Not All Sex Offenders Are the Same

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This article, written by renowned sex and intimacy disorders specialist Robert Weiss, originally appeared in Sex Offender Law Report under the title: “Same Offense, Different Criminal: Understanding a Sex Offender’s Inner World and the Need for Treatment vs. Incarceration and Registration.” By request, we are reposting it here.

Not All Sex Offenders Are the Same
By Robert Weiss LCSW, CSAT-S

A simple and undeniable truth about sex offenders and the American legal system is that punishments have escalated significantly in recent years. Between 1994 and 2007, for example, the mean sentence for a child pornography conviction rose from 36 months to 110 months. (Stabenow, T., 2008. Deconstructing the myth of careful study: A primer on the flawed progression of the child pornography guidelines. Office of Defender Services/Training Branch, Administrative Office of the United States Courts.) Generally speaking, this escalation is a direct result of changes to federal sentencing guidelines—mandates mostly enacted as an over-the-top response to an ongoing series of media misrepresentations, in particular sensationalist television shows like To Catch a Predator, plus a single piece of now heavily criticized research (the Butner study, discussed later in this article).

So we now have some pretty unreasonable sentences for sex offenders, typically imposed without useful clinical insight into who these people are and the dangers they may or may not pose. And there is little opposition to this, because what media personality or politician would advocate for offenders when there is so much to be gained with the opposite stance.

Thus, our current sentencing guidelines are for the most part highly punitive and one size fits all in their approach. In other words, the majority of sex offenders are treated as if they are an ongoing high-level danger to society, even though their motivations for offending, their likely response to informed treatment, and their potential for reoffending may vary greatly. Consider, for example, the two offenders described below, both of whom were arrested for possession of child pornography.

James

James is a 26-year-old male arrested after the IT department at his work, during a routine maintenance check, found about a dozen illegal (underage) images and videos on his laptop computer. In addition to the illegal material, there were hundreds more legal images and videos, mostly depicting adult women. In therapy after his arrest, James immediately admitted that he’d downloaded the illegal pornography even though he knew it was wrong and he felt ashamed about doing it. “This has been going on for a few years. Once I saw the first picture it was like a boulder rolling downhill. I just couldn’t stop myself. My pattern is that I find some illegal content, download it, and then I end up completely hating myself and I delete it. But then a week or two later I do the same thing.” In therapy, James is highly motivated to permanently end his use of all pornography, to maintain his relationship with his long-term girlfriend, and to stay out of prison.

Robert

Robert is a 32-year-old male arrested after the IT department at his work, during a routine maintenance check, found about a dozen illegal (underage) images and videos on his laptop computer. There was no other pornography. In therapy after his arrest, Robert initially denied that he downloaded the illegal material, stating that somebody in his workplace must be out to get him. A review of his life history reveals that he has never had a serious romantic relationship; moreover, he’s been arrested multiple times for a variety of minor offenses (though none of a sexual nature, until now). Eventually, after many sessions and a great deal of therapeutic rapport building, Robert admitted that he “likes young girls,” and that prior to his arrest he had a much larger stash of illegal porn on an external storage device. “I trashed it after I got arrested because I didn’t want the cops to find it.” In therapy, Robert is highly motivated to stay out of prison. Beyond that, he is unmotivated to make life changes. Mostly he wishes that people would stop “spying on him” and “intruding on his personal life.” Moreover, he vociferously defends his right to be turned on by whomever and whatever he finds arousing.

Needless to say, James and Robert are very different people, even if they’ve been arrested for and charged with the exact same offense. Most notably from a psychological perspective, Robert is an individual who searches for and looks at child porn in a dedicated way, with no other sexual interests, whereas James simply stumbled across it when looking at legal porn and found it intensely arousing, though not to the exclusion of more normative (and socially acceptable) sexual behaviors, including a history of age-appropriate romantic and sexual relationships.

