Are Sex Offenders Treatable?

Last week I wrote about clinician prejudice toward sexual offenders. As part of that writing I introduced the four main categories of sexual offenders:

  1. Violent offenders
  2. Fixated child offenders
  3. Regressed child offenders
  4. Sexually addicted offenders

I also mentioned the some of the most damaging misconceptions that most people, including many psychotherapy professionals, have about sex offenders.

  1. All sex offenders are treatable.
  2. No sex offenders are treatable.
  3. All sex offenders are sociopaths

None of these beliefs is correct. The reality is that most but not all sex offenders can benefit from proper treatment. In fact, the recidivism rate is actually quite low, provided the offender is paired with the most effective form of treatment. It’s all about good assessment and knowing who needs what and when.

Who We Do Not Know How To Help (Today)

Effective (and Ineffective) Treatments for Sexual OffendersViolent offenders and fixated/dedicated child offenders (pedophiles and hebephiles with no sexual attraction to adults) typically do not respond well to sexual offender treatment. These individuals do not engage in their offending behaviors because of some childhood trauma, attachment deficit disorder, or similar issue. Instead, they were “born this way” and they are unlikely to change, no matter how hard a therapist tries to help them. In most cases they are either inherently sociopathic or hardwired in their sexual attraction to children. Only the most motivated—those with the least psychopathy who are also willing to also take hormonal anti-androgen drugs (which drastically reduce their sex drive)—have much chance of success. Dedicated hebephiles are more likely than dedicated pedophiles or violent offenders to respond in positive ways to treatment, but even they are not great candidates.

Generally speaking, contraindications to sex offender treatment are:

  • Physical force or violence (or the threat thereof) played a role in the offense
  • The sexual activity involved bizarre or ritualistic acts (such as enemas or bondage)
  • The sexual offense is one aspect of numerous antisocial behaviors or a criminal lifestyle
  • The sexual offense is secondary to a condition of serious mental illness or mental retardation
  • The offender denies the offense occurred or that he/she committed it

The good news is violent sex offenders, fixated child offenders, and others for whom treatment is contraindicated are a minority of the overall sex offender population.

Who We Can Help (If Motivated, Insightful, and Engaged)

As mentioned above, most sexual offenders will respond in positive ways to proper treatment. This is especially true if the underlying causes of their problematic behaviors are similar to the presenting issues of alcoholics and addicts—depression, severe anxiety, low self-esteem, attachment deficit disorders, unresolved childhood or severe adult emotional trauma, etc. Typically, regressed/situational child sex offenders and sexually addicted sex offenders are the groups most amenable to treatment. As long as these individuals are willing to admit to their offense(s) and are fully assessed for concurrent addictions/mental health disorders, the right treatment can be extremely helpful.

Modalities That Don’t Work

Over the years, a wide variety of treatment approaches have been used with sexual offenders. The vast majority of these methodologies have proven to be either ineffective or only partially effective. These modalities include:

Chemotherapy

Various anti-androgenic hormones, most notably Depo-Provera, have a moderating effect on sexual aggressiveness. These hormones have been used as a way to enhance self-regulation of sexual behavior. Depo-Provera shows promise in the treatment of sexual offenders as a chemical control of antisocial sexual acting out. However, the method is only partially effective, as human sex-drive lives primarily in the mind, not the body. Thus, offenders often still want to engage in their antisocial behavior, even if they are unable to become physically aroused and carry it out.

Behavior Modification

This approach attempts to change the offender’s sexual arousal patterns by associating aversive experiences (electric shock, for instance) with deviant sexual behaviors, while at the same time rewarding and therefore encouraging more socially acceptable behaviors. Specific thoughts and behaviors associated with an individual’s particular offense are targeted in this way. This methodology has proven to be only minimally effective, and the efficacy diminishes over time. In other words, the further away the offender is from the aversive experience, the less effect the treatment will have.

Psychodynamic Psychotherapy

This traditional therapeutic approach focuses on the offender’s childhood in the hope that he or she can find the root causes of his/her offending behavior. This method appeals to many (if not most) sex offenders because typically, when entering treatment, they are looking to blame their behavior on anyone but themselves. If they can find something awful that their mother or father did to them when they were young, they’re off the hook, so to speak. They then can think about their sexual offending as “justified.” This is the least effective methodology when working with sex offenders. It has little to no clinical use with this population beyond the building of rapport.

Modalities That Do Work

As mentioned earlier, the sex offenders who respond best to treatment are the individuals who present with underlying issues similar to those of alcoholics and addicts. So perhaps it is not surprising that the most effective treatment approaches are the ones that also work well with alcoholics and addicts—cognitive behavioral therapy (CBT), social learning, group therapy, psycho-education, prescribing SSRIs (to reduce sex drive and compulsivity), etc.

