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A Reconsideration of Treatment Outcome with Sex Offenders
Abstract
An examination of the bases of two influential sets of publications suggests that their conclusions regarding the effectiveness of treatment with sex offenders were unnecessarily gloomy. The present article presents a more optimistic view of the literature, asserting that recent, relatively well-controlled evaluations have shown that treatment can be effective. To be maximally effective, according to this appraisal of the literature, treatment must be comprehensive, cognitive-behaviorally based, and include a relapse prevention component. Earlier outcome research that produced either treatment failure, or at best equivocal results, did not meet these criteria.
... Marshall m.fl. (1991;1994), som tillhör den mjukare falangen bland "evidensforskarna", anser t.o.m. att de metodologiska idealisterna genom sin fundamentalistiska hållning riskerar att bryta mot vissa etiska grundprinciper. De menar att så länge det finns belägg för att åtminstone vissa sexualbrottslingar svarar positivt på behandling, bör det vara en moralisk förpliktelse att erbjuda behandling till så många klienter som möjligt. ...
... Marshall som tillsammans med sina medarbetare genomfört en kvalitativ granskning av ett antal behandlingsstudier i USA och Kanada under 1990-talet framhåller att, även om variationen är stor när det gäller metodologisk förfining och precision, så utmynnar dessa studier i stort sett i samma slutsats, nämligen att behandling lönar sig, t.ex. mätt i antalet återfall (Marshall & Pithers 1994). ...
... The need for more specific knowledge on treatment effectiveness in certain subgroups of sexual aggressors has been called for in sexual aggressor's treatment literature [85,86], both for rapists and for child molesters. Alexander's [87] review showed 14.4% recidivism when Sexual Aggressors Against Children (SOAC), were treated and 25.8% when they were untreated. ...
... Lösel and Schmucker's [89] meta-analysis found a treatment effect for all other offender categories except for intrafamilial child molesters, probably due to a low base rate of incest offending. From another perspective, Marshall and Pithers [85] state that there is enough evidence to conclude that treatment reduces recidivism in the case of some sexual aggressors, even though there is not enough knowledge to identify those who benefit from treatment and those who do not. Therefore, the existence of a treatment provides a moral obligation to offer it to as many as possible, given the devastating consequences of sexual offending to the victims. ...
The sexual crime is a current issue and it is a real and serious problem in our society. Sexual aggressors tend to be people who perform normal professional duties of which no one is suspicious. Incidentally, whoever has knowledge of the crime is the victim and the perpetrator, who makes sure that no one is nearby for to engage in sexual intercourse. This study aims to characterize a sample of sexual aggressors from the north of Portugal to verify if sexual aggressors present a diagnosed mental disorder and if the profile found in sexual aggressors is in accordance with the classification found the literature, as well as to know the relationship of proximity between the victim and the aggressor. This is a quantitative and qualitative study that was carried out with a sample of 48 sexual aggressors in total, in which 46 are of the masculine gender and only two of the feminine gender between 19 and 76 years of age, being the sexual aggressors often family members, close friends or even neighbors. For this purpose, a consultation of the processes of the sexual crimes was carried out in the Court in the north of Portugal. The results of this study corroborate with some of other studies conducted characterizing these aggressors as the age, profession, marital status, proximity relationship and whether the victim is known. This study contributed to the increase of more information about these aggressors, thus allowing, that sentences can be directed to the rehabilitation of offenders, rehabilitation, that this more adjusted to each individual profile, in order to reduce recidivism.
... The factors that contribute to sexual offending, and the therapeutic techniques that are effective at changing offending behavior, have been extensively studied in recent years. There is a growing consensus in the literature that the most effective 66 treatment programs for sexual offenders are those which are cognitive-behavioral in orientation, specifically those which are relapse prevention-based (Marshall, Jones, Ward, Johnston, & Barbaree, 1991;Marshall & Pithers, 1994;Watson & Stermac, 1994). However, there has been little systematic work to develop clinical measures of dynamic risk, and this has been seen as one of the main challenges facing the field of sex offender treatment (Hogue, 1994;Maletzky, 1993;Marques, Nelson, West, & Day, 1994). ...
... Evidence suggests that the selection and implementation of interventions responsive to the sex offender's changing needs over time is an essential element of 67 an effective therapeutic intervention (Andrews et al., 1990;Marshall & Pithers, 1994;Pithers, 1990). Release from incarceration only at the end of an offender's sentence (i.e., Warrant Expiry Date-WED) does not allow professional support persons to monitor the offender's activities in the community. ...
The impact of cognitive-behavioral interventions was assessed for 28 low-moderate risk and 20 high-risk sexual offenders on conditional release to the Greater Toronto Area. Goal Attainment Scaling (GAS—T. Hogue, 1994) for sexual offenders was used to rate clinical and motivational elements of treatment taken from reports written at pretreatment, posttreatment, and after 3 months of community follow-up. Results indicated that both groups of offenders benefited from treatment, although low-moderate risk offenders showed consistently better results on all measures. Performance along nonrelapse prevention related dimensions increased from pretreatment to posttreatment and remained relatively steady in the community. Relapse prevention related treatment components showed a steady increase from pretreatment throughout follow-up in the community for low-moderate risk offenders, but not for high-risk offenders. Both groups improved substantially in level of motivation from pretreatment to posttreatment; however, only those in the low-moderate risk group maintained their motivation levels once released to the community. These results are discussed with respect to the effectiveness of cognitive-behavioral treatment of sexual offenders.
... A comprehensive review of treatment programs by Marshall and Pithers (1994) concluded that sexual offenders participating in specialized treatment had lower reoffense rates than offenders who had not engaged in such treatment. Preliminary results of a longitudinal study supported by the California State Departments of Mental Health and Corrections and the National Institute of Mental Health suggested that treatment subjects were less likely to commit new sexual offenses than subjects who refused treatment (Marques, Day, Nelson, & West, 1994), and a long-term study that followed sexual offender treatment completers from 6 months to 17 years in Minnesota, reported lower sexual recidivism among successful treatment completers or near-completers (Dwyer, 1997). ...
... The magnitude of differences shown in the survival analysis is sufficient to indicate a clinically meaningful effect of the Jackson County program. This finding supports the optimism reported for comprehensive treatment programs with a cognitive/behavioral emphasis (Hudson, Marshall, Ward, Johnston, & Jones, 1995;Marshall & Anderson, 1996;Marshall & Pithers, 1994). ...
