Treatment of Juvenile Sex Offenders
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Running head: TREATMENT OF JUVENILE SEX OFFENDERS
Treatment of Juvenile Sex Offenders
Katie Wilkinson
University of Nevada, Las Vegas
Katie Wilkinson, BS., is currently a graduate student in the Department of Marriage and Family
Therapy at the University of Nevada, Las Vegas, 4505 Maryland Pkwy., Box 453045, Las
Vegas, NV 89154-3045. Her email address is wilkin59@unlv.nevada.edu
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Young people, under the age of 21, commit a large percentage of sexual offenses each
year. The actual number of juvenile sex crimes is presumed underestimated because so many
incidences go unreported (Veneziano & Veneziano, 2002) even if discovered by a third party
(Vizard, Monck, & Misch, 199)). According to the U.S. Department of Justice, 20% of all rapes
and approximately 25% of sexual abuse arrests involve perpetrators under the age of 21
(Weinrott, Riggan & Frothingham, 1997). Valliant and Bergeron (1997) reported that between
30 % and 50% of child sexual abuse cases are committed by juveniles; at least a half million
juveniles carry out a sex crime every year (Weinrott et al., 1997). Arrest statistics maintained by
the FBI indicate that juveniles account for approximately 35% of the arrests made in 2000 for
rape or other sexual offenses (Eastman, 2005).
The field of juvenile sex offenders has become a topic of interest for researches in the
past 15-20 years (Hunter & Figueredo, 1999; Sermabeikian & Martinez, 1994; Vizard et al.
1995). Research on treatment and treatment outcomes for juvenile sex offenders is growing
because of pressure on mental health professionals to identify factors of treatment success and
failure. The failure of an adolescent offender to successfully complete treatment has serious
implications related to community safety. Research on adult sex offenders has strongly
influenced treatment development for adolescents, which has indicated that many adult offenders
initially engaged in sexually deviant behavior in their adolescence (Eastman, 2005). It is
estimated that, without treatment, the average adolescent sex offender will go on to commit 380
sex crimes during his or her lifetime (Barbaree, Hudson, & Seto, 1993).
The best predictors of future offending is if there is a history of chronic offending and the
length of treatment after the first offense (McMackin, Tansi, & LaFratta, 2003). Kelley, Lewis,
and Sigal (2004) found that first treatment gains were made only after the first 8 months of
Treatment of Juvenile Sex Offenders
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treatments in a residential treatment facility. Research stresses the importance of knowing what
factors impact treatment outcomes because treatment does not work for all young offenders.
O’Reilly et al. (1996) found that not all sex offending adolescents responded to treatment. Lowrisk cases showed treatment affects, whereas high-risk cases showed lower ability levels, lower
levels of parental care, and mediocre levels of psychological and psychosocial functioning. In
order to understand what level of risk the young people bring into treatment it is necessary to
continually assess the individuals and families.
The assessment of these young people provides the mental health professional
information regarding the offender’s strengths and weaknesses, treatment needs, and amenability
to intervention (Bonner, Marx, Thompson, & Michaelson, 1998). The literature identifies a
number of factors considered relevant when assessing sexual offenders. Personal characteristics
identified as increasing the probability of treatment failure include a history of personal
victimization, past sexual offenses, and nonsexual criminal offenses. Treatment targets noted as
having a negative impact on treatment completion include extreme levels of distorted beliefs
regarding sexual aggression, difficulty or inability to empathize, under-established interpersonal
skills, and an absence in personal coping skills (Eastman, 2005).
Continual assessment of offenders is imperative and should include both formal
assessment and gathering and reviewing of outside information such as police reports, victim
interviews, and court documents (Marshall, 1999). Many of the initial interviews uncover risk
factors that impact the young person’s behavior and interfere with treatment outcomes, including
sexual and physical abuse; neglect; alcohol and drug use; dysfunctional family relationships;
parental history of substance abuse, incarcerations, and psychiatric illness; criminal record; low
social competence; problems at school; and previous placements (Kelley et al., 2004). Many of
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these offenders are struggling through multiple risk factors and often have not developed proper
coping skills to help them manage such difficult life styles. Vizard et al. (1995) found that
adolescent sex offenders have been reported as (1) being more socially isolated than their peers,
(2) having dysfunctional families in which violence between parents and toward children is
common, (3) having parents with victimization in their own childhood, (4) displaying academic
and behavioral problems in school, and (5) having low self-esteem and depressive/anxious
symptoms.
