Treatment of sexual offenders — methods and recommendations review with reference to solutions used in Poland

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 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.

Sex offender management using the polygraph: A critical review

We conducted a prospective multisite examination of sexual offender risk and treatment change on a large federal Canadian sample of 676 treated sex offenders followed up for an average of 6.31 years post release. The present study featured the clinical application of a risk assessment and treatment planning tool, the Violence Risk Scale-Sexual Offender version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003). The VRS-SO was rated pre- and posttreatment by sex offender treatment providers on the sample of men who were attending institutionally based sex offender programs across the 5 regions of the Correctional Service of Canada. The Static-99 (Hanson & Thornton, 1999) was also rated as part of routine services, and the Static-99R was used for substantive analyses. The VRS-SO dynamic factors and the Static-99R demonstrated significant predictive accuracy for sexual, violent, and general recidivism (area under the curve = .65 to .78). Significant pre-post changes on the VRS-SO dynamic factors were observed, ranging from small to moderate in magnitude (d = 0.22 to 0.62) across low, moderate, and high intensity programs. The change scores, in turn, were associated with decreases in the 3 recidivism outcomes; the majority of relationships examined attained significance after partialing out of pretreatment scores. Cox regression survival analyses, controlling for pretreatment risk, further demonstrated change scores to have associations with postrelease recidivism outcomes to varying degrees. The results are consistent with the dynamic nature of sexual violence risk and suggest that risk-relevant changes associated with participation in sexual offender treatment are linked to reductions in sexual offender recidivism.

A proposed version of these standards was first produced and published in the Journal of Offender Rehabilitation through input from a variety of professionals and from professional meetings (Coleman and Dwyer, 1990). Since that time, the present writers (along with Kurt Freund, M.D., William Marshall, Ph.D., and William Murphy, Ph.D.) have reviewed those proposed standards and have made the changes incorporated into this version. The Standards of Care herein were unanimously endorsed by voice vole by the participants in the Third International Congress on the Treatment of Sex Offenders held in Minneapolis, Minnesota, on September 20-22,1994. The authors invite feedback from readers. Further revisions are anticipated and will be reviewed by current committee members and at future International Congresses on the Treatment of Sex Offenders. Please address comments to Eli Coleman, Ph.D., Director and Associate Professor, Program in Human Sexuality, School of Medicine, University of Minnesota, 1300 S. 2nd Street, Suite 180, Minneapolis, MN 55454 USA.

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.

This paper describes psychological approaches to the treatment of sexual offenders. The empirically generated principles of effective treatment are outlined followed by the identification of the evidence-based issues that need to be addressed. The established important role of the therapists’ behaviors during treatment is then described along with the effectiveness of recruitment strategies and of tactics aimed at ensuring all entrants complete the program. Meta-analytic reports describing treatment efficacy are considered followed by an outline of the appraisal of the effectiveness of two large scale independent treatment programs. Finally, a brief description of a cost-benefit report indicates that when treatment of sexual offenders effectively reduces re-offense rates, it also saves a considerable amount of taxpayers’ money.

To review the definition, sociology, pathogenesis, diagnosis, medicolegal aspects, and pharmacologic treatment of sexual offenders, with emphasis on the antiandrogens, the luteinizing hormone-releasing hormone (LHRH) antagonists, and the serotonergics. An English-language literature search using MEDLINE (1966-1991) yielded clinical trials, case reports, editorials, and review articles. Emphasis was placed on comparative trials and case reports discussing pedophilia, rape, and exhibitionism. Data from controlled human studies were evaluated. The trials were assessed for sample size, duration of therapy, therapeutic response, and incidence of recidivism. The pharmacologic management of sexual offenders is controversial, and treatment is presently focused on psychotherapy and the use of antiandrogenic medications. Few well-controlled, blinded, efficacy trials with adequate sample sizes have been conducted. The populations studied are heterogeneous, and the subjects enrolled present with different sexually coercive behaviors. Consequently, the results of these studies are difficult to extrapolate to the treatment of other sexual offenders. No convincing evidence exists that pharmacologic treatment decreases the recidivism rate. Case reports describing the use of serotonergic drugs and LHRH antagonists hopefully will promote controlled clinical trials. A social consensus must be reached concerning the ethics of using these agents as a part of the treatment of sexual offenders.

Sex offenders represent a variable group of law violators, yet they are often viewed as suffering from a generalized mental illness and in need of treatment and management different from other types of criminal offenders. This often occurs within the context of some form of coercion. However, little is known about how coercion adds to or detracts from the successful treatment and control of sex offenders. This article explores the historical role of coercion in treating sex offenders and controlling their behavior along with the changing and evolving emphasis on treatment of sex offenders. It concludes with a discussion of the proper role that coercion can and should play relative to the overall effectiveness of treatment and a theoretical explanation of how coerced sex offenders may ultimately benefit from treatment.

