Effects of a relapse prevention program on sexual recidivism: final results from California's sex offender treatment and evaluation project (SOTEP)

A consumer satisfaction survey of civilly committed sex offenders in Illinois

The purpose of this study was to obtain feedback from civilly committed sex offenders (N = 113) about the components of treatment that they believed to be most important and helpful in preventing reoffense. Participants were also asked to rate their satisfaction with the treatment process and therapists. Victim empathy and accountability were rated as the most important elements of treatment, along with skills for preventing relapse and methods for controlling sexual arousal. There was a fairly robust correlation between client perceptions of importance and satisfaction on most treatment components. Some clients expressed concerns about respect, confidentiality, and judgmental attitudes of some therapists. Because civilly committed sex offenders are considered to be among the most likely to reoffend, strategies are discussed for engagement of this population in a meaningful process of change.

Theorising sexual media and sexual violence in a forensic setting: men's talk about pornography and offending

This article reports findings from a discourse analytic study which critically explored the language of mental health nurses, and detained sexual offenders, in relation to pornography in one high-security hospital. It recognised previous empirical investigation, and pro-feminist theorising, into mediated representations and male sexual violence, but situated the research process in a forensic nursing context. Decision-making about access to, or restriction of, commercial sexual literature, as a component of therapeutic intervention and offender management, reveals tensions between service-user rights and treatment goals. The aim was to access nurse and patient talk in a specific culture. Semi-structured interviews with eighteen nursing staff, and nine patients, were used to co-construct accounts of pornography, sexual offending, and treatment. Analysis and data collection were undertaken concurrently. Interviews were audio-taped and transcribed. Data was coded to identify theoretical/conceptual themes and sub-themes representing discursive repertoires. Attention was given to how textual variation positioned respondents in relation to each other and the institution. Findings suggested collective male talk textured the environment, promoted gendered inequality, marginalised female nurses, and undermined rehabilitation. Shared discourse enabled male staff and patients to relate to each other as men, while maintaining distance through constructions of otherness. Discussion focuses on discriminatory discursive-practices, where men's talk about pornography and sexual violence embodied gendered knowledge/experience and contributed to a toxic culture. Consideration is given to ways of resisting institutional impediments and promoting positive therapeutic relations.

Potential implications of research on genetic or heritable contributions to pedophilia for the objectives of criminal law

In recent years, there has been increasing scientific research on possible genetic or heritable influences to the etiology of pedophilia, driven by national and public concerns about better understanding the disorder in order to reduce children's vulnerabilities to pedophilic and child sex offenders. This research has corresponded to growing academic dialogue on how advances in genetic research, especially concerning the causes and development of particular mental disorders or behaviors, may affect traditional practices of criminal law and how the justice system views, manages, and adjudicates different types of criminal behavior and offenders. This paper strives to supplement this dialogue by exploring several of the many possible effects and implications of research surrounding genetic or heritable contributions to pedophilia for the five widely accepted objectives that enforce and regulate the punishment of criminal law. These include retribution, incapacitation, deterrence, rehabilitation, and restoration. Although still currently in early stages, genetic and heritability research on the etiology of pedophilia may have the potential moving forward to influence the current and established punitive methods and strategies of how the justice system perceives, adjudicates, regulates, and punishes pedophilic and sex offenders, as well as how to best prevent sexual offending against children by pedophilic offenders in the future.

Service approaches for youths who commit sexual crimes: a call for family-oriented models

Sexual crimes committed by youths are a major social concern. Currently, adult-based models of service delivery are applied to juveniles with very little evidence to support treatment effectiveness. With prevailing limitations to these approaches, consideration of methods for improving services to youths is warranted. Adapting traditional treatment approaches to incorporate family-oriented models of service delivery is likely to improve youth and family outcomes. The goal of this article is twofold: (1) to review the state of the evidence of current treatments for sexually abusive youths, identifying gaps in services and research, and (2) to suggest service improvements by incorporating family treatment approaches and reviewing the extant evidence for existing family-oriented models.

Adverse childhood experiences and adult criminality: how long must we live before we possess our own lives?

BACKGROUND

Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior.

METHODS

Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample.

RESULTS

Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types.

CONCLUSIONS

On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.

Assessing the generalization of relapse-prevention behaviors of sexual offenders diagnosed with an intellectual disability

The generalization of relapse-prevention skills of 10 males residing at a state facility for sexual offenders diagnosed with an intellectual disability was assessed in the community using three different experimental probes: (a) treatment staff (TS), (b) nontreatment staff (NTS), and (c) community adults (CAs). Results indicated a decrease in compliance from the TS to NTS and CAs, with the lowest levels of generalization displayed by offenders who were older and displayed a wider range of paraphilias. The degree of generalization also varied as a function of the contingencies for prevention-plan noncompliance, with higher rates of generalization occurring for violations that were more severely consequated. The implications of the findings for future research in promoting the generalization of relapse-prevention skills of sexual offenders, in general, and those who also exhibit intellectual disabilities, in particular, are discussed.

Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions

OBJECTIVE

To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing.

DESIGN

Systematic review of interventions designed to prevent reoffending among known abusers and prevention for individuals at risk of sexually abusing children. Randomised controlled trials and prospective observational studies were eligible. Primary outcomes were arrests, convictions, breaches of conditions, and self reported sexual abuse of children after one year or more.

RESULTS

After review of 1447 abstracts, we retrieved 167 full text studies, and finally included eight studies with low to moderate risk of bias. We found weak evidence for interventions aimed at reducing reoffending in identified sexual abusers of children. For adults, evidence from five trials was insufficient regarding both benefits and risks with psychological treatment and pharmacotherapy. For adolescents, limited evidence from one trial suggested that multisystemic therapy prevented reoffence (relative risk 0.18, 95% confidence interval 0.04 to 0.73); lack of adequate research prevented conclusions about effects of other treatments. Evidence was also inadequate regarding effectiveness of treatment for children with sexual behavioural problems in the one trial identified. Finally, we found no eligible research on preventive methods for adults and adolescents who had not sexually abused children but were at higher risk of doing so (such as those with paedophilic sexual preference).

CONCLUSION

There are major weaknesses in the scientific evidence, particularly regarding adult men, the main category of sexual abusers of children. Better coordinated and funded high quality studies including several countries are urgently needed. Until conclusive evidence is available, realistic clinical strategies might involve reduction of specific risk factors for sex crimes, such as sexual preoccupation, in abusers at risk of reoffending.

Sex offender treatment outcome, actuarial risk, and the aging sex offender in Canadian corrections: a long-term follow-up

The present study is an examination of sex offender treatment outcome in a large national cohort of Canadian Federally incarcerated sex offenders followed up an average of 11.7 years postrelease. A brief actuarial risk scale (BARS), which predicted sexual and violent recidivism, was created for the purposes of the present study to control for risk-related differences between treated and untreated offenders. In total, 732 offenders were identified as having completed (n = 625) or not attended (n = 107) a sex offender treatment program and for whom sufficient information was available to complete the scale. Controlling for risk and individual differences in follow-up time using Cox regression survival analyses and an 8-year fixed follow-up period, treated sex offenders demonstrated significantly lower rates of violent, but not sexual, recidivism. When the treated and untreated groups were stratified by risk level, significant differences were observed only among moderate or high risk offenders. Some significant group differences also emerged on indicators of recidivism severity, with treated offenders demonstrating slower times to sexual reoffense and lower scores on a quantified metric of sexual and violent recidivism severity after controlling for risk. Differences in recidivism base rates between treated and untreated offenders were also larger in magnitude for younger offenders (i.e., under age 50 at release), than for older offenders; however, interactions between age and treatment were not found. The findings are consistent with the risk principle and have possible implications regarding the dynamic nature of sexual violence risk.

Does volunteering for sex offender treatment matter? Using propensity score analysis to understand the effects of volunteerism and treatment on recidivism

A common critique of program evaluations of prison-based sex offender treatment holds that the samples inherently show selection bias because the participants typically volunteer for treatment. To address this critique, we used propensity score analysis to assess the influence of volunteerism on treatment effects. We examined recidivism outcomes for a sample of participants who volunteered for treatment, of whom some participated in treatment (n = 161) and some did not (n = 282) and compared these outcomes to the recidivism rate of a matched sample of nonvolunteers for treatment (n = 443). The primary finding is that offenders who volunteered for treatment did not demonstrate any differences in recidivism rates when matched with and compared to inmates who did not volunteer to participate in treatment. Furthermore, our results revealed that there were a number of significant differences between unmatched volunteers and unmatched nonvolunteers, perhaps most importantly in their risk for future recidivism as measured by the STATIC-99 risk assessment. We discuss study strengths and limitations and present the implications of the findings for policy, practice, and research.

Sexually violent predators: toward reasonable estimates of recidivism base rates

The sexual recidivism rate of sex offenders is a controversial issue. Perhaps as controversial is the sexual recidivism rate of the select group of sex offenders who are examined pursuant to sexually violent predator (SVP) statutes. At present, reliable estimates of SVP recidivism are unavailable. We propose that reasonable estimates of SVP recidivism can be reached by considering three available pieces of data: (i) a likely recidivism rate of the general population of sex offenders; (ii) procedures typically followed by jurisdictions that civilly commit sex offenders; and (iii) classification accuracy of procedures. Although sexual recidivism rates vary across jurisdictions, the results of our analyses suggest sex offenders referred for examination pursuant to SVP statutes recidivate at substantially higher rates than typical sex offenders. Our results further suggest that sex offenders recommended for commitment as SVPs recidivate at even greater rates than SVP respondents who are not recommended for commitment. We discuss practice and policy implications of these findings.

