The use of psychological interventions for adult male sex offenders with a learning disability: a systematic review†

ABSTRACT

There is a drive to attend to the specific treatment needs of sexual offenders with a learning disability (LD) and increasing recognition of treatment limitations in this group. Cognitive behavioural therapy (CBT)-based sex offender treatment programmes (SOTPs) are being increasingly adapted for the LD population. This review systematically considers the evidence base for LD adapted CBT-based SOTPs. Ten studies together comprising 358 participants were reviewed. LD adapted SOTPs were conducted in prisons, secure settings and in the community. Within-treatment findings generally indicated positive cognitive shift, improvements in victim empathy and increased sexual knowledge on psychometric measures. Whilst findings are encouraging, many of the studies have methodological limitations. In particular, all studies used pre-test post-test study designs lacking control groups therefore restricting the evaluation of treatment outcomes. The LD sex offender literature remains underdeveloped and there is a strong case for further research to establish a valid evidence base for treatment.     

‘Look into my eyes’: can an instruction to maintain eye contact facilitate lie detection?

Abstract

Traditionally, research on offender profiling has investigated the relationships between offender behaviour and offender characteristics. However, evidence about offender behaviour is not the only evidence available at a crime scene. This study extends previous collaborative research between forensic scientists and psychologists (e.g. Bond & Sheridan, Journal of Forensic Science, 52, 1122–1128, 2007) to investigate how forensic science can assist in the psychological process of offender profiling. Specifically, the potential utility of footwear impression evidence in the task of offender profiling is investigated. Using 155 domestic burglaries, the consistency and homology assumptions underlying offender profiling were tested. Evidence supportive of both assumptions is reported. A multiple regression analysis identified significant relationships between cost of footwear and employment status, age of offender, and the relative deprivation of his/her residence.     

On a clear day you can see forever: Integrating values and skills in sex offender treatment

Abstract

The topic of sex offender rehabilitation frequently evokes fierce reactions, ranging from strident demands for harsher sentences contrasted with calls for more imaginative and compassionate sentencing options. There seems to be a polarization of positions centred on the question of offenders’ moral standing: are they moral strangers or fellow travellers? This fundamental disagreement about offenders’ moral status is at the core of a number of independent, although related current practice and research issues confronting the field, namely: (1) risk management versus strength-based treatment approaches; (2) the utility of utilizing individually tailored versus manual-based programmes for offenders; (3) focusing on the technical aspects or therapy as opposed to relationship and therapist factors (what has been called process issues); and (4) the conflict between protecting the community versus promoting the interests of offenders. In this paper I suggest that an approach to sex offender treatment based on a combination of human rights theory (an ethical resource) and strengths-based approaches can help us navigate our way through the above dilemmas in a way that addressees both the needs of offenders and those of the community.     

Sex offender treatment is not punishment

Abstract

The treatment of sexual offenders can be fraught with ethical dilemmas. Practitioners must balance the therapeutic needs of sex offender clients alongside the risks they might pose to others. These ethical challenges include balancing community safety with the rights of the offender, the privileged therapeutic relationship and the potential for coerced treatment. In this paper, we respond to Glaser's argument that treatment is punishment and that sex offender treatment providers breach ethical codes by violating confidentiality, engaging in coercion, and ultimately causing harm to clients. We first consider whether sex offender treatment is indeed punishment. We argue that it is not, and that mandated treatment can and should be conducted in a fashion consistent with professional codes of ethics familiar to mental health providers. We then discuss the human rights model, which we agree is an essential lens through which to view the psychological treatment of sexual offenders. We attempt, as have other scholars, to illustrate the ways in which human rights principles intersect with traditional mental health codes of ethics particularly in the case of sex offender treatment. We conclude that sex offender treatment can be conducted ethically, that treatment differs from punishment in clear and distinct ways, and that ethical treatment conforms to a human rights perspective.     

Déjà vu: from Furby to Långström and the evaluation of sex offender treatment effectiveness

Abstract

The notion that sex offender treatment does not work fuels public outrage and demands for protective legislation. This paper will respond to a recent meta-analysis reporting major weaknesses in research designs that preclude drawing conclusions about the effectiveness of sex offender treatment. Methodological and ethical challenges exist in the investigation of counselling interventions in general and sex offender treatment specifically, and we argue that the medicalization of psychotherapy research may have inherent flaws. Alternatives to dichotomous recidivism outcomes are proposed, including harm reduction measures and reduction of maladaptive behaviours. Future clinical directions for sex offender treatment are explored, including application of risk-needs-responsivity models, a focus on process as well as content and incorporation of principles of trauma-informed care.     

