Treatment of people convicted for sexual offenses; old and new challenges – Wineke Smid

The ultimate challenge in our work is unchanging: stopping sexual abuse. One of the principal ways to achieve this is through the adequate treatment of people who have committed sexual offenses (PCSO). My presentation at this year’s NOTA Annual Conference focused on recent developments on this particular topic. Some challenges have been around for a while, and remain important, and new challenges have arisen, some of which can be seen as new forms of old challenges.

What works to stop reoffending?

First, I always like to emphasize that punishment is rather effective for PCSO, most of whom do not recidivate. Greater investment in consistent, swift and adequate punishment could contribute to the reduction of sexual offending. It is important to realize, however, that judicial punishment is not the only punishment that people learn from. There is a role for all of us. We need to actively discuss what is acceptable and what is not, where exactly the lines are, so they are clear to everybody. We need to consistently address transgressive behaviors and not condone it from friends or powerful or famous people. The #MeToo movement has been helpful in this respect. However, the aim is to change behavior and people should be allowed to learn from their mistakes, improve themselves and not be punished or invalidated forever.

For those for whom punishment does not work, more punishment usually does not work either. People who cannot stop their offending behavior after having been punished repeatedly likely need interventions in which they are supported in the development of a life without offending. The focus in this treatment is not so much on punishing the bad behavior, but on rewarding the good behavior. All people, but specifically forensic patients, learn better that way. We know that the best forensic interventions follow the risk-need-responsivity (RNR) principles (Andrews and Bonta, 2017): More (intensive) treatment for higher risk, a focus on factors related to recidivism, and fitting treatment to the patient.

Risk

Validated risk assessment instruments are needed to assess recidivism risk. There are various instruments with different scores and risk-categories. A new development is the creation of standardized risk levels (Hanson et al, 2017) that calibrate all instruments to the same risk levels. This way we all speak the same risk-language in terms of recidivism rates, but also in terms of the problems PCSO in each risk-level usually have, their treatment needs and their prognosis.

An older challenge that still requires attention is the fact that (intensive) treatment may be counterproductive for low-risk offenders (Lowenkamp et al, 2017). The choice not to recommend any intervention for PCSO is a difficult one, because we often feel the need to do something. If we do involve low-risk offenders in treatment, we should at least be careful not to mix high and low risk offenders within a treatment group and ensure that the intervention does not interfere with protective structures that are still standing in a person’s life, such as work, hobbies, etc.

Need

The Need principle means focus; it is not our goal to change our patients into perfect citizens, we only need them to stop offending. The new incentive model of sexual motivation (Smid and Wever, 2019) may help clarify this focus. One important premise of the model is that (dis)inhibition is an inherent part of the (normal and deviant) sexual motivation process. Treatment of all PCSO can focus on the inhibition part of the sexual motivation process: it is ok to feel what you feel, but not to act on these feelings. If deviant sexual interests themselves become the target of treatment, e.g., through medication or arousal conditioning, there needs to be consensus with the patient about losing (part of) their sexuality.

The World Health Organization (WHO, 2021) describes sexual health as “the possibility of having pleasurable and safe [for self and others] sexual experiences”, and states that all people have “the rights to the highest attainable standard of sexual health”. This implies that anything that is satisfying for the individual and not harmful for them or for others is worthy of consideration. To achieve sexual health with PCSO with deviant interests we can:

  1. stimulate normative interests, if present
  2. if normative interests are unattainable, we may try to find legal alternatives, even if they are unusual, such as crossdressing.
  3. if the deviant interest is exclusive, we may try to find legal expressions of the deviant interest such as masturbating to written stories[i].

Not only is sexual health a human right, but it might also be easier to refrain from offending if some form of satisfying sexuality is still attainable.

Responsivity

Responsivity requires a little love. This may be hard to accept, but if we want to help people change, it is imperative that we are able to give them a little love (of course while strictly rejecting the offending behavior). This challenge has always been relevant, and Bill Marshall introduced his WERD-principles years ago (Marshall et al, 2005):  His findings were that treatments effects could be enhanced by a warm, empathic, rewarding and directive therapist. More recently there is increasing attention for the fact that PCSO often have significant (sexual) trauma in their own background and this should be taken into account in their treatment: trauma informed care (Levenson et al, 2016). Not to excuse their offending behavior but to better support them in overcoming this behavior.

Conclusion

Research shows that treatment of PCSO generally reduces recidivism, making it a viable way to target sexual abuse. A challenge for the future is to improve treatment and increase its effect. Hanson et al. (2009) conclude that adherence to the RNR principles increases treatment effects; Gannon et al (2019) conclude that adequately trained and supported professionals further improve treatment outcome, as does a specific focus on sexual arousal conditioning. Other possible improvements lie in adequate attention for the traumas of PCSO and the development of their sexual health.

Wineke Smid, PhD – Forensic Care Specialists  – Utrecht, the Netherlands

References

Andrews, D.A. & Bonta, J. (2017). The psychology of criminal conduct. (6th edition). New York: Routledge

Gannon, T. A., Olver, M. E., Mallion, J. S., & James, M. (2019). Does specialized psychological treatment for offending reduce recidivism? A meta-analysis examining staff and program variables as predictors of treatment effectiveness. Clinical Psychology Review73, 101752.

Hanson, R.K., Babchishin, K.M., Helmus, L.M., Thornton, D. & Phenix, A. (2017). Communicating the results of criterion referenced prediction measures: Risk categories for the Static-99R and Static-2002R sexual offender risk assessment tools. Psychological Assessment, 29 (5), 582.

Hanson, R.K., Bourgon, G., Helmus, L. & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 9, 865-891. https://doi.org/10.1177/0093854809338545

Levenson, J. S., Willis, G. M., & Prescott, D. S. (2016). Adverse childhood experiences in the lives of male sex offenders: Implications for trauma-informed care. Sexual Abuse28(4), 340-359.

Lowenkamp, C. T., Latessa, E. J., & Holsinger, A. M. (2006). The risk principle in action: What have we learned from 13,676 offenders and 97 correctional programs?. Crime & Delinquency, 52(1), 77-93.

Marshall, W. L., Ward, T., Mann, R. E., Moulden, H., Fernandez, Y. M., Serran, G., & Marshall, L. E. (2005). Working positively with sexual offenders: Maximizing the effectiveness of treatment. Journal of interpersonal violence20(9), 1096-1114.

Smid, W. J., & Wever, E. C. (2019). Mixed emotions: An incentive motivational model of sexual deviance. Sexual Abuse31(7), 731-764.

World Health Organization (2021). Sexual health. https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health

[i] Please note that in the UK while it is not illegal to possess written stories about child abuse, it is illegal to publish such material.

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