Cognitive/behavioral Approaches to the Treatment Adult Sex Offenders

By Witt, Philip H. Phd, Abpp; Greenfield, Daniel P. Md, Mph, Ms et al. | Journal of Psychiatry & Law, Summer 2008 | Go to article overview

Cognitive/behavioral Approaches to the Treatment Adult Sex Offenders


Witt, Philip H. Phd, Abpp, Greenfield, Daniel P. Md, Mph, Ms, Hiscox, Sean P. Phd, Journal of Psychiatry & Law


This article presents an overview of psychotherapeutic treatment modalities of adult sex offenders. It considers recent developments in treatment methods; discusses methods of measuring therapeutic change; presents a discussion of evaluation and outcome studies of these modalities.

"It was the best of times, it was the worst of times, . . ."

-Charles Dickens (1812-1870)

A Tale of Two Cities

For sex offenders, the current legal and sociocultural climate in the West (Noble, 2002) is both the "best of times" and the "worst of times." For the former - the "best of times" - clinical understandings and treatment approaches to deviant, or aberrant, or unacceptable sexual behaviors have advanced considerably over the past 20 years, and show promise for both reduced recidivism and clinical improvement. To the extent that treatment outcome studies can offer evidence-based (Geddes, 2004) data concerning the efficacy of such treatment, such studies suggest that sex offender specific treatment is effective both in terms of reduced recidivism and reincarceration rates (Zgoba, Sager & Witt, 2003) and in terms of improved clinical outcomes such as increased life satisfaction - for those in treatment (Bradford, 2000).

However, for the latter - the "worst of times" - such public attitudes as "All sex offenders repeat their crimes. They are hopeless. Treatment cannot help them" seem increasingly prevalent and are expressed virtually every day in the news media (Witt & Zgoba, 2005). From the criminal/legal perspective, examples of the "worst of times" for paraphilics and sex offenders include the fact that all states and the Federal Jursidiction in the U.S. have community notification and registration laws (Megan's Laws) for convicted and released sex offenders, and as of 2006, 16 states had laws permitting the virtually indeterminate civil commitment of Sexually Violent Predators (SVP's), or Sexually Dangerous Persons (SDP's) following completion of their criminal sentences for sex crimes in the past (Douard, Friedman, Greenfield & Santina, 2006).

In this article - a companion piece to "Organic Approaches to the Treatment of Paraphilics and Sex Offenders" published in a recent issue of this journal (Greenfield, 2006) - we will focus on the former - the "best of times" - by discussing current psychotherapeutic and cognitive/behavioral approaches to the treatment of sex offenders and by emphasizing that such treatment - often in conjunction with organic approaches, especially pharmacotherapy (Greenfield, 2006) - can be effective for sex offenders in a variety of ways.

Sex offender treatment methods

The treatment approach generally accepted (and best researched) for sex offenders throughout North America is a cognitive-behavioral/relapse prevention approach (FreemanLongo, Bird, Stevenson & Fiske, 1995; Witt, Rambus & Bosley, 1996). Recent research, in fact, has focused almost entirely on such programs and methods. Witt and Zgoba (2005, p. 45) characterize these methods as follows:

Cognitive-behavioral treatment aims to change both an offender's maladaptive thinking and actions. Although such a statement might be made about a range of treatment approaches, cognitive-behavioral treatment frequently has a distinctly educational tone, with structured teaching modules and out-of-session tasks (homework assignments). Moreover, relapse prevention, an approach originally developed on substance abusers, aims to help offenders recognize and effectively manage their precursors to sex offending.

The relapse prevention approach has had an enormous impact on sex offender treatment. Over the past few decades, a cognitive-behavioral treatment approach to adult sex offenders has become synonymous with what is characterized as a relapse prevention approach. As Serran and Marshall note (2006, p. 118):

The relapse prevention model has had a major impact on the design and implementation of treatment for sexual offenders. …

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