Section 3: An Overview of Sex Offender Treatment for a Non–Clinical Audience
Elements of Sex Offender–Specific Treatment
4 hours, 30 minutes
TOPIC: THE FOUR DOMAINS OF TREATMENT
Now let’s talk about what should comprise sex offender treatment, that is, what should be addressed in a comprehensive sex offender treatment program?
What thoughts do you have?
Note: This can be done with the large audience, or participants can be broken into smaller groups to list suggested sex offender treatment content areas. Note these, preferably on easel–size paper, and post in the large group.
Use Slide #18: The Four Domains of Treatment
You all have identified a large number of treatment targets, meaning the areas that you think should be addressed in sex offender treatment. Let’s put them into categories according to what we have learned about sex offender treatment outcomes. Research has found that sex offender treatment should include four general domains:24
- Deviant sexual interest, arousals, and preferences;
- Distorted attitudes;
- Interpersonal functioning; and
- Behavior management.
Although not all sex offenders have difficulties or deficits in each of these four domains, most do. Thus, it is essential that treatment programs address all four, and for the exceptional cases where one or another of these domains is not relevant for a particular offender, he can be exempted from that treatment domain. We will discuss interventions in each of these domains shortly, but for now let’s look generally at what we mean by these four areas of focus.
Deviant Sexual Interest, Arousal, and Preferences
Note: Ask audience; elicit answers related to deviant sexual arousal.
What specifically do we mean by “sexual interests, arousal, and preferences?”
We’ve already established that people commit sex crimes for a wide variety of reasons, some of which are secondary to deviant sexual arousal. For example, the offender who fondles the breasts of his 14–year–old stepdaughter likely is not motivated by having sex with children as much as he is acting on his normal sexual arousal with a readily available, easily accessible victim. Assuming he has no other criminal sexual history, if we measured his sexual arousal pattern in the laboratory, we likely would find he is most erotically attracted to adult women, followed in intensity by adolescent girls, which is a normal sexual arousal pattern for a heterosexual adult male. Thus, we might conclude that his principal problem is not one of sexual interests; rather, the reasons he molested his stepdaughter likely have more to do with his having used extremely poor judgment, having difficulties of impulse control, poor self–management, problems in his personal relationships, and other problems.
On the other hand, the person who is motivated to commit sexual assaults to satisfy his sexual arousal to children, or to force people to have sex with him, or to expose his genitals to strangers, has problems in the area of sexual interests. And although it may be surprising to you, some sex offender treatment programs do not directly and effectively address this domain of treatment—sexual interests—a major and powerful motivator for many sex offenders.25
It is almost universally true that sex offenders have distorted attitudes (see, e.g., Bumby, 1996; Hanson and Harris, 2000; Hanson and Morton-Bourgon, 2004; Langton and Marshall, 2000; Marshall, et al., 1999; Murphy, 1990). Distorted attitudes are used by everyone, not just sex offenders, to help justify and sustain behavior that we know, at some level, is wrong, harmful, or inappropriate. It is vitally important to treat distorted attitudes, because these attitudes help to “rationalize” further offenses.
Note: Elicit examples and ideas from audience.
What are some examples of distorted attitudes that child molesters might have? How about rapists? How might these distorted attitudes influence these men’s behavior?
You’ve identified many common attitudes held by child molesters and rapists, including the frequently–cited statement by child molesters that they are not really harming the child because there are no physical injuries, that the child was old enough to give consent, that the child enjoyed the sexual behavior, and so forth. Common rape myths include that the victim really wanted to be raped, that she deserved it, that she couldn’t have been that harmed because she had had sex before, or that as the offender’s wife, she couldn’t be a rape victim. Some sex offenders convince themselves that these cognitive distortions are true, and others profess to believe them but really don’t. In any case, a necessary component of sex offender treatment is to elicit sex offenders’ thinking errors, examine them for accuracy, and have them learn accurate, functional thinking about these matters.
Now let’s talk about the third treatment domain, namely interpersonal functioning.
Sex offenses are violations of other people, often related to difficulties in offenders’ lives in the realm of interpersonal functioning. Examples of this include the husband who is so poor at managing his adult responsibilities that he deals with his conflictual relationship with his wife in part by sexually assaulting his daughter; the man who forces sex on women he dates; and the man who is unable to develop appropriate, satisfactory peer relationships who then uses children to meet his emotional intimacy and sexual needs. Many sex offenders need interventions to assist them to function more responsibly and effectively as adults.
The fourth domain is behavior management.
Although deviant sexual arousal can motivate sex offending, distorted attitudes can promote it, and problems of interpersonal functioning can contribute to it, ultimately sex offenders need to learn to manage their behavior. Deviant sexual arousal, distorted attitudes, and poor interpersonal functioning do not cause sexual offending, though they are correlated (see, e.g., Hanson and Bussiere, 1998; Hanson and Morton-Bourgon, 2004). They do not explain the motivation to act out. So, the focus must be on both the underlying issues and the behavioral acting–out.
An essential component of sex offender treatment is teaching sex offenders very specifically how to manage their behavior. Behavior management is particularly important in situations where an offender easily could commit a sexual assault, such as being in the presence of someone whom he could readily victimize.
