The large‐scale provision of programmes for imprisoned sex offenders: issues, dilemmas and progress

Sex offender management using the polygraph: A critical review

Training in general and forensic psychiatry in the assessment and treatment of sex offenders is in need of considerable improvement. Although most sex offenders are not mentally ill, many are subject to substance misuse, abnormal personality traits, personality disorder, learning disability or dysphoric mood, and in some organic factors will be involved. Comprehensive assessment of sex offenders includes a full history and mental state evaluation, obtaining a collateral history from other sources, observation, psychometric testing, and psychophysiological methods of assessment, including penile plethysmography. Trials of the use of the polygraph are also under way. The treatment of sex offenders, especially those with paraphilias, may include medication with selective serotonin reuptake inhibitors or anti-libidinal agents. Ethical considerations can be problematic, but a balance can often be found between the welfare of the offender and the safety of the public.

Back to table of contents Previous article Next article Book ReviewsFull AccessRemaking Relapse Prevention With Sex Offenders: A SourcebookLaurie L. Guidry, Psy.D.Laurie L. GuidrySearch for more papers by this author, Psy.D.Published Online:1 Sep 2001https://doi.org/10.1176/appi.ps.52.9.1264AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This sourcebook, Remaking Relapse Prevention With Sex Offenders, captures the field of sex offender treatment in an unselfconscious act of self-scrutiny as it attempts to propel forward the evolution of effective treatment of sexual perpetrators. Drawing on contributions from leading experts in sex offender research and treatment, the editors provide us with an essential "re-visioning" of the popular, yet largely critically unexamined, relapse prevention approach to treating sexual abusers. Offering overviews and reviews, critiques and reconsiderations, and expansions and applications of relapse prevention to the treatment of sex offenders, the editors present an updated and well-considered reexamination of the utility of using the relapse prevention approach.Based on addictions theory, relapse prevention is a clinical intervention that was originally formulated as a strategy to maintain behavior change. It promotes the acquisition of self-management skills for dealing with threats to abstinence. By heightening awareness of the pathways to, and the presence of, situations that increase the risk of relapse, along with facilitating access to effective coping strategies, the relapse prevention approach assumes that a motivated individual can successfully negotiate the threat of an alcohol or drug relapse.With an emphasis on preventing the reoccurrence of problematic behaviors, the relapse prevention model was intuitively appealing to professionals in the sex offender treatment field. If substance abuse relapse could be prevented, perhaps a return to sexually deviant behavior could also be prevented. In the early 1980s, sex offender treatment professionals began to make efforts to integrate relapse prevention into the emerging cognitive-behavioral model of treatment for sexual perpetrators.However, theoretical and conceptual differences between the substance abuse and sex offender treatment fields were left unaddressed and unreconciled. Sex offender treatment programs applied relapse prevention in a variety of idiosyncratic ways, including using it inappropriately and ineffectively as a stand-alone treatment model for sex offenders. Moreover, sex offenders often lacked the motivation necessary to maintain the behavior change.Over the 20 years since relapse prevention was first proposed as a possible approach to treating sex offenders, its weaknesses in this application have come to light. Remaking Relapse Prevention With Sex Offenders identifies and examines these weaknesses and offers an emerging and informed reformulation of the implementation of this treatment approach with the very challenging treatment population of sexual perpetrators.The book covers a great deal of ground, including a critique by Hanson of the relapse prevention model; a call by Mann and Thornton to sex offender treatment professionals to commit themselves to evidence-based treatment; and an efficient presentation by Haaven and Coleman of relapse prevention with developmentally disabled sex offenders.With these and many other significant essays, this book is a valuable resource in the ongoing effort to develop an effective and fully integrated treatment approach for sex offenders.Dr. Guidry is program director for a statewide initiative by the Massachusetts Department of Mental Health to develop assessment and treatment programming for psychiatric inpatients with co-occurring major mental illness and sexual behavior disorders.edited by D. Richard Laws, Stephen M. Hudson, Tony Ward; Thousand Oaks, California, Sage Publications, 2000, 550 pages, $95 FiguresReferencesCited byDetailsCited byNone Volume 52Issue 9 September 2001Pages 1264-1264 Metrics History Published online 1 September 2001 Published in print 1 September 2001

This article will review current clinical knowledge on paraphilia and methods of assessment and treatment of sex offenders. In recent years, a better understanding of the physiological and psychological dynamics underlying abnormal sexual behavior was gained through advances on the neurobiology and neuropharmacology of sexual behaviour. Sex offenders form a heterogeneous group that presents a challenge regarding assessment. Components of a full comprehensive sexual behaviors assessment are discussed, detailing the evidence available on the use of penile plethysmography testing. Results of several studies showed that such testing discriminated child molesters from other sex offenders and non-offenders. Treatment modalities include a variety of pharmacological agents and psychological approaches, as treatment outcome studies demonstrate the overall effectiveness of treatment in reducing recidivism of sex offenders. Finally this article discusses future avenues for research, including research aimed at improving the validity and reliability of assessment of sex offenders and the development of non-invasive investigational procedures that make use of new information technology.

