Sex Offender Treatment Research Paper Example

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This research paper provides a brief summary of three key aspects of the treatment of sexual offenders. It begins with a description and critique of the two of the most influential treatment models, namely, the Risk Needs Responsivity (RNR) model and the Good Lives Model (GLM). It then provides a discussion of some of the relevant process issues, namely, whether treatment should be conducted in groups, and the problems of confrontation and coercion. The paper concludes with a description of the primary components of group treatment approaches and a discussion of treatment efficacy.

Treatment Models

In order to fully understand contemporary sex offender treatment, it is useful to first summarize the models which underlie treatment. Obviously, it is not possible to describe all of the relevant models herein; thus, two models which are considered to be especially influential will be discussed, namely, the Risk Needs Responsivity model (Andrews and Bonta 2003a) and the Good Lives Model (Ward and Stewart 2003).

The Risk Needs Responsivity Model

Andrews and Bonta’s (2003a) Risk Needs Responsivity (RNR) approach has been important in guiding treatment across a variety of offender groups, including sexual offenders. Since its development in the late 1990s, it has played a significant role in the way that treatment has been conceptualized and delivered. As indicated by the name of the model, there are three main components. The risk aspect of the model refers to the type and degree of risk that an offender poses and suggests that the risk level should determine the intensity of treatment.Thus, low-risk offenders should receive less intensive treatment, and high-risk offenders should receive higher intensity treatment. As explained by Andrews and Bonta, intensity essentially refers to the duration of treatment.

The need aspect of the RNR model refers to the offender’s specific rehabilitative requirements, which are variously termed criminogenic needs or dynamic risk factors. Essentially, these are the psychological characteristics and/or behaviors of the individual which require treatment. According to the model, treatment should target the specific characteristics that contribute to the individual’s offending so that the likelihood of reoffending will be reduced. As outlined by Andrews and Bonta, some common examples of these sorts of characteristics include antisocial attitudes and beliefs, substance abuse, and relationship problems.

The third part of the RNR model is the responsivity principle which is concerned with the actual delivery of treatment. As stated by Andrews and Bonta, the responsivity principle acknowledges the significance of the therapeutic relationship and assumes that an offender’s response to treatment will be dependent on this, as well as a range of other variables. Also, the model takes the view that in order for treatment to be effective, it needs to identify and manage barriers to treatment and build on the individual’s unique strengths. Furthermore, the responsivity principle espouses that in order for treatment to be successful, it needs to be designed according to best practice guidelines; in other words, it is important that there is evidence that a particular therapeutic approach is effective in treating the offender’s unique range of needs.

According to Ward et al. (2008, p. 180), the RNR model has “constituted a revolution in the way that criminal conduct is managed in Canada, Britain, Europe, Australia, and New Zealand.” While the model is general, insofar as it has been applied to a range of offender types, it is nonetheless pertinent to this discussion as it has been widely used in the design of treatment of sexual offenders. One of the key strengths of the model is the ease with which it can be translated into treatment. It provides clear guidelines in terms of selecting appropriate treatment for offenders, and it assists in the identification of treatment targets. Also, it encourages the therapist to consider the offender’s strengths and weaknesses and to design treatment accordingly. Furthermore, it emphasizes the link between theory, research, and practice and is thus consistent with the principles of the scientist-practitioner model.

However, some researchers have criticized certain aspects of the RNR model. For instance, it has been argued that the RNR model places too much emphasis on rehabilitative needs and not enough emphasis on other aspects of treatment. For example, Wilson and Yates (2009) argue that the RNR model tends to overlook the importance of therapist qualities such as empathy and respect due to its focus on the needs of the offender. However, as outlined above, in a recent explication of the RNR model, Andrews and Bonta highlighted the significance of the therapeutic relationship in treatment success. Ward argues (e.g., Ward and Stewart 2003) that the RNR model is typically implemented in an inflexible manner which fails to adequately deal with individual needs. However, this may be an unfair criticism insofar as this may reflect as inadequate implementation of the model rather than a failing of the model per se. In their critique of the RNR model, Ward and Stewart (2003) also state that the model takes an overly negative approach to therapy by focusing on risk avoidance. They suggest that the model assists offenders in understanding what to avoid, but does not assist them in establishing new pro-social behaviors.

The RNR model continues to provide the framework upon which many contemporary treatment programs for offenders are designed and administered, and this is true also for sex offender programs. Furthermore, there is now mounting empirical support for the model. According to Andrews and Bonta (2010, p. 39), “.. .programs that adhere to the Risk Needs Responsivity (RNR) model have been shown to reduce offender recidivism by up to 35 %.”