Employing mixed methods to explore motivational patterns of repeat sex offenders

PurposeUnderstanding the motivation of sex offenders plays a key role in societal perception of victim culpability and offender responsibility. This study identified patterns of offender motivation, assessed motivation stability across offenses, and estimated the influence of offense/victim specific factors on motivation in comparison to offender factors.MethodsEmploying mixed-methods sequential explanatory research design, the study utilized confirmatory factor analysis (CFA) to identify motivational factors underlying 346 crime events. Second, motivation stability was assessed across offenses committed by 69 offenders. Finally, interview data were reviewed to assess whether offender types emerged corresponding to CFA results.ResultsA motivational typology was identified comprised of five offender groupings built upon two underlying constructs, one driven by sexual gratification and the other linked to anger/aggression. Minimal change in motivation was observed across offenses committed by the same offender against different victims. Offense/victim specific influence (22-23%) and offender related influence (77-78%) were similarly distributed with both sexual and anger-driven motivation.ConclusionsMotivation plays a key role in offending. Offense/victim specific factors have similar proportional influence on crime motivation in comparison to offender factors irrespective of the type of motivation. Contrary to popular public perception, victim blame is not warranted regardless of what motivates offenders.     

Predictors of sex offender treatment dropout: psychopathy,sex offender risk,and responsivity implications

Abstract

We examined sex offender treatment dropout predictors, in particular, the relationship of psychopathy and sex offender risk to treatment dropout in a sample of 154 federally incarcerated sex offenders treated in a high intensity sex offender treatment program. Demographic, criminal history, mental health and treatment-related data as well as data on risk assessment measures including the Static 99, Violence Risk Scale – Sexual Offender version (VRS-SO), and Psychopathy Checklist – Revised (PCL-R) were collected. Logistic regression and discriminant function analyses were used to identify predictors that made significant and unique contributions to dropout among all the variables under study. The Emotional facet of Factor 1 of the PCL-R and never being married were found to be the most salient predictors of treatment dropout and correctly identified about 70% of the cases. The implications of the findings for managing treatment dropout and for the treatment of psychopathic offenders are discussed.     

The use of tactical polygraph with sex offenders

Abstract

Little is known about current re-entry practices, nor the extent to which they facilitate re-entry, reintegration and, ultimately, desistance from future offending. Göbbels, Ward and Willis recently developed the Integrative Theory of Desistance from Sex Offending (ITDSO), which comprehensively describes the individual desistance process in four phases. In the current research, the re-entry phase of the ITDSO was used as a theoretical framework to evaluate current re-entry practices in five North American sex offender treatment programmes. Inductive thematic analyses were conducted using interview data from programme directors and final client assignments. Eleven themes were identified. Findings are discussed in relation to their fit with the ITDSO and suggestions are made for improving re-entry practices so that they better promote desistance.     

Geographical access to treatment for sex offenders under community supervision in Kentucky

Abstract

As sex offenders are probated or paroled into the community, sex offender treatment and monitoring is often a condition of their release. In Kentucky, sex offenders are required to participate in community-based treatment for two years or more. However, some sex offenders are disadvantaged in accessing mandated treatment. This is a result of decisions concerning the placement of treatment programmes, the sex offenders' preference to return to communities where they can rely on family and other indigenous support networks, and some statutes (e.g. sex offender registration and residency restriction laws). This study utilises spatial methodologies, including an origin–destination (OD) matrix, to determine the time, in minutes, that sex offenders travel to sex offender treatment providers and non-spatial ordinary least squares (OLS) regression techniques to determine the association between family, neighbourhood and community characteristics on sex offenders’ travel time to treatment. Findings suggest that there is substantial disadvantage in treatment access, measured by travel time, for sex offenders who live in impoverished rural communities.     

A case study of a male sex offender with zoosexual interests and behaviours

Abstract

This paper reviews assessment, treatment and supervision issues in relation to a high-risk, borderline functioning, male sex offender with zoosexual interests and behaviours. Mr Z was convicted of multiple sexual offences including rape, indecent assault and indecent exposure as well as actual and threatened bodily harm. He was convicted for two counts of attempted buggery of horses and he received a Probation Order to engage in group and individual work, as deemed appropriate. Significant treatment challenges emerged due to his cognitive/intellectual difficulties, coping problems (including anger management issues) and dissimulation. Further, continuing evidence of high-risk behaviours associated with his index offence as well as previously identified patterns of offending were reported. Ongoing concerns prompted a referral for a polygraph examination to gain additional information about Mr Z's offence history and to achieve a better understanding of his treatment needs. These findings are discussed and specific attention is focused on Mr Z's zoosexual behaviours.     

Examining the effectiveness of a UK community-based sexual offender treatment programme for child abusers

Abstract

An analysis of psychometric data from a sample of 341 UK child abusers who had completed a probation-based sex offender treatment programme was carried out in order to assess the effectiveness of therapeutic treatment. A cluster analysis was also undertaken to examine the pattern of pre-treatment problems. Three clusters of offenders, with distinctly different psychometric profiles, were identified depending upon the number and extent of their offence-specific and social adequacy problems. These were labelled Low need, Medium need and High need. Pre–post analyses revealed clinically significant treatment effects for the entire sample, with differing effects found across the clusters as follows: 50–81% of the Low need group scored within the cut-off (or normative range) at the post stage, while between 3% and 26% had shifted to a clinically significant degree; 34–75% of the Medium need group scored within the cut-off range after treatment, while between 9% and 100% had shifted to a clinically significant degree; 16–52% of the High need sample scored within the cut-off at the post-treatment stage, and between 15% and 80% had shifted to a clinically significant degree.     

