C enter for S ex O ffender 

M anagem ent 

A Project of the U.S. Department of Justice, Office of Justice Programs 

Understanding Treatment for Adults and Juveniles Who 

Have Committed Sex Offenses 

November 2006

Introduction 

Specialized treatment has been a mainstay of sex 

offender management approaches for several 

decades. In recent years, however, the heightened 

attention to sex crimes and its impact on victims 

and communities has resulted in a push for more 

punitive responses to the individuals who commit 

these crimes, including lengthier periods of 

confinement, tighter residency restrictions, 

expanded registration and community notification 

laws, and enhanced surveillance and monitoring

strategies. The widespread focus on these types of 

“get tough” strategies consequently has begun to 

overshadow the important role of treatment in sex 

offender management efforts. 

As has already been demonstrated by leading 

researchers in the general correctional field, 

however, an exclusive reliance on punishmentoriented and surveillance-driven approaches has 

limited impact on enhancing community safety (see, 

e.g., Andrews & Bonta, 2003; Aos, Miller, & Drake, 

2006; Cullen & Gendreau, 2000). When offender 

management strategies include a rehabilitative 

focus, the outcomes are much more promising (Aos 

et al., 2006; Cullen & Gendreau, 2000).

Therefore, as stakeholders across the country are 

challenged to identify effective strategies for 

managing individuals who commit sex offenses and 

thereby ensure the safety of communities, the need 

to understand the role of treatment will undoubtedly 

arise. Yet when the topic is broached, it often 

raises more questions than answers. Most notable 

are questions about what treatment “is” for adults

and juveniles who commit sex offenses, how it 

differs from other forms of treatment for different 

populations, and, of course, whether it has a 

significant impact on recidivism. 

The purpose of this brief is to provide a broad 

overview of current research, professional literature, 

and practice trends relative to treatment for sexually 

abusive individuals, in an attempt to better 

illuminate this rather complex topic for those who 

have a stake in sex offender management. 

Although specialized clinicians may find this brief to 

be of interest, the primary intended audience is the 

range of other management professionals seeking 

to understand key issues about treatment for adults 

and juveniles who have committed sex offenses. 

Unique Features of Treatment for 

Sex Offenders 

It may come as no surprise that providing treatment 

to individuals who commit sex offenses is a 

distinctive undertaking. What may be less 

recognized are the ways in which sex offender 

treatment is similar to other types of treatment. 

Regardless of whether treatment is designed to 

address sex offending behaviors or other types of 

psychosocial, mental health, or psychiatric needs, a 

number of shared principles and practices across 

treatment settings exist, including the following: 

y All clients should understand the 

interventions and procedures that will be

utilized and any associated risks and 

benefits (i.e., informed consent should be

provided); 

Established in June 1997, CSOM’s goal is to enhance public safety by preventing further victimization through improving the 

management of adult and juvenile sex offenders who are in the community. A collaborative effort of the Office of Justice Programs,

the National Institute of Corrections, the State Justice Institute, and the American Probation and Parole Association, CSOM is 

administered by the Center for Effective Public Policy. 

1

y Treatment interventions should be driven

by formal assessments and appropriately 

individualized to the needs of the client; 
y Rapport must be established and 

maintained; 

y Treatment goals should be specific and 

measurable; and 

y Progress–or lack thereof–must be 

accurately and thoroughly documented. 

Despite these and other commonalities across 

therapeutic contexts, some aspects of treatment for 

adults and juveniles who commit sex offenses are 

qualitatively different than approaches to 

intervention for other populations. 

How Treatment is Defined 

In other settings, the term “treatment” is used to 

describe the provision of scientifically proven 

procedures to effect a cure, but within the sex 

offender management field, such a definition would 

be somewhat misleading. For the purposes of this 

brief, treatment is defined as the delivery of 

prescribed interventions as a means of managing 

crime-producing factors and promoting positive and 

meaningful goal attainment for participants, all in 

the interest of enhancing public safety. 

Providing Specialized Treatment Requires 

Specialized Training and Experience 

In a field where the stakes are high, the dynamics are 

complex, the interventions are specialized, and the 

literature is evolving, it is essential that treatment providers 

are equipped with the necessary skills and knowledge to 

provide ethically sound and quality treatment. Specialized 

education, training, experience, and supervision cannot be 

overemphasized. In some states (e.g., Colorado, Illinois, 

Texas, and Utah), those wishing to provide treatment for 

adults or juveniles who have committed sex offenses must 

meet established criteria or undergo a formal certification 

process. Many of the criteria used for these purposes are 

based on published practice standards from the 

Association for the Treatment of Sexual Abusers (ATSA), 

a leading authority on the types of educational and 

practical experiences that are considered essential before 

engaging in this work.

Involuntary Nature of Treatment 

Perhaps the most apparent difference is the often 

involuntary nature of sex offender treatment. 

Individuals who have committed sex offenses tend

to enter specialized treatment as a result of external 

pressures or legal mandates, rather than being 

driven solely by internal motivation. In contrast, 

persons who experience depressive or anxietyrelated symptoms, are challenged by problematic 

family dynamics, struggle with peer relations, or 

have problems with self-concept – to name a few – 

tend to come forward voluntarily for assistance from 

a treatment professional and are often motivated by 

their own needs for assistance to change. 

Treatment Goals are not Solely Driven by

the Client’s Desires 

Because many participants in sex offender 

treatment programs may not be internally motivated 

or seeking treatment of their own volition, and 

because of the nature of the behaviors to be 

addressed, the manner by which treatment goals 

are determined often differs from other contexts. 