The Good Lives Model

The Good Lives Model (GLM) by Ward and colleagues (Ward and Stewart 2003) is another model that is influential in the area of offender rehabilitation. Furthermore, the GLM has been widely discussed in relation to sexual offenders. As illustrated above, Ward and various colleagues have criticized the RNR model, and they have developed the GLM, at least in part, to respond to some of the weaknesses of the RNR model. The GLM takes a very different approach to offender rehabilitation; rather than examining the risk level of an offender, it begins by asking what purpose the offending is serving. Specifically, the question is: What gap or need is the offending filling? Ward and colleagues (e.g., Serran et al. 2007) suggest that in order to bring about long-term change in offenders’ behavior, therapy should identify and respond to the underlying motivation for the behavior.

The GLM is founded on the proposition that all human activity revolves around the desire to fulfill basic needs or “goods.” For instance, eating nutritious food and engaging in regular physical exercise might fulfill the basic good of maintaining physical well-being. Painting a picture or acting in a play may fulfill the basic good of creativity. When these sorts of “goods” are maintained pro-socially in an individual’s life that it can be said that he or she has a “good” life. Ward also argues that the drive to attain such “goods” is inherent by virtue of one’s humanity. For example, he states that “.. .both sexual and non-sexual offenders are naturally disposed to seek a range of primary human goods that if secured will result in greater self-fulfillment and sense of purpose” (Ward et al. 2009, p. 304).

In explicating the GLM, Ward draws a distinction between primary and secondary goods. While primary goods are essentially ends in themselves, secondary goods relate to the means of attaining primary goods. For example, as shown below, knowledge is viewed as a primary good; thus, secondary goods that might bring this about would include activities such as reading a book and engaging in educational activities. Drawing on theoretical work from a range of research areas, including anthropology, evolutionary psychology, and ethics, Ward and Stewart (2003) propose that there are at least ten primary human goods, namely, “Life (including healthy living and functioning), knowledge, excellence in play and work (including mastery experiences), excellence in agency (i.e., autonomy and self-directedness), inner peace (i.e., freedom from emotional turmoil and stress), friendship (including intimate, romantic and family relationships), community, spirituality (in the broad sense of finding meaning and purpose in life), happiness, and creativity” (p. 356).

Ward proposes that offenders, like all human beings, value these primary goods and seek to manifest them in their daily lives. However, Ward stresses that for most offenders, and indeed most non-offenders, the drive to attain these goods is not necessarily part of one’s conscious awareness. Thus, the drive to attain these goods is often natural and ingrained and not typically part of a carefully thought-out plan. Ward suggests that while offenders attempt to realize the same goods as those who do not commit crimes, they go about this in a problematic way and he describes four key types of problems. These are the use of inappropriate means (i.e., goods are sought in ways that are inappropriate and counterproductive), a lack of scope (i.e., only some goods are sought), conflict or lack of coherence (i.e., the ways some goods are sought directly reduces the chances of others being secured), and a lack of capacity (i.e., individuals lack the skills, opportunities, and resources to achieve a certain good in specific ways).

With regard to sexual offenders, the use of inappropriate means would be a common example. While a male sexual offender may seek a sexual partner as part of his intention to attain the “good” of “friendship,” he may seek an inappropriate sexual partner. For instance, he may engage in sexual activity with a minor rather than an adult. Furthermore, his sexual offending may be related to a lack of capacity; he may lack the social skills required to establish and maintain an appropriate sexual relationship with an adult.

As outlined by Ward, a GLM approach to offender rehabilitation requires a comprehensive assessment of the relationship between the offending and goods that the offending is being used to attain. Then, a Good Lives Plan is developed which includes setting goals for the future which will ultimately bring about the manifestation of goods in a pro-social manner. Thus, treatment involves the acknowledgement that all human beings have basic needs and the encouragement of offenders to strive to meet these in their lives but to do so in the manner that is consistent with societal norms and laws. According to the GLM, when these basic needs are met, the risk for reoffending will be greatly reduced because the offender will no longer use offending as a means of achieving his goals.