The greater part of the research examines the various therapeutic modalities available for
these young people rather than the treatment outcomes. Today, a majority of the treatment
programs for adolescents who have committed sex offenses use cognitive-behavioral techniques,
incorporating a relapse-prevention component, that are delivered through group, individual, and
family modalities (Becker & Hunter, 1997; Hunter & Figueredo, 1999; Veneziano & Veneziano,
2002). Veneziano and Veneziano (2002) found through their literature review that many
treatment programs for juvenile sex offenders use cognitive-behavioral techniques in group
settings. Most treatment modalities typically include (1) decreasing cognitive distortions; (2)
increasing empathy; (3) enhancing problem-solving skills; (4) decreasing deviant sexual arousal;
(5) enhancing age appropriate social skills, including dating skills; (6) resolving traumatic
consequences associated with being victimized; and (7) enhancing management of emotions,
such as anger (Hunter & Figueredo, 1999).
Within many of the programs there are other cognitive behavior techniques that have
been applied in the treatment of sex offenders, including satiation therapy, verbal (Becker, 1990;
Becker et al., 1988) and masturbatory (Hunter & Santos, 1990). Satiation therapy teaches
offenders to repeat their deviant thoughts to the point of boredom, in turn satiating themselves
Treatment of Juvenile Sex Offenders
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with the same stimuli they may have used to become aroused (Becker, 1990). Another cognitive
behavior technique used with juvenile sex offenders is covert sensitization (Becker, 1990;
Becker et al.,1988; Hunter & Santos, 1990; Weinrott et al., 1997). Covert sensitization involves
articulating feelings and experiences leading up to an offense followed by exploring a variety of
consequences the offense may generate, such as being discovered committing the act or being
sent to a correctional facility (Becker, 1990). Hunter and Santos (1990) used, in combination
with other cognitive-behavioral techniques, insight-oriented approaches which are geared toward
assisting the individual offenders to gain a better understating of their intrapsychic feelings,
needs and conflicts, by exploring how they may have contributed to their behavior.
There are programs, which use psychosocial education and utilize group work to address
sex education, coping skill, taking responsibility for one’s actions, behavior and emotion
management, problem solving, and individual therapy. It appears that educational approaches do
change the knowledge or attitudes of juvenile sex offenders (Fanniff & Becker, 2006).
Unfortunately, many of the studies of psychoeducational techniques did not include recidivism
as an outcome measure, causing difficulty in determining the usefulness of these types of
approaches. Also, comparison groups are included only in about half of the studies, and only one
of these studies utilized random assignment. These factors prevent determination regarding the
effectiveness of the treatment (Fanniff & Becker, 2006).
Treatment programs also need to gear their practices to focus on risk factors from both
inside the family outside the family, including peer relationships and substance use. These young
people have not developed appropriate skills to make age-appropriate relationships. It is believed
that establishing social skills will assist the offender in developing peer relationships instead of
seeking social support and intimacy with weaker, less threatening, and often significantly
Treatment of Juvenile Sex Offenders
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younger persons (Hall, 1996). Young offenders will need to learn appropriate coping skills for
when future experience become challenging rather then depending on the unhealthy and
detrimental coping skills, like substance use. Approximately half of the population of sex
offenders reported they were drinking at the time they committed the offense. Adolescent sex
offenders who are considered substance users create even more challenges for treatment
programs; it is recommended that treatment be geared towards addressing added risk factors
(Kelley et al., 2004). By addressing the young person’s risk factors the counselors will need to
focus treatment systemically rather then just cognitive-behaviorally.
One of the few treatment modalities to have been assessed for efficacy is Multi-Systemic
Therapy (MST) (Swenson, Henggler, Schoenwald, Kaufman, & Randall, 1998). This type of
family therapy has been found to be more successful than individual treatment. The intervention
goals focus on the strengthening cognitive deficits, improving family and peer relations, and
enhancing school performance (Openshaw, 2004). MST is recommended as an appropriate
choice of treatment because its approach attends to the multi-determined nature of delinquent
behavior in young people. Treatment relies on home-based services and intervention in schools
and community (Swenson et al., 1998).
Involving multiple aspects of the young person’s environment is imperative because the
most common characteristic observed in juvenile sex offenders is a history of victimization, most
often at the hands of family members or people in their community. Studies indicate that 60% to
90% of male juvenile sex offenders were previously sexually abused, physically abused,
neglected, or a combination of the three as compared to other adolescent male populations
(Becker, 1998; Veneziano &Veneziano, 2002). Without involving the family in treatment, it is
likely that a young offender will reengage with the risk factors that led him to initially act in a
Treatment of Juvenile Sex Offenders
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sexually deviant manner. Family relationships are frequently described as chaotic, disorganized,
and generally dysfunctional as compared to other populations (Eastman & Bunch, 2004).
