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

(30 minutes)

Use SlideUse Slide #9:Treatment of the Denying Sex Offender


Before we move into our discussion of what constitutes good sex offender treatment, I’d like to address a question that inevitably arises in a discussion of sex offender treatment. Can you effectively treat a sex offender who is in denial? Denial is a pervasive issue when working with sex offenders, and the presence of denial does not, in and of itself, preclude effective treatment.

Note: Elicit ideas from audience, capturing them on a flip chart or white board.

Why is denial such a concern?

Ask Questions

Denial is a major concern because most sex offender treatment is predicated on the offender’s admission that he committed sexual assaults and that these behaviors are a problem for him.13 If a convicted sex offender assumes the position in treatment that he did not commit any sex crimes, then whenever issues are discussed in treatment group meetings, such as cognitive distortions, deviant arousal, and offense cycles, the denying offender simply states that these concepts don’t apply to him. This precludes his addressing his problems, and often interrupts the therapeutic process for the other sex offenders in the group who are admitting their sex offense histories. A corollary concept related to the importance of sex offenders’ taking responsibility for committing sexual assaults is that by implicitly acknowledging that they chose to commit sexual assaults, they can make other choices, namely not to commit future sexual assaults. Sex offender treatment emphasizes that people can change; failure to admit problems provides no impetus to change.

Therefore, before sex offender treatment can be effective, the offender must admit his offense history, at least in part.14 We view treatment of denial essentially as pre–treatment; not all sex offenders need it. However, those who do must substantially abandon their denial in order to benefit fully from sex offender treatment.15

Interestingly, the largest study of factors that predict risk for sex offender reoffense, the Hanson and Bussiere (1998) meta–analysis mentioned earlier, found that sex offenders who denied their offenses were not any more likely to commit additional sexual assaults than those who admitted their offense histories. This suggests that denial, per se, does not render a sex offender more dangerous. However, since treatment reduces recidivism risk in most offenders, and overcoming denial is the gateway to treatment, effective denial reduction is important not because denial predicts recidivism but because coming out of denial allows sex offenders’ access to treatment that, in turn, reduces recidivism risk.

Today we will discuss two approaches for addressing denial—the polygraph and group treatment.

Use SlideUse Slide #10: Tools for Addressing Denial

Addressing Denial—The Polygraph

Denial in sex offenders can be addressed in a number of ways, including the use of polygraph examinations.16 If he denies the crime and the polygraph examiner determines that he is being deceptive, compelling evidence of his culpability is available to challenge his denial. Many offenders abandon their denial when challenged with these test results.

Addressing Denial—Group Treatment

In situations where treatment providers do not have ready access to the polygraph, there are other methods for addressing denial in sex offenders. Usually such methods utilize a group setting.17 In some instances, treatment providers opt to include one or two deniers in an advanced treatment group composed of individuals who have broken through their denial. Others favor working with a treatment group composed entirely of individuals still in denial.

In this curriculum, we will examine this latter approach—the use of a “deniers group” to reduce denial in sex offenders, thus enabling them to be candidates for conventional sex offender treatment. Treatment providers who employ this method report that the great majority of offenders are able to come out of their denial. This approach targets two major issues:18

  • Eliminating cognitive distortions—which, left intact, allow offenders to continue denying or minimizing; and
  • Developing victimization awareness—which can allow offenders to understand the physical and psychological harm they inflict and, thus, render them more reluctant to commit future assaults.

This approach involves a number of techniques geared toward reaching these major issues.19 They may include:

  • Forming a treatment group composed exclusively of individuals who have been convicted of a sex offense and who are in substantial denial (either of committing the offense at all or of having actually harmed the victim as a result of the offense). Another entry requirement for the group is that offenders may not have their cases on appeal, as such offenders are usually advised by counsel to admit nothing.
  • Facilitation of the group by the treatment provider to introduce ideas, suggest discussion topics and activities, praise progress, and ensure that the group remains positive.
  • A time–limited intervention—typically these groups meet for a period of 12–16 weekly sessions of about 90 minutes duration each.
  • Articulating the assumption that denial is a normal reaction for those involved in sexual offending behavior and the reasons for that denial.
  • Focusing on both the benefits and the costs of denial—and of disclosure.
  • Not allowing offenders—initially—to discuss their own offenses (so they do not become solidified in stated denial).
  • Allowing the group itself to identify the cognitive distortions often employed by sex offenders in order to access and assault their victims through role–plays and discussions of what “other” offenders tell themselves in order to convince themselves that their behavior is okay.
  • Utilizing videotaped or live statements of sexual assault victims to communicate to offenders the nature and extent of the trauma suffered by victims.
  • Inviting sex offenders who were formerly deniers to visit the group. They describe the reasons for their initial denial, the reasons they decided to admit, and a description of their sexual offenses.
  • Allowing group members—as the culmination of this 12–16 week process—to describe their offense history.

