Effect sizes in the treatment of sexual offenders

This article considers the benefits of sexual offender treatment in terms of the magnitude of the effect size produced by these interventions. Comparisons are made of the effect sizes with those generated by treatment of other offenders, by treatment for mental health problems, and by treatment for physical health problems. In all cases, effect sizes with sexual offenders are comparable to (and in some cases better than) effect sizes for the treatment of the other groups. As a final note, it is suggested that using a harm reduction index to estimate effect sizes for treatment with sexual offenders would produce more meaningful results.     

Effectiveness of sex offender treatment for psychopathic sexual offenders

Meta-analyses have suggested that sexual offender treatment (SOT) completion is associated with lowered sexual recidivism rates for convicted sexual offenders. The paucity of properly designed studies allows for the alternative explanation of less recidivism among treated samples as reflecting that lower risk offenders disproportionately self-select into treatment. A test of the "self-selection explanation" can occur by investigating treatment effect on known high-risk offenders. Psychopathy correlates with increased sexual recidivism risk, such that an exploration of the SOT effect on psychopathic offenders could clarify the accuracy of the self-selection hypothesis. Additionally, the debated degree to which psychopaths are treatable might obtain clarification by a research review. This article examines empirical findings concerning the effectiveness of SOT for psychopathic sexual offenders. Ten studies were found to meet the minimal quality standards used, stemming from only four data sources. Shortcomings of existing research precluded clear conclusions, though trends in the data are delineated.     

Issues in the treatment of asian sexual offenders

Abstract

This aper considers the scant literature in the field of child sexual abuse in Asian families, and reports the authors' involvement with four male Asian sexual offenders. The therapeutic approach used with the offenders is described, and clinical themes arising from their treatment are identified. Issues and difficulties in therapy are discussed, in particular personal issues arising for the therapists. It is concluded that Asian sexual offenders are a group who have been neglected in the literature and in treatment, partly, perhaps, because they are infrequently referred to treatment services in comparison with non-Asian sexual offenders. Particular therapeutic issues relating to the treatment of immigrant Asians who do not speak English are raised and further research needs are identified in relation to this patient group.     

Using clinical variables to evaluate treatment effectiveness in programmes for sexual offenders

Abstract

Typically, sex offender programmes are evaluated using recidivism, a distal outcome measure. This paper proposes that sex offender programmes also incorporate proximal variables to evaluate treatment effectiveness. Proximal variables assess within treatment changes immediately following the intervention. To demonstrate this approach, the effectiveness of a sex offender treatment programme is evaluated using proximal variables, specifically locus of control, empathy, cognitive distortions and acceptance of responsibility. We provide the findings of this evaluation and discuss the implications of this approach. In particular, we conclude with the importance of identifying relevant treatment targets and selecting suitable proximal measures of those targets in evaluating treatment effectiveness.     

The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis

The article reports a meta-analysis on controlled outcome evaluations of sexual offender treatment. From 2,039 documents published in five languages, 69 studies containing 80 independent comparisons between treated and untreated offenders fulfilled stepwise eligibility criteria (total N = 22,181). Despite a wide range of positive and negative effect sizes, the majority confirmed the benefits of treatment. Treated offenders showed 6 percentage points or 37% less sexual recidivism than controls. Effects for violent and general recidivism were in a similar range. Organic treatments (surgical castration and hormonal medication) showed larger effects than psychosocial interventions. However, this difference was partially confounded with methodological and offender variables. Among psychological programs, cognitive–behavioral approaches revealed the most robust effect. Nonbehavioral treatments did not demonstrate a significant impact. There was no outcome difference between randomized and other designs, however, group equivalence was associated with slightly larger effects. Various other moderators had a stronger impact on effect size (e.g., small sample size, quality of outcome reporting, program completion vs. dropout, age homogeneity, outpatient treatment, and authors’ affiliation with the program). More differentiated, high-quality evaluations are needed to clarify: What works for whom under which circumstances?     