Specifically, in most traditional treatment settings, 

goals of therapy are identified largely by the client’s

desires, in collaboration with the provider. 

Many of the broad goals of sex offender treatment, 

however, are largely pre-determined. Although 

individuals who commit sex offenses are a fairly 

heterogeneous population, they also have in 

common several types of needs and risk factors. 

As such, treatment programs tend to include a 

number of relatively “standard” goals for 

participants, such as addressing denial, identifying 

and managing risk factors, enhancing empathy for 

victims, and developing prosocial skills. This is not 

intended to suggest that adults and juveniles who 

have committed sex offenses should not have a say 

in their treatment goals. Indeed, to promote an 

individualized treatment approach that meets the 

needs of each client, and one in which they are 

more personally invested in the change process, 

participants should certainly have involvement and 

influence in the identification of treatment goals for 

themselves. 

Confidentiality Limits

The forensic context of sex offender treatment – in 

other words, because the criminal and juvenile 

justice systems are usually involved – also creates

a different dynamic with respect to confidentiality 

issues. With the primary exception of threats of 

self-harm or harm to identifiable others, information 

discussed in most treatment settings is held in strict 

confidence. However, for individuals who commit 

sex offenses, the routine involvement of the courts 

and multiple agencies (e.g., corrections, probation 

or parole, social services, juvenile justice, child 

welfare, victim advocacy, and law enforcement) 

often necessitates collaboration and critical 

information sharing in order to support 

accountability, enhance management strategies, 

and ultimately promote public safety. Therefore, 

those who enter sex offender treatment programs

are often expected to waive some or all of the 

typical confidentiality protections that exist for most

other clients who are involved in mental health or 

medical treatments (see, e.g., ATSA, 2005; 

2
National Adolescent Perpetration Network [NAPN], 

1993).

Impact of Unsuccessful Interventions 

In most psychosocial treatment contexts, the 

negative impact of unsuccessful interventions is

relatively limited in scope – either to the individual 

alone or to a small number of involved others. 

With treatment for individuals who commit sex 

offenses, however, the potential impact of failed 

interventions is more far reaching. Beyond the 

potential adverse effects on the client and his 

family, when adults or juveniles are unsuccessful in 

treatment, public safety may be compromised. In 

some circumstances, the net result is additional 

sexual victimization and the associated impact on 

the victim, victim’s family, and the community. 

Increased Potential for Vicarious Trauma 

and Burnout for Treatment Providers 

Similar to the experiences of therapists who work 

with victims of trauma, but considerably different 

from most other mental health professionals, 

individuals who provide treatment to sex offenders 

are exposed routinely to very detailed descriptions

of abusive sexual behaviors, the attitudes and 

statements that support or minimize these 

behaviors, and the readily apparent harm to victims. 

Over time, this cumulative exposure – combined

with other influences, such as professional isolation, 

a high volume of cases, intense public scrutiny, and 

limited healthy coping responses – can lead 

treatment providers to experience what has been 

termed vicarious or secondary trauma, as well as 

professional burnout (Pullen, 1999; Thorpe, 

Righthand, & Kubik, 2001; Way, VanDeusen, 

Martin, Applegate, & Jandle, 2004). This

phenomenon is among the most salient differences

that make sex offender treatment distinctively 

challenging. 

Sex Offender Treatment Can Take a Toll on 

Therapists 

In a recent study on vicarious trauma, individuals who 

provide treatment to sex offenders were compared to 

those who treat victims of sexual abuse (Way et al., 2004.) 

Both groups of clinicians reported similar levels of 

vicarious trauma, suggesting that the nature of the work 

may be associated with clinical levels of distressing 

symptoms. The researchers also found that the use of 

negative personal coping strategies exacerbated the 

impact of vicarious trauma. It is of interest to note that, 

compared to those providing treatment to victims, sex 

offender treatment providers were less likely to use

positive personal coping strategies.

What Treatment “Looks Like” 

It is worth noting that the way in which treatment for 

sexually abusive individuals has been historically 

conceptualized and implemented has not always 

been consistent (see, e.g., Becker & Murphy, 1998; 

Laws & Marshall, 2003; Marshall & Laws, 2003 for 

reviews of its evolution). However, over the past 

two decades, treatment has become more 

standardized, both in terms of the underlying 

theories that drive the interventions and the specific 

programmatic elements.

Primary Frameworks 

At present, most programs for adult and juvenile 

male sex offenders1 report using cognitivebehavioral and relapse prevention models as the 

foundation of treatment (McGrath, Cumming, & 

Burchard, 2003). Cognitive-behavioral treatment 

has a long history in the mental health field and has 

been found to be an effective framework to address 

a range of psychological disorders. Relapse 

prevention was originally designed for addictive 

disorders, such as substance abuse and gambling. 

Although sexual offending is not considered to be 

an addiction, the use of relapse prevention as a 

long-term behavior management strategy – rather 

than a cure – has made it appealing to those in the 

sex offender management field (e.g., Laws, 1989; 

Laws, Hudson, & Ward, 2000). 

Broad Goals and Objectives 

In the broadest sense, the primary goals of sex 

offender treatment are for individuals to take 

responsibility for their behaviors, develop the 

necessary skills and techniques that will prevent 

them from engaging in sexually abusive and other 

harmful behaviors in the future, and lead productive 

and prosocial lives. An associated objective 

through the cognitive-behavioral lens centers 

around understanding the inter-relationship 

between thoughts, feelings, and behaviors, their 

impact on one’s conduct, and then developing more 

healthy thinking patterns and appropriate ways of 

managing emotions. And within the relapse 

prevention framework, a closely related objective is 

to identify the risk factors or triggers that are 

associated with an individual’s sexually abusive 

 

1

 Although it is recognized that adult women and adolescent girls 

engage in sexually abusive behaviors, statistics indicate that the 

overwhelming majority of sex offenses are committed by males 

(Federal Bureau of Investigation, 2005, Snyder & Sickmund, 

2006). Therefore, for the purposes of this brief, discussions of 

relevant research and treatment reflect the literature on adult 

men and adolescent boys. 

