IMPLEMENTING EFFECTIVE TREATMENT FOR SEXUAL OFFENDERS
Dr. Franca Cortoni *The aim of correctional rehabilitation is to manage and reduce the risk of criminal recidivism. Although
historically, it was believed that “nothing works” to change criminal behaviour (Martinson, 1974), a large bodyof empirical evidence has since shown that appropriate correctional rehabilitative interventions do reduce
the likelihood of future criminal behaviour. Meta-analytical research shows that adherence to appropriate
rehabilitative principles improve the efficacy of correctional interventions for sexual offenders (Hanson,
Bourgon, Helmus, & Hodgson, 2009).

I. WHAT ARE EFFECTIVE TREATMENT PROGRAMMES? THE RISK-NEEDSRESPONSIVITY PRINCIPLES
Effective correctional programmes follow the Risk, Needs, and Responsivity principles (Bonta & Andrews,
2017; see also Jung, 2017 for applicability to sexual offenders). The risk principle suggests who might profit
from more intensive treatment. Higher risk offenders need to receive intense levels of interventions (moretherapy hours per week and for longer period of time) and community follow-up, with research suggestingthat at least 300 hours of treatment are needed to reduce recidivism among high risk offenders (Bourgon &Armstrong, 2005). In contrast, low risk offenders should receive little intervention.
There is sometimes confusion between severity of sanction and risk, with stronger sanctions (e.g., longer
sentences) being assumed to denote higher risk of recidivism and, therefore, needing more intensive
interventions. The reverse is also true: an offender with a lesser sanction is often viewed as presenting alower risk of reoffending and, therefore, as requiring little intervention. Research, however, has shown thatrisk of recidivism is not associated with severity of sanctions (Andrews & Dowden, 2006). This is not
surprising since the criminal justice principles guiding the imposition of sanctions are usually not based on
appraisals of risk of recidivism but rather on the nature and severity of the actual offending behaviour.1 Riskof recidivism, however, is associated with the effect of treatment, with higher risk offenders (regardless of
their official sanction) benefitting more from treatment than low risk offenders, but only when that treatment
is concurrently delivered according to the needs and responsivity principles (Andrews & Dowden, 2006).
The needs principle suggests that the criminogenic needs of offenders, as opposed to general psychologicalfactors, are the appropriate targets for intervention. Criminogenic needs are those elements that are directly
related to the offending behaviour and that are changeable. Empirical evidence showed that targeting
general psychological factors unrelated to the offending behaviour does not lead to a reduction of recidivism(Bonta & Andrews, 2017). Criminogenic needs are also called criminogenic factors or dynamic risk factors.
The responsivity principle dictates the selection of the modes and styles of service delivery. The
responsivity principle is based on what works with offenders, as opposed to non-offender populations, and,within offender groups, what may be special responsivity issues (e.g., gender, culture). The modes of treatmentthat have been empirically demonstrated to be effective with offenders are behaviourally based and include
a self-management component (see Cortoni, 2019 for a review). Self-management is an approach that involves
the identification of the negative life cycle that led to the offending behaviour; the identification of the risk
factors in the offender’s life; and the development of strategies to manage his life in a manner that reduces
the impact of those risk factors. A self-management plan also includes the identification of a supportive
community network that will be aware of the offender’s risk factors and his self-management strategies inorder to offer appropriate support once the offender returns to the community.
＊

Professor, School of Criminology, Université de Montréal, Canada.
There are two exceptions in the Criminal Code of Canada: the designations of ‘long-term offender’ and ‘dangerous offender’are based on appraisals of future risk (Greenspan & Rosenberg, 2007).