To be clear here, a whole lot of people fall into the same typology as James—individuals who just stumble on child porn and then find it arousing. As such, a whole lot of people we would not normally think of as sex offenders find themselves actively searching for this material. One study that collected and analyzed more than 400 million Internet searches (via Dogpile.com, a meta-engine combining search results from Google, Yahoo, Bing, and similar internet portals) found that the most commonly used adjectives when searching for pornography were variations of young and teen—used as modifiers in 13.5% of all sexual searches. (Ogas, O. and Gaddam, S., 2011. A billion wicked thoughts: What the Internet tells us about sexual relationships. Penguin.) So quite a lot of seemingly normal people are curious about, searching for, and looking at underage pornography. In all likelihood, the majority of child porn users (especially those whose behavior has not been discovered by authorities) fall into this typology.

Types of Sexual Offenders

From a clinical perspective, every sex offender is unique, even when they’re facing the same criminal charges. For instance, there is a strong likelihood that James has a compulsive and perhaps addictive relationship with porn, and that his online offending (i.e., his use of child pornography) is a byproduct of this issue and its escalation over time. As such, and with no other antisocial or criminogenic factors in play, he is likely to respond to informed treatment, with or without incarceration, and relatively unlikely to recidivate. Robert, on the other hand, has a primary sexual attraction to underage girls, admits his transgressions only reluctantly, has a broader criminal background, and shows little motivation to change. As a fixated/dedicated child offender with a history of other criminal activity, he is less likely to respond positively to treatment, and more likely to recidivate. Thus, Robert is a greater risk than James, and he will require a different and much more comprehensive treatment program to instill long-term behavior change.

Before elucidating further on the various typologies of sexual offenders, it may be helpful to outline the difference between sexual addiction and sexual offending.

Sexual Addiction (aka, Hypersexual Disorder)

Sex addicts are men and women who compulsively engage in sexual activity, including sex with others and solo acts like masturbation and looking at pornography, doing so even when they want to quit or cut back and despite all sorts of directly related negative consequences. For the most part, sex addiction is motivated by a desire to escape from stress and other forms of emotional discomfort—issues that are nearly always rooted in unresolved early-life trauma. (A desire for emotional escape is also why alcoholics drink, drug addicts get high, gamblers place bets, etc. Essentially, these neurochemically intense experiences distract users from stress, depression, anxiety, loneliness, boredom, and anything else they don’t want to feel.)

Sex Addiction is identified in clinical settings based on the following three criteria:

  • Preoccupation to the point of obsession with sexual imagery and/or sexual activity.
  • Loss of control over the use of sexual imagery and/or sexual behaviors, most often evidenced by failed attempts to quit or cut back.
  • Negative consequences directly related to compulsive sexual behaviors. These consequences may include depression, anxiety, shame, isolation, ruined relationships, reprimands at work or in school, financial issues, sexual dysfunction, legal trouble, and more.

Addictive sexual behaviors rarely begin with illegal activity, though over time an addict’s behaviors may escalate to the point where he or she is breaking the law, usually with things like voyeurism, exhibitionism, hiring prostitutes, having sex in public, and looking at illegal pornography.

Sexual Offending

Defining sexual offending is complicated because two sets of criteria can be used, clinical and legal, and the second set (legal) varies by jurisdiction.

The clinical definition of sexual offending is nonconsensual sexual activity. Clinical examples of sexual offending include:

  • Being sexual with a person who is unaware that some form of sexual act is taking place—voyeurism, sex with a person who is sleeping, etc.
  • Being sexual with a person who is incapable of informed consent—a person who is drugged, mentally or emotionally incapacitated, too young, too ill, etc.
  • Forcing a sexual act on another person—rape, snatch and grab molestations, exhibitionism, frotteurism, making or viewing child pornography, etc.

