Few topics cause as much emotional opinion as sexual abuse and the treatment of the abusers. The development of programs promoting therapeutic changes in sex offenders can be negatively affected by societys emotional responses to these crimes. However, the power of these emotions should not be used to condemn sex offenders as monsters, but to fuel the will to search for appropriate treatments. It is important to understand that sex offenders can be very different from one another. The term sex offender applies to people who have shown many different kinds of behavior.
In considering what to do about treating sex offenders, the diversity of their behaviors, motivations, and victims need to be kept in mind. One classification of sex offenders separates them by their victim preferences. The two main categories are rapists and pedophiles. The term child molester is often used as a synonym for pedophile. Sex offenders that commit incest, referring to those who are biological parents, stepparents or siblings of the victim, are considered a special type of child molester.
Whether they prefer victims of the same sex, opposite sex, or both, further classifies child molesters. Exhibitionists, voyeurs, and obscene phone callers, which are another type of sex offender, do not have physical contact with victims. Findings suggest that sex offenders vary with respect to the amount and nature of aggression, vindictiveness and opportunism involved, degrees of fixation and impulsiveness, attitudes toward women, levels of social skills, personal competence, and self-esteem1. Thus, there appear to be no general characteristics that distinguish sex offenders from non-offenders.
The differences among the sex offender population explain why there are conflicting findings in the research and different theories that attempt to explain the causes for sexual assault. These theories can be categorized into three topics; biological, psychological, and environmental. Biological theories include those that link genetics with male aggression, propose biochemical explanations such as abnormal sex steroids or endocrine malfunctions, or causes due to neurological impairments. Psychological theories usually focus on childhood experiences.
Those experiences may include incidents such as sexual, physical or emotional abuse that would repress the development of self-confidence and appropriate attachments to others. As well as experiences that reward aggressive behavior. Environmental theories focus on societal causes of sex crimes such as the availability of pornography, as well as temporary situational factors that encourage inappropriate responses. The environmental theories also focus on factors that remove normal restraints from deviant behavior, such as alcohol and drug abuse2.
The current research on the theories of sexually deviant behavior has focused on three topics; deviant sexual arousal patterns, heterosexual social skills, and the sexual and drug history of the offender3. While treatment professionals see the importance of cognition in sexual offending, little exact research has been done on it4 (cognition is an individuals perceptions, mental thought processes and reasoning). There are indications that some sex offenders may develop distorted thought patterns that help them justify their behavior however.
For example, survey results have found that compared with other respondent groups, child molesters thought that sexual contact was more beneficial to the child and perceived less responsibility for their behavior, greater complicity on the childs part, and less need to punish the adult5. Understanding the sex offender is essential to developing rehabilitation programs. They are closely asociated with the different theories for deviant sexual behavior discussed above. Sex offender treatment is classified under three main types; behavioral, organic or biomedical, and psychological or cognitive treatment.
The goal of behavioral treatment is to reduce sexual arousal patterns using methods targeted at changing the offenders behavioral responses to sexual stimuli. Typical methods include aversion therapy and satiation therapy. In aversion therapy there is the use of a negative stimulus, usually the inhalation of ammonia fumes, while the offender engages in deviant fantasizing. Satiation therapy requires the offender to masturbate to non-deviant fantasies until satiated. Therefore, this causes the offender to pair the inability to become sexually aroused with deviant sexual behavior.
The goal of organic or biomedical treatments is to reduce the sexual drive of sexually aggressive men. Surgical castration, neuro-surgery, psycho-surgery, and the administration of medication are examples of organic treatments. Psycho-surgery involves destroying the part of the brain associated with sexual arousal. Various anti-androgen, or hormonal, drugs have been tested on sex offenders. Tranquilizers, anti-depressants, and anti-psychotic drugs have also been used. Chemical castration is a form of organic or biomedical treatment.
It involves the injection of medroxyprogesterone acetate (MPA), commonly referred to as Depo-Provera. The purpose of this drug is to lower the blood serum testosterone level in the subjected males in the belief that it will lower sexual drive and aggression. The drug reduces the sexual drive by influencing the hypothalamus that stimulates the pituitary to release the hormones that control the production of sperm. Men using the drug can still obtain an erection, ejaculate, and engage in sexual intercourse6.
