Sex Offender Treatment Program Research Articles

“Mr S, you do have sexual fantasies?” The Parole Hearing and Treatment of a Sex Offender at the Turn of the 21st Century

How does the Parole Board decide a sex offender is rehabilitated and can be released into the community? This case study of a parole hearing reveals the significance the Parole Board gives to a sex offender’s management of his arousal as a clear sign of his rehabilitation. To explain the Board’s preoccupation with a sex offender’s sexual fantasies and arousal, I draw on a prison ethnography of a sex offender treatment program. Rehabilitation as risk management relies on the development of a crime cycle and relapse prevention plan designed to grasp the connection between fantasies, arousal and offending. I argue the parole hearing and treatment program exist in a symbiotic relationship that fabricates the sex offender into a species larger than life, one at risk of offending all the time. Key words: rehabilitation, sex offenders, parole, sexual fantasies, ethnography, prison.

“Mr S, you do have sexual fantasies?” The Parole Hearing and Treatment of a Sex Offender at the Turn of the 21st Century

How does the Parole Board decide a sex offender is rehabilitated and can be released into the community? This case study of a parole hearing reveals the significance the Parole Board gives to a sex offender’s management of his arousal as a clear sign of his rehabilitation. To explain the Board’s preoccupation with a sex offender’s sexual fantasies and arousal, I draw on a prison ethnography of a sex offender treatment program. Rehabilitation as risk management relies on the development of a crime cycle and relapse prevention plan designed to grasp the connection between fantasies, arousal and offending. I argue the parole hearing and treatment program exist in a symbiotic relationship that fabricates the sex offender into a species larger than life, one at risk of offending all the time.
 
 Key words: rehabilitation, sex offenders, parole, sexual fantasies, ethnography, prison.

The Good Lives Model (GLM)

The good lives model (GLM) has become an increasingly popular theoretical framework underpinning sex offender treatment programs, and preliminary research suggests that the GLM may enhance the efficacy of programs that adhere to the Risk, Need, and Responsivity (RNR) principles. However, this potential rests on the appropriate operationalization of the GLM in practice. Operationalized appropriately, the GLM aims to facilitate risk reduction alongside equipping clients with the tools to live personally meaningful and fulfilling lives. However, misguided operationalization of the GLM could result in ineffective treatment and ultimately higher rates of reoffending. This article presents findings from a multisite study exploring how the GLM has been operationalized and the degree to which the GLM has been integrated in a sample of 13 North American treatment programs. A comprehensive coding protocol was developed that included items related to program aims and client induction/orientation, assessment, intervention planning, intervention content, and intervention delivery. Each site was visited and items were rated through a review of program documentation, interviews with program directors/managers, and observations of treatment groups. Findings from inductive (how the GLM was operationalized) and deductive (the extent to which the GLM was integrated) analyses are presented and GLM consistent and inconsistent practices are highlighted. The article concludes with suggestions for ways in which program responsiveness to the GLM could be enhanced.

Components underlying sex offender treatment refusal: an exploratory analysis of the Treatment Refusal Scale—Sex Offender version

Approximately half of sexual offenders in prison and community settings refuse to participate in sex offender treatment programmes; however, the reasons for this remain largely unexplored. This pilot study used the previously untested Treatment Refusal Scale—Sexual Offender Version in an English prison, with 72 adult males (63 treatment accepters and nine treatment refusers) imprisoned for sexual or sexually motivated offences. Principal factors analysis revealed three factors within the scale: “pressured to take part in programmes”; “fear of negative effects”; and “programme is not relevant to/appropriate for me”. Treatment refusers scored more highly than treatment accepters on the first and last components, while there was no statistically significant difference in the scores of the two groups on the “fear of negative effects” component. Suggestions for further development of the scale are discussed, along with the practice implications of these findings.

Implications of our developing understanding of risk and protective factors in the treatment of adult male sexual offenders.