The legal definition of sexual offending is often quite different, based not on clinical criteria but on statutes that vary from state to state, not to mention country to country. Thus, legal definitions, when compared to the clinical definition, do not provide the same level of consistency and comprehensive understanding. Consider, for instance, a 19-year-old boy who has consensual sex with his fully cognizant 16-year-old girlfriend. This action may be perfectly legal in one state but a serious felony in another, possibly resulting in jail time and a lifetime of sex offender registration. Either way, the behavior does not meet the clinical definition of sexual offending.

Offender Typologies

From a clinical perspective, there are five primary types of sexual offenders, with some groups more likely to respond to treatment and less likely to recidivate than others.

  • Violent Offenders: These are men (and sometimes women) who commit forcible sexual offenses, including rape and child molestations of the snatch and grab variety. These individuals are relatively rare, but they get a lot of press. As such, their behavior largely informs public opinion about sexual offending, creating a perceived need for harsh punishments for all sex offenders. Typically, these offenders do not respond well to treatment, and their risk for reoffending is high.
  • Fixated/Dedicated Child Offenders: For these individuals, the primary and often sole sexual attraction is toward children and/or teens. Because of their arousal template, they are generally unable to develop true sexual intimacy with an age-appropriate person. When attracted to prepubescent children, they are clinically referred to as pedophilic. When attracted to adolescents, they are clinically referred to as hebephiliac. Research suggests that around 3% of adult males have a primary sexual attraction to children, though only a small percentage ever act on it. (Seto, M.C., 2008. Pedophilia and sexual offending against children: Theory, assessment, and intervention. American Psychological Association.) These offenders typically have a difficult time in treatment and their risk for reoffending is high. Thus, treatment goals must take into consideration their willingness and ability to manage their sexual arousal and to develop strict protocols and interventions. These individuals typically need to stay in treatment longer than other offenders, with more frequent monitoring, and they usually have a number of other dynamic risk factors that need to be addressed.
  • Situational/Regressed Child Offenders: These offenders are attracted to adults as well as minors. In fact, many have healthy adult romantic attachments. Their sexual behavior with minors tends to be purely opportunistic rather than planned. For instance, they may stumble across child pornography while surfing for porn in a more general way, and then choose to explore that. Others will offend related to drug or alcohol abuse, job loss, stress, too much free time, etc. These individuals, especially those who’ve not committed a hands-on offense, typically respond in positive ways to appropriate sex offender treatment, and their risk for reoffending is generally minimal. That said, there are numerous other possible contributing factors, and depending on those the recidivism risk can increase from minimal to moderate.
  • Situational Offenders (Non-Child): These are men and women who occasionally, when an opportunity presents itself, engage in illegal sexual behaviors—peeping, prostitution, public sex, etc. Generally speaking, these individuals have relatively normal sex lives most of the time, and people would not typically think of them as sex offenders (a label we typically reserve for “perverted” individuals). Nevertheless, because their sexual behaviors do break the law, they technically qualify as sex offenders. Generally, these individuals respond positively to appropriate treatment, and their risk for reoffending is minimal.
  • Sexually Addicted Offenders: These are men and women who compulsively engage in sexual behaviors as a way to avoid feelings of stress, depression, anxiety, and the like. They use sexual fantasy and the pursuit of sex (including masturbation, pornography, webcams, prostitution, sexting, and the like) to “escape from life” and to self-regulate their internal emotional state. Unfortunately, as with other addictions, sex addiction tends to escalate. In the same way that a substance abuser might escalate from alcohol to painkillers to heroin, a sex addict might escalate from vanilla porn to illegal porn, or from affairs with co-workers to the serial use of prostitutes. These individuals, especially those who’ve not committed a serious sexual offense, typically respond positively to informed treatment, and they are less likely to reoffend—except, perhaps, in the early stages of sex addiction recovery, where short-term relapses are relatively common.