Evaluation of a national prison-based treatment program for sexual offenders in England and Wales

Treatment efficacy is described for a sample of sexual offenders who had undertaken treatment in United Kingdom prisons (N = 647) and for a retrospectively selected comparison group (N = 1,910). The outcomes under observation in this study were sexual, sexual and/or violent, and general reconviction. Treatment impact was also examined in relation to offenders' risk of reconviction. The treatment group had slightly lower 2-year sexual reconviction rates than the comparison group, but these differences were not statistically significant. Significant differences were found between the treatment and comparison group for sexual and/or violent reconviction. Further analysis suggested that treatment produced a reduction in the probability of sexual and/or violent reconviction (p <.05) when other relevant variables were controlled for. General reconviction rates were consistently lower in the treatment group, but these differences were not significant.     

Social networks of sexual offenders

Abstract

Despite the extensive research attention directed toward criminal peer groups, there has been little attention to the peer groups of sexual offenders. Sexual offenders are often considered to be loners who offend in isolation, but cases of sex crimes involving peer support are not difficult to find, e.g., child sex rings, gang rapes. To examine the role of peers in sexual offending, sexual offenders and nonsexual offenders were asked whether they knew other people who have committed sexual crimes. In comparison to the nonoffender community comparison group, the sexual offenders reported considerably more association and identification with sexual offenders. The associations also tended to be offence specific, such that child molesters knew other child molesters and rapists knew other rapists. These findings have important implications for the assessment and treatment of sexual offenders.     

Psychiatric evaluations of sexual offenders

Ninety-five defendants charged with sexual offenses were evaluated in a forensic psychiatry clinic. Their psychiatric diagnoses, as well as social, demographic, and criminal characteristics, were studied. Almost half were found to have personality disorders, while one-fifth were given a diagnosis of schizophrenia, affective disorder, or an atypical psychosis. Surprisingly few were diagnosed as having a paraphilia.     

Working positively with sexual offenders: maximizing the effectiveness of treatment

In this article, the authors draw on literatures outside sexual offending and make suggestions for working more positively and constructively with these offenders. Although the management of risk is a necessary feature of treatment, it needs to occur in conjunction with a strength-based approach. An exclusive focus on risk can lead to overly confrontational therapeutic encounters, a lack of rapport between offenders and clinicians, and fragmented and mechanistic treatment delivery. The authors suggest that the goals of sexual offender treatment should be the attainment of good lives, which is achieved by enhancing hope, increasing self-esteem, developing approach goals, and working collaboratively with the offenders. Examples are provided of how these targets may be met. When this is done within a therapeutic context where the treatment providers display empathy and warmth and are rewarding and directive, the authors suggest that treatment effects will be maximized.     

A human rights-based practice framework for sexual offenders

Abstract

Human rights create a protective zone around people and allow them the opportunity to further their own valued personal projects without interference from others. In our view, the emphasis on community rights and protection may, paradoxically, reduce the effectiveness of sex offender rehabilitation by ignoring or failing to ensure that offenders’ core human interests are met. In this paper we consider how rights-based values and ideas can be integrated into therapeutic work with sex offenders in a way that safeguards the interests of offenders and the community. To this end we develop a rights-based normative framework (the Offender Practice Framework: OPF) that is orientated around the three strands of justice and accountability, offender needs and risk, and the utilization of empirically supported interventions and strength-based approaches. We examine the utility of this framework for the different phases of sex offender practice.     

Shame and guilt in child sexual offenders

In this article, the authors build on previous discussions of the possible role of shame and guilt in sexual offending. They review the general psychological literature on shame and guilt and conclude that the distinction between internal and external shame is an important one in considering sexual offenders. The effects of shame and guilt on victim empathy and relapse are discussed, and it is proposed that the phenomena of shame and guilt have implications for treatment beyond those identified in previous studies. Shame is a salient feature in the initial presentation of many sexual offenders against children. Furthermore, aspects of the treatment of sexual offenders can be characterized as a shift from shame toward guilt. Implications of shame and guilt for treatment of sexual offenders are described.     