This paper summarizes our developing knowledge of factors that contribute added risk of sexual recidivism (risk factors) and factors that are associated with a reduced risk of sexual recidivism (protective factors). Specific im plications for the design of future treatment programs are drawn. This information is contrasted with the common foci of sexual offender treatment programs that were designed before these research findings emerged, and suggestions made about how common clinical tasks might be re-revisited and revised in the light of this new knowledge.

Empathy deficits and sexual offending: A model of obstacles to empathy

Theoretical models of the role of empathy in sexual offending agree on five components relevant to the experience of empathy: a respectful and compassionate orientation to others, perspective taking, affective responding, the ability to manage personal distress, and situational factors. We identify overlap between these components of the empathic process and established risk factors for sexual offending and create a model detailing potential blocks to the empathic process during sexual offending. The model has external consistency and useful implications for interventions with sex offenders. Viewed in the light of this model, we argue that current sex offender treatment programs spend a disproportionate amount of time examining empathy for past victims. We recommend, instead, that treatment aims to enhance offenders' abilities in relation to the components of the empathic process more generally, using creative and engaging techniques akin to those used to develop “victim empathy”.

Sex Offender Treatment Outcome, Actuarial Risk, and the Aging Sex Offender in Canadian Corrections

The present study is an examination of sex offender treatment outcome in a large national cohort of Canadian Federally incarcerated sex offenders followed up an average of 11.7 years postrelease. A brief actuarial risk scale (BARS), which predicted sexual and violent recidivism, was created for the purposes of the present study to control for risk-related differences between treated and untreated offenders. In total, 732 offenders were identified as having completed (n = 625) or not attended (n = 107) a sex offender treatment program and for whom sufficient information was available to complete the scale. Controlling for risk and individual differences in follow-up time using Cox regression survival analyses and an 8-year fixed follow-up period, treated sex offenders demonstrated significantly lower rates of violent, but not sexual, recidivism. When the treated and untreated groups were stratified by risk level, significant differences were observed only among moderate or high risk offenders. Some significant group differences also emerged on indicators of recidivism severity, with treated offenders demonstrating slower times to sexual reoffense and lower scores on a quantified metric of sexual and violent recidivism severity after controlling for risk. Differences in recidivism base rates between treated and untreated offenders were also larger in magnitude for younger offenders (i.e., under age 50 at release), than for older offenders; however, interactions between age and treatment were not found. The findings are consistent with the risk principle and have possible implications regarding the dynamic nature of sexual violence risk.

Wise mind—risky mind: A reconceptualisation of dialectical behaviour therapy concepts and its application to sexual offender treatment

This paper aims to introduce a reconceptualisation of dialectic behaviour therapy (DBT), “wise mind–risky mind”, and its application to sexual offender treatment. This reconceptualisation holds some promise in addressing issues around general, affective, cognitive and sexual dysregulation, and may provide an alternative way of thinking about sexual offender treatment. The wise mind–risky mind dialectical construct helps clients and therapists utilise a common language that captures and validates the experiential difficulties that clients go through in effectively managing their risk for sexual offending. The incorporation of DBT principles in standard sexual offender treatment programmes can assist clients in effectively managing problems with dysregulation in various domains. It can also afford a more integrated treatment framework when working with sexual offending dynamics. The authors discuss this new construct and its possible applications within the broader forensic mental health field.

Risk and Protective Factors for Recidivism Among Juveniles Who Have Offended Sexually

Literature on risk factors for recidivism among juveniles who have sexually offended (JSOs) is limited. In addition, there have been no studies published concerning protective factors among this population. The purpose of this study was to examine the relationship of risk and protective factors to sexual and nonsexual recidivism among a sample of 193 male JSOs (mean age = 15.26). Youths were followed for an average of 7.24 years following discharge from a residential sex offender treatment program. The risk factor opportunities to reoffend, as coded based on the Estimate of Risk of Adolescent Sexual Offense Recidivism, was associated with sexual recidivism. Several risk factors (e.g., prior offending; peer delinquency) were associated with nonsexual recidivism. No protective factors examined were associated with sexual recidivism, although strong attachments and bonds as measured by the Structured Assessment of Violence Risk in Youth was negatively related to nonsexual recidivism. These findings indicate that risk factors for nonsexual recidivism may be consistent across both general adolescent offender populations and JSOs, but that there may be distinct protective factors that apply to sexual recidivism among JSOs. Results also indicate important needs for further research on risk factors, protective factors, and risk management strategies for JSOs.