3
behaviors and subsequently develop healthy coping

skills to address those risk factors. 

Common Treatment Targets 

To address these broad goals and objectives, 

treatment is often comprised of various offensespecific and offense-related treatment targets, 

primarily derived from various theories about both 

the onset and continuation of sex offending 

behaviors.2 By and large, these factors have been 

supported by research, either as needs that are 

prevalent within samples of sex offenders or as

factors that are associated with sexual recidivism. 

With sexually abusive adults, for example, 

researchers have identified a number of relatively 

enduring but changeable risk factors that are 

associated with recidivism, including – but not 

limited to – the following (see, e.g., Hanson & 

Bussiere, 1998; Hanson & Harris, 2000; Hanson & 

Morton-Bourgon, 2004): 

y Deviant sexual arousal, interests, or 

preferences; 

y Sexual preoccupation; 

y Pervasive anger or hostility; 

y Emotional management difficulties; 

y Self-regulation difficulties, or impulsivity; 

y An antisocial orientation; 

y Pro-offending attitudes, or cognitive 

distortions; and 

y Intimacy deficits and conflicts in intimate 

relationships.

Similarly, for juveniles, dynamic factors that are 

believed be associated with sexual recidivism 

include, among others, the following factors (see 

Hunter, Figueredo, Malamuth & Becker, 2003; 

Longo & Prescott, 2006; Worling & Langstrom, 

2006): 

y Deviant sexual interests;

y Problematic parent-child relationships; 

y Social isolation, poor social skills, and low 

social self-esteem;

 

2

 Most contemporary theories involve a complex interplay of 

developmental, biological, environmental, psychological, 

sociocultural, and inter- and intrapersonal influences (see, e.g., 

Barbaree & Marshall, 2006; Ward, Polaschek, & Beech, 2006).

y Antisocial values and behaviors, including

emotional callousness and an absence of

empathy for others; 

y Pro-offending attitudes or cognitive 

distortions; 

y Impulsivity; and 

y Treatment non-completion.

Again, because of the research support for these 

elements, they are considered to be among the 

most common targets of treatment in many 

programs for adults and juveniles, respectively. 

At the same time, some of these traditional 

treatment targets – namely denial, self-esteem, and 

victim empathy – have not been found to predict 

sexual recidivism for adult sex offenders. The lack 

of predictive value of these targets may be the 

result of difficulties with consistently defining and 

measuring these constructs, or because they are 

related to the initiation of sex offending but perhaps 

are not predictive of future reoffending (see, e.g., 

Hanson & Bussiere, 1998). Despite these 

unanswered empirical questions, many programs

continue to view denial, self-esteem, and empathy 

as important targets of intervention, likely because 

of understandable speculation that these factors are 

related to sex offending behaviors or because of 

their suspected value in the treatment process. 

Snapshot: Common Core Targets Reported by Programs Nationwide

0% 20% 40% 60% 80% 100%

Drama Therapy

Anger management

Trauma

Arousal control

Stress management

Sex education

Relapse prevention

Victim empathy

Social skills

Intimacy skills

Thinking errors

Offense responsibility

Juvenile programs Adult programs

(Adapted from McGrath, Cumming, & Burchard, 2003)

Treatment Should be Individualized 

As noted previously, although several components 

are common to all individuals entering sex offender 

treatment, interventions nonetheless should be 

designed to meet the specific needs of clients. This 

requires that specialized assessments are 

conducted to inform treatment for each participant. 

It is beyond the scope of this brief to detail 

assessment processes with adults and juveniles 

4
who have committed sex offenses, although a few 

key points are worthy of review. 

For example, it is important to use specialized, 

research-based tools that explore not only general 

mental health needs and personality functioning, 

but also assess offense-specific variables, such as

deviant sexual interests and pro-offending attitudes, 

because of their association with recidivism risk. 

When focusing specifically on the assessment of 

risk of sexual recidivism for adults or juveniles, 

practitioners should use instruments that have been 

designed for those populations and, whenever 

possible, measures that have demonstrated 

predictive validity. Additionally, the use of multiple 

sources of data can increase the accuracy and 

completeness of assessments. 

Ideally, then, assessments are the means by which 

levels of risk and needs are identified, such that 

individualized, meaningful, and more effective 

treatment plans can be developed. Indeed, 

researchers who have studied general criminal 

offenders have long known that treatment outcomes 

are maximized when assessments of risk and 

needs are conducted and clients are matched to 

services accordingly. For example, higher risk 

offenders tend to benefit from more intensive 

services than do lower risk offenders, and lower risk 

offenders are better served by low intensity 

programming (e.g., Andrews & Bonta, 2003). A 

recent meta-analysis conducted by Hanson (2006) 

found that these same principles are associated

with maximized treatment outcome among sex 

offender populations as well. Finally, repeated

assessments throughout the course of treatment 

are a critical way to objectively and consistently 

evaluate progress in treatment. 

A Checklist for Policymakers and Administrators 

; Is the program based on an evidence-based model? 

; Is treatment individualized and assessment-driven? 

; Are treatment targets supported by research? 

; Are providers specially trained? 

