ASSESSMENT OF SEX OFFENDER TREATMENT
Recidivism rates for 136 extrafamilial child molesters were evaluated during a follow up period of 6 .3
years . Of the 136 participants 31% were convictedof a new sexual offense, 43% committed a violent
or sexual offense, and 58% were arrested or
returned to the penitentiary . In analyzing theserecidivism rates, the researchers looked at the following variables: sexual assessment measures, treatment variables, and outcome variables . Of thesevariables, marital status, previous time spent in apenitentiary, previous property convictions, previous sexual convictions, diagnosis of a personality
disorder, and sexual age preference as indicated byphallometric responses were found to be thestrongest predictor variables of sexual recidivism .
Fifty percent of the child molesters in the sample
had participated in behavioral therapy . However,therapy did not affect recidivism with this sample .

GENERAL RECIDIVISM RATESHANSON, R .K ., ScoTT, H ., & STEFFY, R.A . (1995) . A
COMPARISON OF CHILD MOLESTERS AND NONSEXUALCRIMINALS: RISK PREDICTORS AND LONG-TERM RECIDIVISM .

JOURNALOF

RESEARCH

IN

CRIME

AND

DELINQUENCY, 32 (3), 325-337 .

This study compared the recidivism rates of a sample
comprised of 191 child molesters and 137 nonsexual
offenders over a 15 to 30-year period . During thistime period, 83 .2% of the nonsexual criminals recidivated while only 61.8% of the child molesters reoffended. In analyzing the characteristics of the offending behavior, the authors reported that when the childmolesters reoffended the crime was of a sexual nature
whereas the nonsexual criminals were responsible forthe majority of nonsexual violent crimes .
PRENTKY, R .A ., LEE, A .ES., KNIGHT, R .A ., & CERCE,

D . (1997) . RECIDIVISM RATES AMONG CHILD MOLES-OVERVIEW OF TREATMENT OUTCOMESTERS AND RAPISTS : A METHODOLOGICAL ANALYSIS .
LAW AND HUMAN BEHAVIOR, 31 (6), 635-659 .

ABRACEN, J., & LOOMAN, J. (2001) . ISSUES IN THE
TREATMENT OF SEXUAL OFFENDERS : RECENT DEVELOP-The authors attempted to evaluate the inconsistencies involved in recidivism research through theexamination of various methodological applications . A data set of 251 sex offenders (136 rapists
and 115 child molesters), which spanned a time
period of 25 years, was analyzed in an attempt tounderstand differences in recidivism rates . The
authors postulated that these changes in recidivism
rates resulted from differences in the operationalization of recidivism, criminal offenses, and followup period . In analyzing this data, the researchers
found that figures were underestimated when thedefinition of recidivism was based on conviction or
imprisonment . It was also concluded that sexual
offenders are at risk of reoffending for a long periodof time.
RICE, M.E., QUINSEY, UL., HARRIS, G .T.
SEXUALRECIDIVISM

AMONG

CHILD

MENTS

JOURNAL

DIRECTIONSFOR FUTURE

RESEARCH .

AGGRESSION AND VIOLENT BEHAVIOR, 1, 1-19 .

This article discussed what constitutes effective
treatment through evaluation of the Regional
Treatment Centre Sex Offender Treatment Program(RTCSOP) and the California Department of
Mental Health's Sex Offender Treatment and
Evaluation Project (SOTEP) . In addition, it
included a discussion about in-treatment changes
on dynamic variables that entails looking at thetreatment of minimization and denial, as well as
reviewing individual versus group treatment . The
article also presented data from several studies thatfrequently discussed the association of alcohol andsexual offending . In summary, the authors concluded that cognitive-behavioral treatment geared
to the principles of risk/need/responsivity can beeffective at reducing recidivism in sex offenders .

(1991) .

MOLESTERSRELEASED FROM A MAXIMUM-SECURITY PSYCHIATRICINSTITUTION .

AND

OF CONSULTING AND

CLINICAL PSYCHOLOGY, 59 (3), 381-386 .

263

BECKER, J.R . (1994) . OFFENDERS : CHARACTERISTICSCRAIG, L.A., BROWNE, K .D ., & STRINGER, I . (2003) .

AND TREATMENT. THE FUTURE OF CHILDREN: SEXUAL

TREATMENT AND

ABUSE OF CHILDREN, 4 (2), 176-197 .

TRAUMA, VIOLENCE, & ABUSE, 4 (1), 70-89 .

This article reviewed what is known about offenders and treatment . First, the role of paraphilias inchild molestation is discussed . Second, the article
looked at what is known about offenders, including
data on juvenile offenders and incest offenders .
Third, the article discussed recidivism and the difficulty of determining recidivism rates, with a summary of what is known about recidivism of
untreated offenders . Fourth, the article looked attreatment, including mechanisms for getting offenders into treatment, goals and types of treatment, theefficacy of treatment, and the need for post-incarceration monitoring and long term treatment . Low
recidivism rates have been reported with cognitivebehavioral treatment .

