Sex offender treatment
The treatment of sexual offenders is a unique challenge to professionals tasked with the duty to offer this supervisory and treatment service. A successful treatment of offenders requires a well trained professional who understands the dynamics of sexual offenders. The person must also be able to apply current approaches to assess and treat these offenders. The goal of sexual offender treatment is to find a means to assist offenders manage the deviant tendency in them for the purpose of reducing their likelihood of repeating the offence. When a person is involved in sexual assault, it is an indication that the individual is unable to manage his deviant tendencies (Hanson et al., 2009).
It is common practice to place external controls on sexual offenders as they begin their therapy process. The restrictions are mainly on contact with victims, their residence and work place (O’Connell, Leberg & Donaldson, 1990). There may be other restrictions on personal activities and a limitation in privacy. By the end of treatment, it is expected that an offender will have developed internal controls which are essential in the prevention of recidivism. Progress in treatment can be measured by determining how far an offender has moved towards attaining internal control. Progress is demonstrated through behaviour. As offenders develop internal controls, the restrictions placed on them can be relaxed gradually as they become less necessary (Hanson et al., 2009).
Psychiatric experts believe that though difficult, the risk of sexually offensive behaviour can be reduced through psychiatric treatment. The treatment involves accurate diagnosis, careful assessment, and use of evidence-based treatment approaches. The goal of sexual offender treatment entails more than just reducing the risk of recidivism. The treatment seeks to improve the quality of life for these individuals, increase their autonomy, decrease their distress, and facilitate reintegration into society (O’Connell, Leberg & Donaldson, 1990).
Research conducted over the past decade indicates that sex offenders who undergo treatment at community level, in prison or both have lower rates of sexual reconviction as compared to those who do not undergo treatment. The most applied and effective treatment is cognitive‐behavioural treatment. This treatment is often paired with pharmacological treatment that involves use of hormonal drugs to increase effectiveness. There are other treatment approaches such as psychotherapy, non‐behavioural treatment and counselling but these are not proven as effective in reducing reconviction (Hanson et al., 2009).
A majority of reviews on sexual offender treatments also indicate that programmes which apply the risk, need and response approach have the largest reductions in cases of reconviction. The treatments are most beneficial to high and medium risk offenders. However, the sex offender treatment program offers negligible benefit for low risk sexual offenders. The reason for this is that they do not require high intensity treatment to remedy their problem. In most cases, counselling is sufficient to remedy their problem (Wakeling, Webster & Mann, 2005).
In the treatment of high risk sex offenders and those portraying or with highly disturbed backgrounds, it is recommended that a combination of treatment approaches is the best suited approach to their treatment. One of the approaches is to apply a therapeutically oriented milieu that combines behaviour change expectations with individual monitoring, multidisciplinary oversight and personal support. Another approach is to combine cognitive-behavioural interventions that address personality and criminogenic factors in relation to the offender. This approach also includes anti-libidinal medication meant to reduce sexual arousal (O’Connell, Leberg & Donaldson, 1990).
Sexual offences do not result from a single cause. As such, their treatment should address a wide scope of risk factors. These factors may include: sexual preference; rare sexual interests; preference for children; violent sexual offenders; lack of emotions; rebellious attitude; impulsive lifestyle; criminal partners. Current literature on sexual offender treatment programs suggests that it is quite challenging to measure and evaluate these programs. As such, it makes it difficult to determine their rate of success or failure.
Kraft-Ebing is credited with the medicalisation of sexual offending through his 1885 influential publication, Psychopathia Sexualis. The debate on the mental welfare of sexual offenders is a highly contentious one. While some experts believe that sex offenders have mental disorders that require treatment, there are those who believe that their behaviour requires punishment. In cases where sex offenders are mentally ill, risk of future sex offending can be reduced through treatment of the mental illness. However, there are cases where the sexual fantasy life of an offender may be quite complex to treat (O’Connell, Leberg & Donaldson, 1990).
