A review of the factors that can influence the effectiveness of sexual offender treatment: Risk,need, responsivity,and process issues

The aim of this paper is to review various factors that may affect the effectiveness of sex offender treatment. First, attention to risk level is discussed as an important factor in terms of ensuring that treatment is administered according to the level of an offender's problems and that treatment addresses criminogenic needs. Second, a number of responsivity/intra-individual characteristics (e.g., psychopathy, motivation, and locus of control), which may influence treatment outcome, are examined. Third, the importance of considering process issues, such as the therapeutic climate of the group, the composition of the group, and therapist characteristics is discussed. Finally, suggestions for future research and for optimizing the effectiveness of sex offender treatment are provided.     

An overview of the literature on female-perpetrated adult male sexual victimization

The rape of women has been an issue of concern in research literature for the past 40 years. Conversely, rape against men has only relatively recently received investigation. The current paper reviews the existing research literature regarding male rape and sexual assault, with particular emphasis on female perpetrated male sexual victimization. The review covers issues regarding biased legal definitions, rape myths, feminist theory, and stereotypical or negative beliefs; all of which create a problematic social environment for male victims of female perpetrated assault to report crimes. The review also discusses the prevalence of female perpetrated attacks against men, with evidence from self-reports by female sex offenders to highlight the existence of male sexual victimization and the aggressive manner in which the sexual activity is committed. The review concludes that male sexual victimization by women should be taken as seriously as that of women by men.     

Understanding cognitive,affective, and intimacy deficits in sexual offenders: A developmental perspective

Factors, such as intimacy deficits, problems empathizing with victims, and cognitive distortions, have all been associated with the genesis of sexual abuse. Importantly, they all point to a lack of awareness of other peoples' beliefs, desires, perspectives, and needs. We argue that sexual offenders' problems in these domains can be viewed as partially arising from deficits in one central mechanism: the ability to infer mental states. Following a review of the above three areas, we discuss the developmental literature on children's theory of mind and develop a model informed by this work. We apply this model to sexual offenders and discuss its research and clinical implications.     

Transparenz und Fairness in der Therapie von Sexualstraftätern in Haft und Maßregelvollzug

It makes sense to treat sexual offenders in prison. Treatment can be successful even if coerced. However, particular difficulties arise due to the great power disparity between therapist and patient and the latter’s remoteness from normal living conditions. This report will describe the current status of treatment techniques/approaches for sexual offenders in prison (with particular regard to social therapy) and special forensic hospitals as viewed by an external reviewer judging the process, methods and success of treatment for preventing relapse and estimating criminal prognosis. We mention standards for a respectful and positive approach towards the patient client. With regard to the Good Lives Model, it is supportive to develop positive resources in the perpetrator. This also requires a heightened readiness from therapist and team for transparency (instead of confidentiality) towards the perpetrator as to the assessment of progress and status of therapy. We criticize tendencies for a confrontative, if not humiliating approach, which undermines the self-esteem of the client and exploits the power disparity between therapist and perpetrator.     

Sexual offenders' cognitive distortions as implicit theories

In this article, I argue that sexual offenders' cognitive distortions emerge from underlying causal theories about the nature of their victims. These implicit theories function like scientific theories and are used to explain empirical regularities (e.g., other people's actions) and to make predictions about the world. They are relatively coherent and constituted by a number of interlocking ideas and their component concepts and categories. Following a review of research from other areas in psychology on implicit theories, I consider the implications of this perspective for understanding cognitive distortions in sexual offenders. Finally, I discuss the research and clinical implications of viewing cognitive distortions in offenders as implicit theories.     

What we do and don't know about sex offenders' intimacy dispositions

Despite the significant role attributed to intimacy deficits in the etiology of sexual offending, current understanding of sex offenders' intimacy dispositions remains limited. The present article reviews the theoretical and empirical literature in order to better define the intimacy dispositions of sex offenders, and understand the role of intimacy in sexual offending. Research on sex offenders evidences a marked fear of intimacy and a low involvement in practices that can lead to intimacy, which suggests a poor inclination for the experience of intimacy. Moreover, scarce available data show that aspects of intimacy increase sex offenders' susceptibility to adopt sexually abusive behaviors. Although research has suggested that intimacy deficits contribute to sexual offending behaviors, no common operationalizable definition of intimacy has yet been put forth. Consequently, our understanding of the components of intimacy and their specific etiological role in interpersonal functioning and in sexual offending lacks theorization and evidence-based research. The present article proposes to answer the following question: what are the intimacy deficits in sex offenders identified in the scientific literature, and what is the role of these deficits in sexually offending behaviors?     