Victim Empathy Intervention With Sexual Offenders

A sexual offender is thought to have victim empathy when he has a cognitive and emotional understanding of the experience of the victim of his sexual offense. Most sex offender treatment programs devote significant time to developing victim empathy. The authors examine three meta-analytic studies and some individual studies that suggest victim empathy work is unnecessary, or even harmful. Service user studies, however, report positive reactions to victim empathy work. The authors conclude that the enthusiasm for victim empathy work as a rehabilitative endeavor is disproportionate given the weak evidence base and the lack of a coherent theoretical model of change. However, because the research is inconclusive, it is not possible to conclude that victim empathy work is "correctional quackery." We suggest a research program to clarify whether or not victim empathy intervention for sexual offenders has value.

How to Integrate the Good Lives Model Into Treatment Programs for Sexual Offending

The good lives model (GLM) represents a new theoretical framework informing sex offender treatment programs; however, substantial variation has been observed in terms of how GLM-related ideas and practices have been applied. Integrated appropriately, the GLM offers potential for improving outcomes of programs following a cognitive-behavioral therapy (CBT) approach and operating according to a narrow operationalization of risk, need, responsivity (RNR) principles. Conversely, misguided or otherwise poor integration could increase the very risk practitioners work to prevent and manage. The purpose of this article is to provide an introduction and overview on how to integrate the GLM into treatment using CBT and RNR. The authors describe clinical implications of the GLM as they relate to program aims and orientation, assessment and intervention planning, content, and delivery.

Do Low‐risk Sexual Offenders Need Treatment?

AbstractThe risk principle of offender rehabilitation states that the intensity of treatment should be proportional to the offender's risk. This article reviews the evidence base for the risk principle with sexual offenders, as well as identifying other arguments, in order to determine whether low‐risk sexual offenders need treatment, and of what type and magnitude. We conclude that low‐risk sexual offenders probably need no more than 100 hours of offence‐focused treatment given their very low reconviction rates. Low‐risk sexual offenders should be kept separate from higher‐risk offenders, and treatment should not interfere with other activities that will enable a non‐offending lifestyle.

Predicting Reoffense for Community-Based Sexual Offenders

This study contributes to the area of risk prediction by exploring whether the Static-99R is useful for predicting reoffense in community-based samples, and for noncontact offenders with and without identified victims. A total of 744 participants drawn from an outpatient sex offender treatment program in a large metropolitan area were followed for a period of up to 30 years. Multiple Cox Regressions were run; covariates included length of treatment, status in treatment, Static-99R items, and number of technical probation violations. Overall, reoffending was an infrequent occurrence in this sample regardless of how it was defined, with sexual reoffenses identified in 13% of the sample and any criminal reoffense identified in 20% of the sample. Consistent with previous research, the Static-99R was a better predictor of sex-related reoffenses than of nonsexual reoffenses. However, in no case were more than a couple of the items significantly related to reoffending and these items differed depending on reoffense definition.

Intrafamilial Adolescent Sex Offenders' Response to Psychological Treatment

This qualitative study examined perceptions of a community-based treatment program for intrafamilial adolescent sexual offenders, from the perspective of the adolescent clients. The post-treatment interviews of 12 adolescents generated information regarding the participants' experiences of treatment and the effect of treatment on individual and family functioning. Greatest improvements occurred in the areas of communication with family and friends, anger management, and impulsivity. All participants agreed that group therapy was the most beneficial component of the program. The space to express feelings about the inappropriate sexual behaviours, as well as other personal and family issues was regarded as key to positive change. Greater improvements in family functioning were reported when at least one parent also attended therapy. There were fewer indications of change in the expression of empathy and construction of relapse prevention plans.