Examining the impact of mixing child molesters and rapists in group-based cognitive-behavioral treatment for sexual offenders

This study examines the relationship between recidivism rates, therapeutic climate, and composition of offenders in group-based cognitive-behavioral treatment (CBT) for sexual offenders. The Group Environment Scale (GES) is employed to measure social climate. The GES is administered to 73 male sexual offenders in groups of those who only victimized adults or children (five groups) or men who both victimized adults and those who victimized children (five groups). Group environment is not found to differ significantly as a function of group composition. Group member's ratings on the GES are in the medium to high range, indicating a generally positive group environment. Although the group environment overall does not differ between groups, groups do differ significantly in terms of expressiveness. There are no differences in recidivism rates between groups as a function of group composition. The results are discussed in the light of mixing child molesters and rapists in group-based CBT.     

Specialization and versatility in sexual offenders referred for civil commitment

Offense specialization and versatility have been investigated in general offender populations, but have only recently been examined in sexual offenders. This study explored the extent of both tendencies in the criminal histories of 572 adult male sexual offenders referred for civil commitment. The specialization threshold and the diversity index were used to compare offender subgroups by referral status (committed versus observed) and offense type (rape, child molestation, and incest). Offense versatility was the more likely tendency across the sample. Committed and observed offenders did not differ. Although predominantly versatile, child molesters were significantly more likely than rapists to specialize in sexual offenses, and were also more likely to specialize in child molestation (compared to rapists specializing in rape). These results confirm previous findings on criminal versatility among sexual offenders. This adds to a growing body of research that questions universal and selective crime control policies designed exclusively for sexual offenders.     

Psychopathy, treatment change, and recidivism in high-risk, high-need sexual offenders

The present study investigated 154 consecutive admissions to the Regional Treatment Center (Ontario) Sex Offender Treatment Program with reference to psychopathy and outcome. Ratings of treatment behavior, as well as clinical judgments as to whether risk was reduced, were coded based on treatment reports. With reference to Psychopathy Checklist-revised (PCL-R) scores, survival analyses indicated that high scorers recidivated at significantly higher rates than low scorers. However, offenders who received high PCL-R scores and lower scores on measures of treatment behavior recidivated at the same rate as low scorers on the PCL-R. Furthermore, among high PCL-R offenders, those rated as lower risk at post treatment in fact reoffended at a lower rate than those whose risk was rated as unchanged, although this difference failed to reach significance. Findings are discussed in light of the clinical and research literature.     

Empathy in sexually sadistic offenders: an experimental comparison with non-sadistic sexual offenders

Previous studies suggest that severe sexual sadism and psychopathy are phenotypically different, although both are characterized by deficits in emotional processing. We assessed empathic capacity in a sample of 12 sexual sadists in comparison with 23 non-sadistic offenders using the Multifaceted Empathy Test (MET). All participants were forensic patients under mandatory treatment orders who had committed sexual offenses. The MET is a computerized rating task that differentiates and measures cognitive and emotional components of empathy, or perspective-taking versus compassionate components. To identify the effects of possible empathy deficits caused by psychopathic traits, we controlled both samples for psychopathy as a covariate, measured by the Psychopathy Checklist-Revised (PCL-R). According to our results, sexual sadists did not differ from non-sadistic sexual offenders with regard to emotional empathy for either positive or negative stimuli. The results suggest that severe sexual sadism is a distinct, pathological sexual arousal response, not a deficit in emotional processing.     

The violent reconvictions of sexual offenders

The violent reconvictions of a sample of sexual offenders discharged from prison between 1992 and 1996 (who had not been reconvicted of a sexual offence) were examined. The hypothesis was that a proportion of these violent reconvictions would have a sexual motivation. The sample consisted of 104 adult male sexual offenders for whom detailed information regarding their violent reconviction was available. The sample was categorized according to the motivation of the violent reconviction. It was found that a proportion of the violent reconvictions were sexually motivated (12%) and that some of these had resulted from an original charge for a sexual offence. Significant differences were found between the sexual motivation and violent motivation group on the number of criminal history and victim characteristic variables. It was concluded that, in the case of sexual offenders, violent convictions might mask the true motivation of the offence.