This article points out that cognitive-behavioral
treatment has emerged as the principal type of sex
offender treatment targeting deviant arousal,
increasing appropriate sexual desires, modifying
distorted thinking, and improving interpersonal
coping skills . The authors indicated that since
1995, 19 treatment studies have been published,
and a third demonstrated positive treatment effects
and used sound methodological principals to establish the most effective way of reducing sexual reoffending . This article reviewed such studies and concluded that meta-analytical studies of treatment
efficacy provide conflicting viewpoints . Furby et al .
(1989) and Quinsey et al . (1993) previously foundno convincing evidence that treatment reduces
recidivism, whereas W. L . Marshall and Barbaree(1988) and W. L. Marshall, Eccles, et al . (1991)
demonstrated positive treatment results in reducing
sexual offense recidivism . Further, the meta-analysis
by Hall (1995) reported a small but robust treatment effect . The authors contend that although sex
offender treatment programs appear to reduce sex
offense recidivism, what is not clear is whether thisis specific to particular types of sex offenders (adultor adolescent offenders, exhibitionists, child molesters, adult rapists, personality disordered), which
may in turn be limited to specific modalities oftreatment (cognitive-behavioral, MST, chemical
castration, and behavioral therapy) . Further, theauthors suggested that treatment efficacy may bebetter served by exploring which dynamic factors
affect recidivism in order to facilitate the forensic
practitioner when assessing if the offender isreleased back into the community . Research on
those dynamic factors associated with the environment, opportunity to offend, and changes in criminogenic factors, once integrated into treatment
programs, would contribute to reducing the recidivism rates . One reason some studies fail to find significant treatment results is that the base rates forsexual reoffending are relatively small . By virtue ofthe sample, programs that target lower risk offenders are likely to have difficulty in demonstrating
treatment effects in already low rates of recidivism .

BURDON,WM ., &GALLAGHER,

C.A .

(2002) .

COERCION AND SEX OFFENDERS : CONTROLLING SEXOFFENDING BEHAVIOR THROUGH INCAPACITATION AND
TREATMENT. CRIMINAL JUSTICE AND BEHAVIOR, 29(1), 87-109 .

This article examined the dual roles that coercion
has played in treating sex offenders and controlling
their behavior. In addition, the article suggested atheoretical explanation for the apparent effectiveness of cognitive-behavioral approaches to treating
sex offenders . The authors suggested that coercion
has served two primary and important roles : incapacitation and ensuring entry into and retention intreatment . However, the authors reported that as
efforts to assess the overall effectiveness of sex
offender treatment continue, self-determination
theory and organism integration theory offer somepossible insight into the apparent effectiveness ofcognitive-behavioral therapy and suggest a numberof alternative dependent measures that can be used
to assess overall effectiveness of sex offender treatment. Although the current reliance on dependentmeasures such as recidivism and refunding may
speak to the overall effectiveness of treatment, it
does not reveal much about the treatment processitself. According to the authors, this knowledge isessential in terms of ongoing efforts to further
improve treatment effectiveness .

264

SEXUALOFFENSERECIDIVISM .

EFFECTIVENESS OF TREATMENT OF SEXUAL
OFFENDERS: REPORT OF THE ASSOCIATION FOR THE

treatment . The current review suggested that treat-

TREATMENT OF SEXUAL ABUSERS, COLLABORATIVE

through their ability to monitor risk . Further, there is

DATA RESEARCH COMMITTEE, NOVEMBER 3, 2000 .

reliable evidence that those offenders who attend andTHEment programs can contribute to community safety

cooperate with treatment programs are less likely to
re-offend than those who rejected intervention .

This report outlined the treatment effectiveness for
reducing sexual offense recidivism and general

K .R .,GORDON,A., HARRIS, A .J .R .,W., QUINSEY, V.L ., &recidivism through evaluation of studies used in the

HANSON,meta-analysis . The studies evaluated were predom-

MARQUES, J .K .,inantly cognitive behavioral . Found that reductions

SETO, M .C . (2002). FIRST REPORT OF THE COLLABO-

in both sexual recidivism (17% to 10%) and gen-RATIVE OUTCOME DATA PROJECT ON THE EFFECTIVE-

MURPHY,(51% to 32%) are possible when

NESS OF PSYCHOLOGICAL TREATMENT FOR SEX OFFEND-

current treatment programs are evaluated with

ERS . SEXUAL ABUSE : A JOURNAL OF RESEARCH AND

credible designs .

TREATMENT, 14 (2), 169-194 .