A community service for high-risk mentally disordered sex offenders: a follow-up study

There is sparse literature on mentally disordered sex offenders, and little is published on treatment participation and outcomes for this group. This article aims to describe the characteristics of a cohort of high-risk mentally disordered-largely personality disordered-sex offenders at risk in the community in southeast London. Drawing on various measures of personality dysfunction-including key developmental variables, a self-report personality disorder questionnaire Millon Clinical Multi-axial Inventory-III (MCMI-III) and psychopathy as measured by the Psychopathy Checklist: Screening Version (PCL:SV)-the researchers describe the characteristics of a cohort of mentally disordered sex offenders referred to the Challenge project. Follow-up data for those placed in treatment are reported and include consideration of treatment completion and reconviction: the relationship between personality dysfunction and a dynamic measure of risk are also explored. Of the 137 participants, 53% were placed in the community treatment project. Seventy five percent completed treatment, and were followed up for an average of 40 months. Eleven percent were sexually reconvicted, 3% violently reconvicted. Community failure was best predicted by a combination of static risk and personality-related variables.

Comparing sexual offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center

Sexual offender civil commitment (SOCC) continues to be a popular means of managing risk to the community in many U.S. jurisdictions. Most SOCC states report few releases, due in large part to the reluctance of the courts to release sexually violent persons/predators (SVPs). Contemporary risk prediction methods require suitable comparison groups, in addition to knowledge of postrelease behavior. Low SVP release rates makes production of local base rates difficult. This article compares descriptive statistics on two populations of sexual offenders: (a) participants in high-intensity treatment at the Regional Treatment Centre (RTC), a secure, prison-based treatment facility in Canada, and (b) SVP residents of the Florida Civil Commitment Center. Results show that these two samples are virtually identical. These groups are best described as "preselected for high risk/need," according to Static-99R normative sample research. It is suggested that reoffense rates of released RTC participants may serve as a comparison group for U.S. SVPs. Given current release practices associated with U.S. SOCC, these findings are of prospective value to clinicians, researchers, policy makers, and triers of fact.

Psychological treatment of sex offenders

This article reviews the research evidence, practice guidelines and accreditation standards for the psychological treatment of individuals who commit sexually motivated crimes. Overall, the sexual offender treatment outcome research is not well developed, which limits strong conclusions. There is, however, strong research evidence concerning the effectiveness of interventions for general (non-sexual) offenders. Given the considerable overlap in risk factors for sexual and general offending, the "what works" principles for general offenders provide useful guidelines for sexual offender treatment. Specifically, the intensity of treatment should be proportional to the offender's risk level (risk principle), treatment should focus on characteristics associated with recidivism risk (i.e., criminogenic needs; need principle), and be tailored to the learning style and abilities of clients (responsivity principle). Examples of promising new approaches to sexual offender treatment are provided.

Attitudes supportive of sexual offending predict recidivism: a meta-analysis

Attitudes supportive of sexual offending figure prominently in theories of sexual offending, as well as in contemporary assessment and treatment practices with sex offenders. Based on 46 samples (n = 13,782), this meta-analysis found that attitudes supportive of sexual offending had a small, yet reasonably consistent, relationship with sexual recidivism (Cohen's d = .22). To the extent that differences were observed, attitudes predicted recidivism better for child molesters than for rapists. There was no difference in the predictive accuracy of attitudes assessed at pretreatment or at posttreatment. The current study indicates that attitudes supportive of sexual offending is a psychologically meaningful risk factor for sex offenders. However, given that many different constructs have been designated as sex offender attitudes, further research and theory is needed to understand how these various constructs contribute to recidivism.