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II. THE POSITIVE IMPACT OF EFFECTIVE CORRECTIONAL TREATMENT
The risk-needs-responsivity principles of effective correctional treatment with sexual offenders have been
extensively researched and supported through the use of meta-analyses. A meta-analysis is a statisticalmethod to aggregate the research findings of numerous individual studies. By analysing the results of a large
number of single studies, the meta-analysis controls for variations and potential biases among individual
studies to establish whether a treatment effect exists. Meta-analyses provide effect sizes, a statistic which
can be interpreted as the percentage difference between treated and untreated groups.
There are now over fifty meta-analyses that examined the effectiveness of the risk-need-responsivity
principles with adults and juvenile offenders; female offenders; ethnic minorities; violent offenders; and sexual
offenders (Hollin & Palmer, 2006). The results from these meta-analyses have shown that when correctional
treatment adheres to the risk-needs-responsivity principles, reductions of recidivism are consistently
observed, with effect sizes typically ranging anywhere between .10 and .30, although effect sizes above
between .25 and .35 are more typical (Bonta & Andrews, 2017). The following example is offered to understandthe interpretation of effect sizes: reoffending rates of 30% (TR=treated rates) among treated offenders
compared to 45% (UR=untreated rates) among comparable untreated offenders would result in an effect sizeof .15. This difference in treated and untreated recidivism rates can also be interpreted as meaning thattreatment has led to a 33% reduction in recidivism (calculated as: (TR – UR) / UR; in our example (3045)/45=33%).
In terms of practical significance, the effect sizes found in meta-analyses of correctional treatment are
actually comparable, and in some cases even better, to those of well-recognized medical interventions suchas the use of aspirin and heart bypass surgery to reduce the risk of heart attacks (Marshall & McGuire, 2003;
McGuire, 2001). Further, cost-benefits analyses, an issue of importance in the ever-increasing costs ofadministering criminal justice, demonstrate that for each dollar invested in effective correctional interventions,the return is anywhere between $1.13 to $7.14 in savings (Welsh & Farrington, 2001). More importantly
though, reductions in recidivism also mean reductions in future victims as well as improved positive societal
contributions by ex-offenders, cost savings not included in the above calculations. These results demonstrate
the importance of adhering to the risk-needs-responsivity principles when developing and implementing
correctional interventions for all types of offenders, including sexual offenders.

III. THE ISSUE OF MOTIVATION AND TREATMENT ATTRITION
Treatment attrition is a universal phenomenon that is well recognized in the correctional literature, andstudies show that all offenders who start but fail to complete treatment reoffend at higher rates thanoffenders who either complete treatment or do not start at all (Nunes & Cortoni, 2006; Wormith & Olver,
2002). Typically, offenders drop out of treatment because their expectations were not met: they found thetreatment too demanding or they did not believe the treatment was relevant or could help them (Day, Casey,
Ward, Howells, & Vess, 2010). In addition, treatment participants may be removed from a programme forbeing disruptive or due to lack of attendance. Another potential cause of attrition is a lack of correspondence
between the referral and the programme. For example, if an offender is assessed as having a lower need ina given area, and yet is required to complete a treatment programme designed for offenders with higher
needs, he may become discouraged, and fail to complete the programme. The reasons for dropping out oftreatment are often seen as indicative of a lack of motivation on the part of the offender. A lack of motivation
may be related to a reluctance on the part of the offender to engage in treatment, also called resistance totreatment; to a failure to envision the intrinsic benefits of participating in treatment; or to a poor relationshipwith treatment providers. Taken together, these characteristics may be indicative of a lack of readiness fortreatment (Day & al, 2010). Motivation is therefore an important variable that must be considered when
implementing treatment programmes. Treatment must include elements designed to assess, increase, andmaintain motivation prior, during, and after treatment.

IV. SYSTEM FACTORS
A. The Importance of Skilled Treatment Providers
The characteristics of treatment providers are important elements of positive rehabilitative efforts. The
effectiveness of correctional treatment is enhanced when the services are delivered by therapists who
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adhere to the treatment objectives and strategies, who concurrently serve as anti-criminal models, and who
reinforce offenders’ pro-social attitudes and efforts (Dowden & Andrews, 2004). The fundamental desirable
characteristics of therapeutic staff that have demonstrated value regardless of the type of correctional
programme, correctional setting, or offender population include:•

Relationship factors: relating to offenders in clear, open, caring, and enthusiastic ways, and providing
a structured positive therapeutic environment.

•

Authority (i.e., “firm but fair” stance): making a distinction between rules and requests, and monitoring
and reinforcing compliance to rules.

•

Anti-criminal modelling and reinforcing: demonstrating and reinforcing vivid alternatives to prooffending styles of thinking, feeling, and acting.