In sum, some types of sex offenders are more likely to respond to treatment than others. However, even violent offenders and fixated/dedicated child offenders can be helped if they are sufficiently motivated. Of course, many (maybe most) are not. In such cases, civil commitment, post-incarceration, may be a viable option. (Levenson, J.S., 2004. Sexual predator civil commitment: A comparison of selected and released offenders. International Journal of Offender Therapy and Comparative Criminology, 48(6), pp.638-648.) That said, even civilly committed individuals may eventually respond to an informed treatment regimen.

Other factors that can complicate and/or hinder successful treatment include:

  • If the sex offense is merely one aspect in a larger antisocial or criminal lifestyle.
  • If the sex offense included bizarre or ritualistic acts, like extreme bondage or enemas. (Often, these offenders require as part of their treatment extensive trauma work, as they are typically reenacting a version of their own victimization.)
  • If the offender consistently and persistently denies the offense occurred or that he or she committed it.
  • If the offender consistently and persistently externalizes the blame for the offense. (For instance, “She wanted me to do it.”)
  • If the sex offense is secondary to an unremitting condition of serious mental illness and/or mental retardation.

Although the above factors can complicate and sometimes hinder treatment, they do not automatically signal that an offender is untreatable. In fact, there are sex offender treatment groups that specialize in trauma issues, deeply rooted denial, and even mental illness and mental retardation.

We do not have official statistics on what percentage of sexual offenders fall into each of the five primary typologies. However, clinical experience and the small amount of available research strongly suggest that in today’s world, where the internet is “creating” all sorts of sexual offenders, most of whom never come into contact with the legal system, there are many more sexually addicted and situational offenders than violent and fixated/dedicated child offenders. (Fortney, T., Levenson, J., Brannon, Y. and Baker, J.N., 2007. Myths and facts about sexual offenders: Implications for treatment and public policy. Sexual Offender Treatment, 2(1), pp.1-15.) Moreover, and this has always been the case, the majority of sexual offenders, particularly if they are internally motivated, will respond positively to informed treatment.

Thinking back to the examples with Robert and James: After a thorough risk assessment is conducted, Robert will probably be typed as a fixated/dedicated child offender—with difficulty responding in positive ways to treatment, at least initially, meaning longer-term treatment is likely needed, with a higher likelihood of recidivism. Meanwhile, James will probably be typed as either a situational or a sexually addicted offender. And because he is internally motivated to make necessary life changes, he is an excellent candidate for treatment and less likely to recidivate. Unfortunately for James, when he goes to court he’s going to be lumped in with Robert and sentenced based on the same outdated guidelines.

The Judicial System…

Generally speaking, our nation’s ongoing rationale for tougher and mostly inflexible sentencing laws is based on the mistaken belief that a person who’s committed one sexual offense is highly likely to commit another, and the next offense will probably be more harmful than the first.

For the most part, proponents of these harsh and rigid sentencing statutes have backed their arguments by citing the now thoroughly debunked Butner Study, mentioned in the opening paragraph of this article. This spurious piece non-scientific research, coauthored by a US Marshall, looked at 155 men convicted of child porn offenses, finding that many of these individuals had also committed a previously undisclosed and unprosecuted hands-on offense. (Bourke, M.L. and Hernandez, A.E., 2009. The ‘Butner Study’ redux: A report of the incidence of hands-on child victimization by child pornography offenders. Journal of Family Violence, 24(3), pp.183-191.) However, because of its inherent bias and some blatantly obvious design flaws, more equitable researchers believe (and have stated rather vociferously) that the Butner Study does not definitively establish a causal relationship between the viewing of child pornography and contact offending. (588 F. Supp. 2d 997, S.D. Iowa 2008, and, Seto, M.C., 2008. Pedophilia and sexual offending against children: Theory, assessment, and intervention. American Psychological Association.) In fact, better designed, less biased, peer-reviewed scholarly studies almost uniformly show results that are diametrically opposed to the Butner Study.