Psychological interventions for adults who have sexually offended or are at risk of offending

BACKGROUND

Sexual offending is a legal construct that overlaps, but is not entirely congruent with, clinical constructs of disorders of sexual preference. Sexual offending is both a social and a public health issue. Victim surveys illustrate high incidence and prevalence levels, and it is commonly accepted that there is considerable hidden sexual victimisation. There are significant levels of psychiatric morbidity in survivors of sexual offences.Psychological interventions are generally based on behavioural or psychodynamic theories.Behavioural interventions fall into two main groups: those based on traditional classical conditioning and/or operant learning theory and those based on cognitive behavioural approaches. Approaches may overlap. Interventions associated with traditional classical and operant learning theory are referred to as behaviour modification or behaviour therapy, and focus explicitly on changing behaviour by administering a stimulus and measuring its effect on overt behaviour. Within sex offender treatment, examples include aversion therapy, covert sensitisation or olfactory conditioning. Cognitive behavioural therapies are intended to change internal processes - thoughts, beliefs, emotions, physiological arousal - alongside changing overt behaviour, such as social skills or coping behaviours. They may involve establishing links between offenders' thoughts, feelings and actions about offending behaviour; correction of offenders' misperceptions, irrational beliefs and reasoning biases associated with their offending; teaching offenders to monitor their own thoughts, feelings and behaviours associated with offending; and promoting alternative ways of coping with deviant sexual thoughts and desires.Psychodynamic interventions share a common root in psychoanalytic theory. This posits that sexual offending arises through an imbalance of the three components of mind: the id, the ego and the superego, with sexual offenders having temperamental imbalance of a powerful id (increased sexual impulses and libido) and a weak superego (a low level of moral probation), which are also impacted by early environment.This updates a previous Cochrane review but is based on a new protocol.

OBJECTIVES

To assess the effects of psychological interventions on those who have sexually offended or are at risk of offending.

SEARCH METHODS

In September 2010 we searched: CENTRAL, MEDLINE, Allied and Complementary Medicine (AMED), Applied Social Sciences Index and Abstracts (ASSIA), Biosis Previews, CINAHL, COPAC, Dissertation Abstracts, EMBASE, International Bibliography of the Social Sciences (IBSS), ISI Proceedings, Science Citation Index Expanded (SCI), Social Sciences Citation Index (SSCI), National Criminal Justice Reference Service Abstracts Database, PsycINFO, OpenSIGLE, Social Care Online, Sociological Abstracts, UK Clinical Research Network Portfolio Database and ZETOC. We contacted numerous experts in the field.

SELECTION CRITERIA

Randomised trials comparing psychological intervention with standard care or another psychological therapy given to adults treated in institutional or community settings for sexual behaviours that have resulted in conviction or caution for sexual offences, or who are seeking treatment voluntarily for behaviours classified as illegal.

DATA COLLECTION AND ANALYSIS

At least two authors, working independently, selected studies, extracted data and assessed the studies' risk of bias. We contacted study authors for additional information including details of methods and outcome data.

MAIN RESULTS

We included ten studies involving data from 944 adults, all male.Five trials involved primarily cognitive behavioural interventions (CBT) (n = 664). Of these, four compared CBT with no treatment or wait list control, and one compared CBT with standard care. Only one study collected data on the primary outcome. The largest study (n = 484) involved the most complex intervention versus no treatment. Long-term outcome data are reported for groups in which the mean years 'at risk' in the community are similar (8.3 years for treatment (n = 259) compared to 8.4 in the control group (n = 225)). There was no difference between these groups in terms of the risk of reoffending as measured by reconviction for sexual offences (risk ratio (RR) 1.10; 95% CI 0.78 to 1.56).Four trials (n = 70) compared one behavioural programme with an alternative behavioural programme or with wait list control. No meta-analysis was possible for this comparison. For two studies (both cross-over, n = 29) no disaggregated data were available. The remaining two behavioural studies compared imaginal desensitisation with either covert sensitisation or as part of adjunctive drug therapy (n = 20 and 21, respectively). In these two studies, results for the primary outcome (being 'charged with anomalous behaviour') were encouraging, with only one new charge for the treated groups over one year in the former study, and in the latter study, only one new charge (in the drug-only group) over two years.One study compared psychodynamic intervention with probation. Results for this study (n = 231) indicate a slight trend in favour of the control group (probation) over the intervention (group therapy) in terms of sexual offending as measured by rearrest (RR 1.87; 95% CI 0.78 to 4.47) at 10-year follow-up.Data for adverse events, 'sexually anomalous urges' and for secondary outcomes thought to be 'dynamic' risk factors for reoffending, including anger and cognitive distortions, were limited.

AUTHORS' CONCLUSIONS

The inescapable conclusion of this review is the need for further randomised controlled trials. While we recognise that randomisation is considered by some to be unethical or politically unacceptable (both of which are based on the faulty premise that the experimental treatment is superior to the control - this being the point of the trial to begin with), without such evidence, the area will fail to progress. Not only could this result in the continued use of ineffective (and potentially harmful) interventions, but it also means that society is lured into a false sense of security in the belief that once the individual has been treated, their risk of reoffending is reduced. Current available evidence does not support this belief. Future trials should concentrate on minimising risk of bias, maximising quality of reporting and including follow-up for a minimum of five years 'at risk' in the community.

