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

Short Version
Section 1: An Overview of Sex Offender Treatment for a Non–Clinical Audience
The Basics of Sex Offender–Specific Treatment
30 Minutes

(10 Minutes)

What are some characteristics of current sex offender–specific treatment methods? What might you expect to see in a sex offender treatment program that incorporates those practices that have been demonstrated to be effective in reducing sexual recidivism?

Use SlideUse Slide #8: Characteristics of Current Sex Offender–Specific Treatment Methods

Group Treatment

First, most sex offender treatment takes place in a group treatment setting. Although individual treatment sometimes accompanies group treatment (and, under certain circumstances, might replace group treatment altogether), there are a number of advantages to group treatment.8

One is economic—treating offenders in groups consumes fewer resources than treating them individually.

A second reason to treat sex offenders in groups is that they learn and benefit significantly from teaching one another. As long as the treatment provider ensures a pro–social milieu, group treatment can provide a rich therapeutic environment in which offenders learn from hearing about the experiences of others. Such an environment provides offenders with opportunities to challenge and confront one another—in a constructive and helpful fashion—about the inappropriate and distorted thinking that is associated with the abuse they have perpetrated. Well–functioning treatment groups also serve as a support to individual offenders who are having problems with the treatment process.

Additionally, attending group treatment represents another level of acknowledgement by the offender of his behavior—it provides an opportunity for sex offenders to begin to practice talking openly about their issues. The group treatment setting helps address denial and confront distorted thinking far more effectively than the individual, one–on–one treatment provider–offender setting.

Cognitive–Behavioral Therapy

The most widely accepted mode of treatment in use today with sex offenders is cognitive–behavioral (applied in a group setting). Cognitive–behavioral treatment addresses both the cognitions—that is, the thoughts—and the behaviors of offenders.

People commit sex offenses for a variety of reasons. What they have in common, however, are thought patterns that are conducive to sex offending. For example, if an offender believes that children are not harmed by having sexual contact with adults, then this cognitive distortion (distorted thought) justifies, and indeed encourages, his sexual offending behavior. Of course our concern is not so much with thoughts as it is with behaviors, which are the ultimate targets of our treatment and the relevant measure of treatment effectiveness, but the fact that thoughts can both promote and discourage sex offending behavior requires that offenders’ cognitions (thoughts) be addressed in the therapeutic environment.

The behavioral component in cognitive–behavioral treatment refers, of course, to offenders’ behaviors. But more than that, it speaks to particular treatment methods that are effective in changing behavior. Just because offenders have assimilated non–distorted or appropriate thoughts doesn’t necessarily mean that their behavior will always reflect their thinking. Relapse prevention is an intervention strategy that is designed to assist offenders to implement new behaviors and to recognize—and take specific actions—to avoid high–risk situations that increase the likelihood that they will reoffend.9

To sum up, then, when both cognitions (thoughts) and behaviors are addressed, offenders are able to make greater and more long–lasting changes. The research—which we will review shortly—reflects that it is this combination that is most impactful in lessening the likelihood of reoffense.

Psychopharmacology: Treating Sex Offenders with Medication

As was already mentioned, people commit sex offenses for a wide variety of reasons. These might include expressions of anger or power, inadequate skills in initiating or maintaining social and sexual relationships, having erotic attraction to persons or activities that, if acted on, constitute criminal sexual behavior, and so on. Treatment must be geared to addressing those specific issues.

The individual whose sexual arousal involves, for example, children or forcing sex on adults, has a problem that is deeper than simply poor judgment or poor impulse control. In part, what motivates him to commit sexual assaults is that to do so is sexually arousing. For some of these individuals, the only way they can become aroused is to fantasize about or act on these deviant interests. Not all sex offenders have deviant interests, but many do. This is especially true of sex offenders who sexually assault pre–pubescent children; that is, kids under the age of 13, as well as some sex offenders who use extreme violence in the commission of their offenses. For these individuals, medications can be helpful in reducing the intensity of their sexual urges and can serve as an effective adjunct to standard cognitive–behavioral treatments.

Because not all sex offenders have deviant sexual arousal, nor are they all compulsive, these medications aren’t useful for all sex offenders. However, for those who do have these characteristics, medication can be a very important tool in the “tool bag” of treatment options. It is important to know, however, that pharmacological treatment alone—without other interventions such as cognitive–behavioral treatment and community supervision—is not sufficient. In other words, although medication can be an appropriate adjunct to treatment for some sex offenders, it is not a stand–alone remedy to the problem of sexual offending.

Use SlideUse Slide #9: Specialized Sex Offender Assessment

Note: Inform participants that CSOM is developing a training curriculum and a policy and practice brief on specialized sex offender assessment.

Specialized Sex Offender Assessment

Because of the complex and varying nature of sexual abuse and the offenders who perpetrate it, treatment providers, probation/parole officers, and others must assess sex offenders and their behavior effectively and in an ongoing, collaborative fashion. This enables them to respond appropriately to offender risks and needs as they change over time.

