MODELS OF TREATMENT FOR OFFENDERS
WHO ABUSE CHILDRENOVERVIEW OF SEX OFFENDER
TREATMENT PROGRAMS

child molesters and discusses the methodologicalissues associated with evaluating treatment outcome . In addition, it discussed various treatment
approaches, including organic treatment, nonbehavioral psychotherapy, comprehensive cognitive-behavioral therapy, and the treatment of thesex offender in the context of the mental health andcorrectional systems . The discussion pointed to thedifficulties in conducting treatment outcome
research in this area and offers suggestions as towhat might be considered the minimum requirements of a treatment outcome study. The authors
reported that applying these criteria to the extant
reports of treatment for the sex offender leads to theconclusion that the reports to date are not sufficientto evaluate most treatment programs ; however, theyoutlined a number of guidelines for treatment .

ABEL, G .G ., OSBORN, C., ANTHONY, D ., & GARDOS,
P. (1992) . CURRENT TREATMENTS OF PARAPHILIACS .

ANNUAL REVIEW OF SEX RESEARCH, 225-290 .

The authors provided an update of treatment components over the past 10 years (circa 1992) . The
advances made in behavior therapy include covert
sensitization, olfactory aversion, combined covert
sensitization and olfactory aversion, imagined
desensitization therapy, modified aversive behavioral rehearsal, masturbatory reconditioning, thematic shift, fantasy alternation, directed masturbation, satiation, and electrical aversion . The
developments made in pro-social behavior development include social skills training, assertivenesstraining, and sex education . Advances made in cognitive interventions have consisted of cognitive
restructuring and victim awareness . The authors
provided a detailed description of the relapse prevention model, in conjunction with an overview
concerning the outcome data of cognitive behavioral and relapse prevention treatment programs . A
discussion is included concerning the various pharmacological treatment interventions, hormonal
agents (CPA and MPA), as well as the legal and ethical issues associated with their use . The authors
concluded that treatment with cognitive behavioral
and pharmacological intervention is effective andincarceration without treatment appears destined to
produce relapse .
BARBAREE,

H .E .,BARBAREE,

H .E .,PEACOCK,

E .J .,

CORTONI, F.,

MARSHALL, W.L ., & SETO, M . (1998) . ONTARIOPENITENTIARIES' PROGRAM . IN W.L . MARSHALL (ED.) .

SOURCEBOOK OF TREATMENT PROGRAMS FOR SEXUAL
OFFENDERS (PP. 59-77) . NEW YORK : PLENUM PRESS .

The authors described the treatment programs forincarcerated sex offenders sponsored by theCorrectional Services of Canada with emphasis on
the Warkworth Sexual Behavioral Clinic and theBath Institution Sex Offenders' Program . The programs utilized a cognitive behavioral approach andgroup therapy . The Warkworth program was established in 1989 in a medium security federal penitentiary located in Toronto and houses 650 inmatesserving sentences of two or more years .
Approximately half of these offenders were convicted of a sexual offense or a violent offense inwhich sexual motivation or behavior was considered to be important. In a follow-up group of 202
offenders, 13 individuals committed a new sexual
offense and an additional four individuals committed a new violent offense but not a sexual offense .
A total of 36 individuals committed a new offenseof any kind. After an average follow-up period of
2 .5 years there was a sexual offense recidivism rate

& MARSHALL, W.L . (1991) .

TREATMENT OF THE ADULT MALE CHILD M OLESTER . I N
C .R . BAGLEY & R .J . THOMLISON (EDS .) . CHILD SEX-UAL ABUSE: CRITICAL PERSPECTIVES ON PREVENTION,
217-256) .

INTERVENTION, AND TREATMENT (PP.
TORONTO, ONT. : WALL & EMERSON .

This article is a critical review of a wide range ofapproaches to the treatment of sex offenders . It
provided a brief outline on the characteristics of246

of 6 .4% . These rates compare favorably with there-offense rates reported by other larger treatment
programs . However, they are too low to conduct
discriminate function or logistic regression analysis .
The Bath program, which operates within a federal
penitentiary, was established in 1991 and is directedby William Marshall . The penitentiary is a "stepdown" from medium security but offers more constraints than a minimum security facility andhouses 300 inmates, 50% of which are sex offenders . The program offers two levels of treatment offenders who are deemed to be low/low-moderaterisk (open groups) and moderate or above (closed
groups) . Tentative outcome evaluations of the first
107 men treated and released revealed a 2 .7%
recidivism rate, but so far it has been impossible toestimate the untreated base rate .

end of treatment, 54% of child abusers displayed
profiles that fell largely within the non-offending
range . The results also illustrated the relationshipbetween treatment change and length of time intherapy . Highly deviant child abusers needed a considerably longer amount of time in treatment before
they reached a non-deviant "successfully treated"
profile . Overall, 65% of the men who began treatment with a low deviancy profile were successfully
treated, compared to only 42% of men who started
treatment with a highly deviant profile . Short-termgroup work successfully treated 6S% of offenders
entering treatment with low deviancy profiles . Withhighly deviant men, however, short-term programs
were largely unsuccessful . Less than 20% of theseoffenders had treated profiles by the end of treatment . Long-term therapy, averaging 462 hours oftreatment, was more successful than short-term therapy in treating low deviancy men (80% comparedwith 62%), and considerably more successful intreating highly deviant men (60%) . In addition to
reducing denial, justifications, and cognitive distortions, long-term treatment was particularly successful in improving the self-esteem, assertiveness, andintimacy skills of these highly deviant child molesters . Currently treatment programs still vary considerably in the number of treatment hours they offer .
The amount of time spent in treatment, per offender,
can range from 8 to 225 hours per year, with an average of 81 hours . Seventy-percent of the programs
offer weekly treatment sessions, with 31% offering
intensive treatment on a daily basis . Group work
remains the most common form of treatment intervention (97%), though in the majority of programs,
co-working, ongoing supervision by individual probation officers, and involvement with mental healthprofessionals are also cited as parallel treatment
interventions . With regard to treatment intervention,
the most commonly cited goals are increasing victim
empathy, controlling sexual arousal, reducing denial,
and improving family relationships . Interestingly, lessthan half of the programs surveyed still cite relapse
prevention as an explicit goal .

BECKETT, R . (1998) . COMMUNITY TREATMENT IN THE
UNITEDK INGDOM .

IN

W.L.

MARSHALL(ED .) .

SOURCEBOOK OF TREATMENT PROGRAMS FOR SEXUAL
OFFENDERS ( PP. 133-152) . NEW YORK : PLENUM PRESS .

Beckett discussed the STEP study (Beckett et al .,1994) that evaluated six representative communitybased treatment programs for sex offenders, in conjunction with the Gracewell Clinic, a specialist residential treatment program for child abusers .
Beckett examined the impact treatment had on theclients in order to identify which elements of thetreatment programs were the most effective and toformulate recommendations on, how programsmight improve their effectiveness as well as to collect data for a long-term reconviction study . Of the
programs selected, two were rolling long-term,
open-ended programs and three were short-term,
intensive programs offering on average 54 hours oftreatment over two weeks . The other was a shortterm intensive week program followed by the client
seeing his own probation officer and one of thegroup leaders as a team . In total, 52 child abusers
were systematically assessed before and after 54
hours of community-based treatment and thesewere compared with clients treated by the residential program who had on average received 462
hours of therapy. Cognitive behavioral methods
were utilized in all of the programs . Clients were
tested pre and post participation in treatment on
personality and offense-specific measures. At the

ECCLES, A ., & WALKER, W.

(1998). COMMUNITY-

BASED TREATMENT WITH SEX O FFENDERS . IN WL .
MARSHALL (ED .) . SOURCEBOOK OF TREATMENT PROGRAMS FOR SEXUAL OFFENDERS . ( PP.
YORK: PLENUM PRESS .

