Engagement, denial, and treatment progress among sex offenders in group therapy

Differences in Sociodemographic Characteristics and Treatment Refusal Between Lone and Multiple Perpetrator Rapists

Studies that compare lone and multiple perpetrator rape offenders often use police files. This study explores the differences between lone and multiple perpetrator rapists using a sample of 172 convicted sexual offenders. The first objective is to explore sociodemographic differences between the two groups of perpetrators. Differences are found in offenders' age, the use of drugs or alcohol, the release phase, sexual behavior, the use of a vehicle, the place and time of the assault, and victim characteristics. The second objective is to explore differences between the two groups regarding the number of perpetrators. No differences are found, except for the presence of a leader in groups of three or more perpetrators. Finally, no differences are found regarding treatment variables (responsibility assumption, treatment program participation, program dropout or expulsion, and reconviction rates) that support a different profile for the purpose of intervention.

Do Changes in Emotional States Predict Therapy Alliance in Dutch Male Offenders in Mandated Clinical Care?

Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders' emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders.

Early Treatment Change in Perpetrators of Sexual Versus Non-Sexual Violence

The purpose of this study is to assess treatment change at both a group and individual level in a sample of 81 Dutch male patients who received mandated care for either violent (non-sexual) behavior or sexual violent behavior. Psychiatric nurses rated patients' social skills, insight, hostility, physical violence with the BEST-Index every 6 months over the course of 2 years after patients were admitted to hospital. Mixed analysis of covariances and the reliable change index indicated that patients, irrespective of offense type, showed treatment change over time with exception of physical violence. This study shows that general treatment may be useful in the first 18 month for risk factors common to different types of offenses, but that specialized treatment is needed to establish further change.

An Exploration of Service Providers' Experiences With Latinos Convicted of a Sex Offense

Despite the growing Latino presence in the U.S. criminal justice system and among those who have committed sex offenses specifically, little is known about the barriers and challenges faced by this population when accessing treatment services. This study sought to gather more information about responsivity factors that may be specific to Latinos who have committed sexual offenses. Service providers who worked with Latinos convicted of sexual offenses completed an online survey and answered questions regarding perceived challenges and barriers they encountered when working with Latino clients and were asked to provide recommendations concerning services and treatment provision. Service providers frequently reported issues related to a lack of culturally sensitive services, bilingual professionals, and clients' limited knowledge about the U.S. legal system. Among service providers with experience working with undocumented Latino immigrants, some indicated specific challenges such as stressors related to their immigration status and a lack of resources. Professionals' recommendations were consistent with the challenges reported and findings are discussed as they pertain to responsivity issues in the provision of treatment services to Latino individuals who have committed sexual offenses.

A qualitative study of forensic patients' perceptions of quasi-coercive offers of biological treatment

At various points in the trajectory through the criminal justice system, a person may be encouraged by the hope of legal benefit to consent to medical treatment. This benefit may consist of diversion from prosecution, a favorable sentence, or parole. This form of legal encouragement has been referred to as legal leverage, quasi-coercive, or quasi-compulsory treatment. In this article, we analyze interviews with 15 men convicted of sexual offenses to explore their reactions to two hypothetical scenarios involving men consenting to a range of treatments intended to reduce risk of recidivism. In particular, we explore their reactions to quasi-coercive treatment using both real and hypothetical forms of biological therapy (e.g., drugs, brain stimulation, surgery), as opposed to psychological counselling. Here, we consider the extent to which these individuals perceive the situation to be coercive, the factors affecting these perceptions, and the ways in which physicians may mitigate perceived coercion. We found there is usually some degree of coercion identified when treatment consent is given in exchange for potential legal benefit, although this fact alone did not necessarily render the practice unacceptable. The degree of concern expressed over this potential coercion was related to the invasiveness and/or permanence of the treatment, and all participants highlighted the necessity of obtaining fully informed consent in the context of legally motivated treatment offers.

