Treatment and The Sex Offender by Brent M. Pergram, Masters of Arts in Sociology

The Martinson Report of the early 1970’s, said that rehabilitative efforts or treatment programs in general had failed to reduce recidivism. The Report led those in control of government and the criminal justice system to say that rehabilitation does not work, and therefore focus on deterrence and punishment of offenders. Martinson’s study of 231 treatment studies measured offender improvement in various areas, but recidivism is the issue here. Martinson says “With few and isolated exceptions, the rehabilitative efforts that have been reported so far have had no appreciable effect on recidivism” (p.292).

Martinson says that education and vocational training in the studies he reviewed had no influence on reducing recidivism. But he admits that a correctional facility running a truly rehabilitative program that gets inmates ready for life on the outside by way of education and vocational training will have more successful persons than prisons that have no such programs (Martinson, p.292).

Martinson says that individual counseling also fails to reduce recidivism. In terms of group counseling he admits that a study of adult offenders did show improvement in attitudes of offenders, but since it did not include information on recidivism it was discounted.

Martinson is criticized because the counseling programs may not seem to work because of the institutional environment outside the program. Martinson says that even in institutional environments that control every part of the offenders environment and treatment, did show a reduction in recidivism for one year. But he says the effects of such treatment did not reduce recidivism any more than no treatment after two years. And it had no influence on reducing the recidivism rates of young offenders (Martinson, p.296).

Prisoners with less sentences were found to have a higher parole success rate than those with longer sentences, but did not deal with the issue of offender degree of risk (Martinson, p.299).

Martinson says that since these treatment programs in prison did not work, maybe rehabilitating offenders outside an institutional setting may work. But the studies he reviewed showed no effect in treating the client. But he says that individual psychotherapy may work in a community setting.

Martinson said that their was no evidence to believe that intensive supervision of adults would reduce recidivism. But he said that a smaller case load did improve a person’s chances of parole success (p.305). But he says that intensive supervision works not because of the mechanisms of treatment or rehabilitation, but due to the mechanism of deterrence (Ibid).

Martinson says that community treatment may not reduce recidivism, but it does insure that the client will not become worse. Also community treatment is cheaper than treatment in prisons.

Martinson admits that the reason why treatment has not worked is due to these reasons:

“the education we provide to inmates is still poor education, that the therapy we administer is not administered skillfully enough, that our intensive supervision and counseling do not yet provide enough personal support for the offenders who are subjected to them” (p.307).

Sundt et al. (1998) article says that past research has shown that the public supports rehabilitation as a core goal of corrections. They say that over the past decade, the conservative campaign to get tough on crime has grown in strength and influence. Stundt et al (1998) article replicates a 1986 study by Cullen et al that explored attitudes toward correctional treatment. They found that public support for rehabilitation has declined , but that the public continues to view treatment as a legitimate correctional objective. A majority of the public now believes that the main emphasis of prisons should be to punish offenders or protect society. But the majority of the public still favors expanding rehabilitation programs. In terms of early release from prison for good behavior and participation in educational and work programs, half of the public opposes early release. Also 40% of the public oppose expanding treatment programs (p.426).

Sundt et al (1998) found that two thirds of the public perceived correctional rehabilitation to be very helpful or helpful. They found that only with regard to sex offenders and violent offenders did a majority of the public perceive that treatment would be ineffective, but 40% believed that treatment would be slightly helpful for these offenders.

The Sundy et al (1998) article shows that the belief in the efficacy of rehabilitation is somewhat stable. Even if the public is less confident that specific treatment programs work, most still perceive rehabilitation as being an effective way to treat offenders. They say that the decline in support from 1986 is not due to the belief that nothing works. They say that many studies from the past decade (the late 1980’s through the early 1990’s) shows the effectiveness of treatment interventions is now extensive and stronger that it was in 1986. For example Palmer 1995 article shows that treatment programs do work to reduce recidivism and are effective ways to treat offenders in prison. The change in support for rehabilitation is due to the penal harm movement that wants to punish offenders, and opposing any treatment or rehabilitation due to cost and perception that criminals cannot change.