HALL, G.C .N. (1995) . SEXUAL OFFENDER RECIDIVISM

This meta-analytic review examined the effective-

REVISITED : A META-ANALYSIS OF RECENT TREATMENT

ness of treatment by summarizing data from 43

STUDIES . JOURNAL OF CONSULTING AND CLINICAL

studies (combined n = 9,454) . Most of the studies in

PSYCHOLOGY, 63 (5), 802-809 .

the review were produced after 1995 and 23% were
only available after 1999 . Forms of treatment oper-eral recidivism

Hall performed a meta-analysis ontreatment with sexual offenders

12 studies of(N=1,313) . A

ating prior to1980 appeared to have little effect .

When averaged across all studies, the sexual offense

small, but robust, overall effect size was found forrecidivism rate was lower for the treatment groups .

treatment versus non-treatment . Cognitive-behav-

Current treatments were associated with reductions

ioral treatment and hormonal treatment reduced

in sexual recidivism and general recidivism . The

30% (from 27% torecidivism rates for treated sex offenders wererecidivism by approximately

19%) . He also found that studies with longer fol-lower than the recidivism rates of untreated sex

low-up periods that included outpatients in theiroffenders . Studies comparing treatment completerssamples had larger effects as did those with higher

to dropouts consistently found higher recidivism

base-rates . Cognitive-behavioral treatment was

rates for the dropouts, regardless of the type offound to be superior to behavioral treatment and as
effective as hormonal treatment .

treatment provided .
R .K ., STEFFY, R .A ., & GAUTHIER, R.
(1993) . LONG-TERM RECIDIVISM OF CHILD MOLES-HANSON,HANSON, K., & BUSSIERE, M .T. (1998) . PREDICTINGRELAPSE:A META-ANALYSIS OF SEXUAL OFFENDERTERS . JOURNAL

RECIDIVISM STUDIES. JOURNAL OF CONSULTING AND

OFCONSULTINGAND

CLINICALPSYCHOLOGY, 61 (4) .

CLINICAL PSYCHOLOGY, 66 (2), 348-362 .
This study examined the long-term recidivism rates
Even though this article primarily reviewed recidi-

of male child molesters who were released from a

vism studies, it does discuss treatment effectivenesswith regard to recidivism . Evidence from 61 follow-

maximum-security Ontario provincial prison
between 1958 and 1974 . The treatment group in

up studies was examined to identify the factors

this study included child molesters who weremost strongly related to recidivism among sexual

treated between

offenders . With regard to treatment, examination

program aimed to increase the social competence ofof these studies found that offenders who failed tothe offenders through individual and group coun-complete treatment were at increased risk for both

seling and by creating a therapeutic milieu thatsexual and general recidivism . The article statedencouraged the men to recognize and correct socialand sexual adjustment problems . The offenders alsothat reduced risk could be due to treatment effectiveness ; alternatively, high-risk offenders may be1965 and 1973 . The treatment

received aversive conditioning training to decrease

those most likely to quit, or be terminated, fromtheir sexual interest in children . Because the26 5

severity of these offenses . The data concerning theactual number of offenses indicated that treatment
was effective in reducing the number of new offenses
when offenders do recidivate .

program was designed in the 1960s, it was not
informed by the subsequent developments in thefield, such as relapse prevention and various cognitive-behavioral techniques . Results of this study
found that the child molesters who were enrolled in
the treatment program showed clinically significant
improvements on almost all of the mental healthand personality measures used in this study. Fortytwo percent of the sample engaged in another sexual of serious offense and ten percent of the participants were reconvicted . The factors found to havean affect on recidivism include previous sexual
offenses, never having been married, and victim
preference . Incest offenders were the least likely torecidivate whereas those who selected only malevictims were at the greatest risk of recidivism .
However, the lack of equivalent measures on a control group limited the extent to which these changes
could be attributed to the treatment program itself .
The authors concluded that sexual offense recidivism is most likely to be prevented when interventions attempt to address the life-long potential for
re-offense and do not expect child molesters to bepermanently "cured" following a single set of treatment sessions .

MALETZKY, B.M . (2002) . A 25-YEAR FOLLOW-UP OF
COGNITIVE-BEHAVIORAL THERAPY WITH 7,275 SEXUAL
OFFENDERS . BEHAVIOR MODIFICATION, 26 (2), 123-148 .
Outcome data is presented, grouped into five year
cohorts, for 7,275 sexual offenders entering a cognitive-behavioral treatment program. The assessment variables included treatment completion, selfadmission of covert and/or overt deviant behaviors,
the presence of deviant sexual arousal, or being
recharged for any sexual crime (regardless of plea
or conviction) . It proved possible to follow 62% for
the cohort at five years after initiating treatment,
but follow-up completion rates decreased withtime . Outcomes were significantly different basedon offender subtype, with child molesters and exhibitionists achieving better overall success thanpedophiles or rapists . Prematurely terminating
treatment was a strong indicator of committing a
new sexual offense . Of interest was the general
improvement of success rates over each successive
five year period of many types of offenders .
Unfortunately, failure rates remained comparatively
high for rapists (20%) and homosexual pedophiles(16%), regardless of when they were treated overthe 25-year period .

