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.     

Current Practices in Residential Treatment for Adolescent Sex Offenders: A Survey

SUMMARY

A list of all treatment facilities for adolescent sex offenders that described themselves as inpatient or residential was requested from the Safer Society Foundation in Brandon, Vermont. A total of 203 such facilities were identified in this manner. Each was sent a questionnaire regarding their policies and practices. Of the 50 questionnaires that were returned, 49 were usable. Items on the questionnaire dealt with major phases of operating a residential program, including number of beds, average daily census, number of males and females in treatment, testing and assessment procedures, most frequent diagnoses, average IQ of patients, abuse history, therapeutic approaches used, number and types of individual/group treatment sessions per week, qualifications of therapists, average length of treatment, and follow-up research on treatment.     

Supervision and Treatment of Juveniles with Sexual Behavior Problems

Responses to a survey, distributed at the 2005 Conference for Sex Offender Management, were studied to identify treatment theories, client behavior expectations, and level of interagency collaboration relied upon to produce positive outcomes for Juveniles with Sexual Behavior Problems (JSBP). Analysis of 112 responses to the 31-item survey identified three potential subscales (Integration of Theory, Readiness for Program Release, and Collaboration) and indicated support for an integrative approach to treatment. Clinicians were more likely than probation, institutional officers and caseworkers to use cognitive-behavioral approaches to enhance positive outcomes. Results are discussed regarding three controversial issues related to JSBP supervision and treatment: use of polygraphs with juvenile sex offenders, referrals to 12-Step Sexual Addiction programs, and victim/offender reunification.     

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.     

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

ABSTRACT

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.     

Public Attitudes Toward Sexual Offenders and Sex Offender Registration

This study explores the relationship between fear of various types of sexual offenders and a belief that those sexual offenders should be subject to sex offender registration. We hypothesized that those who offend against children would elicit the most fear; consequently, the most feared offenders would be rated as most requiring registration. As part of a telephone survey, 733 participants answered questions about fear of sex offenders and agreement with requirements about registration for offenders convicted of incest, statutory rape, marital rape, pedophilia, date rape, and an offense committed more than 10 years prior. Results indicated that all types of sexual offenders elicited some fear from respondents, and fear was related to support of registration requirements.     

The Effects of Polyvictimization and Quality of Caregiver Attachment on Disclosure of Illegal Sexual Behavior

ABSTRACT

The current study examined the relationship among self-disclosure of illegal sexual behaviors and two conceptually relevant constructs in psychotherapy: childhood polyvictimization (i.e., cumulative types of victimization experienced during childhood) and caregiver attachment. Participants consisted of 63 adolescent males participating in mandated treatment for illegal sexual behavior. Childhood polyvictimization and caregiver attachment were expected to predict self-disclosure of illegal sexual behaviors. Quality of caregiver attachment was also expected to mediate the relationship between polyvictimization and disclosure. Consistent with our main hypothesis, results indicate that quality of caregiver attachment mediated the relationship between childhood polyvictimization and self-disclosure of illegal sexual behaviors in psychotherapy. The current findings highlight the impact of polyvictimization on important therapeutic processes as well as the importance of assessing for multiple types of victimization in adolescents who engage in illegal sexual behavior. Further clinical implications regarding the use of trauma-informed approaches during sex offender treatment are discussed.     

Introduction to Dr. Leonore Tiefer's Commentary

No abstract available for this article.     

The Current Role of Post-Conviction Sex Offender Polygraph Testing in Sex Offender Treatment

SUMMARY

Polygraph testing is becoming increasingly important in sex offender treatment. Polygraph advocates cite dramatic increases in historical disclosures that presumably allow more precise targeting of treatment interventions, earlier detection of risky behaviors that often lead to new offenses, and improved treatment and supervision compliance. Based on this, they believe the procedure supports desirable behavior that continues to various degrees after treatment and supervision end. Opponents cite ethical problems related to inaccurate results, unproven accuracy rates, and the risk that examinees may be coerced into making false admissions. To counter these criticisms, proponents have developed standards, best practices, and examiner training and certification programs intended to reduce error rates and address ethical issues. Opponents argue that these measures have not been tested and that empirically established error rates and best practices may not be possible for a variety of reasons. This article reviews the current situation, leaving readers to decide the wisdom and ethics of using polygraph testing in their own practices.     

