Section 4: Treatment
2 Hours

Lecture Topic TOPIC: TREATMENT

Part IV: Common Treatment Targets

Broadly speaking, these issues have become common targets of treatment primarily because they are thought to be related either to the initiation of sex offending behaviors, related to the continuation of sex offending behaviors in the future, or both.49 And as we just discussed, many of these targets are designed to increase adaptive, healthy, and prosocial functioning overall—not just in terms of a youth’s sexual behaviors. As such, you will also note that the words “sex” or “sexual deviance” do not appear in most of the items on this list.

Common Treatment Targets

Broadly speaking, the common targets of treatment have become common targets of treatment primarily because they are thought to be related either to the initiation of sex offending behaviors, or related to the continuation of sex offending behaviors in the future, or both.

You will recall that when we reviewed potential etiological factors—as well as the kinds of risk factors that are believed to be related to recidivism—a wide range of issues were listed. So, you won’t be surprised to see that many of these same areas, and some additional ones, translate into common treatment targets for these youth. And as we just discussed, many of these targets are designed to increase adaptive, healthy, and prosocial functioning overall—not just in terms of a youth’s sexual behaviors. As such, you will also note that the word “sex” or “sexual deviance” do not appear in most of the items on this list.

Use SlideUse Slide #16: Common Treatment Targets

Responsibility–Taking

Of course, treatment programs for juvenile sex offenders focus on helping the youth take responsibility for his or her sex offending behaviors. It is hard to imagine that a youth can learn how to manage their sexual behavior problems—or any other problem behaviors, for that matter—if they don’t first acknowledge that they have engaged in the behavior.

And again, it is common for youth to present to treatment professionals with some form of denial, such as denial that they engaged in the behavior at all, or a certain aspect of the offense. Or they may blame other people or other things for their offending behaviors, rather than taking full responsibility. So, offense accountability becomes an important focus of treatment.

Cognitive Distortions or Thinking Errors

Similarly, the majority of treatment programs for juvenile sex offenders address thinking errors, or cognitive distortions. In other words, even though many youth who commit sex offenses are probably aware that these kinds of behaviors are illegal or harmful, they engage in the behavior anyway. In order to do so, these youth often distort their thinking—beforehand, during, and afterward—to give themselves “permission” to commit the offense, to feel “okay” about doing something that they know is wrong, and to avoid considering the harm they are causing. These cognitive distortions take the form of minimizations, excuses, justifications, and rationalizations.

It is important to note that cognitive distortions are not unique to juvenile sex offenders or to sex offending behaviors. Rather, we all use cognitive distortions to allow ourselves to engage in certain behaviors, like “cheating” on a diet, driving in excess of the speed limit, or coming in late to work. For example, what are some cognitive distortions that you have used to allow yourselves to drive in excess of the posted speed limit?

(ALLOW FOR AUDIENCE RESPONSES.)

Yes, those are some very good examples. And again, it highlights that using cognitive distortions is a common practice for all of us. The key is to help youth identify these distorted ways of thinking, help them understand why they use cognitive distortions, and help them identify more adaptive and healthy ways of thinking.

Victim Empathy

Another similar emphasis in treatment involves victim empathy enhancement. This component of treatment is designed to assist youth with recognizing the short–and long–term impact of their abusive behaviors on victims and others. Part of victim empathy enhancement involves helping youth identify and anticipate emotions in others, engage in perspective–taking exercises in which they attempt to put themselves in the victim’s shoes, so to speak, and more fully explore the types of reactions and feelings that their victims may have experienced. It is believed that if youth understand the harmful impact of their behaviors, they may be deterred from engaging in similar behaviors in the future.

Additional Intra– and Interpersonal Skills

Since we know that many juveniles who commit sex offenses have difficulties with interpersonal and intrapersonal skills, treatment programs also commonly target issues such as social skills, anger management, stress management, and problem solving. This may involve teaching youth to become more assertive and self–confident, helping them manage discomfort in social situations, working with youth to identify healthy ways to express their emotions, and assisting them with managing conflict and solving the kinds of problems that may be encountered on a day–to–day basis.

Healthy Sexuality and Sex Education

In order to promote healthy sexuality, teach youth about sexual development, and provide important information about safe and responsible sexual practices, sex education is commonly provided in juvenile sex offender programs.

Relationship Skills

And along those lines, some programs provide interventions that are designed to help youth develop and maintain healthy relationships or enhance intimacy in relationships. Oftentimes, this involves helping youth recognize and understand that sex does not equal intimacy. Rather, intimacy is about closeness, sharing, emotional connectedness, and—in some ways—vulnerability. Helping youth learn to manage difficulties in relationships, such as jealousy and rejection, may be emphasized as well.

Healthy Masculinity

It is also important that adolescent males develop a healthy sense of masculinity, rather than holding more aggressive, hostile, and dominating beliefs about what it means to be a “man.”  Because some of these youth have been exposed to male-modeled violence and aggression, treatment programs should help youth “unlearn” the negative patterns of problem-solving, conflict resolution, and inequity in relationships.

Arousal Control

Remember that a key difference between adult and juvenile sex offenders is that deviant sexual arousal is less common among juveniles. That may be one reason that arousal control interventions tend not to be nearly as common as a target of treatment for youth in programs nationwide. Of course, for those youth who do appear to have deviant sexual interests or preferences, treatment programs will need to address them.

