CHAPTER 1

SELECTION CRITERIA AND TREATMENT COMPONENTS FOR THE SEX OFFENDER TREATMENT PROGRAMME 

PROGRAMME DEVELOPMENT

Introduction

Development of the Sex Offender Treatment Programme (SOTP) was begun in 1990. After some preliminary work the underlying strategy was announced in 1991 and the initial treatment model introduced. The strategy includes a commitment to continually evaluating the effectiveness of the programme and to regularly revising it in the light of clinical experience and research findings. This chapter describes the current status of two elements of the SOTP the procedures for selecting participants and the integrated set of programmes which now compose the SOTP. 

Selection Procedures 

When originally developed the SOTP was intended for men serving a prison sentence of at least four years following conviction for a sex offence. Since the potential demand for treatment places from men meeting this criterion greatly exceeded the available supply of treatment places it was necessary to have some method for deciding who it was more important to treat. The procedure adopted was to give priority to those who had committed more serious offences as indicated by sentence length, but also to take account of probability of repetition, as indicated by previous convictions. Nearness to release was also considered relevant, though more in terms of when someone was treated than whether they should complete the programme. 

As the number of treatment places increased it was possible to extend eligibility criteria. For men serving determinate sentences the principle now is that any man serving a sentence for a sex offence should be offered a place in the programme so long as they have long enough in prison after sentencing for them to complete it. The introduction of a revised sentence planning system which includes actuarial risk classification is expected to widen the definition still further by identifying men on the basis of their previous convictions as well as their index offence. The intention is that those men whose previous records indicate a raised risk of future sex offences should be offered a place on the SOTP regardless of offence for which they are serving a sentence.

The position for Life Sentence prisoners is somewhat different as a more sophisticated form of selection is already employed. In England, a Life Sentence involves two components, a period served as a punishment for the crime (the tariff) and then detention until it is judged that there is no more than a "minimal" risk that the prisoner would commit a serious offence if released. To meet this requirement a careful assessment is made of the different kinds of risk that a Life Sentence prisoner might present and an attempt is made to get the prisoner to address each of these risks before the tariff has been completed so that release need not be unnecessarily delayed.

The SOTP is regarded as potentially relevant to a Life Sentence prisoner who has committed an offence which has a sexual element. In this context a sexual element can be regarded as present if either a) the offence included the sexual abuse of or assault on the victim, regardless of whether the offender's motive was to seek sexual gratification, or b) if the offence was motivated by some inappropriate sexual interest, regardless of whether it was experienced as a specifically sexual intrusion by the victim. Most "typical" sex offences would meet both these conditions but the first definition would also include both rapes carried out for non-sexual reasons, say to terrorise the victim, and cases where a woman was murdered because a man was enraged at her refusing to have sex with him. Likewise, the second definition would apply to most "typical" sex offences but would also include, say, a murder committed because the offender found strangling someone sexually exciting. 

In addition to these eligibility criteria, there are also a number of factors which are taken as indicating that, the SOTP is not an appropriate way of addressing the sexual element in a man's offending. The main considerations here are: 

1. Does not speak English: 
   a small but not negligible minority of sex offenders in English prisons do not speak English. In practice this makes it impossible for a group-based programme of this kind to be provided for them. 
2. Mental Illness: 
   if the man was suffering from a major mental illness at the time of his offence, or is currently suffering from such an illness, his treatment would be better provided by people who have expertise in mental illness as well as in working with offenders. 
3. Insufficient Intelligence: 
   men with low IQs often have difficulty understanding the programme - an IQ of 80 is taken to be necessary. Work is however underway aimed at producing a version of the programme suitable for low IQ offenders. 
4. Suicide Risk : 
   although men who complete the programme typically emerge with higher self-esteem and less vulnerable to negative emotions, there is no doubt that the programme can be stressful for participants and those whose emotional vulnerability means that such a stress would lead to self-injury may (be) appropriately excluded.
5. Personality Disorder : 
   men with severe personality disorders, full psychopathy as defined by Hare, for example, may disrupt other's treatment while typically not benefiting themselves.

Clear possession of any of these criteria may debar an offender from the programme

Treatment Model 

Over the last decade our understanding of the ingredients of programmes which
reduce re-offending has steadily increased. Don Andrews and his associates
(1990) have argued that to be effective programmes need to : 

Summarising this and other meta-analyses, Losel (1995) concluded
that it was cognitive- behavioural skill-orientated, multi-modal programmes
that had produced the best results. Consistent with this, Hall (1995)'s
analysis identified comprehensive cognitive-behavioural programmes as one of
the two treatment approaches that has worked best in reducing sexual
re-offending (the other being hormonal treatments).

In the light of this research the Prison Service's Sex Offender Treatment Programme was therefore intended to apply appropriate cognitive-behavioural procedures to address a range of crimogenic factors relevant to sexual offending. Its distinctive feature is that it is designed so that it can be delivered in a consistent way across multiple sites by a broad range of staff who are selected for their personal qualities rather than their academic or professional background. 