How should “acceptance of responsibility” be addressed in sexual offending treatment programs?

Sexual offenders in treatment programs are usually expected to take responsibility for their offending—which we define, on the basis of a literature review, as giving a detailed and precise disclosure of events which avoids external attributions of cause and matches the official/victim's account of the offense. However, research has not established that a failure to take responsibility for offending is a risk factor for future recidivism. In this paper, we critically review and evaluate the literature on taking responsibility for offending, to determine the rationale for the popularity of this treatment target. We consider the reasons why sex offenders fail to take responsibility for their offending and examine some potential problems with focusing on this goal in treatment programs. We also describe alternative treatment strategies for taking responsibility and conclude that there is less need for offenders to take responsibility for their past offending than there is for them to take responsibility for their future actions.     

Ethical issues in therapy: therapist self-disclosure of sexual feelings

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosure of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions.     

Abstracts

The demand for therapy groups for child sexual assault victims has risen as detection of abuse has increased, but little has been published about conducting and evaluating such groups. The authors present a comprehensive review of the literature and describe their sixteen-week therapy group with seven eleven- and twelve-year-old girls. Treatment themes, activities, group process issues, and psychometric findings on the Piers-Harris Children's Self Concept Scale and the Child Behavior Checklist are discussed. Suggestions for future groups and research are offered.     

Female perpetrators of child sexual abuse: A review of the clinical and empirical literature

Although women have long been viewed as offenders in cases of physical child abuse, it is only recently that clinicians and researchers have begun to seriously consider the problem of female-perpetrated sexual abuse of children. The purpose of the present paper is to review existing clinical and empirical literature on female sex offenders, in order to develop a summary profile of female perpetrators that may be of value to professionals involved in the assessment and treatment process.     

Assessing sexual aggression: Addressing the gap between rape victimization and perpetration prevalence rates

Obtaining consistent and accurate rates of women's sexual assault experiences and men's history of sexual aggression has proved difficult and rates vary tremendously throughout the literature [Koss, M.P. (1993a). Detecting the scope of rape: A review of prevalence research methods. Journal of Interpersonal Violence, 8 (2), 198–222].It has been suggested that methodological factors influence the detection of women's sexual assault experiences and contribute to the rate disparities [Fisher, B. S., Cullen, F. T. & Turner, M. G. (2000). The sexual victimization of college women (NCJ 182369). Washington, DC: Bureau of Justice Statistics,National Institute of Justice.; Hamby, S. L. & Koss, M. (2003). Shades of gray: A quantitative study of terms used in the measurement of sexual victimization. Psychology of Women Quarterly, 27, 243–255.; Koss, M.P. (1993a). Detecting the scope of rape: A review of prevalence research methods. Journal of Interpersonal Violence, 8 (2), 198–222].Survey methods are commonly used in the assessment of women's experience with sexual assault victimization. Men's history of sexually aggressive behaviors is typically examined using parallel versions of the survey instruments used with women.While much is known about variables affecting the reliability, validity, and utility of these assessment methods when applied to women, less is known about the influence of these factors in the assessment of men's self-reported aggression. This paper discusses current sexual victimization and perpetration incidence and prevalence rates.An overview of the major sources of these data, as well as a review of the methodological factors known to influence levels of rape detection in women is presented. An examination of how these issues may be relevant in the measurement of male sexual aggression is discussed with suggestions for future research.     

Understanding Motivational Interviewing Effectiveness: Contributions From Rogers' Client-Centered Approach

The object of this article is to gain a better understanding of motivational interviewing (MI) effectiveness using the framework of Rogers' approach. Examining MI's common points and differences with Rogers' client-centered therapy can make it possible to identify some of MI's active ingredients and its underlying process of effectiveness, especially related to MI relational component. In return, MI, a strongly evidence-based approach, could provide empirical basis and support of effectiveness for Rogers' client-centred therapy. The review of literature on Rogers' therapy and MI shows strong links between the two approaches. MI applies most of Rogers' therapy attitudes and techniques such as empathy, acceptance, autonomy support, collaborative style, and confidence in the client's ability to change. The article further presents a review of research data related to the therapeutic effects of each of these attitudes. Finally, implications for clinical practice and further research are discussed. MI and Rogers' client-centered approach have much to offer each other. The strong process and outcome research tradition in MI could bring about evidence on Rogers' therapy effectiveness. Rogers' work provides a testable theoretical basis for the mechanisms of MI effectiveness. Further MI research should operationalize more than just empathy in the relational component.     