The GLM approach to offender rehabilitation is consistent with the work of Maruna (e.g., 2001) which stresses the importance of taking a positive approach in therapy. The GLM is also compatible with the strengths-based approach which has become increasingly popular within the field of mental health treatment (Wong 2006). However, as yet, there is insufficient empirical evidence that applying the GLM to offender treatment is advantageous. Also, the suggestion put forward by proponents of the GLM that the more traditional RNR model has a negative focus and is not strengths-based has been challenged. For example, it has been noted that the RNR framework does have positive and forward-looking components (New Zealand Department of Corrections 2009). Furthermore, Andrews and Bonta (2003b) take issue with Ward’s proposition that a focus on criminogenic needs and risk factors is incompatible with a focus on more positive factors.

At this time, in light of current research and theory, it would seem that a combination of the RNR model and a “good lives” approach is the best way forward in the treatment of sexual offenders. While the GLM still requires empirical support, given its alignment with positive and strengths-based approaches. which have already proven their worth, it is arguably a useful model which is likely to prove efficacious.

Process Issues

Over recent years researchers have predominantly focused on the content of sex offender treatment programs rather than the process. However, with regard to the process of treatment, there are a number of important issues which require attention.

Group Versus Individual Approaches

Treatment of sexual offenders is typically conducted in groups with between eight and ten participants with either one or two facilitators (Marshall 2001). As stated by Marshall, group treatment is more economical and has been found to be more effective. Marshall points out that in group settings, clinicians are less likely to collude with offenders. Collusion is more likely with this offender group as due to society’s strong aversion to sexual offending; it is especially difficult for these sorts of offenders to admit to their crimes. Sexual offenders are more likely to deny their offending or to minimize their degree of culpability, and this can pose a challenge in terms of establishing rapport in individual treatment. In contrast, in a group setting, participants are able to challenge each other which assists in maintaining the rapport between the facilitator and the offender.

As explained by Harkins and Beech (2008), effective group treatment is dependent on the presence of several qualities within the group. One that has been found to be particularly important is cohesiveness (Harkins and Beech 2008) which is essentially the positive feelings that group members have for each other and the extent to which they are able to work together. As stated by Harkins and Beech, the role of the therapist is crucial in establishing cohesiveness within the group. In particular, the therapist needs to earn the respect of the participants by displaying a range of positive characteristics, such as flexibility, warmth, and empathy. However, it is equally important that the therapist is firm and directive and is able to challenge the participant when necessary, although this should be done in a gentle and compassionate manner (Serran et al. 2003).

Many contemporary sex offender treatment programs utilize mixed groups, that is, they treat rapists and child sexual offenders together, and some researchers have questioned whether this is appropriate. For example, Harkins and Beech (2008) compared the “therapeutic climate” in mixed groups and in homogenous groups. They measured therapeutic climate with the Group Environment Scale (GES) which targets a range of phenomena, including expressiveness, cohesion, and leader support. Harkins and Beech found that there was no difference in the quality of the therapeutic climate between the group types. Furthermore, they found that both types of group appeared to have very positive therapeutic climates. Also, recidivism data examined in the study showed that the type of group that child sexual offenders participated in had no impact on the likelihood of reoffending (however, similar data was not available for rapists).

Some researchers have argued that even when treatment is delivered within a group setting, it should still be tailored to the unique needs of the individual. For example, Marx et al. (1999) suggest that facilitators should adapt their approach to suit the various personality traits and learning styles of group members. Thus, it is proposed that even within a group setting, therapists can respond to individual needs. It is important to note though that such an approach would be dependent on a thorough and accurate assessment of the group participants which would allow for the identification of individual factors that would then facilitate appropriate tailoring of the therapist’s interaction with group members.

Many group-based sex offender treatment programs provide individual therapy sessions as an adjunct to group treatment. For example, the Te Piriti Sex Offender Treatment Program in New Zealand includes individual therapy sessions alongside group-based treatment. These sessions allow the facilitator to provide additional support to the offender and to discuss any problematic issues that may arise during group sessions. They also provide an opportunity for the offender to raise issues that he may not feel comfortable raising within the group. For example, often offenders feel apprehensive about the idea of disclosing the details of their offending to their fellow group members, and thus individual sessions provide an opportunity to discuss such concerns prior to disclosure and to provide appropriate guidance and support.

Confrontation

There is an ongoing debate about the merit of using outright confrontation in the treatment of sexual offenders. This sort of approach is questioned because it is incompatible with the sorts of qualities which are considered to be fundamental to effective therapy. However, it is sometimes considered to be necessary because sexual offenders often deny or minimize their offending. Marques et al. (2005) state: “.. .too many sex offender treatment providers appear to believe that it is necessary to be extremely confrontative when working with these clients” (p. 1098). However, as Marque and colleagues explain, such an approach is inconsistent with the principles of motivational interviewing (MI), principles which the research shows are very helpful in guiding offender treatment. Although one of the key tasks of MI is to “develop discrepancy,” this should be done carefully and in conjunction with the other components, which include the expression of empathy and avoiding arguments.

