Research on the methods of
treatment which are most effective in rehabilitating sex offenders is still in
the very early stages of development. Researchers face difficult problems in
designing studies that permit conclusive statements about the effective
components of treatment.
Nevertheless, advances are beginning to appear and there is growing evidence
that offenders who receive some form of treatment have reduced chances of
recommitting sexual crimes. Based on the most recent Canadian studies, estimated
recidivism rates for treated sex offenders fall in the vicinity of about 10%. If
20% is used as a rough estimate of the recidivism rate for untreated sex
offenders, it appears that treatment can have an appreciable impact on sex
Innovations in treatment techniques have been guided by developments occurring
in research on sex offenders. A number of methods have been devised to address
the problem of deviant sexual preferences. These techniques employ some of the
methods which have been pioneered by behavioural psychologists. There has also
been some experimentation with the use of drugs in the treatment of sex
offenders (see box).
Behavioural approaches are based on principles of conditioned learning in which
attempts are made to either reduce deviant sexual arousal or increase the
offender's arousal to more appropriate sexual behaviours. The techniques used to
achieve these treatment objectives vary. In one approach, the therapist monitors
the offender's level of arousal to deviant sexual cues which are presented under
laboratory conditions. Various forms of punishment are used to discourage
responses to deviant sexual imagery. For example, when arousal to inappropriate
cues reaches a predetermined level, the offender might receive a mild electric
shock or be exposed to extremely noxious odours. Another method based on
biofeedback procedures allows the offender to monitor his own responses by
providing signals at the onset of arousal to deviant behaviours. By anticipating
the signal the offender learns to reduce arousal to deviant cues and increase
his arousal to more appropriate cues. An alternative method assists the offender
to force the recall of unpleasant thoughts or experiences when sexual excitement
to the wrong type of sexual behaviour begins to occur.
Generally, behavioural techniques have been found to be effective in many
studies. Unfortunately, there has been concern among many experts that the
methods produce only short-term changes in deviant sexual preferences. In a
study conducted at the forensic psychiatric facility in Penetanguishene,
Ontario, Dr. Vernon Quinsey and his colleagues used a combination of biofeedback
and electric shock to treat a group of child molesters. Significant improvements
were witnessed for most of the offenders who received the treatment. Offenders
who had experienced a reduction in arousal to sexual cues involving children
maintained lower rates of reoffence for two years following treatment.
Unfortunately, the researchers discovered that initial treatment gains were
reduced when the follow-up was extended beyond the two year period.
There is some evidence, however, that recidivism in treated offenders can be
controlled for longer periods if periodic "booster' treatments are
administered following termination of the initial treatment. A study conducted
by University of Oregon researcher, Dr. Barry Maletzky, reported considerable
success with a behavioural program designed for the treatment of pedophiles and
exhibitionists. The offenders received weekly treatments for 24 weeks followed
by booster treatment sessions every three months for a period of three years.
For the most part, reductions in arousal to inappropriate sexual cues were
maintained by the treated offenders over the three year period. More
importantly, their rate of recidivism was less than 10%.
Behavioural methods for the treatment of sex offenders have focused primarily on
the problem of deviant sexual arousal. Obviously, sex offenders who possess
relatively normal sexual preferences will have little to gain from this type of
treatment. For example, incest offenders and the more impulsive rapists may have
treatment indications that are unrelated to sexual arousal. More recently
additional treatment approaches have evolved to address some of the other
factors which appear to be related to sex offending. A more comprehensive
approach, which often includes a behavioural treatment component, has begun to
emerge in many programs for sex offenders in Canada. Most therapists refer to
this form of treatment as Cognitive Behavioural Therapy.
Psychologists use the term "cognitive" to refer to attitudes and
thought processes which influence an individual's behaviour. Therapists who use
cognitive treatment techniques with sex offenders attempt to modify distorted
attitudes and beliefs which may contribute to the likelihood that a sex offender
Group and individual therapy sessions are used to confront distorted beliefs
about the victims of sex offences and to assist offenders in the development of
more socially acceptable expressions of sexuality. A principal component of many
sex offender programs which are modeled on the cognitive behavioural framework
is to teach program participants to identify the patterns of thought and
sequences of behaviour that will lead them to become reinvolved in deviant
sexual activities. This approach, often called "relapse prevention",
helps the individual sex offender to develop knowledge about the risk factors
that are likely to promote relapses.(10) Identification of risk factors becomes
highly personalized so that a given offender focuses on the risks that are
particularly relevant to his situation.
Cognitive behavioural treatments usually focus on a variety of behaviours which
are viewed as requiring change if the offender is to become successfully
rehabilitated. For example, anger control, alcohol abuse, social skill deficits,
coping with stress, and lack of knowledge about normal sexual behaviour are
factors which may be related to sex offending. For this reason, many treatment
programs offer special skill-training sessions which allow sex offenders to
address needs in these areas. In addition, behavioural treatments designed to
reduce deviant sexual preferences are also incorporated in many of the more
comprehensive treatment programs in Canada.
Tests of the effectiveness of the cognitive behavioural model of treatment await
studies that will provide statistics on the recidivism of offenders treated with
these new methods. Preliminary findings of studies which are in progress in
Canadian treatment centres suggest that the treatments possess a great deal of
promise. In addition, studies that have focused on the use of cognitive
behavioural treatments for other types of psychological problems have produced
very positive results.
One of the most encouraging signs of the newer, more comprehensive programs for
sex offenders is that treatment strategies have taken into account a broad range
of factors - factors which research has identified as potentially relevant to
the control of sex offender behaviour. As researchers pursue the remaining
unanswered questions about sex offending, designers of treatment programs will
continue to benefit from the new advances.
In the meantime, the existing body of research on sex offenders points to a
number of key areas which should be addressed by current treatment programs in
Canada. There is a well-established need to carry out careful assessments on sex
offenders who are being considered for treatment. Research findings are clear on
the point that sex offenders are a very diverse group and that differences in
their characteristics will have important implications for the development of
individualized treatment programs. In particular, facilities for conducting
assessments of sexual arousal are essential for identifying those offenders who
possess deviant sexual preferences and who need special treatment that
specifically targets this problem. The available research also suggests that
institutionally-based programs which offer little in the way of follow-up may
produce only short-term treatment gains. It appears that effective treatment of
sex offenders must incorporate follow-up contact or "booster"
treatments if long-term benefits are to be attained.