Recent research in the treatment of sexual offenders suggests that comprehensive cognitivelbehavioral approaches may yield lower recidivism. This study reviewed such a program, existing in Jackson County, Oregon, since 1982. Offenders were mandated into this community-based program upon conviction of a felony or misdemeanor sexual offense, and averaged 2-3 years of participation. A group of offenders who participated in the Jackson County program between 1985 and 1995 was identified through archival data from the Oregon Department of Corrections. The data revealed success or nonsuccess in treatment, and any new convictions for sexual or nonsexual offenses. A control group of nonsexual offenders in Jackson County, and a group of sexual offenders in Linn County who did not have access to any treatment program were also studied. As hypothesized, those Jackson County offenders who successfully completed treatment had lower recidivism rates than those who were unsuccessful in the program. The observed effect of the program was particularly strong for offenders who remained in treatment for 1 year or more. When review was restricted to those participants, the reoffense rate for Jackson County offenders was reduced by over 40% when compared with Linn County offenders.
... p. 102 Sometimes even the same researcher will change views about a single study. For example, Marshall and Pithers ( 1994) called the research by Marques et al. (1993 ), on the California SOTEP program, "the most methodologically elegant study reported to date ," adding that "we eagerly await the ongoing appraisals of this excellent study (p. 20)." ...
... For years, the public believed that sexual offender treatment did not work and had no outcome on recidivism ( Furby et al., 1989 ). However, it was pointed out that the meta -analyses that suggested this contained outdated studies involving programs that did not resemble the multi-faceted , cognitive-behavioral programs that address many skill deficit areas and include relapse prevention ( Marshall & Pithers, 1994). More recently, research has finally been able to show that treatment can have a small but significant positive effect on recidivism (Alexander, 1999;Gallagher et al., 1999 ;Hall, 1995;Hanson et al., 2002 ), provided that it is a comprehensive cognitive-behavioral program , including relapse prevention interventions . ...
... Meeting the requirements of randomised control trials is problematic for research involving young people who have committed a sexual offence. Such a statement is reinforced by the sensitive criminal and social issues presenting logistical, legal and ethical challenges (Långström et al., 2013;Marshall, 1993;Marshall & Marshall, 2007;Marshall & Pithers, 1994). ...
... There have been debates about whether or not treatment for sex offenders had been shown to be effective. Some authors (Quinsey, Harris, Rice, & Lalumière, 1993;Rice & Harris, 2003;Seto et al., 2008) argue that it has not, whereas others (Marshall, 1993;Marshall & McGuire, 2003;Marshall & Pithers, 1994) suggest that overall the evidence indicates a positive outcome. Much of this debate revolves around what counts as an appropriate evaluation procedure. ...
We begin by briefly describing the history of cognitive–behavioural treatment (CBT) for sex offenders up to the late 1990s. This is followed by an account of recent developments, which begins with an outline of Andrews and Bonta's Principles of Effective Offender Treatment . These Risk–Needs–Responsivity principles are described in terms of their relevance to sex offender treatment. The utility of Ward's Good Lives Model (GLM) is noted for a strength‐based approach. We then consider the current status of treatment, noting that effective interventions need to address known criminogenic factors by employing soundly based procedures and by delivering treatment according to established therapeutic principles. We note that despite the widespread popularity of CBT, the evidence indicates that not all CBT programmes are effective, although clearly some are. We point to the evidence on effectiveness and the features of effective approaches. Finally we encourage treatment providers to adopt an approach that integrates the RNR, the GLM, and Motivational Interviewing. With the present state of knowledge, this appears most likely to result in reduced reoffending.
... These programs were therefore seen as promising. Indeed, the early evaluative research on sex offender treatment programs based on a cognitive-behavioral approach presented encouraging findings, particularly with regard to individuals who had perpetrated a sex crime against a child and those who were involved in exhibitionism (Marshall & Barbaree, 1990;Marshall & Pithers, 1994). Their optimism would certainly contribute to the development and proliferation of CBT in North America in spite of the modest findings of these initial evaluative studies. ...
The uneven history of sex offender treatment reflects the premise of this book: the relative absence of a rigorous scientific approach aimed at identifying the root cause of sexual offending and the factors responsible for its maintenance. In the absence of evidence-based information about the factors responsible for sexual offending, treatment providers have been more or less working in the blind. Indeed, in North America, the evolution of sex offender treatment has not been based on a theory of rehabilitation or reflective of scientific advancement with respect to the causes of sexual offenses. Rather, we posit that the evolution of treatment guidelines and practices reflect the confluence of a series of factors including the predominant social movement and predominant, untested, general psychological theory of human behavior of the time. The development of these rehabilitation models has been based on untested and unproven assumptions about the causes of sexual offending. This approach has fueled the pessimistic stance that sex offender treatment does not work and favored a shift toward increased community protection and repressive measures. Rather than learning from past experiences, we posit that tenets of the rehabilitation ideal have moved to yet other unproven and untested approaches.
... 국내에서도 2008년부 터 성폭력 범죄자 치료감호제도가 시행되고 있으며, 성폭력 범죄에 대한 처벌에서 더 나아가 심리교육, 인지행동치료, 약물치료가 실시되고 있다 (Han IY et al., 2011). 그 중 인 지행동치료는 인지, 정서, 행동이 서로 영향을 미친다는 것 을 전제로 하는 개입으로, 성폭력 범죄자에게 가장 보편적으 로 적용되고 있는 치료적 접근이다 (Hanson et al., 2002;Lösel et al., 2005 (Hanson et al., 1999;Yates, 2013 (Song WY et al., 2008;Song WY et al., 2013;Jeong YH et al., 2014;Lee JR, 2014 (Abel et al., 1984;Stermac et al., 1989;Murphy, 1990;Barbaree et al., 1991;Marshall et al., 1994;Johnston et al., 1996). 인지 왜곡은 성범죄에 이르게 하는 성적 행동에 대한 왜곡된 믿 음, 사고, 가정 (Abel et al., 1986;Plaud et al., 1996;Ward et al., 2006b) (Carich et al., 2001a). ...
