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

Treatment Satisfaction in a Civil Commitment Facility for Sexually Violent Persons

Evaluating patient satisfaction in therapeutic settings is consistent with a Risk-Needs-Responsivity (RNR) model. This study provides results from a program improvement initiative in a sexually violent person (SVP) civil commitment facility that queried patients and treatment providers about their satisfaction with therapeutic processes and assessment methods. Overall, patients reported high levels of satisfaction with treatment at the facility, with the highest levels of satisfaction on items about being treated with kindness and respect and staff acting professionally. Providers rated current assessment methods such as the Penile Plethysmography (PPG) assessment, polygraph testing, and neuropsychological testing as most helpful for patients in treatment progress; however, patients rated PPG assessment and polygraph testing as the least helpful of the assessments conducted. Soliciting patient feedback periodically could be important for maintaining treatment engagement and discovering opportunities to enhance patient satisfaction to treatment in a SVP civil commitment setting.

[Therapeutic Factors in Offender Treatment: A Systematic Review]

This paper presents a systematic literature review of international research on therapeutic factors in offender treatment. The review was based on the PRISMA criteria; PsycINFO and PSYNDEX as well as references given in included studies were browsed. Only quantitative empirical studies published between 1990 and 2018 were included. In this paper, evidence for common factors (therapeutic alliance, social climate, feedback) and therapist factors (interpersonal skills/characteristics, personality, therapy expectations) from 19 journal articles are reported. Some tendencies emerged, but there was no conclusive evidence on the effect of common factors and therapist factors on the therapy outcome. This non-conclusive evidence is mostly due to the methodological shortcomings of primary studies, heterogeneity of outcome variables and the low number of studies that looked at each of these variables. In sum, there is not enough evidence to date to show a strong relationship between common factors and therapist factors and a (positive) outcome in the treatment of offenders.

Referral for group or individual treatment? Factors for consideration in the case of self-referred individuals with a sexual interest in minors

In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.

A narrative review of research on clinical responses to the problem of sexual offenses in the last decade

Research on the treatment and programs for people who have committed sexual offenses has greatly increased in the past decade. The aim of this review is to discuss research that has been published over that period (2010-2019) that is relevant for treatment providers. The articles included in this review were found through PsycINFO and PubMed (Medline) using the keywords "treatment or therapy" and "sex offen*". The inclusion criteria were publications that discuss treatment of persons who have committed sexual offenses (written in the English language only). Any articles that examined only special populations were excluded, such as those that examined persons who committed sexual offenses who were female, had intellectual disabilities, deafness, juveniles, etc., because these groups will likely have needs and responsivity factors that differ from the "average" natal-born male sex offender. Results showed that several meta-analyses indicate that treatment is effective in reducing sexual recidivism. The most frequently used treatment for sex offenders is cognitive behavioral therapy, which is often provided in conjunction with pharmacological treatment to reduce sexual impulsivity and/or sex drive. This review is limited to the specific key search terms. The findings of this review support the use of treatment and a community reintegration approach when treating persons who have committed sexual crimes to prevent sexual recidivism.

Well-Being as a Precursor and Consequence of Micro-Processes in a Group Psychotherapy With Forensic Patients

Psychotherapy is an important approach for the treatment of psychiatric disorders. Apart from treating disorders as such, psychotherapy aims at increasing patients' well-being. The Therapeutic Cycles Model (TCM) is a process-oriented theoretical model that makes predictions about the psychotherapeutic progress based on verbatim content. The model helps to identify therapeutic factors on a language level. The present study aims at analyzing transcripts of group therapy sessions with forensic psychiatric patients using the rationale of the TCM. Furthermore, the relationship between linguistic features of psychotherapy sessions and patients' well-being before and after therapy are investigated. In order to identify therapeutic factors, a group psychotherapy with nine drug addicted forensic psychiatric patients was videotaped and transcripts of N = 16 sessions were analyzed. Process-oriented measures were rated by the patients, their therapists, and an external observer. Patients' self-reported well-being before therapy was negatively related to Connecting (indicating emotional insight), and the frequency of therapeutic cycles, which are both thought of as key moments in therapy. Well-being of forensic patients is not necessarily a helpful precursor for insightful and productive events in therapy to occur. The findings help to better understand psychotherapeutic micro-processes throughout forensic therapies, and their relationship with patients' well-being. Implications for research and the forensic practice are discussed.

Forensic Staff Attitudes Toward Men Who Have Sexually Offended: A General Public Comparison

OBJECTIVES

The aim of this study was to explore the attitudes toward men who have sexually offended (MSO) between the general public and professionals and paraprofessionals in forensic settings.

BACKGROUND

Existing research shows a number of different factors that appear to be important in the development, maintenance, and deterioration of attitudes toward MSO. The exploration of such factors requires further exploration.

METHOD

A convenience sample was used for the cross-sectional study. Five hundred fifty-three participants were recruited from the general public and forensic hospitals, both private and National Health Service. An online version of the Attitudes Towards Sex Offenders scale (Hogue, 1993) was distributed via email and social media.

RESULTS

Gender was not found to have any impact on the attitudes individuals held toward MSO. The general public was found to have significantly more negative attitudes when compared with those exposed to MSO at work (professional and paraprofessional staff). Duration of employment did not make attitudes any more or less positive.

CONCLUSION

The clinical and societal implications of the research are important for MSO to reduce risk within forensic establishments and be supported to reintegrate successfully into the community. Without the support from both staff and the general public at each stage of rehabilitation, desistance is less likely to be maintained. Research continues to provide varying results regarding the factors that influence the nature of attitudes toward MSO.

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.

Measuring Cohesion and Self-Disclosure in Psychotherapy Groups for Patients with Advanced Cancer: An Analysis of the Psychometric Properties of the Group Therapy Experience Scale

Objectives

Understanding the group process informs group interventions. However, there is little systematic research on group process variables in psychotherapy groups for patients with cancer.

Methods

We analyzed the psychometric properties of the Group Therapy Experience Scale and evaluated its potential importance in advanced cancer therapy groups.

Results

The GTES demonstrated good internal consistency (coefficient alpha=.84). An exploratory factor analysis with varimax rotation yielded four factors. Although all four models were explored, the 1- and 2-factor models appeared to provide the best fit for the data. The GTES total score was negatively correlated with group size and positively correlated with number of groups attended by participants. Furthermore, the GTES total score was correlated with post-intervention spiritual well-being, benefit finding, post-traumatic growth and quality of life.