A comparison of rape and molest offenders in prison psychiatric treatment

Differences in offense history, brain functioning, and psychological functioning of rape (n = 45) and molest offenders (n = 15) who were receiving psychiatric treatment while in prison were evaluated. Significant differences were found in each of these domains. Rape offenders were more likely to have histories of high violence offenses other than sexual offense, including murder, serious juvenile offenses, and both juvenile and adult sexual offenses. Rape offenders were more likely to show lower intellectual functioning and diffuse brain dysfunction associated predominantly with temporal and prefrontal brain cortices. Rape offenders were also more likely to display psychological functioning associated with illogical thinking and disordered attachment but less immature self-focus and fewer feelings of alienation than demonstrated by molest offenders. Implications for treatment and social policy for sexual offenders are suggested. Logistic regression demonstrated that these neuropsychological measures resulted in 71.7% accurate prediction and Rorschach measures resulted in 79.2% accurate prediction in differentiating rape from molest offenders. Implications for theoretical understanding of sexual offending are discussed.

Rape Treatment: An Overview of Current Knowledge

Sexual offending is frequently seen by the lay person as being a result of an innate abnormality that is relatively fixed and unchangeable. Accordingly, sexual offenders are seen as more likely to recidivate than other types of offenders. In fact, this is not the case, and most sexual offenders do not re-offend. Also, contemporary research has shown that treatment programs driven by cognitive behaviour therapy significantly reduce rates of sexual offender recidivism. Nevertheless, while there has been a great deal of research on the treatment of child sexual offenders, the treatment of rapists has received comparatively less attention. Thus, the main aim of this article is to summarise current knowledge of sexual offender treatment, paying specific attention to the needs of rapists. In particular, we pay attention to the content of sexual offender treatment programs, and the relevance of this content to rape. We also discuss therapeutic issues of relevance for rapist treatment that are typically ignored or underestimated in the research literature. Finally, based upon our analysis of the literature, we present a schematic overview of rape treatment and identify important areas for further research.

Comparing recidivism rates of treatment responders/nonresponders in a sample of 413 child molesters who had completed community-based sex offender treatment in the United kingdom

Analysis of psychometric data from a sample of 413 child molesters who had completed a U.K. probation-based sex offender treatment program was carried out to assess (a) the effectiveness of therapy in the short term and (b) the longer term implications of treatment in relation to sexual recidivism. It was found that 12% (51 offenders) of the sample had recidivated within 2 to 4 years. Of these recidivists, 86% (44 offenders) had been reconvicted for a sexually related offense. One hundred thirty-five offenders (33%) demonstrated a treated profile (i.e., demonstrated no offense-specific problems and few, or no, socioaffective problems at the posttreatment stage). This group was compared with a sample of offenders deemed as not responding to treatment, matched by their levels of pretreatment risk/need. It was found that a significantly smaller proportion (n = 12, 9%) of treatment responders had recidivated, compared to the treatment nonresponders (n = 20, 15%), indicating a 40% reduction in recidivism in those who had responded to treatment (effect size = .18). Matching length of treatment to the offenders' level of pretreatment risk/need (i.e., higher risk/treatment-need offenders typically undertook longer treatment) reduced the rate of recidivism among this group to the level of recidivism observed among the lower risk/need offenders.

Predictors of child pornography offenses and child sexual abuse in a community sample of pedophiles and hebephiles

Little is known about factors that distinguish men who act upon their self-identified sexual interest in prepubescent or pubescent children from those who do not. Even less is known about pedophiles or hebephiles who are not involved with the criminal justice system. In this study, a sample of 155 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia (or paraphilia not otherwise specified for those who were sexually attracted to pubescent children). Two sets of group comparisons were conducted on sociodemographic variables and measures of dynamic risk factors. The first set was based on recent activity and compared men who had committed child pornography only or child sexual abuse offenses in the past six months with men who remained offense-free during the same period. The second set was based on lifetime offense history (excluding the most recent six months) and compared child pornography offenders with child sexual abuse offenders and men who had committed both kinds of offenses. Overall, there were more similarities than differences between groups.