; Are approaches tailored for special populations? 

; Are community-based and institutional programs 

parallel and linked? 

; Are within-treatment changes and long-term 

outcomes measured?

Modernizing Treatment 

In the preceding sections, sex offender treatment 

for adults and juveniles was outlined in a manner 

that reflects the traditional model that has been in 

place for many years. More recently, experts have 

begun to modify and build upon this model because 

of concerns that it resembles a “one size fits all” 

approach to treatment and one which presumes 

that the same interventions are equally important 

and effective for every offender (e.g., Hunter, 2006; 

Laws & Ward, 2006). 

Additionally, the ever-growing body of 

contemporary literature – which includes additional 

theories of sex offending that take into account the 

diversity of these populations, greater appreciation

of the differences between adults and juveniles who 

have committed sex offenses, and attention to 

variables that enhance treatment engagement and 

response – has provided a catalyst for further 

refining and updating treatment approaches (see

Barbaree & Marshall, 2006; Longo & Prescott, 

2006; Marshall, Fernandez, Marshall, & Serran, 

2006; Ward, Polaschek, & Beech, 2006). Taken 

together, these elements are beginning to change 

the face of traditional programs, revealing a more 

modernized approach to treatment for adults and 

juveniles. 

Different Pathways to Offending Means 

Treatment Should Vary

Although it has been long recognized that 

individuals who commit sex offenses are not all 

alike, until recently the field has lacked 

comprehensive theoretical and research-based 

models that addressed their different vulnerability 

factors, motivations, and contextual circumstances 

and that could guide treatment accordingly. 

Promising models for adults

In response to this limitation in the treatment field to 

date, Ward and his colleagues (see Ward & 

Hudson, 1998, 2000; Ward, Hudson, & Keenan, 

1998; Ward & Siegert, 2002; Ward et al., 2006) 

proposed the Self-Regulation and Pathways models 

as a means of outlining the varied pathways that 

can lead to sex offending. The Pathways model 

takes into account various biological, cultural, 

environmental, and other underlying factors that are 

believed to result in sexually abusive behavior 

toward children. Specifically, the extent to which 

individuals have difficulties in one or more of the 

following core and interacting clusters of symptoms 

reflects their pathway to offending, including (see, 

e.g., Ward & Siegert, 2002; Ward et al., 2006): 

5
y Emotional management difficulties, or 

emotional dysregulation; 

y Interpersonal problems, including intimacy 

deficits, loneliness, and social isolation;

y Attitudes and beliefs that support antisocial 

or sexually abusive behaviors, commonly 

referred to as cognitive distortions; and 

y Deviant sexual fantasies, arousal, and 

internal interpretations about how to 

approach sexual encounters. 

Also recognizing that individuals commit sex 

offenses for different reasons and possess different 

coping skills and deficits, a key focus of the SelfRegulation model is to classify individuals based on

specific motivations and goals, self-management 

strategies, cognitive and behavioral elements, and 

contextual factors that lead to offending (Ward & 

Hudson, 1998, 2000; Ward et al., 1998, 2006). 

Four distinct categories of offense pathways are 

proposed: 

y Avoidant-Passive. The intent of these 

individuals is to avoid sex offending, but an 

overall lack of effective coping strategies

and self-management skills results in a 

failure to take definitive steps to manage 

their behaviors; 

y Avoidant-Active. For offenders in this

category, the desire to refrain from sexually 

abusive behavior is hampered by a use of 

ineffective strategies, and those which 

actually increase their likelihood of 

offending; 

y Approach-Automatic. Although these 

individuals desire deviant sexual activity, 

their offenses are more driven by situational 

factors and circumstances rather than 

active planning and are often the result of 

poor self-management skills and 

impulsivity; and 

y Approach-Explicit. Persons in this category 

are motivated to offend and engage in 

explicit planning, including specific steps to 

groom victims and avoid detection, which 

highlights an ability to regulate their 

behaviors for self-serving purposes. 

A promising model for youth 

Similarly, with juveniles who have committed sex 

offenses, emerging typology research by Hunter 

and his colleagues suggests that a range of 

personality characteristics, developmental 

experiences, and risk factors may be associated 

with different pathways to sexually abusive behavior 

among youth, with preliminary research suggesting 

the following three subtypes and trajectories (see, 

e.g., Hunter, 2006): 

y Lifestyle delinquent youth. These youth 

exhibit conduct problems early in life and 

continue to engage in delinquent and 

criminal behaviors throughout adolescence 

and perhaps adulthood, including sexually 

aggressive behavior toward peer and adult 

females;

y Adolescent onset, non-paraphilic youth. 

The sex offending behaviors of these 

individuals tend to be directed toward prepubescent females and appear to be either 

experimental in nature or as compensation 

for deficits in social skills and self 

confidence; and 

y Early adolescent onset, paraphilic juveniles. 

This group is believed to have emerging

deviant sexual interests and arousal and 

may subsequently target both prepubescent males and females. 

By providing more comprehensive explanations of 

the multiple characteristics and varied means by 

which adults and juveniles commit sex offenses, 

these models offer a classification system that can 

assist treatment providers with the development of 

more refined and appropriately tailored 

interventions (Hunter, 2006; Ward & Seigert, 2002, 

Ward et al., 2006). 

Sex Offenders Aren’t Just “Sex Offenders” 

When individuals are labeled as “sex offenders,”

there is a tendency for professionals and others to 

define them solely in terms of their sexually abusive 

behaviors. Within the context of sex offensespecific treatment, this narrow view can result in 

incomplete intervention strategies as providers may 

be tempted to focus exclusively on the sexually 

deviant nature of their actions. 