A major concern of the group members is often about what other group members will say about their discussions when they are not in the group. One way to address this concern is to ask the group participants to come to an agreement about their own confidentiality, and in virtually every instance, the agreement they make among themselves is that what is discussed in group does not get discussed outside of group, as it pertains to anyone besides the person talking. Typically, it is best to have the group members come to this agreement among themselves rather than imposing such rules on them for three reasons. First, it is a simple way to begin their involvement in a discussion they are likely to understand and be interested in, without discussing any threatening content such as sex offending. This provides practice for what will be occurring in the group. Second, it requires that the group build cohesiveness and trust among its members, at least about this issue. Building trust among themselves can be a useful exercise because it leads to group members sensing that they can be helpful to each other. Finally, compliance with confidentiality agreements is more likely to occur among people who devise the agreement themselves than those for whom such rules were imposed.

Most of what occurs during group sessions is discussion among the participants. The facilitators’ (or treatment providers’) primary function is to introduce ideas, suggest discussion topics and activities, praise progress, and most importantly, ensure that the therapeutic milieu remains pro–social.20 By this we mean that it is essential that as the group progresses, group members feel they will be rewarded—principally by other group members—for admitting their sexual assaults, which often is different from most of their previous experiences.

Note: Ask audience; note answers on board.

Ask QuestionsFacilitators begin the “denier group” treatment by talking about definitions of and the continuum of denial, asking group members to define what is meant by denial, followed by a discussion of the degrees of denial that range from complete denial, such as “I wasn’t even in the house at that time,” to minimization. How would you define denial? What about minimization? What might be examples of sex offender minimization? Examples of substantial minimization include offenders who say they can’t remember anything about their offenses, but don’t deny that they might have occurred.

Next the facilitators turn the discussion to how denial is commonplace and normal in human experience. Examples of denial and minimization, unrelated to sex offending, are elicited from the group. Common examples are people who know smoking is harmful but continue to smoke, people who say they want to lose weight but continue to overeat, traffic law violations such as speeding, and so forth. The purpose of such normalization of denial is to acknowledge to the offenders that their having denied isn’t unusual or difficult to understand. Offenders find this supportive, which in turn promotes their being more willing to risk acknowledging their offense histories.

Use SlideUse Slide #11: Treating Denial Focuses on its Complexity

Facilitators then guide the discussion to the purposes of denial, that is, the advantages and disadvantages of it. The group is asked to list the advantages of denying having committed sexual assaults, which are written on a board by the facilitator, followed by a list of disadvantages. Typically the offender–generated list of advantages of abandoning denial is much lengthier than the list of advantages to maintaining denial. The purpose of this exercise is for group members to begin to consider what they might have to gain by admitting their offenses, although this is not overtly discussed at the time. Consistent with adult learning theory, group members participate in experiences that help them draw their own conclusions, rather than being told what to think.

Next the discussion is directed to the varying pressure to deny that people feel according to the magnitude of the matter in question (whether people are less likely to deny having done something wrong if it is a fairly trivial thing, such as driving a few miles over the speed limit, versus a very major thing, such as speeding resulting in hitting and killing a child with one’s car, for example). Of course the group members quickly observe that the latter would be much more difficult for the responsible party to admit. They are asked by group facilitators to account for the difference since both involved the same action by the driver—speeding—and the typical answer relates to the consequences of the action. When asked to compare this to the pressure to admit or deny having committed sex offenses, group members readily agree that because society views sex offending as such a serious violation, the pressure to deny is great. The purpose of this exercise is to acknowledge that denying having committed sexual assaults is not surprising; its dysfunctional aspects will be addressed in subsequent group discussions. As in previous interventions, offenders find this supportive, which in turn encourages them to be willing to relinquish stubborn adherence to denial.