Much of the recent credible research into pedophilia, hebephilia, and sexual offending has been done by renowned Canadian scholar Michael Seto, Director of Forensic Rehabilitation Research at Royal Ottawa Health Care and author of the 2013 book, Internet Sex Offenders. In a 2005 study, Seto and his colleague, Angela Eke, examined 201 convicted child porn offenders, finding that both recidivism and escalation into hands-on offending are relatively predictable among this population. Moreover, the most likely indicator for both recidivism and escalation is a prior history of other criminal offenses rather than a sexual attraction to minors. (Seto, M.C. and Eke, A.W., 2005. The criminal histories and later offending of child pornography offenders. Sexual abuse: a journal of research and treatment, 17(2), pp.201-210.) In other words, Seto and Eke found that a child porn user’s attraction to minors is not a primary risk factor for future sexual offending of any kind, while a history of criminal behaviors in general is a risk factor, perhaps indicating an ongoing propensity to disregard laws in all areas of life.

And this is hardly a lone finding. Seto and Eke’s groundbreaking work has been backed up and expounded upon by other researchers, most notably a 2009 European study by Swiss and German scientists. This study found that among people who had not previously committed a hands-on sexual offense, the viewing of child pornography—even the extensive viewing thereof—was not, by itself, an indicator of future hands-on offending. In fact, only 1 out of 220 test subjects without a prior contact offense went on to commit one. (Endrass, J., Urbaniok, F., Hammermeister, L.C., Benz, C., Elbert, T., Laubacher, A. and Rossegger, A., 2009. The consumption of Internet child pornography and violent and sex offending. BmC Psychiatry, 9(1), p.1.)

After publication of this study the lead researcher, Dr. Frank Urbaniok, told members of the press that “the motivation for consuming child pornography differs from the motivation to physically assault minors.” (Biomed Central. 2009, July 13. Viewing Child Porn Not A Risk Factor For Future Sex Offenses, Study Suggests. Available at www.sciencedaily.com/releases/2009/07/090713201446.htm.)

Seto makes a similar statement in Internet Sex Offenders, writing, “There may be a meaningful difference between those who engage in interactions with minors to attain sexual gratification while online (fantasy-driven offenders) and those who engage in online interactions with the goal of meeting for sex in real life (contact-driven offenders). (Seto, M.C., 2013. Internet sex offenders. American Psychological Association, pp 165-66).

Needless to say, the Butner Study is now thoroughly discredited. Nevertheless, the unforgiving laws it helped to create remain in place, adversely affecting numerous sexual offenders—most notably situational and addicted offenders who might better respond to treatment than imprisonment. Simply put, our current legal system treats all sexual offenders as if they are the same, even when their motivations for offending and their likelihood of reoffending are quite dissimilar. So the fact that Robert and James are very different and will likely respond very differently to treatment vs. incarceration matters little in the eyes of our lock them up and throw away the keys judicial system.

What is missing, in both our courts and in the public discourse on sexual offending, is differentiation between offenders who are likely to reoffend and those who aren’t. For example, it would be helpful to separate individuals who use child pornography because an addiction or other risk factors are in play and their behavior has escalated in that direction from those who use child pornography to satisfy a fixated/dedicated pedophilic (prepubescent) or hebephiliac (adolescent) attraction. It would also be useful to differentiate between those who will probably only ever use online imagery, albeit illegally, to satisfy their sexual desires, and those who seem likely to engage in contact offending. And we do have the ability to make these distinctions.

Psychosexual Evaluations: Creating Clarity for the Judicial System

It can be difficult to differentiate between the various typologies of sexual offenders, primarily because these individuals are typically not forthcoming about their sexual arousal patterns, their past and current sexual behaviors, and other important factors like early-life trauma, substance abuse, anger, and secondary criminal behaviors. As such, therapists, when performing psychosexual evaluations on sexual offenders, must emphasize from the start that honesty and cooperation are part of the assessment—noting that anything a client admits or denies or simply won’t talk about will be fact-checked with external sources.

