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

Short Version
Section 3: An Overview of Sex Offender Treatment for a Non–Clinical Audience
Elements of Sex Offender–Specific Treatment
25 Minutes

Lecture Topic TOPIC: THE FOUR DOMAINS OF TREATMENT
(10 Minutes)

Introduction

Use SlideUse Slide #8: The Four Domains of Treatment

Research has found that sex offender treatment must include four general domains:9

  • Deviant sexual interests, arousal, and preferences;
  • Distorted attitudes;
  • Interpersonal functioning deficits; 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. Let’s look generally at what we mean by these four areas of focus.

Deviant Sexual Interests, Arousal, and Preferences

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.10

Distorted Attitudes

It is almost universally true that sex offenders have distorted attitudes. 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.

Ask QuestionsWhat 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.

Interpersonal Functioning

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.

Use SlideUse Slide #9: Behavior Management—The Fourth Domain of Treatment

Behavior Management

The fourth 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.11 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. 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. This is the rationale underlying covert sensitization.

Use SlideUse Slide #10: Goals of Covert Sensitization

Use SlideUse Slide #11: Relapse Prevention

Thus, the primary goal of covert sensitization is to help offenders substitute thinking about what is appealing about sex offending with considering instead possible aversive consequences of committing sex offenses. 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.

Relapse Prevention

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.12 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.13

Use SlideUse Slide #12: 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.14

Relapse prevention involves sex offenders learning that they must be extremely vigilant to avoid committing new offenses throughout their lives. Relapse prevention also involves offenders learning that a chain or cycle of thoughts and behaviors can take them from self–control to committing additional sex crimes.15

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.16 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 behavior.

Use SlideUse Slide #13: Adjunctive Therapies

Adjunctive Therapies

Before we move on to the topics of ethical standards, I would like to point out that, 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.