Use Slide #19: Sex Offender Treatment Goals and Plans
Sex Offender Treatment Goals and Plans
Let’s look at common sex offender treatment goals and plans. As we know, sex offenders are not all the same; likewise, not all of their treatment should be the same. Before treatment begins, sex offenders should be assessed by treatment providers so that they understand what has motivated them to offend, what reoffense risk each poses, and other relevant information. Based on an initial assessment, each sex offender should have an individualized treatment plan that addresses his particular criminogenic needs and his reoffense risk. As treatment progresses, treatment plans should be modified based upon further assessments, and additional information derived from victims, the offender, laboratory testing of sexual arousal, and the polygraph, or other sources. In general, though, some common treatment goals include: (see, e.g., Association for the Treatment of Sexual Abusers, 2005; Becker and Murphy, 1998; Laws, 1989; Laws, Hudson, and Ward, 2000; Marshall, et al., 1998, 1999; Salter, 1988; Schwartz and Cellini, 1995, 1997; Wars, Laws, and Hudson, 2003).
- Acknowledging and accepting personal responsibility for a complete sexual assault history;
- Improving social, relationship, and assertiveness skills;
- Appropriately managing anger;
- Learning about the traumatic effects of sexual assault behavior and developing empathy; and
- Learning to separate anger, power, and other motivational issues from sexual behavior and improving understanding of human sexuality.
We expect sex offenders to acknowledge and accept responsibility for all of their sexually exploitative behaviors, not just those they’ve been caught for. Sometimes we learn about additional offenses because sex offenders reveal them during group meetings or in their homework assignments; sometimes we learn about additional offenses when sex offenders complete sexual history questionnaires in preparation for polygraph examinations; and sometimes we learn about previously undisclosed offenses from other sources, such as from victims.
We expect that sex offenders will examine all their offenses, not just the ones for which they were apprehended. All of their offenses are important, not just those for which they were criminally charged. We also expect sex offenders will improve their social, relationship, and assertiveness skills in order to assist them to function more appropriately and effectively as responsible adults.
Some sex offenders are motivated to commit sexual assaults in part because of mismanagement of anger. For example, they may displace their anger toward one person or a group of people onto a victim, or they may “punish” their wives or children by sexually assaulting them. Helping sex offenders effectively manage their anger can reduce their risk for subsequent sexual assaults and other forms of violence.
Many sex offenders don’t commit sexual assaults with the goal of harming their victims. Instead, they selfishly use their victims for their own gratification, discounting the harm to the people they are abusing. When these offenders come to understand the enormous trauma that their sexual assaults typically cause, it makes it more difficult for most of them to continue these activities. Exceptions to this are sexual sadists, whose erotic arousal is to victim suffering, and psychopathic offenders, who are unaffected by others’ distress. As mentioned earlier in the denial group section, treatment for sexual sadists and psychopaths—a small sub–group of sex offenders—needs to differ in the realm of victimization awareness. For the majority of sex offenders, however, we expect them to develop empathy for their victims.
Many sex offenders confuse non–sexual matters with sex, such as anger, power, control, affection, and so forth. Sex offenders often do not understand that sexual behavior isn’t appropriate when it is used to gain control over someone, express anger or power, or otherwise exploit others. We expect sex offenders to separate sexuality from these other issues, and we accomplish this in part by teaching them about normal human sexual behavior and attitudes. Other goals include: (see, e.g., Association for the Treatment of Sexual Abusers, 2005; Becker and Murphy, 1998; Laws, 1989; Laws, Hudson, and Ward, 2000; Marshall, et al., 1998, 1999; Salter, 1988; Schwartz and Cellini, 1995, 1997; Ward, Laws, and Hudson, 2003).
Use Slide #20: Sex Offender Treatment Goals and Plans (cont.)
- Recognizing and changing cognitive distortions;
- Minimizing deviant sexual arousal;
- Understanding the offender’s own offense cycle and developing the skills to interrupt that offense cycle; and
- Adopting a non–exploitative, responsible lifestyle.
Research has taught us that a disproportionately larger number of sex offenders were victimized when compared to other adult males (see, e.g., Dhawan and Marshall, 1996; Garland and Dougher, 1988; Hanson and Slater, 1998; Lambie, Seymour, Lee, and Adams, 2002; Langevin, Wright, and Handy, 1989; Prentky, Knight, Sims-Knight, Strauss, Rokous, and Cerce, 1989; Seghorn, Prentky, and Boucher, 1987). Not surprisingly, sex offender treatment often elicits unresolved issues of offenders’ own histories of victimization. Although victimization per se has not been shown to be associated with reoffense risk26, it is often beneficial to assist sex offenders in their recovery from the trauma of their own victimization.27 Thus, although not directly a criminogenic need, to discount this aspect of sex offenders’ lives is to send them a hypocritical message, namely that we want them to understand and recognize how sexual assaults have hurt their victims, but that their own suffering from having been assaulted is not our concern. Skilled treatment providers can assist sex offenders with their own trauma recovery, as necessary, often separate from the work done in sex offender treatment. This work needs to be carefully managed, however, to avoid the pitfalls of over–focusing on sex offenders’ personal assault histories as a distraction from the primary tasks of sex offender treatment directed at reducing recidivism risk.
One of the vexing problems of sex offender treatment is knowing when offenders have made actual progress, as opposed to simply performing well in group or professing changes, such as in attitudes, that they don’t really believe. While there are pre– and post–measures of such progress, sex offenders sometimes pretend—quite convincingly—to have made more progress than is actually the case. Perhaps the best measures of risk reduction are more global indicators of attitude and behavior change, such as the adoption of a non–exploitative, responsible lifestyle. People who live responsibly and don’t exploit others don’t commit sex offenses. Therefore, as another way to evaluate progress, probation and parole officers, treatment providers and others assess the extent to which sex offenders conduct themselves responsibly and non–exploitatively in all areas of their lives, not just when they are focused in treatment on their sex offending attitudes and behaviors. Indeed, a better indicator of progress is an offender’s behavior in his ordinary life, not while being scrutinized in treatment.