Gendreau et al (1996) article discusses effective assessment, believing that good risk measures can predict recidivism in the .30 – .45 range. In terms of the methods of assessment, Gendreau et al (1996) says their is two models of assessing and predicting human behavior, which are clinical and actuarial. They say that the clinical model dominates, and in the case of corrections clinical assessment consists of an expert, such as probation officer interviewing an offender for the purpose of determining their risk to reoffend. The expert bases their decision on intuition, experience, and file information on the client to make the correct decision. The actuarial method is based on empirically established correlation’s between a standardized objective risk measure and recidivism, and therefore limits the experts subjective opinion in the decision making process.

Gendreau et al. (1996) article says the actuarial approach is the best, since the clinical method only predicted recidivism 8% of the time (r=.08). The actuarial method was r=.22, and produced higher correlation’s with outcome 76% of the time. The results apply to corrections, such as that sex offenders (Hanson & Bussiere, 1996) and violent offenders (Mossman, 1994) clearly demonstrated the superiority of the actuarial model. The Hanson & Bussiere, 1996 study of sex offenders found the actuarial model to be about three times more powerful. Gendreau et al (1996) say that “there is simply no justification whatsoever for the continued use of the clinical model of assessment considering what is at stake (i.e., protecting the public) in our line of work.”

The static risk factors that are criminal behavior predictors are age, gender, past criminal history, early family factors, and criminal associates that predict recidivism. But their is also dynamic risk predictors, such as criminogenic needs. Simourd (1996) defined criminogenic needs as attitudes, values, beliefs, and behaviors held by an offender that support negative attitudes toward all forms of official authority and conventional non deviant pursuits (e.g., education, work, stable pro social relationships); deviant values that are used to justify aggression, and substance abuse; and rationalizations for antisocial behavior that free one from any moral constraints. Gendreau et al. (1996) tested the static risk predictors by a meta-analysis of 131 studies from 1970-94 that produced 1,14f1 correlation’s with recidivism. They confirmed that age, gender, early family factors, adult criminal history and history of antisocial behavior as a teen, and criminal associates are reliable predictors of recidivism. They found that dynamic predictors, especially criminogenic needs predicted recidivism (r=.17) as well as static predictors including past criminal history (r=.16).

Gendreau et al (1996) article found that the prediction of recidivism is best accomplished by using measures that assesses static and dynamic risk factors. They recommend the Level of Service Inventory (LSI-R) (Andrews & Bonta, 1995), due to the studies that confirm its predictive validity in predicting recidivism and prison adjustment for a variety of offender populations, such as sex offenders.

The sex offender literature is complex, such as Marshal (1996) belief that assessment of the sex offender with phallometric procedures is ethically questionable, and that it is much easier to predict violent recidivism than sexual recidivism.

However, Hanson and Bussiere’s (1996) meta-analysis of 61 sex offender studies found 970 correlation’s with recidivism concluding the following: a) the largest single predictor of sexual offending were sexual preference for children and deviant sexual preference as measured by phallometric methods. The respective r values were high (.32 and .22); b) measures of personal distress, be they anxiety, depression, or self-esteem, were not significant predictors of sexual, non-sexual, or violent recidivism; c) combinations of variables identified in their research should be able to predict recidivism in the .30-.40 range, that is similar to what has been found in studies of general recidivism (Gendreau et al., 1996).

Gendreau et al. (1996) says that assessments of general criminal deviance, such as antisocial personality attitudes, and non-sex offending criminal history have been under used in the sex offender area. This is especially true of the rapist who appears to have a good deal in common with the high risk non-sex offender (Quinsey, Lalumiere, Rice, and Harris, 1995).

Researchers in the area of sex offending have identified a list of other factors that should be assess in the future, such as the lack of empathy toward the victim, denial and minimization, deviant sexual fantasies, unfulfilled intimacy needs, association with other sex offenders, access to victims, and the interaction of psychopathy and deviant sexual arousal (Hanson & Bussiere, 1996; Marshall, 1996; Quinsey et al, 1995). Gendreau et al. (1996) says that well-galidated measures designed specifically for use with sex offenders are rare (e.g., Epperson, Kaul, & Huot, 1995).