LOOMAN, J ., ABRACEN, J ., & NICHOLAICHUK, T.P.
(2000) . RECIDIVISM AMONG TREATED SEXUAL OFFENDERS AND MATCHED CONTROLS : DATA FROM THE
REGIONAL TREATMENT CENTRE . JOURNAL OF
INTERPERSONAL VIOLENCE, 15 (3), 279-290 .

MARQUES, J .K ., NELSON, C ., ALARCON, J.M., & DAY,
D .M . (2000) . PREVENTION RELAPSE IN SEX OFFENDERS:
WHAT WE LEARNED FROM SOTEP'S EXPERIMENTAL
TREATMENT P ROGRAM . IN D .R . LAWS (ED .) . REMAKINGRELAPSE PREVENTION WITH SEX OFFENDERS (PP . 321340) . CALIFORNIA: SAGE PUBLICATIONS .

Follow-up data are reported on 89 sexual offenders
at the Regional Treatment Centre in Ontario and
89 untreated sex offenders matched for pretreatment
risk . The average time at risk was 9 .9 years. It was
found that the treated group had a sexual recidivism
rate of 23 .6%, whereas the untreated group had asexual recidivism rate of 51 .7% . The treated participants were less likely to be convicted for either sexual or nonsexual offenses, and those who werereconvicted spent significantly less time incarcerated
than the untreated participants at the time of followup . These data suggested not only that treatment
resulted in fewer incarcerations but also that when
the treated participants were convicted, they tended
to receive shorter sentences than the untreated group .
The authors suggested that if shorter sentences reflect
less severe offenses, then treatment had an impact
not only on the number of offenses but also on the

The authors provided an overview of the Sex
Offender Treatment and Evaluation Project(SOTEP), which is housed at Atascadero State
Hospital in California . The SOTEP is a longitudinal
research program (1985-1995) that was designed toevaluate the effectiveness of an innovative relapse
prevention program for sex offenders who areunder civil commitment as sexually violent predators . The project is now in the follow-up phase, inwhich recidivism data are being collected on both
treated and untreated study participants . The article266

described some of the lessons learned from SOTEP,MARSHALL, WL ., & ANDERSON, D .

particularly those that highlighted the strengths and

RELAPSE PREVENTION COMPONENTS ENHANCE TREATMENTEFFECTIVENESS?
IN D .R . LAWS (ED .) .

weaknesses of the Relapse Prevention model as wasapplied in the treatment program . It is acknowl-(2000) .

Doedged that some of the information is based on pre-REMAKING RELAPSE PREVENTION WITH SEX OFFENDERS (pp. 39-55) . CALIFORNIA : SAGE PUBLICATIONS .

liminary analyses of the recidivism data, as well as
informal and qualitative data sources . In addition,

This article attempted to evaluate the effectivenessthe authors indicated some specific ways that theof the Relapse Prevention (RP) model by discussing

model could be improved and describe their newest

achievement of within-treatment goals, issues inapplication of the RP model .

evaluating treatment (i.e ., indices of reoffending
and duration of follow-up), features to be evaluated

MARQUES, J .K . (1999) . HOW TO ANSWER THE QUESTION "DOES SEX OFFENDER TREATMENT WORK?"(i .e ., the components of RP and the effects of(4),

behavioral treatment), and looking at programs

JOURNAL OF INTERPERSONAL VIOLENCE, 14

adding RP components to standard cognitive-

437-451 .

without RP. The authors concluded that this review
offered strong support for the idea that sexual

The author focused on the Sex Offender Treatment

offenders can be effectively treated . Cognitive-

and Evaluation Project (SOTEP), which is a longi-

behavioral programs utilizing an internal self-man-tudinal research program that the author and heragement RP component that is not too elaborate
appear to be the most successful .

colleagues have been conducting in California forthe past ten years . The overall design of the study is

MARSHALL, WL ., ANDERSON, D ., & FERNANDEZ, Y.

discussed as well as some of the problems that the
researchers encountered when conducting treat-(1999) . THE DEVELOPMENT OF COGNITIVE BEHAV-

ment outcome studies . In conclusion, a summary of

IORAL TREATMENT OF SEX OFFENDERS (PP . 146-163) .
ENGLAND : JOHN WILEY & SONS, LTD .

the preliminary findings is given which suggest thattreating the more serious offender is worthwhile
be teaching some skills that can be important to

The authors discussed ways to evaluate treatment
programs . They concluded that treatment with sex

high-risk offenders .

offenders can be effective and that the balance ofand that their relapse prevention program seems to

the evidence weighs in favor of a positive treatment
outcome . Cost-benefit analyses are discussed but
they exclude the cost of therapy for the victims .