We’ll begin our discussion of sex offender assessment with an overview of empirically validated, actuarial–based risk assessment instruments. (These are often referred to simply as actuarial tools.) It is likely that many of you have heard of—or are already using—one or more of them in your work with sex offenders. Examples include the RRASOR and the Static–99.10

These instruments are noteworthy because they enhance our ability to identify sub–groups of sex offenders who pose a higher risk to reoffend than others (and who, therefore, require more intensive treatment and supervision responses than others). The tools are developed using historical or static (unchangeable) risk factors (such as the number of sex offense convictions) that are statistically correlated with sexual recidivism risk and they play a prominent role in the ongoing risk assessment process in which treatment providers and probation/parole officers are involved. Let’s talk briefly about this process.

Risk assessments that inform our sex offender management decisions (including those related to treatment and supervision) occur in both the clinical (or treatment) and criminal justice settings. We will quickly cover both here, and highlight the importance of collaboration between treatment providers and probation/parole officers in the assessment process.

Criminal Justice Assessments

Criminal justice assessments are undertaken and used by supervision officers to inform their sentencing, case planning, and case management decisions; and are shared with treatment providers to inform their work with sex offenders.

The different types of criminal justice assessments include: pre–sentence investigation assessments, assessments for supervision case planning, and assessments for ongoing case management.

Pre–Sentence Investigation Assessments

Those (usually supervision officers or staff) responsible for conducting a pre–sentence investigation (PSI) rely on many different kinds of information about sex offenders from a variety of sources to assess the risk that offenders pose, and to make disposition recommendations based on that assessed level of risk.11 The information considered in a PSI assessment includes an instant offense summary, the offender’s prior criminal record, offender statements, a victim impact statement, the offender’s social history, the offender’s substance/drug history, the offender’s level of admission of the instant sex offense, the offender’s willingness to enter sex offender–specific treatment, the risk posed by the offender as determined by one or more empirically validated risk assessment, and the results of a sex offender–specific (psychosexual) evaluation (which we will discuss in a moment).

Assessments for Supervision Case Management

Planning assessments for supervision case planning are conducted by supervision officers and—like pre–sentence investigation assessments—rely on information from many different sources, including treatment providers. A primary purpose of these assessments is to identify the unique dynamic risk factors that are related to the risk that each offender poses to the community so that individualized case management plans can be designed that respond appropriately to these factors.12

Assessments for Ongoing Case Management

Supervision officers continually monitor and assess short–term (hourly, daily, or weekly) changes in sex offender–risk to inform their ongoing case management activities and decisions. They seek input from treatment providers and others involved in the case management process to assure that their case management plans are responsive to offenders’ current risk levels and specific needs.

Clinical (or Treatment) Assessments

Clinical assessments are undertaken by sex offender–specific treatment providers and are used to help guide the treatment process. Their results are also shared with supervision officers to inform their work with sex offenders. There are two types of clinical assessments: sex offender–specific (psychosexual) evaluations and ongoing assessments of risk and criminogenic needs.

Sex Offender–Specific (Psychosexual) Evaluations

Ideally, sex offender–specific evaluations are conducted prior to community supervision and entrance into treatment. Their purposes are to:13

  • Assess the risk that sex offenders pose to the community (using one or more of the actuarial tools we just discussed);
  • Identify specific criminogenic needs (which we also covered earlier) that are related to the risk that each offender poses and that must be addressed in treatment—these become specific targets of treatment;
  • Determine the most appropriate method of treatment delivery (based upon each offender’s learning style); and
  • Determine the most appropriate treatment setting (i.e., institutional or community) and level of treatment intensity for each offender.

Ongoing Assessment of Risk and Criminogenic Needs

Like supervision officers, treatment providers continually monitor and assess short–term (hourly, daily, or weekly) changes in sex offenders’ risk and criminogenic needs to inform their treatment decisions and to update offender treatment plans. During this ongoing process, treatment providers seek input from supervision officers and other professionals to assure that treatment plans are responsive to current offender–risk levels and needs.

Because the information from the different types of assessments informs the responses of treatment providers and supervision officers to sex offenders, it is critically important that treatment providers and supervision officers communicate clearly and consistently about the assessment process.

Psycho–Physiological Assessments

Although we do not have time to cover them in any detail, you should be aware that there are three other assessment tools that are often used as part of sex offender assessment: the polygraph, the penile plethysmograph, and the Abel Assessment of Sexual Interest.

  • The polygraph is used to assess whether sex offenders are being deceptive.
  • The penile plethysmograph is a laboratory device that measures increments of erection of the penis to different stimuli. It is used to identify deviant sexual arousal.
  • The Abel Assessment of Sexual Interest involves offenders’ viewing slides of clothed males and females (adults and children) and measuring their level of attraction to each. This determination is made by measuring small differences in the visual reaction time of the person being evaluated; that is, how long they look at each slide, with longer reaction time being associated with increased sexual interest.

Although these assessments each have disadvantages, they can offer treatment providers and others important information about sex offenders that they otherwise might not have.