Holistic programming is vital 

However, adults and juveniles who have committed 

sex offenses may also have a range of intervention 

needs in the psychiatric, healthcare, family, peer, 

substance abuse, vocational, or educational 

domains, and if these additional issues are left 

unaddressed, their ability to lead a stable and 

productive life may be understandably hampered. 

Contemporary programs address this limitation by 

designing treatment in a more holistic manner, thus 

6
offering a more complete approach to intervention 

that better maximizes the potential for longstanding 

positive impact. 

Shifting toward a more positive approach

A related limitation of a more traditional approach to 

programming involves its primary focus on deficits, 

whereby treatment centers around the negative 

attributes of individuals and the use of escape and 

avoidance strategies as a means of preventing 

further sexual behavior problems. As one can 

imagine, a treatment program that outlines only 

what is problematic about an individual and offers 

restrictions and prohibitions as the road to wellness 

may not lead to engagement and investment in the 

change process (see, e.g., Mann, Webster, 

Schofield, & Marshall, 2004; Thakker, Ward, & 

Tidmarsh, 2006; Ward & Stewart, 2003). This, too, 

exemplifies a failure to consider individuals 

holistically and may neglect important clinical 

needs, thus limiting the impact of interventions. 

Consequently, experts have recently begun to 

argue that an emphasis of modern rehabilitative 

efforts should be to equip participants with the 

necessary skills, competencies, values, and beliefs 

that will ultimately allow them to lead “good lives” 

(Thakker et al., 2006; Ward & Stewart, 2003). Put 

simply, leading a “good life” – in which needs are 

met in positive and self-fulfilling ways but not at the 

expense of others – is incompatible with sex 

offending, and therefore is an important treatment 

goal. Through this approach, adults and juveniles 

develop positive goals, including intimacy, health, 

knowledge, autonomy, and emotional balance. At 

the same time, they learn how to counteract 

obstacles, whether internal or external, that may 

prevent them from attaining these goals. 

Because this “good lives” model of rehabilitation is 

strengths-based and designed to facilitate overall 

wellness and meaningful change for individuals, it 

has the potential to enhance engagement and 

internal motivation in treatment (Mann et al., 2004; 

Thakker et al., 2006; Ward & Stewart, 2003). This 

important shift from an exclusive risk management 

approach, therefore, represents a key advancement 

in the sex offender treatment field – and one that 

can enhance the likelihood of success of 

participants, thus translating into community safety. 

Treatment for Juveniles Should Not Mirror 

Treatment for Adults 

Early in the history of the juvenile sex offender field, 

experts acknowledged that treatment for these 

youth should take into account developmental 

considerations (Barbaree, Marshall, & Hudson, 

1993; Ryan & Lane, 1991). As the field evolved, 

however, significant concerns arose because 

interventions for these juveniles were nonetheless 

based primarily on the approaches used for adults 

(Chaffin & Bonner, 1998; Weinrott, 1996). Even 

today, the specific differences between adults and 

juveniles who have committed sex offenses are not 

always appreciated fully within the context of 

treatment3

, and current reviews note that the design 

and delivery of programming for youth still 

resembles adult treatment in many ways (Bumby & 

Talbot, in press; Letourneau & Miner, 2005; Longo 

& Prescott, 2006). 

Fortunately, practitioners do have guidance from

the professional literature about the ways in which 

treatment can be modernized to meet the 

developmental needs of these youth, both in terms 

of the models that drive treatment and the 

modalities through which interventions are delivered

(e.g., Fanniff & Becker, 2006; Hunter, Gilbertson, 

Vedros, & Morton, 2004; Longo & Prescott, 2006). 

Contemporary treatment models for juveniles 

Recognizing the inherent value of the tenets and 

approaches used as part of cognitive-behavioral 

and relapse prevention interventions, some have 

proposed that the manner in which these programs

are implemented can be modified to ensure that it is 

more appropriate and relevant for youth (e.g., 

Murphy & Page, 2000; Hunter & Longo, 2004; 

Worling & Curwen, 2000). For example, the 

language, style, and approach to activities and 

treatment tasks within the relapse prevention 

framework can be tailored for youthful participants 

overall, as well as individualized to the variations

within the juvenile sex offender population (Hunter

& Longo, 2004; Murphy & Page, 2000.) In addition, 

experts suggest reframing the “incurability” 

emphasis within relapse prevention with juveniles, 

because of the potential negative impact it may 

have on self-esteem, motivation, and confidence to 

make positive life changes in treatment (Hunter & 

Longo, 2004). 

The use of different underlying frameworks 

altogether has also been suggested as a means of 

intervening with sexually abusive juveniles, with a 

 

3

 Included among the primary suggested differences between 

adults and juveniles who commit sex offenses are deviant sexual 

arousal or preferences (which may be less common), family, 

peer, and environmental factors (which may be more critical for 

juveniles), and the potential role of maltreatment (which may be 

more influential for juveniles). In addition, the period of 

adolescence is characterized by cognitive, emotional, social, 

moral, and biological processes that are qualitatively different

from those in adulthood (see, e.g., ATSA, 2000; Chaffin, 

Letourneau, & Silovsky, 2002; Fanniff & Becker, 2006; 

Letourneau & Miner, 2005). 

7
primary recommendation for the use of communitybased social-ecological models that address the 

multiple interactive factors that are associated with 

problem behaviors (Hunter et al., 2004; Hunter, 

2006; Letourneau & Miner, 2005; Saldana et al., 

2006). One very promising example is 

Multisystemic Therapy (MST), a community- and 

family-based treatment approach that is designed to 

address individual, family, peer, school, and 

community influences (Henggeler et al., 1998). 

