Sex Offender Treatment

ABSTRACT: For those convicted of sex crimes, probation with mandated treatment along with some jail time is a common disposition.  The major goal of treatment for sex offenders is the prevention of sexual offenses in the future.  However, until recently there has been little evidence that treatment reduces recidivism.  The type of treatment which is most likely to succeed is an individually-tailored approach that includes careful assessment and uses a broad mix of cognitive-behavioral techniques to support individual behavior change.  There is little evidence for the effectiveness of many commonly-used treatment approaches.

Psychotherapy is often ordered for child sexual abuse perpetrators.  Of possible treatment modalities, the most common approach has been group therapy that relies heavily upon punitive and hostile confrontation and a nonsystematic blend of psychoanalytic concepts and traditional talking therapy.  There is often little or no effort to provide a theoretical base for the program.  The result is a procedure that is essentially highly moralistic and reflects the judgmental emotional response of the society rather than an empirically-based healing technique.

Treating people with disordered behavior patterns as morally defective and requiring a change in moral commitments has a long history (Siegler & Osmond, 1974).  However, moral treatments, such as those currently vended for perpetrators of child sexual abuse, should be labeled for what they are.  It is professionally irresponsible to call a procedure therapy, implying it is value free, when, in fact, it is based upon moral values and pursues goals defined moralistically.

Psychotherapy is a venture much studied and researched and there is an extensive literature on psychotherapy processes and outcomes.  There is sufficient information to have some understanding of what may actually work to change behavior. The scientific knowledge available permits more than an educated guess or a trial and error methodology.  Unfortunately, many current treatment programs for sexual abusers fall to use techniques known through research to be effective.

The effectiveness of therapeutic treatment is often measured by its contribution to restoration of emotional health and normal functioning along with the subjective sense of well-being of the individual.  Normal behavior may be defined either by reference to the applicable social norms or by statistical frequency.  With treatment for a person guilty of child sexual abuse the essential goal is the prevention of sexual offenses in the future.  Subjective well-being or conformity to generally accepted norms in other areas is not sufficient to measure treatment outcomes.

In providing treatment to persons accused and/or convicted of child sexual abuse, the situation can be complicated by a number of factors.  When a person is accused of sexual abuse, the accusation is either true or it is not true and the accused may admit or deny the accusation.  But there also may be plea bargaining, dropping of charges for insufficient evidence, dismissal by stipulation in family court, admission of guilt, admission of a mistake by the social service agency, and acquittal by the criminal court along with a finding of abuse by family court.  An accused person may be required to enter a treatment program as a sexual abuser long before there is a determination by the justice system about the accusation.  Often this is a requirement laid down by child protection as a precondition for a parent to have contact with his or her children.  For many parents this is a highly coercive demand.  It is difficult to imagine a more powerful club to hold over parents who love their children.

Such events confront the therapist with a complex situation.  Determining what is to be treated may not be easy.  There are many permutations of the interaction of truth or falsity, denial and admission, and substantiated or unsubstantiated allegations in people entering sex offender treatment programs.  The most difficult is the situation of a person accused who in reality did not do it, denies it, but the accusation is substantiated or the court rules that the abuse had occurred.

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