“Positive” Treatment Approaches

The program model, modalities employed, and targets of intervention in sex offender treatment are very important, as they establish the foundation for the “substance” of treatment. However, process–related variables must be taken into account as well, including therapist characteristics and the therapeutic climate (see, e.g., Fernandez, 2006). Roughly a decade ago, experts raised concerns about the highly aggressive, harshly confrontational, and shame–inducing approaches that were commonly used in treatment programs and suggested that these strategies may actually increase resentment, hostility, and externalization of responsibility, while decreasing disclosure, motivation, and engagement (see, e.g., Bumby, Marshall, & Langton, 1999; Kear–Colwell & Pollack, 1997; Marshall, 1996; Marshall et al., 1999).

Emphases on more positive approaches to sex offender treatment can facilitate clients’ investment in the intervention process, minimize attrition from treatment, and ultimately promote successful completion of treatment.

Perhaps not surprisingly, research has since confirmed that employing these types of aggressive and confrontational approaches is associated with poorer treatment outcomes, whereas clinicians who demonstrate empathy and encouragement, are firm but flexible, and create a cohesive and positive therapeutic climate are more likely to facilitate positive treatment gains and outcomes (see, e.g., Beech & Hamilton–Giachritsis, 2005; Marshall et al., 2003; Marshall et al., 2005). Therefore, treatment programs must ensure that providers practice skills, techniques, and strategies that will facilitate clients’ engagement and success in treatment.

One such strategy is Motivational Interviewing (Ginsburg, Mann, Rotgers, & Weekes, 2002; Miller & Rollnick, 2002). This approach emphasizes the need for clinicians to modify their interactions with clients based on the level of motivation and readiness for change demonstrated by those clients. Through Motivational Interviewing techniques, clients are encouraged to explore their own internal reasons to change, which ultimately results in decreased resistance and increased investment during the intervention process (Miller & Rollnick, 2002). Over the past several years, it has become increasingly popular for working with sex offenders (Ginsburg et al., 2002).

Just as the process–related variables in sex offender treatment have begun to shift in a more positive direction, so have the overall philosophies of treatment (see, e.g., Fernandez, 2006; Marshall et al., 2005; Thakker et al., 2006; Ward & Fischer, 2006; Ward & Stewart, 2003). A positive approach to sex offender treatment recognizes the importance of addressing risk factors and effective coping skills, but reframes them within a strengths–based model that is designed around establishing “approach” goals (Thakker et al., 2006; Ward & Stewart, 2003). In other words, treatment is not built around teaching individuals how to prevent themselves from continuing to lead “bad lives,” so to speak. Rather, the focus of treatment is to assist sexually abusive individuals with developing skills, competencies, and values that will allow them to lead “good lives” that are incompatible with sex offending (Mann et al., 2004; Thakker et al., 2006; Ward & Fischer, 2006; Ward & Stewart, 2003). This is a change from the traditional approach to treatment that focused almost exclusively on deficits, problems, and lifelong risk management techniques (e.g., escape and avoidance goals) as a means of promoting long–term success.

Taken together, these emphases on more positive approaches to sex offender treatment can facilitate clients’ investment in the intervention process, minimize attrition from treatment, and ultimately promote successful completion of treatment. This is important because research demonstrates that adults and juveniles who complete sex offender treatment are less likely to recidivate than treatment non–completers (see, e.g., Hanson et al., 2002; Hunter & Figueredo, 1999; Lösel & Schmucker, 2005).

Therapeutic Climate in Facility–Based Treatment Programs

Ensuring a positive climate in sex offender treatment is important regardless of the setting. However, when programs are based within correctional, juvenile justice, or other residential facilities, administrators and staff must be especially mindful of environmental influences that can either enhance or undermine treatment efforts. Because they are able to observe and interact with clients across multiple contexts, at all hours, and on a daily basis, the correctional officers and youthcare workers within facilities can potentially play an important role in the overall treatment process.

If empowered through practical training and included as contributing members of treatment teams, they can provide clinical staff with invaluable information about behaviors that occur outside of the treatment setting, assist clients with practicing communication and problem–solving skills, reinforce and reward positive behaviors, and intervene when necessary to prevent problems from escalating. This type of involvement can enhance the integrity, generalizability, and sustainability of treatment within institutional and residential programs, and may mitigate some of the negative influences that can directly and indirectly undermine treatment (Fernandez & Marshall, 2000; Gordon & Hover, 1998). As noted previously, this is particularly salient within juvenile facilities, in light of the research that highlights the potential for negative outcomes when delinquent youth are aggregated in treatment programs and other settings (see Dodge et al., 2006). (For additional information about mitigating the impact of long–term placement, see the Reentry section of this protocol.)

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