Marshall and others (Marshall et al. 2003) examined the effect of therapist qualities on the efficacy of sex offender treatment and concluded that there are several therapist characteristics which are associated with treatment success. For instance, they found that emotional warmth, empathy, directiveness, and positive reinforcement were all associated with positive treatment outcomes. Arguably, these types of therapist qualities are not compatible with a confrontational approach; thus, Marshall’s research raises further doubts about the usefulness of such an approach in sex offender treatment. Overall, research suggests that therapists working with sexual offenders should probably be supportively challenging. That is, they should challenge in a way that allows them to remain positive and encouraging. Supportive challenges differ from confrontational challenges in that they are typically expressed in a warm and understanding manner which displays a genuine interest in the individual and concern for his or her well-being.

Coercion

Another process issue, which is pertinent to the rehabilitation of sexual offenders, is the impact of coercion on treatment effectiveness. Although many sexual offenders are recommended by judges, parole boards, and psychologists to engage in offense-related treatment, many choose not to. A comprehensive study by Langevin (2006) found that approximately 50 % reported that they wished to undertake treatment and about 13 % successfully completed treatment. Thus, a high number of sexual offenders decline treatment and only a small proportion complete treatment. Furthermore, with regard to those who do engage in treatment, there are a variety of reasons that may underlie their decision. For example, while some offenders may believe that they need treatment and will benefit from it, others simply undertake treatment in order to gain early release from prison. Thus, the provision of consent in a prison setting may not reflect a genuine motivation to engage in therapy but may simply reflect other motivations. Also, the offender may feel coerced by others; he may believe he has no choice but to abide by the wishes of the judicial system.

As explained by Burdon and Gallagher (2002), the coercion that forms the backdrop to offender treatment is part of broader societal efforts to coerce the offender, including imprisonment, registration, and community supervision. Thus, coercion reflects society’s desire to control the offender in order to prevent reoffending. But of course, in terms of treatment some degree of motivation and cooperation is necessary in order for treatment to progress, and this is recognized by most therapists who are involved in selecting treatment participants. Also, often there are constraints on program delivery which limit the number that can be run at any one time, and this in turn limits the number of places that are available. Thus, it is often necessary to choose participants that are most likely to benefit from the program, and these are often those who express a desire to undertake treatment. However, it is interesting to note that involvement in sex offender treatment tends to increase an offender’s openness to the idea of engaging in treatment and can lead to success in treatment, even in individuals who are initially unenthusiastic (Burdon and Gallagher 2002).

Treatment Components

There are many different components that may be used in the treatment of sexual offenders. The components that are covered herein are those that are commonly used in group treatment approaches and which have described in detail in the research literature.

Deviant Sexual Arousal

It is not surprising that deviant sexual arousal is often targeted in treatment as it has been found to be one of the most significant risk factors for sexual reoffending. However, it has been reported that deviant arousal is now not routinely targeted in treatment as it was previously, due to the acknowledgement that problematic sexual preferences do not always play a significant role in an individual’s offending (e.g., Marshall 2006). Also, the factors that lead to sexual offending are many and varied and differ across offender and offense type. For example, in rape offenses, anger and aggression may play a more significant role than problematic sexual preferences. Further, research suggests that sexual arousal to stimuli associated with rape has been found in men who have not committed rape; thus, it is not necessarily associated with deviant behavior. Thus, it may be the case that offense-related sexual preference is more likely present in child sexual offenders. Nonetheless, many sexual offender treatment programs, for those with adult and juvenile victims, continue to include a component that focuses on deviant sexual arousal (Marshall 2006).

As explained by Marshall et al. (2009), there are two general types of behavioral approaches to treating deviant sexual pBibliography: aversion techniques (such as covert sensitization and satiation therapy) and techniques that utilize positive reinforcement (such as masturbatory reconditioning). Covert sensitization involves pairing the deviant sexual behavior with an aversive stimulus via imaginal exposure so that the offender eventually finds the sexual behavior to be aversive. In contrast, satiation therapy involves combining the deviant stimulus with prolonged masturbation so that over time the stimulus loses its appeal. Masturbatory reconditioning involves replacing the deviant sexual stimulus (e.g., child) with a pro-social stimulus (e.g., an adult) which is then reinforced through masturbation. While these sorts of techniques have been in use for many years, there is little research available that has examined their efficacy. Also, much of the research that has been conducted has used single-case designs which of course do not allow comparison with other treatment methods.

