those attitudes, beliefs, cognitions and behaviours believed to contribute towards the maintenance of sexually abusive practices. Community-based programmes have mushroomed during this decade, with 97% of regional probation services now having provision for sex offender treatment. However, these relatively recent and dramatic developments of practice have to a large extent occurred outside of a framework of rigorous planning and evaluation. This article begins by outlining a rationale for both the treatment of sex offenders and evaluating programmes. This is followed by a framework for evaluation within which treatment providers can consider the issues involved (including the methodological difficulties) in setting up research designed to evaluate treatment effectiveness. It is suggested that, while small-scale (in-house) research may tell us something about the success or otherwise of individual programmes, it is the larger-scale projects carried out by independent researchers that will inform us as to the impact of cognitive-behavioural group work on recidivism and offence-related psychological variables. Such research has the potential to assist policy-makers and to aid managers and practitioners in the development of effective treatment programmes. © 1998 John Wiley & Sons, Ltd.     

Advances in Sex Offender Treatment and Challenges for the Future

Abstract

This paper describes what the authors believe to be the major advances, the areas of debate, and the future direction of sexual offender treatment as we leave the 20th century and enter the new millennium. In the area of sex offender treatment, the modification of relapse prevention for use with sex offenders has had a profound effect on the way that therapy is done. Additionally, the development of the selective serotonin reuptake inhibitors and other pharmacotherapies has moved the field more toward a bio-psychosocial model of etiology and treatment, and focused more attention on comorbid psychiatric disorders in the treatment of sexual offenders. The late 1990s saw major advances in the development of actuarial prediction tools for recidivism, and a concerning move toward phallometric stimuli with unclear reliability and validity. Additionally, the development of the Abel Screen for Sexual Interest has provided a promising, but as yet unvalidated, alternative to phallometry. The 1990s were also a period of considerable growth in the application of sexual offender treatment to special populations, such as adolescents, the developmentally disabled, women and children. The major challenge for the future is to develop methodologically sound research on which to base our decisions about the treatments to apply, the unique needs of special populations, and the assessment of dangerousness.     

The Treatment of Adult Male Child Molesters Through Group Family Intervention

Abstract

This paper explores the effectiveness of treating the child molester in multiple contexts as opposed to in-group therapy alone. Research indicates that sexual abuse may stem from a combination of family dysfunction (Hanson et al., 1994) and further, that family members' decisions impact the therapeutic process (Lipovsky, 1991). These and other findings suggest that effective counseling of sexual offenders should include not only the perpetrator, but the family members as well. This paper outlines a current treatment program utilizing a group process of relapse prevention and cognitive behavioral therapy techniques in concert with a companion group for partners and a therapeutic nursery for preschool-aged children. Using archival data, this paper addresses the effectiveness of the program and highlights the usefulness of involving family members in the process.     

Recidivism and Resilience in Juvenile Sexual Offenders: An Analysis of the Literature

SUMMARY

The majority of research that exists studying juvenile sex offenders (JSOs) is dominated by the predilection that identifying risk factors associated with recidivism will benefit both the JSOs and treatment providers. Further, the majority of existing treatments are guided by research that has identified what makes JSOs more likely to reoffend. Absent from the majority of the literature is an examination of the strengths and positive characteristics demonstrated by JSOs that may prove useful in both reducing recidivism and increasing the likelihood of achieving positive outcomes (i.e., demonstrating resilience). Research examining known risk factors for sexual and nonsexual recidivism is described. Next, literature on resilience is reviewed, followed by a discussion of this literature in the context of treatment for JSOs. Finally, future directions of research are presented.     

Judicial Decision-Making and Juvenile Offenders: Effects of Medical Evidence and Victim Age

ABSTRACT

A growing body of evidence suggests that jurors place greater weight on DNA or other types of forensic evidence than non-forensic evidence (Cole & Dioso-Villa, 2009). For cases involving child sexual abuse, certain types of evidence, including forensic medical evidence, may be viewed as more important or indicative of abuse than other types of evidence, such as victim statements or disclosure. The present study evaluated perceptions of juvenile offenders and victim credibility across four vignettes that systematically manipulated variables related to victim age and physical indicators of abuse. A sample of 636 participants read vignettes and answered questions pertaining to the vignette. Participants also provided demographic information and responded to a series of items assessing participants’ judicial decision-making strategies and outcomes. Broadly, the presence of medical evidence significantly influenced participants’ decision-making across a variety of variables, including verdict outcome, verdict confidence, confidence that the victim was truthful, and determinations involving sex offender registration and notification requirements. The influence of medical evidence and victim age on perceptions and sentencing of juvenile sex offenders across these and additional outcome variables will be discussed.     

