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

(60 minutes)

Use SlideUse Slide #48: Behavior Management — The Fourth Domain of Treatment


The final domain that is necessary to address in sex offender treatment is self–management. Of course, sex offending is mismanagement of behavior by the offender; thus, the purpose of intervening in this treatment domain is to assist offenders to manage their behavior related to sexual and non–sexual matters in responsible and non–victimizing ways. We will discuss two treatment methods to address behavior management.

One of the things we will emphasize in particular in this section is the degree to which treatment providers and criminal justice supervision agencies can partner in teaching and reinforcing responsible behavior management on the part of sex offenders.

In essence, criminal justice supervision agencies and treatment providers work collaboratively, each bringing a unique set of tools and resources to the task of sex offender management.50 Supervision agencies have the legal authority to provide a set of external controls (e.g., surveillance, restricting access to victims, reducing opportunities to engage in high–risk behavior, and the like). On the other hand, sex offender treatment providers have a set of therapeutic tools that are aimed at assisting the offender to develop his or her own internal controls over his behavior. In some areas, these functions overlap and support one another. Together the two sets of controls can contribute to successful offender management.

Covert Sensitization: Visualizing the Consequences of Sexual Assault

One behavior management technique that is taught as a part of sex offender treatment is something called covert sensitization (see, e.g., Abel, Blanchard, and Becker, 1978; Dougher, 1995; Laws, 1995; Marshall, et al., 1999; Marshall and Eccles, 1995). As sex offenders contemplate committing sexual assaults, they seldom consider the long–range consequences of their behavior to their potential victims or even to themselves. Instead, they focus on the anticipated immediate pleasure they expect to experience during the commission of the crime. If offenders can learn to anticipate and consider the likely potential consequences of their sexual assaults, it is expected that they will more realistically consider the costs of their behavior and, hopefully, divert themselves from offending.51 This is the rationale underlying covert sensitization.

Use SlideUse Slide #49: Goals of Covert Sensitization

Use SlideUse Slide #50: Methods of Covert Sensitization

Thus, the primary goal of covert sensitization is to help offenders substitute thinking about what is appealing about sex offending with considering instead possible negative consequences of committing sex offenses.52 Treatment efforts are directed toward offenders taking a broader, more long–range view of their behaviors, rather than thinking solely of themselves and their immediate gratification.

The specific steps of covert sensitization begin with facilitators describing the reasons for the intervention, as we’ve just outlined. Group members then are encouraged to identify the antecedent thoughts, behaviors, and cognitive distortions that precede their particular sex offenses. Consistent with what we know about sex offending patterns, offenders typically traverse a number of steps (that create circumstances where they can commit sexual assaults), both internally in their thinking and externally in their behavior. Group members are assisted in identifying these offense precursors, and the patterns and strategies they utilize.

Following the identification of these offense precursors, offenders are asked to identify several imaginary neutral scenes. Neutral scenes are those which each individual offender can associate with being very relaxed and comfortable, such as lying in a hammock on a warm afternoon, or enjoying a leisurely talk with an old friend. Next, offenders also are asked to identify several imagined aversive scenarios, reality–based scenes that, if they actually occurred, would be extraordinarily unpleasant for the offender. Examples of aversive scenes include having an offender’s wife walk in on him while committing a sexual assault and telling him that their marriage and his relationship with his family are over, or being described in the newspaper as a sex offender.

Offenders are instructed to create audiotapes as homework. In the case of covert sensitization, the offender starts each audio taped homework assignment by describing one of his neutral scenes, followed by a description of his antecedent behaviors that might lead to a sexual assault. Offenders are encouraged to discuss the early stages of sexual offense behaviors, such as the arrangements the offender might make to isolate his victim, gain trust, and so forth. Next, the offender is instructed to describe in detail an aversive scene, such as being taken from his workplace by the police while being observed by his co–workers. He spends two to five minutes focused on this aversive scene, then repeatedly goes back and forth between antecedent behavior scenes and aversive scenes. The purpose of this aspect of the exercise is to pair thoughts of setting up sex offending situations with thoughts of aversive consequences. The offender is instructed to use an escape scene occasionally instead of an aversive scene, which consists of fantasies of pleasurable adult consenting sexual activity. The use of the escape scene is to underscore that if the offender avoids sex offending, he can have a more pleasurable and satisfying life.

Offenders typically are assigned to complete about ten, 15–minute covert sensitization audiotapes. Treatment providers review the covert sensitization audiotape homework, provide feedback to the offenders, and erase and return the cassette tapes.