Marshall et al. (2009) conclude that based on the available evidence, the best approach to treating deviant sexual arousal would be to use a combination of masturbatory reconditioning and satiation therapy. In this way the individual’s arousal to the pro-social stimulus would be strengthened, while the arousal to the deviant stimulus would be weakened.

Emotional Regulation

Research indicates that those who commit sexual offenses tend to have difficulties regulating their emotions and may commit sexual crimes as a means of avoiding experiencing negative emotion (Mandeville-Nordon and Beech 2004). Evidence suggests that, in particular, sexual offenders often struggle to cope adaptively with stressful life events. It seems that when faced with stressful situations, sexual offenders often use maladaptive and ineffective coping strategies which increase the likelihood of reoffending (Cortoni and Marshall 2001). For example, it has been observed that rapists may experience high levels of anger and resentment in response to stress which may contribute to their offending.

Other evidence indicates that sexual offenders often use masturbation with either appropriate or inappropriate sexual fantasies as a means of escaping the experience of negative emotion (Cortoni and Marshall 2001), and such responses could increase the likelihood of sexual offending, especially, if it reinforces the idea of inappropriate sexual interaction. Thus, researchers have suggested that treatment should include a component that teaches offenders how to respond constructively to the negative emotions that may arise from stressful life events (Beech and Fisher 2002). However, to date, there is little research available that shows whether the inclusion of such components in treatment leads to a reduction in sexual reoffending. A study by Serran and colleagues (2007) found that sex offenders who had completed treatment which included a coping skills component appeared to be better equipped (than the wait-listed controls) at dealing with high-risk situations. However, the study did not include a follow-up looking at recidivism; thus, it is unclear whether this would translate into a reduction in reoffending.

As mentioned above, in terms of rape, anger is a particularly prominent negative emotion. Howitt (2006) states: “Anger control problems have to be seen as an issue with rapists for whom issues of anger are common” (p. 369). However, some researchers have questioned the use of anger management components in treatment programs for rapists due to the fact that anger does not appear to be a problem for all rapists. For example, Loza and Loza-Fanous (1999) investigated anger levels across a range of offender groups and found no difference in levels between rapists and non-rapists (or between violent and nonviolent offenders). The authors then question the usefulness of anger management in the treatment of rapists. Arguably, this study would have been more worthwhile if it had also included a non-offender population as it may be the case that offender populations have high levels of anger problems. If so, then rapists’ anger levels, though similar to other offenders, may still be problematic and potentially contribute to their risk of reoffending.

Cognition

It is widely acknowledged that sexual offenders may harbor a range of offense-related attitudes and beliefs. Cortoni (2009) states: “.. .an overall predisposition to be tolerant of sexual offending is related to sexual recidivism” (p. 44). Thus, the targeting of offense-related attitudes and beliefs is a mainstay of rehabilitation approaches. One common type of belief that is endorsed by sexual offenders is a belief of “entitlement” to sex. This can include specific beliefs such as “men need more sex than women do” and “everyone is entitled to sex” (Pemberton and Wakeling 2009). Also, child sex offenders may believe that children are sexual objects and that having sex with children is good because it educates them about sex. In contrast, research has shown that those who commit rape offenses tend to objectify and sexualize women and that they hold quite specific beliefs about specific situations. For instance, rapists often endorse beliefs along the lines of “if a woman flirts, then she wants to have sex” or “if a woman accepts a free drink, then she wants to have sex.”

Within the sex offender field these problematic attitudes and beliefs are typically referred to a “cognitive distortions,” and they are frequently used by offenders to justify their offending. In this way, they may be used by the offender to feel comfortable with continued offending. For example, a child sex offender might justify his ongoing abuse of a child with the belief that the sexual interaction with the child is appropriate because the child is choosing to engage in the sexual activity and shows no sign of being unwilling. In association with his belief, he may also believe that the child is not being harmed in any way. In this way the abuser attempts to minimize his level of culpability, and this contributes to his decision to continue with the behavior. While sexual offenders will usually report that they had an awareness of wrongdoing, they will often use their cognitive distortions to distract themselves from this awareness.