... L'absence d'investissement narcissique suffisant de la part du père, la non reconnaissance émotionnelle de la mère (Balier, 1996), toutes ces défaillances conduisent à des troubles identitaires majeurs par l'impossibilité pour ces sujets de trouver en eux -même une « zone de sécurité », ou à des vécus agonistiques (Roussillon, 1999) Les relations d'attachement perturbées conduisant à des représentation parentales complexes (Marshall, 1993, Cornet 2012, la solitude émotionnelle, la peur de l'intimité et l'incapacité qui en résulte à développer des relations interpersonnelles permettant le partage émotionnel ou la capacité à véritablement communiquer, constituent autant d'indicateurs cliniques particulièrement pertinents. Ceux -ci se manifestent dans la pauvreté de l'expression affective, la difficulté d'apporter ou de recevoir un soutien d'autrui, les déficits d'empathie, etc. (Brankley, 2017, Marshall, 1994. ...
... The first position assumed that the cognitive-behavioral treatment programs were showing promising results. Tenants of this perspective reviewed positively evaluative studies of cognitive-behavioral treatment programs for sex offenders, especially for child molesters and exhibitionists (e.g., Marshall Barbaree, 1990;Marshall Pithers, 1994). In spite of earlier reports suggesting a positive impact, several scholars argued that no firm conclusions about treatment efficacy could be drawn due to methodological shortcomings of evaluative studies (Furby, Weinrott Saylor, 1989;Quinsey, Harris, Rice Lalumire, 1993;McConaghy, 1999;. ...
This chapter presents an overview of the relatively brief history of crime control strategies to deal with sex offenders. It emphasizes the most current policies, and the role and importance that sexual recidivists have taken in policy development. The chapter argues that the focus on the sexual recidivist has limited the development of a more comprehensive crime control strategy that tackles various criminal career aspects (i.e., onset, frequency, persistence, desistance, etc.). By focusing on criminal justice and law enforcement strategies aiming to deter, incapacitate, and rehabilitate known offenders, policymakers have largely neglected other means of tackling the issue of sexual violence and abuse. For some time now, however, several scholars have stressed the need for a more comprehensive strategy using the principles of a public health approach. The public health approach requires a different level of intervention strategies that are not limited to individual-level prevention programs.
... Other specific theories have been generated to explain the origin of, and treatment implications for, a variety of targets that have been addressed in sexual offender treatment. There have been theories about the role and nature of empathy deficits (Marshall, Hudson, Jones, & Fernandez, 1995;Pithers, 1994), self-esteem and shame (Marshall, Anderson, & Champagne, 1997;Marshall, Marshall, Serran, & O'Brien, 2009), self-regulation (Ward, 1999;Ward & Hudson, 2000), offense pathways (Hudson, Ward, & McCormack, 1999), attitudes and cognitions (McFall, 1990;Murphy, 1990), schemas (Mann & Shingler, 2006), attachment, intimacy and loneliness (Marshall, 1989;Ward, Hudson, Marshall, & Siegert, 1995) and sexual preoccupation (L. E. Marshall & Marshall, 2001. ...
This chapter first addresses the problems with punishment-based strategies with sexual offenders in order to demonstrate the inadequacy of this approach and turn to a consideration of more positively based, and demonstrably effective, ways of dealing with the problems these offenders present. Next, it considers the relevance of theories for effective treatment, beginning with a brief survey of target-specific theories followed by a similar examination of theories that encompass all aspects of sexual offending. The attention is then directed at treatment evaluation where it considers the value of the random controlled trial (RCT), the so-called incidental design involving a comparison with an incidentally available group of untreated offenders, and finally the use of risk estimates of expected recidivism as the basis upon which to evaluate treatment-induced reductions in reoffending. This is followed by a brief appraisal of the available outcome literature.
... We (Marshall, 1993(Marshall, , 2006Marshall & Marshall, 2007Marshall & Pithers, 1994) have engaged in what we believe has been a fruitful discussion regarding the best way to conduct long-term outcome studies of sexual offender treatment. We (Marshall & Marshall, 2007) challenged the accepted doctrine that Random Controlled Trials (RCT) are the only scientifically acceptable way to evaluate treatment. ...
Where do we come from? What are we? Where are we going?Process and motivational issuesStrength-based approachCognitions, behaviors, and emotionsIntegrating pharmacological strategiesAssessment of treatment-induced changesTreatment outcome evaluationConclusions
References
... In den 1990er Jahren wurden vermehrt Untersuchungen zur Wirksamkeit von Straftätertherapien, insbesondere im Hinblick auf Sexualstraftäter, durchgeführt. Die überwiegende Zahl der Metastudien zeigte bei behandelten Straftätern geringere Rückfallraten als bei unbehandelten [7][8][9][10][11][12][13][14][15]. Nur drei Studien konnten keine Behandlungseffekte nachweisen [16][17][18]. ...
Urbaniok F, Stürm M. [The 'Zurich Intensive Programme' for the treatment of sexual and violent offenders. Part 1: History of origins and methodical principles.] Schweiz Arch Neurol Psychiatr 2006; 157:103–18. In the Zurich PPD model a broad spectrum of therapy for the prevention of offences is integrat-ed into Law Enforcement by the incorporation of a forensic psychiatric-psychological centre of com-petence into the organisational structures of the legal authorities. In this context, the 'Zurich Inten-sive Programme', a therapy programme for the pre-vention of offences by sexual and violent offenders with a high habitual risk disposition deep-seated in the personality, has been running in the largest of the Swiss penal institutions since 2000. The programme is part of the overall strategy of Law Enforcement in the Zurich PPD model, oriented towards a maximum prevention of offences. The programme in this form is unique in Switzerland. Up to now predominantly repeat offenders in detention have been treated. With reference to the findings of forensic therapy evaluation studies the 'Zurich Intensive Programme' advocates an integrative, specifically offence-oriented and group-therapeutic treatment approach. The underlying concepts are built on a continuous systematic integration of methods on the basis of the epistemological position of prag-matism and anthropological concepts, which take account of the variety of people's life patterns, self-responsibility and life-long development.The treat-ment concept is also strictly oriented towards the results of therapeutic efficacy research (common-factor approach). The following aspects are essential conceptional elements of the 'Zurich Intensive Programme': interdisciplinary co-operation in the transprofes-sional sphere of the penal system, the specific vari-ation of the treatment setting in the therapeutic course of the process, the treatment group as the central therapeutic work field, an offence-oriented mode of operation and the inclusion of resource-promoting intervention strategies. Central to this is the orientation of treatment work directed at the maximum prevention of offences on the basis of a multidimensional target matrix, which integrates approximate and precise objectives, and short-, mid-and long-term changes. The treatment programme integrated into the structures of the penal institution can be regarded, on the basis of experience to date, as a forward-looking model for a differentiation process orient-ed towards the consistent prevention of offences in a modern penal system. The comprehensive concept of the 'Zurich Intensive Programme' must take into account both the distinct structural dan-ger of relapse of the treated detainees, the high treatment intensity to be presented in a sustained way and the interdisciplinary requirements, which result from the integration of such a treatment approach into the structures of a penal institution. By specifically employing therapeutic resources and consistently using synergetic potentials, it is possible on the basis of this plan to implement a high-quality range of treatments, which are favour-able in price in comparison with other in-patient programmes of similar intensity. The fundamental conceptional aspects of the 'Zurich Intensive Programme' are presented in this article. The specific therapeutic concept for the prevention of offences, such as the interplay and importance of obligatory offence-oriented and complementary personality-focussing treatment Originalarbeit elements, diagnostic focus, group cohesion/rela-tionship patterns, offence orientation, controlled testing and aftercare will be shown and explained with examples in a later study.