Optimizing risk mitigation in management of sexual offenders: a structural model

Sexual violence is an insidious and pervasive problem that insinuates itself into all aspects of contemporary society. It can neither be mitigated nor adequately controlled through current socio-legal practices. A more promising approach must embrace four integrated elements: (1) public policy, (2) primary prevention, (3) statutory management, and (3) secondary intervention. In the present paper we tackle the 3rd and 4th elements by proposing an integrated model for reducing and managing sexual violence among known sex offenders. Relying on the highly effective Risk-Need-Responsivity (RNR) model as the core of our Sex Offender Risk Mitigation and Management Model (SORM(3)), we draw together evidence based practices from clinical interventions and risk assessment strategies. Developed by Andrews & Bonta (2006), RNR has a strong empirical track record of efficacy when applied to diverse samples of offenders, including sex offenders (Hanson, Bourgon, Helmus, & Hodgson, 2009). We offer a detailed structural model that seeks to provide a more seamless integration of risk assessment with management and discretionary decisions, including a primary focus on RNR-based post-release aftercare. We end with the mantra that sex offender treatment alone will never effectively mitigate sexual violence in society, since the problem is not confined to the handful of offenders who spend time in prison and are offered some limited exposure to treatment. Any truly effective model must go well beyond the management of those known to be violent and embrace a comprehensive and integrated approach that begins by recognizing the seeds of sexual violence sown by society. Such a public health paradigm places victims - not offenders - at the center, forcing society to come to address the full gamut of hazards that fuel sexual violence.

Real-time functional magnetic imaging-brain-computer interface and virtual reality promising tools for the treatment of pedophilia

This chapter proposes a prospective view on using a real-time functional magnetic imaging (rt-fMRI) brain-computer interface (BCI) application as a new treatment for pedophilia. Neurofeedback mediated by interactive virtual stimuli is presented as the key process in this new BCI application. Results on the diagnostic discriminant power of virtual characters depicting sexual stimuli relevant to pedophilia are given. Finally, practical and ethical implications are briefly addressed.

Reinforcement sensitivity of sex offenders and non-offenders: An experimental and psychometric study of reinforcement sensitivity theory

This study tested predictions of Gray's Reinforcement Sensitivity Theory (RST) in subgroups of sex offenders and male non-offenders using an experimental choice task consisting of a reward and a non-reward phase. In addition, RST-related psychometric measures were used. Both experimental and psychometric data were of interest to determine whether sex offenders could be reliably differentiated from non-offenders. Paraphilic (N=50) and impulse control-disordered (N=48) sex offenders showed greater sensitivity to continuous reward than male non-offenders (N=51). Impulse control-disordered sex offenders showed less behavioural adaptation under non-reward than both paraphilic sex offenders and male non-offenders. In addition, reward sensitivity, rash-spontaneous impulsivity, and anxiety measures discriminated sex offenders from male non-offenders. The results suggest that reinforcement sensitivity is a promising personality trait for differentiating subgroups of sex offenders from non-offenders. The experimental and psychometric results illustrate that predictive accuracy in forensic settings could be improved by combining several types of data.

A review of the use of therapeutic communities with sexual offenders

Sexual offender treatment programmes are often facilitated in secure settings such as prisons or psychiatric hospitals, which are not ideal environments for such treatment. Arguably, however, when these environments are structured as therapeutic communities (TCs), opportunities are created to enhance the effectiveness of treatment. This article describes the concept of a TC, its operating principles and rationale, as well as the benefits and rationale for establishing TCs in conjunction with cognitive-behavioural treatment with sexual offenders. This is discussed in terms of the potential of TCs to improve targeting of treatment content, to enhance treatment process, to provide optimal environments for therapeutic gain, and to provide a broad therapeutic framework for treating sexual offenders. The article reviews and summarizes what evidence exists for the use of TCs with both non-sexual offenders and sexual offenders. Finally, it highlights the gaps in our knowledge of the use of TCs to inspire further empirical and conceptual consideration of these issues.

Psychological dimensions of antisocial personality disorder as predictors of psychotherapy noncompletion among sexual offenders

The goal of this study was to examine whether psychological dimensions of antisocial personality disorder (ASPD), as conceptualized by Kernberg (1992), could predict psychotherapy noncompletion (PNC) among 50 men found guilty of sexual abuse of children. All participants began a 65-week, court-mandated course of cognitive-behavioral psychotherapy, which 20 (40%) of them did not complete. Pretherapy personality was assessed with the Structured Clinical Interview for DSM Axis II Disorders (First, Spitzer, Gibbon, Williams, & Benjamin, 1997), the Personality Organization Diagnostic Form (Diguer, Normandin, & Hébert, 2001), and Blatt and colleagues' (Blatt, Bers, & Schaffer, 1993; Blatt, Chevron, Quinlan, Schaffer, & Wein, 1988) scales of mental representations, as well as the State-Trait Anger Expression Inventory (Spielberger, 1988). A discriminant function analysis, which explained 46% of the total variance, showed that descriptive (antisocial and narcissistic personality disorders), psychological (primitive defense mechanisms, identity diffusion and self-representations), and demographic (work status and income) variables predicted PNC. The classification analysis correctly classified 78% of the participants. These findings support the hypothesis that psychological dimensions of ASPD help explain PNC among sexual offenders. The authors discuss the theoretical and clinical implications of these results.

