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

Our minds are made up--don't confuse us with the facts: commentary on policies concerning children with sexual behavior problems and juvenile sex offenders

This commentary examines four common policy-relevant perceptions of teen and preteen sex offenders-high risk, "specialness," homogeneity, and intransigence. Each perception is contrasted with long-standing as well as more current scientific facts. It is argued that public policies for these youth have been fundamentally driven by misperceptions, resulting in a set of well-intentioned but ultimately flawed policies and practices that are unlikely to deliver either child protection or juvenile justice benefits. These include federal and state policies pertaining to public registration and notification, community management, institutional placement, treatment approaches, and treatment standards. The research evidence about these juveniles is considerably more positive than current policies or clinical practices might suggest, and reflects a sharp disconnect between popular policy-relevant perceptions and the facts as we know them about these diverse cases.

Seeking enlightenment on the dark side of psychology

A life devoted to the study of antisocial behavior and anomalous sexual preferences is examined. Although successive ontogenetic intellectual metamorphoses have yielded theoretical and applied progress, future reincarnations will be necessary for the achievement of full enlightenment.

The Effective Treatment of Juveniles Who Sexually Offend: An Ethical Imperative

This article raises serious concerns regarding the widespread use of unproven interventions with juveniles who sexually offend and suggests innovative methods for addressing these concerns. Dominant interventions (i.e., cognitive-behavioral group treatments with an emphasis on relapse prevention) typically fail to address the multiple determinants of juvenile sexual offending and could result in iatrogenic outcomes. Methodologically sophisticated research studies (i.e., randomized clinical trials) are needed to examine the clinical and cost-effectiveness of cognitive-behavioral group interventions, especially those delivered in residential settings. The moral and ethical mandate for such research is evident when considering the alternative, in which clinicians and society are willing to live in ignorance regarding the etiology and treatment of juvenile sexual offending and to consign offending youths to the potential harm of untested interventions. Encouraging signs of a changing ethical climate include recent federal funding of a randomized clinical trial examining treatment effectiveness with sexually offending youths and the introduction of separate (i.e., developmentally informed) clinical and legal interventions for juvenile vs. adult sexual offenders.

The Rockwood Preparatory Program for sexual offenders: description and preliminary appraisal

This article describes the Rockwood Preparatory Program for sexual offenders. This program operates in the Millhaven induction center of the Correctional Service of Canada. Clients remain in the program for 6 to 8 weeks, depending on when they are placed in their home prison, where they will receive a full treatment program. The preparatory program takes a motivational approach, integrating several theoretical views and employing the therapeutic approaches that have been shown to maximize effectiveness with sexual offenders. The content and approach of the program are described and the observed benefits are outlined.

Improving the measurement of criminal sexual behavior: the application of randomized responding technique

Randomized responding technique (RRT), a method for maintaining anonymity, was used with a sample of sexual offenders recruited into a treatment outcome study. Prior to release from incarceration, three groups--those randomly assigned to treatment, those randomly assigned to no-treatment control, and those who refused participation in the treatment study but consented to a prerelease interview--participated in an alternate-questions RRT procedure. This procedure pairs a nonsensitive question with the sensitive question of interest, in this case, the number of prior sex offenses. Respondents answered either the sensitive or nonsensitive question, depending on the results of a randomizing device (roll of dice). The distributions for the nonsensitive questions were highly skewed; therefore, the outliers were removed and RRT estimates calculated. RRT estimates of prior offending (2.20 prior offenses) were significantly higher than officially recorded prior offenses (0.51 prior offenses). The pattern of differences between treatment and control groups were similar in RRT estimates and officially recorded priors, as were the correlations between RRT estimates and other self-report scales. These results provide preliminary evidence that RRT is a useful method for generating reoffending data that are more sensitive than officially recorded offenses and that contain less bias than other self-reports.

Examining the impact of mixing child molesters and rapists in group-based cognitive-behavioral treatment for sexual offenders

This study examines the relationship between recidivism rates, therapeutic climate, and composition of offenders in group-based cognitive-behavioral treatment (CBT) for sexual offenders. The Group Environment Scale (GES) is employed to measure social climate. The GES is administered to 73 male sexual offenders in groups of those who only victimized adults or children (five groups) or men who both victimized adults and those who victimized children (five groups). Group environment is not found to differ significantly as a function of group composition. Group member's ratings on the GES are in the medium to high range, indicating a generally positive group environment. Although the group environment overall does not differ between groups, groups do differ significantly in terms of expressiveness. There are no differences in recidivism rates between groups as a function of group composition. The results are discussed in the light of mixing child molesters and rapists in group-based CBT.

Validation of the Treatment Motivation Scales for Forensic outpatient treatment (TMS-F)

The validity of the Treatment Motivation Scales for outpatient offender treatment (TMS-F), a self-report questionnaire with scales for the motivation of patients to engage in the treatment and six cognitive and emotional determinants of this motivation, is evaluated in two studies. In Study 1 (N = 620), the construct validity of the TMS-F is investigated applying a multitrait-multimethod design with a therapist-rating instrument as the criterion method. All scales were found to have adequate convergent validity and acceptable discriminant validity. In Study 2 (N = 328), the criterion validity of the TMS-F is addressed. Applying covariance structure analysis, the instrument is found to predict therapist ratings of the treatment engagement of patients to a substantial degree. Treatment engagement is best predicted by the scales for Motivation to Engage in the Treatment and Perception of the Suitability of the Treatment and not by the scales for Distress and the Perceived Legal Pressure.