Some of the common goals for MST include: 

y Improving family functioning; 

y Enhancing parenting skills;

y Increasing the youth’s associations with

prosocial peers;

y Improving school performance; and 

y Building upon community supports. 

Research indicates that these and other positive 

goals are often attained in a cost-effective manner; 

with significant reductions in recidivism (Henggeler

et al., 1998). Although the application of MST to 

the treatment of juvenile sex offenders is relatively 

new, it has particular appeal because of the very 

promising outcomes that have been revealed (see, 

e.g., Borduin & Schaeffer, 2002). 

An emphasis on multiple modalities 

Although group therapy has been the favored, if not 

exclusive, mode of treatment with sex offenders, its 

use with juveniles has been challenged recently by 

experts in the field (Chaffin, 2006; Hunter, 2006; 

Hunter et al., 2004), particularly in light of the 

research which demonstrates the potential for 

negative outcomes when delinquent peers are 

aggregated for the purposes of intervention (e.g., 

Chamberlain & Reid, 1998; Dishion, McCord, & 

Poulin, 1999). 

Although group treatment with juvenile sex 

offenders has its advantages – such as resource 

and time efficiency, opportunities to practice 

positive skills with peers, and sharing common 

experiences – it can be very limiting if used as the 

sole mode of treatment with youth4

 (see, e.g., Rich, 

2003; Worling, 2004). For example, the relatively 

small amount of time spent in group treatment may 

be insufficient for addressing the range of needs of 

any given youth. Additionally, youth who are less 

mature, suffer from mental health difficulties, or who 

 

4

 Many of the limitations regarding an exclusive reliance on 

group treatment for juveniles may also be applicable when 

considering treatment modalities for adults. 

have lower levels of cognitive functioning may be 

less able to understand and apply the concepts 

being addressed in the group setting. Furthermore, 

the group context is not conducive to raising 

particularly sensitive issues, nor does it provide the 

opportunity to address critical family issues and 

other environmental influences. 

Individual therapy can be an appropriate solution to 

address some of these and other issues, and it also 

provides a forum in which the concepts and skills 

covered in group can be reinforced and individually 

tailored to each youth’s circumstances. Family 

therapy, too, is an essential modality, particularly 

when used as part of a more integrated approach to 

intervention with juveniles who have committed sex 

offenses (e.g., Rich, 2003; Thomas, 2004; Worling, 

2004). Perhaps for these and other reasons, most 

juvenile sex offender treatment programs 

nationwide report using multiple modes of 

treatment, including individual, family, and group 

treatment as part of their programming (McGrath et 

al., 2003). 

How Treatment is Delivered is as Important 

as What is Delivered 

The underlying frameworks and substantive content 

are certainly among the critical factors to consider 

for ensuring quality sex offender treatment 

programs. Indeed, much of the professional 

treatment literature to date has focused on 

treatment models and content of programs for 

adults and juveniles who have committed sex 

offenses. Notwithstanding these elements, experts 

in the field are now drawing attention to the 

importance of process-related variables in

treatment, recognizing the influence of treatment 

providers’ characteristics and engagement 

strategies (e.g., Fernandez, 2006; Marshall, Ward, 

Mann, Moulden, Fernandez, Serran, & Marshall, 

2005). 

Therapist characteristics 

To illustrate, for many years, providers in sex 

offender programs seemed to favor somewhat 

aggressive, confrontational, and punitive

approaches to treatment, a style which was later 

questioned because of concerns that it may actually 

lead to undesirable outcomes such as increased 

resistance and hostility, less engagement, and 

fewer within-treatment changes (Bumby, Marshall, 

& Langton, 1999; Kear-Colwell & Pollack, 1997; 

Marshall, 1996). 

Researchers have since supported these concerns, 

finding poorer outcomes when sex offender 

treatment providers were cold and confrontational, 

8
and when they failed to create a cohesive and 

therapeutic climate for participants (see, e.g., 

Beech & Hamilton-Giachritsis, 2005; Marshall, 

2005). Conversely, treatment progress – such as

reductions in denial, minimization, and victim 

blaming – is enhanced when sex offender 

therapists are empathic, warm, rewarding, 

encouraging, firm but flexible, and relatively 

directive (Beech & Hamilton-Giachritsis, 2005; 

Marshall, 2005). 

Engagement strategies 

Practitioners are also becoming more familiar with 

specific techniques and strategies that have been 

found to be helpful for engaging clients, both adult 

and juvenile. Perhaps one of the most common is

Motivational Interviewing (Miller & Rollnick, 2002). 

Generally speaking, this approach suggests that the 

way in which professionals interact with a client 

should vary depending upon the client’s level of 

motivation and readiness for change, which may 

ultimately reduce client resistance and promote 

engagement in the assessment and intervention 

process. Motivational Interviewing has become an 

increasingly popular strategy for working with sex 

offenders (Ginsburg, Mann, Rotgers, & Weekes, 

2002). 

Similarly, and specifically for professionals working 

with juvenile sex offenders, the Invitations to 

Responsibility model has been suggested as a 

means of promoting internal motivation to invest in 

the treatment process, rather than using 

confrontation as an attempt to externally motivate 

youth (Jenkins, 1998). The accompanying 

techniques and strategies are based on the 

importance of personal choice and identifying one’s 

own reasons to change, and emphasize the need to 

develop partnerships – rather than coercive 

relationships – with clients (Jenkins, 1998, 2006). 