24 7

93-103) . NEW

Eccles & Walker focused on Forensic Behavior
Services, which utilizes a cognitive behavioral perspective in conjunction with a relapse prevention
approach . The authors stated that in general, there
is sufficient evidence to provide optimism that childabusers can receive treatment that lowers their risk
to re-offend . With regard to treatment efficacy, thearticle refers to Marshall & Barbaree (1988), who
followed child sexual offenders treated at theKingston Sexual Behavior Clinic for an average ofapproximately four years . They found that recidivism rates were markedly lower for treated than for
untreated groups . Specifically, the comparisons ofrecidivism rates for treated versus untreated groups
were 18% for molesters of non-familial male children, and 8% versus 22% for incest offenders .

perspective of others, and ill-equipped to deal withemotional distress . They characteristically denied orminimized the extent of their sexual offending andproblems . A significant portion were found to havelittle empathy for their victims, strong emotional
attachments to children, and a range of distorted
attitudes and beliefs in which they portrayed children as able to consent to-and not be harmed bysexual contact with adults . Treatment effectivenesswas measured using a battery of psychological tests
that measured the areas covered in the treatment
program . Individuals were regarded as having
shown a treatment effect when their post-treatment
test profiles were within a normal range of responding on the measures used. The results revealed that
more than half of the total sample showed a treatment effect. All of the programs were found to havea significant effect on offenders' willingness toadmit to their offenses and sexual problems . The
programs appeared to have significantly reduced
the extent to which offenders justified their offending as well as the offenders' distorted thinking
about children and sexuality.

FISHER, D., & BEECH, A.R . (1999) . CURRENT PRACTICE IN BRITAIN WITH SEXUAL OFFENDERS. JOURNAL OF
INTERPERSONAL VIOLENCE, 14 (3), 240-256 .

Discussed the management and treatment of sex
offenders in Britain and provides a brief overview ofthe first in a series of treatment evaluation studies
commissioned by the British government . According
to a 1993 survey of the provision of communitybased treatment programs for sex offenders, only
three of the 63 treatment programs were in existence
for more than five years . The increase in treatment
programs has been attributed to an increased awareness by the public owing to media attention given to
the recidivism of sexual offenders and the realizationthat these offenders rarely receive any treatment . The
authors analyzed sex offender treatment in the community, hospitals, and prisons . An overview of theSexual Offender Treatment Evaluation Project is also
discussed. Cognitive behavioral therapy with relianceon Finkelhor's four preconditions model and theoffense cycle was found to be widely used by probation services . Even though the programs were generally successful in covering the specific cognitive areasof therapy, they had little or no behavioral component. Little evidence was found in any of the programs of offenders having been given any formal
training in relapse prevention skills . Prior to treatment, the child abusers in the sample were found tobe significantly different from the comparison groupof non-offenders. Typically, they were emotionallyisolated individuals, lacking self-confidence . There
were under-assertive, poor at appreciating the

GORDON,

A., & HOVER,

G.

(1998).

THE TWIN

RIVERS SEX OFFENDER TREATMENT PROGRAM . IN WL .
MARSHALL (ED .) . SOURCEBOOK OF TREATMENT PROGRAMS FOR SEXUAL OFFENDERS .

(pp. 3-15).

NEW

YORK : PLENUM PRESS .

The Twin Rivers Sex Offender Treatment Program
was established in 1988 and operates within an 816bed medium security prison . Of those 816-beds, 200
are dedicated to the sex offender treatment programthat consists of a staff of 27 individuals . The therapy
utilized by the program consists of cognitive behavioral treatment techniques placed within a relapse
prevention framework . Most treatment occurs inboth group and individual formats . As of July 1996,
11 .4% of the 132 released offenders who completed
treatment between 1988 and 1992 had returned toprison for a new sexual offense ; of the 235 released
offenders who completed treatment between 1993
and 1995, only 4 .3% had returned to prison for a
new sexual offense .
HORTON, T.

(2002).

DUCKINGFROM ANGELS-FALLING FROM GRACE : A TREATMENT SUPPLEMENT FOR
CLERGY WHO SEXUALLY OFFEND . BLOOMINGTON, IL :ACME HALO PUBLISHING .

24 8

Ducking from Angels is a treatment supplement for

The authors contend that the present approaches
utilized to treat the pedophile are not as effective as
they should be . The recent developments in thesex offender treatment providers to utilize whentreating sexually offending clergy of all faiths . It
focuses on the authority and trust that was broken
by clergy offenders and the unique trauma that thevictims of clergy offenders have endured . It is not atreatment program, but as the title implies it is atreatment supplement meant to augment existing
sex offender treatment curriculums . The main
premise of the supplement is to counteract the cognitive distortions that religious sex offenders holdin order to carry on their misdeeds . It is argued thatapplication of attachment theory and the treatmentof the "difficult client" may lead to improvementsin the treatment of such individuals . Attention isdrawn to some of the characteristics that pedophiles
have in common with personality disordered individuals and with the difficult client . One conclusion isthat confrontation during treatment could be counter
therapeutic, if not anti-therapeutic, when used intreating the pedophile. It is postulated that othermany of these offenders use Biblical verses as an
excuse to commit sexual acts on children . To that
end, this guide enables clinicians to use other quotes
from the Bible to help encourage change, closure,and empathy in these offenders . In a respectful but
powerful way, Ducking from Angels becomes amore empathic and supportive approaches areneeded, at least at the beginning of the treatment
process . The authors discussed the incorporation of
the tenets of attachment theory at the initial stages oftreatment in order to develop a therapeutic alliance
as opposed to a confrontational approach .

mirror for the offender, encouraging him to honestly look at himself and the damage he has done
beyond any potential facades that religious titles orclergy collars can provide .

LAWS, D .R ., MARSHALL, WL . (2003) . A BRIEF HISTORY OF BEHAVIORAL AND COGNITIVE BEHAVIORALAPPROACHES TO SEX OFFENDERS: PART 1 . EARLY
DEVELOPMENTS . SEXUAL ABUSE: A JOURNAL OFRESEARCH AND TREATMENT, 15 (2), 75-92 .

HUDSON, S .M ., WALES, D .S ., & WARD, T. (1998) . KIAMARAMA : A TREATMENT PROGRAM FOR CHILD MOLESTERS IN NEW ZEALAND . IN WL . MARSHALL (ED .),This article outlined the development of behavioral
and cognitive behavioral treatment of sex offenders
from the mid-1800s to 1969 . It explored the role of
Sigmund Freud and noted that a broad scientificinterest in deviant sexual behavior was well established by 1900 . John B . Watson and Alfred Kinsey
were prominent in the development of behavioral
approaches in the early to mid-20th century. A

SOURCEBOOK OF TREATMENT PROGRAMS FOR SEXUAL
OFFENDERS. (PP. 17-28) . NEW YORK: PLENUM PRESS .

This program in New Zealand was established in
1989 and is housed in a sex offender specific unit
with 60 self-contained rooms . The structure of the
program is entirely group based and utilizes behavioral treatment within a relapse prevention framework, where individual therapy is kept to a minimum . As of November 1996, 335 men successfullycompleted the program and have been released . The
mean period individuals are considered to be "atrisk" is three years and two months (range, 0-5
years 9 months) . Twelve of these men have beenreconvicted of a sexual crime yielding a reconviction rate of 3 .6% .

combination of behavioral and cognitive behavioral
treatments began to emerge in the late 1960s . Penile
Plethysmography (PPG) was developed in 1957, byKurt Freund, in response to the sexual preference
hypothesis . Despite many criticisms of the PPG, itremains a popular assessment tool and continues tobe widely used . Earlier non-behavioral treatment
approaches were important in establishing that sexual offenders could be engaged in treatment . It is
now evident that the sexual preference hypothesis,
underpinning behavioral approaches to deviant sexuality, failed to account for the complexity of such
behaviors . Gebhard et al. (1965) provided extensive
details of the features of sexual offenders, many ofwhich distinguished them from nonsexual offenders
and from non-offenders . On these bases, Gebhard
et al . were able to classify sexual offenders into sub-KEAR-COLWELL, J., & BOER, D .P. (2000) . THE
TREATMENT OF PEDOPHILES : CLINICAL EXPERIENCEAND THE IMPLICATIONS OF RECENT RESEARCH .
INTERNATIONAL JOURNAL OF OFFENDER THERAPYAND COMPARATIVE CRIMINOLOGY, 44 (5), 593-605 .

249

types that differed on specific features . This empirically derived classification began a process thatrecently resulted in the sophisticated systems of
Knight and Prentky (1990, 1993) . Gebhard et al(1965) were also among the first researchers todemonstrate that some child molesters were violent
toward their victims, an observation subsequently
confirmed by Marshall and Christie (1981) . The
earliest behavioral approaches reflected the viewthat deviant sexual behavior was a distorted manifestation for pedophilia and other paraphilias .
Exhibitionists and child molesters were treated withelectrical aversion therapy; the modification of sexual fantasies was the target of efforts applied tosadists and voyeurs . However, there was limited
evidence on the long-term effects on overt behavior
using these techniques .

