Treatment approach for sexual offenders

Studies which look specifically at the efficacy of treatment for sex offenders are scarce
and are diverse in both methodology and the therapeutic techniques used. In the
following section the diversity of therapeutic interventions is summarized.
Surgical Treatments
The use of surgical techniques in the treatment of sex offenders has been reported over
the years although such procedures are now very rare. A major problem with surgical
techniques is the ethics of ablating healthy tissue and the resulting side effects such as
nausea, thrombosis and gynecomastia. Another surgical technique that has been rarely
used is stereotaxic hypothalamotomy.
Pharmacological Treatments
A number of studies have examined the value of pharmacological interventions for sex
offenders. The agents used range from anti-androgens to serotonergic drugs. Treatment
radically lowered the sexual interest of their patients and proved very useful in
allowing therapeutic engagement.
Psychological Treatments
Psychological treatment of sex offenders can be broadly divided into
(1) helping the offender gain insight into his/her acquisition of offending
behaviour/personality, (2) helping to control or remove those influences which
maintain the offending pattern and
(3) helping to prevent relapse into re-offending when under stress/in high risk
situations in the community.
Recent literature reflects a consensus amongst therapist-researchers is that all three
areas are important.
Recent therapies used in treating sex offenders are as follows:

Schema-focused therapy: Recent work has suggested the relevance of schemafocused therapy for sex offenders but this is in its early stages of development. This
approach stems from findings that sex offenders have schemas, or ways of
viewing the world, which stem from early attachment experiences and contribute to
offending behavior
Family therapy: Some success has been reported with family therapy. This involved
the participation of the family in therapy and homework.
Relapse prevention therapy: Laws and Pithers have developed some of the basic
relapse prevention ideas (for example high risk situations, social pressure etc) into a
systematic and integrated approach within a broadly cognitive behavioral framework
of assessment and treatment for sex offenders.
Cognitive-behavioral training: Cognitive-behavioral training in anger
management, social skills and assertiveness training have all been used with
varying degrees of success with sex offenders.

Modification of the cognition distortions: It is associated with offending behavior

has been addressed in many programs through detailed psychometric assessments,
interviewing and group discussion, didactic input on the nature of cognitive
distortion.
Sex Offender Treatment Program (SOTP)
Sex Offender Treatment Program (SOTP), which is now the largest of its kind in the
world

SOTP, based on a cognitive behavioral model, covered offence-focused targets such as

a reduction in the extent to which offenders minimized and justified their offence, the
enhancement of victim empathy and the development of plans to manage personally
relevant risk factors.
Offender with mental illness:
Mental illness is usually regarded as a pathological state, much like an illness, that is
universally and intrinsically undesirable.
Medical model of mental illness: The key to the medical is that the bizarre, unusual,
and inappropriate behavior exhibited by individuals who are mentally disordered
are symptoms or manifestations of underlying internal pathology of some sort.
The hard or strict medical model argues that mental illness is always a manifestation
of abnormal biophysical functioning brain damage, a chemical imbalance,
pathological genes, neurological malfunction, and so on. This school or model
suggests environmental factors such as stress, early childhood experiences, and
so on have little etiological significance; at most, they act as triggering
mechanisms that exacerbate an already established predilection for mental illness.
Consequently, any legitimate and effective form of therapy for psychic disorder must
be physical in nature such as drugs, or psychopharmacology, electroshock
therapy (EST), and psychosurgery.
The soft or less extreme medical model agrees that mental illness is a disease in much
the same way as physical diseases are. This means a mental illness need not have a
pathological correspondence; a mentally ill person may have nothing physically
wrong, yet still have a disordered mind.
Substance abusing offenders:
Substance abuse involves the use of any chemical to modify mood or behavior in a
way that differs from socially approved therapeutic or recreational practices. The
American Associations third edition of the Diagnostic and Statistical Manual of
Mental Disorders lists three criteria for the diagnosis of substance abuse: a pattern of
pathological use; impairment of social or occupational functioning; and duration
of the problem for least one month.
Drug rehabilitation/ treatment: In 1990, the National Institute of Drug Abuse
(NIDA) distilled some therapies for the drug abusers. The following are examples of
highly regarded, NIDA approved therapeutic approaches:

