History of Psychological Treatment for Sex Offenders

History of Psychological Treatment for Sex Offenders

Introduction The phenomenon of sexual offence is an increasing social trend which has seen a perceptible rise over the years . Estimates indicate that there are over 12 ,000 sex offenders in prisons in America (Hernandez 2006 . This trend is not restricted to the United States . Many studies across the board including in Canada have also revealed that there has been a proportionate increase in the number of sexual offenders as compared to other types of crimes (Motiuk . Belcourt , 1996 . The proliferation of media has

also led to increase in reporting of such offences which were not coming into the public eye in the past (Cooper 1994 .Greater awareness of the impact of variant sexual conduct including assault has generated an overall understanding of the underlying phenomenon of sexual offences , their intensity and impact on society in general . Sexual misbehavior is increasingly regarded as a social offence which needs to be addressed through correctives at various levels

The history of sexual offenders and their treatment has been considerably long . There has also been an awareness of the need for psychological treatment rather than medication , though the initial focus remained on medicalisation (Gordon . Grubin , 2004 . This field has now been expanded to include a multi pronged approach in treatment . However it is seen over the years that psychological treatment has received the most favorable response from both therapists as well as offenders . The history of psychological treatment of sex offenders examined over a period indicates that this is the most effective methodology employed for reduction as it employs a holistic approach and addresses the core psychological impulses of deviants

Sex Offenders : History

Sex offenders are classified as persons who have been convicted for an offence of sexual nature . This could include rape or sexual assault lewd behavior and inappropriate sexual contact (Sex Offender , 2003 The legal position of sexual offence also indicates that in some countries as well as states of the United States , sex with partners of the same gender even when it is between consenting adults is objectionable (Sex Offender , 2003 . However in general sexual offence is said to be committed when there is an unnatural sexual contact be it with adults or children which lies beyond social acceptability . Given the propensity of sexual crime , there has been an increase of sexual offenses over a period

There are three main categories of sexual offenders . These could be those who commit an offence against adult women , or indulge in incestuous relationships and finally the pedophiles (Langevin . Wright Handy , 1988 . Each type of deviant behavior needs to be seen in a different social and psychological context and thus may need varied treatment parameters . On the other hand it has been proved over the years that psychological and behavioral approach may be a commonality impacting all these conditions

The phenomenon of sexual offences is extremely complex . One of the main reasons for committing sexual crimes over the years is seen to be poor social skills and appalling interpersonal relations . There is thus a powerful motive for use of psychological treatment for sexual offenders The background to each case and the sequence of the same may vary in many respects . The history of sexual offenders will also differ both from the point of view of their criminal record as well as their personal sexual history . What is even more complex as is seen over the years from the record of such crimes is that circumstances under which these are committed are also diverse (Gordon . Porporino , 1990 . This also supports the premise that the need for treatment of such individuals should be varied . This is so as each person tends to respond to different stimuli . Even post treatment follow up has to be need based (Marques . Day . Nelson . West , 1994 . Thus reduction of sexual offences needs a thorough understanding of the psycho social make up of individuals

A major problem in sexual offences is that of recidivism . Recidivism denotes repetition of the same crime by an individual (Recidivism 1998 ) Since the physical exposure of people to each other in modern society is widespread , the scope for recidivism in the case of sexual offences is extensive . On the other hand where recidivism implies commission of other related crime , sexual offenders have shown a greater propensity . The key issues for prevention of sexual offenders thus indicate the need for proper monitoring of deviant behavior within the required period of committing an offence and prevention of recidivism This necessitates a holistic approach in treatment

Treatment Methodologies Sex Offenders

The treatment of sexual offenders is a compound issue which transcends a number of disciplines . There is a need to ensure that assessment techniques used in treatment are good and emanate from well researched paradigms which have withstood the test of time (Dwyer . Pallone Coleman , 1996 . As recidivism is a common occurrence , there is a need to ensure that the methodologies used considerably restrain recidivism . The need will also be to identify special problems of individuals and see how treatment will work in each case . Thus understanding the entire gamut of mind-body linkages in treatment of sexual offenders is essential . This therefore highlights the importance of psychological treatment which has a mind-body approach

