Academic journal article The International Journal of Behavioral Consultation and Therapy

Problem Solving Treatment for Intellectually Disabled Sex Offenders

Academic journal article The International Journal of Behavioral Consultation and Therapy

Problem Solving Treatment for Intellectually Disabled Sex Offenders

Article excerpt


Over the past thirty years, Problem Solving Therapy (PST) has been shown to be an effective treatment for many different problems and patient populations (Nezu, 2004). Among its many clinical applications, PST interventions were developed for persons with intellectually disabilities (ID), where improving problem-solving skills led to adaptive behavioral improvements (Nezu, Nezu, & Arean 1991). This article provides a rationale and description of the potential benefits of including PST as a treatment for ID sex offenders. Recommendations regarding future research directions are offered.

Keywords: Problem Solving Therapy, (PST), Intellectually Disabled, (ID).


Among the many adaptations of Problem Solving Therapy (PST; Nezu, 2004), interventions were developed for intellectually disabled (ID) populations, where improving problem-solving skills led to improvements in psychological and adaptive functioning (Nezu, Nezu, & Arean 1991), and decreases in challenging social behavior. Our clinical experience in providing cognitive behavior therapy (CBT) to sex offenders with intellectual disabilities (ID) and a growing body of literature suggest that PST may potentially serve as an integral part of a multi-component treatment plan for this population.

Sex Offending Defined

We define a sex offender as an individual who has committed a sex offense or engaged in sex offending behavior (Lanyon, 2001; Nezu, Nezu, Klein, & Johnson, in press). The term sex offending is a psycholegal one that encompasses a broad set of behaviors, such as nonconsensual sexual conduct with an adult or sexual behavior with a minor (Lanyon, 2001; Nezu, et al., in press). Many individuals identified as sex offenders are also characterized as having deviant sexual interests or diagnosed with specific paraphilias, such as pedophilia or voyeurism. However, having these interests is different from committing a sex offense; some individuals with paraphilias and other deviant sexual interests may never actually engage in sex offending behavior. Likewise, it is possible for some individuals to commit a sex offense in the absence of deviant sexual interests or a diagnosed paraphilia. There is a significant degree of heterogeneity among individuals who commit sex offenses. Individuals who commit such offenses vary across age, race, gender, socioeconomic status, offending history, and a plethora of other variables. Further adding to the heterogeneity of the sex offending population is the ubiquitous presence of additional, comorbid disorders. Individuals identified as sex offenders may also be diagnosed with other medical or psychiatric diagnoses, including mood, anxiety, or personality disorders, brain injury, physical disabilities, impulse control disorders, sexual dysfunction, developmental disabilities, including mental retardation, or any combination of these (Nezu, et al., in press).

Sex Offenders with Intellectual Disabilities (ID)

Individuals who commit sex offenses and are also diagnosed with ID represent a subset of all offenders, and constitute an estimated 10 to 15% of the population of sex offenders who come to the attention of the courts (Murphy, Coleman & Haynes, 1983). The prevalence rate is even higher, reaching over 40%, when individuals with borderline intellectual functioning are included (Nezu, Nezu & Dudek, 1998).

Vulnerability Factors for Sex Offending

It is generally accepted that sex-offending behavior does not have a single cause but is the result of a general vulnerability that is a combination of risk factors (Marshall, Anderson, & Fernandez, 1999). Various behavioral and cognitive pathways made up of these risk factors interact to affect an individual's unique vulnerability for engaging in sex offending behavior. Marshall et al., (1999) describe vulnerability as an individual's attitudes, beliefs, cognitions, behavior patterns and emotions, and stress the importance of the role of learning in the development and maintenance of these factors. …

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