Trauma Resolution

Since a significant proportion of juvenile sex offenders have experienced trauma in their lives—for example, as a victim of physical, emotional, or sexual abuse themselves, or being exposed to maltreatment or domestic violence in the home—treatment programs for these youth often include interventions designed to address or resolve traumatic experiences.

It is important that a youth’s own experiences with victimization are not used as an “excuse” for his or her offending behaviors. It may be, however, that by addressing their own victimization, youth may be better able to consider the impact of their offenses on their victims. In addition, through trauma resolution interventions, these adolescents can learn to develop healthy ways of dealing with the unpleasant or negative thoughts and feelings, rather than resorting to unhealthy outlets for expressing their thoughts and feelings.

Family Functioning

Finally, a critical target of treatment involves the family. As you know, it is important to consider youth within the context of their families and environments, and make sure that treatment addresses any concerns or needs that are identified. For some families, treatment may be necessary to help parents, caregivers, and others deal with the shame, guilt, or other emotional reactions that are common to these circumstances. And for other families, a focus of treatment may be on increasing their abilities to enhance communication skills, establish firm structure and limits, provide adequate supervision, and maintain healthy boundaries. Also, because many youth commit sex offenses against younger family members, family interventions will need to take into account the needs and interests of the victim, the dynamics of the family as a whole, and the potential for family reunification.

Use SlideUse Slide #17: Treatment Targets in Programs Nationwide

So those are among the common targets of treatment for sexually abusive youth. And when we look at the data from the juvenile sex offender treatment programs across the country that responded to the most recent Safer Society Survey,50 it is clear that the vast majority of the responding programs address those very issues. But just because treatment programs offer interventions to address these needs or deficits, it does not mean that every youth should receive each of these interventions. The goal is to create an individualized treatment plan for each youth, and one that is based on good assessment information.

Process–Related Variables

Now that we’ve covered some of the important frameworks and content for treatment, I’d like to spend a few minutes talking about process-related issues. Remember, our style and approach when interacting with youth and their families can have either a positive or negative impact on their willingness to engage in assessment, treatment, and supervision processes. For example, as we discussed during the assessment section of this training, working hard to develop a trusting and respectful professional relationship—in contrast to an adversarial and harsh relationship that is based on the power of your position—can enhance the likelihood that the youth and his or her family will be willing to engage more fully in the process. And as a reminder, there are a couple of specific models of engaging clients—such as the Invitations to Responsibility and the Motivational Interviewing approaches—that can be helpful for tailoring your style to interacting with these youth and their families.51

Some of the same process–related considerations should be applied to our approaches to treatment, too, although for many years, some practitioners were not nearly as mindful of them. In fact, not all that long ago, it was fairly commonplace for treatment providers to use a very harsh confrontational style of interacting with sex offenders. Part of the underlying rationale seemed to be that sex offenders were incredibly resistant to intervention, and that in order to break through denial, get them to see how serious their crimes were, see the errors of their ways, and give them a “wake up” call, so to speak, it was assumed that the therapist needed to resort to an adversarial—and sometimes even shaming and hostile—approach. Perhaps there was a concern among professionals that using a more therapeutic tone might undermine the treatment process by minimizing the seriousness of the crimes and leaving the therapist vulnerable to manipulation by the offender.

Let’s take a moment to think about this approach. How might an argumentative, loud, shame–inducing, and aggressive style impact youth that we are trying to engage in treatment? What messages might we be sending to them? And what are we modeling?

(ALLOW FOR AUDIENCE RESPONSES.)

That’s right. Just from a rational or logical point of view, it doesn’t seem that this would be an effective way of getting youth to become interested or invested in treatment, let alone talk about some of their most personal and shameful experiences. And we can hypothesize that this kind of approach might impact their self–esteem and their views of others, and cause them to become more resentful, angry, and hostile themselves. And in fact, we would be modeling disrespectful—and even abusive—communication styles. Yet, these are some of the very areas that we are expecting youth to change!

Fortunately, there has been a growing recognition within the field that such an approach may not only be illogical and harmful—but also may result in poorer outcomes.52 And some fairly new research confirms just that, with researchers finding that sex offenders showed better gains in treatment when the climate was more therapeutic and when sex offender therapists used warm, empathic, and respectful styles—in contrast to the more cold, hostile, and rejecting types of approaches.53 For some reason—perhaps because of a perceived need to approach sex offenders differently—many sex offender treatment providers overlooked what the more general literature on therapeutic styles had been telling us for years. And it has taken several years, along with some specific research on these contextual variables in sex offender treatment, to draw attention to the importance of process and style with this population.

Use SlideUse Slide # 18: Process–Related and Contextual Variables

Another key process–related approach that is worth noting involves the way in which goals and expectations are structured for youth in treatment. Historically, treatment programs focused primarily on the negative attributes of individuals and the use of escape and avoidance strategies as a means of preventing further sexual behavior problems. I’m sure you can imagine that if all a youth hears about in treatment are the things that are “wrong” with them and what they are restricted from doing, they may feel frustrated, resistant, or even hopeless. So, more recently, experts in the field have been suggesting that it is very important to help youth identify positive goals—or approach goals—that can help youth identify healthy direction, purpose, and meaningful life goals as a key part of the treatment process.54 In so doing, treatment can help youth examine the kinds of attitudes, thoughts, feelings, and behaviors that have interfered with or can interfere with their ability to be successful and to attain these goals, and they can create strategies to address these barriers or obstacles.55 The inclusion of approach goals is also very important when developing supervision strategies, as we will discuss a little bit later.

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