Thus, in addiction to standard therapeutic interview techniques and evaluation with various psychological instruments, such as the Hare Psychopathy Checklist, therapists must seek out and incorporate into their evaluation information from external sources, including police reports, victim accounts, conversations with family members, etc. (Hare, R.D. and Vertommen, H., 1991. The Hare psychopathy checklist—revised. Multi-Health Systems, Incorporated.) Additionally, if the equipment is available, an offender’s level of truthfulness can be tested via polygraph, and his or her sexual arousal patterns can be tested via plethysmograph and/or the (somewhat controversial) Abel Assessment for Sexual Interest. (Abel, G.G., Jordan, A., Hand, C.G., Holland, L.A. and Phipps, A., 2001. Classification models of child molesters utilizing the Abel Assessment for sexual interest TM. Child Abuse & Neglect, 25(5), pp.703-718.)

When dealing with sexual offenders, the primary goals of a psychosexual evaluation are as follows:

  • To accurately assess the facts as presented, and based on that assessment to answer any specific referral questions that were posed.
  • To implement standardized testing (that has been proven valid and reliable) to further assess the client.
  • To see if standardized testing results are consistent with the structured clinical assessment.
  • To make recommendations for treatment, including goals and methodologies.
  • To assess whether the client is likely to find treatment success, and where that might best take place.

It is not the job of the evaluator to make recommendations about treatment vs. incarceration. Rather, evaluations are an attempt to explain the offender’s motivations for illegal behavior, along with how likely he or she is to respond positively to treatment and his or her propensity to recidivate. If the evaluation is conducted pre-trial or otherwise prior to a guilty plea or conviction, the evaluator should not discuss the alleged offense, leaving any specifics in that regard out of the report.

In general, a well-organized psychosexual evaluation will detail the offender’s general psychological functioning, sex and relationship history, and family and social history. It will also include an in-depth examination of the offender’s trauma history—emotional, physical, and sexual. (This history may be extensive.) Additionally, any related physical or mental health concerns should be outlined, as these issues are often relevant to the treatment vs. incarceration debate. Last but not least, the evaluation should include commentary on the level of openness and honesty in the offender’s self-disclosure.

Therapists must keep in mind when preparing psychosexual evaluations for the court that their reports are not useful unless the information contained therein can be understood by the reader. They must also understand that the legal system typically treats all sex offenders as if they are the same, even though the propensity for reoffending and/or escalated contact offending may be quite different. Moreover, therapists must accept that the general (though not universal) attitude of people who work within the criminal justice system is somewhat punitive, and in cases where treatment seems more appropriate this bias must be overcome with clear and concise language that explains, in lay terminology, the differences between various types of offenders and why this particular individual (and his or her family and community) is better served with a different approach to sentencing. Of course, mandates may still force a mostly punitive course of action.

Treatment of Sexual Offenders

As discussed above, a significant percentage of sexual offenders are solid candidates for treatment, either in or out of prison. This is particularly the case if and when the underlying causes of their problematic sexual activities are similar to the presenting issues of alcoholics and other addicts—unresolved early-life or severe adult trauma, attachment deficits, ongoing depression, severe anxiety, pathologically low self-esteem, etc. And the vast majority of situational and/or addicted offenders do fall into this category. Notably, there are specific tests and protocols that can be used to determine if a person is addictive/compulsive, such as the Hypersexual Behavior Inventory and the Sexual Dependency Inventory. (Reid, R.C., Garos, S. and Carpenter, B.N., 2011. Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient sample of men. Sexual Addiction & Compulsivity, 18(1), pp.30-51, and, Green, B.A., Arnau, R.C., Carnes, P.J., Carnes, S. and Hopkins, T.A., 2015. Structural Congruence of the Sexual Dependency Inventory—4th Edition. Sexual Addiction & Compulsivity, 22(2), pp.126-153.) As long as situational and addicted offenders are willing to admit what they’ve done and to make significant life changes, informed treatment can be and usually is extremely productive, further reducing these offenders’ already low propensity for recidivism.