Next, group facilitators initiate a more comprehensive discussion of denial by asking the group to consider and suggest examples of denial in three phases of sex offending: before the offense, during the offense, and after the offense.

Note: Capture examples on flip chart or white board. Ask participants for reactions.

Ask QuestionsWhat are some examples of denial that sex offenders might employ before the offense? During the offense? After the offense?

Group members often volunteer examples of before–offense denial such as “I’m not really going to be sexual with him; I’m only taking him camping,” or “I’m just driving around because I like to drive,” denying that the offender’s real purpose is to isolate a victim to rape. Examples of during–sex offense denial include “I’m not physically hurting her so I’m not really harming her” and “She didn’t really say no, so she must be liking it.” Examples of after–offense denial are “This is the last time I’ll do that—never again,” and “He hasn’t reported the assaults, so he must have liked it.” Often group members offer as examples of denial the very denial they have engaged in themselves, although they don’t typically identify their examples as such, nor do facilitators (or group members) observe when this appears to be the case. Facilitators typically notice these examples and consider them as additional information about this individual. The overall purpose of this discussion is to broaden offenders’ recognition of denial as not simply a matter of whether one admits having committed sex offenses but also that denial can be used in many aspects of sex offending.

A Technique to Address Cognitive Distortions Regarding Informed Consent

A major component of many sex offenders’ denial is not simply that they say they did not have sexual contact with their victims, but that their victims were in fact “partners” because they gave consent. This is a common facet of denial for many offenders, both those who commit acquaintance rape and those who sexually assault minors. Therefore, the concept of informed consent is discussed at length both in sex offender denial treatment as well as in conventional sex offender treatment.

Although there are many ways for the concept of informed consent to be explored, we’ll illustrate one such method. In this intervention, a facilitator turns to a randomly chosen group member and asks him to sign a piece of paper that purportedly will grant the facilitator permission to perform a pre–frontal lobotomy on him. Of course the group member refuses. Feigning surprise, the facilitator asks the group why this group member would not sign the consent. Answers given typically include that the group member couldn’t possibly give such consent because he doesn’t even know what a pre–frontal lobotomy is. In reply, the facilitator says, “Oh, it’s brain surgery,” then leans over toward the group member who refused to sign the imaginary form and asks, “Now will you give me permission?” Of course, the group member refuses again. The facilitator then turns again to the group and asks them why they think this group member still refuses to give his consent. This typically generates many replies, including that the group member doesn’t know why he should allow this surgery, why the facilitator thinks he needs it, what qualifications the facilitator has to perform such surgery if he needed it, what the likely benefits and costs might be, and so forth. After these comments are made, the facilitator observes that it appears the group believes that in order for someone to give consent, that person needs a great deal of information. The group readily agrees, because in fact they demonstrated this with their comments.

The facilitator then observes that when people engage in sexual behavior with each other, a similar dynamic exists, namely that in order to give consent, both persons need to know what they are consenting to. Indeed, largely because adults have a lot of information about sex that children typically don’t, laws exist to prohibit adults from having sex with children.

Use SlideUse Slide #12: Methods to Address Cognitive Distortions

The facilitator then performs a role–play demonstration to illustrate this point. This role–play avoids the hazards of lecturing on the topic that often is ineffective and can be sidetracked by challenges to the merits of laws prohibiting sex with minors, arguments that many adolescents are sexually experienced and, therefore, can give consent. As the role–play begins, the facilitator stands next to an empty chair and asks the group to imagine that in the chair is an 11–year–old boy. The facilitator tells the group that he will be playing the role of a sex offender who believes what the group just concluded, namely that in order for children to give consent to sex, they must have a great deal of information. As a child molester who believes in children’s right to consent, he will be telling the child what he needs to know about having sex with him, then ask him if he wants to have sex.

Standing next to the empty chair, the facilitator speaks loudly enough for the group to hear as he looks at the imaginary child in the chair and says,

Johnny, I want to talk with you about something. I want to have sex with you.