The utility of the random controlled trial for evaluating sexual offender treatment: the gold standard or an inappropriate strategy?

This paper examines the scientific, practical, and ethical issues surrounding the employment of the Random Controlled Trial (RCT) in the evaluation of sexual offender treatment. Consideration of these issues leads us to conclude that the RCT design is not suitable for determining the effectiveness of sexual offender treatment. We also examine the RCT study by Marques et al. (Sexual Abuse: A Journal of Research and Treatment and Evaluation 17:79-107, 2005) that is often held up as the model for the evaluation of sexual offender treatment. We found several problems with this study that, in our opinion, reduce its relevance for deciding whether treatment is effective with these clients. Finally, we examine two alternative strategies for evaluating treatment that may allow treatment providers to more readily examine, and report, the results of their programs.

[Paraphilia, sexual preference disorders. Diagnosis, etiology, epidemiology, treatment and prevention]

Hostility towards relationships is one prominent characteristic symptom for disorders of sexual preference (ICD-10) and paraphilias (DSM-IV). Paraphilic symptoms sometimes progress to obsessive or addictive- like forms leading to a loss of self-control but can occur also as single incidents or as episodic events. Besides constitutional aspects, problems in the development of close relationships to primary caregivers (attachment) play an important role in the development of these disorders. Actual relationship- and self-confidence problems often trigger the severity of disturbance, especially in the episodic forms of paraphilia. For patients who are in conflict with the law, cognitive-behavioral therapeutic approaches with the aim to minimize self-deception regarding the effects of the paraphilic behavior have become more and more relevant. Regarding the medical treatment, anti-hormonal therapy plays an important role, but also treatment with serotonergic agents and naltrexone are used. Only little can be advised in terms of prevention; general psycho-hygiene (regarding the parent-child relationship) is recommended. Beside these general measures, institutions which offer special treatment for people in danger to become delinquents may be able to prevent serious harm for possible victims of abuse.

[Evaluation of risk assessment instruments for sex offenders]

In order to evaluate risk assessment instruments for sex offenders in Germany, we compared the predictive validity of the Static-99, HCR-20, SVR-20, and PCL-R scales for 134 sex offenders. The mean follow-up time was 9 years (range 1-340 months), using the first entry into the National Register of Criminal Convictions as endpoint variable. For the estimate of predictive power, the area under the curve (AUC) of receiver operating characteristic (ROC) analysis was calculated. The AUC plots accurately identified violent or sexual recidivists and "false positives" at all scale levels. Comparing the predictive validity of these four instruments, the results favored Static-99. As for the limited sample size, differences between the assessment instruments were, however, not statistically significant. The ROC analysis for Static-99 showed that including treatment dropouts does not improve predictive accuracy (including dropouts: AUC 0.710; excluding dropouts: AUC 0.721). Kaplan-Meier survival analyses yielded highly a significant correlation to recidivism time point for two Static-99 and SVR-20 risk categories. Higher-risk categories were related to earlier recidivism. However, relying on the Static-99 and SVR-20 alone showed false positive results: for up to two out of three sex offenders, they predicted recidivism which did not occur.

Acceptance and completion of treatment among sex offenders

A sample of 778 male sex offenders, assessed from the 1960s to the 2000s, was examined on expressed desire for treatment, treatment attendance, and completion of at least one course of therapy. A variety of treatment approaches was used, reflecting practices of the times. Overall, 50.6% expressed a desire for treatment, 42.0% attended, and 13.6% completed therapy. Offenders' admitter status, criminal history, age, education, and marital status all played some role in desire for treatment, attendance, and completion. Analysis revealed that the desire for and completing treatment has declined over time. Offenders who were exhibitionists or substance abusers or who scored higher on psychopathy, attention deficit/hyperactivity disorder, or learning difficulties or had head injuries were more likely to enter treatment but were no more likely to complete it than were offenders who scored low. The need to focus on motivating different types of sex offenders to accept and participate in treatment is discussed.

Relapse prevention for sexual offenders: considerations for the "abstinence violation effect"

Relapse Prevention (RP) is a cognitive-behavioral approach originally developed for treatment of addictions and has since become an effective and popular method for treating sexual offenders. The Abstinence Violation Effect (AVE) is a pivotal RP construct describing one's cognitive and affective response to re-engaging in a prohibited behavior. We review the literature on the AVE in both addiction and sexual offender applications. We summarize the original and subsequent formulations of the AVE for addictions and modifications adopted for its application to sexual offenders. We argue that these modifications have generally failed to characterize sexual offense relapse cycles accurately or comprehensively. In particular, these modifications fail to specify accurately the AVE's occurrence and influence in the offense cycle. In response to these limitations, we suggest future directions for AVE research in sexual offenders.

Responsivity issues in the treatment of sexual offenders

Andrews and Bonta (2003) have presented a model of effective correctional programming focusing on risk, need, and responsivity factors for a general criminal population. When applied to sexual offenders, the first two issues (risk assessment and treatment targets such as cognitive distortions) have received a great deal of research attention. However, little attention has been paid to responsivity issues: those factors that influence the extent to which clients benefit, or fail to benefit, from treatment programs. This article presents a review of several potential responsivity factors related to sexual offender treatment and outlines areas that require further research attention.