Unfortunately, some of the sex offender treatment modalities currently in use are less effective than others, most notably chemical therapies, behavior modification, and psychodynamic psychotherapies.

  • Chemical therapies involve the use of anti-androgenic hormones, in particular Depo-Provera (medroxyprogesterone). Essentially, this is a form of chemical castration. This methodology is mostly ineffective because the human sex drive lives more in the mind than the body. Thus, offenders may still want to engage in their antisocial sexual behaviors, even if they are unable to become physically aroused and carry out those desires. Nevertheless, a small amount of research has shown that when used in conjunction with cognitive and behavioral modalities, Depo-Provera can increase treatment efficacy on a time-limited basis. (Maletzky, B.M., Tolan, A. and McFarland, B., 2006. The Oregon depo-provera program: a five-year follow-up. Sexual Abuse: A Journal of Research and Treatment, 18(3), pp.303-316.)
  • Behavior modification tries to change a sex offender’s arousal patterns through negative association, most often electric shocks. Generally, specific thoughts and arousal patterns are targeted, like a pedophile’s attraction to prepubescent children. This methodology has proven to be only minimally effective, and the efficacy diminishes over time. The further away the offender is from the aversive experience, the less effect the treatment will have. Behavior modification has also been tried as a way to combat smoking and alcoholism, with similarly disappointing results. (Anant, S.S., 1968. Treatment of alcoholics and drug addicts by verbal aversion techniques. International Journal of the Addictions, 3(2), pp.381-388, and, Wolpe, J., 1964. Conditioned inhibition of craving in drug addiction: A pilot experiment. Behaviour Research and Therapy, 2(2-4), pp.285-288, among others.)
  • Psychodynamic psychotherapy is a form of talk therapy that focuses on the individual’s childhood, hoping to uncover the root causes of his or her current behaviors. In general, sex offenders take to psychodynamic psychotherapy like a fish takes to water, mostly because they’re looking to blame anyone but themselves for what they’ve done, and psychodynamic work sometimes provides an avenue for this. That said, elements of psychodynamic therapy can, at times, be incorporated into a larger treatment regimen. For instance, family of origin work may eventually be needed, and that is a useful area for certain psychodynamic techniques. Still, when dealing with sex offenders, psychodynamic therapy should not be used as a primary approach to treatment.

So what does work?

With sex offenders, as it is with any psychotherapeutic client, no matter the issue to be addressed, the first step toward useful clinical intervention is proper assessment. In other words, what kind of sexual offender are we dealing with? What is the offender’s primary motivation for behaving this way? Is the offender likely to respond to treatment? Is the offender likely to recidivate? Moreover, beyond sexual offending, what other issues must eventually be dealt with?

If, after a full assessment, an offender looks like a solid candidate for treatment, the most effective methodology is a combination of cognitive behavioral therapy (CBT), social learning, psycho-education, and external support. Sometimes selective serotonin reuptake inhibitors (SSRIs) are utilized in conjunction with other forms of treatment, as these antidepressant medications, as a side effect, often reduce a person’s sex drive. (Piazza, L.A., Markowitz, J.C., Kocsis, J.H., Leon, A.C., Portera, L., Miller, N.L. and Adler, D., 1997. Sexual functioning in chronically depressed patients treated with SSRI antidepressants: a pilot study. American Journal of Psychiatry, 154(12), pp.1757-1759.). The “Good Lives Model of Offender Rehabilitation,” which essentially incorporates and formalizes all of the above, has proven successful in the treatment of sexual offenders in many countries, including the United States. (Ward, T. and Gannon, T.A., 2006. Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders. Aggression and Violent Behavior, 11(1), pp.77-94, and, Willis, G.M. and Ward, T., 2013. The good lives model. What works in offender rehabilitation: An evidence-based approach to assessment and treatment, pp.305-317, among others.)