Gendreau concludes that the most effective model of assessing offender characteristics predictive of recidivism is the actuarial technique, and that “the realization that dynamic predictors (i.e., criminogenic need) are crucial for the accurate assessment of offender risk”.

Male sex offenders in prison represent a major problem for correctional administrators in the United States, due to the public, legislative, and legal pressures to do something about these most reviled offenders. Most correctional systems in the United States and Canada offer some form of treatment for sex offenders, ranging from individual to group counseling to highly intensive therapeutic communities that use the most recent treatment techniques (US Dept. of Justice).

The responsibility for treating and supervising sex offenders has increasingly shifted from mental health institutions to corrections, as the Mentally dangerous Sexual Psychopath laws adopted by many states in the 1940’s have been phased out. In general treatment professionals have concluded that most sex offenders are not mentally ill and have not benefited from traditional psychiatric treatment. Fortunately for society, promising new approaches in corrections have been developed to help treat sex offenders that hopefully will reduce recidivism.

The Association for the Treatment of sexual Abusers supports the position that treatment of sex offenders should not replace a criminal justice response, but should be one of several tools used by society to meet the needs of the offender and protect and insure public safety. The fact is that treatment can be combined with other criminal justice responses, such as jail, incarceration in prison, probation, and community monitoring and supervision (ATSA).

The U.S. Department of Justice, National Institute of Corrections article, “An Administrator’s Overview-Questions and Answers on Issues Related to the Incarcerated Male Sex Offender,” hereafter cited as (US Dept. of Justice) adapted by Barbara Krauth and Roger smith from A Practitioner’s Guide to Treating the Incarcerated Male Sex Offender summarizes the new treatment approach used to meet the needs of this offender population. The Administrator’s Overview highlights material contained in the Practitioner’s Guide used by those expected to treat sex offenders and is focused at correctional administrators, who must make critical decisions with limited resources. The NIC training seminars, and the Practitioner’s Guide produced as a result of these seminars that began in 1986, stress the importance of a systems approach to program planning, design, and management. The approach requires the active participation and support of legislators, prosecutors, judges, mental health professionals, advocacy groups, and all segments of the correctional system. It grew out of the belief that supportive administrators play an important role in the developing and operating effective treatment programs for sex offenders who are incarcerated to help end the vicious cycle of abuse, in which victims frequently become offenders.

There is more than one type of sex offender. Sex offenders are a diverse group that cannot be characterized by any single motivation or causal factor. Typologies have been created to account for the different forms of sexual deviance. The categories developed by the FBI, based on other typologies, are currently most frequently used in criminal investigations. The FBI categories of sex offenders are as follow:

Child molesters who turn to prepubescent youths for sexual gratification. The two main types of child molester are the situational and preferential (often called the pedophile).

The situational child molester is made up of persons that do not have a defined sexual preference for children. They include the following subtypes: Regressed, who is an immature, socially inept person that relates to children as peers. This person usually experienced a brief period of low self-esteem and turned to his own kids or others for sexual satisfaction. He is morally indiscriminate, with an antisocial attitude that uses and abuses everyone. He chooses his victims based on vulnerability and opportunity and only coincidentally because they are kids. He is sexually indiscriminate, who may be developmentally disabled, psychotic, senile, or organically dysfunctional (US Dept. of Justice, pp.2-3).

The preferential (pedophile) child molesters are fixated, in that they are attracted to children throughout their lives and have been unable to attain any degree of psycho-sexual maturity. The subtypes of this type of child molester is as follows: Seductive, having an exclusive sexual interest in children and trying to court and seduce them. He is introverted, having a fixated interest in children but does not have the social skills to seduce them. He typically molests strangers or very young children or marries women with children the age of his preference. He may be sadistic, having a sexual preference for children, coupled with a need to inflict pain in order to obtain sexual gratification (US Dept. of Justice, p.3).

