CSOM Long Version: Section 4 1

Learning Objectives

Participants will be able to: Summarize researchOutline treatment componentsIdentify reasonable expectations of

treatment providerIdentify treatment provider qualificationsOutline collaboration strategies

CSOM Long Version: Section 4 2

Effectiveness of Treatment

Difficult to studyPoor dataPrograms and definitions varyDesign criteria difficult to meet

BUT“Good grounds for optimism”

(Marshall and Pithers, 1994)

CSOM Long Version: Section 4 3

Review of the Research

Individuals who had received treatment had consistently lower recidivism rates than untreated individuals.

Better outcomes after 1980--perhaps better programs or better research.

Treatment over long periods of time is more effective.

Completing treatment is important.(M.A. Alexander, 1994)

CSOM Long Version: Section 4 4

Review of the Research (cont.)

Recidivism rates of untreated offenders are approximately 60%.

Recidivism rates of offenders completing specialized treatment are between 15% and 20%.

(U.S. Department of Justice, 1991)

CSOM Long Version: Section 4 5

Review of the Research (cont.)

Grossman et al (1999): reduction in recidivism of 30% over seven years

Gallagher et al (1999): cognitive-behavioral approaches appear particularly promising

Polizzi et al (1999): prison and non-prison based programs show effective or promising results

CSOM Long Version: Section 4 6

Review of theResearch (cont.)

1995 meta-analysis found (Hall, 1995) small but significant treatment effect 12 studies--all with control groups 8 percent reduction in recidivism in the

treatment group

CSOM Long Version: Section 4 7

Summary of Research on Treatment Effectiveness

Many studies, many poorly designed.Well-designed studies associate treatment

with lower recidivism--some very significantly

Outcomes differ by type of offenderGreater reductions found in more recent

studiesTreatment and/or evaluation methods are

improving

CSOM Long Version: Section 4 8

Summary of Research on Treatment Effectiveness (cont.)

Analytic or insight oriented therapies are not effective (Quinsey, 1990, 1994; Salter, 1988; Lanyon, 1986)

A combination of educational, cognitive-behavioral, and family system interventions is effective (Knopp and Stevenson, 1988, 1992)

When reviewing all studies; conclude that treatment reduces recidivism by 10%

CSOM Long Version: Section 4 9

Effectiveness of Treatment Plus Supervision

Only a few studies done--they support effectiveness of combined treatment and supervision (some with the polygraph). (Romero and Williams, 1985 , 1991)

Current study of Maricopa County program is revealing low rates of recidivism.(Maricopa County Adult Probation Department, 1999)

CSOM Long Version: Section 4 10

Traditional vs. Sex Offender Treatment

Offender-focused Targets reduction

in anxiety/inadequacy

Individual counseling

Usually voluntary

Victim/community safety focused

Targets accountability and thinking errors

Primarily group settingOften mandated

Traditional Sex Offender Specific

CSOM Long Version: Section 4 11

Traditional vs. Sex Offender Treatment (cont.)

Client/patient confidentiality

Provider works as an individual practitioner

Generalist” training for a variety of client types

Waivers of confidentiality

Provider is part of management team

Specialized training/ experience essential

Traditional Sex Offender Specific

CSOM Long Version: Section 4 12

Means of Reducing Recidivism through Treatment

Accepting responsibility and modifying cognitive distortions

Developing victim empathyControlling sexual arousalImproving social competenceDeveloping relapse prevention skillsEstablishing supervision conditions

and networksClarification

CSOM Long Version: Section 4 13

Methods of Treatment

Psycho-educational groups

Cognitive-behavioral groups

Medication

Individual therapy

Psychological and physiological testing

Referrals to other necessary treatments

CSOM Long Version: Section 4 14

Components of Treatment

To cause acceptance of responsibility: Education about denial Support for incremental steps Making responsibility a prerequisite for

entry/completion Confronting/challenging discrepancies,

cognitive distortions

CSOM Long Version: Section 4 15

Components of Treatment

To develop victim empathy: Psychoeducation on effects of abuse Exercises to imagine victim experience Teaching empathy skills Meeting with victim(s)

CSOM Long Version: Section 4 16

Components of Treatment

To control sexual arousal: Education about fantasy and behavior Cognitive-behavioral techniques for

interrupting/reducing deviant urges, developing/increasing non-deviant urges

Methods for practice outside of therapy setting

Medication

CSOM Long Version: Section 4 17

Components of Treatment

To improve social competence: Using group setting for practice Referral to specialized treatment Involving significant others

CSOM Long Version: Section 4 18

Components of Treatment

To develop relapse prevention skills: Education about relapse prevention Identifying individual’s cycle Teaching strategies to avoid lapses Teaching/practicing strategies to

minimize lapses

CSOM Long Version: Section 4 19

Components of Treatment

To establish supervision conditions and networks: Provider collaborates with officer Advises on cycle and appropriate

conditions Assists with modifications Educates network

CSOM Long Version: Section 4 20

Components of Treatment

To Clarify: Verbalize full responsibility Acknowledge grooming, set up State details of offense Support decision to report to police Acknowledge ongoing problem

CSOM Long Version: Section 4 21

What to Expect from a Sex Offender Treatment Provider

Team workCommunity safetyLimited confidentialityIncorporates evaluationAlso: Experience and/or recent

specialized training

CSOM Long Version: Section 4 22

Monitoring Treatment and Providers

Written reportsCase conferences

New cases Specific offender issues System problems

CSOM Long Version: Section 4 23

Monitoring Treatment and Providers (cont.)

Observation Content Process

Emergency case reviewsCommunity feedbackGraduation Criteria

CSOM Long Version: Section 4 24

Treatment Providers Must Deal With:

DominationManipulationAngerAggressive

outburstsDepressionSelf-defeating

behaviors

Variety of skill deficits

Family educationVictim issuesOngoing risk

assessment

CSOM Long Version: Section 4 25

Collaboration Between Treatment and Supervision

Probation/parole may offer classesComplementary treatment and

supervision plansProbation/parole participate/observe

in treatment sessionsWritten treatment plan exchanged

with probation Joint understanding of offense cycles

CSOM Long Version: Section 4 26

Primary Goal of Treatment -- Reduce Future VictimizationThe following are means to that end:Reducing cognitive distortionsAccepting responsibilityDeveloping victim empathyControlling sexual arousalImproving social competenceDeveloping relapse prevention skillsEstablishing supervision conditions

and networks

CSOM Long Version: Section 4 27

Treatment Providers Must be Willing to...

Work as part of a team

Share information

Protect the community as a primary

responsibility

Evaluate their work by these

standards