MARSHALL, WL . (1993) . THE TREATMENT OF SEX
OFFENDERS : WHAT DOES THE OUTCOME DATA TELL US?
A REPLY TO QUINSEY, HARRIS, RICE AND LALUMIERE .
JOURNAL OF INTERPERSONAL VIOLENCE, 8

Cohen and Miller (1998) derived data relevant tothis issue from various American organizations .

(4),524-530 .

Based on means for 1991, the total cost of treatment for victims of recent child sexual abuse

Marshall agreed with Quinsey et al . (1993) that theapplication of rigorous methodological standards

exceeded $600 million. For victims of historicalneeds to be applied to a well developed field of sex

childhood sexual abuse, the total was over $4 billion whereas for adult victims of attempted or com-

offender treatment outcome studies ; however, thisfield is still in its early stages . On the other hand,pleted rape, the cost of their treatment exceeded$800 million . The value of treatment with sex

Marshall disagreed with these authors' conclusion

offenders far exceeds the obvious benefits ofreduced recidivism . From these types of analyses, itregarding controlled, random-design study, andappears that out of every 100 sex offenders treated,

meta-analytic approaches to evaluation because
there is little data on which to base our inferences

we only have to prevent 3 or 4 who would otherwise have offended from reoffending in order toabout effectiveness .

cover the costs of treatment .

267

MARSHALL, W.L ., & BARBAREE, H .E . (1990) .
OUTCOME OF COMPREHENSIVE COGNITIVE-BEHAV-

programs seem to offer the best hope, with antian-

IORAL TREATMENT PROGRAMS . I N WL . MARSHALL

individuals .

drogens having a valuable adjunctive role for some(ED .) . HANDBOOK OF SEXUAL ASSAULT : ISSUES, THEORIES, AND TREATMENT OF THE OFFENDER (PP . 363-

MARSHALL, W.L., JONES, R., WARD, T., JOHNSTON,
P., & BARBAREE, H . (1991) . TREATMENT OUTCOME385) . NEw YORK : PLENUM PRESS .

WITH SEX OFFENDERS .

CLINICALPSYCHOLOGYThis article outlined the nature of comprehensive
cognitive-behavioral treatment programs for the

REVIEW, 11 (4), 465-485 .

treatment of sex offenders . It discussed the content

The article discusses the methodological stancesof these programs and outlined the major treatmentthat guide the review of the effectiveness of sex

targets that included (1) sexual behaviors and inter-

offender treatment in the literature . In determining

ests, (2) a broad range of social difficulties, and (3)the value of treating sex offenders, the authors fol-cognitive distortions about the offensive behavior.

lowed in the tradition of reporting failure rates that

Further, the article discussed how cognitive-behavioral treatment programs are evaluated andare typically derived from official records, re-arrestor reconviction, and that report the percentage ofincluded a revision of both institutional and outpa-

men who re-offend (recidivism rates) . They statedtient programs . The article concluded that cognitive-behavioral programs for the treatment of sex

that the most common criticism of treatment stud-

offenders offer encouragement for the continued
application and development of such programs .

with untreated offenders . When reviewing outcome
studies, the authors considered : physical treatments

However, according to the article, there are someinconsistencies in observed outcome across studies .

(psychosurgery, castration), pharmacological internon-behavioral
ventions(MPA andCPA),

For instance, some programs are very effective inapproaches (programs considered weretreating exhibitionists,

while others are not .

within prisons, or at least with maximum security

Similarly, some programs seemed to be relatively

settings), cognitive behavioral programs, institu-

more effective with men who molest boys than withtional based programs, and outpatient programs .

men who molest girls, while the reverse seems to be

The article concluded that the most effective treat-true for other offenders . The authors surmised thatment approaches are a combination of pharmaco-

the future of cognitive-behavioral approaches to thelogical and psychological treatment and cognitive

treatment of sex offenders appears to be positive,

behavioral treatment .

ies is the failure to provide a controlled comparison

offeredalthough there is much work still to be done .
MARSHALL, W.L ., & PITHERS, W.D . (1994) . A
MARSHALL, W.L ., & ECCLES, A. (1991) . ISSUES IN
CLINICAL PRACTICE WITH SEX OFFENDERS . JOURNAL OF

RECONSIDERATION OF TREATMENT OUTCOME WITH SEX

INTERPERSONAL VIOLENCE, 6 (1), 68-93 .

(4), 10-27 .

