A review of sex offender treatment programs.

Abstract: The author analyzes the current literature and research concerning sexual offender treatment including research on treatment methods and a brief review of three populations: wife batterers; alcoholics; and substance abusers. A brief description of several treatment programs is followed by a discussion of sex offender treatment effectiveness, and a qualitative study of alcoholics' perception of treatment to illustrate how qualitative results were utilized to structure a treatment approach. Key Words: Sex Offender, Treatment Programs, Wife Batterer, Substance Abuser, Alcoholics How do we understand sexual offender treatment? What therapies and interventions are useful? On what should the goals of treatment focus? The intent of this review is to analyze some of the current literature and research concerning sexual offender treatment. To best achieve this end, this review includes research on treatment methods and a brief review of the literature on three related populations: wife batterers, alcoholics, and substance abusers. Following a detailed description of several treatment programs, the problems of studying sex offender treatment effectiveness are discussed. Also included is a discussion of a topic-relevant qualitative study on sex offender treatment. Finally, a qualitative study of alcoholics perception of treatment is discussed to illustrate how qualitative results were utilized to structure a treatment approach. OVERVIEW OF TREATMENT METHODS FOR SEX OFFENDERS Sex offender treatment consists of physical and psychological techniques offered through various inpatient and outpatient services. Physical treatments include three approaches: stereotaxic ablation of the central nervous system, physical castration, and pharmacologic agents (Marshall, Jones, Ward, Johnston & Barbaree, 1991; Prentky, Knight & Lee, 1997). Psychological intervention processes consist of non-behavioral approaches, evocative therapy, cognitive behavioral programs delivered in milieu-- based settings such as institutional-based programs, and outpatient programs (Marshall et al., 1991; Prentky, Knight & Lee, 1997). The goal of all of these treatment interventions is the cessation or control of sexual offending. Some treatment research cited above report high recidivism rates (Furby, Weinrott, & Blackshaw, 1989, Marshall et al., 1991). These studies are important because they provide a historical background of the progress and gaps in the treatment of sex offenders. What follows is a brief discussion of these psychological, pharmacological and physical treatment methods. Three reviews (Furby et al., 1989; Marshall et al., 1991; Prentky et al., 1997) are most helpful in this regard. In the 1970s and early 1980s, physical interventions became popular especially in Europe. Literature on the effectiveness of physical treatment interventions described findings of psychosurgery, pharmacologic agents and castration; they demonstrated limited practicality (Marshall et al., 1991 ). For example, stereotaxic ablation procedures (hypothalamotomies) are still ethically questionable. The intent of these procedures was to control sexual behavior by obliterating the ventromedial nucleus of the hypothalamus. As a method of intervention for sex offenders, the intended outcome is to direct sexual behavior toward more socially acceptable and appropriate outlets. Marshall's and others (1991) review found that this extreme intervention had limited results. In their review of studies on stereotaxic ablation procedures, they found that some homosexual offenders continued to be "preoccupied with boy love" (Marshall et al., 1991 p. 469) and not all subjects were sexual offenders. In one of the studies reviewed by Marshall and others (1991) there were intellectual and emotional side effects (loss of all sexual interest), and the overall failure rate for this treatment was 36%. However, 26% of the subjects who failed were sexual offenders (Marshall et al. …