1980s was the beginnings of the work on classificatory (or taxonomic) systems applied to sexual
offending. Unlike prior attempts at classification,these models were empirically driven and refined byrepeated research . The 1990s were characterized by
an explosion of treatment programs and a remarkable increase in the publication of research articles ;the emergence of strictly actuarial approaches torisk assessment ; the construction of theories
describing the cognitions, emotions, and intimacy
in sexual offenders ; and the introduction of the"self-regulation" model as a revision of the relapse
prevention model .
MANN, R .E., & THORNTON, D . (1998). THE EVOLUTION OF A MULTISITE SEXUAL OFFENDER TREATMENTPROGRAM . IN W.L . MARSHALL (ED .) . SOURCEBOOK OF
TREATMENT PROGRAMS FOR SEXUAL OFFENDERS (PP.

LAWS, D .R ., MARSHALL, WL . (2003). A BRIEF HIS-

47-57) . NEW YORK : PLENUM PRESS .

TORY OF BEHAVIORAL AND COGNITIVE BEHAVIORALAPPROACHES TO SEX OFFENDERS : PART 2 . THE MOD-The authors discussed a national strategy for thetreatment of sex offenders in England . Since then, theSex Offender Treatment Program (SOTP) has been
established in 25 correctional facilities . The program
utilizes a cognitive behavioral approach and grouptherapy. No outcome results are present at this time .

ERN ERA . SEXUAL ABUSE : A JOURNAL OF RESEARCH
AND TREATMENT, 15 (2), 93-120 .

The authors continued their review of the treatment
literature by providing an overview of the advancesin treatment during the 1970s . The most importantdevelopments in the 1970s include : further development of phallometric evaluations in assessment
and the associated focus on modifying sexual preferences ; introduction of cognitive processes ; and thefirst description of more comprehensive treatment
programs . In the early 1970s cognitive psychology
began to penetrate the field with particular emphasis upon social skills training, assertiveness, sexual
dysfunctions, and gender role behavior. The first
conference, at which sexual offender issues werediscussed from a behavioral or cognitive behavioral
perspective was in 1975 and later became known as
the Association for the Treatment of Sexual Abusers(ATSA). The most significant innovation of the
1980s was the adaptation from the addictions fieldof the relapse prevention model, as well as the formulation of social learning theories of sexual
offending . Further, a wide variety of programs
described targets such as sexual preferences, sex
education, empathy, social skills, self-esteem, substance abuse, anger management, and relapse prevention . The final important development of the

MARSHALL, WL . (1999). CURRENT STATUS OF NORTHAMERICAN ASSESSMENT AND TREATMENT PROGRAMSFOR SEXUAL OFFENDERS. JOURNAL OF INTERPERSONALVIOLENCE, 14 (3),221-239 .

The author discussed how treatment programs havebecome more empirically based since the advent ofcognitive behavioral therapy in the early 1970s .
Marshall described a hypothetical program that
includes the assessment of offenders in eight areas sexual behavior, social functioning, life history, cognitive processes, personality, substance use, physicalproblems, and relapse-related issues . Further, hewent on to describe the structure, process, and content of treatment .
MARSHALL, WL .
AND

(1996). ASSESSMENT, TREATMENT,

THEORIZING

ABOUT

SEX

OFFENDERS :DEVELOPMENTS DURING THE PAST I WENTY YEARS AND
FUTURE

DIRECTIONS .

CRIMINAL JUSTICE AND

BEHAVIOR, 23 (1), 162-199 .

250

This article considered developments during thepast 20 years in the assessment and treatment of sex
offenders and in theoretical interpretations of their
behavior. Marshall reviewed research indicatingthat in the field of assessments there is a movetoward including more cognitive features . One
interpretation of the evidence to date suggests thatphallometry has been overvalued and that considerable work remains to be done on the psychometricaspects of erectile measurement . Treatment also has
moved in a more cognitive direction, but the addition of a relapse prevention approach has been themost significant innovation . Theory development isaccelerating, but there needs to be more emphasis
on developing and refining our specific constructs
rather than elaborating broad explanatory theories .

50% showed statistically significant findings infavor of sex offender treatment programs . Of six
studies that showed a positive treatment effect, fourincorporated a cognitive-behavioral approach . Non
prison-based sex offender treatment programs weredeemed as being effective in curtailing future criminal activity. Prison-based treatment programs displayed promise, but the evidence is not strong
enough to support a conclusion that such programs
are effective . Few of the studies focused on particular types of sex offenders . Thus, the researchers
were unable to formulate any type of conclusion
concerning the effectiveness of programs for different sex offender typologies .
SPENCER, A . (1998) . PETERHEAD PRISON PROGRAM. IN
W.L . MARSHALL (ED .) . SOURCEBOOK OF TREATMENTPROGRAMS FOR SEXUAL OFFENDERS (pp. 29-46) . NEW
YORK: PLENUM PRESS .

MATSON, S . (2002) . SEX OFFENDER TREATMENT: A
CRITICAL MANAGEMENT TOOL . CORRECTIONS TODAY,
64 (6), 114-118 .

The Peterhead Prison Program operates out of a
maximum security penitentiary and is owned andoperated by basic prison (correctional) staff . Sex
offenders comprise at least 85% of the prison population . The program is group based and employs
cognitive behavioral techniques . There are no outcome results for this program available at this time .

The author described the uses of cognitive behavioral and psychotropic interventions (SSRIs) to treat
sex offenders . Matson concluded that effective
treatment interventions incorporate a variety of
approaches, including cognitive behavioral techniques, relapse prevention strategies, psychopharmacology, group therapy, and treatment planningthat addresses both the risks and needs of individual offenders . He suggested that the most comprehensive approach to managing sex offenders
involves strategies that emphasize collaborationand information-sharing while employing individualized supervision plans and the use of sex offenderspecific treatment .

COGNITIVE BEHAVIORAL TREATMENT
AND RELAPSE PREVENTIONAYTEs, K .E ., OLSEN, S .S ., ZAKRAJSEK, T., MURRAY, P.,& IRESON, R . (2001) . COGNITIVE/ BEHAVIORAL
TREATMENT FOR SEXUAL OFFENDERS : AN EXAMINATION OF RECIDIVISM . SEXUAL ABUSE: A JOURNAL OFRESEARCH AND TREATMENT, 13 (4), 223-231 .

POLIZZI, D .M ., MACKENZIE, D .L ., & HICKMAN, L .J .
(1999) . WHAT WORKS IN ADULT SEX OFFENDER TREATMENT? A REVIEW OF PRISON-AND NON PRISON-BASEDTREATMENT PROGRAMS . INTERNATIONAL JOURNAL OF

The authors reviewed a cognitive behavioral treatment program in Jackson County, Oregon, that wasestablished in 1982 . Offenders were mandated toparticipate in this community-based program uponconviction of a felony or misdemeanor sexual
offense . These offenders averaged between two andthree years of participation . A group of offenders
who participated in the Jackson County program
between 1985 and 1995 was identified througharchival data from the Oregon Department ofCorrections . The data revealed success or non success in treatment, as w ell . as any new convictions for

OFFENDER

THERAPY
AND COMPARATIVECRIMINOLOGY, 43 (3), 357-374 .

An evaluation of 21 sex offender prison and nonprison-based treatment programs was undertakenusing the format of the University of Maryland's
1997 report to the U .S . Congress . Eight of the studies were deemed as being too low in scientific meritto include in assessing the effectiveness of the treatment . Of the remaining studies, approximately

25 1

sexual or nonsexual offenses . A control group of
nonsexual offenders in Jackson County, and agroup of sexual offenders in Linn County who were
not in a treatment program were also studied . As
hypothesized, those Jackson County offenders who
successfully completed treatment had lower recidivism rates than those who were unsuccessful in the
program . The observed effect of the program wasparticularly strong for offenders who remained intreatment for one year or more. When review wasrestricted solely to those participants, the re-offense
rate for Jackson County offenders was reduced byover 40% when compared with Linn County
offenders . These optimistic findings support theneed for comprehensive treatment programs with acognitive behavioral emphasis .
BEECH,

A., & FISHER, D.