This article addressed issues that the authors
believed to be the most relevant to clinical work

This article presented an optimistic view of the lit-

with

sex

(Diagnosis

offenders,&

including :Evaluation)

andOFFENDERS . CRIMINAL JUSTICE AND BEHAVIOR, 21

erature, asserting that recent, relatively well-controlled evaluations have shown that treatment canAssessment
Treatment

be effective . To be maximally effective, according tothis appraisal of the literature, treatment must be(Antiandrogens, Non-behavioral Psychotherapy, &Cognitive-Behavioral Therapy) . The authors con-comprehensive, cognitive-behaviorally based, andinclude a relapse prevention component . According

cluded that assessments are essential because they
allow us to define the individual's problem, deter-

to the article, earlier outcome research that pro-mine his risk for reoffending, specify his treatment

duced either treatment failure, or at best equivocal

needs, and evaluate the effectiveness of treatment .

results, did not meet these criteria . The article

The authors asserted that the treatment of sex

reviewed two sets of publications

offenders is effective . Overall, cognitive-behavioral

Weinrott, & Blackshaw, 1989, and reports by the268-

Furby,

Penetanguishene Group - concerning therapeutic

for how to manage sex offenders . The data fromefficacy with sex offenders that in both cases pres-this study highlighted the importance of consideringent "gloomy" conclusions . The authors outlined thesex offender treatment completion as a factor inlimitations of the studies considered by both sets ofmaking release decisions . In this study, the reduc-publications . With regard to Furby et al, they discussed such issues as including outdated programstion in the sexual recidivism rate among partici-

in their review, potential biases against treatment

well as clinically significant . Treatment completers

effects, and duplication of data . With regard to thewere almost six times less likely to be charged forreports by the Penetanguishene Group, the authors

committing a new sexual offense than were partici-

discussed methodological problems such as the limited scope of the Pentanguishene treatment pro-pants who refused, dropped out, or were terminated from treatment . The authors acknowledgedgram, the problem of matching treated withthat these results were consistent with other recent

untreated subjects, and the fact that subjects wereoutcome results, however, they caution, that despite

not randomly assigned . The article also discussed

the fact that treatment completion was strongly

more recent evaluations of treatment efficacy andassociated with reductions in sexual recidivism,

concluded that even though these studies converge

inferences about the meaning of this association areon the conclusion that sex offenders who haveconfounded by some methodological difficulties .

engaged in specialized treatment re-offend at lower

The difficulties included the degree to which treat-

rates than offenders who have not participated inment groups were equivalent and the trouble

treatment, the authors noted that many of the evalu-

involved in sorting out the relative effects of theations do not include comparison with an untreatedthree interventions (prison treatment, community
treatment, and community supervision) .

pants who completed treatment was statistically asgroup . However, they referred to a study conductedby Marques et al . (1993), which was able to compare
three groups of sex offenders . Their research design

NICHOLAICHUK, T., GORDON, A ., GU, D ., & WONG,

matched volunteers who were randomly allocated toS . (2002) . OUTCOME OF AN INSTITUTIONAL SEXUAL

treatment or no treatment, and non-volunteers who

OFFENDER TREATMENT PROGRAM : A COMPARISON

were matched with the volunteers .

BETWEEN TREATED AND MATCHED UNTREATEDSEXUAL ABUSE : A JOURNALRESEARCH AND TREATMENT, 12 (2), 139-153 .
OFFENDERS .

MCGRATH, R .J ., CUMMING, G ., LIVINGSTON, J .A ., &OF

HOKE, S .E . (2003) . OUTCOME OF A TREATMENT PROGRAM FOR ADULT SEX OFFENDERS: FROM PRISON TO
COMMUNITY.

JOURNALOF

Data from a sex offender treatment program oper-

INTERPERSONAL

ated by the Correctional Service of Canada at the

VIOLENCE, 18 (1), 3-17 .

Regional Psychiatric Center in Saskatoon supported
the conclusion that cognitive behavioral treatment

The study, which is a retrospective study whereinwith high risk/need offenders can reduce sexual

random assignment was not possible, was an evalu-

offense recidivism . The study compared 296 treatedation of a component of the Vermont Treatment

and 283 untreated offenders followed for a mean ofProgram for Sexual Aggressors (VTPSA) . It is a

six years after their release . An untreated compari-prison-based treatment program for adult male sex

son subject was located for each treated offender on

offenders that include a community aftercare component. The study extended a preliminary evalua-

three dimensions (1) age at index offense, (2) dateof index offense, (3) prior criminal history.

tion of the program presented by increasing theConvictions for new sexual offenses among treatedsample size and lengthening the follow-up period .
The purpose of this study was to identify the char-offenders were 14 .5% versus 33 .2% for untreated
offenders. During the follow-up period, 48% of

acteristics of men who completed treatment andtreated offenders remained out of prison compared

compare them with those who refused or dropped

to 28 .3% of untreated offenders . Time series com-out of treatment and then to compare the re-offense
rates among these three groups . Treatment was cog-parisons of treated and comparison samples also

nitive-behavioral and relapse-prevention in nature .