Sex offender treatment: consumer satisfaction and engagement in therapy

Convicted sex offenders attending an outpatient treatment program in Connecticut were surveyed about their experiences in therapy, their perceived importance of treatment content, their satisfaction with the help they receive, and their engagement in therapeutic services. There were strong correlations between perceived importance of content items and satisfaction with services. A robust correlation was also found between engagement and satisfaction. Clients rated accountability and victim empathy as the most important components of treatment. Other popular content areas were thinking errors, relapse prevention concepts, uncovering motivations to offend, and controlling deviant arousal. Most sex offenders valued the peer support and confrontation offered by group therapy. Though reduced recidivism is clearly the crucial measure of treatment success, clients who are engaged in the treatment process and develop healthy interpersonal skills by participating in therapy may be less likely to engage in abusive behavior. Implications for practitioners are discussed.

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias

OBJECTIVES

The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions.

METHODS

The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990-2009 for SSRIs) (1969-2009 for antiandrogen treatments), supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability and feasibility.

CONCLUSIONS

An algorithm was proposed with six levels of treatment for different categories of paraphilias.

Treatment for juveniles who sexually offend in a Southwestern state

A 25-item questionnaire was mailed to sex offender treatment providers from counties with 60 or more reported juvenile sex offenders in a Southwestern state to determine the most effective treatment for juvenile sex offenders. Results indicated that cognitive behavioral therapy was the most successful reported approach to treatment with an average success rate of 87%. The most commonly used approach was cognitive behavioral therapy with relapse prevention. The most common sexual offense was indecency with a child involving sexual contact, contrary to studies that found that in the Probation Commission data, aggravated sexual offense was the most common. These results have ramifications for state policies on treatment for juvenile sex offenders.

The impact of prison-based treatment on sex offender recidivism: evidence from Minnesota

Using a retrospective quasi-experimental design, this study evaluates the effectiveness of prison-based treatment by examining recidivism outcomes among 2,040 sex offenders released from Minnesota prisons between 1990 and 2003 (average follow-up period of 9.3 years). To reduce observed selection bias, the authors used propensity score matching to create a comparison group of 1,020 untreated sex offenders who were not significantly different from the 1,020 treated offenders. In addition, intent-to-treat analyses and the Rosenbaum bounds method were used to test the sensitivity of the findings to treatment refuser and unobserved selection bias. Results from the Cox regression analyses revealed that participating in treatment significantly reduced the hazard ratio for rearrest by 27% for sexual recidivism, 18% for violent recidivism, and 12% for general recidivism. These findings are consistent with the growing body of research supporting the effectiveness of cognitive-behavioral treatment for sex offenders.

Legal and social service responses to child sexual abuse: a primer and discussion of relevant research

This paper provides a broad overview of legal and social service responses to child sexual abuse, the overarching legal framework provided by federal legislation, and funding mandates and the unique and shared investigative concerns of law enforcement and child protective service entities. Relevant psychological research is highlighted throughout, including research on investigator training, forensic interviewing techniques, children's suggestibility, jurors' perceptions of child witnesses, and courtroom accommodations for child witnesses.

Pedophilia

Pedophilia is defined as a sexual interest in prepubescent children. It is empirically linked with sexual offending against children: Child pornography offenders and sex offenders with child victims are more likely to be pedophiles based on self-report or objective measures of sexual interests. At the same time, some pedophiles have not had any known sexual contact with children, and perhaps half of sex offenders against children would not meet diagnostic criteria for pedophilia. Pedophilia can be diagnosed using a variety of methods and is an important factor to consider in the assessment of sex offenders because pedophilic offenders are more likely to sexually reoffend and require different interventions. There is no evidence to suggest that pedophilia can be changed. Instead, interventions are designed to increase voluntary control over sexual arousal, reduce sex drive, or teach self-management skills to individuals who are motivated to avoid acting upon their sexual interests.

Outcome evaluation of a high-intensity inpatient sex offender treatment program

The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with the addition of 176 participants, an extra 4 years follow-up, and the use of Cox regression survival analysis to control for three potentially confounding variables: age of release, sexual offending history, and length of follow-up. Treated offenders sexually recidivated significantly less than the comparison group over nearly 20 years of follow-up, even after controlling for the aforementioned variables. The substantive findings suggest that treatment adhering to the what works principles can reduce long-term sexual recidivism for a moderate- to high-risk group of sex offenders.