Sexual Abuse Victimization and Psychological Distress Among Adolescent Offenders

ABSTRACT

This study focused on sexual abuse victimization and psychological distress among 272 adolescent offenders. The respondents were interviewed while they were being detained in a short-term holding facility. Female respondents reported more sexual abuse victimization and psychological distress than did their male counterparts. Furthermore, church attendance moderated the association between sexual abuse victimization and psychological distress among the male respondents. Implications of these findings for research and interventions with adolescent offenders are discussed.     

An Integrated Experiential Approach to Treating Young People Who Sexually Abuse

SUMMARY

This article promotes the use of an integrated (holistic) approach to treating juvenile sexual offenders. An integrated model takes into account the fact that: (a) youth are resilient, (b) youth progress through various stages of development, (c) these stages are often arrested as a result of trauma, child abuse and neglect, and attachment disorders, (d) humanistic approaches and the therapeutic relationship are essential to the healing and recovery process, (e) youth learn and work with a variety of learning styles and multiple intelligences, (f) many traditional assessment and treatment approaches can be modified and blended with an integrated approach, and (g) the use of experiential treatments can have a positive and profound impact in treating youth with sexual behavior problems.     

Practical Considerations in the Interview and Evaluation of Sexual Offenders

SUMMARY

The evaluation and assessment of sexual offenders is different than any other type of evaluation, and most clinicians are not properly trained to interview this population. This article addresses the clinical and ethical issues particular to the interview, assessment, and evaluation of these types of offenders. It offers both practical information regarding the interview itself, along with an overview of classification systems, paraphilias, and assessment techniques used with this population. In addition, issues related to risk assessment and risk management are also addressed, and an introduction to the use of actuarial risk assessment instruments is provided.     

Adult and Adolescent Female Sex Offenders

Abstract

Female sex offenders (N = 18) were compared with male sex offenders (N = 332) and with females who were not sex offender (N = 215) on various experiences in their personal histories. Female sex offenders who were victims of sexual abuse were compared to female sex offenders who were not. The present study is part of a comprehen sive, seven-year research project described elsewhere (Miccio-Fonseca 1995, 1996). The project dealt with comparative experiences and char acteristics of adult and adolescent sex offenders, victims, and thei families. The groups in the present study were analyzed with regard to an array of variables, including psychological, medical, gynecological urological, drug, law enforcement, and homicidal and suicidal histories Other variables studied were sexual difficulties and dysfunctions, sexu al health, and life stressors.

Female and male sex offenders differed significantly on numerou psychological, life-stressor, and sexual variables. Female sex offender differed significantly from females who were not sex offenders on the same sets of variables, and they were significantly younger. Implica tions for clinical practice with this population are discussed.     

Testing an Etiological Model for Male Juvenile Sexual Offending Against Females

SUMMARY

Research on the origin of sexual aggression has identified several important contributing factors: (a) early abuse (physical and sexual), (b) personality/behavioral traits (callousness and unemotionality, antisocial behavior/impulsivity, and hypersexuality), and (c) attitudinal/cognitive variables (negative masculinity, hostility toward women, misogynistic fantasies). We developed and tested an etiological model of sexual coercion on adult samples of sexual offenders and community controls. The model proposes three major causal pathways to sexual coercion. Using data gathered from a computerized interview, we employed this same model to predict sexually coercive behavior in a sample of 218 juvenile sexual offenders. The cross-sample consistency of the model provides support for a unified theory of sexual aggression against women.     

Treatment for Juveniles Who Sexually Offend in a Southwestern State

A 25-item questionnaire was mailed to sex offender treatment providers from counties with 60 or more reported juvenile sex offenders in a Southwestern state to determine the most effective treatment for juvenile sex offenders. Results indicated that cognitive behavioral therapy was the most successful reported approach to treatment with an average success rate of 87%. The most commonly used approach was cognitive behavioral therapy with relapse prevention. The most common sexual offense was indecency with a child involving sexual contact, contrary to studies that found that in the Probation Commission data, aggravated sexual offense was the most common. These results have ramifications for state policies on treatment for juvenile sex offenders.     

Physical Activity as a Helpful Adjunct to Substance Abuse Treatment

ABSTRACT

While limited research exists on the topic of physical activity as an adjunct to substance abuse treatment, a review of relevant multidisciplinary literature indicates a logical rationale for its potential benefits to recovery from addiction. This article provides an overview of common variables that contribute to addictive disease and summarizes the relationship of regular physical activity to improvements on many of these variables. The stages of change from the Transtheoretical Model (TTM, Prochaska & DiClemente, 1982; Prochaska & Velicer, 1997) are described in the context of effectively matching clients in substance abuse therapy to interventions that may include physical activity. Finally, important practical suggestions for implementing physical activity as a useful adjunct to substance abuse treatment are provided.