Attenuation of Deviant Sexual Fantasy across the Lifespan in United States Adult Males

Deviant sexual fantasy is identified as a risk factor for sexual offending, yet no study has examined deviant sexual fantasy across the lifespan in nonoffending adult males. To bridge this gap, this study examined the frequencies of normative and deviant sexual fantasies among 318 nonoffending adult males in the United States. Participants were recruited via Amazon Mechanical Turk™. Participants took two inventories that assessed demographics and types of sexual fantasies. Normality tests, means tests, Kruskal-Wallis 1-way analyses of variance (ANOVAs), binary logistic regressions, and odds ratio post hoc analyses were conducted. Deviant sexual fantasies progressively declined across all three age groups, while normative sexual fantasy did not. Results suggest that deviant sexual fantasy changes across the lifespan. Applicability of the findings to applied settings, such as sexually violent predator evaluations, is discussed. Limitations and future considerations are addressed.

Relationships Between Treatment Delivery, Program Attrition, and Reoffending Outcomes in an Intensive Custodial Sex Offender Program

Retention of sex offenders to the completion of treatment is critical to program adherence to risk need responsivity (RNR) principles; however, it is also important to consider the potential interaction between attrition and treatment outcomes such as reoffending. The first aim of this study was to evaluate the influence of changes to treatment delivery in a residential sex offender treatment program (SOTP), including introduction of rolling groups and systematic emphasis on positive therapist characteristics, on likelihood of program noncompletion ( n = 652). Pooled regression modeling indicated that these operational interventions were associated with a significantly increased likelihood of program completion. We also examined whether variance in rates of participant attrition was related to reoffending outcomes for program completers ( n = 494). Incidence of attrition within completing participants' treatment cohorts had a significant negative association with hazard of sexual reoffending that was not accounted for by pretreatment risk. Results are discussed in terms of their implications for treatment delivery processes that aim to optimize both participant retention and treatment effectiveness.

Beyond Circles of Support: "Fearless"-An Open Peer-to-Peer Mutual Support Group for Sex Offense Registrants and Their Family Members

The term sex offender carries expectations that include a continuous level of sexual criminal risk and untreatable mental health conditions that govern sex offending behaviors. These role expectations by the public can socially isolate individuals who have been convicted of a crime and the people who love them. This is likely to contribute to negative self-images that can result in loneliness, isolation, and depression, and, subsequently, contribute to discontinuing support for sex offender's loved ones and reoffending. This article highlights the creation and maintenance of a peer-to-peer social support group for registered sex offenders and their family members that helps combat the effects of "sex offender" labels. This group differs from formal organized circles of support model and traditional self-help groups such as Alcohol (AA) or Narcotic (NA) Anonymous. We review this group's creation, processes and procedures, and outcomes, including changes in cognition, mood, and affect over time for members in the group.

Review of the Empirical and Clinical Support for Group Therapy Specific to Sexual Abusers

This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender-specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist-specifically warmth, empathy, encouragement, and guidance-can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

A neuropsychological study of older adult first-time sex offenders

BACKGROUND/AIMS

The issue of whether sex offenders have cognitive deficits remains controversial. The objective of this study was to compare the neuropsychological function of older adult first time sex-offenders (FTSO), who had not previously been charged with a sexual offence prior to the age of 50, to historical long-term sex offenders (HSO) and non-sex offenders (NSO). The hypotheses were (a) that FTSO would demonstrate greater deficits in executive function, decision-making, and memory compared to non-sex offenders; and (b) the HSOs would present similar neuropsychological deficits to non-sex offenders.

METHOD

A battery of neuropsychological measures was administered to 100 participants comprising 32 FTSOs, 36 HSOs, and 32 NSOs.

RESULTS

Both FTSOs and HSOs showed significant impairment on tests of executive function (including verbal fluency, trail-making, and the Hayling test of response inhibition) as well as on tests of verbal and verbal memory compared to NSOs; however, there was no difference between the two sex offender groups.

CONCLUSIONS

Older adult sex offenders, overall, demonstrated poorer neuropsychological performance than older adult non-sex offenders did, although there was no difference between older first-time and historical offenders. Cognitive deficits may increase the risk of sexual offending due to impaired capacity in self-regulation, planning, judgment, and inhibition. A proportion of older adult sex offenders may be harboring acquired frontal lobe pathology.

Pathways to Desistance Among Men Convicted of Sexual Offenses: Linking Post Hoc Accounts of Offending Behavior and Outcomes

Within many sexual offender-specific treatment programs, clients and their therapists devote considerable time to understanding "cycles" or "pathways" to sexual offending, and clients often need to fit their stories into existing offending paradigms. Although this post hoc processing of offending behaviors may assist clients in understanding their individual pathway toward crime, we know little about how they situate this information within their lives moving forward. Relying on in-depth interview data, the current study examined accounts of the sexually related crimes that brought 28 men to prison. Analyses suggest varied perspectives among the men regarding pathways to and from their sexual offenses; some aligning with existing models, but others merging around different theoretical frameworks. Implications are discussed as they relate to treatment models and the desistance process for men convicted of sexual offenses.