 Motivational Enhancement Therapy (MET): is a client-centered counseling

approach designed to resolve the ambivalence many patients have about entering
treatment and stopping drug use. MET can be used to reduce drug use to prepare
patients for more intensive forms of treatment, even in cases with a history of
treatment failure.
The Community Reinforcement Approach (CRA) :The CRA approach also makes
use of contingency management, a behaviorally based strategy that uses a system of
rewards and punishments to reinforce abstinence and make drug use less attractive.
Patients submit urine samples over the course of treatment, and they receive
vouchers for drug-free samples. Vouchers can then be exchanged for goods and
services that help promote a drug-free lifestyle.
Multidimensional Family Therapy (MDFT) for adolescents is an outpatient familybased treatment for teen-agers. In this approach, adolescent drug use is believed to be
influenced by factors related to the individual, the family, the peer group, and the
larger community. Treatment includes both individual and family sessions and
may occur in the clinic, the patients home, or in the community (e.g., court,
school).
Relapse Prevention Therapy: uses a variety of cognitive-behavioral strategies to
facilitate abstinence and reduce the risk of a return to drug use. Relapse Prevention
Therapys approach recognizes that many patients will resume drug use after
treatment and that most patients will require multiple treatment episodes before they
are able to achieve sustained abstinence. Thus, a central element of this approach is
helping patients anticipate and prepare for situations that may trigger a relapse.
Reality therapy:(William Glasser)
Reality therapists care little about standard psychological diagnoses and they generally
describe people by the general behaviors chosen to attempt to satisfy their needs.
Essentially, two broad classes of people defined by their similar behaviors are:
(1) those who generally fulfill themselves and are successful and happy much of
the time, and
(2) those unable to do so and who suffer much pain and failure. Those who fail
are main focus of reality therapy.
Those who fail are further divided into several groups. First, are those who give up; for
example, children who fail in school and seem to settle for this failure. Second, some
who attempt to give up find that they cannot do so. They then choose a wide variety of
symptomic behaviors, mostly painful and ineffective.
Varieties of community corrections:
Criminologist David Duffees delineation of three varieties of community corrections
illustrates this diversity.

1. Community-run correctional programs: controlled by local government, with

minimal connection to state and federal authorities.
2. Community-placed programs: offenders are handled by agencies within the
local district, but agencies in community-placed programs are connected to
central state or federal authorities, or both.
3. Community-based correctional Connection to central authority for resources
and other support services is combined with strong links between the program
and the surrounding locality.
Different types of community corrections:
Intensive supervision probation and parole (ISP):
Intensive supervision probation and parole (ISP) provides stricter conditions, closer
supervision, and more treatment services than do traditional probation and parole.
Offenders are often selected for ISP on the basis of their scores on risk-and-assessment
instruments.
Day reporting centers:
Structured fines, or day fines:
Home confinement and electronic monitoring:
Halfway houses:( 6months): As the term halfway implies, the offender is midway
between jail or prison and the free community.
Temporary-release programs:
Model of prisonization:
Deprivation model of prisonization:
Especially, imprisonment deprives inmates of such things as material possessions,
social acceptance, heterosexual relations, personal security, and liberty. The
environment of shared deprivation gives inmates a basis of solidarity. Inmates have
few alternatives to alleviate their deprivations, loss of status, and degradation. They
cannot escape psychologically or physically; they cannot eliminate the pains of
imprisonment. But inmates have a choice of unity with fellow captives in a spirit of
mutual cooperation or withdrawing to seek only satisfaction of their own needs. This
mutual relationship among the criminals breeds criminality and hampers process of
decriminalization as well. This process of prisonization caused from the deprivation
has impact on the prisoners such as impact on their self-esteem and deterrent effect.
Importation model of prisonization:
It is a model of prisonization based on the assumption that the inmate subculture arises
not only from internal prison experiences but also from external patterns of behavior
that inmates bring to the prison. The importation model is illustrated by the work of
John Irwin and Donald Cressy, who argue that the prison subculture is a combination
of several types of subcultures that exist outside the prison and are imported by
offenders when they enter.