A Project of the Office of Justice Programs, U.S. Department of Justice

Long Version
Section 3: An Overview of Sex Offender Treatment for a Non–Clinical Audience
Elements of Sex Offender–Specific Treatment
4 hours, 30 minutes

Lecture Topic TOPIC: A FRAMEWORK FOR THINKING ABOUT SEX OFFENDER–SPECIFIC TREATMENT
(25 minutes)

Use SlideUse Slide #4:Characteristics of Sex Offender–Specific Treatment

Introduction

First let’s look generally at the essential elements of effective sex offender treatment programs. What is done in treatment is not random or haphazard. Instead, treatment is based on an explicit, empirically–based model of change. What does this mean? It means that there is a philosophy that underlies the overall treatment program that can be described and is based on what has been learned through research. This treatment philosophy outlines how the sex offender’s behavior will change following treatment and how the treatment methods used will facilitate the changes in behavior. The primary methods used in sex offender treatment are based on a combination of a number of theories.2 This allows for a less narrow focus to treatment and ensures that we are considering behavioral, biological, behavioral, cognitive, socio–cultural, and other issues. Sex offender–specific treatment involves pro–social and life skills learning as a replacement for dysfunctional, anti–social learning.

Treatment Addresses Criminogenic Needs

As we discussed in the first section of this training, it is essential that sex offender treatment focus on criminogenic needs. That is, since our purpose in sex offender treatment is not to enhance the well–being of the offender but rather to make our communities safer, treatment must address the factors that lead people to commit sex offenses. This isn’t always as easy or straightforward as it sounds, as we will see when we get into the specific cognitive–behavioral sex offender treatment components. But wherever possible, sex offenders’ criminogenic needs should be the beacon that guides treatment.

Use SlideUse Slide #5:What Methods are Effective?

Treatment Strategies

What sex offender treatment methods have been found to be most effective? As we’ve discussed already, a variety of therapeutic methods have been used with sex offenders over the years, and the one type that has emerged as the most consistently effective in reducing recidivism is a group of interventions described as cognitive–behavioral.3

Cognitive–behavioral treatment for sex offenders is mental health treatment that focuses on changing both how offenders think and how they behave. With respect to its cognitive dimension, cognitive–behavioral treatment identifies and challenges thinking errors and assists offenders to replace those errors with correct thinking.

With respect to behavior, this treatment is skills oriented. It provides opportunities for offenders to practice and develop skills and pro–social behaviors that are in line with correct (or pro–social, non–abusive) thinking. In the case of sex offenders, cognitive–behavioral treatment focuses on correcting the thinking errors that help convince them that their sexual offending is acceptable and assists them to integrate behaviors into their daily lives that are pro–social and non–abusive.

But what about treatment strategies? Since we’re treating adults, principles of adult learning theory are utilized in sex offender treatment to enhance its effectiveness. Adult learning theory, which has a strong basis in research, is the most effective method for adults to learn new information and skills.4 Although adult learning theory is a complex specialty unto itself, the basic assumptions related to sex offender treatment are that adults learn best when the material being presented is relevant to them in their daily lives, allows them to come to their own conclusions rather than being told what to think, provides opportunities to practice new skills, and reinforces content with material presented through multiple methods (oral, visual, etc.).5

We also know from a good deal of educational psychology research that people learn better when they are rewarded for things they do well rather than being punished for things they do poorly.6 Although rewarding bright young students in the classroom comes easily to most of us, our inclination with sex offenders can be just the opposite, namely to look for opportunities to punish them because their offenses are so harmful. Additional research supports the use of positive reinforcement. I’m sure many of you are familiar with the work of Paul Gendreau and his colleagues in Canada in the mid–1990s. Gendreau’s (1996) research quantified the importance of positive reinforcement with the general offender population. He found that programs that provided four positive reinforcements to every one negative reinforcement were far more successful in their work with offenders. This benchmark of 4:1 has important implications for our work with sex offenders as well. Although being punitive might satisfy our desire for revenge or our feelings of helplessness against sexual assault, the most effective sex offender treatment interventions put aside these understandable but dysfunctional intervention styles and instead emphasize positive reinforcement with sex offenders and avoid being punitive.7

In a similar vein, it can be satisfying to the treatment provider who is in an undisputed position of power to confront sex offenders in an aggressive fashion when they rationalize their offending behavior or blame their sex offending on their victims (see, e.g., Beech and Fordham, 1997; Beech and Hamilton-Giachritsis, 2005; Bumby, Marshall, and Langton, 1999; Marshall, 1996, 2005; Marshall, et al., 1999, 2002, 2003). But research has taught us that people learn more effectively and are more likely to change their behavior when their beliefs are questioned in a non–confrontational way. That is, when offenders are afforded respect, not attacked or made to look stupid, and questioned in a thoughtful way, they are more likely to come to their own conclusions about the errors in their thinking. Such a process is much more likely to result in long–term, authentic change in offenders’ thoughts and behaviors (rather than teaching offenders to parrot back what they know the treatment provider wants them to say).