showed that treated men reoffended at significantly
lower rates after ten years . This article stressed that a

The results of this study had several implications

necessary step in evaluating treatment outcomes is to269

outcome research with sex offenders has so seriously
failed to demonstrate effectiveness that a controlled,
random-design study is demanded and that metaanalysis is the best evaluative approach .

ensure that proper comparison samples are identified
rather than relying upon samples of convenience .
NICHOLAICHUK, T., & YATES, P. (2002) . TREATMENTEFFICACY: OUTCOMES OF THE CLEARWATER SEXQUINSEY, V.L., KHANNA,OFFENDER P ROGRAM. I N B . SCHWARTZ (ED .) . THE SEX

A

A., &

MALCOLM, P.B .

RETROSPECTIVE EVALUATION OF THE

OFFENDER : CURRENT TREATMENT MODALITIES AND
SYSTEMS ISSUES (CH . 3) . NEW JERSEY: CIVIC RESEARCHREGIONAL TREATMENT CENTRE SEX OFFENDER TREAT-INSTITUTE, INC .

MENT PROGRAM .

(1998) .

JOURNAL OF INTERPERSONALVIOLENCE, 13 (5), 621-644 .

This chapter discussed the controversy over theeffectiveness of cognitive-behavioral intervention
with sexual offenders and provided both qualitativeand quantitative reviews of sex offender treatment
efficacy with particular attention devoted to themethodological limitations of treatment effectiveness research. Further, the authors described the"Clearwater Study," which supports the findings ofprior research that postulated that cognitive-behavioral treatment, when applied to appropriate subjects, can reduce the occurrence of post treatment
sexual offending . This article highlighted the importance of addressing responsivity in treatment .
Specifically, findings indicated that risk for posttreatment recidivism is differentially associatedwith age, sexual offense history, type of offender,
deviant sexual arousal, psychopathy, and severity ofpre-treatment offense history .
QUINSEY, V.L .,LALUMIERE,HARRIS,M.L .

G .T.,RICE,

M .E .,The purpose of this study was to examine the relationship of psychological assessment data, provision of treatment, and progress in treatment to subsequent recidivism among inmates treated in the
Regional Treatment Centre (RTC) Sex Offender
Treatment Program between the years 1976 and1989 . The program employed behavioral and cognitive-behavioral approaches to treatment while
utilizing both individual and group therapy in three
to four month cycles. The follow-up period ended
in 1992 and a total of 483 inmates were followed .
Of these men, 213 received sex offender treatment,
183 were assessed for the program but were judged
as not requiring it, 52 refused to be assessed, 27
were assessed but judged to be unsuitable, and nine
were considered to require treatment but did notreceive it for various reasons, such as being released
before they could enter the program . Outcome data
were gathered from the Royal Canadian Mounted
Police computerized arrest and convictions records .
Sexual and violent offenses were defined as mutually exclusive . Of 483 inmates who were referred tothe sex offender treatment program and followed
for an average of 44 months of opportunity to reoffend, 38% were arrested for new violent or sexual offenses . The treated offenders were the mostfrequently rearrested for sex offenses . Inmatesjudged unsuitable for treatment were rearrested lessfrequently, particularly for sex offenses . Inmatesjudged to not require treatment and those who
refused treatment also had fewer re-arrests for sex
offenses than did treated participants, although
they had more re-arrests for violent offenses . After
statistically controlling for the static variables thatpredicted reoffending, the treatment program was
associated with a higher rate of sexual re-arrests but
had no effect on the composite variable, which was
violent or sexual re-arrests . Among treated offenders,&(1993) . ASSESSING TREATMENTEFFICACY IN OUTCOME STUDIES OF SEX OFFENDERS .

JOURNAL OF INTERPERSONAL VIOLENCE, 8(4),

512-523 .

The authors provided a critique of a study by
Marshall et al. They argued that the treatment literature does not support the conclusions of Marshallet al ., and that the approach taken in Marshall et
al .'s review is unable to provide scientifically satisfactory answers to questions concerning treatment
efficacy. The article discussed the methodologicalissues of the Marshall et al .'s review and enumerated the principle threats to the validity of the conclusions . The authors endorsed Marshall et al .'s view
with regard to cost-benefit analyses ; however, theauthors recognized that it is completely dependent onwhether the recidivism associated with treatment isstatistically significant . The authors concluded that

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being treated in the community, excluded a measureof social desirability, and excluded questions aboutother types of sexual fantasies . The article does not,however, specify what treatment approach was usedwith the participants .

clinical assessment of treatment gains was not significantly associated with recidivism . Overall the
results of this study mirrored the state of the literature on sex offenders . According to the authors, weare much better at measuring risk than we are atmodifying it, although substantial changes can bemade in proximal measures of treatment change .
The study found that the best prerelease predictors
were static historical variables .