You look puzzled. Let me tell you what I mean, and what I hope we’ll be doing. I know that you like to be with me, to come over to my house, and for us to do stuff together. You’ve been coming over here after school now since October, right? You like to play my video games, drink the Mountain Dew I always keep in the refrigerator for you, stuff like that, don’t you?

I know that you really like me, and I’ve acted like I really like you. I don’t actually like you that much, but I’ve pretended that I do, and I think that’s made you feel really good. It’s not that I don’t like you, it’s that if I get you thinking I like you really a lot, then you might be more willing to do what I want you to do.

Anyway, let me tell you about what I’m hoping will be happening between us.

The instructor then proceeds to explain to the mythical child exactly what having sex with him means, graphically describing the physical act, describing the consequences he (the offender) will suffer if anyone finds out about it, and the great lengths he will go to in order to avoid being discovered and punished. This, of course, involves making the child out to be a liar if he were ever to disclose the behavior. He also goes into great detail about what the child will have to face should he have to go to court and all the different people who will know about what has happened. He also describes in detail how the child will feel—including physical pain, feelings of guilt and isolation—immediately after the abuse and later, as an adult. He goes on to indicate that, when the child grows to the age of puberty, this experience may have longer–term consequences on his comfort with his adult sexuality. He concludes…

So, Johnny, now that you know about all this stuff, would you like to have sex with me?

After this role–play demonstration, the facilitator asks the group for their reactions. Typically, there is considerable discussion about the fact that no child would voluntarily have sex with an adult. The facilitator points out that the information given to the child in the role–play is the information that most adults know. That is, by the time people become adults, they have learned about sex, about how people get other people to have sex with them, and so forth. But kids don’t know this information and, therefore, in order to give consent, they need just as much information as an adult typically has in order to give consent to sex. In fact, children need even more information because they are in an inferior power position to adults in other ways as well.

Use SlideUse Slide #13: Methods to Address Cognitive Distortions (cont.)

Another Approach to Addressing Cognitive Distortions

Other concepts that are introduced during the course of this 12–18 week series of group sessions include sexual boundaries and cognitive distortions. As is the case with other concepts such as informed consent, there are many ways to present this material to sex offenders. One such method will be detailed here to illustrate how this work can be done.

A group facilitator asks the offenders in the group to think about how a sex offender might complete the sentence, “Even though I knew my sex offenses are wrong or at least illegal, what I said to myself to make it seem okay was _____________________.” Since at this point in treatment the denial group members have not been asked to reveal their offense histories, they are not asked what excuses and cognitive distortions they used personally; instead they are asked to suggest what excuses other offenders might use to justify their behavior. Of course the cognitive distortions group members give are those that come to them most readily, typically ones they have used themselves.

Common examples include the child wanting sex, that the child is old enough to have sex, that women like to be forced sexually, that the sex is okay because the offender loves the child, and the offender promising himself that he won’t do it again. Group members tend to readily identify what is wrong with the various justifications, especially those of others because they recognize these rationalizations as well or better than most people.

Following this exercise, the group facilitator inquires of the group the purpose of these cognitive distortions, that is, why sex offenders use them. Some group members typically understand and can explain that people justify their misbehavior to enable them to continue to do it because it brings them pleasure. Finally, the facilitator asks the group to discuss whether any of these cognitive distortions—or even all of them together—justify or make sex offending acceptable. Typically among group members there is unanimous agreement that they do not.

Use SlideUse Slide #14: Increasing Victimization Awareness

Increasing Victimization Awareness

As we’ve already observed, most sex offenders don’t enjoy harming their victims; nonetheless, they cause trauma because they selfishly use their victims as objects and they disregard the harmful effects they cause. The exceptions to this are sexual sadists, who derive erotic arousal from causing victims to suffer, and psychopaths, who are indifferent to others’ discomfort. Therefore, it may not be appropriate to include sexual sadists or psychopaths in the following treatment component—victimization awareness and empathy.

The overarching purpose in increasing victimization awareness and empathy with sex offenders is the belief that if they come to understand the harm they cause, primarily psychological harm, they will be more reluctant to commit future sex offenses because they will find it more difficult to disregard the consequences of their actions to their victims and others.21 Research suggests that many sex offenders don’t have generalized empathy deficits; rather they have empathy deficits related specifically to their sex crimes and victims.22 Therefore, the development of victimization awareness and empathy needs to be quite specific to their own sexual assault behavior.