Research on family communication styles has found that supportive communication and
comments are limited in the families of both juvenile sex offenders and violent offenders,
whereas negative communication, such as aggressive statements and interruptions, are frequent
(Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). Interventions specific to the
multisystemic treatment of adolescent sex offenders include: delineation of a sexual assault cycle
and interruption of the cycle using work with the offenders and members of the family and
community to help recognize and prevent the pattern, acknowledgement of the offense,
acceptance of responsibility of the adolescent, psychological restitution to the victim,
development of a safety plan, assistance in family reunification, and the development of
friendships (Swenson et al., 1998).
It is important to involve the family in the treatment of juvenile sex offender because
early developmental trauma and familial dysfunction appear to be more common and severe in
the histories of young people with sexual behavior problems than in those of adult sexual
offenders (Hunter & Becker, 1994). Research indicates that trauma was often pervasive and
chronic and occurred in the absence of environmental protections and supports (Hunter &
Figueredo, 1999). If the young offenders are expected to return to their home after treatment, it is
imperative that the family functioning is changed in order to create an environment that does
support and protect the reformed young person. Cognitive-behavioral techniques and
multisystemic therapy have been the most promising techniques used with juvenile delinquents.
Relapse prevention approaches would also appear logically to be techniques that might prove to
Treatment of Juvenile Sex Offenders
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be effective with juvenile sexual offenders. Further research into classification, assessment, and
treatment of this population is much needed (Veneziano & Veneziano, 2002).
Scott Henggeler, Sonja Schoenwald, Charles Borduin, Melissa Rowlands, Phillippe
Cunningham, Cynthia Swenson, Keith Kaufman, and Jeff Randall are important researchers and
practitioners of Multisystemic Therapy (MST) (Borduin & Shaffer, 2002; Henggeler et al.,
1998; Swenson et al., 1998; Borduin, Henggler, Blake, & Stein, 1990). MST is considered on of
the most promising holistic approaches to treating adolescent sex offenders because it has
demonstrated long-term reduction in criminal activity and violence in high-risk aggressive young
people (Henggeler et al., 1996). MST addresses the numerous determinants of deviant behavior
from the young persons’ environment including family, school, peers, work, and community,
which are viewed as interconnected systems with reciprocal influences (Henggeler et al., 1996;
Swenson et al., 1998).
Howard Barbaree is Head of Impulse Control Disorders Program at Clark Institute of
Psychiatry in Toronto. He has devoted his teaching and research and practice to issues related to
sexual aggression and deviance. Barbaree has published numerous articles and book chapters as
well as finding the Warkworth Sexual Behavior Clinic. William Marshall is a Professor at
Queen’s University in Kingston, Canada and the founding director of the Kingston Sexual
Behavior Clinic and has helped to develop treatment programs in six different countries
throughout the world. He has dedicated his profession to research and practice to aspects of
assessment and treatment of the sex offender. Marshall has published over 100 journal articles
and book chapters throughout the years.
William L. Marshall and Howard E. Barbaree (2006) co-edited and updated the book
The Juvenile Sex Offender, 2nd Edition (Guliford Press) which includes chapters by leading
Treatment of Juvenile Sex Offenders
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researchers and practitioners. Information includes what is known about the nature and
development of sexually abusive behavior, consequences for both the abuser and the abused, and
treatment including assessment, intervention and relapse prevention. Marshall and Barbaree
(1990) also co-edited the book Handbook of Sexual Assault: Issues, Theories, and Treatment of
the Offender (Plenum Publishing Corp.).
Judith V. Becker is a Professor in the Department of Psychology at the University of
Arizona. She taught at the University of Tennessee and Columbia University prior to the
University of Arizona. Becker has written numerous articles on assessment and treatment of
juvenile sex offenders and the efficacy of treatment modalities (Fanniff & Becker, 2006; Becker
& Hunter, 1997; Becker, Kaplan, & Trenke, 1992; Becker, 1990; Becker, Kaplan, & Kavoussi,
1988). Becker is the President of the International Academy of Sex Research and the Association
for the Treatment of Sexual Abusers
Brenda J. Eastman is currently an associate professor in the School of Social Work at
East Carolina University in Greenville, North Carolina. She is a LCSW and has extensive
clinical experience working with both adult and juvenile sex offenders. Eastman has written
articles examining personality characteristics of, why treatment fails, and the efficacy of
treatment modalities for adolescent sex offenders (Eastman 2005; 2004; Eastman & Bunch,
2004).
John A. Hunter is Research Associate Professor in the Psychology Department of the
University of Virginia. He has written multiple articles on the treatment of juvenile sex offenders
(Hunter & Figueredo, 1999; Hunter & Becker, 1994; Hunter & Santos, 1990). He is currently
working on Juvenile Sex Offenders: A Cognitive-Behavioral Treatment Program Workbook, due
out in 2008.
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