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Long Version
Section 4: Lecture Content and Teaching Notes
Sex Offender Specific Treatment in the Context of Supervision

2 hours

(10-15 minutes)


Use Slide # SymbolUse Slide #2: Effectiveness of Treatment
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As one might imagine, great interest and controversy surround sex offender treatment. And as you also might imagine, it is a very difficult area to study. Data are poor, programs vary tremendously, requirements for truly valid research designs (e.g., random assignment of subjects to treatment and nontreatment groups) are difficult to meet, etc. There is also a problem in terms of how recidivism is defined (rearrest, reconviction, etc.) and how long the subjects are followed. This is further compounded by how notoriously underreported all sex offenses are. Nonetheless, to quote Marshall and Pithers,1 "There are clearly, on all indices of treatment outcomes, good grounds for optimism about the value of the more recent comprehensive cognitive-behavioral treatment programs." English2 provides a synopsis of Marshall and Pithers' review of treatment outcome studies that were conducted between 1988 and 1994 that included control groups:

  • Child molesters who victimized outside the family and who received treatment had lower recidivism rates than a matched sample of untreated molesters.3
  • Father-daughter child molesters who received treatment had lower recidivism rates than a matched sample of untreated molesters.4
  • Exhibitionists who received treatment had lower recidivism rates than a matched sample of untreated exhibitionists.5
  • One recent study using a control group is showing a treatment effect with rapists but not with child molesters (the number of subjects in this study is small, so treatment effects are difficult to detect).6
  • In other studies, reductions in recidivism rates are consistently greater for child abusers than for rapists.7

Use Slide # SymbolUse Slide #3: Review of the Research
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M.A. Alexander analyzed 74 studies in 1994 and concluded that individuals who had received treatment had consistently lower recidivism rates than untreated individuals. She also found that recidivism rates seemed to decline in studies conducted after 1980, suggesting an improvement in treatment methods in recent years, or more effective evaluation methods, or both.8 Other findings from Alexander's review suggested that treatment over a long period of time may be needed in order to be effective, that completing treatment (rather than dropping out) seems to be important in sustaining treatment effects, and that mandatory treatment may be even more effective than voluntary treatment. Recently, Alexander (1999) conducted an analysis of a large group of treatment outcome studies, encompassing nearly 11,000 sex offenders. In this study, data from 79 sex offender treatment studies were combined and reviewed. Results indicated that sex offenders who participated in relapse prevention treatment programs had a combined rearrest rate of 7.2 percent, compared to 17.6 percent for untreated offenders.9

A number of researchers have also observed that the research is inconclusive-that there are so many problems in how studies are designed, that it is difficult to know whether or not treatment is effective. Some of the most common studies that are cited on these points include Furby et al., (1989) and the GAO Report (1996) and they reach similar conclusions:

  • There are serious methodological problems with the studies that have been conducted;
  • There is no evidence or it's inconclusive that treatment reduces recidivism; and
  • Current programs may be more effective than those that were studied in the past.10

Use Slide # SymbolUse Slide #4: Review of the Research
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David D'Amora, in reviewing literature, cites a 1991 U.S. Department of Justice study that found the recidivism rate of untreated sex offenders to be about 60 percent within 3 years of release from prison. Recidivism rates of those sex offenders who have completed a specialized treatment program are between 15 and 20 percent. In other words, untreated sex offenders appear three or four times more likely to recidivate than untreated offenders.11

Use Slide # SymbolUse Slide #5: Review of the Research
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Recent reviews of the research support these basic findings. Grossman et al. (1999) found "a reduction in recidivism of 30 percent over seven years, with comparable effectiveness for hormonal and cognitive-behavioral treatments."12 Gallagher et al. "quantitatively synthesized the results of 25 studies evaluating the effectiveness of different types of treatment for sex offenders. Cognitive-behavioral approaches appear particularly promising while less support is found for behavioral, chemical, and general psychosocial treatment."13 Polizzi et al. (1999) evaluated 13 studies that met criteria for scientific merit and were based on research completed in the past 10 years. They found "Non-prison-based sex offender treatment programs were deemed to be effective in curtailing future criminal activity. Prison-based treatment programs were judged to be promising." Cognitive-behavioral programs appear to be the most effective.14

Use Slide # SymbolUse Slide #6: Review of the Research
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A 1995 meta-analysis of sex offender treatment outcome studies found a small, yet significant, treatment effect (Hall 1995). This meta-analysis included 12 studies with some form of a control group. Despite the small number of subjects (1,313), the results indicated an 8 percent reduction in the recidivism rate for sex offenders in the treatment group.15

In summary—

  • A large number of studies of treatment effectiveness have been conducted, many of them so poorly designed that it is difficult to draw any conclusions from them;

  • Use Slide # SymbolUse Slides #7-8: Summary of Research on Treatment Effectiveness
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    Well-designed studies clearly indicate that treatment interventions are associated with lower rates of recidivism—some of them very significant;

  • Treatment outcomes may differ by type of sex offender;

  • There is some evidence that greater reductions in recidivism are found in more recent studies, perhaps associated with increasingly effective treatment and/or evaluation techniques;

  • Analytic or insight oriented therapies are not effective;16

  • Cognitive-behavioral approaches appear most promising, and a combination of educational, cognitive-behavioral, and family system interventions can be effective;17 and

  • When all studies are reviewed, we can conclude generally that sex offender treatment reduces sexual recidivism about 10 percent. The generally accepted recidivism rate for all untreated sex offenders is about 30 percent compared with a recidivism rate of about 20 percent for treated sex offenders.18

Use Slide # SymbolUse Slide #9: Effectiveness of Treatment Plus Supervision
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A few studies support the effectiveness of a combination of specialized supervision and sex offender-specific treatment (with or without the polygraph).19 Agencies that have moved to a Containment Approach are hopeful that the combination of these three resources will prove significantly effective in reducing re-offense rates. An evaluation currently underway of the program in Maricopa County, Arizona, which incorporates all three elements of the Containment Approach, is showing promising results with single-digit rates of re-offense (although this does not include some offenders who were returned to prison as a result of technical violations).20