The development and accreditation of a treatment model for prisoners with a learning disability and personality disorder

PurposeThe paper's aim is to describe the development of a therapeutic community for prisoners with a learning disability and suggested methods for increasing responsivity of the programme for this population.Design/methodology/approachThis is a technical paper providing a descriptive account of the development of a new service provision for prisoners with a learning disability.FindingsNo research findings are presented, but the paper seeks to illustrate that programme responsivity can be enhanced by incorporating flexibility into the design and delivery of programmes.Originality/valueWith the exception of the adapted sex offender treatment programme there have been few available interventions for offenders with a learning disability in the criminal justice system. This paper provides an overview of both the process of accreditation and the development of the current accredited TC model for this population.

Utilization and Implications of the Static-99 in Practice

The Static-99 is the most commonly used risk assessment instrument for sexual violence in North America and its results can affect highly consequential decisions made in the criminal and civil justice systems. Despite its influence, few studies have systematically examined how the Static-99 is used by clinicians in practice. The current study compares the Static-99 ratings of clinicians to those of researchers for 100 adult males who completed an outpatient sex offender treatment program and were followed up over an average of about 4 years. Results showed good agreement between the ratings of clinicians and researchers for total scores on the Static-99, as well as for most individual items. Ratings by clinicians tended to be slightly lower than those made by researchers. The predictive validity of ratings made by clinicians and researchers was very similar and moderate in terms of effect size. In 30 cases, clinicians used discretion to "override" or adjust the Static-99 ratings when making final risk judgments, but the predictive validity of the clinical adjusted ratings was worse than that of the original Static-99 ratings made by clinicians. The need for quality assurance and training are discussed along with the need for clear empirically supported guidelines regarding overrides.

A treatment component designed to enhance empathy in sex offenders with an intellectual disability

PurposeThis paper seeks to describe the introduction of a component designed to enhance empathy, to an established cognitive behavioural treatment program for sexual offenders with an intellectual disability.Design/methodology/approachThe treatment group received an empathy component and was compared with a control group. Therapeutic efficacy was assessed pre‐ and post‐treatment and at follow‐up using the interpersonal reactivity index which assesses fantasy; perspective taking; empathic concern and personal distress experienced due to others' misfortune.FindingsThere were no significant differences between treatment and control groups at baseline. For the treatment group, significant differences were identified between pre, post and three‐month follow‐up assessments indicating an increased empathy at post‐treatment assessment, the treatment group had significantly improved over the controls.Research limitations/implicationsFuture research could compare empathy measures and investigate specifically the relationship between what is taught in empathy programs and what is measured by empathy assessments. Difficulties with the study are discussed.Originality/valueThe empathy component appears to enhance empathic responses.

‘It’s Intense, to an Extent’: A Qualitative Study of the Emotional Challenges Faced by Staff Working on a Treatment Programme for Intellectually Disabled Sex Offenders

This study explores the emotional challenges faced by staff working on a sex offender treatment programme for people with an intellectual disability. Semi-structured interviews were carried out with eight participants working on a treatment programme for sex offenders with an intellectual disability. Interviews were analysed using interpretative phenomenological analysis. Staff experienced a range of negative emotions that they dealt with in a variety of ways including through the use of humour and various emotional defences. Empathy was a challenging and complex issue with individuals taking a variety of positions. Staff awareness and understanding of the role of emotions in relation to their own well-being and in relation to therapeutic processes varied. Emotional intelligence was associated with greater therapeutic understanding. Recommendations are made in relation to personal and professional characteristics and need for clinical supervision to support staff well-being and the development of therapeutic competence and effectiveness.