Victimization awareness is a component of sex offender treatment for offenders in denial for the above reasons and because many sex offenders deny that their victims were truly victims, that is, they fail to see the harm done.23 By coming to understand such harm, they are more likely to view themselves as sex offenders and less as misunderstood lovers. This revised definition of their behavior makes it more likely that they will come to acknowledge what they have done, because they no longer see themselves as misunderstood victims of “the system” but instead people whose sexual behavior has harmed others.

Use SlideUse Slide #15: Methods to Address Victimization Awareness

Victimization awareness can be addressed in treatment groups in a variety of ways. First, by showing videotaped programs of sexual assault victims describing how they have been traumatized by sex offenders and second, by a live version of that—namely having actual adult survivors of sexual assault visit the group to describe their experiences of trauma.

The obvious advantage of using videotape material is its accessibility and control—group facilitators choose the audiovisual materials carefully and they know exactly what the content will be. On the other hand, the advantage of live sexual assault survivors is that their presence is much more powerful than videotape, and there can be interaction in the form of questions and answers between the offenders and the survivors. (These, of course, are always volunteers who have worked with offenders before. Sex offender treatment group facilitators can locate potential volunteers by contacting treatment providers at treatment facilities for sexual assault survivors.)

The purpose of the group meeting involving sexual assault survivors is not to enable aggressive confrontation or anger. Instead, it is to provide a forum for important education and thoughtful discussion, which occurs when the intervention is carefully organized. The intervention takes considerable therapeutic skill on the part of the group facilitators to set up the necessary expectations, requirements including mutual respect and boundaries, and so forth. Sex offenders and survivor volunteers alike almost always report that the experience was powerful, instructive, and important for their growth and understanding.

Use SlideUse Slide #16: Involving Sex Offenders Formerly in Denial

Note: Elicit answers to question, focusing on pro–social role modeling effects

Involving Sex Offenders Formerly in Denial

The next component of treatment of sex offenders in denial involves a visit to the group by sex offenders who formerly were in denial but now admit their offense histories.

Ask QuestionsWhy do you suppose this might be a valuable component of treatment for sex offenders who are in denial?

These sex offender visitors are carefully chosen by the group facilitators; often they are “graduates” of previous sex offender denial treatment groups. In this group session, the visitors describe to the group members how they initially denied having committed their offenses, sometimes for years after they were convicted; how they came to abandon that denial and admit to their assault histories; and how doing so has been positive for them. These men become role models for the denial group members, essentially suggesting, “If I can do it, then so can you.”

Use SlideUse Slide #17: The Culmination of Denier’s Treatment

The Culmination of Deniers Treatment—Providing a Sexual Offense History

The interventions described thus far have consumed most of the 12–16 weekly meetings of the deniers group. As we discussed before, until this time the group members have been prohibited from talking about their own offenses. The last phase of the group process is to have each participant take his turn describing his offense history.

As the various group members take their turns describing their offenses, the earliest volunteers are the most forthright and the last volunteers are the most reluctant to admit. Sex offender treatment providers who conduct this sort of group therapy for deniers find that usually about 80% of the group members admit to the offenses they were convicted of, which is sufficient to make them eligible for sex offender treatment. Treatment providers take different approaches to those offenders who persist in denial even after they have received significant therapy to assist them to break through denial. Some proceed to use the polygraph, or provide another opportunity for these offenders to participate in deniers treatment, citing instances of success in breaking through denial after a subsequent treatment experience. Others no longer consider such offenders candidates for treatment. Of course, the implications for community safety will depend in part on whether the offender is receiving treatment in a secure facility as opposed to in the community. If the offender is confined, the consequences of continued denial are not as significant as they would be for an offender residing in the community.

Note: Ask audience, capture responses on a flip chart or white board.

Ask QuestionsWe’ve described in considerable detail one common treatment group method, in order to give you a sense of what treatment providers do when working with sex offenders—particularly around the issue of denial. Does this discussion of handling sex offenders’ denial raise any questions for you about how to respond to denial as a probation or parole officer? Next we’ll look at the treatment methods typically used with sex offenders who admit their offenses.