RELAPSEPREVENTIONTREATED

CHILD

IN

AND

STRATEGIES

D .R .

RELAPSEPREVENTION . I N WL . MARSHALL (ED.) . THE DEVEL-OPMENT OF COGNITIVE BEHAVIORAL TREATMENT OFSEXOFFENDERS( PP. 127-146) . ENGLAND : JOHNWILEY & SONS, LTD .

This chapter discussed the development of therelapse prevention model by Marlatt in response to
the clinical difficulties associated with the treatmentof substance abusers . The authors reviewed and critiqued the Marque-Pithers Model as well as Ward's
Model of the offense chain . They noted two potential problems with relapse prevention : (1) clientswould be overwhelmed by having to learn the complex language of Relapse Prevention, by having todetail each feature of their offense chain, and byhaving to provide a lengthy series of plans to prevent a relapse ; (2) making treatment (i .e ., the aspectof the Relapse model that Pithers, 1990, refers to as
the "internal self-management dimension") overly
elaborate, and coupling that with extensive postrelease supervision, send a message to the client that
we believe they can manage their lives on their own .
The authors outlined their attempt to apply a modified Relapse Prevention approach (which includes
some cognitive approaches) with three main features :(1) the development of the offense chain ; (2) the generation of plans to deal with potential future problems ; and (3) the delineation of warning signs thatserve to indicate to the offender and his supervisor
that he is slipping back into problematic behavior .
However, the authors noted that even though they
have not yet evaluated the Relapse Prevention component, other researchers have and found support for
the value of the Relapse component in achieving its
goals . Despite this evidence these studies are limited
due to methodological problems.

(2000) . MAINTAININGSKILLA BUSERS .

ECCLES, A., & MARSHALL, WL . (1999) .

IN

LAWS (ED .) .

REMAKING RELAPSE PREVENTION WITH SEX OFFENDERS (pp. 455-465) . CALIFORNIA : SAGE PUBLICATIONS .

This chapter described a relatively quick and easy
way of evaluating the extent to which offenders
have successfully engaged in the relapse prevention(RP) part of treatment . A newly developed questionnaire was utilized in order to measure change inbehavior as a function of treatment . This measurement assesses an offenders' awareness of their own
risk situations and use of appropriate coping strategies to deal with such risky situations . An evaluation of a treatment program for imprisoned sex
offenders in the United Kingdom found that this
instrument was effective in measuring changes in
RP skills from the beginning to the end of treatment . More interestingly, when completed again
some months after the end of treatment, resultsfrom the measure indicated that only men who had
also shown significant changes in areas typicallytargeted in cognitive-behavioral therapy maintained
their RP skills . This was not noticeable among men
who were no longer in prison and who had gone
through a fairly regular treatment regime . Results
support the need for both maintenance programs toprevent deterioration in the community and followup testing to assess current level of relapse prevention skills .

FERNANDEZ,

Y.M .,&MARSHALL,

WL . (2000) .

CONTEXTUAL ISSUES IN RELAPSE PREVENTION TREATMENT. I N D .R . LAWS (ED .) . REMAKING RELAPSE PREVENTION

WITH SEX

OFFENDERS( pp.

225-235) .

CALIFORNIA : SAGE PUBLICATIONS .

This chapter suggested that the context within
which treatment is provided can have a significant
influence on the degree to which the clients change .
The article attempted to answer the following questions : Is it best to adopt an individual one-on-one

252approach or does all or most of treatment occur ingroups ; Should we employ open or closed-groupformats ; Or should treatment be seen as a set of
psycho-educational components or as a therapeutic
process having a guide set of treatment targets? The
authors discussed their sex offender program at theBath Institution, which includes a Relapse modelwith open group formats . The focus of this program is placed on approach goals rather than
avoidance goals .
HANSON, K .
RELAPSEThe authors discussed the problems of the Relapse
Prevention model as it pertains to treatment andmaintenance . They presented a brief summary of
the model and examine what the assessment andtreatment agenda might look like for each of thepathways of offending patterns associated with the
major goals (avoidance vs . approach) and predominant strategy (passive vs . active) . They make thepoint that unless we understand the processes
involved for an individual offender, how can we
credibly identify areas for clinical intervention? The
article proposed having assessment and intervention strategies that reflect the heterogeneity present
in the offending process . Further, the authors suggested that we need to gain greater clarity concerning the type of offense process exhibited by various
offenders (i .e., an adequate taxonomy) in order todifferentially evaluate intervention outcomes . The
authors asserted that the global strategy of whether
treatment works is inadequate because we predictthat some types of the offending process are likely
to be more difficult to change and maintain .

(2000) . WHAT IS SO SPECIAL ABOUTPREVENTION?

IN

D .R .

LAWS (ED .) .

REMAKING RELAPSE PREVENTION WITH SEX OFFENDERS (pp. 27-38) . CALIFORNIA : SAGE PUBLICATIONS .

This chapter discussed the basic principles ofRelapse Prevention (RP) and outlined some of thepositive and negative aspects of this treatment
approach . Hanson promoted the Relapse model asa means of identifying and avoiding high-risk situations and providing a medium through which therapists and offenders can discuss offense behavior .
However, he argued that some implications ofRelapse Prevention have generated pointless distractions for both therapists and offenders . The
chapter also questioned how the more innovative
concepts of Relapse Prevention, such as the abstinence violation effect or the lapse/relapse distinction, accurately describe the problem faced by sex
offenders . The author offered evidence that sex
offenders often lack the motivation that is the prerequisite of Relapse Prevention's interventions andthat offenders whose crime patterns do not matchthe assumption of the model's approach (i .e., negative affect, covert planning, etc .) are unlikely toderive benefit from attempts to force their accounts
into a standard Relapse Prevention mold . The
model's inability to conceive of untreated, low-risk
offenders has diverted attention away from the
majority of offenders who naturally desist and has
contributed to some sex offenders receiving interventions poorly suited to their needs .

LAUNAY, G . (2001) . RELAPSE PREVENTION WITH SEXOFFENDERS:

PRACTICE, THEORY AND RESEARCH .
CRIMINAL BEHAVIOR AND MENTAL HEALTH, 11, 38-54 .

The aim of this article was to evaluate the Relapse
Prevention (RP) technique by looking at evidence
presented by the Rochester Relapse Prevention program as well as reviewing the theoretical andresearch basis for the program . Relapse Prevention
is used to help offenders understand the interactionof the behavioral, affective and cognitive factors aswell as the steps involved that lead to the offending
behavior. The program enabled them to generate
and practice alternative strategies in order to halt
this cycle . The theory on which relapse prevention
for sex offenders is based is sound in essence, but
the Relapse model suffers from an overlay of cumbersome vocabulary and from the recent additionof some complex constructs that are not clinicallyuseful . Second, there is some reliable research tosupport the practice of RP even though the crucial
findings that would inform its development are still
missing . Launay concluded that the original model
provides sound principles for therapy to which themodern revisions add little .

HUDSON, S .M., & WARD, T . (2000) . RELAPSE PREVENTION : ASSESSMENT AND

TREATMENT IMPLICATIONS . IN D . R . LAWS (EDS) . REMAKING RELAPSE PREVENTION

WITH SEX

OFFENDERS(PP.

102-121) .

CALIFORNIA : SAGE PUBLICATIONS .

2 53

LAWS, D .R ., HUDSON, S .M ., & WARD, T (2000) . THE

Recidivism rates were examined for 122 sex offend-

ORIGINAL MODEL OF RELAPSE PREVENTION WITH SEX

ers from a rural Vermont county who were under

OFFENDERS: PROMISES UNFULFILLED . IN D .R . LAWS

correctional supervision from 1984 through 1995 .

REMAKING RELAPSE PREVENTION WITH SEX

Seventy-one non-randomized participants were

OFFENDERS ( PP. 3-24) . CALIFORNIA: SAGE PUBLICATIONS .