Overall, the emphasis on process-related variables, 

positive treatment goals, and strategies that can 

enhance internal motivation is reflective of a more 

positive psychological approach to sex offender 

treatment (e.g., Fernandez, 2006; Thakker et al., 

2003; Ward & Stewart, 2003). This shift – which 

promotes engagement, investment, and success in 

the treatment process – is critical because of the 

research demonstrating that adults and juveniles 

who complete treatment are less likely to recidivate 

than treatment non-completers (Hanson, Gordon, 

Harris, Marques, Murphy, Quinsey, & Seto, 2002; 

Hunter & Figueredo, 1999; Marques, Wiederanders, 

Day, Nelson, & van Ommeren, 2005; Worling & 

Langtstrom, 2006). 

“Early studies of sexual offender treatment focused 

primarily on techniques and virtually ignored the influence 

of the therapist...it may now be time to turn our attention 

to those who provide the treatment in an effort to further 

refine and improve our ability to provide effective 

treatment” p. 195, emphasis added. 

(Fernandez, 2006) 

Does Treatment Work? 

For professionals in the sex offender management 

field, it is virtually impossible to avoid the inevitable 

question about whether sex offenders can be 

treated or rehabilitated. A definitive response – 

either in the negative or affirmative – would imply 

that a simple answer exists, when in reality, the 

answer is not a clear-cut one. Yet as is often the 

case in the social and behavioral sciences, there 

tends to be evidence on either side of the issue of 

interest. The same holds true with research on sex 

offender treatment, whereby both skeptics and 

advocates can produce some level of empirical 

evidence to support their respective positions. 

The Skeptical Perspective 

Roughly two decades ago, a review of multiple 

treatment outcome studies led to the bleak 

conclusion that treatment for sex offenders does not 

reduce recidivism significantly (Furby, Weinrott, & 

Blackshaw, 1989). The authors acknowledged, 

however, that the designs of many of these 

treatment outcome studies were significantly 

flawed, recognized that many of the evaluated 

programs were somewhat outdated when

compared to the then-current approaches to 

treatment, and left open the possibility that 

treatment actually may be effective for some types 

of sex offenders. Nonetheless, their review became

very influential in putting forth the notion that 

treatment does not work for sex offenders. In some

areas, this research was used to support the 

elimination of specialized sex offender treatment 

programs. 

Years later, additional groups of investigators 

synthesized the findings of multiple studies and 

reached the same general conclusion, noting that 

the poor methodology of the range of available 

studies made it impossible to determine with any 

certainty whether treatment for sex offenders 

“worked” (Quinsey, Harris, Rice, & Lalumiere, 1993; 

United States General Accounting Office, 1996). 

Even today, some experts contend that no 

conclusions can be drawn about treatment 

effectiveness because of the lack of scientific rigor 

in the available research (Rice & Harris, 2003). 

9
Most recently, critics point to the final analysis of a 

single long-term study in California with perhaps the 

best research design to date for exploring the 

impact of treatment interventions on recidivism 

rates for sex offenders (Marques et al., 2005). No 

significant differences in recidivism rates were 

found between the treated sex offenders and the 

untreated comparison groups overall, seemingly 

supporting previous assertions that scientific 

evidence does not support the effectiveness of 

treatment. However, it should be noted that the 

authors acknowledged a variety of limitations to 

their study and warned consumers against 

prematurely drawing broad conclusions that 

treatment for sex offenders is not effective. 

A More Optimistic Perspective 

After the initial unfavorable reviews of treatment 

outcome research were published, several experts 

responded with a series of investigations that 

offered evidence to the contrary (see, e.g., 

Alexander, 1999; Hall, 1995; Marshall & Pithers, 

1994). These analyses indicated that a treatment 

effect does in fact exist for specialized treatment 

programs for sex offenders, particularly when

programs utilize more contemporary approaches to 

treatment, such as cognitive-behavioral and relapse 

prevention models. 

In the years that followed, there was no shortage of 

additional scientific inquiries into the issue of 

treatment effectiveness, with multiple reviews

synthesizing and integrating the ever-growing body 

of research to examine whether an overall 

treatment effect existed. And these most recent 

analyses converge around optimistic findings, 

namely that recidivism rates are lower for those 

who complete sex offender treatment than for those 

who do not receive or complete treatment (e.g., Aos 

et al., 2006; Gallagher, Wilson, Hirschfield, 

Coggeshall, & MacKenzie, 1999; Hanson et al., 

2002; Lösel & Schmucker, 2005). 

Among the most commonly cited examinations, 

because of its relatively strong research 

methodology, breadth of credible studies included, 

and attempt to discern treatment effects for more 

current versus older programs, is the Hanson et al. 

(2002) meta-analysis. After combining 43 

published and unpublished studies that included 

more than 9,000 sex offenders, the authors found a 

significant difference between the “treated” and 

“untreated” groups, with better outcomes for those 

who received treatment – particularly current 

approaches to treatment. The researchers noted, 

nevertheless, that more conclusive evidence was 

needed because of the variations in the quality of 

the various studies that were included in the metaanalysis. In addition, it was reiterated that, given 

the diversity of the sex offender population, 

additional research is critical in order to better 

determine which types of offenders benefit from 

which types of treatment. 

0%

10%

20%

30%

40%

Treated (n = 5,078) Untreated (n = 4,376)

Recidivism

Sexual General

Snapshot: Treatment Effectiveness for Sex Offenders

(Hanson et al., 2002)

It is worth noting that the California study used by 

some to argue that treatment is not effective 

actually provides some evidence of the differential 

impact of treatment on different types of offenders 

(Marques et al., 2005). Namely, individuals with 

child victims who met the goals of treatment 

recidivated at lower rates than those who did not. 