Over the years essentially two approaches have been attempted in treatment of sexual offenders . The first and oldest approach is the medical one which includes use of drugs as well as surgical intervention to reduce proclivities of the offender for sexual misdemeanors (Dwyer Pallone . Coleman , 1992 ) On the other hand the psychological approach relies on psychiatric treatment including therapy to wean away basic tendencies for sexual offences . Historically there is also a tendency for attempting a hybrid approach , wherein a combination of treatments medical , psychological and psychiatric are attempted either simultaneously or sequentially (Dwyer . Pallone . Coleman , 1992

While many of these methods have been well established , there is always hesitancy in subjects for treatment other than psychological . This is a recorded fact over the years . Preference is thus more for psychological rather than drug induced or physical treatment such as castration (Langevin . Wright . Handy , 1988 . Reduction of sexual drive through drugs has also been less favored . The problem of a differential between the requirements expressed by the offenders and what is being administered by the therapists has also been a cause for concern (Langevin . Wright Handy , 1988 ) This establishes the need felt over the years for greater congruity of treatment being imparted by therapists and the needs of the offenders . A psychological approach is seen to overcome all these anomalies

Evolution of Psychological Treatment for Sex Offenders

The history of treatment of sexual offenders through medical and psychological means is considerably vast . A mention of the means of treatment is found in the volume published by Kraft-Ebing way back on 1885 which was named as Psychopathia Sexualis (Gordon . Grubin , 2004 There has also been wide acknowledgement of the need for treatment based on a psychological approach as much or even more than medical techniques over the years

The American Psychiatric Association has identified five stages in treatment of sexual offenders (APA , 1999 . The first stage is most difficult as it involves making the offender realize that there is a problem which needs to be addressed . This is so as in many cases it is seen that the maximum resistance comes at this stage (APA , 1999 ) This is also seen to be best addressed by use of psychological interventions rather than other means . The second stage is of family assessment followed by interventions through therapeutic treatment of the family (APA , 1999 . This is then followed by reconstruction and finally sustained follow up after the course is completed . All these stages are considered to be a part of the process of normalization . While over the years , these have been the principal methods used in treatment of sexual offenders , it is only now that these have been effectively documented in a systematic form (APA , 1999

The treatment of sexual offenders psychologically begins with assessment . For this purpose psychological tests have been the most effective means used over the years . Personality tests such as the MMPI or the Minnesota Multiphaisc Personality Inventory have been most effectively used and have proved successful in determining the psychological make of individuals (MMPI Dahlstrom Welsh , 1960 . Thus MMPI is one of the most frequently used tests for assessment in cases of sexual criminals over the years

Another psychological methodology which has been used historically in assessment is behavioral observation . This is based primarily on clinical observations and has been very successfully used to determine social behavior of individuals and the inter personal skills possessed This has maximum support in history of assessments and has been used quite frequently in the past (Marshall , 1971 . The lack of pro social behavior has been identified as one of the primary proclivities in sexual offenders and this has been proved time and again providing sufficient historical validity (Rice et al , 1990

Amongst the psychological methodologies for assessment , the clinical interview has occupied a special place over the years . Maximum extraction of information is said to be done through the clinical interview and hence is likely to be the most effective intervention which has been proved many times in the past . This however has to be done by an expert . There is also evidence to prove that this provides information which cannot be obtained through other means (Weinrott Saylor , 1991

Psychological methodologies have also been used to create a typology of sexual offenders . This has been done with maximum emphasis on inclination of such offenders towards committal of a typical crime such as molestation of a child . For such a purpose , complex psychological and behavioral tools have been used (Knight . Prentky , 1991

In the case of offences as rape , there is also a need felt for creating a different typology which includes the opportunistic type of criminal who comities the act in an unplanned manner without any premeditated behavior . Such people are known to have very limited control on their impulses and thus indulge in rape on the spur of the moment . They are also known to be aggressive in nature (Knight . Prentky , 1991 . Other types of rapists may include those who have a heightened sexual urge which may lead them to conduct the heinous act or those who are excessively angry and aggressive and also some who are vindictive in nature (Knight . Prentky , 1991 ) These would also be more susceptible to committal of crime . Thus it would be evident that it is only through such intimate psychological profiling a clear picture of the psychological make up which may lead to deviant sexual behaviors would emerge (Knight . Prentky , 1991 . These methodologies have historical validity