The continuous and progressive growth in cognitive–behavioural treatment in recent years has helped in developing better treatments for sexual offenders. The cognitive–behavioural therapy can assist an offender in taking responsibility for behaviour that leads to an offence. It further helps to develop behavioural and cognitive controls which are essential to enable him avoid situations that can trigger reoffending. The techniques are not necessarily a cure; they are a means to attain self control so that the person does not revert back to old ways. There are quite a number of studies which look into the issue of sex offender treatment. The therapeutic treatment methods applied are diverse. The main categories of treatment are: surgical treatment, pharmacological treatment and psychological treatment (O’Connell, Leberg & Donaldson, 1990).
Surgical Treatments
Surgical treatment was quite common in the past but today it is rarely practiced. Surgical techniques face major ethics challenges due to their perceived alteration and interference with healthy human tissue. This treatment may also result in side effects which include nausea, gynecomastia and thrombosis. The irreversible nature of surgical procedure also makes it a risky process (Wakeling, Webster & Mann, 2005).
A 1971 study recorded a 1% reconviction rate from its research on 900 sex offenders who were under follow up for up to 30 years after castration surgery. A subsequent study in 1979 also produced similar results. The 1971 study also revealed that 33% of the castrated offenders shifted to committing non-sexual violent offences. Apart from surgical castration there is another technique, stereotaxic hypothalamotomy, but it is rarely used. This technique is widely criticised for its questionable credibility and ethical qualification (Drake & Ward, 2003).
Pharmacological Treatments
Pharmacological treatments are also applied in the treatment of sexual offenders. These treatments involve the use of medication to fight the problem. There is a wide range of medication that can be used for this purpose. These range from serotonergic drugs to anti-androgens (Wakeling, Webster & Mann, 2005). The drug DepoProvera has also been used as treatment. In a 10 year study on its use, it was concluded that DepoProvera caused a radical reduction in the sexual interest of the subjects and was highly useful in facilitating therapy (Wakeling, Webster & Mann, 2005).
A medical trial using the drug Medroxy-Progesterone Acetate (MPA) showed that about 15% of the test subjects re-offended. In a non-user population, the rate was at 68% (Perkins, Hammond, & Bishopp, 1998). These studies underscore the value of anti-libidinal medication. Although the medication reduces libido levels, it may not be able to satisfy all needs for the sexual offender if used alone. The argument in this case is that a large number of sexual offences are motivated by more than just the desire for sexual gratification. For such cases, a simple reduction in their libido may not be sufficient to control their other desires.
It is possible that in the process of complying with treatment, the use of medication may be necessary to ensure effectiveness of treatment. The pharmacological drugs used to treat anxiety and sexual arousal are also useful in increasing a patient’s susceptibility to psychological treatment (Perkins, Hammond, & Bishopp, 1998).
Psychological Treatments
The first step before undertaking psychological treatment is to record full history of the offender to give a clear background on the person. This should be followed by a comprehensive evaluation of the offender’s mental state. In a situation where the offender is diagnosed as mentally ill, it is up to the treatment expert to determine the relationship, if any, between the illness and the sexual offence. The starting age of mental illness can be compared to that of sexual offence to seek a correlation. Any presence of disability, conduct disorder, antisocial personality, narcissism or learning disability should be noted (Wakeling, Webster & Mann, 2005).
The offender should also be assessed for psychosexual history. One should note any indicator of hyper-sexuality such as multiple partners and sexual rumination such as uncontrollable sexual urges. In case paraphilia is diagnosed, it is important to assess the frequency and intensity level of any sexual fantasies including the possible desire to act out the fantasies. If the offender suffers from mental illness, there should be an evaluation to establish if the illness is accompanied by deviant fantasies. In cases of substance abuse, it should be determined whether it was the cause for the sexual offence (Wakeling, Webster & Mann, 2005).
Psychological treatment has a number of broad classifications. The classifications have a number of purposes. First, they help the offender gain insight into his/her offensive behaviour. Second, they help to remove or control influences associated with the offensive behaviour. Lastly, the treatment may help prevent relapse for offenders who work under stressful conditions in the community. A study on possible factors of sexual re-offence for untreated persons came up with the following factors: weak commitment to re-offence avoidance, antisocial character, limited response to possible victim distress, deficits in ability to solve interpersonal and personal problems, loneliness, poor emotion control, poor intimacy skills, and drug abuse history.