Thus, sex offender treatment emphasizes selective reflection of responsible remarks from offenders and praise for positive comments and behavior. Effective treatment providers avoid telling sex offenders what they should think—which typically does not result in changing people’s minds. Instead, treatment providers engage offenders in Socratic questioning that guides them through their own reasoning processes to pro–social conclusions. A Socratic question is one which is open–ended, cannot be answered by a yes or no, and requires the person answering the question to think to formulate an answer. Such a question is, for example, “Knowing what you know from having been sexually assaulted yourself as a child, what might your victim be experiencing now?”

Use SlideUse Slide #6: Treatment is Skills Oriented

Treatment is Skills Oriented

Effective sex offender treatment is skills oriented. That is, it helps offenders learn specific skills to avoid sex offending and to engage in activities that don’t harm others. This may seem so self–evident that stating it is unnecessary. But some sex offender treatment programs primarily teach offenders information, such as why they commit sexual assaults, but they don’t adequately teach specific skills and strategies for avoiding recidivism. Skills oriented treatment includes:

  • Defining the skill;
  • Identifying the usefulness of the skill;
  • Modeling the skill;
  • Practicing the skill;
  • Giving feedback; and
  • Practicing the skill again.

Although sex offenders benefit from knowing why they do what they do, the most important learning is how to avoid committing sexual assaults again (see, e.g., Becker and Murphy, 1998; Laws, 1989; Laws, Hudson, and Ward, 2000; Marshall, et al., 1999; Pithers, et al., 1983; Salter, 1988; Ward, Laws, and Hudson, 2005). These “how to’s” are an essential part of sex offender treatment. For example, offenders need to know how to avoid putting themselves in situations that might place them at risk for committing another sexual assault, or how to solve their problems in ways that reduce, not escalate, their anger.

Use SlideUse Slide #7: How Long Should Sex Offender Treatment Last?

Note: Ask participants to call out what they believe to be an appropriate duration of sex offender treatment.

Optimal Length of Treatment

Ask Questions How long should sex offender treatment last? There has been much discussion about the length of time sex offenders should be required to participate in treatment. As we’ve seen, even among this audience, there is disparity of opinion on this question. At one extreme are those who believe that sex offenders should remain in treatment for the remainder of their lives; at the other, there are those who think a year or two of weekly treatment should suffice.

Until recently, this has been an opinion–based argument, but now we have some research that provides us with evidence to inform our decisions. We have one study completed by Dr. Anthony Beech and his colleagues in England.8

The study seems to support the general proposition that sex offenders with higher levels of sexual deviancy and denial require longer and more intense treatment to generate reductions in recidivism. However, the specific findings on length of treatment from this study are preliminary and have not yet been replicated by other studies, so caution should be used in applying the findings. What is important to recognize, however, is that the length of treatment is best determined by the specific needs of each offender and the risk that they present to the community (see, e.g., Association for the Treatment of Sexual Abusers, 2005; Becker and Murphy, 1998; Marshall, et al., 1999; Marshall, Fernandez, Hudson, and Ward 1998; McGrath, Cumming, and Burchard, 2003; Ward, Laws, and Hudson, 2003). That is, rather than assigning the same treatment requirements to all sex offenders, a better approach considers sex offenders’ reoffense risk, degree of sexual deviancy and denial, and other factors particular to each individual, and uses this information to develop a specific treatment plan.

Note: Elicit answers to questions, promote audience discussion.

Ask Questions What implications do you think this should have for sentencing? For community supervision? For prioritizing which offenders should be assigned to treatment groups if there are not enough treatment openings for all sex offenders? For community notification? For home visits, electronic monitoring, and polygraph testing for rules compliance?

Use SlideUse Slide #8: Monitoring and Quality Control of Treatment are a Must

Monitoring and Quality Control of Treatment Programs are a Must

An excellent treatment program has provisions for ongoing monitoring of its activities, both of its programs and its clients.9 This means that while the treatment program might be well constituted and designed, it should be scrutinized by informed evaluators from time to time to ensure, for example, that the treatment methods and styles utilized are truly consistent with the agency’s treatment philosophies. It is all too easy for treatment methods to “drift” away from the best intentions of the program design because treatment providers each have their own idiosyncratic methods. Regular monitoring of programs also helps to ensure that programs are in accordance with best practices.

Of course just as programs need to be monitored, so do the sex offenders in them. This should take many forms. An example is that sex offenders’ progress should be measured from time to time throughout treatment, not simply at the close of treatment in a “final exam” fashion. Variables in the offender’s environment can increase or reduce his risk, such as changes in his access to potential victims.10 Compliance with probation supervision, return to drug abuse, new relationships, job changes, and so forth, can and do affect an offender’s risk.11 The risks and needs of many sex offenders change over time, and ongoing monitoring is necessary to recognize and respond appropriately to these changes.12