•Concrete problem-solving ability: providing skill-－building tools and helping offenders to identify andremove obstacles to their efforts to engage in anti-offending behaviours.

Not surprisingly, genuineness, the ability to remain non-judgmental, respect, warmth and empathy, allelements that contribute to a positive therapeutic relationship with other non-criminal populations, areequally important when working with offenders. It is important, however, that treatment providers do notconfuse acceptance of, and empathy for the offender, with unconditional acceptance of the offender’s distorted
views of himself, others and his offending. The latter is actually counter-productive when working withoffenders as it would only reinforce, rather than reduce, the factors that contribute to the criminal behaviour(Bonta & Andrews, 2017).
Behaviours in treatment include adopting a Socratic rather than a didactic approach, asking open-ended
questions, being flexible, encouraging and rewarding participation, instilling hope and confidence, and being
emotionally responsive to offenders (Fernandez & Serran, 2002). When working with offenders, thesecharacteristics help toward establishing a positive therapeutic climate during treatment; in turn, a positive
therapeutic climate contributes to the effectiveness of treatment in reducing recidivism (Beech & HamiltonGiachritsis, 2005; Dowden & Andrews, 2004).
No matter how interpersonally and clinically skilled the treatment providers may generally be, they
additionally must be committed to rehabilitation and well-trained in the delivery of offender treatment(McGuire, 2001). Concurrently, organizations must ensure that treatment providers have the needed resources
to carry out their work. As McGuire (2001) stated, ‘There are no known treatment or training material thatthat will achieve its goals in the absence of trained and committed staff with adequate resources andmanagerial support’ (p. 34). Consequently, therapists should:
•
•
•
•
•

possess relevant academic credentials;
be skilled in the principles of cognitive-behavioural interventions;
understand the theoretical and empirical findings that explain sexual offending behaviour;
receive ongoing training and clinical supervision by supervisors skilled in interventions with sexual
offenders;receive support from managers for their work.

B. The Importance of Support by the Correctional Administration
Although research has clearly demonstrated that correctional treatment can be effective in reducing
recidivism in sexual offenders, the lack of adherence to the elements that contribute to the effectiveness ofcorrectional treatment continues to be quite frequent. Gendreau, Goggin, and Smith (2001) examined theresults of three large-scale reviews of correctional treatment programmes that included 291 different
treatment programmes in Canada and the United States. In total, Gendreau et al. (2001) found that 70% of
these treatment programmes failed to attend to the principles of effective correctional treatment. The mostcommon problems included:•

untrained clinical staff that were not familiar with the theoretical and empirical literature on criminal
behaviour;13

RESOURCE MATERIAL SERIES No. 110
•
•
•
•
•

non-existent risk assessment procedures, or procedures that were not in line with current professional
standards for risk assessments;
the provision of treatment for non-criminogenic factors
the use of treatment approaches to address criminogenic factors that have been shown to be ineffective;
an almost complete failure to attend to responsivity factors of offenders in treatment;
and finally, a lack of systematic evaluations.