Forty-eight male patients with long-standing histories of deviant sexual behavior received medroxyprogesterone acetate and milieu therapy for up to 12 months. Forty subjects responded positively, all within 3 weeks, with diminished frequency of sexual fantasies and arousal, decreased desire for deviant sexual behavior, increased control over sexual urges, and improvement in psychosocial functioning. Improvement in deviant sexual behavior and psychosocial functioning was maintained after treatment ended, and there was no evidence of permanent physiological changes. The author suggests that medroxyprogesterone acetate associated with counseling may be the treatment of choice for patients with long-term deviant sexual behavior. He discusses the ethical issues involved.

This paper proposes standards of care for the treatment of adult sex offenders, primarily in (but not limited to) outpatient settings. A first draft was presented at the International Conference on the Treatment of Sex Offenders at the University of Minnesota School of Medicine in May 1989. A second draft was compiled at the Conference of the Association for the Behavioral Treatment of Sexual Abusers, with input from some sixty professionals. A third draft was circulated to a variety of professionals in the United States, Canada, and Europe in Fall 1989. The current draft is published in the Journal of Offender Rehabilitatino prior to formal presentation at the Second International Conference on the Treatment of Sex Offenders to be held at the University of Minnesota in September 1991. Readers are urged to communicate their reactions and comments to the authors.

In recent years public attitudes toward sex offenders have become increasingly punitive. Consequently, new legislation pertaining to the sentencing and treatment of convicted sex offenders has been focused on containment and monitoring rather than rehabilitation. However, research suggests that treatment programs for sex offenders are effective in decreasing subsequent sexual recidivism. This study describes the development and refinement of a brief scale for assessing public attitudes toward the treatment of sex offenders (ATTSO). Of the original item pool, 15 items were found to statistically and theoretically function well, forming three internally consistent factors measuring attitudes of incapacitation, treatment ineffectiveness and mandated treatment. The utility of the scale as it pertains to treatment centers and public policy development will be discussed.

In this brief article, we provide relevant background concerning the prevalence, characteristics and vulnerabilities of intellectually disabled (ID) sex offenders, as well as scientifically-informed guidelines for treatment. Finally, we provide a description of Project STOP, an outpatient cognitive behavioral assessment and treatment program. Keywords: intellectually disabled, sex offenders, cognitive behavioral assessment and treatment , problem solving, intervention Introduction Sex offending behavior in persons with intellectual disabilities (ID) is a serious problem with significant and long-term consequences for the victims, offenders, and their communities (Barron, Hassiots, & Banes, 2002). A growing awareness of such problems in persons with ID requires effective solutions with regard to assessment and treatment. Defining Sex Offending The term sex offender is a broad one that is applied to individuals who commit a sex offense (Lanyon, 2001). Examples of sex offenses include sexual conduct with a minor and forcible, nonconsensual sexual acts toward an adult, including sexual acts involving an individual who is unable to give consent for sexual acts. Moreover, people who sexually offend may be diagnosed with additional psychological or behavioral disorders, including s, deviant sexual interests, mood or anxiety disorders, psychotic disorders, personality disorders, brain injury, or ID, such as mental retardation. Thus, sex offenders represent a heterogeneous population for which few generalizations can be made regarding etiology, assessment, or treatment that can be easily applied to all offenders. Sex Offenders with Intellectual Disabilities The prevalence of people with mental retardation among sex offenders is estimated between 10 and 15% (Murphy, Coleman, & Haynes, 1983) and much higher if persons with borderline intellectual functioning are included in this estimate. However, there is no support for a direct or causal association between intellectual functioning and sex offending behavior (McCurry et al., 1998), and estimated rate may be partially due to the decreased likelihood that people with ID can evade detection and arrest. When compared to other sex offenders, the availability and investigation of effective treatment programs for ID offenders has lagged far behind those of than their non-disabled cohorts (Barron, Hassiotis, & Banes, 2002; Lindsay, 2002; Timms & Goreczny, 2002;). In order to develop effective interventions for this population, it is important to understand what diathetic factors contribute to the development of sex offending behavior in persons with ID. This requires an integration of existing scientific knowledge concerning both sex offending treatment and the unique challenges to sexuality concerning persons with ID. Unique Challenges of Sexual Risk for ID Offenders Due to a history of institutionalization, the sexual of lives of persons with ID have been historically under society's control (Kempton & Kahn, 1991; Pitceathly & Chapman, 1985). Such societal controls, including and sterilization, were viewed as acceptable prevention methods and no education in sexuality or treatment for sexual disorders were provided (Woodill, 1992). Despite several decades of a nationwide de-institutionalization and a trend toward community integration, negative community biases still serve as obstacles to the adaptive sexual expression of people with ID. One extreme stereotypic view characterizes people with ID as having uncontrollable sexual desires. An alternative, but equally extreme view is that they are innocent and naive persons who have no sexual desire (Szollos & McCabe, 1995). It is unfortunate that such views prevail, because significant restrictions concerning sexuality continue to occur. Without the support from caregiving systems to provide accurate and effective sexual educative experiences, the sexual knowledge that an individual inadvertently learns can be subject to significant distortion and misinterpretation (Jurkowski & Amado, 1993). …