Sex Offending and Situational Motivation: Findings From a Qualitative Analysis of Desistance From Sexual Offending

Sex offending is typically understood from a pathology perspective with the origin of the behavior thought to be within the offending individual. Such a perspective may not be beneficial for those seeking to desist from sexual offending and reintegrate into mainstream society. A thematic analysis of 32 self-narratives of men convicted of sexual offences against children suggests that such individuals typically explain their pasts utilizing a script consistent with routine activity theory, emphasizing the role of circumstantial changes in both the onset of and desistance from sexual offending. It is argued that the self-framing of serious offending in this way might be understood as a form of "shame management," a protective cognition that enables desistance by shielding individuals from internalizing stigma for past violence.

An Exploration of Responsivity among Violent Offenders: Predicting Access to Treatment, Treatment Engagement and Programme Completion

This retrospective archival study examines whether pre-treatment responsivity characteristics influence access to, engagement in, and completion of a violent offender treatment programme. The participants are 115 violent offenders referred for a group-based multi-module treatment programme in medium- and high-security correctional facilities in Victoria, Australia. The case files for each participant were reviewed and information regarding responsivity factors and responses to treatment were gathered. Responsivity characteristics include psychopathy (Psychopathy Checklist: Screening Version; PCL:SV), denial and minimisation (Denial and Minimisation Checklist - Third Edition; DMCL-III), and measures of motivation to engage in treatment and guilt and shame associated with violent offending. Engagement was scored using the Response to Treatment Scale. Offenders with higher PCL:SV Factor 2 scores were less likely to be offered a place in the programme and offenders with greater external pressure or motivation to participate in treatment were more likely to commence treatment. Psychopathy and pre-treatment denial and minimisation of offending are related to poorer engagement in treatment; feelings of guilt and shame, along with motivation to participate in treatment, are positively associated with engagement. Predictors of treatment completion include external motivators promoting participation in treatment, within-treatment behaviours (e.g. inappropriate or disruptive behaviour), and psychopathy.

Relationships between denial, risk, and recidivism in sexual offenders

The aim of this study was to examine the relationship between denial, static risk, and sexual recidivism for offenders with different types of current sexual offense. Denial was defined as failure to accept responsibility for the current offense and was assessed using the Offender Assessment System. Static risk level (measured using a revised version of the Risk Matrix 2000) was examined as a moderator in the relationship between denial and sexual and violent recidivism. In the full sample (N = 6,891), lower levels of sexual recidivism were found for those who denied responsibility for their offense, independent of static risk in a Cox regression analysis. Higher levels of violent recidivism among those denying responsibility were not significant after controlling for static risk using Cox regression. For specific offender types, denial of responsibility was not significantly associated with sexual or violent recidivism. In conclusion, the presumption that denial represents increased risk, which is common in much of the decision making surrounding sex offenders, should be reconsidered. Instead, important decisions regarding sentencing, treatment, and release decisions should be based on empirically supported factors.

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.

Building Men’s Engagement in Intimate Partner Violence Groups

Group programs, which are generally preferred in treatment with violent partners, often have a high dropout rate. Engagement, however, can be an influential factor in program completion (Rondeau, Brochu, Lemire, & Brodeur, 1999) and in maintaining those aspects learned by the end of the program (Contrino, Dermen, Nochajski, Wieczorek, & Navratil, 2007). This article looks at the meaning given by men to the concept of engaging in an intimate partner violence (IPV) group. In our effort to understand engagement, this study tries to identify characteristics, which are more representative of the complexity of engaging in IPV groups. Interviews and two focus groups were conducted with men who participated in group programs in two agencies in Canada. Our qualitative analysis emphasized that engagement is not a spontaneous attitude but rather something that is constructed over time by striving to work on oneself. Limitations are discussed and implications for practice and research are explored.

