Treatment Effectiveness

When sex offenders are convicted and sent to treatment, does that mean they will not abuse another child victim? 

If your child has been sexually abused, you may wonder if the offender is safe after treatment. If the offender is a family member, you may want to believe that at some point you will not have to worry about this any more - that treatment has fixed the problem. Unfortunately, treatment is not always effective. For some types of offenders it is less effective. Those offenders who prefer children as sexual partners are less likely to give up offending behaviors.
 

Characteristics that predict treatment difficulty include:  

• History of childhood abuse. This predictor is specific to fixated child molesters.
• Early development of sexual deviant sexual fantasies.
• Antisocial personality disorders.
• Untreated juvenile sex offenders may develop more deviant or dangerous adult offender behaviors.

The Good Lives Model (GLM)l of treatment is a strength-based approach, that is used in addition to risk management models. The GLM takes a more holistic and constructive approach to rehabilitation, through enabling offenders to live better lives (i.e. good lives) as opposed to simply teaching offenders to avoid re-offending and, consequently, incarceration. The foundation of the GLM lies in its emphasis on the achievement of a life characterized by emotional well-being. That well-being is dependent on actions, experiences, and thought patterns that are beneficial to human beings. One of the major goals of GLM is helping offenders build capabilities and strengths in order to reduce reoffending.

Other types of treatment for sex offenders include cognitive behavioral treatment and relapse prevention treatment. Because of the difficulty in treating sadistic rapists and fixated child molesters, the need for specialized programs for these two types of offenders is apparent. Wiklund (1995) asserts that probability of effective treatment of preferential molesters (fixated-type) is "impossible" (p. 21). 

In a study conducted by Lin, Maxwell, and Barclay (2000), the Groth sex offender typology (1979) was used to determine treatment effectiveness among sex offenders. Groth describes three types of rapists: power type, approximately 55%; anger type, approximately 40%; and sadistic type, approximately 5%. Power rapists intend to show dominance and control over victims. The intent of anger rapists is to show contempt for victims and hurt or humiliate them. Sadistic rapists inflict the most serious harm, sometimes torturing or killing victims. Child molesters are divided into two types, regressed and fixated. The regressed molester is a situational offender and has not always been attracted to children. The fixated rapist has always had a sexual preference for children. Results of the study showed treatment difficulty in rank order, most difficult to least difficult. Rankings for difficulty are directly associated with treatment effectiveness and treatment success.  

1. Sadistic-type rapists are the most difficult sex offenders to successfully treat.
2. Fixated-type child molesters are the second most difficult group of sex offenders to treat.
3. Power-type rapists are third in the difficulty ranking.
4. Anger-type are fourth in the ranking of treatment difficulty.
5. Regressed-type child molesters are the least difficult to treat and have the highest rate of treatment success.

The Center of Sex Offender Management (CSOM) of the U.S. Department of Justice reviewed recidivism rates for different types of sex offenders. Studies vary in reoffense rates for child molesters:

• Incest offenders reoffended at rates of 4-10%.
• Child molesters with female victims reoffended at rates of 10-29%.
• Child molesters with male victims reoffended at rates of 13-40%.

In a meta-analysis of 61 studies (Hanson & Bussiere, 1998), the average reoffense rate for child molesters was 12.7% in a four to five year period. Factors that predicted reoffense in sex offenders included:

• Young and single
• Prior sex offenses
• Male victims
• Victimized strangers or non-family members
• Began history of sexual offending at young age.
• Involvement in other sex crimes
• Sexual preference for children
• Deviant sexual preferences
• Sexual preference for boys
• Failure to complete treatment
• Personality disorder

Having psychological problems, other than personality disorders, and having a history of childhood sexual abuse was not found to be related to recidivism rates of child molesters.

Hanson and Harris (1998) studied 400 sex offenders and found other factors that strongly predict reoffenses. These include:

• No remorse or concern for the victim
• See themselves at little risk for reoffending
• Less likely to avoid high-risk situations
• More likely to engage in other deviant sexual activities

CSOM describes three treatment approaches for sex offenders. These treatments can be used in combination or alone.

1. Cognitive-behavioral - Focus is on changing thinking patterns and changing deviant arousal patterns.
2. Psycho-educational - Focus is on development of empathy for victim and recognition of responsibility.
3. Pharmacology - Use of medication to reduce sexual arousal.

Alexander (1999) conducted an analysis of 79 sex offender treatment programs including a total of 11,000 sex offenders. Rearrest rates for untreated sex offenders was 17.6% and for offenders who had completed relapse prevention treatment, 7.2%. For all sex offenders who had received treatment, the rearrest rate was 13.2%. 

Many factors contribute to the effectiveness of sex offender treatment. These include:

• Sex offender treatment model and techniques.
• Location of treatment, whether prison, psychiatric hospital, community program.
• Offender's criminal and sex offense history.
• Offender's willingness to participate in treatment, whether voluntary or mandated.

Studies of recidivism rates have varied widely, with most showing low rates. However, results of a 25-year follow-up study of sex offender recidivism (Langevin, Curnoe, Federoff, Bennett, Langevin, Peever, Pettica, & Sandhu, 2004), approximately 3 in 5 (60%) committed sex reoffenses charges, as shown by conviction or court hearings. The rate increased to 4 of 5 (80%) when all offenses and undetected sex crimes were included. The typical span of criminal activity was almost 20 years. In a meta-analysis of studies of sex offender characteristics, Hanson and Morton-Bourgon (2005) report that most sex offender treatment programs address characteristics unrelated to recidivism rates, such as offense responsibility, victim awareness, and empathy, and may not effectively target recidivism predictors: lifestyle instability, deviant sexual interests, and sexual preoccupations.   

See Good and Poor Prognosis Factors in offenders.