Learning Objectives

CSOM Long Version: Section 4 1

Learning Objectives

Participants will be able to: Summarize researchOutline treatment componentsIdentify reasonable expectations of

treatment providerIdentify treatment provider qualificationsOutline collaboration strategies


Effectiveness of TreatmentDifficult to studyPoor dataPrograms and definitions varyDesign criteria difficult to meet

BUT“Good grounds for optimism” (Marshall and Pithers, 1994)


Review of the ResearchIndividuals who had received treatment

had consistently lower recidivism rates than untreated individuals.

Better outcomes after 1980--perhaps better programs or better research.

Treatment over long periods of time is more effective.

Completing treatment is important.(M.A. Alexander, 1994)


Review of the Research (cont.)

Recidivism rates of untreated offenders are approximately 60%.

Recidivism rates of offenders completing specialized treatment are between 15% and 20%.

(U.S. Department of Justice, 1991)


Review of the Research (cont.)

Grossman et al (1999): reduction in recidivism of 30% over seven years

Gallagher et al (1999): cognitive-behavioral approaches appear particularly promising

Polizzi et al (1999): prison and non-prison based programs show effective or promising results


Review of theResearch (cont.)

1995 meta-analysis found (Hall, 1995) small but significant treatment effect 12 studies--all with control groups 8 percent reduction in recidivism in the

treatment group


Summary of Research on Treatment EffectivenessMany studies, many poorly designed.Well-designed studies associate treatment

with lower recidivism--some very significantly

Outcomes differ by type of offenderGreater reductions found in more recent

studiesTreatment and/or evaluation methods are

improving


Summary of Research on Treatment Effectiveness (cont.)

Analytic or insight oriented therapies are not effective (Quinsey, 1990, 1994; Salter, 1988; Lanyon, 1986)

A combination of educational, cognitive-behavioral, and family system interventions is effective (Knopp and Stevenson, 1988, 1992)

When reviewing all studies; conclude that treatment reduces recidivism by 10%


Effectiveness of Treatment Plus SupervisionOnly a few studies done--they support

effectiveness of combined treatment and supervision (some with the polygraph). (Romero and Williams, 1985 , 1991)

Current study of Maricopa County program is revealing low rates of recidivism.(Maricopa County Adult Probation Department, 1999)


Traditional vs. Sex Offender Treatment

Offender-focused Targets reduction

in anxiety/inadequacy

Individual counseling Usually voluntary

Victim/community safety focused

Targets accountability and thinking errors

Primarily group settingOften mandated

Traditional Sex Offender Specific


Traditional vs. Sex Offender Treatment (cont.)

Client/patient confidentiality

Provider works as an individual practitioner

Generalist” training for a variety of client types

Waivers of confidentiality

Provider is part of management team

Specialized training/ experience essential

Traditional Sex Offender Specific


Means of Reducing Recidivism through TreatmentAccepting responsibility and

modifying cognitive distortionsDeveloping victim empathyControlling sexual arousalImproving social competenceDeveloping relapse prevention skillsEstablishing supervision conditions

and networksClarification


Methods of TreatmentPsycho-educational groupsCognitive-behavioral groupsMedicationIndividual therapyPsychological and physiological testingReferrals to other necessary treatments


Components of Treatment To cause acceptance of

responsibility: Education about denial Support for incremental steps Making responsibility a prerequisite for

entry/completion Confronting/challenging discrepancies,

cognitive distortions


Components of TreatmentTo develop victim empathy:

Psychoeducation on effects of abuse Exercises to imagine victim experience Teaching empathy skills Meeting with victim(s)


Components of TreatmentTo control sexual arousal:

Education about fantasy and behavior Cognitive-behavioral techniques for

interrupting/reducing deviant urges, developing/increasing non-deviant urges

Methods for practice outside of therapy setting

Medication


Components of TreatmentTo improve social competence:

Using group setting for practice Referral to specialized treatment Involving significant others


Components of TreatmentTo develop relapse prevention skills:

Education about relapse prevention Identifying individual’s cycle Teaching strategies to avoid lapses Teaching/practicing strategies to

minimize lapses


Components of TreatmentTo establish supervision conditions

and networks: Provider collaborates with officer Advises on cycle and appropriate

conditions Assists with modifications Educates network


Components of TreatmentTo Clarify:

Verbalize full responsibility Acknowledge grooming, set up State details of offense Support decision to report to police Acknowledge ongoing problem


What to Expect from a Sex Offender Treatment Provider

Team workCommunity safetyLimited confidentialityIncorporates evaluationAlso: Experience and/or recent

specialized training


Monitoring Treatment and ProvidersWritten reportsCase conferences

New cases Specific offender issues System problems


Monitoring Treatment and Providers (cont.)Observation

Content Process

Emergency case reviewsCommunity feedbackGraduation Criteria


Treatment Providers Must Deal With:DominationManipulationAngerAggressive

outburstsDepressionSelf-defeating

behaviors

Variety of skill deficits

Family educationVictim issuesOngoing risk

assessment


Collaboration Between Treatment and SupervisionProbation/parole may offer classesComplementary treatment and

supervision plansProbation/parole participate/observe in

treatment sessionsWritten treatment plan exchanged with

probation Joint understanding of offense cycles


Primary Goal of Treatment -- Reduce Future VictimizationThe following are means to that end:Reducing cognitive distortionsAccepting responsibilityDeveloping victim empathyControlling sexual arousalImproving social competenceDeveloping relapse prevention skillsEstablishing supervision conditions and

networks


Treatment Providers Must be Willing to...

Work as part of a teamShare informationProtect the community as a primary

responsibilityEvaluate their work by these standards

Documents

Learning Objectives