Most of the properly trained therapists who work with sexual offenders (and sexual addicts) rely heavily on CBT, a behavior-driven approach that looks at feelings, thoughts, and circumstances that trigger an offender’s desire to engage in problematic sexual activity, at the same time identifying and implementing ways to short-circuit the offending process. Essentially, sex offenders are taught to recognize their triggers and to respond in healthier ways, practicing new coping mechanisms and applying interventions that interrupt the cycle of abuse.

With CBT, treatment is directive and reality-based, focusing on the here and now rather than on the exploration of childhood issues that may or may not have led to the offending behaviors. (The exploration of childhood issues, if necessary, should occur only after the offender has taken full and total responsibility for and effectively halted his or her offending behaviors.) As such, a therapist’s role, at least initially, is to implement a task-oriented, accountability-based program geared toward containment of the offender’s problematic actions and the development of healthier in-the-moment coping skills.

Very often, the treatment of sex offenders presents demands that cannot be met within the confines of an individual therapeutic relationship. As such, offenders typically require external reinforcement and support if they are to implement lasting behavior change. For this, group therapy geared toward sexual offending is the recommended modality. In a facilitated group setting, offenders can see that their problem is not unique, which helps to reduce the guilt, shame, and remorse associated with their actions (any and all of which can be triggers toward further bad behavior). Furthermore, and perhaps more importantly, the group format is ideal for confronting the denial used by offenders to justify their activities. (Levenson, J.S. and MacGowan, M.J., 2004. Engagement, denial, and treatment progress among sex offenders in group therapy. Sexual Abuse: A Journal of Research and Treatment, 16(1), pp.49-63.) Such confrontation is powerful not only for the individual being confronted, but for group members doing the confronting. In this way, everyone present is able to see how internal misconceptions and rationalizations facilitate and sustain sexual offending. Inpatient recovery settings, both voluntary and mandatory, including treatment settings within prisons, can provide an even deeper level of social learning, as every aspect of an offender’s life is scrutinized by his or her peers, and vice versa.

Many sex offenders, especially sexually addicted offenders, also benefit from 12 step sexual recovery meetings, which provide both guided recovery and social support. Sex Addicts Anonymous (saa-recovery.org), Sexual Compulsives Anonymous (www.sca-recovery.org), Sex and Love Addicts Anonymous (slaafws.org), and Sexual Recovery Anonymous (sexualrecovery.org) are excellent recovery programs for sex addicts. Sexually addicted offenders are welcome in most groups.

For further information about sexual offending and the treatment of sexual offenders, please visit the organizational websites listed below:

  • The Association for the Treatment of Sexual Abusers (www.ATSA.com): ATSA promotes evidence based strategies for the assessment and treatment of individuals who have sexually abused/offended or are at risk to do so. ATSA also provides referrals to qualified therapists.
  • The Safer Society Foundation (www.SaferSociety.org): The Safer Society Foundation is dedicated to ending sexual abuse and offending through effective prevention and treatment.

Where Are We Now?

Unfortunately, not all members of the clinical and legal communities are fully versed in the intricacies of sexual offending. Instead, most people, professionals and laypeople alike, possess only a base and sensationalistic sense of sexual misbehavior, failing to understand that all sex offenders are not created equally. The criminal justice system, thanks to harsh mandatory sentencing guidelines, is especially blind in this regard. As such, it is up to therapists, defense attorneys, and other officials to evaluate an offender’s motivations, history, and likelihood of future wrongdoing, and to present, when appropriate, an argument for therapeutic rather than purely punitive sentencing. To this end, informed and experienced therapists must be invited into the legal process to help well-meaning but underinformed judges and prosecutors understand that not all sex offenders are the same, and that many, perhaps even the majority, have the psychological and emotional awareness needed to not reoffend.