Psychosocial Approaches to Treatment of Sex Offenders

• Author: Howard Barbaree and Laura C. Ball
• Pages: 903-918

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CHAPTER 42

Psychosocial Approaches to

Treatment of Sex Of‌fenders

Howard Barbaree and Laura C. Ball

I. INTRODUCTION

e present chapter is meant to provide an overview of psychosocial interventions for sex oenders.

Psychosocial interventions include all non-medical treatments or other clinical interventions used for

the treatment and management of the sex oender.

is chapter will use the term child molester interchangeably with sex oender because the majority

of sex oenders seen in any forensic mental health setting are child molesters. Among child molest-

ers, pedophiles are those that meet criteria for pedophilia set out in the Diagnostic and Statistical Manual

(DSM- IV-TR ) (APA, 2000). In correctional settings, child molesters are equally represented by rapists —

sex oenders who have assaulted adult victims.

e history of the treatment of the sex oender is one of an accumulation of treatment and manage-

ment methods with continuing elaboration or improvement of methods that have been originated earlier.

For example, sex education and social skills training were two of the rst psychosocial interventions

used with sex oenders. Today, many programs oer sex education and social skills trai ning as program

components or modules, combined with numerous other components that have been developed more

recently. As a consequence, for the sake of simplicity of presentation, the present chapter outlines the

historical development of psychosocial approaches to treatment and proceeds with an outline of present

treatment opt ions.

II. TREATMENT CONTEXT

A. Recruiting Sex Of‌fenders to Treatment

From its beginnings, treatment of the sex oender diered from most other medical or mental health

treatment in the sense that it has not been primarily for the benet of the person being treated. Treatment

has been funded by agencies of the government (corrections, mental health authorities) for the express

purpose of preventing further sexual abuse. erefore, treatment professionals oen see themselves, and

are seen by the sex oender, as agents of the government (or general public) as much as they are agents for

the person being treated. While treatment of the sex oender is not funded and provided for the benet

of the oender being treated, nevertheless, there are many benets derived by the oender. For example,

release from custody or parole is oen contingent on completion of treatment; and consequently oend-

ers oen complete treatment to increase their chances for release.

Most oen the person being treated would not have sought treatment had they not been apprehended,

charged, convicted, or incarcerated for their sexual crimes. Most candidates are resistant to treatment

and even though they formally consent to treatment in the sense that they sign consent forms, they oen

complain that they have not consented freely — i.e., they have consented under duress or pressure from

their parole or probation ocers. Obviously, in this circumstance, a great deal of attention must be paid

Howard Barbaree and Laura C. Ball

at the outset of therapy to increasing the oender’s treatment motivation, to engaging the oender in the

therapeutic process and to developing the therapeutic relationship.

B. Prison, Hospital and Community Settings

Treatment of the sex oender may be provided in one of three dierent settings, depending on the cir-

cumstances of the oender, as described in Table 42.1 below.

Table . Treatment Settings

Of‌fender Circumstances General Setting Specif‌ic Facility Type

Of‌fenders who are serving

criminal sentences

Correctional Institute • Prison

• Penitentiary

• Jail

Mentally disordered sex of‌fenders Hospitals • Secure hospital facilities

• Mental health institutions

Of‌fenders who have been

released from custody or those on

parole

Community • Social service agencies

• Outpatient programs

• Community treatment

programs

Earlier in the history of sex oender treatment, special facilities were established in which only sex

oenders were housed and treated. is was due to perceived dangers of integrating sex oenders into

general prison populations where they could be at risk for persecution or physical violence. More recent-

ly, sex oender treatment programs have been integrated quite safely into general population facilities.

C. Group Versus Individual Therapy

From the beginning, sex oender treatment has been delivered most oen through group therapy. is

format is especially preferred in institutional settings, primarily due to cost and eciency considerations.

Group therapy is convenient to use in an institutional setting since all members are available and can

meet according to a common schedule. Even when a program utilizes a group therapy format, treatment

can be tailored to the needs of the individual oender. Most programs provide treatment in “modules”

delivered in a group format and oenders may only attend specic group sessions on the modules that

are relevant to their particular needs.

Individual (one-on-one) therapy is more frequently used in a community or outpatient setting when

the oenders have work and family schedules to accommodate. Additionally, individual therapy formats

are used in the application of some of the behavioural therapies described below that are delivered in a

phallometric laboratory. Of course, assessments are usually done on a one-on-one basis.

III. TREATMENT

e most signicant desired outcome for psychosocial treatment of sex oenders is the cessation of sex-

ually abusive behaviour. Consequently, studies evaluating the eectiveness of treatment have focused

on measuring sex oender recidivism over long periods of follow-up. We review the outcome literature