Treating adolescent sexual offenders.

VioLit summary: OBJECTIVE: The aim of this paper by Becker was to examine some of the clinical and ethical issues that surround the assessment and the treatment of adolescent sexual offenders. METHODOLOGY: The author employed a non-experimental exploratory study design to address a number of issues concerning the adolescent sexual offender. FINDINGS/DISCUSSION: Whilst the exact incidence of adolescent sexual offenses is unknown, the National Crime Survey suggests that male adolescents accounted for 20% of the forcible rapes in the United States. Studies have found that these boys come from diverse racial and socio-economic backgrounds, and that there are many different antecedents to deviant sexual behavior. Some adolescents display an overall pattern of disordered behavior, others suffer from clinical paraphilias, and others are socially isolated or have problems with impulse control. No empirically tested model is currently available to explain the onset and the development of sexually deviant behavior in adolescents. When assessing the adolescent offender, the author sees the primary role of the clinician as evaluating the degree to which the individual understands that the behavior was inappropriate, and recommending the type of treatment that would best suit each person. The assessment report should provide information concerning the adolescent's sexual behavior and fantasies, the details of the offense, both before, during and after commission, any victimization experiences of abuse or violence in the background of the offender, intelligence levels, substance abuse history, prior behavioral and delinquent history, social and coping skills and peer relations, sexual knowledge and information about the offender's family. Assessment should be based not only upon a clinical interview of the adolescent, but also upon court records, victim statements, prior treatment reports, psychological testing and interviews with the individual's parents. Since few studies have examined the effectiveness of various treatments upon adolescents, the author begins with an examination of various treatments that have been tested with adults. Biological medications have been used to modify levels of androgens, but the presence of serious side effects has precluded use in adolescent populations. Castration has been used in Europe, but the ineffectiveness of the treatment, coupled with the ethical considerations involved in the procedure, have kept this method from being employed in the United States. Psychotherapy and family therapy, as well as behavioral techniques, have all been found to work for some people, although widespread success has not been achieved. Several ethical issues must be considered when treating the adolescent sexual offender. The clinician must assure the adolescent of confidentiality, but must also warn the person about laws requiring the reporting of stated intentions to commit a sexual offense. The clinician must also be sure not to reveal to the parents any information that the adolescent does not want them to know. Of great importance is the client-clinician relationship and the client's confidence in the honesty and reliability of the clinician to keep information between the two of them. The clinician must develop a therapeutic contract with any unwilling offenders, outlining what will be provided to them and what type of behavior is expected of them. Any reports to be sent to the courts should be shared with the adolescent. Whilst few treatment programs have published descriptions of their treatments, the National Adolescent Perpetrator Network has stipulated 19 issues that must be considered in the treatment of the juvenile offender: 1) accepting responsibility; 2) identification of behavioral patterns; 3) interrupting the cycle before an offense occurs; 4) victimization history; 5) development of victim empathy; 6) power and control; 7) the role of sexual arousal; 8) development of a positive sexual identity; 9) understanding the consequences of behavior; 10) family dysfunctions that trigger offending; 11) cognitive distortions that support offending; 12) identifying and expressing feelings; 13) appropriate social peer relations; 14) appropriate trust in adults; 15) addictive qualities reinforcing deviance; 16) substance abuse; 17) skills deficits; 18) prevention of relapse; and 19) options for restitution to victims. The author suggests that the ideal treatment program would address all of these issues and would combine various treatment methods with particular emphasis on the specific needs of each adolescent. The Sexual Behavior Clinic at the New York State Psychiatric Institute provides treatment based upon a cognitive-behavioral model. The treatment begins with verbal satiation, teaching offenders to repeat deviant thoughts to the point where they are no longer stimulated by them. Cognitive restructuring follows, where adolescents learn through role playing to refute old rationalizations about the acceptability of deviant behavior. Covert sensitization is then used to disrupt antecedents to the offenses, so that the thoughts that preceded the incident are immediately negated by thoughts of the negative consequences of the act, such as correctional treatment. Social skills training is the fourth element of the treatment, and it aims to teach the adolescents the necessary skills to relate to peers in an appropriate manner. Nonaggressive but assertive conflict resolution is taught through role playing. Sex education and clarification of values is also taught, as is prevention of sexual diseases. The sixth and last phase of restructuring the adolescents' behavior patterns is relapse prevention, where offenders are taught identify and cope with situations that could lead to inappropriate sexual arousal. After this final stage, participants are re-revaluated, and those who need further help are referred to other service providers. Although participation in this particular program was low, post-treatment follow-up data of 55.9% of those who had completed the therapy show that only 5 of the 52 adolescents had recommitted a sexual offense. AUTHOR'S RECOMMENDATIONS: The author suggested that future research be dedicated to the development of a comprehensive theory that would include individual, social, familial and environmental factors. Studies should be conducted in a controlled fashion, with analysis of specific treatment components. Long-term follow-up studies are needed to examine the factors that influence the recommission of sexually deviant behaviors. EVALUATION: The author presents an interesting and valuable paper in an area that has received little attention in the past. A thorough discussion of assessment methods and treatment and ethical issues provides a very useful basis for further research and development in the field of prevention and intervention for the adolescent sexual offender. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - Male Offender KW - Male Violence KW - Juvenile Male KW - Juvenile Offender KW - Juvenile Treatment KW - Juvenile Violence KW - Offender Treatment KW - Offender Assessment KW - Rape Offender KW - Rape Treatment KW - Sexual Assault Offender KW - Sexual Assault Treatment KW - Violence Against Women Language: en