Similarly, higher risk sex offenders who evidenced 

more progress in treatment had lower rates of 

recidivism than high risk sex offenders who made 

less progress in treatment. These findings are 

consistent with other research that reveals better 

outcomes when offenders are matched differentially 

to services based on identified levels of risk and 

needs (e.g., Andrews & Bonta, 2003). 

Finally, as noted previously, the researchers in the 

California study cited a number of factors that may 

have impacted the overall null findings, including a 

program design that may not be considered stateof-the-art when evaluated against current 

standards, a less than optimal individualization of 

treatment based on risk and needs, and the lack of 

a more developed and collaborative aftercare 

component (Marques et al., 2005). 

Taken together, the best available evidence 

suggests that these interventions hold promise for 

adults who have committed sex offenses. 

Nonetheless, additional high quality research is 

needed in the field.

Treatment Outcomes for Juveniles 

Given that the juvenile sex offender management 

field is much less developed than the adult field, it is 

not surprising that there is a paucity of well10
controlled research on treatment effectiveness with

these youth. Similar to the mix of skepticism and

support of the treatment outcome evidence with 

adults, the jury remains out within the juvenile field. 

While some experts question the ability to draw a

conclusions about treatment efficacy with these 

youth because of the wide variability in the quali

of research designs, others suggest the data is 

promising for some types of interventions with so

types of youth (Chaffin, 2006; Fanniff & Becke

2006; Letourneau & Miner, 2005; Marshall & 

Fernandez, 2004; Reitzel & Carbonell, in pre

ny

ty

me

r,

ss; 

alker, McGovern, Poey, & Otis, 2004).

w-up

ent

ffenses, and non-sexual, non-violent offenses. 

s

l.,

l

ved

cidivism for 

oth sexual and non-sexual crimes. 

ent

.

nt 

ose

ho did not (Reitzel & Carbonell, in press). 

W

From a cognitive-behavioral perspective, one 

published study is particularly noteworthy because 

of its relatively sound research design and follo

across different types of recidivism (Worling & 

Curwen, 2000). Compared to untreated juveniles, 

youth who received cognitive-behavioral treatm

with an emphasis on family interventions had 

significantly lower recidivism rates not only for 

sexual offenses, but also for non-sexual violent 

o

As described previously, researchers have also

highlighted the promise of Multisystemic Therapy 

(MST) with sexually abusive youth, most notably 

because of the exceptional research designs and 

positive outcomes from treatment efficacy studie

(see, e.g., Borduin, Henggeler, Blaske, & Stein, 

1990; Borduin & Shaeffer, 2002; Saldana et a

2006). The first randomized trial, comparing 

outcomes between juvenile sex offenders who 

received MST and those who received individua

therapy, revealed superior results for the MST 

group (Borduin et al., 1990). The most currently 

published study yielded similar findings (Borduin &

Schaeffer, 2002). More specifically, in contrast to 

youth in the comparison group, those who received 

MST evidenced fewer behavior problems, impro

family and peer relationships, better academic 

performance, and reduced rates of re

b

Perhaps most compelling are the recent metaanalyses examining the effectiveness of treatm

for juvenile sex offenders, both of which have 

yielded very positive results that favor treatment 

(Reitzel & Carbonell, in press; Walker et al., 2004)

In the most current examination, the researchers

considered treatment outcomes across multiple 

studies that included nearly 3,000 sexually abusive 

youth, and found that youth who received treatme

recidivated at significantly lower rates than th

w

Snapshot: Treatment Effectiveness for Juvenile Sex Offenders

0%

10%

20%

30%

40%

Treatment (n = 1,655) No Treatment (n = 1,331)

Recidivism

(Reitzel & Carbonell, in press)

Conclusion 

A comprehensive approach to managing individuals 

who have committed sex offenses requires the 

consideration and integration of a number of key 

components, including the critical and very 

promising role of treatment. In recent years, the 

face of treatment has begun to change in important 

ways, primarily in response to the ever-growing 

body of research on those who perpetrate these 

crimes. The future of treatment may indeed reflect 

more tailored and ultimately more effective 

interventions for adults and juveniles, taking into 

consideration the diversity both within and across 

these populations. It will also be dependent upon 

the steadfast attempts of researchers to highlight 

which types of individuals benefit most from which 

interventions.

For now, although the current research on 

treatment effectiveness remains somewhat 

equivocal, the available evidence suggests that 

these interventions hold promise for reducing

recidivism both among adults and juveniles who 

have committed sex offenses. Moreover, there is 

no compelling reason to conclude that specialized 

treatment and other rehabilitative interventions 

should be abandoned in favor of a sole reliance on 

more punitive approaches that have already been 

demonstrated as having very limited impact on 

enhancing community safety. 

Acknowledgements 

This brief was authored by Dr. Kurt Bumby of the 

Center for Sex Offender Management. Special 

thanks to Dr. Judith Becker, Dr. John Hunter, Jr., 

and Mr. Robert McGrath for their helpful insights 

and reviews.

11
Contact 

Center for Sex Offender Management 

8403 Colesville Road, Suite 720 

Silver Spring, MD 20910 

Phone: (301) 589-9383 

Fax: (301) 589-3505 

E-mail: askcsom@csom.org 

Internet: www.csom.org 

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This project is supported by Cooperative Agreement No. 2005-WP-BX-K179, awarded by the U.S. Department of Justice, Office of 

Justice Programs. Points of view in this document are those of the authors and do not necessarily represent the official position or 

policies of the U.S. Department of Justice. 

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