As mentioned above, sexual offenders often find it difficult to admit to their offending due to the social ramifications. For example, they may believe that if they admit to what they have done, they will lose the support of family and friends. Also, in some cases, the sense of shame and embarrassment make it very difficult for them to talk to others about it, including those involved in correctional and rehabilitative services. It has been reported that most sexual offenders either deny that they committed the crime or at least attempt to minimize their level of responsibility (Marshall 2006). Thus, it might be assumed that denial and minimization would be important targets for treatment. In fact, many treatment programs do not allow deniers to participate because some components of treatment require the offender to admit to their offending. For example, often offenders are expected to describe their offense in detail in order to identify points at which they could have behaved differently and avoided offending.

There may be a range of other reasons that treatment programs may preclude those who deny their offending. For instance, deniers may have a negative impact on other individuals in the group; if they are not willing to be honest, then others may be less inclined to be upfront and open. Also, those who are unwilling to admit to and discuss their offending may be less likely to benefit from treatment; thus, they may take the place of someone who may have had more to gain from taking part in treatment. This issue arises because most sex offender treatment programs have limited places available. As they require significant resources to run, organizations (typically prisons) are only able to run a limited number. However, Marshall (2001, 2006) argues that excluding those who deny their sexual offending has the effect of putting the public at greater risk because those offenders are then released untreated.

When denial is addressed in treatment, there are two general approaches. One approach is to include a specific module that targets denial during the initial stages of the treatment program, while the other approach is to place deniers in a specially designed treatment program. When the former approach is taken, the issue of denial is usually discussed in an individual setting, prior to the beginning of treatment proper, so that the offender can consider and perhaps reconsider the extent to which they will be willing to discuss the offense, prior to having to communicate with fellow group members.

Intimacy And Social Skills

Evidence suggests that sexual offenders find it difficult to establish and maintain consensual intimate relationships and that subsequently they are vulnerable to experiencing social isolation and loneliness (Mandeville-Nordo and Beech 2004). Mandeville-Norden and colleague also report that individuals who commit sexual crimes tend to lack confidence and assertiveness skills; thus, it may be hypothesized that the lack of confidence and problems being assertive contribute to the intimacy difficulties. Also, research has shown that sex offenders report significant feelings of loneliness even within the context of intimate relationships. Therefore, social skills training is a mainstay of sex offender treatment programs. As explained by Marshall (2006), social skills training is usually a broad-based aspect of treatment which may include a range of components, including problem solving skills, assertiveness training, self-esteem building, and sex education.

The Extended Sex Offender Treatment Programme (ESOTP) in the United Kingdom is an example of a program that addresses social functioning. This program for high-risk offenders, which involves 140 h of treatment over 68 sessions, includes a component titled “intimacy skills.” This component includes skill development in the areas of jealousy management, conflict resolution, and giving and receiving social support. A recent survey of sex offender treatment programs in Canada reported that three quarters of their programs included components that targeted intimacy, relationships, and social skills. Overall, research shows that both intimate relationships and more general social functioning are addressed in most sex offender treatment programs.

Some research has examined the relationship between sexual offending and adult attachment styles. For instance, Lyn and Burton (2004) examined attachment styles in a “Midwestern United States” sample of sex offenders and found that the majority (85 %) were assessed as having insecure patterns of attachment. Furthermore, when Lyn and colleague compared sex offenders with non-sex offenders, they found that the former were significantly more likely to display signs of insecure attachment. In a further study Lyn and Burton (2005) explored the particular types of problematic attachment that sexual offenders tended to display, and they found that anxiety and avoidance were seen most frequently.

William Marshall is well known for his work on the role of attachment in sexual offending. He has long argued that attachment problems contribute to the development of sexual offending. Furthermore, he has examined some of the childhood difficulties which may be associated with attachment problems. For example, he has reported that sexual offenders often have problematic childhoods, characterized by disruption, neglect, and abuse (both physical and sexual) (e.g., Marshall and Marshall 2000). Also, as explained by Marshall and Marshall, while such aversive early experiences may lead to attachment problems, they may also lead to a range of more general difficulties, such as low self-esteem and limited relationship skills. Thus, attachment theory offers a psychological mechanism that may explain the intimacy and relationship problems that are seen in sexual offenders.

Victim Empathy

Many, if not most, contemporary sex offender treatment programs include a component that focuses on the development of victim empathy. Research examining empathy in sexual offenders has found that while they often lack empathy for their victims, they do not typically have more generalized empathy deficits. Thus, treatment that aims to develop sexual offenders’ empathy is usually victim-focused. For instance, some treatment programs will require offenders to listen to a voice recording of a victim talking about the impact of his or her own sexual abuse experience. Alternatively, the offenders may be required to read stories of victims’ experiences or to read accounts written by their own victims.