The SOTP consists of four linked treatment components together with an elaborate assessment process. The components are 

With the exception of one module from the Extended Programme all of these treatments are delivered through structured groupwork, and each component is defined by a detailed manual. 

1. The Core Programme

The Core Programme is the one essential component of the SOTP. It is intended to achieve two purposes: increasing participants' motivation to avoid re-offending and developing the self-management skills which will make it easier for them to achieve this. 

The Core Programme seeks to build motivation in three ways. 

The self-management skills that the programme seeks to develop are similarly multi-faceted. They involve first helping each participant to identify the behaviours, thoughts, feelings and situations which have increased their likelihood of offending. And then helping them to identify effective and realistic strategies which could be used to avoid, control or escape from these risk factors. 

In addition to these direct treatment targets the process of participating in the group is intended to produce indirect effects. During treatment participants are encouraged to learn how to give and receive constructive criticism and to provide non-collusive support as their fellows seek to go through the painful process of change. 

In addition, they have the experience of disclosing their most shameful secrets, of exposing those things which make them least loveable, and nevertheless being rewarded supported, and cared for during this process. These group processes are expected to inculcate co-operative interpersonal skills which can be used outside the group and to ameliorate some of the negative emotions and damaged self-esteem which commonly interfere with sex offenders ability to manage their lives more constructively.

2. The Enhanced Thinking Skills Programme

The Enhanced Thinking Skills Programme is designed to improve a range of skills needed for effective problem-solving and decision-making. In particular it makes participants 

Thinking Skills are targeted in the SOTP for two reasons: first, effective problem-solving and decision-making skills should make it easier to generate and apply effective relapse prevention strategies and second, repeated failures in coping with the everyday problems of ordinary life may be an important factor in producing the negative mood states which play an important part in many offence-cycles. 

The programme also teaches a number of specific interpersonal skills which are relevant to implementing good problem-solving strategies, especially where the problem is an interpersonal one. These centre round the deficits in assertiveness skills which are commonly found in sexual offenders. The programme also rehearses participants in productive ways of coping when their attempts at solving a problem do not initially succeed.

3. The Extended Programme

The Extended Programme consists of a family of shorter and more narrowly focused modules intended to be used on an as-needed basis. Potential participants should have completed the Core and Thinking Skills Programmes so targets for the Extended Programme would [be] crimogenic factors which had not responded sufficiently to these earlier interventions. 

At present the Extended Programme contains four modules: 

The philosophy behind this programme though is that other modules should be added where additional treatment needs become apparent.

4. Booster Programme

This programme is designed to be run in the year before release for men who had completed the Core Programme some years earlier in sentence. It is intended to reinforce the gains produced by the earlier programme to compensate for differences in responsiveness to earlier interventions, and further build up relapse prevention strategies in the context of a realistic release plan. 

Changes in the SOTP since its Inception

Apart from the change in selection procedures (which has already been discussed), the main changes that have been introduced to the SOTP since its inception are: 

1. Revision and Extension of the Core Programme : 
   this has involved two major changes. The first being the introduction of psychodrama techniques as a way of enhancing Victim Empathy and the second being replacing an approach to relapse prevention based on the concept of offence-cycles with an approach based on a combination of cognitive-behavioural chains and the explicit identification of risk factors and coping strategies. 
    
2. Introduction of the Thinking Skills Programme :
   the introduction of this integrated cognitive skills training package was stimulated firstly by research indicating that this was a cost-effective means of addressing a range of crimogenic needs and secondly by evidence that these needs were relevant to a majority of sex offenders and that meeting them was as important to reducing sexual recidivism as the more offence-focused aspects of the programme (see Robinson, 1995) 
    
3. Development of the Booster Programme : 
   it had always been envisaged that a booster programme of some kind would be necessary for those serving very tong sentences as this seemed to have the twin advantages of both allowing treatment to be begun relatively early in sentence when memories of the offence were still fresh and ensuring that the benefits of treatment were fully in place at the point when the offender was released. It is only recently though that this has become more than an aspiration. And the Booster Programme is now seen as relevant, not just to very long sentence prisoners, but also as potentially valuable for anyone who had completed the Core Programme more than a year before release.

Conclusion

The SOTP has grown and flourished since its inception. As well as having practically doubled in length and strengthened various of its treatment procedures, it is now available on a very large scale. It will only continue to flourish if those involved are committed, not just to maintaining high standards, but to progressively improving its effectiveness. Doubtless it will continue to evolve.

REFERENCES

Andrews D.A., Zinger I., Hoge I.D., Bonta J., Gendreau P. and Cullen F.T. (1990) Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. In Criminology 28, 364-404. 

Hall G.C.N. (1995) Sexual recidivism revisited: a meta-analysis of treatment
studies. In Journal of Consulting & Clinical Psychology 63 802-809

Losel F. (1995) The efficacy of correctional treatment: a review and synthesis of meta-evaluations. In J.McGuire(ed) What works: reducing re- offending. Chichester, John Wiley & Son.

Robinson D. (1995) The impact of cognitive skills training on post- release recidivism among Canadian federal offenders. Ottawa: Correctional Services of Canada.