Plusieurs affaires retentissantes ont suscité d’intenses questionnements au sein de l’opinion publique européenne sur la prise en charge que la société actuelle peut proposer aux délinquants sexuels. Le désaveu de l’efficacité de l’action judiciaire et pénitentiaire en matière de récidive, la demande d’une répression accrue dans le sens de l’instauration de peines incompressibles de très longue durée vont de pair avec un appel croissant à la psychiatrie comme recours humaniste. Un certain nombre de pays disposent de législations permettant d’imposer un traitement psychiatrique contraint dans le cadre de peines privatives de liberté ou comme alternative à l’incarcération. Certaines législations vont même jusqu’à imposer la prescription de médicaments inhibiteurs de la libido en dehors de toute règle de consentement éclairé. D’autres pays traditionnellement hostiles aux théories de la défense sociale ou du positivisme criminologique viennent de légiférer en associant peine et soin comme en France où le législateur propose d’instaurer une peine de suivi médical de cinq ou dix ans.
Les questions éthiques que les praticiens devront affronter à l’avenir sont multiples et doivent amener à s’interroger sur les attentes de la société vis à vis de la psychiatrie et sur la toute puissance qu’elle semble lui conférer. Il y a presque deux décennies la psychiatrie américaine était secouée par le cas Tarasoff. Le questionnement qui se développe maintenant en Europe aussi, rejoint certaines questions de fond déjà évoquées alors sur la confidentialité de l’acte médical vis à vis de la justice. Cette question se double de celle l’impact de la thérapeutique sur de tels sujets. Problématique ou inefficace pour certains, indispensable pour d’autres
Confidentialité, consentement éclairé, primum non nocere, respect de l’intégrité du patient, tous ces principes qui fondent la pratique médicale sont singulièrement malmenés dès que l’on s’attache à la question des délinquants sexuels. Cela doit il signifier que le psychiatre sort du domaine médical dès qu’il s’adresse à cette population pour ne plus être qu’un agent du contrôle social et l’alibi d’une répression accrue ? Les réflexions et élaborations cliniques qui se développent à propos des délinquants sexuels peuvent-elles nous permettre de repenser une obligation de soin, ou du moins une injonction de soin qui ne reproduise pas les impasses dans lesquelles la loi de 1970 sur les toxicomanies a amené les thérapeutes à se fourvoyer ? L’incitation à la rencontre avec un thérapeute doit-elle faire partie intégrante du cadre que vise à mettre en place le contrôle social ? Finalement, le thérapeute doit il prendre position dans ce qui apparaît comme une véritable mutation dans le rapport de la société à la sanction et à la pénalité ?
The purpose of this study was to investigate the relationship between the electricity saving behavior in the heads of households in Tehran, and moral norms and various energy saving motivations. The present study use a descriptive-correlational design. The statistical population consisted of all the heads of households in Tehran in 2019. In addition, the convenience sampling method was used (N=366). The research instruments consisted of items for assessing Demographic and Housing Characteristics (DHC), the Problem Awareness Scale (PAS), the Ascription of Responsibility and Outcome Efficacy Scale (AROES), the Personal Norms Scale (PNS), the Energy Saving Behavior Scale (ESBS), and the Motivation toward Saving Energy Scale (MTSES). In total, there were 44 items in this survey. The data were collected online and via a paper-pencil form. Structural Equation Modeling (SEM), SPSS ver. 25 and Smart PLS ver. 3 were used to analyze the data. The findings showed that of the demographic variables, only marital status was connected with the electricity saving behavior. The problem awareness, and ascription of responsibility and outcome efficacy had a direct and significant relationship with personal norms; and personal norms were directly related to the electricity saving behavior. According to the findings, problem awareness, ascription of responsibility and outcome efficacy, and personal norms were connected with the electricity saving behavior through partial mediation of motivation. Lastly, the results showed that integrated, intrinsic, identified and introjected motivations had the most significant relationships with the electricity saving behavior. By strengthening motivation, the components of norm activation model could be transformed into the electricity saving behavior.
Reviewer
Martin Killias and Patrice Villettaz, School of Forensic Science and Criminology, University of Lausanne, CH‐1015 Lausanne, Switzerland. E‐mail: Martin.Killias@ipsc.unil.ch . Phone: (0041‐21) 692 46 40, Fax (0041‐21) 692 46 05
Objective
To assess the relative effects of imprisonment and non custodial (“alternative” or “community”) sanctions on reoffending.
Background
Throughout the western world, community‐based sanctions have become a popular and widely used alternative to custodial sentences. There have been many comparisons of rates of reconviction among former prisoners and those who have served any kind of community sanction. So far, the comparative effects on reoffending of custodial and non custodial sanctions is unresolved, due to many uncontrolled variables.
Search Strategy
Relevant studies which meet the eligibility criteria (see below) will be identified through multiple sources, including abstracts, bibliographies, and contacts with experts in all possible countries.
Eligibility Criteria
Randomized or quasi‐randomized experiments, as well as non experimental comparisons between former prison inmates and those who served community sanctions will be included, provided that variables in addition to those found in registers have been controlled for (attitudes, personal or employment history etc.). Studies published in any language after 1960 will be considered for inclusion.
Data Collection and Analysis
A coding protocol will be prepared along the guidelines of the Campbell Collaboration.
Sources of Support
An application for funding of this review has been filed at the National Science Foundation of Switzerland. The decision is expected to arrive by March, 2003. Financial support by the National Science Foundation of Switzerland does not affect the independence of the reviewers.