The impact of sex offender’s interpersonal style,treatment readiness and the therapeutic alliance on treatment gain

The impact of internal responsivity factors and therapeutic process variables on intra-individual within-treatment gain in sex offenders has received little empirical attention. This study examined how (1) internal responsivity factors, including treatment readiness and interpersonal style, and (2) therapy process variables, including the therapeutic alliance and the presence of ruptures in the therapeutic relationship, impacted intra-individual within-treatment gain. Participants comprised 71 sex offenders who participated in group-based sex offender treatment programmes in prison or the community. Results showed that offender hostile-dominance and the affective and interpersonal characteristics of psychopathy, as measured by the Psychopathy Checklist: Screening Version Factor 1 score, negatively impacted treatment gain. Pre-treatment readiness, client ratings of the therapeutic alliance and whether or not there were ruptures in the therapeutic relationship had no association with within-treatment gain. The strength of the therapeutic alliance later in treatment did not moderate the relationship between offender interpersonal style, or psychopathy, and treatment gain.     

Therapists’ perceptions of the therapeutic alliance in “Mandatory” therapy with sex offenders

ABSTRACT

Research suggests that the therapeutic alliance (TA) plays an important part in successful therapy. The pantheoretical concept of the alliance (Bordin, 1979) assumes a client seeks to make a change and joins the therapist in a willing journey. However, treatment with sex offenders can entail various levels of coercion. Little is known about the process of the TA in therapy with sex offenders whose therapy could be seen as coerced or mandated. Thus, the aim of this research was to explore therapists’ perceptions of the TA with sex offenders whose therapy could be seen as “mandated” because it was part of their plan for release/rehabilitation. Eleven therapists were interviewed about their experiences and a qualitative thematic analysis elicited five themes: dynamics of forced work, explicit terms of working, persuasive encouragement to engage, connecting with the human element and preservation and protection. Implications for practice are discussed alongside recommendations for future research.     

Training multi-disciplinary teams to work with sex offenders: Effects on staff attitudes

Abstract

A recent British Prison Service initiative has focused on providing sex offender programmes facilitated by multi-disciplinary teams of staff. A three week long training programme was designed to provide staff with the necessary knowledge, skills and experience to facilitate these structured treatment groups. Following the training, staff indicated they were more confident in their ability to provide treatment and showed a greater belief that treatment could be successful. In addition, they showed significantly more positive attitudes towards sexual offenders and to offenders in general. However, participants did not indicate undue concern about working in a sensitive treatment area. This pattern continued at six month follow-up, indicating that the training changed attitudes as expected, and that the training was seen by participants as adequately preparing them to undertake provision of a structured sex offender treatment programme in a secure setting.     

University student beliefs about sexual violence in prison: rape myth acceptance,punitiveness, and empathy

Abstract

The public desires more punitive sentencing for sex offenders; however, treatment has been shown to be most effective in increasing public safety. It has been suggested that public education about the benefits of sex offender treatment could influence public policy. The purpose of this study was to determine if a brief psychoeducational intervention could influence individuals’ attitudes towards the treatment of sex offenders. Overall, findings showed that a psychoeducational intervention can affect subsequent attitudes; furthermore, the nature of the intervention will be significant in determining the level of attitude change.     

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.     

Incorporating trauma-informed care into evidence-based sex offender treatment

Abstract

As we move forward in the field of sex offender treatment, clinicians should consider incorporating principles of trauma-informed care (TIC) into evidence-based sex offender treatment models. Early adverse experiences are prevalent in the general population and more so in criminal and sex offender populations. Early trauma paves the way for maladaptive coping and interpersonal deficits, which can lead to abusive behaviour. Content-oriented sex offender treatment models emphasising cognitive-behavioural skills should integrate process-oriented components that address the ways in which early trauma shapes adult cognitions and behaviour. Relational approaches to therapy can enhance clients' interpersonal skills and improve general well-being. This type of personal growth would be expected to mitigate future offending as the client adopts and successfully practices healthier, non-destructive strategies for meeting emotional needs.     

The big 5 dimensional personality approach to understanding sex offenders

Abstract

Although previous research has reported that the incarceration of sex offenders does not significantly reduce re-offending, there is no adequate theory guiding remedial programs for this population. The aim of the present study was to examine whether normal personality variation provides useful theoretical insight into the nature of sex offences against children. The Revised NEO Personality Inventory (NEO PI-R), a measure of the five-factor model (FFM) of personality, was administered to 64 males incarcerated for child sex offences. Sex offenders were categorised into different offender groups comprising incest within the immediate family, incest within step-family and extra familial offence. A comparison group of 33 non-offender males also completed the NEO PI-R. Results indicated that the sex offender groups were significantly higher in Neuroticism and significantly lower in Extraversion and Conscientiousness compared to the non-offender group. Significant differences between the sex offender groups and comparison groups for NEO PI-R facets were also found. The implications of these findings in terms of early identification and treatment are discussed.