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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. Good Lives
&
Protective Factors
Risk Management
Future