Sex Offender Specific Treatment

1. Sex Offender Specific Treatment Howard Levine Ph.D., LCP Coles County Mental Health Center Mattoon, IL hlevine@ccmhc.org

2. Grateful Acknowledgements • Center for Sex Offender Management (www.csom.org) For their expertise and excellent training curricula used here. • Kurt Bumby, Center for Effective Public Policy (www.cepp.com) Work on shame/guilt and other excellent slides used in this presentation. • Donya Adkerson, Alternatives Counseling, Glen Carbon, IL, 62034, (618) 288-8085 (donya2@aol.com) For dedication to the field and her slides on PGE use in treatment.

3. The Goal of Sex Offender –Specific Treatment • Community protection through effective treatment and management of sex offenders in order to REDUCE THE LIKILIHOOD OF FURTURE VICTIMIZATION • MISSION: NO MORE VICTIMS

4. Not All Sex Offenders Are The Same • Majority, but not all, offenses are committed by males • Sex offenders can be adolescents or adults, male or female, rich or not, white or not, straight or not, bright or not • Offenders differ in preference of victim and offense, risk to offend, supervision and treatment needed • Odds are the offender is family, friend or acquaintance to the victim; but not always • This presentation will focus on adult male sex offenders; however, “special populations’ will be discussed

5. Why do most sex offenders sexually abuse? • They want to (deliberate,no accident) • They are interested (suspend empathy and fear of consequences) • The option is unappealing • Victimization is not a self esteem issue

6. Sexual abuse is the last step in a long effort to manipulate • Victim, wife, partner and other adults • Environment and family The purpose of all this is to Feed his imagination, strengthen justifications Co-opt other adults, and victim(s) Create reliable source for ongoing victimization Decrease chances of being caught or stopped Without external intervention most offenders behavior escalates and continues

7. Why would a sex offender change? • When dire consequences are about to ensue • Severe consequences have already been experienced • He is reliably and credibly managed by a system (natural and official) that can intervene with personally relevant consequences before reoffense • The offender has become disgusted with himself (herself) AND views his deviance as a liability, intolerable and ‘too expensive’

8. The Problem of Motivation • It takes a different set of motivation (internal and external) to make initial change and to sustain that change • Offenders are asked to change NOT to a previously more healthy state BUT to a never known/unfamiliar responsible state • Big difference between compliance and change • Natural and official systems can assist in compliance. Change is up to the offender

9. Two Facets of Sex Offender Management: Addressing both External and Internal Controls • External Controls: • Probation/Parole • Supervision • Polygraph • Testing • Registration/ • Notification • Use of • Community • Networks • Internal Controls—The Four Domains of Treatment: • Sexual Interests • Distorted • Attitudes • Interpersonal • Functioning • Behavior • Management External Controls Internal Controls

10. Differences From Other Forms of Mental Health Treatment • Involuntary clients (need leverage) • Victim and community focus • Limited confidentiality • Treatment goals set by provider • Collaboration with others essential • Length of treatment • SPECIALITY AREA • NO TREATMENT BETTER THAN BAD TX

11. Characteristics of Sex Offender Specific Treatment • Published standards • Containment approach • Specialized providers • Specialized assessments • Group treatment is treatment of choice • Individual treatment alone is rare exception • Cognitive behavioral therapy • Judicious use of medicines

12. Characteristics of Sex Offender-Specific Treatment (cont) • Explicit, empirically-based model of change • Expected to reduce, never eliminate, recidivism • Social learning theory-based • Addresses criminogenic needs • Targets factors closely linked to sex offending (criminogenic needs)

13. What Methods are Effective? • Cognitive-behavioral techniques • Adult learning theory methods • Positive reinforcement rather than punishment • Respectful confrontation

14. Treatment is Skills Oriented • Skills to avoid sex offending • Skills to engage in legitimate activities • “Skills oriented treatment” includes: • Defining the skill • Identifying the usefulness of the skill • Modeling the skill • Practicing the skill • Giving feedback • Practicing the skill again

15. How Long Should Sex Offender Treatment Last? • Until recently, answers to this question were based only on opinion—there is now research that addresses this question • Different offenders require different lengths of treatment • Higher levels of denial, sexual deviancy, and risk require longer, more intense treatment