Significance of Psychological Treatment : Historical Backing

There have been a large number of studies on treatment of sexual offenders over the years . These denote that the history of psychological treatment is long and varied . There are a number of issues which are involved in this approach . Starting with the early days of behavioral approach to treatment of sexual offenders which related to basis of this being a sexually generated streak of criminal intent , cognitive behavioral techniques have been extensively used in the treatment over the years . The advantage of such behavioral treatments lies in that these can be administered in different environments be it in correctional institutions or in post release settings within the community . This has replaced the predominantly community based treatments which were prevalent in the earlier days of evolution of this method . The aim of such treatments over the years has been to reduce deviant attitudes and behaviors and to decrease the limitations of social behavior in the criminals (Marshall . Barbaree , 1990

Generally over the years it has been seen that psychological treatment has a much favorable response in offenders . This increases perceptibly when the focus is on individual rather than group therapy sessions (Langevin . Wright . Handy , 1988

Over the years a variety of psychological treatments for sexual offenders have been evolved . These include measures to be taken when the person is in a correctional institution to those that are to be administered when he is released . Such treatment programs are distributed from high intensity to moderate and low intensity based on the manner in which these are administered and the degree of affectation of a patient

The most effective historically proven treatment programme for sexual offenders is that of individual counseling . However , there is a general problem seen in administering this programme as it comes with the need for personnel who are well trained for providing such counseling . As the problem of sexual offences has grown so has the need for more number of counselors . There is an innate paucity of good quality counselors who are trained as well as adaptive to the needs of their clients . The problem of the gap between psychological treatment providers and increase in the number of patients continues over the years . There are no immediate answers , but involving greater number of family members training of trainers concept being extended to that of `counseling of counselors ' appears to be the answer in the days ahead

There have also been efforts to define the best method of treatment of sexual offenders through interaction with the accused at various stages of their trial such as pre and post trial or preceding the award of sentence . This is a new development in the history of treatment of sexual offenders as it indicates an effort to involve the offenders in finding solutions to their problems . This study conducted by the Clark Institute of Psychiatry , Toronto establishes that less than 40 percent of the convicts surveyed accepted that their sexual behavior was abnormal (Langevin . Wright . Handy , 1988 . The propensity for denial could thus be seen as a common phenomenon over the years . This can be assessed only through psychological profiling enhancing significance of psychological treatment

There are many skeptics who question the effectiveness of studies which have been carried out in this field (Quinsey et al , 1993 ) However the programmes are considered as effective even if these have been able to reduce the number of cases of relapse by a handful (Williams , 1996 ) The social cost of minimal reduction is more than compensated with lessening risk of deviant behavior . There is no doubt that historically it is evident that some action taken may be better than at all

Increasingly over the years the treatment of sex offenders is seen to be taken over by psychologists and in some cases where the personnel are incarcerated by prison officers who are specially trained . These have been very effectively assisted by psychiatrists in various cases which enable them to assess the roots of the abnormal behavior and recommend treatment trajectory . Thus increasingly there is a team based approach rather than a single stream bias based on medical or psychological methods . Not withstanding the above , the psychological methodology is seen to provide considerable advantages

Conclusion

The history of psychological treatment of sex offenders examined over a period indicates that this is the most effective methodology employed for reduction as it includes holistic methods and addresses core psychological impulses . While in the beginning , medicalisation was the main methodology considered for use as early as in the 19th Century gradually the focus shifted to psychological treatment which was supported by other methods such as clinical and psychiatric . The trend is increasingly towards adoption of a multi disciplinary approach which given the large number of sexual offenders as indicated by numerous studies as well as testimonies should prove the most effective . Never the less , the primacy of the psychological approach within the overall variety of treatment available is well highlighted . Other means are seen to more or less support psychological treatment rather than replace the same