The adult sex offender is the rapist, who are usually motivated by a fusion of anger and power needs and sexuality. They are classified according to the characteristics of the assault as well as of the assailant. There is three main types of rapists, the anger rapist, the power rapist, and the sadistic rapist.

The anger rape is associated with gratuitous violence and the intention to hurt, devalue, and express contempt for the victim. This type of assault is typically opportunistic and is usually committed in response to a precipitating stress.

The power rape is typically used as a way of exercising dominance, mastery, strength, authority, and control over the victim. The power rapist has little need for excessive physical force beyond what is needed to gain the victim’s submission. They are less physically dangerous that the anger rapist, but may be more compulsive and often engage in elaborate fantasies and plans.

The sadistic rape is the most severe pathology of rape on the part of the offender as well as the most dangerous type of assault. This type of rape has the ritual of torturing the victim and the perception of her suffering and degradation gives the offender erotic pleasure. As the rapists arousal builds, so may his sadistic acts of violence, progressing in some cases to the point of lust murder (US Dept. of Justice, p.3).

The Administrator’s Overview, says that just about every incarcerated sex offender in treatment is a rapists or child molesters. Therefore I will not discuss voyeurs, exhibitionists, or obscene phone callers in jail, except to say that this misdemeanor sex behavior may be about to commit a rape, or is engaged in an escalating pattern of deviant behavior that may lead to rape. Also the sex offender may not specialize in one type of sex abuse, but be engaged in voyeurism, rape, and child molestation.

The vast majority of offenders are males, with about 80% of sex offenses against children being committed by males and about 20% by females (ATSA-reducing sex abuse…). The offender is usually know by the victim or family eighty to ninety-five percent of the time. The sex offender is a family member in less than 50% of cases, and are identified as acquaintances, such as neighbors, coaches, teachers, religious leaders in the remaining cases (Ibid.).

Clearly intervention and treatment is very important to treat the sex offender. Sex crimes are viewed with horror by the public. Those that fear this offender population would prefer to lock them up forever. This negative public attitude has caused some corrections officials to not spend scarce resources on creating treatment opportunities for this group of offenders, thinking that punishment and deterrence are more appropriate (US Dept. of Justice, p.4).

The typical atmosphere in the usual prison tends to aggravate the problem of most sex offenders. The secrecy, negative social interactions, poor self-esteem, denigrating attitudes toward women, and deviant sexual arousal are usually reinforced in prison.

Despite the criticism, without treatment, sex offenders are highly likely to re-offend. The statistical data suggests that the recidivism rate of untreated offenders is about 60 percent, while recidivism among those who have been treated is about 15 to 20 percent. Therefore, it is in the interest of society to protect potential victims by treating sex offenders.

Treatment is not a cure for sex offenders, but successful treatment does reduce the likelihood of recidivism. It does not permanently eliminate the attraction of deviant sexual acts for sex offenders, who are always at risk of repeating their deviant behavior. But, only through treatment can the offender learn to control their behavior. The sex offender must use what they learn in treatment to maintain self-control over their behavior. It can help them to recognize the situations that increase their likelihood of re-offending, and teach them techniques to control their behavior in these situations.

Kaufman, et al. (1998) discusses factors that influence sexual offender’s modus operandi, including an examination of victim-offender relatedness and age. They say that the majority of research literature in this area has focused mainly on adult offenders, and offers only preliminary understanding of sexual- offending process. The general findings indicate that it may be useful to describe offense patterns based on specific variables, such as relationship of the victim to the offender. For example, Faller (1989) found that intrafamilial offenders with close relationships to victims, such as biological and stepfathers abuse their victims more often and for a longer duration of time than do intrafamilial offenders of more distant relations, such as noncustodial fathers, or other relatives.