Studies in Denmark and Switzerland showed that voluntary chemical castration reduced recidivism rates from 50 percent or higher to substantially less than 10 percent7. However, it must be recognized that in the European studies, the offenders volunteered. This raises questions about whether Depo-Provera would work for offenders less eager to be reformed. Given that the safety of children is at stake, it is obvious that the benefits of castrating sex offenders outweigh the drawbacks. California passed legislature in 1996 that mandated chemical castration for repeat child molesters.
As of that date several other states have considered passing such laws, those being Colorado, Florida, Louisiana, Massachusetts, Michigan, Texas and Washington. The goal of psychological or cognitive treatments is to reduce sexually deviant behavior by teaching sex offenders how to control their sexual interest patterns. It is based on the understanding that cognition plays an important role in sexual offending as well as sexual arousal patterns. Group therapy, role playing, individual counseling, and sex education are typical methods of this type of treatment.
Through group interaction and structured educational sessions, sex offenders learn about the cognitive distortions that they use to justify their own deviant behaviors. They are also taught about appropriate sexual behavior. Individual problems, such as lack of self-esteem, alcohol and drug abuse, inadequate anger control, or poor social skills are also identified and may be dealt with in therapy sessions. Experts believe that there is no cure for sexually deviant behavior. A more realistic goal of treatment is managing or controlling that behavior8.
For this reason, treatment professionals have developed a specific model within the broad category of psychological treatments referred to as relapse prevention. Sufficient evidence exists to conclude that efforts to change sex offenders behavior through the use of traditional mental health interventions are ineffective. While the shortcomings of traditional treatment approaches have been documented, evidence that specialized interventions can reduce the recidivism rate of at least some sex offenders is accumulating. These treatment programs have a number of important components in common.
Among the aspects of sex offenders functioning addressed by these programs are sexual arousal disorders, social competence, emotional management, victim empathy and resolution of personal sexual victimization. Relapse prevention has gained increasing recognition as one essential component to include in comprehensive treatment programs for sex offenders. 9 Initially developed for substance abusers, relapse prevention was then modified for sex offenders10. There are two different parts of relapse prevention; the Internal, Self-Management Dimension and the External, Supervisory Dimension.
These aspects of relapse prevention have been associated with dramatically reduced recidivism rates among pedophiles and to a smaller degree, rapists. The internal, self-management dimension assists sex offenders to do several things. They allow them to identify high-risk situations leading to abuse; they allow them to analyze seemingly unimportant decisions that allow them to be put into high-risk situations; they allow them to develop strategies to avoid, or cope more effectively with high-risk situations11.
The external, supervisory dimension assists in the supervision of sex offenders by probation and parole officers. There are three functions of this dimension: To enhance the efficacy of supervision by monitoring specific precursors to offences; to increase the efficiency of supervision by creating a network of collateral contacts which assists the probation officer in monitoring the offenders behavior; to create a collaborative relationship with mental health professionals conducting therapy with the offender12. Relapse prevention offers some advantages over traditional approaches to sex offender treatment.
In a study done at the Vermont Treatment Program for Sexual Aggressors, only 3 percent of pedophiles committed new offences13 as compared to a 43 percent recidivism rate for untreated pedophiles14. Another advantage of relapse prevention is that it places a more realistic therapeutic goal of control versus cure on the offender. As well, the reliance on multiple rather than single sources of information about an offenders behavior is another advantage. Sex offender rehabilitation should be viewed as a staged process. Every step of this process is vital to reducing the risk a sex offender poses when he or she is returned to the community.
An essential part of this process is post-release assessment and treatment, both of which should be established in the release plan prepared by the institution that the sex offender was imprisoned in. Assessments done in the community may cause a loss of treatment gains from the institution and may indicate a need to treat these problems and to adjust relapse prevention plans. Community treatment can continue and develop upon the processes established by institutional treatment and can begin implementing the offenders relapse prevention plan.