Most therapists working with sex offenders rely heavily on CBT, looking closely at the thoughts, feelings, and circumstances that trigger an offender to act out, while at the same time identifying ways to short-circuit the process. In other words, offenders are taught to stop problematic sexual thoughts and behaviors by thinking about something else or by engaging in some other, healthier behavior (talking with a therapist or 12-step sponsor, going to the gym, reading a book, cleaning the house, etc.) The therapist is directive and reality-based, focusing on the here and now rather than on the exploration of childhood issues that may or may not have led to the offending activity. In other words, the therapist’s role, at least initially, is to implement a task-oriented, accountability-based methodology geared toward containment of the individual’s problematic behaviors.

Initial CBT for sex offenders can be divided into three major stages:

  1. Identification of the Problem: Close questioning and observation help the clinician and patient identify the specific behaviors that make up the problematic sexual pattern.
  2. Behavioral Contracting: The clinician and patient work together to define, in written terms, specific sexual behaviors that are to be eliminated. Contracts may include tasks that encourage the use of alternate coping mechanisms such as journaling, check-in phone calls, and attendance at 12-step meetings.
  3. Relapse Prevention: The clinician and patient work together to identify and reduce patterns of experience and interaction that support and/or trigger offending behaviors.

Oftentimes the treatment of sex offenders presents demands that cannot be met solely within the confines of an individual therapeutic relationship. Offenders typically require external reinforcement and support if they are to implement lasting behavior change. Group therapy is especially helpful in this regard. In a facilitated group setting, offenders can see that their problem is not unique, which helps in reducing the guilt, shame, and remorse associated with their behavior. More importantly, the group format is ideal for confronting the denial used by offenders to justify their activities. Such confrontation is powerful not only for the individual being confronted, but for group members doing the confronting. In this way, everyone present is able to see how internal rationalizations facilitate and sustain sexual offending. Inpatient recovery settings, both voluntary and mandatory, can provide an even deeper level of social learning, as every aspect of the offender’s life is scrutinized by his or her peers, and vice versa. The extended 24/7 nature of inpatient treatment inevitably leads to a deeper and fuller understanding of the individual’s triggers and potential coping mechanisms.

Many sex offenders, especially sexually addicted offenders, also benefit from 12-step meetings, which provide both guided recovery and social support. Sexaholics Anonymous (SA), Sex Addicts Anonymous (SAA), Sexual Compulsives Anonymous (SCA), Sex and Love Addicts Anonymous (SLAA), and Sexual Recovery Anonymous (SRA) are all nationwide programs for sex addicts. Sexually addicted offenders are welcome in most groups.

Boundaries

In all instances, effective sex offender treatment requires transparency with clients regarding the therapist’s treatment expectations, the need for collateral information which may require appropriate releases, and obligations to report certain behaviors to the authorities. It is also important to provide clear structure, rules, and boundaries for clients, including swift and clear interventions when rules and boundaries are disregarded. This is especially important when treatment is involuntary. In such settings, the clinician must exercise power over the client in a responsible fashion through:

  • Appropriate confrontation
  • Outreach and monitoring
  • Support that anticipates the guidance clients may need
  • Even-handed implementation of consequences when the conditions of treatment are not fulfilled

Expectations Regarding Treatment

The general expectation when dealing with sex offenders is that they will come to:

  • Admit to all of their problem sexual behaviors
  • Accept responsibility for what they have done
  • View their sexual offending as both intellectually and socially inappropriate
  • Recognize their sexual offending as a pathological behavior that causes harm
  • Acknowledge that they must live differently, accepting new life limitations and accountability
  • Become diligently honest in treatment and with their support network

Of course, every sex offender arrives in recovery with a unique background and a specific set of offending behaviors. As such, each individual needs a program of treatment tailored to his or her precise needs. That said, some combination of CBT, group therapy, social learning, and psycho-education nearly always works, as long as the client is legitimately interested in changing his or her behavior. Unfortunately, there are individuals—particularly violent offenders and dedicated child offenders—who are unlikely to respond to even the best treatment regimen. These individuals are simply not good candidates for lasting behavioral change. Happily, these folks are a small percentage of the overall sex offender population. Most offenders—particularly regressed child offenders and sexually addicted offenders—respond in more positive ways.

The Association for the Treatment of Sex Offenders  and The Safer Society Foundation provide excellent resources for therapists, offenders, victims, and families.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

 

 


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    Last reviewed: 10 May 2013

APA Reference
Weiss LCSW, R. (2013). Effective (and Ineffective) Treatments for Sexual Offenders. Psych Central. Retrieved on November 29, 2014, from http://blogs.psychcentral.com/sex/2013/05/effective-and-ineffective-treatments-for-sexual-offenders/

 

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