The purpose of the Kaufman et al. (1998) study was to investigate and contrast the modus operandi (MO) of key subgroups of sexual offenders in an effort to increase the understanding of the behavioral process associated with sex offending. Their findings support the assertion that offender age group (i.e.

adolescent vs. adult) as well as victim / offender relatedness maintain victim silence following the onset of sex abuse. The study found that adolescent offenders consistently reported using MO strategies with greater frequency than did their adult counterparts. Adults larger physical size as well as their inherent power, social or parental may reduce their need to engage in MO strategies. The impact of offender / victim relatedness was found to have a major impact on some MO dimensions. The intrafamilial offender reported the use of gifts to gain victim compliance in sexual activities more than did extrafamilial offenders. They may use gifts to maintain their relationships with victims as well as to obtain compliance in sexual activities. Extrafamilial offenders said they gave victims alcohol and drugs more than did their intrafamilial counterparts to gain compliance in sexual activities. The study suggests some prevention programs conveying simple messages (e.g., “Say no, run, and tell”) are unlikely to lead to a reduction in sex offenses. Prevention must look at the subtle nature of the grooming process (i.e., including the involvement of prosocial behaviors), the reality that most offenders are known to the victim, and the impact of key subgroup factors (e.g., offender age and relationship to the victim) on the offenders modus operandi.

Some sex offenders cannot be treated successfully, such as those with lifelong histories of antisocial acts are not likely to benefit from treatment. Also very violent and sadistic offenders, sociopathic offenders with no empathy, and those not motivated for treatment are typically impossible to treat. Offenders with the best prognosis for treatment have committed few sex crimes, having little history of Alcohol and other Drug dependence, are not mentally ill, and are of normal intelligence can benefit from treatment. Clearly those with a mental illness, or who are under the influence of mind altering drugs or who have less that a seventh grade education cannot possible benefit from a cognitive behavioral treatment program that requires the ability to comprehend and think on a level to overcome thinking errors, cognitive distortions, and other problems.

The Administrator’s Overview, says that it is difficult to determine if sex offender treatment programs in correctional institutions have been successful by reducing recidivism because experimentally based data is rare, and different treatment programs collected data in different ways and tracked divergent groups of sex offenders without the use of classical experimental design (US Dept. of Justice, p.5). Also they say that recidivism data may vary because different definitions of recidivism exist. They do say that these problems should be resolved over the years to come, due to the improvements in keeping reliable outcome data for programs.

The approaches to assessment and treatment of sex offenders must include the following techniques to identify sex offender treatment needs. Techniques used to assess sex offenders include clinical interviews, self-reporting, psychological tests, questionnaires, and physiological methods, such as use of the plethysmograph to measure deviant sexual arousal.

The following are important types of information that is used to assess candidates for sex offender treatment programs:

1) Nature of the offense – level of violence; 2) Characteristics of the victim – age, gender.

3) Circumstances of the offense – AOD use, presence of stress, or psychological state such as depression; 4) Criminal history – career criminals and those with antisocial personalities usually do not respond to sex offender treatment; 5) Development history – nature of the offenders relationship with his parents and siblings, especially information on abuse, neglect, parental death or abandonment, methods of discipline, family sexual behavior, and the adequacy of parental role models. 6) Educational, social, and sexual history; 7) Inhibiting beliefs – sex offenders are sometimes from backgrounds that have instilled repressive sexual attitudes and a fear of adult sexuality; 8) Level of anger – anger serves as the main motivation for many sex crimes, especially rapists; 9) Acceptance of responsibility – offenders who accept responsibility for their actions are more likely to be successfully treated; 10) Ability to empathize – sex offenders who can empathize with their victims are better candidates for treatment; 11) Awareness of emotions – sex offenders are often not aware of their emotions, or unable to express, their feelings; 12) Cognitive distortions – sex offenders usually blame their victims or have distorted notions about sex.

13) Degree of sexual arousal to deviant stimuli – must be considered in relation to degree of arousal to appropriate stimuli to non-deviant sexual behavior.

All of the above information can not only identify those persons most likely to benefit from treatment, but also help to identify specific areas that need to be targeted for intervention and treatment ( US Dept. of Justice, p.7-8).