An ecological examination of factors influencing men's engagement in intimate partner violence groups

This article examines the findings of an ecological analysis of the factors influencing men's engagement in intimate partner violence (IPV) groups. Individual interviews and two focus groups were conducted with men who participated in group programs in two agencies in Canada. Our qualitative analysis of interviews and focus groups suggested that both individual and program-related factors were determinants in the men's engagement. These findings drew our attention to the influence of certain factors outside of the group therapy, in particular organizational practices. Implications for practice are explored, in particular the role of time in the intervention, and implications for research and limitations are discussed.

Factors associated with treatment acceptance and compliance among incarcerated male sex offenders

The files of sex offenders who had been offered treatment at a medium-security state prison were divided into three groups: treatment refusal (n = 59), treatment noncompliance (n = 61), and treatment compliance (n = 36). Demographic, offense-related, clinical, and psychological assessment data were collected. Significant differences were found between groups on years to parole eligibility; plea; relation to victim; childhood sexual victimization; and Minnesota Multiphasic Personality Inventory-2 Variable Response Inconsistency (VRIN), Lie (L), and Masculinity-Femininity (Mf) scale scores. Logistic regression analyses revealed that significant predictors of treatment refusal include increased time until parole eligibility and lower VRIN and Mf scores (vs. noncompliant) as well as no history of childhood sexual victimization and higher L scores (vs. compliant). Having entered a not-guilty plea was the only significant predictor of noncompliance among those who initially accepted treatment. These findings are discussed in relation to previous studies of sex offender treatment compliance and directions for future research.

"But I didn't do it!": ethical treatment of sex offenders in denial

This article addresses ethical questions and issues related to the treatment of sex offenders in denial, using the empirical research literature and the ethical codes of American Psychological Association (APA) and National Association of Social Workers (NASW) to guide the ethical decision-making process. The empirical literature does not provide an unequivocal link between denial and recidivism, though some studies suggest that decreased denial and increased accountability appear to be associated with greater therapeutic engagement and reduced recidivism for some offenders. The ethical codes of APA and NASW value the client's self-determination and autonomy, and psychologists and social workers have a duty to empower individual well-being while doing no harm to clients or others. Clinicians should view denial not as a categorical construct but as a continuum of distorted cognitions requiring clinical attention. Denial might also be considered as a responsivity factor that can interfere with treatment progress. Offering a reasonable time period for therapeutic engagement might provide a better alternative than automatically refusing treatment to categorical deniers.

A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment

This article reports a systematic review of engagement measures for psychosocial therapy. MEDLINE, EMBASE, and PsycINFO databases were searched to identify English-language studies (published 1980 to February 2010) that reported on an instrument/rating scale to measure engagement in psychosocial treatment for mental health difficulties. Forty-seven studies were identified, reporting information on 40 measures of treatment engagement. Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess, they also reveal that there is little consensus in the definition of engagement employed. Few measures are generalizable across treatment settings and clinical populations, and limited information is reported on the indices of reliability and validity. It is concluded that further work is required to develop adequate measures of therapeutic engagement.

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.

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.

Considering the pedophile subculture online

The development of the Internet and computer-mediated communications has fostered the growth of a wide range of deviant sexual behaviors along with deviant subcultures that support and approve of these behaviors. Some of these practices pose little risk to public safety, though acts such as pedophilia and the creation and distribution of child pornography have significant negative ramifications for victims. A growing literature has examined the function of the Internet for child pornography distribution, social networks of pedophiles, and tactics of child solicitation. Few, however, have explored the utility of the Internet to develop a subculture of pedophiles and its role in fostering attitudes and justifications for relationships with children. This study will explore the subcultural norms and enculturation of the pedophile community using a qualitative analysis of five Web forums run by and for pedophiles. The findings suggest that the values of the pedophile culture support and encourage emotional and, in some cases, sexual relationships with boys and girls in virtual and real settings. Implications for the study of pedophiles and the role of the Internet are explored.

Child sexual abusers' views on treatment: a study of convicted and imprisoned adult male offenders

In spite of an increasing focus on the assessment and treatment of sexual offenders over the past two decades, much debate persists as to the effectiveness of treatment in reducing recidivism. Given the dearth of research on offenders' perspectives in this area and the potential for offenders' views to inform the development of effective treatment, we consider the views of 35 adult male child sexual abusers on the prison treatment program. Focusing on a number of key themes, namely victim empathy, strategies for desistence, group or individual treatment, motivation, and postprogram support. In doing so, the extent to which this work furthers knowledge in this area and future research directions was considered.

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.

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.