(ED.) .

enrolled in a comprehensive outpatient cognitive-

This chapter provided an historical background of

program, 32 participants received less specialized

the Relapse model and critiqued the original model .

mental health treatment, and the remaining 19 par-The authors questioned whether the Relapse model,

ticipants received no treatment . At follow-up, theas was intended, provides us with insight into offend-

cognitive-behavioral treatment group demonstrated

ing behavior as well as its efficacy in reducing recidi-

a statistically significant treatment benefit . This find-vism . They concluded that the issue of scope, or theing is consistent with previous research findings .

behavioral and relapse-prevention based treatment

lack thereof, is a fundamental criticism of the model .
Furthermore, it is reported that the model is contra-

MARSHALL, W.L ., ANDERSON D ., & FERNANDEZ, Y.

dictory with respect to the mechanisms proposed .

(1999) .

THE DEVELOPMENT OF COGNITIVE BEHAVIORAL TREATMENT OF SEX OFFENDERS (pp. 9-31) .
ENGLAND : JOHN WILEY & SONS, LTD .

For example, sometimes phenomena are simply
being described while at other times, incompatible
mechanisms are proposed in addition to mechanismsthat are more complex than required.

This chapter provided an historical overview of sex

LAWS, D .R. (1999) . RELAPSE PREVENTION : THE STATE

tive behavioral approaches . Cognitive issues were

OF THE ART . JOURNAL OF INTERPERSONAL VIOLENCE,

directly brought into mainstream behavior therapy
in the mid-1970s . The authors discussed the use of

offender treatment up to the development of cogni-

14 (3), 285-302 .

attachment theory and its relevance to sex offenderThis article summarized the development of thetreatment .

Relapse Prevention treatment model through thepast 20 years . The author described the original

PITHERS, WD . (1990) . RELAPSE PREVENTION WITH SEX-

model applied to addictive behavior as conceived

UAL AGGRESSORS : A METHOD FOR MAINTAINING THERA-

by Marlatt and his associates . It proved necessary

PEUTIC GAIN AND ENHANCING EXTERNAL SUPERVISION .

to make alterations to the classical model in orderI N WL . MARSHALL (ED .) . HANDBOOK OF SEXUALASSAULT: ISSUES, THEORIES, AND TREATMENT OF THE

to make it applicable to sexual offenders . The
author postulated that the use of the RP model

OFFENDER ( PP. 343-361) . NEW YORK: PLENUM PRESS .

should be confined to disorders of impulse control .
Present and future developments in RP include

This chapter described the premise behind Relapse

recognition of the concept of harm reduction, use ofPrevention (RP) and treatment procedures . Pithers

stepped care, emphasis on motivational interview-stressed that since RP is a highly individualized

ing, the revised cognitive-behavior chain, andapproach to therapy, thorough assessment is neces-recognition of cognitive deconstructionism . The

sary in order to determine the issues to focus upon

greatest weakness of the RP model is that it hasescaped empirical evaluation . Future prospects forin treatment . The assessment of high-risk situations

the model are discussed, and it is recommended thatis outlined and an External Supervisory Dimensionof the RP model is discussed . In conclusion, thea revised RP be the model for sexual offender treat-author reported data from a five-year follow-up

ment for the foreseeable future .

study of 167 offenders (20 rapists, 147 pedophiles)
who were treated under the RP model . The data

MCGRATH, R .J ., HOKE, S .E .,& VOJTISEK, J .E .

revealed a 4% relapse rate . The author claimed that

(1998) . COGNITIVE-BEHAVIORAL TREATMENT OF SEX

this initial data suggests that relapse prevention rep-

OFFENDERS : A TREATMENT COMPARISON AND LONG-

resents an effective means of enhancing maintenance of change in sexual aggressors .

TERM FOLLOW-UP STUDY. CRIMINAL JUSTICE AND
BEHAVIOR, 25 (2), 203-225 .

2 54

PITHERS,

WD ., KASHIMA, K .M ., GUMMING,

.,
G .F

PITHERS, W.D ., MARQUES, J .K .,GIBAT,C .C ., &BEAL, L .S ., & BUELL, M.M . (1988) . RELAPSE PRE-MARLATT, G .A . (1983) . RELAPSE PREVENTION WITH

VENTION OF SEXUAL AGGRESSION . ANNALS OF THE

SEXUAL AGGRESSNES : A SELF-CONTROL MODEL OF

NEW YORK ACADEMY OF SCIENCES, 528, 244-260 .

TREATMENT AND MAINTENANCE
GREER

The authors reported that an early meta-analysis ofrelapse data revealed that nearly 66% of all relapses
occurred within the first 90 days after the end oftreatment . The probability of relapse decreased
markedly after that period . However, when it
comes to sex offenders, the first nine months after
discharge is the time period marked by the highest
recidivism rate . The authors attributed the longer
period prior to relapse for sex offenders to the more
severe violations of social norms inherent in theiracts and the greater penalties imposed for their
behavior than for the relapse of a substance abuser .
The authors outlined a study that they had conducted that analyzed precursors to offenses of 136
pedophiles and 64 rapists . They looked at multiple
determinants of sexual aggression in an effort toidentify a relapse process occurring over a longer
time . They found that 89% of the subjects reported
experiencing strong emotional states prior torelapse ; 46% of pedophiles more frequently
recalled having felt anxious or depressed (38%),
generally as a consequence, or cause, of prolonged
social disaffiliation . In analyzing precursors, a common sequence of changes that ultimately led to asexual offense was often found . The first change inthe relapse process from the client's typical function
was a change in affect . They referred to themselves
as "feeling moody," or "brooding ." The second
alteration involved fantasies of performing theaberrant sexual act . These fantasies were converted
into thoughts, often cognitive distortions, in thethird step of the relapse process . As fantasies andthoughts continued, the clients engaged in a processof passive planning, cognitively refining the circumstances that would permit commission of a sexual
offense . In the final step of the relapse process, theplan was manifested behaviorally . The article went
on to outline Relapse Prevention (RP) assessment
and treatment procedures . The authors concluded
that RP serves as a comprehensive training program
designed to help sex offender avoid reoffenses . It isstressed that RP is not an activity that a sex
offender completes and the crucial lesson is thatmaintenance is forever.

(ED .) .

CHANGE .

THE SEXUAL AGGRESSOR :PERSPECTIVES ON TREATMENT (PP.

I N J .G .
CURRENT

214-239) . NEW

YORK : VAN NOSTRAND REINHOLD .

This chapter described Relapse Prevention (RP) as asystematic assessment and treatment program
designed to provide sexually aggressive individuals
with cognitive and behavioral skills that will reduce
the probability of another offense . The model
enhances maintenance of changes that have been
induced by other treatments (e .g . presents a description of the sequence of behavioral changes that ultimately culminates in relapse) . The authors outlined
the basic concepts and terms of relapse prevention
and provided a thorough description of the behavioral assessment and treatment components of therelapse prevention treatment model for sexual
aggressors .
STONER, S .A ., & GEORGE, W.H. (2000) . RELAPSEPREVENTION WITH HARM REDUCTION : AREAS OF O VERLAP. IN D.R. LAWS (ED .) . REMAKING RELAPSE PREVENTION WITH SEX OFFENDERS (PP .

56-75) .

CALIFORNIA : SAGE PUBLICATIONS .

The authors considered the merits of applying harm
reduction to sex offender treatment paradigms . They
described harm reduction and reviewed and updated
key Relapse Prevention constructs in order to foster
better reconciling with harm reduction . The authors
also addressed several of the challenges involved withtranslating harm reduction to sex offender work . The
issues of lapse and relapse, the cognitive-behavioral
offense chain, and the abstinence violation effect,
concepts that are central to RP, are also central to anunderstanding of how a harm reduction philosophy
might be beneficial . In conclusion, the authors were
optimistic that harm reduction may be profitably
applied to sex offender treatment protocols ; however, they acknowledge that this concept is still relatively new and requires further investigation .
WARD, T, & HUDSON, S .M. (2000) . A SELF-REGULATIONMODEL OF RELAPSE P REVENTION. IN D.R . LAWS (ED .) .
REMAKING RELAPSE PREVENTION WITH SEX OFFENDERS(PP. 79-101) . CALIFORNIA : SAGE PUBLICATIONS.

255

to deviant sexual cravings, as when rape is commit-

the notion that medication can assist in identifying

ted opportunistically or in response to anger and hos-thoughts and emotions that can disrupt self-regula-tility. Stereotactic psychosurgery is still a somewhattion, as well as providing a means to facilitate it .

controversial procedure that is not yet widely available to be considered a practical treatment option for

HUCKER, SJ ., & BAIN, J . (1990) . ANDROGENIC HOR-

sexual deviation syndromes at this time . However,

MONES AND SEXUAL A SSAULT. IN WL . MARSHALL (ED .) .

behavioral therapy may help some offenders learn

HANDBOOK OF SEXUAL ASSAULT' ISSUES, THEORIES,AND TREATMENT OF THE OFFENDER (PP. 93-102) . NEW

how to better resist their urges .

