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 offender recidivism.

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 will reoffend.

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.