Beyond sexual recidivism: A review of the sexual criminal career parameters of adult sex offenders

The current study claims that measures of sexual recidivism provide a distorted view of the criminal activity of adult sex offenders. To address this important limitation, the criminal career perspective is presented and key concepts are defined and described. The study also provides an up-to-date review of the scientific literature on various criminal career parameters of the sexual criminal activity of adult sex offenders. Hence, current empirical knowledge on the prevalence, age of onset, frequency, continuity, versatility, and desistance from sex offending is presented. The findings highlight the complexities of the sexual criminal career of adult sex offenders, and most importantly, its dynamic aspect, both of which are not captured by traditional measures of sexual recidivism. The review also underscores the importance of recognizing that sexual offending develops according to a series of stages, that, if not recognized, may lead to the underestimation of risk for some and over-estimation of risk for others. The review provides a framework to stimulate new areas of research as well as policy-development that is not limited to the identification of the “high-risk” convicted sex offenders.     

Psychopathie,antisoziale Persönlichkeitsstörung und Sexualdelinquenz

In today’s field of forensic psychiatry, psychopathy is seen as a subtype of antisocial personality disorder and includes manipulative behavior, egocentric and arrogant characteristics, high-risk behavior as well as a lack of empathy. Empirical data on the prevalence of psychopathy and antisocial personality disorder among offenders greatly vary depending on the study design and the composition of the sampled population. Offenders who committed both violent and sex offenses seem to have antisocial traits with a higher probability than offenders who committed only violent or only sex offenses. In the context of criminal responsibility and risk assessment for sex offenders, antisocial and psychopathic traits have a negative impact on the prediction of recidivism. Many study results, even though not all, additionally indicate that the combination of psychopathic traits and sexual deviance (i.?e. for example a paraphilic disorder such as sexual sadism) in sex offenders may be associated with a particularly high risk to reoffend. Due to the specific interpersonal characteristics (e.?g., dominant, provocative behavior, exaggerated self-esteem), therapeutic treatment of sex offenders with antisocial and psychopathic traits is often difficult. The regular supervision by the therapist is considered to be crucial to avoid harmful relationship dynamics or distorted perception of the therapist.     

Cognition in rapists Theoretical patterns by typological breakdown

Cognitive processing has been implicated in sexual offending in a number of recent theoretical and empirical papers. Clinicians have emphasized the need to challenge the cognitive distortions that are often exhibited by sexual offenders, and they have incorporated cognitive restructuring components into treatment programs. However, until recently, the literature has lacked an integrative theoretical approach to cognition in sexual offenders. In addition, the use of generic classifications (i.e., rapist, child molester) in both theoretical and empirical work has obscured understanding of the role played by a number of etiological factors, including cognition. In this paper, we present a multifaceted approach to cognition in rapists. We begin with a brief overview of a conceptual framework of cognitive dimensions. Next, we consider the heterogeneity that characterizes rapists as a group and the problems this presents for research. We suggest that Knight and Prentky's typology may prove useful for dealing with these problems and, in the final section, we provide our conceptualization of the potential distorted cognitions for each of the subtypes within the typology.     

Ethnicity, Culture, and Group Psychotherapy

Ethnicity and culture have great therapeutic import in the practice of group psychotherapy, especially given the increasing diversity of the population of North America, and this issue has not received appropriate recognition in the literature. In this paper these terms are defined, and the literature is reviewed. Ethnicity, culture, and psychopathology are discussed, focusing on treatment issues including transference, countertransference, resistance, group cohesion, group process, and multi-ethnic groups. The group therapist must be knowledgeable about ethnic and cultural issues in the lives of the group members in order to promote group cohesion and therapeutic effectiveness. The recognition and exploration of ethnic/cultural differences enhances the work of the group. Recommendations for treatment are discussed.