Use SlideUse Slide #51: Relapse Prevention

Relapse Prevention

Another and probably the best known treatment component related to sex offender behavior and self–management is relapse prevention. Relapse prevention first was used in the treatment of alcohol and other drug abuse, where it was found that getting people to stop drinking and using drugs was not nearly as difficult as was getting them to continue their abstinence.53 Chemical dependency treatment providers discovered that alcohol and other drug abusers were especially vulnerable to relapse when they found themselves in specific situations that were, for them, previously associated with drinking or using drugs. Thus, if they could be taught to manage their lives to either avoid these situations or, if they found themselves in such circumstances, to use strategies to keep from returning to chemical use, they would be less likely to relapse.54

Sex offender treatment utilizes many of these relapse prevention principles (see, e.g., Laws, 1989; Pithers, et al., 1983, 1988). Although there are similarities between chemical abusers and sex abusers, there are differences as well. Principal among these differences is that occasional relapses by drug abusers typically harm only themselves, however, relapses by sex offenders harm others and are, therefore, enormously serious. Thus, when persons who abuse alcohol and other drugs occasionally relapse, treatment providers use this information as important feedback to guide further treatment. But sex offenders must maintain uninterrupted abstinence, since even one more sex crime translates to one more victim.

Use SlideUse Slide #52: Rationale for Relapse Prevention

Over the years, many sex offender relapse prevention strategies have been posited (see, e.g., Laws, 1989; Laws, Hudson, and Ward, 2000; Marshall, et al., 1999; Pithers, et al., 1983, 1988; Pithers and Cumming, 1995). Generally speaking, they all share certain underlying principles. Among these are the belief that sex offenders must not assume that treatment has eliminated their risk for reoffense, and that offenders who believe they are “cured” are, in fact, more likely to recidivate. Sex offenders must recognize their particular offense precursors and avoid the specific thoughts, feelings and behaviors that place them at risk to reoffend. Essentially, relapse prevention is a maintenance model designed to provide sex offenders with strategies to sustain the positive changes made during treatment—changes that hopefully will last throughout their lifetimes.55

Use SlideUse Slide #53: Relapse Prevention Cycle

Use SlideUse Slide #54 – #56: Goals of Relapse Prevention

Slide #54
[Click to Enlarge]
Slide #56
[Click to Enlarge]
Slide #55
[Click to Enlarge]

Relapse prevention involves sex offenders learning that they must be extremely vigilant to avoid committing new offenses throughout their lives. Sex offenders are taught that certain situations, chains of events, or cycles place them at increased risk for committing sex offenses.56 “Seemingly unimportant decisions,” or “SUDs” are decisions sex offenders make that are a part of their pre–offense cycles that may seem unimportant or irrelevant to offending, but are not. Examples might include an individual who initiates an argument with a spouse to provide an excuse to leave the household, which places him in a situation where he can offend. Another example might be an individual who leaves work early, providing him with time that he won’t have to account for to a probation officer or his family. Of course, SUDs are extremely varied and can be quite idiosyncratic to each offender, based on his mental and behavioral offense precursors.

Relapse prevention involves offenders learning that a chain or cycle of thoughts and behaviors can take them from self–control to committing additional sex crimes.57 Here is a simplified example: Many sex offenders can progress quickly and easily from a positive to a negative mood state (such as anger, depression, or loneliness). Such feelings are often followed by fantasies involving criminal sexual behaviors that may lead to the actual planning of an offense and by the use of alcohol or other drugs, which disinhibit impulses. The result, if the chain or cycle is not interrupted, is the commission of a sex crime.

Of course not all sex offenses neatly follow this pattern. Nonetheless, this thought and behavior cycle appears to describe accurately the pattern of precursors to offending for many sex offenders.58 The goal, of course, is for sex offenders to develop the skills and coping methods necessary to interrupt their pre–offense cycles long before they perpetrate sexual abuse. Sex offenders are taught to differentiate lapses—defined as the initial occurrence of a prohibited behavior (such as being alone with a child) from relapses—the actual commission of the crime (such as child molestation). As we addressed in the covert sensitization segment, interrupting the pre–offense behavior chain is easiest to do in its early stages. Offenders find it much more difficult to stop themselves after they have created a sex offending situation, and they are psychologically prepared to commit an assault.

