Treatment and Supervision of Sex Offenders

Learning Objectives Name the commonly used model of treatment for adult sex offenders; Identify three targets of treatment designed to reduce recidivism among sex offenders; and Discuss the current controversies that lead to differing opinions regarding treatment of sex offenders;

Learning Objectives (cont.) Name three areas in which “specialization” applies to supervising sex offenders; and List three examples of specialized supervision conditions that may be relevant for sex offenders.

O VERVIEW Comparison of Sex Offender Treatment with Other “Behavioral Health” Treatments Research Strengths and Weaknesses What Sex Offender Treatment Looks Like Treatment and Supervision Professionals

Two Overarching Goals of Sex Offender Treatment Prevent further harm, victimization Promote offender stability, success

C OMPARISON OF S EX O FFENDER T REATMENT WITH O THER “B EHAVIORAL H EALTH ” T REATMENTS

How is Sex Offender Treatment... Similar to other types of psychological treatment? Different from other types of psychological treatment?

Sex Offender- Specific Treatment Other Mental or Behavioral Health Treatment Clients generally involuntary, mandated Often voluntary, self-selected clients Limited confidentiality, waivers common Strict confidentiality, few exceptions Therapeutic climate is vital Blend of client-determined and pre-determined goals Primarily client-determined goals Treatment Comparisons

Sex Offender- Specific Treatment Other Mental or Behavioral Health Treatment Assessment-driven interventions Group therapy modality most common Individual therapy sessions most common Success or “failure” impacts public safety Success or failure primarily impacts the client Treatment Comparisons (cont.)

Different Approaches to Sex Offender Treatment: Which Seem Most Likely to Work? Psychoanalysis Insight-oriented therapy

Different Approaches to Sex Offender Treatment: Which Seem Most Likely to Work? (cont.) Behavioral techniques Medical, pharmacological interventions Cognitive-behavioral treatment

R ESEARCH S TRENGTHS AND W EAKNESSES

Understanding the Controversy What do we need to understand about treatment research to know if it validly informs us as to whether treatment works? A little background on research design

General: How Do We Know if a Treatment Works? Test it scientifically for risks and benefits Standard: scientific studies –Adequate sample of subjects –Randomized –Controlled Measure outcomes with accuracy

After the Research Findings of safety and efficacy allow for treating within guidelines of “dose” and duration Findings apply to a certain population with extreme care for extrapolation “Off-label use” – new applications of treatment

Experimental vs. Quasi-Experimental Studies

W HAT S EX O FFENDER T REATMENT L OOKS L IKE

Commonly Used Approach to Sex Offender-Specific Treatment Cognitive-behavioral model Multiple modalities –Group, individual, marital/family –Pharmacological

What Does Cognitive Behavioral Treatment Look Like? Individual and/or group sessions Focus on past offenses and the pattern of thoughts, feelings, and behaviors that led up to the offense –e.g., substance use, viewing pornography, fantasies Challenges old patterns, introduces alternative thought and behavior patterns

Primary Targets of Sex Offender Treatment (Static and Dynamic) Sexual deviance, sexual preoccupations Intimacy deficits, conflicts in relationships Pro - offending attitudes Hostility, pervasive anger Lifestyle instability Research data does not show that treatment of specific risk factors works.

Assessment-Driven Treatment Individualized dose and duration of treatment and supervision Target known risk factors Measurement of progress –e.g., Treatment needs and progress cale every six months

Medication Approaches Decrease testosterone  decrease sex drive Does not change sexual interests Time-limited effect Side effects: bones, liver

Medications Antiandrogens –Provera™ –Lupron™ SSRI Antidepressants

Research on Treatment Effectiveness Increasing body of research Several meta-analyses Treatment associated with lower recidivism rates in non-randomized studies However, randomized study found higher rate of recidivism in treatment group

“Balanced Approach” to Sex Offender Management Risk Management through Specialized Supervision Risk Reduction through Sex Offender Treatment Maximized Public Safety

T REATMENT AND S UPERVISION P ROFESSIONALS

Treatment Provider Expertise Relevant advanced degree Forensic training, experience Specialized training, clinical supervision Licensure, professional affiliations Continuing education

Elements of Sex Offender Supervision Specialized officers Specialized conditions Specialized technology

Specialized Officers Internal expertise Focused efforts Awareness of resources Collaboration emphasis

Areas Addressed by Specialized Conditions Treatment Victim contact

Areas Addressed by Specialized Conditions (cont.) Employment, leisure activities Surveillance Monitoring

Supervision – Query What types of specialized conditions do you believe are most important for sex offenders under community supervision? To what extent are specialized conditions for sex offenders used in your jurisdiction? Who is responsible for imposing these conditions?

Supervision Orientations and Philosophies Surveillance, Monitoring, Enforcement Social Casework

Surveillance and Monitoring GPS Polygraph UDS

Applying Risk Principles to Sex Offenders Supervision Target higher risk offenders for more intensive supervision strategies Provide longer periods of supervision for higher risk offenders than for lower risk offenders Focus programming referrals on higher risk offenders Ensure that more risk factors, rather than non-risk factors, are the focus of intervention

Summary and Implications Cognitive-behavioral sex offender treatment reduces recidivism in non- randomized studies. Supervising sex offenders involves specialization Balancing treatment and supervision may increase public safety Risk reduction and risk management can be targeted through sentencing orders