Howard E. Barbaree’s article, discusses the assessment and treatment outcomes of sex offenders that use denial and minimization to not accept responsibility. Denial is usually seen as a main impediment to successful therapy and as a consequence, most treatment programs exclude offenders who deny their offense. The offender use denial to conclude that he has no problems and that there is no reason for him to be treated, even if he admits to the offense, he may history the truth by minimizing the frequency severity and variety of his criminal sexual behavior. He found that in a nonrandom survey, 114 incarcerated rapists were divided into those that admitted to the offense for which they had been convicted (41% and those who denied it (59%). Also both groups presented justifications that were used to support their denial or to minimize responsibility for the offense. They blamed the victim, by saying she had a bad sexual reputation, an by saying they it was alcohol an drugs that caused them to do it. Also some blamed a bad childhood. Denials and distortions weakens both the accurate assessment and the effective treatment of sex offenders. Therapists depend on offenders to provide truthful descriptions of the events that lead of to their offenses to help determine what behaviors need to be targeted in therapy. Denial and minimization is the results of a psychological process involving distortions, mistaken attributions, rationalization, and selective attention and memory, which helps the offender avoid blame and responsibility for their actions. They recommend that offenders not be excluded from treatment due to denial and minimization, because such cognition’s can be amenable through treatment and should be the first stage of treatment, to increase motivation for treatment and set the stage for further assessment and treatment (Barbaree).

Nancy Howard and Rick Caslin (1999) says that cognitive training and not excuses is what sex offenders need to avoid recidivism. Sex offenders often show thinking errors and rationalizations to justify their actions and avoid accepting responsibility for their actions. Sex offenders used several defensive mechanisms, such as rationalization, minimization, intellectualization, and denial to avoid the truth and reality. They may feel guilty or ashamed of their actions, but want to hide it instead of accepting responsibility. An essential element of any sex offender that works, must be to challenge an offender’s thinking errors to help the offender learn responsible, non-criminal behavior. The use of thinking journals or logs of their daily thinking can be used to help them and the treatment provider identify thinking errors and become aware of how often they make them. Offenders should assist one another in recognizing thinking errors. This will help the offender to have a better decision making process, and reduce their risk of recidivism (Howard & Caslin).

Sex offender treatment can be treated by professionals from various disciplines, such as rehabilitation counselors, social workers, psychologists, criminologists, and educators. Also correctional officers, counselors, and caseworkers can be trained to facilitate group therapy and teach modules to sex offenders. Also inmates are expected to be active participants in the group process, and can assist in providing certain treatment techniques under the supervision of the treatment provider.

The kind of personality of the treatment provider that works best has the ability to work in a group setting. They are confrontative in a non-defensive proactive way and have an empathetic and caring attitude. They are comfortable with their sexuality. They must maintain a professional relationship with the offender. They must not be influenced by their personal bias, and be objective with sex offenders whose behavior may be viewed as personally repugnant. Also if the counselor has been sexually victimized themselves, must successfully resolve their own personal issues before they can best interact effectively with sex offenders.

Gerber (1995) article discusses counter-transference in working with sex offenders to help treatment providers recognize their reactions to the male sex offender. Professional working with male sex offenders in treatment programs must work to enhance self-knowledge in order to protect their clients from personal bias. Polson & McCullom (1995) article examined therapists feelings toward sexual abuse offenders and the offenders’ perceptions of caring on the part of the therapist. Therapists working with offenders should periodically assess the family member caring for the offender as well.

If it is possible, male-female teams should be used to conduct group sessions. The advantages to this approach is as follows: 1) A positive male role model can demonstrate correct non-deviant social skills and attitudes toward women; 2) A positive female role model can help the offender practice social skills, as well as work through anger, power, and other issues;

3) The male-female team can model appropriate interactions, conflict resolution, and non-sexual relationships (US Dept. of Justice, p.8-9).

Gordon et al. (1990) article dealing with Canada, shows that there is a need the match risk and needs of sex offenders to give them treatment, since only one quarter of sex offenders in Canada received any treatment. They say that even if treatment is shown to reduce recidivism, some sex offenders may have less a need for specialized and intensive treatment. Also that some can