YORK : PLENUM PRESS .
BRADFORD, J .M . (1990) . THE ANTIANDROGEN AND
HORMONAL TREATMENT OF SEX O FFENDERS. IN W.L .

The authors reviewed studies that have evaluatedinteractions among hormones, sex, and aggression . It

MARSHALL (ED .) . HANDBOOK OF SEXUAL ASSAULT•ISSUES, THEORIES, AND TREATMENT OF THE OFFENDER

discussed the basic physiology of sex hormones in thehuman male, hormones and sex drive, testosterone-(pp. 297-310) . NEW YORK: PLENUM PRESS .

level responses to erotic stimulation, treatment ofThis article outlined the use of hormones and otheragents in the treatment of sexually deviant behavior .

hypogonadal men with testosterone, the behavioral

It discussed hormonal controls over sexual behavior,
MPA and CPA, and included a review of clinicalnormal males, testosterone and aggression in maleoffenders, and hormones and sexual aggression . The

studies in order to explain both treatment methods .

authors concluded that the studies reviewed in thisIn conclusion, the author provided evidence that thearticle are characterized by small groups of subjects

treatment of sex offenders with antiandrogens isand that results are conflicting . Further evidence sug-clearly successful in reducing recidivism rates .

gests that there may be an abnormality of androgen

However, he implied that CPA should have limited

metabolism in individuals who display aberrant sex-

use in a correctional facility owing to the uncertainty

ual behavior, though this is not well supported bythat informed consent may not be gotten freely .

empirical evidence .

effects of castration, testosterone and aggression in

There is the danger that CPA is too likely to becomeof parole contingent on accepting treatment, without

ROSLER, A ., & WITZTUM, E . (2000) . PHARMACoTHERAPY OF PARAPHILIAS IN THE NEXT MILLENNIUM .

a truly independent psychiatric consultation prior to

BEHAVIORAL SCIENCES AND THE LAW, 18, 43-56 .

part of a subtle coercion process involving the offer

its use . Further, the author indicated that after agradually tapered off in a significant number of indi-

This article discussed how CPA, MPA, GnRH andpsychotropic drugs work to decrease sex offending

viduals, without causing relapses, which does not

behavior . It stated that psychotropic drugs are highly

seem to be true for MPA .

controversial because of the erratic results and lack ofpermanent eradication of paraphilic manifestations .

GRUBIN, D . (2000) . COMPLEMENTING RELAPSE PRE-

Long-acting

VENTION WITH MEDICAL INTERVENTION . I N D .R. LAWS

(GnRH) agonist analogues are the most potent

treatment period of 6 to 12 months, CPA can be(ED.) .

REMAKING RELAPSE PREVENTIONOFFENDERS (pp.
PUBLICATIONS .

201-212) .

hormoneantiandrogens that selectively abolish testosterone

WITH SEXCALIFORNIA :gonadotropin-releasing

secretion in a totally reversible fashion . The article
indicated that GnRH analogues, together with psychotherapy, are highly effective in controlling selected
and(pedophilia,
exhibitionism,
paraphilias

SAGE

Grubin discussed the use of medications such as
Reuptake Inhibitors (SSRI's) in conjunction withvoyeurism), and these are the most promising modeof therapy in the next millennium . Further, thecognitive-behavioral treatment . While acknowledging the message that the use of medication sends toauthors reported that there is an urgent need forstrong methodological research . These would consist

the offender (i .e ., that his drives are not wholly under
his power, and that he has only a limited ability toof carefully designed double-blind controlled studies

CPA,

Depo-Provera

andSelective

Serotoninwith a large number of subjects in order to validate or
not the use of the various pharmacological therapies .

control his offending behavior), the author supported257

to deviant sexual cravings, as when rape is committed opportunistically or in response to anger and hostility. Stereotactic psychosurgery is still a somewhat
controversial procedure that is not yet widely available to be considered a practical treatment option forsexual deviation syndromes at this time . However,behavioral therapy may help some offenders learn
how to better resist their urges .

the notion that medication can assist in identifying
thoughts and emotions that can disrupt self-regulation, as well as providing a means to facilitate it .
HUCKER, S .] ., & BAIN,,J. (1990) . ANDROGENIC HORMONES AND SEXUAL ASSAULT. IN WL . MARSHALL (ED.) .

HANDBOOK OF SEXUAL . ASSAULT: ISSUES, THEORIES,AND TREATMENT OF THE OFFENDER ( PP. 93-102) . NEW
YORK: PLENUM PRESS.

BRADFORD, J .M . (1990) . THE ANTIANDROGEN AND
HORMONAL TREATMENT OF SEX OFFENDERS . IN WL .

The authors reviewed studies that have evaluatedinteractions among hormones, sex, and aggression . It
discussed the basic physiology of sex hormones in thehuman male, hormones and sex drive, testosteronelevel responses to erotic stimulation, treatment of
hypogonadal men with testosterone, the behavioral
effects of castration, testosterone and aggression innormal males, testosterone and aggression in maleoffenders, and hormones and sexual aggression . The
authors concluded that the studies reviewed in thisarticle are characterized by small groups of subjects
and that results are conflicting . Further evidence suggests that there may be an abnormality of androgenmetabolism in individuals who display aberrant sexual behavior, though this is not well supported byempirical evidence .

MARSHALL (ED .) . HANDBOOK OF SEXUAL ASSAULT:ISSUES, THEORIES, AND TREATMENT OF THE OFFENDER(PP. 297-310) . NEW YORK : PLENUM PRESS .

This article outlined the use of hormones and otheragents in the treatment of sexually deviant behavior.
It discussed hormonal controls over sexual behavior,
MPA and CPA, and included a review of clinicalstudies in order to explain both treatment methods .
In conclusion, the author provided evidence that thetreatment of sex offenders with antiandrogens isclearly successful in reducing recidivism rates .
However, he implied that CPA should have limited
use in a correctional facility owing to the uncertainty
that informed consent may not be gotten freely .
There is the danger that CPA is too likely to become
part of a subtle coercion process involving the offer
of parole contingent on accepting treatment, without
a truly independent psychiatric consultation prior to
its use . Further, the author indicated that after atreatment period of 6 to 12 months, CPA can be
gradually tapered off in a significant number of individuals, without causing relapses, which does notseem to be true for MPA .
GRUBIN,ROSTER, A ., & Wrrz7UM, E. (2000) . PHARMACOTHERAPY OF PARAPHILIAS IN THE NEXT MILLENNIUM .

BEHAVIORAL SCIENCES AND THE LAW, 18, 43-56 .

This article discussed how CPA, MPA, GnRH andpsychotropic drugs work to decrease sex offending
behavior It stated that psychotropic drugs are highly
controversial because of the erratic results and lack ofpermanent eradication of paraphilic manifestations .
Long-acting gonadotropin-releasing
hormone(GnRH) agonist analogues are the most potent
antiandrogens that selectively abolish testosterone
secretion in a totally reversible fashion. The article
indicated that GnRH analogues, together with psychotherapy, are highly effective in controlling selected
paraphilias(pedophilia, exhibitionism,
andvoyeurism), and these are the most promising modeof therapy in the next millennium . Further, theauthors reported that there is an urgent need forstrong methodological research . These would consistof carefully designed double-blind controlled studies
with a large number of subjects in order to validate or
not the use of the various pharmacological therapies .

D. (2000) . COMPLEMENTING RELAPSE PRE-

VENTION WITH MEDICAL INTERVENTION. IN D .R . LAWS
(ED .) .

REMAKING RELAPSE PREVENTIONOFFENDERS(PP.

201-212) .

WITH SEXCALIFORNIA :SAGE

PUBLICATIONS .