AS37-02 - Cost efficiency of sex offender treatment programmes in Switzerland

There is robust empirical evidence for the efficacy of offense-oriented treatment programs. These programs help reducing the rate of recidivism. In the case of sex-offender treatment, a lower rate of recidivism results in lower rate of victims. For the victims, experiencing sexual assaults is a relevant risk factor for the development of a series of mental health disorders. It is thus not surprising that sex-offenses lead to substantial financial costs and preventing sexual re-offending help reducing treatment costs. In Switzerland, a longitudinal study, that started in 2000, allowed to compare the outcome of more than 300 treated violent and sex-offenderswith a control group of untreated offenders. Though the risk for re-offending was estimated to be higher in the treatment group, the rate of recidivism was considerably lower. Using this difference of re-offending among the groups, it could be demonstrated that the treatment program was cost-efficient since the costs of the treatment programs were substantially lower than the expected treatment costs for the victims.

Functional Analytic Psychotherapy with juveniles who have committed sexual offenses.

The results of a recent meta-analysis (Reitzel & Carbonell, 2006) indicate that approximately 19% of adolescents who did not receive specialized, sexual-offense-specific treatment were subsequently charged for a sexual reoffense after a follow-up period of approximately 5 years. In contrast, approximately 7% of adolescents who received sexual-offense-specific treatment were charged with a new sexual offense during the same time period. Thus, participation in treatment to address sexual offense behavior reduces sexual offense recidivism by almost two-thirds. Like other forms of therapeutic intervention, treatment for juveniles who commit sexual offense behavior (henceforth referred to as JSOs) was adapted from interventions that had been developed for treating adults who had committed sexual offense behavior. With regard to therapy for adults who have committed criminal offense behavior, including sexual offense behavior, current best practice emphasizes the principles of Risk, Need, and Responsivity (RNR; Andrews & Bonta, 1998). Briefly, the Risk Principle states that the level of intervention is matched to the assessed level of recidivism risk level of the client; a low risk client should receive relatively less intervention, whereas a high-risk client should garner relatively more intervention. Applied to treatment for juveniles, the Risk Principle suggests that more resources should be allocated to juveniles whose sexual offenses were motivated by an underlying interest in sexually deviant themes (i.e. use of force, attraction to pre-pubescent children), and/or juveniles with a long-standing history of behavior. The Need Principle states that effective treatment should focus on criminogenic also known as dynamic risk i.e. factors that have are statistically associated with recidivism, and which are amenable to change. Applied to treatment for juveniles, the Need Principle suggests that therapeutic interventions should be focused on the emotions, attitudes, and behaviors that facilitate a generally delinquent or non-prosocial lifestyle, such as anger/aggression/negative affect, substance use, stability of school and social functioning, negative peer influences, and an unstable/unsupportive family environment. The Responsivity Principle refers to the use of empirically based treatment approaches and delivery of treatment in a manner that takes into account the individual needs of the client (learning style, cognitive ability; Dowden & Andrews, 2000). This principle discourages therapists from using poorly theorized approaches (e.g., psychoanalysis) or administering treatment programs in a mechanistic one size fits all fashion to improve treatment outcomes. Applied to treatment for juveniles, the Responsivity Principle suggests that treatment should be tailored to adapt to the client's level of physical, cognitive, social, emotional, and psychosexual development (Newring et. al 2010). There are many variants of the RNR approach, both in program design and delivery (Polaschek, 2011). Andrews and Bonta (2010) recently reported that RNR approaches have been shown to reduce offender recidivism by up to 35%. In their recent meta-analysis, Hanson, Bourgon, Helmus, and Hodgson (2009) found strong support for the application of RNR to sexual offender treatment programs. RNR approaches are being used successfully with sexual offenders (Harkins & Beech, 2007), intellectually disabled sexual offenders (Keeling, Beech & Rose, 2007), and personality-disordered violent forensic clients (Wong, Gordon, & Gu, 2007). NEW DIRECTIONS IN TREATMENT FOR SEXUALLY OFFENSIVE BEHAVIOR Positive and collaborative approaches. In recent years, traditional confrontation-based and avoidance-focused treatment approaches have been challenged (Marshall, Ward, Mann, Moulden, Fernandez, Serran, & Marshall, 2005; Wheeler, 2003; Wheeler, George, & Marlatt, 2006; Wheeler, George & Stoner, 2005). …