Objectives
The purpose of this article is to try to answer the question whether and how important are batterer intervention programs in formation of the attitudes and beliefs of perpetrators of domestic violence.
Material and methods
The data from surveys carried out in nine prisons in the Subcarpathian Voivodship were analyzed. As many as 277 men convicted for mistreatment of the family member were examined, including 133 perpetrators who completed batterer intervention programs (experimental group) and 144 convicts who did not take part in these types of interactions (control group).
Results
The statistical analysis of research results proved that convicts who took part in batterer intervention programs in prisons were significantly more often convinced than those who did not take part in them that such programs could be effective in preventing perpetrators from further harming family members. However, no differences were found between respondents when it comes to their declarations concerning further family behaviors, as well as the sense of responsibility for domestic violence. In contrast, weak statistically-significant differences were found only in the case of assessing one's own violent behaviors. All the more, perpetrators from the experimental group most often recognized only some of their behaviors (for which they were punished by the court) as acts of domestic violence, while respondents in the control group more often completely denied the use of violence.
Conclusions
These results demonstrate the relatively low effectiveness of batterer intervention programs in formation of the attitudes and beliefs of perpetrators of domestic violence.
Recent outcome data are reviewed and an attempt is made to compare treatment programs having either no relapse prevention (RP) features, only the internal management component of RP, or both internal management and the external supervisory components of RP. Presently available data are limited. Although treatment seems to produce effects, these benefits do not appear to be enhanced by the addition of elaborate internal management or by the provision of extensive RP aftercare procedures.
In the last decade the application of the relapse prevention (RP) model to both the conceptualization and the treatment of sexual offenders has emerged as an innovative approach. Underlying the treatment utility of this perspective has been a social learning view of the relapse process in addictive behavior. In this paper we critically examine both Marlatt's original RP model and Pithers' application of this perspective to the sexual offending area. After outlining its basic assumptions, we describe the RP model in some detail. Following a critique of Marlatt's theory, we examine the strengths and weaknesses of Pithers' RP approach. Finally, we conclude with some comments on the implications of our critique.
The field of psychology has only recently begun to recognize the extent and impact of professional impairment of its members, whereas several other professions have established formal identification and treatment plans for impaired colleagues. Impairment in psychologists may be caused by various factors, but it has the same result: diminished levels of care and, frequently, ethics violations. Sexual contact with clients is considered in particular. Several alternate avenues for remediation exist, including mandatory psychotherapy for ethics offenders. Although the majority of psychologists value personal therapy for training purposes, it is the authors' opinion that mandated therapy is not an appropriate form of rehabilitation for such violations of the ethics code.
The "clarification session" has been implicated as an important component of the treatment of families affected by incest. On the basis of information presented in clinical literature, however, the specific nature of this intervention varies widely. This exploratory study examined the practices and attitudes regarding clarification sessions of select members of the Association for the Treatment of Sexual Abusers. Surveys were completed by 483 members. Results indicated that approximately 77% of respondents had experience in conducting clarification sessions. The top two reported reasons for conducting clarification sessions were for the perpetrator to assume all responsibility for the abuse and to decrease the level of self-blame of the victim. The majority of respondents concurred that several activities needed to occur prior to the clarification session, whereas less consensus was indicated for activities that were deemed essential during the clarification session. Respondents' practices, attitudes, and beliefs are discussed in terms of the current state of limited, empirically based knowledge in this area. Directions for future research are suggested.
This chapter provides an overview of what is known about sex offenders in terms of sexual offender typologies, recidivism, and treatment. This chapter will summarize the current knowledge in each area and identify areas requiring additional attention. Implications for sex offender policy are considered against the background of current empirical knowledge.
The treatment of sexual offenders is purported to have evolved over the last 40 years, with new models of practice being developed and implemented based variously on theory, research, and policy. Currently, it is recommended that sex offender treatment follow a cognitive-behavioural approach, adhere to the principles of risk, need, and responsivity, and make use of effective therapeutic practices and therapist characteristics. Within this context, clients increase their awareness of factors that contribute to offending and develop skills and strategies to effectively manage risk for recidivism by addressing such areas as general and sexual self-regulation, cognition, and emotion management and altering their cognitive, affective, and behavioural responses in these areas. Despite advances in the provision of sexual offender treatment and some evidence supporting treatment outcome, there are a number of important shortcomings. Indeed, effect sizes for the effectiveness of sexual offender treatment are small, and some methods of intervention currently are not supported by research and thus hold the potential to be ineffective or harmful. In this chapter, the current state of sexual offender treatment is reviewed, with a focus on the shortcomings of both research and intervention practices in an effort to evaluate the current status of sexual offender treatment.
It has long been debated as to whether psychotherapy is effective for sexual offenders. This chapter reviews the existing systematic reviews and meta-analyses regarding the scientific evaluation of psychosocial treatments as applied to such individuals; such interventions are almost all applied in “justice-related” settings and thus should be regarded as “forensic” treatments. This chapter is intended to provide a straightforward, reasoned, and accessible review of the existing research findings and issues regarding psychotherapy for sexual offenders. First, a brief synopsis of the research literature regarding psychotherapy in general is presented. Both the accepted methodological practices utilized in studying the effectiveness of psychosocial treatment and the results of the extant psychotherapy outcome literature are summarized. Such a review provides a context for viewing the parameters for the more specific research literature on sexual offender treatment outcome. In general, many psychotherapies appear effective for persons with negative affect, but they are markedly less effective for more entrenched or complex problems. Second, the primary systematic reviews and meta-analyses of sexual offender treatment are examined. The clear consensus of the most recent reviews would best be summarized as suggesting that, to date, the general efficacy of sexual offender treatment has not been scientifically demonstrated. Empirically, few or no claims can be made for the “success” of such interventions either at affecting changes in characteristics of sexual offenders or at reducing future sexual offending. Third, a critical analysis of select methodological issues and inadequacies related to results of existing treatment research will be presented that provides perspective on the inaccurate claims of certain studies that claimed to demonstrate that sexual offender treatment might reduce sexual offense recidivism. Fourth, evidence is reviewed of the particular failure of psychosocial treatments to demonstrate personal and/or systematic change among sexual offenders who participate in sexual offender treatment and to reduce sexual offense recidivism among those individuals deemed “higher risk.” Finally, implications of the lack of demonstrated effects of psychosocial interventions for sexual offenders are discussed relative to alternative forms of offender management.