Empathy is a complex concept and, historically, there have been a variety of approaches to defining it. While some theorists have conceptualized it as essentially involving cognitive processes, others have construed it as the ability to recognize emotion in others and to take on the perspective of another person. More recently, it seems that many theorists have viewed it as a multifaceted concept involving thoughts, emotions, and behaviors. With regard to sexual offenders, Marshall (2006) suggests that empathy deficits are frequently associated with the presence of victim-related cognitive distortions. For example, a child sex offender may believe that his sexual activity with his victim is educational and, therefore, not harmful. Or he may believe that if the child is quiet during the sexual interaction, then the child is enjoying it; thus, the offender may misinterpret the child’s emotional response. Given the apparent connection between empathy deficits and cognitive distortions, Marshall proposes that it may be possible to address empathy deficits simply by challenging an offender’s cognitive distortions, rather than directly targeting empathy problems.

Other researchers have suggested that empathy deficits in sexual offenders may be associated with difficulties with the identification and awareness of emotion (e.g., Gannon et al. 2008). Although, this seems to contrast with the suggestion that sexual offenders’ empathy deficits are specific to their offending. Arguably, if they have difficulty with their own emotional awareness, then one might expect that they would have more general problems empathizing with others. One commonly used technique for the development of emotional awareness in group treatment is encouraging participants to identify and describe the emotion that they are experiencing at that moment in treatment. This is believed to facilitate the development of an ability to put a name to one’s emotional experience and to describe that experience to others.

Some treatment programs utilize victim role plays as a way of enhancing offenders’ empathy for their victims. A study by Webster et al. (2005) examined the effectiveness of offense reenactments and concluded that their inclusion in treatment appeared to enhance offenders’ victim empathy. The approach used in the study, which was tailored to each participant, included the development of an offense map which was then used as a guide for walking the offender through the offense while he was role-playing the victim. Any sexual or violent acts were depicted symbolically, using light touch on a nonsexual area of the body. The study included a control group who carried out “empathy deficit role play scenarios” (p. 67) but did not engage in any victim role plays. While, as mentioned above, the researchers found this approach had clinical benefits, they also found that the method seemed to be more effective in treating rapists than child sex offenders and that the differences between the two approaches were small.

It is important to point out that although, as outlined above, victim empathy is a frequently utilized component of sex offender treatment programs, research has not been able to show that it leads to a decrease in reoffending. However, demonstrating this sort of causal connection will always be a challenging task because treatment is typically multifaceted; therefore, it is difficult to know for sure which elements of treatment are bringing about change. Furthermore, given that sexual offenders present with victim-specific empathy deficits, it makes clinical sense to address this in treatment.

Substance Abuse

There is now a significant body of research that demonstrates a link between alcohol use, other drug use, and various types of criminal behavior. Further, as stated by Fridell and colleagues (2008, p. 800), “Alcohol abuse precedes or accompanies a large proportion of violent crime.” Also, research has shown that problematic alcohol use is associated with a tendency to reoffend. With regard to sexual offenders, evidence suggests that a significant proportion have drug and or alcohol-related problems. For example, a study by Marshall (1996) found that 50 % of sexual offenders were intoxicated with alcohol at the time that they committed their most recent sexual offense. Also, as with general offending, drug and alcohol abuse has also been found to be associated with sexual reoffending. For instance, research suggests that alcohol abuse at least doubles the likelihood that a sexual offender will reoffend. Some researchers have observed that drug and alcohol problems are often associated with problematic lifestyle choices which lend themselves to offending behavior. Thus, drug and alcohol issues and offending may have a common origin.

While this may indeed be the case, it is important to acknowledge that intoxication with any substance has a range of consequences that can directly impact on offending. For example, alcohol can significantly diminish an individual’s ability to understand and respond appropriately to a social situation. Specifically, it impairs one’s judgment, thus making it more likely that an individual will respond in an antisocial manner. Furthermore, research has shown that alcohol can increase one’s tendency for impulsivity, meaning that an offender will be more likely to respond to a situation quickly and without a proper appraisal of the consequences of his behavior. Also, there are well-established links between excessive alcohol use and aggression in those who have already demonstrated aggressive tendencies.

A study by Abracen et al. (2006) compared sexual and violent (nonsexual) offenders in terms of the presence of alcohol abuse, using the Michigan Alcohol Screening Test (MAST). Results showed that sexual offenders had significantly higher scores thereby indicating that they were more likely to have problematic patterns of drinking. In their discussion of the results, they suggest that myopia theory may offer an explanation of why alcohol use may contribute to sexual offending. Myopia theory suggests that when an individual is considering engaging in a risky behavior, alcohol may have the effect of decreasing their inhibition via a reduction in their information processing capacity. This is similar to effect of alcohol use on judgment which is suggested above.