WEISS, P. (1999) . ASSESSMENT AND TREATMENT OFSEX OFFENDERS IN THE CZECH REPUBLIC AND IN
EASTERN EUROPE . JOURNAL OF INTERPERSONALVIOLENCE, 14 (4), 411-421 .
SWATTER, T., HOLLIN, C ., BEECH, A., BECKETT, R., &The author described the experiences with the comprehensive therapeutic program for sexual offenders in the Czech Republic. Since 1976, specialized
departments for the treatment of sex offenders were
established in psychiatric hospitals . The treatment
is imposed by the court as per the recommendationsof forensic experts . As a rule, inpatient therapy isfollowed by treatment in outpatient "sexological"
departments . The therapeutic goals are as follows :adjustment of behavior, acquisition of information,
overcoming defensive mechanisms and creating
insight, strengthening of conscious control, changes
in attitudes and values, sexual adaptation, andsocial reintegration . These goals are achieved bymeans of a set of diagnostic, psychotherapeutic,
pharmocotherapeutic, and social measures including penile plethysmography, individual and grouppsychotherapy (in their psychodynamic and cognitive-behavioral forms), antiandrogen suppression,and social interventions . After 20 years (19761996), the author claimed that the recidivism rateof 953 treated offenders is 17.1% . He reported that
this rate compares very favorably with the observed
relapses of those offenders who did not receive
comprehensive treatment (approximately 80% during one- year after release) . The author acknowledged that the low recidivism rate might not be
entirely the effect of the therapy per se and postulated that it may also be attributed to the lengthy
period of outpatient aftercare and the close supervision by social workers given to the offenders after
discharge from the program . According to theauthor, of all the ex-communist countries, only the
Czech Republic has developed a special model ofsex offender treatment .

FISHER, D . (2000) . AN EXPLORATION OF CHILD SEXUAL ABUSERS' SEXUAL FANTASIES BEFORE AND AFTERTREATMENT.

SEXUALABUSE :A

JOURNALOF

RESEARCH AND TREATMENT, 12, 1 .

This study looked at the content, type, and frequency of deviant fantasies, both pre- and post psychotherapy, of 30 males with an average age of 43
years and seven months . Subjects were selected at
random from a larger group who participated in the
Sex Offender Treatment Evaluation Program(SOTEP) . Sixty percent of the subjects had been
convicted of an extra familial act of abuse . Sixty
percent of the victims were female, and 83 .3% were
12 years old or younger when the abuse first began .
The men had been convicted of a range of sexual
offenses, including indecent assault (S7%), incest(10%), and anal intercourse (7%) . The study usedboth qualitative and quantitative methodologies
and described the frequency, content of, and triggers for child sexual abusers' deviant fantasies asreported both pre- and post therapy . Of the eightquestions asked on a semi-structured interview, asignificant difference in the offenders' responses
were found on three of the items . A significant difference was found on pairing sexual fantasies withmasturbation directly after offending, fantasy triggers associated with the offender, and age of child insexual fantasies . A significant difference was notfound in time spent fantasizing about children
before the offense, fantasy triggers associated withchildren, developmental factors associated withsexual fantasies, and gender of child in sexual fantasies . The authors outlined the limitations of thisstudy, which included the issue that it was conducted on a small number of participants who were

27 1

Assessment it was found that the majority of subjects returned to previous or higher levels of vocational functioning and felt that the treatment had
been beneficial . It was found that the clerics in thissample struggled with loneliness, masturbatory
conflicts, and displayed a desire to have others perceive them beyond their vocational roles . Thosepriests identified as homosexual engaged in the following sexual behavior that was initially labeled ascompulsive : frequent, occasional, or self thwarted
procurement of anonymous sex, attempts to begin a
relationship with a rejecting individual, entitled,
defiant, rebellious sexual relationships with a gay
man, and use of pornography . Upon follow-up it
was found that these behaviors thought to havebeen compulsive had subsided and none of the clerics had relapsed .

CLERIC OFFENDERS AND
TREATMENT OUTCOMES
FONES, C .S .L ., LEVINE, S .B ., ALTHOF, S .E ., & RISEN,
C .B . (1999) . THE SEXUAL STRUGGLES OF 23 CLERGYMEN :A FOLLOW-UP STUDY. JOURNAL OFSEX&MARITAL THERAPY, 25, 183-195 .

Researchers followed 19 clergymen (17 Roman
Catholic priests) for a period of one to six years
after their evaluation in the Program forProfessionals sex offender treatment program . It
was found that 39% of the sample had offended
against adolescents . Of that percentage, 52% characterized their sexual behavior as being of a deliberate nature . Through clinical interviewing andadministration of the MCMI-III and PPG/Abel

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