This chapter offers perspectives as to a variety of possible reasons why sexual offender treatment has yet to have empirically or scientifically demonstrated its efficacy. Various aspects of sexual offenders as client characteristics, characteristics of clinicians who provide therapeutic services to such offenders, the nature and delivery of psychotherapy for sexual offenders, and evidence that specific components of psychotherapeutic interventions that comprise the core of most forensic sexual offender treatment have demonstrated neither general effectiveness nor specific effects on sexual offenders all likely account for failure to demonstrate the effectiveness of sexual offender treatment to reduce sexual reoffending. First, the available psychotherapy literature generally and that for sexual offenders is briefly reviewed. From this, it is apparent that most psychotherapies appear to be generally effective interventions for persons with mood and anxiety problems but less effective for persons with more chronic, entrenched behavioral problems. Client variables are identified as accounting for the largest portion of variance in general psychotherapy outcome. Further, most recent systematic and meta-analytic reviews indicate that, to date, no or little scientific evidence exists that psychosocial interventions affect sexual reoffending among sexual offenders, let alone produce meaningful personal change in such offenders. Second, a historical perspective is considered on the largely non-theoretical and nonempirical nature by which sexual offender treatment developed in North America. This historical review provides an important context for understanding problematic aspects of the development of and implementation of almost all current programs of sex offender treatment. Finally, a critical analysis of the client, therapist, process, and intervention delivery elements as applied in sex offender treatment as well as the more specific treatment components of forensic sex offender treatment is provided. This review identifies the striking degree to which few aspects of conventional and contemporary programs of sex offender treatment have been demonstrated to have any relationship to enduring behavior change generally and reductions in sexual offense recidivism more specifically. It is concluded that the available evidence would suggest that, in particular, client characteristics and treatment components, both theoretically and empirically, have no effect on decreasing the likelihood of future sexual offending. Finally, the implications of the current state of affairs regarding the apparent failure to develop and demonstrate the efficacy of varied presumed “key” elements of general and specific intervention programs directed at reducing sexual offender recidivism are discussed and future directions for research and practice in the management of sexual offenders are identified.
We have two general locations in which we operate our treatment programs: Canadian federal penitentiaries, and a community-based outpatient clinic. The treatment program we describe here is adapted to suit the special conditions in each of the locations, but essentially it involves the same components and processes. The only inconsistent process concerns the fact that, in some circumstances, we use closed groups (i.e., all clients start and end group treatment at the same time and progress at approximately the same rate) and in others we use open-ended groups (i.e., clients progress at their own rate and when they complete the program, they are individually replaced by another client). The program we describe here is designed specifically for adult male sex offenders and targets those (including nonfamilial and familial offenders) who have sexually offended against either women or children. We conduct mixed groups because we have found that this helps overcome beliefs in particular offenders that their crimes were not as bad as those of some other types of offenders, or that they are not, in fact, sex offenders.
SELECTION CRITERIA: Prospective controlled trials of antilibidinal medications taken by individuals for the purpose of preventing sexual offences, where the comparator group received a placebo, no treatment, or 'standard care', including psychological treatment.
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Sexual abuse and sexual assault continue to be major social problems in our society. Finkelhor and colleagues (1990) reported on the prevalence of sexual abuse in a national survey of adult men and women. Twenty-seven percent of all females and 16% of males surveyed reported that they had been sexually abused prior to age 18. Pithers and colleagues (1995) note that sexual abuse has both emotional and financial consequences. The majority of females seeking outpatient mental health services report a history of sexual abuse at some point in their lives (Frontline, 1988). In terms of the financial costs to society, Pithers et al. (1993) reported that in the state of Vermont, the annual cost of responding to child sexual abuse can be estimated at $42 million.
This study compared psychopathic and nonpsychopathic rapists on static risk factors and on emotional and motivational precursors. Sixty incarcerated rapists were assessed for psychopathy with the Psychopathy Checklist—Revised (R. D. Hare, 1991), and they were classified according to the Massachusetts Treatment Center: Revised Rapist Typology, Version 3 (R. A. Knight & R. A. Prentky, l990b). Psychopathy was positively associated with past nonsexual offenses and negatively associated with age onset for criminal offending, number of sexual victims, and the intensity of negative emotions experienced before sexual offending. However, psychopathy was not related to sexual offense history, age of onset for sexual offending, or victim harm. Last, psychopaths were most likely to be classified as opportunistic and pervasively angry rapists. The findings indicate that psychopathy should be considered when developing intervention strategies for rapists. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the past two decades, the federal government and states have enacted a wide range of new laws that target sex offenders. A series of U.S. Supreme Court cases has addressed the constitutionality of such legislation and, in so doing, contributed to the current policy landscape. The Court's influence is noteworthy in part because of the calls during this same time period for evidence-based policy. Does the influence, however, reflect not only the legal considerations that necessarily attend to these cases but also an accurate and balanced assessment of social science theory and research? We address this question by examining Supreme Court cases from 1991 to 2011 involving sex crime laws. The findings indicate that the Court demonstrates an awareness of scientific research by referencing it in almost all decisions involving sex offender legislation, yet the Court frequently overstates or misinterprets empirical findings. Implications for research and policy are discussed.
Relapse prevention is a multimodal, cognitive-behavioural approach to treating, among other types of clients, child molesters. Rather than positing a cure as the outcome of treatment, it emphasises self-management and personal responsibility for avoiding or coping with situations that threaten self-control. The motivation to use these self-control strategies is likely to vary according to beliefs about the causes of their offending behaviour, particularly as a function of the degree to which they are seen as controllable. Fifteen child molesters, classified as preferential or situational type, and familial or nonfamilial, from the Kia Marama unit at Rolleston Prison reported on their causal beliefs concerning their offence-related behaviour at four points in their description of their most typical or recent relapse. This assessment was carried out at four points in the 35-week relapse-prevention based treatment program.
All participants made clinically positive changes in their causal ascriptions over treatment. Preferential participants judged the cause of their offending to be less controllable, and more stable at the time of offence, and more global than situational offenders. Compared with non-familial participants, incestuous participants evaluated the cause of their offending to be less stable at the time of their offence and less global across all the assessment points. The results are discussed in terms of the utility of attributional assessment as an interim measure of progress, particularly with respect to motivation to avoid reoffending.
