Treatment and Supervision of
Sex Offenders

Learning Objectives
• Name the commonly used model of treatment for adult sex offenders;
• Identify three targets of treatment designed to reduce recidivism among sex offenders; and
• Discuss the current controversies that lead to differing opinions regarding treatment of sex offenders;

Learning Objectives (cont.)
• Name three areas in which
“specialization” applies to supervising sex offenders; and
• List three examples of specialized supervision conditions that may be relevant for sex offenders.

Health” Treatments
Research Strengths and
Weaknesses
What Sex Offender Treatment Looks
Like
Treatment and Supervision
Professionals
O VERVIEW

Two Overarching Goals of Sex
Offender Treatment
• Prevent further harm, victimization
• Promote offender stability, success

C OMPARISON OF S EX
O FFENDER T REATMENT
WITH O THER
“B
EHAVIORAL
H EALTH
” T
REATMENTS

How is Sex Offender Treatment . . .
• Similar to other types of psychological treatment?
• Different from other types of psychological treatment?

Treatment Comparisons
Sex Offender-
Specific Treatment
Clients generally involuntary, mandated
Other Mental or Behavioral
Health Treatment
Often voluntary, self-selected clients
Limited confidentiality, waivers common
Strict confidentiality, few exceptions
Therapeutic climate is vital Therapeutic climate is vital
Blend of client-determined and pre-determined goals
Primarily client-determined goals

Treatment Comparisons (cont.)
Sex Offender-
Specific Treatment
Other Mental or Behavioral
Health Treatment
Assessment-driven interventions
Assessment-driven interventions
Group therapy modality most common
Individual therapy sessions most common
Success or “failure” impacts public safety
Success or failure primarily impacts the client

Different Approaches to
Sex Offender Treatment:
Which Seem Most Likely to Work?
• Psychoanalysis
• Insight-oriented therapy

Different Approaches to
Sex Offender Treatment:
Which Seem Most Likely to Work?
(cont.)
• Behavioral techniques
• Medical, pharmacological interventions
• Cognitive-behavioral treatment

R ESEARCH S TRENGTHS
AND W EAKNESSES

Understanding the Controversy
• What do we need to understand about treatment research to know if it validly informs us as to whether treatment works?
• A little background on research design

General: How Do We Know if a
Treatment Works?
• Test it scientifically for risks and benefits
• Standard: scientific studies
– Adequate sample of subjects
– Randomized
– Controlled
• Measure outcomes with accuracy

After the Research
• Findings of safety and efficacy allow for treating within guidelines of “dose” and duration
• Findings apply to a certain population with extreme care for extrapolation
• “Off-label use” – new applications of treatment

Experimental vs.
Quasi-Experimental Studies

W HAT S EX O FFENDER
T REATMENT L OOKS L IKE

Commonly Used Approach to Sex
Offender-Specific Treatment
• Cognitive-behavioral model
• Multiple modalities
– Group, individual, marital/family
– Pharmacological

What Does Cognitive Behavioral
Treatment Look Like?
• Individual and/or group sessions
• Focus on past offenses and the pattern of thoughts, feelings, and behaviors that led up to the offense
– e.g., substance use, viewing pornography, fantasies
• Challenges old patterns, introduces alternative thought and behavior patterns

Primary Targets of Sex Offender
Treatment (Static and Dynamic)
• Sexual deviance, sexual preoccupations
• Intimacy deficits, conflicts in relationships
• Pro-offending attitudes
• Hostility, pervasive anger
• Lifestyle instability
• Research data does not show that treatment of specific risk factors

Assessment-Driven Treatment
• Individualized dose and duration of treatment and supervision
• Target known risk factors
• Measurement of progress
– e.g., Treatment needs and progress cale every six months

Medication Approaches
• Decrease testosterone  decrease sex drive
• Does not change sexual interests
• Time-limited effect
• Side effects: bones, liver

Medications
• Antiandrogens
– Provera™
– Lupron™
• SSRI Antidepressants

Research on
Treatment Effectiveness
• Increasing body of research
• Several meta-analyses
• Treatment associated with lower recidivism rates in non-randomized studies
• However, randomized study found higher rate of recidivism in treatment group

“Balanced Approach” to
Sex Offender Management
Risk
Management through
Specialized
Supervision
Maximized
Public
Safety
Risk
Reduction through
Sex
Offender
Treatment

T REATMENT AND
S UPERVISION P ROFESSIONALS

Treatment Provider Expertise
• Relevant advanced degree
• Forensic training, experience
• Specialized training, clinical supervision
• Licensure, professional affiliations
• Continuing education

Elements of Sex
Offender Supervision
• Specialized officers
• Specialized conditions
• Specialized technology

Specialized Officers
• Internal expertise
• Focused efforts
• Awareness of resources
• Collaboration emphasis

Areas Addressed by
Specialized Conditions
• Treatment
• Victim contact

Areas Addressed by
Specialized Conditions (cont.)
• Employment, leisure activities
• Surveillance
• Monitoring

Supervision – Query
• What types of specialized conditions do you believe are most important for sex offenders under community supervision?
• To what extent are specialized conditions for sex offenders used in your jurisdiction?
• Who is responsible for imposing these conditions?

Supervision Orientations and
Philosophies
Surveillance,
Monitoring,
Enforcement
Social
Casework

Surveillance and Monitoring
• GPS
• Polygraph
• UDS

Applying Risk Principles to Sex
Offenders Supervision
• Target higher risk offenders for more intensive supervision strategies
• Provide longer periods of supervision for higher risk offenders than for lower risk offenders
• Focus programming referrals on higher risk offenders
• Ensure that more risk factors, rather than non-risk factors, are the focus of intervention

Summary and Implications
• Cognitive-behavioral sex offender treatment reduces recidivism in nonrandomized studies.
• Supervising sex offenders involves specialization
• Balancing treatment and supervision may increase public safety
• Risk reduction and risk management can be targeted through sentencing orders