Sexual Offender Treatment (SOT) New Approaches, New Knowledge David Thornton, Ph.D. Prepared for Strafferettskonferansen i Loen April 24 2017

Knowledge and SOT Firm knowledge about what is effective in SOT is hard to obtain Few controlled trials using random allocation The institutions containing known sexual offenders are not organized in a way that supports random allocation and there may strong objections from key participants Random allocation trials are expensive, slow, give inconclusive results, and vulnerable to sabotage Low base rate of sexual recidivism which gradually builds over time Minimum meaningful follow up is 5-years but only half of all recidivism events will have occurred by then This means that prospective studies will normally take over 10 years to complete Heterogeneous nature of Sexual Offender Treatment and of Sexual Offenders Offenders may respond differently to treatment so lumping them together may give misleading results Treatment can differ in kind and quality of implementation and so would be expected to have different results. Combining different treatment methods as SOT can be misleading

Dilemmas Choice between Focus on the best research designs – this yields too few studies and requires lumping different kinds of treatment together Yields uninformative results with higher certainty Attending to studies that use second class methods allows comparison between methods Yields informative results with low certainty Slow and weak feedback makes it hard to learn how to do better

Consequences Trends in SOT reflect More general changes in knowledge about sexual offending and sexual recidivism, What is known about what works in general offender treatment or in psychotherapy Some weak feedback from direct studies of sexual offender treatment There have been major changes in the ideas we bring to constructing SOT and I am going to try to describe these, at least in broad outline, concluding with where we are heading now

Dominant Beliefs in Three Eras that Guide Treatment Approximate Eras First Era: Early 1980s and 1990s Second Era: 2000s Third Era: 2010s and 2020s Beliefs about Sexual recidivism base rate Endurance of Risk Change Model Expectations for Change Role of the Release Environment

Five Year Sexual Recidivism Base Rate (SRBR) First Era Second Era Third Era SRBR unknown but thought to be very high Varies between 5 and 40% depending on static risk factors Varies between 2 and 20% with exceptions defined by rare combinations of static and dynamic factors

Endurance of Risk First Era Second Era Third Era Endures for a lifetime without intervention Risk is long-term; half risk occurs after the first five years Risk halves for every five years in the community offense-free

Change Model (CM) First Era Second Era Third Era Cognitive Distortions Victim Empathy Offense Cycles Relapse Prevention RNR Empirical identification of risk and need RNR with an emphasis on individualization, motivation and engagement

Expectations for Change First Era Second Era Third Era All untreated sexual offenders highly dangerous Treated sexual offenders may be safer if very compliant Low-risk sexual offenders need little treatment Treatment drop outs high risk Good treatment can halve recidivism for moderate-risk and high-risk offenders Change can be measured and its effect on sexual recidivism quantified Meaningful but imperfect change associated with major reduction in recidivism for moderate and high actuarial risk offenders

What does meaningful but imperfect change look like? Working on at least two-thirds of the individual’s psychological risk factors Sees them as a problem Actively working to change / manage them Some evidence of behavioral change but may be occasional lapses

Role of the Release Environment First Era Second Era Third Era Release environment disregarded Deviancy and manipulation enough to lead to recidivism in any environment in which potential victims are present Varied by jurisdiction USA: Aggressive long-term supervision associated with recidivism reduced to a quarter of unsupervised rate Release Environment understood in terms of Protective Factors

Protective Factors Internal External / Professional Social / Motivational Able to manage internal risk factors Ability to access rewarding life through prosocial behavior Coping Skills Self-control Empathy External legal controls Support & Stabilization Address active treatment needs Prison Supervised Group Home Community Supervision Supervised Living Community SOT Psychiatric treatment Informal policing Prosocial reward Work Leisure Friends Romantic relationship

Treatment Elements Pre-treatment Assessment Treatment Engagement Risk Criminogenic Need Responsivity Issues Motivations and Aspirations Treatment Interfering Factors Learning style Treatment Engagement Motivational emphasis Compatible with learning style Flexible response to TIFs Sufficient buy-in to manage risk factors and work towards better way of satisfying needs Connecting new behaviors to their own motives/values Work / Practice / Doing it Building protective factors

One size doesn’t fit all Individualize Motivation Criminogenic Needs Responsivity Factors Treatment duration & intensity

Pitfalls for Two Popular Approaches Good Lives RNR Humans all strive for similar primary goods (e.g. Relationships, Autonomy, Peace of Mind, Pleasure etc.) Criminal behavior arises when legitimate ways to “primary goods” are blocked. Treatment focuses on developing prosocial routes to primary goods Danger Loses focus on managing risk factors Criminal behavior arises from criminogenic needs like Sexual Interest in Children, Impulsivity or Antisocial Attitudes Treatment focuses on helping the individual manage these risk factors Danger Fails to engage sustainable motivation

Good Lives & Protective Factors Risk Management Future