Probation Management of Sex Offenders

This research examined how probation officers and clinicians assigned to co-facilitate sex offender treatment groups assess treatment progress. Data for this study were collected from the progress assessments of 144 sex offenders assigned to treatment as a condition of their probation. Using a survey instrument, the probation officer—clinician teams assigned to co-facilitate the treatment groups scored offenders on items associated with compliance to probation conditions, self-labeling, and psychological insight. Consonant with the hypotheses, clinicians had a greater tendency to indicate progress that was driven by their perceptions of offenders of psychological insight. When probation officers perceived progress, it was driven by their perception of self-labeling by offenders. Ironically, offenders who were perceived as engaging in self-labeling were in fact more prone to violations. Findings are discussed in terms of the implications for effective management and supervision of convicted sex offenders.

Sex Offender Civil Commitment: Recommedations for Empirically Guided Evaluations

Evaluations of sex offenders in the context of civil commitment occur both pre- and post-commitment. Pre-commitment evaluations must address the relevant prongs of the state's civil commitment statute including the presence of a mental disorder or abnormality, likelihood of future sexual violence, and the volitional link between the two. Post-commitment evaluations must assess treatment progress and readiness for release. A thorough understanding of assessment and diagnostic issues relating to sexual offender civil commitment are essential in conducting both pre- and post-commitment evaluations. The high stakes nature of sex offender civil commitment demands rigorous and empirically based evaluations.

Resistance, reluctance, and readiness in perpetrators of abuse against women and children

Perpetrators of abuse and violence against women and children are often reluctant participants in intervention programs. They frequently fail to attend scheduled appointments, are sometimes openly hostile to intervention staff, and often judge program materials as irrelevant to their situation. Recognizing this problem, researchers and practitioners have begun to develop models and tools to more appropriately assess and intervene with reluctant clients. Unfortunately, the resulting proliferation and inconsistent application of terms and theories have led to considerable confusion in characterizing reluctant clients and have significantly hampered research on strategies that may be helpful to better meet the needs of this client group. The purpose of this review is to help standardize the definition and measurement of treatment reluctance as it applies to violence perpetration and to review evidence for the importance of these aspects of client reluctance to intervention. Recommendations for assessing reluctance in research and clinical practice are also provided.

Alcohol and drug consumption among sexual offenders

PURPOSE

To evaluate the role of alcohol and drug consumption between sexual offenders against boys and girls.

METHOD

It was an observational, retrospective and cross-sectional study carried out by the Ambulatory for the treatment of sexual disorders of ABC Medical College, Santo André, São Paulo, Brazil (ABSex). The sample comprised 104 convicts, over 18 years old, sentenced only for sexual crimes against children (below 11 years old). Alcohol and drug consumption, sexual abuse history, sexual impulsivity, and risk of recidivism were evaluated.

RESULTS

The sexual offenders against boys showed higher alcohol consumption problems than sexual offenders against girls (chi2=19.76, 1d.f., p<0.01). The severity of alcohol consumption was also significantly higher in the sexual offenders against non-related boys than in the sexual offenders against non-related girls (p=0.037, ANOVA). After adjustment for other variables, such as monthly income before the penalty and alcohol consumption at the moment of the crime, the alcohol consumption severity in sexual offenders against boys was significantly higher than in sexual offenders against girls (OR=1.05, CI 1.01-1.08, p<0.01).

CONCLUSIONS

Alcohol use or abuse is associated with the perpetration of sexual aggression. The role of alcohol consumption seems to be greater in sexual offenders against boys than in girls and this can contribute to criminal recidivism.

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.

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.

Post-conviction sex offender polygraph examination: client-reported perceptions of utility and accuracy

Post-conviction polygraph testing of adult sex offenders in treatment has been a somewhat controversial subject. This study (n = 95 participants who took 333 polygraph tests) explored how sexual offenders enrolled in outpatient treatment programs perceived their polygraph experience. Participants reported a relatively low incidence of false indications of both deception (22 of 333 tests) and truthfulness (11 of 333) tests, suggesting that clients agreed with examiners' opinions 90% of the time. The majority of clients reported that polygraph testing was a helpful part of treatment. Finally, about 5% of participants reported that they responded to allegedly inaccurate accusations of deception by admitting to things they had not done. The data offer encouragement for continued but cautious use of polygraphs by sex offender treatment programs. Implications for practice and research are identified.