Grubin discussed the use of medications such as
CPA, Depo-Provera and Selective Serotonin
Reuptake Inhibitors (SSRI's) in conjunction withcognitive-behavioral treatment. While acknowledging the message that the use of medication sends tothe offender (i .e., that his drives are not wholly under
his power, and that he has only a limited ability tocontrol his offending behavior), the author supported

257

are more likely to favor adolescent males and they
are less likely than non-clerics to be serial offenders
or have multiple paraphilias . In examining the literature concerning characteristics of the offender, it isillustrated that in regards to cognitive distortions
cleric offenders displayed extreme minimization of
personal problems and were less likely to rationalize and justify child molestation . The chapter also
provided two case studies, which illustrated offending behavior, evaluation and outcome . In evaluating
sex offenders, it is recommended that clinical andactuarial methods be utilized . It is also important toassess sexual preference and the extent of cognitive
distortions . The "being a person" (BAP) treatment
paradigm is discussed, which includes 100 items
that help mold the course of therapy . In discussing
relapse prevention the red light/green lightmetaphor is used to help teach offenders how tomanage their behavior.

CLERIC SEX OFFENDERSAND TREATMENTBRYANT, C . (1999) . PSYCHOLOGICAL TREATMENT OFPRIEST SEX O FFENDERS . IN T.G . PLANTE (ED) . BLESSME FATHER FOR I HAVE SINNED : PERSPECTIVES ONSEXUAL ABUSE COMMITTED BY ROMAN CATHOLICPRIESTS (PP.

87-110) .

WESTPORT, CT: PRAEGER

PUBLISHERS .

This chapter provided an overview of theories concerning offending and treatment . The literature isreviewed in order to provide the reader with different possibilities as to why an individual molests achild . A brief discussion of assessment is included
and the author made a distinction between assessment and treatment . Several goals of inpatient
treatment are outlined . The priest must acknowledge that he has a sexual problem and that something must be done . This first step facilitates theacceptance of responsibility. It is important that theoffender understands what initiates his offending
and that he has a firm grasp of the tools used to
manage his behavior. The offender must also appreciate the inappropriateness of his behavior and recognize the fact that he can be treated, but nevercured. A brief overview of cognitive-behavioral
treatment and relapse prevention is included .

HUDSON, P.E . (1997) . SPIRITUALITY AS A COMPONENTIN A TREATMENT PROGRAM FOR SEXUALLY ADDICTEDROMAN CATHOLIC CLERGY. COUNSELING & VALUES,

41 (2), 174-183 .
This article described a European program forclergy sex offenders that is based on spirituality .
The article also featured an interview with the headof the treatment program, David Fitzgerald . The
program includes only Roman Catholic priests andbrothers from Africa and Europe who are typically
fixated/regressed pedophiles and ephebophiles . The
philosophy of this 12-step program is that addiction results from a spiritual void that is combatedthrough prayer, meditation, and scripture reading .
Success is measured through identification of highrisk situations and mastery of the tools presented in
the program for managing offending behavior . It is
required that the men participate in two years ofaftercare. Fitzgerald asserted that those individuals
for whom treatment had proved unsuccessful will
be reported to civil authorities if there is an indication that the Diocese or community would fail toreport that person .

HAYWOOD, T.W. & GREEN, J. (2000) . CLERIC SERIALOFFENDERS : CLINICAL CHARACTERISTICS AND TREATMENT A PPROACHES. IN LOUISSERIAL

B. SCHLESINGER (ED .) .

OFFENDERS: CURRENT THOUGHTS, RECENTFINDINGS ( PP. 247-262) . BOCA RATON, FL: CRC PRESS .

Haywood and Green provided an overview of theliterature pertaining to prevalence, offense/victim
characteristics, and evaluation of cleric serial
offenders . Depending upon the study, prevalence
rates ranged from 2% to 6% (pedophiliac andephebophiliac clerics), 20% to 40% (sexual misconduct with adults), 8 .4% (in a sample of 1322),
and 5 .8% to 24% (boundary violations withadults) (Sipes, 1990 ; Loftus & Camargo, 1993 ;Friel & Friel, 1988 ; Goetz, 1992; Seat et al ., 1993) .
In examining offense/victim characteristics, theauthors concluded that clerics are more likely toengage in sexual misconduct with adults thanminors . Of those who offend against children theyKELLY,

A.F. (1998) . CLERGY O FFENDERS . IN WL .

MARSHALL ET AL . (EDS .) . SOURCEBOOK OF TREAT-MENT PROGRAMS FOR SEXUAL OFFENDERS (PP .

318) . NEW YORK, NY: PLENUM PRESS.

258

303-

This chapter provided an overview of the problems
associated with managing cleric offenders . The
author cited the reforms made by the Chicago
Archdiocese in 1992, which instituted a policy ofremoval for any priests who had been accused ofabuse . The Archdiocese also established a review
board comprised of lay persons not associated with
the Church, as well as psychologists, psychiatrists,and lawyers . This revision is concurrent with thesuggestions made by the Canadian bishops Ad Hoc
Committee on Child Sexual Abuse in 1992 . In
1993, various experts in the field of child sexual
abuse met with the National Conference ofCatholic Bishops in order to evaluate the problems
in the Church . Among the suggestions included
improving the care allotted to victims, improving
education and the screening of candidates for theseminary, and creating guidelines for relapse prevention and reassignment . The author posited thatthe abuse is made possible by the cleric's position of
power and that the problem extends beyond theindividual . Among the problems involved in establishing treatment facilities include the societal
stigma associated with clergy offenders . Since childsexual abuse by members of the clergy has becomea public issue, some hospitals may not want to institute a program for fear of having to deal with theswarms of media . Thus, this hinders the treatment
program, which may be forced to act in secrecy. The
surrounding community will also pose a challenge
to establishing a program as the offender may resist
treatment for fear of being ostracized by fellow
priests . In combating these issues, confidentiality
must be handled with care . The therapeutic alliance
may be hindered when the treatment referral ismandatory and the cleric may feel that there is apolitical motive behind the referral . These ulterior
motives foster a sense of resistance to cooperationand the offender becomes defensive in talking about
himself. Cleric offenders differ from the general
population in the fact that they have a built inalliance and sense of caring and community as aresult of their work . This may assist is creating a
helpful, productive relationship . In assessing theclergy, Kelly asserted that the assessment at the very
least should consists of a series of clinical interviews, a complete sexual history, personality testing, cognitive and neuropsychological testing, and aphysical examination . The treatment center must be
viewed a neutral party and may accomplish this byhaving a Church representative clearly spell out theallegations in front of the cleric and evaluator.
According to Kelly, this creates an air of openness
and implies that "yes, we know all of this, and we
still care about you and want to help you ." During
the course of the evaluation, a spiritual assessment
should be conducted because clerics often professthat at the time of the offense their prayer life wasseriously hindered . The Church is expected to refer
all alleged offenders for an evaluation in order todefend against an allegation . Another issue, whichmust be addressed in evaluations, is the vague criteria for what constitutes an effective cleric . Kelly
asserted that psychosis, antisocial characteristic
traits and paraphillas are definite rule outs, but thepositive behaviors are more vague and possibly
immeasurable . There has also been resistancedirected towards the use of the penile plethysmograph (PPG) to evaluate sexual deviancy due to its
intrusive nature and stimulus material . Thus, thisassessment technique is not used often with theclergy. The true prevalence of cleric abuse isunknown but it has been estimated that 2% to 3%
may have acted out sexually with a child . There isalso the myth that these offenders are true
pedophiles who engage in predatory acts, but Kellycontends that this is false . In citing the work ofFather Canice Connors, former director of St .
Luke's Institute, 44 priests were diagnosed as
pedophiles, 185 were ephebophiles, 142 were compulsives, and 165 were diagnosed with unintegrated
sexuality . The treatment center must also be prepared to respond to the needs of the parish. Thiscan be achieved through organizing educational
programs and providing counseling to those members of the laity who are likely to feel hurt andbetrayed . In communicating with the Church
regarding the progress of the cleric, it is recommended that the clerics review every written communication and sign it before it is shared . While thetreatment center should not be biased in any manner, being biased in favor of the cleric can enable
treatment progress since they usually display a trustof self and others . Characteristics of clergy offenders are discussed and the subjugation of self makes
treatment very difficult in the beginning . They have
limited awareness of their emotional life, poor useof leisure time, poor physical health, and underdeveloped relations and may also profess that theirrole is to be concerned with the well being of others259