These problematic issues indicate that correctional systems are still struggling with the implementationof effective correctional interventions. These struggles may be due to a lack of knowledge, a lack of resources
or alternatively, a simple resistance to correctional treatment based on Bonta & Andrews’s (2017) principles.
The lack of knowledge can be easily rectified via training and further education. At a minimum, appropriate
levels of education in a relevant domain such as criminology or psychology should be a requirement forclinical staff. Formal education, however, has its limits if these staff members do not ensure their professional
knowledge is up to date. Given the rapid growth of empirical information on risk factors and interventions
with sexual offenders, periodic training by specialists may be a cost-effective strategy for correctional systems
to ensure their staff members keep current on the latest available theoretical and empirical information.
Training will only be effective, however, if it is fully supported (and even at times mandated) by management.
The lack of resources is a much more difficult issue to address. Correctional systems are expensive andresources are typically allocated by governmental bodies. In this context, despite best intentions, correctional
managers may not have sufficient discretion to allocate appropriate levels of funding to the treatment ofoffenders. An argument in favour of appropriate levels of funding, as discussed earlier, may lie in helping
funding agencies understand the cost effectiveness of correctional interventions when compared to the costof incarceration. Unfortunately, despite best efforts by correctional managers, increased funding forcorrectional interventions too often occurs only in response to major offences (e.g., sexual assaults, murders)committed by offenders on parole who had been inappropriately assessed and managed. While clearly, nocorrectional systems can ever completely prevent such unfortunate events, the evidence on risk assessmentand management of offenders, including the provision of appropriate intervention services, is strong. By
ensuring their practices adhere to this evidence, correctional systems will be better equipped to differentiallymanage higher risk offenders while ensuring that lower risk offenders are not subjected to unnecessarily
severe practices (Andrews & Dowden, 2007).
Resistance to correctional treatment may fundamentally be the most problematic issue to resolve. Somecorrectional systems (or individuals in these systems) may simply choose to discard the evidence on effective
interventions due to expediency, or to management, organizational, and socio-political demands and decisions.
In other instances, correctional staff may have differing theoretical orientations that do not include cognitivebehavioural approaches or do not focus on dynamic risk factors, preferring instead to focus on sociologicalmodels of crime or on traditional models of psychopathology as the theoretical basis for the treatment ofsexual offenders. Alternatively, staff members may simply hold personal views of sexual offenders thatprevent them from supporting the treatment programme.
It is in these circumstances that the support offered by the administration of the correctional system andthe education and training of all correctional staff members become crucial. No matter how well designed
the treatment may be, or how well skilled and trained the therapists are, treatment programmes that are
not supported from the top administration of the correctional system, or from other staff members, will fail.
Treatment programmes do no operate independently from the rest of the correctional system. As such, thesystem must ensure that all other staff members are aware of and support the treatment programme. For
example, treatment participation by offenders should be mandated by the offender management system;
institutional case managers and parole officers need to support the offender in his participation in thetreatment programme; prison officers must ensure the offenders can physically attend their treatment;
institutional administration must ensure an appropriate treatment environment is provided; treatment
results and corresponding updated risk assessments must be integrated in release decisions and community
supervision strategies.
To address these issues, once a decision has been made by senior administrators to offer specialized
treatment to sexual offenders in their system, a comprehensive strategy to inform and educate all staff
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members of the importance of the treatment for the reduction of sexual recidivism should be developed andimplemented. Within this context, as systems and people do not readily change, it is useful to consider
identifying a specific site that will offer the treatment programme, and devote efforts to create an environment
through staff selection and training that will support the efforts by the therapists in their treatment of sexual
offenders. Finally, it is important to evaluate the treatment programme in order to identify and rectify
problems before implementing the treatment programme to other sites.
C. The Importance of Programme Evaluations
Conducting evaluative research to determine the effectiveness of correctional treatment programmes inaddressing the criminogenic factors of sexual offenders and reducing sexual reoffending is an important, yetfrequently neglected, component of correctional treatment. Too often, the evaluation of the treatment
programme is an activity that is reserved for the future, after the programme has been in operation forseveral years, and sufficient time has elapsed to determine outcome. This situation, however, leads to very
unsatisfactory results: during the evaluation, questions inevitably arise that will be unanswerable. To avoid
wasted resources on treatment that are not functioning well, it is recommended that when treatment
programmes are implemented, concurrent efforts be devoted to developing the evaluative framework thatcan be reviewed and adjusted as changes to the programme take place. This process ensures that safeguards
are in place to prevent errors and to allow for valid conclusions to be drawn.
To examine the various aspects of treatment programmes, two broad categories of evaluative researchshould be in place: formative (process) evaluations and effectiveness evaluations. Formative evaluation isdesigned to establish how well current treatment programmes operate and how they can be improved. Suchevaluations, however, only provide part of the information regarding well-designed and well-implemented
correctional interventions. Effectiveness evaluation is intended to determine whether the correctional
intervention is successfully addressing the criminogenic factors of offenders and whether changes on thosefactors are related to intended outcomes, such as abstinence from substance abuse, and a reduction inrecidivism.
D. Formative Evaluation
The overall goal of formative evaluations is to examine issues related to the process of the intervention.
This type of evaluation is concerned with what the correctional intervention does and is designed to help
programme managers and others improve on what they do. Formative evaluations yield information on theimplementation of the correctional intervention in the designated setting. The focus of the evaluation is on
issues related to the implementation and the management of the correctional intervention and its users.
These evaluations are thereby required to examine the general quality of the programme implementationand delivery, including whether the programme was implemented as per the programme manual; whether
staff are appropriately selected, trained and supervised as needed; and whether the appropriate candidates
were enrolled, and the appropriate setting selected. The following are basic questions that are typicallycovered by formative evaluations:•

