Sex Offender Treatment: Just Say No to the Dodo

Talk about reductionist thinking: try this corner of the mental health industry. It’s a dark little corner, where the journeymen and women of our profession go…because someone has to, supposedly. Not that therapists are wanted, necessarily. As in the treatment mileus depicted in my book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment, administrators and directors of SO treatment programs, or the “supervising officers” (euphemism for correctional officers) that are actually in charge of the three-headed mon–sorry–treatment team, want straightforward instructors for implementing of program protocols. They want containment based upon a structured approach designed to elicit successful behavioral outcomes–a teleological perspective.
       Recidivism: the repetition of offending behavior. That’s the operative concept in sex offender treatment: the standard by which this entire arena of care is judged, or will be judged, if it is indeed on trial. And why not? you may ask. Surely the problem of sexual abuse needs to be addressed as aggressively as possible, with a behavioral lens front and center; with recidivism the criteria for assessing everyone in the process, participants and providers alike.
       The problem is with the research, and thereafter with the spinning upon said research for anxious listeners. At a recent presentation of sex offender treatment protocols at a CCOSO (California Coalition on Sex Offending) conference, I listened to program officials assert the need to implement a structured treatment program consisting of an RNR (Risk Needs Responsivity) model, in conjunction with Cognitive Behavioral Therapy (CBT), and that unstructured psychotherapy (unclear what that was referring to–perhaps the aforementioned “Freud stuff”) was contra-indicated (meaning, ill-advised), because its methods were not associated with a significant decrease in recidivism. By RNR model, presenters were alluding to the work of criminologists Don Andrews and James Bonta, who outlined what are termed dynamic risk factors central to treatment, alongside corresponding so-called criminogenic needs. The list of factors include some of the following: antisocial personality, antisocial cognitions, social support for crime (meaning, friends or family with criminal attitudes), impulsive behavior, family dysfunction–again, such as criminality, low education. Other factors of ancillary importance are early childhood negative experiences, family of origin stressors, age, gender, and ethnicity. Spot the issue yet? Well, the likes of Ward, Melser, and Yates (2007) did, opining that the RNR etiological theory was too general to explain criminal conduct, and as a result, was unfalsiable–meaning, not especially useful.
        As for recidivism, the research here is generally thin and unconvincing. According to Duwe and Goldman (2009), a reduction of 18% in sexual recidivism existed for one in-prison treatment program. But researcher Stephen Brake, who in 2010 published his examination of 37 studies of sex offender treatment outcomes conducted over a quarter century, found that only 41% of such studies indicated reductions in recidivism, with 37% not significantly reducing recidivism, and a remainder of studies indicating mixed, partial evidence based upon different factors (violent versus non-violent recidivism, for example). Overall, it’s been known since the early 90s (via federal reports) that sex offenders exhibit among the lowest recidivism rates (4-12%–tracked over 5 years), compared to other criminal profiles. But it’s unclear whether such findings can be attributed to specific treatment models. The authors of another meta-analysis study, Losel and Schumacker (2005), concluded that there is a significant effect of treatment on recidivism, but the studies they examined indicated treatment programs that featured not only CBT methods, but also surgical castration. Pardon me while I imagine the principals of each intervention strategy arguing over whose method worked best.
       Several critics point out basic problems with research into sex offender treatment: findings that indicate as much effect upon recidivism for no-treatment versus treatment; inadequate control groups; the fact that sex crimes are the least reported types of crimes (thus confounding statistics on recidivism). Add to this discrepancies in study designs, outcome measurement protocols, time-frames for follow-up, and what researchers have is a messy globule of information that strains against the community’s desire for straightforward action. Critics of the RNR model point out its limitations: the opinion that attention to criminogenic needs is insufficient, and that attention must be paid to individual needs, self-esteem issues, personal distress; that treatment alliance is an unassailable factor in positive treatment outcomes. Amen, I say. However, these are borderline heresies for those presenting on the topic of sex offender treatment, for sex offenders aren’t really allowed to talk about personal distress and low self esteem–at least, not until they’ve admitted to all of their crimes and then said they were sorry…like, really sorry. And so, with all this in mind, I wade into this dodgy realm of care, becoming a ‘certified’ provider of sex offender treatment. Why? because I have some clients who fit the profile, and because they are people about whom I care. I’ll nod my head at the pronouncements of those looking to codify practices and reign in the unconscious. I’ve got my eye on the Dodo.
* Stephen Brake (2010) The Effectiveness of Treatment for Adult Sex Offenders.

* Ward, Melser, and Yates (2007) Aggression and Violent Behavior, 12, 208-228.

* Losel and Schumacker (2005) The effectiveness of treatment for sexual offenders. Journal of Experimental Criminology, 1, 117-146.