Use SlideUse Slide #57 – #59: Methods of Relapse Prevention

Slide #57
[Click to Enlarge]
Slide #59
[Click to Enlarge]
Slide #58
[Click to Enlarge]

Relapse Prevention Methods

In sex offender relapse prevention treatment, most of the focus is on offenders assessing their own offense patterns, their particular high–risk situations, and their coping strategies.59 Offenders learn how they can avoid lapses and relapses, and how to monitor themselves for mood states and behaviors that might place them at increased risk for reoffense.

Interventions to assist offenders to engage in this self–examination can include writing an autobiography to gain a greater understanding of life patterns that result in offending, learning more effective problem–focused rather than emotion–focused coping strategies, avoiding high–risk situations, learning that urges that are not acted upon diminish with time, and practicing, such as with role–playing, how best to manage risky situations. Do you know what we mean by problem–focused and emotion–focused coping strategies?

  • Problem–focused coping strategies involve examining alternative methods to address the problem, deciding on the most effective strategies, and implementing the plan utilizing those strategies.
  • Emotion–focused coping strategies involve actions derived primarily from immediate emotions rather than considering various alternatives and the efficacy of each.

Note: Elicit ideas from participants.

Ask QuestionsCan you think of an example of a risky situation that we might want to role–play in sex offender treatment to prepare sex offenders to manage such a challenge?

Ultimately, sex offenders are expected to make global lifestyle changes that promote their behaving in pro–social, responsible ways in all areas of their lives, to assist them in not violating others in sexual and non–sexual ways. Additionally, sex offender management may be enhanced by having others in their lives, such as friends and family, who know their offending patterns and history and provide them with instructive feedback about their positive and negative behaviors.60 These individuals can be particularly helpful to treatment providers and supervision officers by providing feedback regarding the offenders’ efforts to assimilate the information they have learned during the treatment process and develop strategies to avoid (and respond appropriately to) lapses.61

Recent adaptations of the relapse prevention model emphasize the acquisition of more functional problem–solving and coping strategies with less emphasis on the particulars of relapse prevention principles and coping methods described above (see, e.g., Laws, Hudson, and Ward, 2000; Ward, Laws, and Hudson, 2003). This is one of many examples of evolution in the field of sex offender treatment. Further research will guide practice toward increasingly effective methods.

Refer to Handout Refer to Handout: Refer to Handout: Learning Activity 3–3: How Supervision Officers Can Support Relapse Prevention.

Learning Activity Learning Activity

Let’s go back to the list of relapse prevention methods, so that we can discuss some of the ways in which a supervision officer can support the relapse prevention process. Refer to the handout that we’re distributing. Please take a few moments and review the list of relapse prevention methods. In the adjacent column, jot down a few strategies you have employed—or think you might employ—to support offenders in their efforts to address each relapse prevention method. Once you’ve had the opportunity to record your thoughts and suggestions, we’ll share some of our ideas and experiences with one another.

Note: Take about five minutes to hear from a few participants regarding their answers to these questions. This is an opportunity for participants to integrate the information they have just heard and apply it to their own work; it is also an excellent opportunity for participants to learn from one another.

Processing of Learning Activity

Let’s select a few of these strategies and hear from some of you about the ways in which you have supported offenders’ relapse prevention efforts. For example, did any of you note things you’ve done in the past to help offenders assess their high–risk situations? Tell us first who you are (probation officer, parole officer, etc.) then share one thing you have done in the past to help an offender assess his high–risk situations.

Let’s shift our focus to another one of the strategies: designing intervention plans to avoid a first lapse. Does anyone have experience assisting an offender with this strategy? Let’s hear two or three things a supervision officer can do to assist offenders in this way.

Use SlideUse Slide #60: Adjunctive Therapies

Slide #60
[Click to Enlarge]

Adjunctive Therapies

Before we move on to the topics of ethical standards and treatment provider characteristics, I would like to point out that we have focused on four domains of treatment: sexual interests, distorted attitudes, interpersonal functioning, and behavior management—and have given some examples of relapse prevention methods. Of course, depending on the specific issues that individual offenders are facing, there are other adjunctive therapies that may be appropriate in our work with them. These would include family and marital therapy, family education seminars and couples’ groups, substance abuse treatment, educational/vocational supports, and individual therapy (usually for other interpersonal issues). It is important to remember that these other therapies must always be designed and undertaken in the context of the offender’s sexual abuse history and his treatment goals regarding sexual offending should not be subordinated to other treatment goals. Further, if a combination of therapies are employed, they should be coordinated to assure their effectiveness.