Specialized assessment and treatment of adolescent sex offenders

A new national prison strategy for the assessment and treatment of sex offenders in England is described. Its main features are the potential inclusion of all convicted sex offenders sentenced to 4 or more years in prison, a coordinated and systematized assessment and treatment package, reliance on nonspecialist personnel to deliver treatment, and the integration of population and program research. Individuals are allocated to treatment depending on an assessment of the seriousness of their offending and their risk of reoffending, using an algorithm based on conviction history. The rationale underlying key decisions is described, and issues raised by the program are discussed.

The present paper reviews what is currently known about sexual abuse and the treatment of the offenders. Sexual offending is primarily committed by males and as many as 50% of females and 33% of males are sexually victimized in some way during their life. While some of these acts involve minimally intrusive behaviours (e.g. exhibitionists), many involve forced vaginal or anal intercourse and varying degrees of associated physical violence and deliberate humiliation of the victim. The effects on the victim can be severe and long-lasting. Current theories of the aetiology of these behaviours incorporate biological and developmental factors occurring within a socio-cultural context that fails to discourage sexual abuse. Experience is said to create a vulnerability that in some men finds expression in sexually abusive behaviour. Appropriate assessment targets the issues that are addressed in treatment, including: cognitive distortions, sexual behaviours and attitudes, social functioning and substance abuse. In addition, treatment also attempts to generate a set of relapse prevention plans for each offender. While some reports have not found benefits for treatment, the majority of acceptable studies have demonstrated clear reductions in re-offending among treated sexual offenders. Copyright © 2000 John Wiley & Sons, Ltd.

The aim of this review is to examine the literature related to the assessment and treatment of sex offenders’ distorted schemas. Where appropriate, the review draws upon current insights from the field of social cognition to aid in the critical evaluation of the findings. First, the review considers the various different methodologies for assessing distorted schemas, discussing their strengths and limitations. Second, the review examines the work related to the treatment of sex offenders’ schemas. Suggestions for future research, and the implications for clinical practice, are highlighted in the article.

Empathic deficits in sexual offenders: An integration of affective, social, and cognitive constructs

Nonsexual criminogenic needs are often overlooked in the assessment and treatment of sex offenders because of the focus and emphasis on issues surrounding sexual arousal. Augmenting sexual arousal information with objective evaluations of nonsexual criminogenic needs offers a comprehensive management and treatment strategy for this type of offender. The Level of Service Inventory-Revised (LSI-R) is an objective risk/need assessment instrument, which has demonstrated considerable promise among juvenile, adult, and female offender groups. Unfortunately, there is no documented research on the LSI-R with sample populations of sex offenders. In this present study, the LSI-R was completed on a representative sample of 216 Canadian, federally incarcerated sex offenders as part of an intake assessment. The study sample was composed of 74 sexual aggressors of adult victims, 54 extrafamilial child molesters, and 88 familial child molesters. Consistent with previous research among nonsexual offenders, the LSI-R displayed acceptable psychometric properties (alpha = .89). Convergent validity was also demonstrated with measures of relevant general criminogenic constructs as well as those specific to sex offenders (i.e., deviant sexual arousal and denial/minimization). Additionally, comparisons between the three offender groups indicated that familial child molesters scored significantly lower on the LSI-R total score as well as on the Criminal History, Education/Employment, Accommodation, Companions, and Attitude/Orientation subcomponents.

Human rights create a protective zone around persons and allow them the opportunity to further their own valued personal projects without interference from others. All human beings hold human rights and that includes sex offenders, although some of their freedom rights may be legitimately curtailed by the State. In this paper we apply the concept of human rights to sex offenders. First we briefly analyze the concept of human rights, their structure, and justification. Second, we apply our own model of human rights to the assessment and treatment of sex offenders. We conclude that a significant advantage of a human rights approach is that it is able to integrate the value and capability aspects of offender treatment.