Factor Structure of the Adolescent Clinical Sexual Behavior Inventory

ABSTRACT

An inability to identify betrayal may increase risk for victimization. Harm perpetrated by close others early in life may impair the ability to identify betrayal and develop trust. Dissociation may facilitate impaired betrayal awareness. The present study examined the impact of high betrayal trauma on state dissociation and betrayal awareness in a college sample (N = 216). Self-report measures were used to assess trauma history and state dissociation. Awareness for betrayal was measured using a drawing depicting an ambiguous interpersonal interaction between an adult and a child. We hypothesized that high betrayal trauma would be associated with both more state dissociation and lower awareness for betrayal. Participants with histories of high betrayal trauma reported high levels of state dissociation. Contrary to our second hypothesis, high betrayal trauma did not directly predict impaired betrayal awareness. State dissociation contributed significantly to betrayal awareness. Implications of findings for theory and practice are discussed.     

Female Juvenile Sexual Offenders: Understanding Who They Are and Possible Steps That May Prevent Some Girls From Offending

In recent years, there has been accumulating evidence that sexual abuse committed by females is not rare and can be just as traumatic as sexual abuse committed by males. Despite the increased recognition given to sex offending by adult women, however, very little attention has been given to sex offenses committed by juvenile females. There has further been very little published material that has focused specifically on intervening with female children and adolescents before they offend. In an attempt to fill this gap, this article describes common characteristics of juvenile female sex offenders, ways in which juvenile female sex offenders are similar to and different from juvenile male sex offenders, and the limitations that exist related to our knowledge about these offenders. Based on this information, suggestions are given for possible ways to intervene in the lives of at-risk female youth before they offend.     

Effects of School-Based Risk and Protective Factors on Treatment Success Among Youth Adjudicated of a Sexual Crime

Youth with sexually problematic behaviors are impacted by the reciprocal interplay between individual characteristics and the key social and ecological systems in which they are embedded. The paucity of research on protective factors mitigating risks within various socioecological systems is of concern, as the school is one such system that has been overlooked. This study retroactively investigated probation files among youth who were adjudicated of a sexual crime (N = 85) to determine how school-level variables are associated with treatment completion. A sequential logistical regression model revealed reduced odds for school-based risk factors and a greater proportion of variance explained when school-based protective factors were included. Implications and research considerations are discussed.     

Group Treatment of Latency-Age Male Victims of Sexual Abuse

Researchers and clinicians across the country have documented increases in reports of sexual victimization of males. Awareness of the immediate and long-term needs of young male victims has highlighted the need for specialized, multi-modal treatment programs for these youngsters. Group therapy can be an important adjunct to individual and family unit therapy with this population. This article provides concrete suggestions for developing, implementing and evaluating a group therapy program for young male victims of sexual abuse. Specific areas addressed include: selection and preparation of group members; structure, phases, and salient tasks of the group; therapeutic group activities; co-leadership issues; managing transference and countertransference in the context of group; and, methods for evaluating the group's effectiveness.     

Relationships between Early Life Victimization,Antisocial Traits,and Sexual Violence: Executive Functioning as a Mediator

ABSTRACT

Few research studies examine how the relationship between trauma and executive functioning can influence sexual violence among youth. Knight and Sims-Knight (2004) proposed a Developmental Etiological Theory (DET) connecting early life physical and sexual victimization to sexual violence via antisocial traits. Drawing from research that identifies a link between early life victimization and executive functioning, this study tests an adaptation to the DET by including executive functioning as an intervening factor. Using data on adolescents adjudicated of sexual and non-sexual crimes in a western state (N = 200), multiple structural equation models tested direct and indirect relationships between early life sexual, physical victimization, and other adversity, four differential forms of executive functioning, callousness, and sexual violence. Results revealed statistically significant direct pathways between variables of interest and a multi-meditational effect of certain forms of executive functioning and callousness in the relationship between victimization and sexual violence. Treatment and research implications are discussed.     