In both the United States and Canada, a community protection approach to the perceived enduring dangerousness of sex offenders has emerged since the 1980s, in response to several high profile cases involving the sexual assault and murder or mutilation of young children. The key elements in this community protection approach are sex offender registration and tracking, community notification, and post-sentence controls in the form of civil commitment, peace bonds, and community surveillance. This paper compares the different trajectories community protection has taken in the United States and in Canada and offers an explanation for the relatively slower and more cautious approach taken by the Canadian federal government, compared to the rapid, aggressive approach taken in the United States at both a federal and state level.
Thirty-four (34) federally sentenced sex offenders in British Columbia were surveyed using the Yalom (1995) 12 therapeutic factors presented in a 60-item questionnaire Likert format, as well as a semi-structured interview regarding their perceptions of which curative factors were most beneficial to them in treatment. The mean scores for catharsis and self-understanding were found to be rated significantly more helpful than the other factors, while the mean scores for Guidance and Identification were rated significantly less helpful. These findings were consistent with previous research with male sex offenders. Years of education was positively correlated with catharsis, cohesion, self-understanding, and universality. Results suggest that if therapists and programme designers want to maximize the investment of sexual offenders in therapy, they need to build a programme that fosters an atmosphere where group members can work together in a supportive environment and can express thoughts and feelings, and share stories, in such a way that they gain a greater self-understanding.
1 Criminal justice policy makers and practitioners in the field of corrections have a keen interest in reducing the likelihood of repeat offending because of the enormous costs to victims and society. While crime continues to present a serious social problem, changes in legal definitions coupled with reduced public tolerance for serious crimes and focused media attention have led to significant improvements in policing, court processing and corrections. Being acutely aware that the general public does not fully understand the inner workings of the criminal justice system, correctional service providers are being called upon to provide timely responses and accurate information on the care, custody and safe reintegration of criminal offenders. Realizing too, that the media has stretched public tolerance to the limit for any failure in the community, has meant that correctional service providers are learning everything there is to know about outcome measurement and become actively involved in public relations. To summarize the problem --offenders, staff, volunteers, and public opinion exert a significant influence over the realization of correctional service delivery objectives. In particular, the task of safely reintegrating offenders in the community continues to fall squarely on the shoulders of staff and volunteers located in correctional facilities, mental health settings, and the community at large. Certainly, these people are being called upon to deliver more sophisticated services to a clientele constantly changing and for a public that is uncertain. And to top it all off, they must do so in an effective and cost efficient manner as possible. It's a common challenge, but one that's difficult to measure. This chapter tries to address why correctional outcome is so tough to measure and tries to show how we can measure it as best we can.
The increasing recognition of the large number of people victimized by sexual assault has focused considerable attention on methods for deterring its perpetrators. In particular, law enforcement and mental health professions alike seek ways to prevent sex offenders from repeating their criminal behavior. Some evidence suggests sex offenders often continue offending even after incarceration or clinical treatment. However, recidivism rates for sex offenders are unusually hard to establish, owing to gross underreporting of sex crimes. This article presents a comprehensive review of empirical studies of sex offender recidivism. It brings together data from a wide variety of studies on both treated and untreated sex offenders of all types. Because of the variety and gravity of methodological problems in these studies, guidelines are discussed for sample selection and description, study design, criterion assessment, and data analysis. With these methodological principles in mind, the results of some 42 studies are examined for what they can tell us about sex offender recidivism and efforts to reduce it.
The recidivism of 136 extrafamilial child molesters who had received phallometric assessment in a maximum security psychiatric institution from 1972 to 1983 was determined over an average 6.3-year follow-up. Fifty had participated in behavioral treatment to alter inappropriate sexual age preferences. Thirty-one percent of the subjects were convicted of a new sex offense, 43% committed a violent or sexual offense, and 58% were arrested for some offense or returned to the institution. Subjects convicted of a new sex offense had previously committed more sex offenses, had been admitted to correctional institutions more frequently, were more likely to have been diagnosed as personality disordered, were more likely to have never married, and had shown more inappropriate sexual preferences in initial phallometric assessment than those who had not. Behavioral treatment did not affect recidivism.
Because of the enormous human and financial costs society incurs as a result of sexual crimes, any reduction in the recidivism of sex offenders caused by treatment is very worthwhile. Although treatment can be valuable if this reduction is small, the reduction must nevertheless be real. Real effects are statistically significant differences between treated and untreated subjects in controlled studies. In general, statistical significance is a necessary criterion for clinical and economic significance. In the field of sex offender treatment, it is likely to be a sufficient condition as well. In the view of the authors, the effectiveness of treatment in reducing sex offender recidivism has not yet been scientifically demonstrated. To demonstrate the effectiveness of sex offender treatment, more well-controlled outcome research is required that can be evaluated with meta-analytic techniques.
In the first study, 30 child molesters who had received behavioral treatment designed to modify inappropriate sexual age preferences were followed after their discharge or transfer from a psychiatric institution for an average of 29 months. Posttreatment penile response data in the form of ratio of response to adult stimuli divided by response to child stimuli significantly differentiated the six recidivists from the nonrecidivists, providing support for the external validity of the assessment technique. In the second study, 18 hospitalized child molesters received biofeedback alone or in combination with signaled punishment aversion therapy as methods designed to modify inappropriate sexual age preferences. The biofeedback procedure involved signaling the patient by different colored lights when his penile response to a child or adult slide was above a preset criterion. Signaled punishment was superimposed on the biofeedback procedure and involved programming a mild shock to the arm to occur at intervals when the patient was above criterion during a child slide. The punishment plus biofeedback procedure was more effective in modifying inappropriate sexual arousal both as a first and second treatment type.
Direct observations by a legally trained observer were made of staff decisions concerning whether psychologically abnormal sex offenders committed as dangerous were still dangerous. The staff's decision was found to be influenced by the offender's willingness to admit guilt and responsibility and by his fantasies of future offenses. It was also affected by the offender's behavior in the institution, the duration of institutionalization, the seriousness of the offense committed, and changes in the situation to which the offender would be discharged. Anticipated benefits from continued exposure to the institutional program were also considered. The apparently necessary reliance upon a conceptualization of antisocial conduct as a response to stress and factors only indirectly if at all related to an objective standard of 'continued dangerousness' raises significant doubts concerning the propriety of programs of social control that make continued institutionalization depend upon a professional determination of continued dangerousness.