Psychological treatment has a variety of interventions that may be used to arrive at a remedy. One approach is through skills-based intervention for example sex education and anger management lessons. In some cases, the treatment may entail behaviour modification such as masturbatory satiation and aversion therapy. Some interventions use motivation as a tool to remedy re-offence. Individuals can be motivated through creative and group therapy. It is important to integrate different treatment techniques on a range of targets as this makes it easier to meet the individual needs of offenders as pertaining to the issue of treatment (Drake & Ward, 2003).
There is a continuous modification and improvement of approaches applied to psychological treatment of sex offenders. Psychiatric experts are increasingly shifting their focus from treatment that seeks to gain insight into why offenders perpetrate sexual crimes; also known as psychotherapeutic in style; to a cognitive behaviour approach that is structural in nature. The cognitive behaviour approach focuses on a wide range of risk factors that have the potential to contribute to future offences. The model adopts relapse prevention techniques based on drug and alcohol research in its sexual offender intervention. The techniques are individually tailored to specifications attributable to a specific offender (Perkins, Hammond, & Bishopp, 1998).
Little scientific evidence exists to prove that dynamic psychotherapy has a positive effect on sex offenders. Scientists are now focussing on behavioural and cognitive-behaviour as a means to remedy the problem. Behavioural approaches include covert aversion, masturbatory reconditioning and satiation therapy. The efficacy of these techniques is still subject to conflicting debate. Cognitive-behavioural treatment draws from both the research on multi-modal functional analyses and that on criminogenic factors. The combination of these two methods helps to tailor treatments to the specific needs of individual offenders (Drake & Ward, 2003).
Lack of victim empathy in sex offenders led to development methods to deal with the issue. There are programs in place aimed at making offenders understand the effect of their offences on victims. One of the ways through which this is done is discussion of evidence. Here, the aspects of an incident are laid out to the offender in a manner that addresses the effects of their acts. The offenders also undergo cognitive-behavioural training in social skills, anger management, and assertiveness to empower them with an ability to resist recidivism. Other training that can enhance self esteem includes intimacy skill training and relationship therapy (Perkins, Hammond, & Bishopp, 1998).
The concept of relapse prevention has also been integrated into sex offender treatment. The main idea behind this concept is prior identification of factors that are likely to lead to a relapse in order to prepare counter measures. Based on the identified factors, the treatment expert can develop a basic relapse prevention system which is then integrated into the cognitive behavioural framework (Perkins, Hammond, & Bishopp, 1998).
Generally, the varied approaches to sex offender treatment all seem to give mixed information and guarantee of success. Research conducted over the past decade indicates that sex offenders who undergo treatment at community level, in prison or both have lower rates of sexual reconviction as compared to those who do not undergo treatment. The treatment of sexual offenders is a unique challenge to professionals tasked with the duty to offer this supervisory and treatment service. A successful treatment of offenders requires a well trained professional who understands the dynamics of sexual offenders. This will ensure proper and effective delivery of treatment. The general recommendation on treatment is to apply a combination of treatment approaches especially for high risk offenders. The wide scope of factors that lead to sexual offences implies that a wide scope approach should also be employed when remedying the problem.
References
Drake, C. R., & Ward, T. (2003). Treatment models for sex offenders: A move toward a
formulation-based approach. In W. Ward, D. R. Laws, & S. M. Hudson (Eds.), Sexual
deviance: Issues and controversies (pp. 226-243). Thousand Oaks, CA: Sage
Publications.
Hanson, R.K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective
correctional treatment also apply to sexual offenders: A Meta-analysis. Criminal
Justice and Behavior, 36, 865-891.
O’Connell, M.A., Leberg, E., & Donaldson, C.R., (1990). Working with sex offenders:
Guidelines for therapist selection. Newbury Park, CA: Sage.
Perkins, D., Hammond, S., Coles, D., & Bishopp, D. (1998) Review of Sex Offender
Treatment Programmes. Department of Psychology Broadmoor Hospital
Wakeling, H.C., Webster, S.D., & Mann, R.E. (2005). Sexual offenders’ treatment
experience: A qualitative and quantitative investigation. Journal of Sexual
Aggression, 11, 171-186.