This chapter focuses on the treatment of adult male sexual offenders. Since 1986, The Safer Society Foundation has been surveying sex offender treatment programs and publishing their results. Beginning in the 1980s, the sex offender treatment field was dominated by the relapse prevention model. The Risk–Need-Responsivity (RNR) model of offender treatment has emerged as one of the most empirically validated and commonly used approaches to offender treatment, including sex offender treatment. The responsivity principle guides the delivery of service. Specifically, it suggests that treatment must be delivered in a way that considers the individual's personality, cognitive ability, language skills, and learning styles. A newer model of sex offender treatment that has quickly gained popularity in sex offender treatment programs is the good lives model (GLM). The GLM also posits four main difficulties that offenders may have in achieving a balanced life. These obstacles include means, scope, conflict, and capacity.

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.

Serious sexual offending almost invariably attracts a custodial sentence, but sexual deviancy is among the most obviously interpersonal disorders, and the target or victim often very specific. In this context, many doubts have been expressed about the possibility of adequate assessment and treatment of sex offenders when in an institution, divorced from ordinary life, and generally also from the real objects of their desire. Since 1991 the prison service in England and Wales has progressively implemented a systematic strategy for the treatment of imprisoned sex offenders. At the heart of this is a structured group work programme designed to be delivered by para‐professional staff. The programme includes elements that, far from allowing the offender to `escape’ into the institution and its routine, bring him face to face with his cognitive distortions with respect to sexual interests and activity, possibly for the first time. By April 1994 over 700 sex offenders will have completed this programme, about half of those approached, demonstrating that such a programme is possible within a closed instituition. This paper considers issues arising in relation to the large‐scale delivery of this programme in such a setting, with particular reference to treatment integrity, selection of offenders for the programme and factors affecting offenders acceptance or refusal of the programme. The dangers of institutional reinforcement of attitudes in treatment refusers are also considered.

Process variables in the treatment of sexual offenders: A review of the relevant literature

Back to table of contents Previous article Next article Book ReviewsFull AccessPsychiatric Treatment of Sexual OffendersRobert Hilt M.D.Fabian Saleh M.D.Robert Hilt M.D.Search for more papers by this authorFabian Saleh M.D.Search for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.2006.57.4.584aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail P sychiatric Treatment of Sexual Offenders aims to be a concise, yet thorough, resource on the current state of treatment of sexual offenders with a humanistic approach. It is generally successful at this goal. What the book does well is provide summaries of the literature in such a way that readers feel as though they are hearing from a full range of voices on each topic. References are used so frequently that it is unusual for a page of this book to contain less than four different sources. At each point of interest Dr. Marvasti quotes several authors' opinions and generally creates a good narrative flow. Given the volume of literature reviewed, this was no small task. Unfortunately, in creating a good narrative flow, what can be lost is a critique of the quoted sources. Data are rarely provided, and when they are it is usually the number of patients in the study and the frequency of comorbidity. We found ourselves often wondering more about the quoted sources, especially when it came to treatments. The descriptions of therapies for sexual offenders are intriguing intellectually, but no data are given to support the effectiveness of any of these treatments. After 30 pages of descriptions of nonbiologic sexual offender treatments, Dr. Marvasti mentions that no program has been able to prove success at reducing recidivism and finally begins to address our question on page 95.The chapter on pharmacotherapy and surgical treatments is impressive in both its thoroughness and its brevity. As a psychiatrist, Dr. Marvasti would likely know this area best, although he has reportedly worked primarily as a therapist at a clinic specializing in treatment of sexual offenders and their victims for the past 16 years.Some redundancy is in the book, such as chapters 1 and 2 starting prominently with definitions of paraphilia and pedophilia and other overlapping content. Both of the first chapters tend to be definition heavy and relatively dry to read, especially given the attention-grabbing subject matter.As relative newcomers to this field, we found the book to be a helpful introduction to current biologic and nonbiologic treatments for sexual offenders. What is lacking is some further editing to make the book more coherent as a whole, more critical comments from the author about his quoted sources, or at least selected data which would have allowed the readers to provide their own critiques.Dr. Hilt is a pediatrician and child psychiatry fellow and Dr. Saleh is assistant professor in the department of psychiatry at the University of Massachusetts Medical School in Worchester. FiguresReferencesCited byDetailsCited ByNone Volume 57Issue 4 April, 2006Pages 584-585PSYCHIATRIC SERVICES April 2006 Volume 57 Number 4 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 2006

This paper discusses the use of the Trans-theoretical Model of Behavior Change in the treatment of sex offenders. Constructs within this theory are the Stages of Change, Processes of Change and Decisional Balance. The first section of this paper provides a brief description of these constructs. The second section provides a brief review of research related to these constructs and discusses the implications of this research in relation to the treatment of sex offenders. The third section of this paper provides a practical description of the use of the constructs of the Trans-theoretical Model of Behaviour Change in the treatment of sex offenders. Although the validity of this model among sex offenders requires further investigation, the Trans-theoretical Model of Behavior Change appears to have considerable utility as an overarching theoretical model to conceptualize and facilitate behavior change among sex offenders.