Masturbatory reconditioning procedures all involve having the client use masturbation to modify his sexual preferences. Four methods of masturbatory reconditioning—thematic shift, fantasy alternation, directed masturbation, and satiation—are evaluated. There are few controlled studies and no group comparison studies. Most of the literature involves uncontrolled case reports and expresses confidence in the application of these procedures. However, a careful appraisal of the evidence offers little encouragement for thematic shift or fantasy alternation, but some hope that directed masturbation and satiation may be effective. More careful, larger scale studies are required before we can say that these procedures rest on a sound empirical basis.
Previous reviews have taken either a severe methodological stance and concluded that treatments have not been demonstrated to be effective with sex offenders, or they have ignored methodological considerations and expounded about the value, of particular treatment approaches. We have attempted to adopt a position somewhere between these, two and have concluded that some treatment programs have been effective with child molesters and exhibitionists but not, apparently, with rapists. In examining the value of the different approaches, we concluded that comprehensive cognitive/behavioral programs (at least for child molesters, incest offenders, and exhibitionists) are most likely to be effective, although there is a clear value for the adjunctive use of antiandrogens with those offenders who engage in excessively high rates of sexual activities.
The present study examined the difference in compliance and outcome measures in the treatment of self-referred versus court-referred sexual offenders. Self-referred patients entered therapy of their own accord while court-referred patients entered therapy under coercion from a legal source. Four separate groups of patients were identified: self-referred pedophiliac, court-referred pedophiliac, self-referred exhibitionist, and court-referred exhibitionist. The major treatment approach employed was “assisted” covert sesitization, though a variety of adjunctive therapies were also utilized. Compliance and outcome measures were evaluated at the end of treatment (approximately 6 months) and again at 6, 12, 18, 24, and 30-month follow-ups. Results indicated that treatment was effective across all four groups with no significant differences between self-referred and court-referred patients. The results indicate that the same techniques successfully applied to voluntary patients with maladaptive sexual approach behaviors can also be applied to an involuntary population as well.
Three experimental studies are reported. The first examined assertion therapy, Provera (Medroxyprogesterone) and sex of therapist on drop-out rate and recidivism in male genital exhibitionists. The other two studies were double blind comparisons of Provera and placebo administered for one week to exhibitionists and three weeks to normals. The results of the first study showed drop-out rate for Provera plus assertion therapy was significantly increased over assertion therapy alone. There was a trend to a higher recidivism rate for female over male therapists. The other two studies showed that serum testosterone was significantly reduced by Provera but penile responsiveness was not affected. Reported sexual behavior changes and side effects from Provera were not consistently found at 100 to 150 mg dosages. It was suggested that Provera is limited in the treatment of genital exhibitionism.
In three cases of exhibitionism, two of transvestism and one of masochism, tapes were made involving descriptions of each subject's individual deviant behavior divided into three sequential segments. Five of the six subjects were placed on a schedule on which, at first, the final segment of the tape was followed by shock, at later sessions the second segment and ultimately the first. At each session the shocked tape runs were followed by runs in which the patient avoided shock by verbalizing normal sexual behavior in the place of the shocked segment. The sixth subject was given shocks out of relation to taped material, as a control. Treatment was evaluated by measuring penile responses to sexually deviant and non-deviant tapes, and by clinical reports. In the experimental subjects there was reduction of erectile responses to deviant tapes but sustained responses to non-deviant tapes. These subjects reported weaker deviant responses, less frequent deviant behavior and fewer symptoms of psychopathology in general.
Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.
The increasing recognition of the large number of people victimized by sexual assault has focused considerable attention on methods for deterring its perpetrators. In particular, law enforcement and mental health professions alike seek ways to prevent sex offenders from repeating their criminal behavior. Some evidence suggests sex offenders often continue offending even after incarceration or clinical treatment. However, recidivism rates for sex offenders are unusually hard to establish, owing to gross underreporting of sex crimes. This article presents a comprehensive review of empirical studies of sex offender recidivism. It brings together data from a wide variety of studies on both treated and untreated sex offenders of all types. Because of the variety and gravity of methodological problems in these studies, guidelines are discussed for sample selection and description, study design, criterion assessment, and data analysis. With these methodological principles in mind, the results of some 42 studies are examined for what they can tell us about sex offender recidivism and efforts to reduce it.
Recidivism data derived from various sources over a follow-up period of 1–11 yr, provided the basis for appraising the effectiveness of a comprehensive cognitive-behavioral treatment program for familial and nonfamilial child molesters. Unofficial records held by police and Children's Aid Societies proved to be the best data for estimating recidivism. These data revealed increases in recidivism with longer follow-up periods, but there were consistent advantages for the treated over the untreated patients. Men who had sexually abused the daughters of other people demonstrated the clearest treatment benefits. The younger offenders and those who had engaged in genital-genital contact with their victims were more likely to reoffend even if they were treated. Contrary to the expectations of behavior therapists, indices of deviant sexual preferences did not predict outcome.
A consideration of the literature on the behavioral therapy of sexual deviations suggests that the direct modification of fantasies will provide an effective treatment method. A combination of two procedures for modifying the content of sexual fantasies is outlined and the results of treatment with twelve patients using this combined approach are described. The hypothesis that the modification of fantasies would have a direct effect on both deviant behavior and attitudes toward deviant material, was not unequivocally supported. However, the program had eliminated deviant behavior in all subjects by the end of treatment, and this was maintained at follow-up in at least 75 per cent of the patients.
After 9 years of experience with this law, we are convinced that a program which embodies the principles of indeterminate sentencing and psychiatric treatment is both workable and useful. We feel that it is the best approach currently available through which society can deal with the agonizing problem of the sex offender. We would be negligent, however, if we did not emphasize some of the problems and shortcomings of our own program. Obviously even an enlightened prison setting is not an ideal environment in which to conduct a flexible treatment program(8, 16). Until we can build our own"prison-hospital" for this group of offenders, we are forced to make many compromises which may not be therapeutic. Finding adequately trained therapists to work in a correctional environment remains a constant problem(19). We do not feel that we are anywhere close to giving optimum psychotherapy to each offender who can benefit thereby. A constantly haunting problem is our inability, because of the statutory requirements, to set up adequate control studies which would afford scientific validity to our work.
Perhaps the most important issue raised by our experience involves the frightening responsibilities which the therapists must assume. A psychiatrist or psychologist in our sex deviate program often must step out of his traditional clinical role; he makes crucial decisions which effect the liberties of his fellowman. There is no room for an arrogant and dogmatic attitude. If we are to become involved in the problems of social justice, we must be prepared to assume the overwhelming responsibilities with sincere humility as well as scientific fervor.