Treatment experiences of civilly committed sex offenders: a consumer satisfaction survey

The purpose of the study was to elicit feedback from sex offenders about the components of treatment that they believed to be most helpful in preventing reoffense. A sample of civilly committed sex offenders from the Sand Ridge Civil Commitment Center in Wisconsin (n = 44) was surveyed about their perceptions of treatment, including content, process, therapists, rules, and completion requirements. Clients were asked to rate the importance of treatment components to their recovery and to rate their satisfaction with the treatment they received for each component. Participants expressed fairly positive sentiments about their treatment experiences, though specific concerns were noted. There was an overall positive correlation between importance of and satisfaction with treatment, but ratings of importance were consistently higher than ratings of satisfaction. Implications for practice and future research are discussed.

Risk assessment of sexual offenders for extended supervision orders in New Zealand: basic principles and current practice

A growing number of jurisdictions in North America, the United Kingdom, and Australasia have enacted legislation allowing for special sentencing, civil commitment, and community supervision options for high risk sexual offenders. In New Zealand, one example of this concern for public protection is the Parole (Extended Supervision) Amendment Act 2004, which provides for additional supervision of sexual offenders with child victims for up to 10 years after their release from prison. Recent experience with expert evidence and judicial decision making in such cases suggests that those involved in the process might benefit from a more thorough understanding of the current state of sexual offender risk assessment that can be provided by mental health professionals.

Perceptions of sex offenders about treatment: satisfaction and engagement in group therapy

Surveying the views of sex offender clients can help ensure that treatment is relevant and responsive to client needs. The purpose of this exploratory study is to elicit sex offender clients' perceptions of their experiences in treatment in order to better understand the components of treatment perceived to be helpful in preventing reoffense. Samples (N = 338) of male sex offenders in outpatient group therapy are found to be generally satisfied with treatment services and have positive perceptions of treatment effectiveness. Offenders in treatment value the role of group therapy, and they find accountability, victim empathy, relapse prevention, and "good lives" concepts to be most helpful in managing their behavior. Their engagement in group therapy is assessed using the Group Engagement Measure, and a positive correlation is found between engagement and treatment satisfaction. Eliciting client opinions about the helpfulness of program content and process, and adjusting treatment protocols accordingly, is consistant with the principles of risk, need, and responsivity, a model recommended for therapeutic interventions with criminal offenders.

Sex offender management using the polygraph: a critical review

Reducing recidivism is a central goal in the treatment of sex offenders. In Europe, there is an increased interest in using the polygraph ("lie detector") as a tool in the treatment and risk assessment of convicted sex offenders. This interest originated from optimistic reports by American clinicians who argued that polygraph testing in the treatment of sex offenders is akin to urine analysis in the treatment of drug addiction. In this article, we critically examine the validity and utility of post-conviction sex offender polygraph testing. Our review shows that the available evidence for the claims about the clinical potential of polygraph tests is weak, if not absent. We conclude that portraying post-conviction polygraph testing as analogous to urine analysis is inaccurate, misleading, and ultimately, risky.

Analyzing the Impact of a Statewide Residence Restriction Law on South Carolina Sex Offenders

Recently, several states have enacted legislation that restricts sex offenders from living in close proximity to certain areas in an effort to counter recidivism and alleviate community safety concerns. The South Carolina Legislature is currently debating two pieces of legislation that would prohibit registered sex offenders from living in close proximity to schools, daycare centers, child recreational facilities, parks, playgrounds, bus stops, and other areas where children are known to congregate. Given the recent emergence of residence restriction statutes, insufficient research has examined their impact on offenders, communities, and the criminal justice system. Using spatial analysis, four of the six South Carolina counties with the highest number of registered sex offenders are examined in relation to the effects of the two proposed statewide residence restriction laws. Implications concerning offender access to housing and treatment opportunities are discussed along with potential effects to local communities and the criminal justice system.

Treatment of sexual offenders with psychopathic traits: recent research developments and clinical implications

This article provides a review of recent literature related to the treatment of psychopathy in forensic settings, with particular focus on studies with sexual offenders. The lack of empirical support for the position that psychopaths are untreatable is noted, and data suggesting optimism is discussed. Research demonstrating an interaction between psychopathy and substance abuse and between psychopathy and sexual deviance is also presented. Both substance abuse disorders and inappropriate arousal are frequently encountered in high-risk groups of sexual offenders. These topics are of relevance, in that the question of whether treatment is beneficial with high-risk sexual offenders, including those who are psychopathic, cannot be answered unless groups presenting with typical concurrent disorders (paraphilias, substance abuse, dependence) are discussed. It is argued that, although the evidence is still preliminary, there is reason for optimism with reference to whether psychopathic sexual offenders are responsive to treatment, including offenders presenting with concurrent disorders.