Are the appropriate participants enrolled in the treatment programme? (e.g., high risk offenders
enrolled in a corresponding high intensity treatment programme)•

How do the participants react to the treatment programme? (e.g., engagement; group cohesion; active
participation; satisfaction with the process; drop-out rates; reasons for drop-out)•

Is the programme implemented as per its established requirements? (e.g., appropriate setting;appropriate number of delivery staff; appropriate number of sessions; appropriate length of sessions)•

Is the application of the programme consistent with the intended programme? (e.g., the programmedelivery style is consistent with the manual; content is fully delivered as per the manual)•Is the environment conducive to the implementation of the programme? (e.g., general staff members
aware and supportive of programmes; collateral behavioural information is collected as required;programme participation reports are useful to parole officers & other decision makers; management
supportive and ensure the appropriate resources are allocated to the programme).

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Is the programme delivery attentive to responsivity issues? (e.g., literacy level; mental health issues).

E. Effectiveness Evaluation
The overall goal of effectiveness evaluations is to determine whether the programme has led to thedesired outcomes. This type of evaluation is concerned with whether the programme achieved its goals. In
other words, the evaluation is concerned with what changed as a result of the programme. To determine
whether the programme has led to change, planned comparisons with appropriate groups of offenders who
did not participate in the intervention are invariably part of the evaluative design.
Although correctional interventions have as an ultimate outcome the reduction of recidivism, variationsin the types of expected short-term outcomes for particular interventions are expected by the simple factthat correctional interventions should be designed to address specific dynamic factors. The elements targeted
for intervention and the desired outcomes are a necessary part of the development of the correctional
intervention. Specific research questions and testable hypotheses about the effectiveness of the intervention
will therefore be based on these targeted elements and desired outcomes. As previously mentioned, suchresearch questions and hypotheses should be established during the development phase of the correctional
intervention to ensure that appropriate data collection procedures are established to permit the eventual
testing of these hypotheses.
F. Outcomes of RelevanceWithin the context of correctional programmes, the proximate outcomes are the cognitive and behaviouralchanges that are expected to result from participation in the intervention. Changes on these characteristics
should be apparent in the short and longer terms as well as being linked to the overall goal of reduced
recidivism. A short-term outcome is defined as the immediate results expected from participating in thecorrectional intervention. Attitudinal changes or changes in self-regulation skills are examples of short-term
outcomes. Longer-term outcomes are defined as expected changes that would manifest themselves aftersome passage of time following programme completion. In this context, expected behavioural changes, suchas a reduction in institutional incidents, improved behaviour in the community, and a reduction of recidivism,are all viewed as longer-term outcomes.
G. Evaluative Research Questions•

Has the intervention led to demonstrated cognitive and behavioural changes in participants?

•

Are those changes maintained over time?

•Is the intervention, and its resulting changes, linked to a reduction in recidivism?

V. CONCLUSION
Jurisdictions from around the world are concerned with the rehabilitation of sexual offenders. Treatment
programmes that are based on the risk, criminogenic needs, and responsivity principles are effective methods
to manage and reduce the risk of sexual recidivism. It is noted that our current empirical knowledge is basedon studies mostly conducted in the Western world. Little is known about the validity of our current
correctional interventions when they are implemented in vastly different correctional systems and countries.
Although to date it appears that our findings on the risk factors for criminal recidivism are valid across anumber of jurisdictions (Bonta & Andrews, 2017), much research is yet needed to establish the effectivenessof correctional programmes in differing systems. It is hoped that jurisdictions that develop and implement
correctional treatment programmes based on the principles of effective interventions with offenders willconsider the value of research in their efforts. It is through the ongoing accumulation of empirical evidence
that we will all collectively improve our abilities to assess, manage, and rehabilitate offenders.

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