The Bowl of Terror: A Case Study of an Adolescent Perpetrator of Sexual Abuse

This article describes a complex multimodal intervention with a family where inappropriate sexual contact had occurred between Taro and his younger sister Lara, when they were young children. The family presented to clinical services when Lara was brought to hospital with suicidal ideation, traumatic flashbacks and regressed behaviour at 13 years of age. Treatment involved multiple components: family work with all members of the family individual work with Lara, joint work with Lara and Taro, and finally, a brief intervention with Taro. This article focuses primarily on the therapist's work with Taro, the perpetrator of the inappropriate sexual contact. The Adult Attachment interview (AAI), a semi‐structured interview, was used by the therapist to assess Taro's developmental experiences and psychological functioning. Information from the AAI helped the therapist identify both the relationship factors that had contributed to the perpetration of sexual abuse and the self‐protective strategies Taro had come to use in order to elicit maximum comfort and protection from neglectful attachment figures. The therapist used the functional formulation derived from the AAI to structure a time‐limited intervention.     

Eating Disordered Behaviors and Body Disapproval in Adolescent Males Adjudicated for Sexual and Nonsexual Crimes

Using a large sample of adjudicated delinquent male youth (N = 696), we compared data from youth who had been adjudicated for sexually aggressive crimes and those who had been adjudicated for nonsexual offenses on eating dysfunction, body disapproval, history of sexual abuse, and pornography exposure. The sample included 526 (75.8%) youth adjudicated for sexual offenses and 170 (24.4%) youth adjudicated for nonsexual crimes. The average age of the sample was 16.8 years (SD = 1.6), and approximately half of the sample (47.7%, n = 310) self-identified as White. The results of hierarchical multiple regressions indicated that sexually aggressive youth scored significantly higher than nonsexually offending youth on both eating dysfunction and body disapproval measures. Pornography exposure and substance use predicted body disapproval and eating dysfunction in the entire sample of adjudicated youth. History of sexual abuse was a significant predictor of body disapproval in all adjudicated youth but was not a significant predictor of eating dysfunction. Implications for research and practice are offered.     

Treatment Experiences of Child Sexual Offenders in Norway: A Qualitative Study

This article is an attempt at gaining a better understanding of treatment of adults who have committed sexual offenses against children. In this study we aimed to explore what people who have committed sexual offenses against children find useful in therapy. The study was approached using qualitative methodology, and information was collected through semistructured interviews. Four male child sexual offenders were recruited from the Institute of Clinical Sexology and Therapy in Oslo, Norway. The informants were interviewed with a focus on what factors they found useful in therapy. Through an explorative, thematic analysis, five main themes were found. These themes include: “Why I started going to therapy,” “Why did I do it?” “Therapy as life,” “Previous and current relationships with others,” and “I lived in a fantasy world where everything was okay.” Based on this study and other earlier studies and theories it appears that the previously mentioned themes recur as important contributory factors in the treatment of child sexual offenders.     

Standards of Care for the Treatment of Adult Sex Offenders

Summary

A proposed version of these standards was first produced and published in the Journal of Offender Rehabilitation through input from professional meetings (Coleman and Dwyer, 1990). Since that time, The Standards of Care were reviewed and revised by a group of professionals and unanimously endorsed by voice vote by the participants in the Third International Congress on the Treatment of Sex Offenders held in Minneapolis, Minnesota, September 20–22, 1994. These Standards were again published in the Journal of Offender Rehabilitation (Coleman, Dwyer, Abel, Berner, Breiling, Hindman, Honey-Knopp, Langevin, and Pfäfflin, 1996). Those Standards have been subsequently reviewed by the current authors at the Fifth International Conference on the Treatment of Sex Offenders held in Caracas, Venezuela, March 22–27, 1998 and minor modifications and changes were incorporated into this version. The authors invite feedback from readers. Further revisions are anticipated and will be reviewed by current committee members and at future International Conferences on the Treatment of Sexual Offenders.