References

APA (1999 . Dangerous Sex Offenders : A Task Force Report of The American Psychiatric Association . Arlington : APA

Cooper , M (1994 . Setting Standards and Guiding Principles for the Assessment , Treatment , and Management of Sex Offenders in British Columbia . Vancouver : BC Institute on Family Violence

Dahlstrom , W . M Welsh , G . S (1960 . An MMPI Handbook : A Guide to Use in Clinical Practice and Research . Minneapolis : University of Minnesota Press

Dwyer , Margretta S . Pallone , Nathaniel , J . Coleman , Eli (1996 . Sex Offender Treatment : Biological Dysfunction , Intrapsychic Conflict Interpersonal Violence . Binghampton : Haworth Press

Gordon , A Porporino , F . J (1990 . Managing the Treatment of Sex Offenders : A Canadian Perspecitve (Research Report No . B-05 . Ottawa Correctional Service of Canada

Gordon , Harvey . Grubin , Don (2004 . Assessment and treatment of sex offenders . Advances in Psychiatric Treatment . Vol . 10 , 73-80

Hernandez , Andres (2006 . Statement of Andres E . Hernandez . Before the Subcommittee on Oversight and Investigations Committee on Energy and Commerce United States House of Representatives September 26 , 2006 Accessed at HYPERLINK "http /www .projectsafechildhood .gov /HernandezTestimonyCongress .pdf on 8 April 2007 " www .projectsafechildhood .gov /HernandezTestimonyCongress .pdf on 8 April 2007

Knight , R . A Prentky , R . A (1990 . Classifying sex offenders : The development and corroboration of taxonomic models . In W . L . Marshall H . E . Barbaree (Eds , Handbook of Sexual Assault : Issues , Theories , and Treatment of the Offenders (pp .23-52 . New York : Plenum

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. Handy ,L (1988 ) What treatment do sex offenders want ? Journal Sexual Abuse : A Journal of Research and Treatment . Volume 1 , Number 3 / September , 1988 . Pages 363-385

Marques , J . K , Day , D . M , Nelson , C West , M (1994 . Effects of cognitive-behavioral treatment on sex offender recidivism : Preliminary results of a longitudinal study . Criminal Justice and Behavior , 21 (1 28-54

Marshall , W . L (1971 . A combined treatment method for certain sexual deviations . Behaviour Research and Therapy , 9 , 292-294

Marshall , W . L Barbaree , H . E (1990 . Outcome of comprehensive cognitive-behavioral treatment programs . In : William L . Marshall , D . R Laws H . E . Barbaree (Eds , Handbook of Sexual Assault : Issues Theories , and Treatment of the Offender (pp . 363-385 . New York : Plenum PressMotiuk , L . L Belcourt , R (1996 . Profiling the Canadian federal sex offender population . Forum on Corrections Research , 8 (2 3-7

Quinsey , V . L , Harris , G . T , Rice , M . E Lalumiire , M . L (1993 Assessing treatment efficacy in outcome studies of sex offenders Journal of Interpersonal Violence , 8 (4 , 512-523

Recidivism (1998 ) West 's Encyclopedia of American Law . New York HYPERLINK "http /www .answercentral .com /main /Record2 ?a NR url http /www .galegroup .com " The Gale Group , Inc

Rice , M . E , Harris , G . T Quinsey , V . L (1990 . A follow-up of rapists assessed in a maximum security psychiatric insititution . Journal of Interpersonal Violence , 5 , 435-449

Sex Offender (2003 . Law Dictionary . HYPERLINK "http /www .answercentral .com /main /Record2 ?a NR url http /www .barronsed uc .com " Barron 's Educational Series , Inc . New York : Barrons

Sex Offender Treatment : Psychological and Medical Approaches (1992 Dwyer , Margretta S . Pallone , Nathaniel , J . Coleman , Eli . Binghampton Haworth Press

Weinrott , M . R Saylor , M (1991 . Self-report of crimes committed by sex offenders . Journal of Interpersonal Violence , 6 (3 , 286-300

Williams , S . M (1996b . A national strategy for managing sex offenders Forum on Corrections Research , 8 (2 , 33-35

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