and not themselves . This idea must be challenged intreatment and it must be explained that if they can
not help themselves then they will be ineffective in
helping others . Intimacy must be addressed during
treatment in order to develop a sense of interpersonal security. Intimacy building also allows thetreatment provider to teach the cleric healthy strategies to deal with emotions . Shame and guilt mustalso be addressed during the treatment progresssince shame reinforces denial, which is an unfavorable evaluation of the self. Shame may also serve toannihilate the self for those clerics who have notdeveloped a sense of self, which is separate fromtheir vocation . Clerics are placed upon a moral
pedestal by the parish and a lapse in moral behavior is devastating because of these high standards .
Guilt may be used in a healthy manner since it is anunfavorable view of behavior, not the self, and may
be used to prevent future behavior whereas shame
may perpetuate it . The presence of grandiosity inthe cleric results in a minimization of abuse andblame being directed towards the victim . This is evident in those clerics who have an insecure sense of
self and display a need to rely on the parishioners
who idolize him. This idolatry and lack of intimacy
play a role in facilitating boundary violations . Oncethe initial denial stage has been combated, clerics
are likely to regret their actions and vow never to
do it again . Due to their intelligence and alienationfrom emotions, these vows are hollow because
while they may have made up their minds, they
have not yet found a way to control their emotions .
Empathy deficits may be present in those clerics
who have lost touch with the needs of others andonly seek to fulfill their selfish wishes and issues
with authority may be played out in the boundary
violation . Treatment aftercare is discussed and it isemphasized that psychotherapy should be continued for a minimum of 6 months to a year . A support team should also be established with at least one
member of the Church hierarchy on the committee .
This team would enable the cleric to communicate
his feelings with someone whom he knows will be
there to care for him whenever he needs it . The clericshould also be required to attend a 12-Step meetingand discuss it with his therapist in order to ensurethat the program is meeting his needs . The issue ofreassignment and the legal implications associatedwith child abuse are briefly discussed .

LOFTUS,

J.A . & CAMARGO, R.J . (1993) . TREATINGTHE CLERGY. ANNALS OF SEX RESEARCH, 6, 287-303 .

This article described a study conducted over a twoyear period at the Southdown Treatment Center for
cleric offenders . WAIS and MMPI scores from thepast 25 years were compared for the sample thatwas comprised of clerics described as age inappropriate offenders, homosexual, heterosexual, andbisexual . These scores were then compared to thoseof a control group comprised of clerics in order toestablish a baseline . The authors found evidence
that 2 .7% of the clerics in the age inappropriategroup had contact with children under age of 13 .
The following characteristics emerged in analyzing
the data concerning the age inappropriate group :most were priests from Dioceses, they were between
the ages of 49 and 60 when they were first refereed
for treatment, they ministered in parishes and educational settings, there was no criminal or psychiatric history for the individual clerics or their families, and they had no history of substance abuse .
The offense data illustrated that the abuse occurred
frequently (four or more times) and the ages of thevictims varied . The MMPI data suggested that thepersonality profile for the clerics was comprised ofshy, passive, and lonely characteristics . In evaluating their treatment, the authors urged that clerics
should be treated no differently from other sex
offenders . They have had some evidence that nonverbal psychotherapies have been helpful because
the patients show signs of being alienated fromtheir body before entering treatment . Recidivism is
discussed with caution because out of the 111 menin the sample, the treatment providers know thestatus of only 40 individuals . Based upon these figures, there appeared to be a recidivism rate of 10% .
MANUEL, G . (1999) . BEGINNING AN INTERVENTION IN
CLERGY SEXUAL ABUSE . IN T.G . PLANTE (ED) . BLESS ME
FATHER FOR I HAVE SINNED: PERSPECTIVES ON SEXUAL
ABUSE COMMITTED BY ROMAN CATHOLIC PRIESTS (PP.

22-26). WEsTPORT, CT: PRAEGER PUBLISHERS .
This chapter is based upon the author's own experience as a clinician and provided a brief overview
of the various considerations that must be taken
into account when staging an intervention . The
mental health professional must be aware of themandatory reporting laws for child sexual abuse as260well as the sexual misconduct policies and procedures the institution . It is important that the mental
health professional alert Church authorities thatthey must pay serious attention to their reactions
and they must be made aware of the issue of denial .
Withdrawing from the intervention is appropriate if
the religious superior will not allow for a fair intervention . The issues of shame and guilt must be
addressed in order to make religious superiors
aware of the need for neutrality . The mental healthprofessional is also responsible for educating thereligious superiors as to how they should address
the victim and the perpetrator in a manner that isclear and effective .

displayed insight into his disorder and is committed
to preventing the recurrence of the behavior . Insight
into one's own risk factors, a willingness to disclose
problems, and participation in an aftercare program are also encouraging. In order for aftercare to
be successful the diocese needs to create and enforce
certain guidelines that spell out the conditions forreassignment .
WARBERG, B .W, ABEL, G .G ., & OSBORN, C . (1996) .
COGNITIVE-BEHAVIORALPASTORAL PSYCHOLOGY, 45 (1), 49-63 .

This article explained cognitive-behavioral therapy
with clerics through discussion of case studies . The
authors asserted that clergy offenders describe their
misconduct as being sudden, impulsive, andunplanned . Through various methods, therapists
are able to teach clerics that the behavior is anything but impulsive and can be interrupted early inthe process . The authors also discussed the role ofcognitive distortions and their impact on treatment
outcome . Professional sexual misconduct treatment
failures are more prone to have sustained rationalizations and justifications . Victim empathy in clerics
is examined and certain factors prevent the ministerfrom understanding the harm he has inflicted .
Failure to appreciate the power differentiation
between minister and parishioner, naivety about
sexual issues/minimal training in transference/countertransference, and desensitization of the intimacyof the minister/laity relationship all combine to affectvictim empathy. The presence of paraphilias mustalso be evaluated when assessing treatment needs.
The authors asserted that 20% of professional sexual
misconduct cases were found to have a history ofprior paraphilias . It is stressed that interpersonal andemotional factors (anxiety, stress, depression, deficits
in social/assertive skills, alcohol/drug abuse, personality disorders/intrapsychic conflicts) play a role inthe development of professional sexual misconduct .
In order to ensure the safety of the minister and congregation, those who have engaged in sexual misconduct must be thoroughly evaluated and placed underconstant surveillance by staff. These individuals mustbe trained in recognizing the ministers offending
behavior. The congregation can also serve as a sourcefor evaluating the minister's behavior through theadministration of a "bill of rights", which outlines

VALCOUR, F. (1990) . THE TREATMENT OF CHILD SEXUAL ABUSERS IN THE C HURCH . IN S .J . ROSSETFI (ED .) .
SLAYER OF THE SOUL: CHILD SEXUAL ABUSE AND THE

CATHOLIC

CHURCH(pp.

45-66) .

MYSTIC,TREATMENT FOR PROFES-SIONAL SEXUAL MISCONDUCT AMONG THE CLERGY.

CT:

TWENTY-THIRD PUBLICATIONS .

Valcour described different forms of treatment andrisk factors associated with sexual offending . The
author asserts that while sexual deviancy is not curable, it can be treated and cites the success of theSaint Luke Institute (of the 55 child molesting
priests none are known to have relapsed) . Certain
risk factors such as chromosomal abnormalities areunalterable and the evaluator must pay attention to
the perpetrators own childhood trauma because theoffending may be a form of acting out . These traumas also stunt the psychological development ofthese individuals . Valcour asserts that in conjunction with the previously mentioned risk factors,
early experiences, hormonal problems, neuropsychological deficits, denial, and countertransference
also play a role in the offending behavior and treatment survival . The problems involved in psychotherapeutic interventions include idealization,authority conflict, control issues, self-loathing, anda need for forgiveness . While these are fairly common, the individual may be hindered by other problems such as paraphilias, eating disorders, anddepression . An alternative form of treatment involves
the hormone Depo-Provera, which stifles sexual
arousal but has numerous side effects . Valcour contends that before reassignment can be considered forthe priests, a formal appraisal of the individual's riskof reoffending must be obtained from the treatment
center. It is considered encouraging if the priest has

267to protect the congregation, the authors recommend that close monitoring be implemented . Thusfar, group therapy sessions that include various professional who have been involved in sexual misconduct have shown promise .

appropriate minister/Church member behavior.
When the sexual misconduct is rampant, steps must
be taken in order to manage the clerics .
Prohibitions may be implemented that prevent theminister from working with parishioners . In order262