Evidence suggests that there are a variety of approaches to addressing drug and alcohol problems. While some programs include a substance abuse component, others do not address it directly but direct individuals to appropriate drug and alcohol programs. Often drug and alcohol problems are construed as responsivity barriers and are thus seen as being best addressed prior to offense-specific treatment. For example, even in many prison environments, drugs are available and, therefore, it is considered that in order for an offender to make the most of offense-specific treatment, he should first address his drug use. Obviously, in community settings drug and alcohol use is more prevalent; thus, the same approach is often taken.

Treatment Efficacy

There is now a growing body of research that has examined the efficacy of sex offender treatment programs. A study a decade ago (Hanson et al. 2002) examined the outcome evaluations of 43 sex offender treatment programs with a mean follow-up period of 76 months. Hanson et al. reported a sexual recidivism rate of 12.3 % for sex offenders who had completed treatment and a 16.8 % recidivism rate for untreated sex offenders. They also found that the treated sex offenders committed significantly fewer general offenses than their untreated counterparts (27.9 % and 39.2 %, respectively). Note that the majority of treatment programs that were included in this study had a cognitive-behavioral orientation; thus, this lends support to the efficacy of cognitive-behavioral programs.

Similarly, Losel and Schmucker (2005) carried out a meta-analysis of 69 studies of sex offender treatment efficacy that contained 80 separate comparisons of treated and untreated offenders. The authors concluded that treatment led to a mean reduction in sexual recidivism of almost 37 % (when low base rates are taken into account). The actual difference in recidivism rates between treatment groups and control groups (who were untreated or had completed another type of treatment) was 11.1 % and 17.5 %, respectively. They also found that sex offender treatment led to a significant reduction in general reoffending. In summarizing their findings, Lo¨ sel and colleague state: “The most important message is an overall positive and significant effect of sex offender treatment” (p. 135).

Another study (Seager et al. 2004) looked at recidivism rates in 109 sex offenders who had completed offense-specific cognitive-behavioral treatment and 37 who had not completed any treatment for their sexual offending. Note that of the 109, only 81 were assessed as having successfully completed the program. The recidivism rates that were examined included sexual and violent offenses. Results showed that regardless of whether individuals were considered to have been successful in completing the program, those who completed were found to have a lower recidivism rate. Specifically, 4 % of successful completers and 7 % of unsuccessful completers were reconvicted within the 2-year follow-up period. This contrasted with 18 %, 42 %, and 100 % (respectively) of those who withdrew from treatment, declined it, or were terminated from the program. However, the authors concluded that there was no evidence of a connection between offenders’ change in clinical phenomena (such as empathy) and their reoffending. For example, they found that the participants risk scores on the Static 99 (an actuarial risk measure) predicted their likelihood of reoffending regardless of whether they completed. Seager and colleagues concluded that “participation in the sex offender program did not reduce recidivism rates for those who complied with treatment but merely enabled motivated offenders to concretely demonstrate their commitment to not reoffend” (p. 609).

It is unclear whether the two aforementioned meta-analyses took into consideration the various ways in which treatment completers and those who did not complete treatment might have differed. The study by Seager et al. suggests that apparent treatment effects may simply be a result of preexisting differences between those who undertake such programs and those who do not. However, it is important to note that Seager’s study was comparatively small and only included a small number of offenders. Nonetheless, it does raise questions about the way in which studies of treatment efficacy are conducted and how results are interpreted.

It seems reasonable to conclude that sex offender treatment is often effective and that at the very least it does no harm. Furthermore, there is growing evidence that cognitive-behavioral approaches may be especially useful. However, further studies are needed to determine if the effects that are being found are indeed due to treatment or to the fact that particular individuals tend to undertake and complete treatment.

Summary

This research paper has discussed two of the key models that underlie sex offender treatment. It has also examined some of the relevant process issues, such as whether treatment should be delivered in group settings. Further, it looked at the components that are typically found in sex offender treatment programs. The paper concluded with a brief discussion of treatment efficacy. It is hoped that this overview will provide the reader with some understanding of how the treatment of sexual offenders is ordinarily delivered and of some of the issues surrounding such treatment. Obviously, there is a need for ongoing research in many areas as many findings remain preliminary.

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