16. How Long Should Supervision of Sex Offenders Last? • Different offenders require different lengths of supervision based on risk determined through specialized SOS evaluations • Typically, active supervision should continue long after active treatment • Offenders should have the burden to establish that they no longer require official supervision • Longer is usually better

17. Monitoring and Quality Control of Treatment are a Must • Monitoring of: • Program activities • Clients • Containment team members • Containment team protocol • Natural supervisors

18. Treatment of the Denying Sex Offender • Denial is common among sex offenders • But, admitting is vital to treatment • Sex offenders who do not admit at some point can’t be treated • Therefore, treatment of denial is usually necessary to make a client ready for sex offender treatment

19. Various Forms of Denial • Complete denial • Victim or other blaming • Denial of personal intent • Minimize extent or impact • Denial of planning • Denial of risk to reoffend • Family, community, system denial

20. Tools for Addressing Denial • The polygraph—aimed at specific deceptions • Physiological indications of deception • Offenders often abandon denial • Group treatment—targets four issues • Eliminating cognitive distortions • Facilitating engagement in treatment • Challenge offenders need to protect himself • Developing victim awareness

21. Treating Denial Focuses on its Complexity • Many purposes—why offenders are often in denial • Multiple pressures to deny • Denial in various phases of the offense (before, during, and after)

22. Methods to Address Cognitive Distortions • Role play explaining to a victim all the information he would need to give “informed consent” to sexual activity

23. Methods to Address Cognitive Distortions(cont.) • Articulating the thinking errors and cognitive distortions offenders use to excuse their behavior

24. Increasing Victimization Awareness If sex offenders come to understand the harm they cause, they will be more reluctant to commit future sex offenses because they will find it more difficult to disregard the consequences of their actions to their victims and others

25. Methods to Address Victimization Awareness • Videotaped programs of sexual assault victims • Visits by victims to the treatment group

26. Involving Sex Offenders Formerly in Denial • Often graduates of the “deniers’ group” • Emphasis on the positive benefits of abandoning denial • “If I can do it, so can you”

27. The Culmination of Denier’s Treatment • The denier is at last permitted to discuss his own offense—many are now quite willing to do so • Some therapists report that 80% of deniers admit to the offense when this approach is used

28. Bottom Line for Denial • Admitting to a sex crime is a necessary condition for successful treatment • Offenders are to be given a specified period of time to resolve their denial or risk removal from treatment • Denial is inversely related to treatment progress and engagement in treatment

29. Sex Offender Treatment Goals and Plans • Accepting personal responsibility for a complete sexual assault history • Improving social, relationship, and assertiveness skills • Appropriately managing anger • Learning about the traumatic effects of victimization and developing empathy • Learning to separate anger and power from sexual behavior • Developing pro-social support networks

30. Sex Offender Treatment Goals and Plans(cont.) • Recognizing and changing cognitive distortions • Identifying and modifying sexual arousal patterns as appropriate via • Behavioral interventions and/or • Medication • Developing and using interventions to interrupt the offense cycle • Adopting non-exploitative, responsible lifestyle

31. Conditions for Community Supervision • NO CONTACT WITH CHILDREN UNDER 18, unless approved in advance and in writing by supervising officer and provider • No contact with victim(s) • Not to date or befriend anyone who has children or lives with children • No access or loitering near places used primarily by children

32. Conditions for Community Supervision, continued • No employment or volunteering that includes contact with children • Not possess or use any pornographic, sexually oriented or stimulating material • No internet use • No alcohol or illegal drug use • Residence pre-approved • ‘Successfully complete’ all conditions of TX

33. Why No Contact Orders? • Sex offenders are not purists, ‘victim profile’ is a myth. Anyone weaker than an offender is a potential victim. • It is more a matter of opportunity than preference. • The “official record” is always wrong. • Realigns incentive to cooperate in treatment. • NO MORE VICTIMS. Community safety first.

34. ‘Crossover effect’ Gene Abel et. al, (1983) landmark study on the frequency and variety of sexual offending behavior offenders commit. The 411 offenders in the study on average over a 12 year period had attempted 581 crimes, completed 533 crimes, had 366 victims and completed an average of 44 crimes a year. These crimes included ‘hands off’ offenses. 73%+ had two or more types of deviant sexual interest.

35. More on crossover Freeman-Longo, 1985 23 ‘rapists’ 5090 incidents of sex offending 319 child molestations 178 rapes 30 ‘child molesters’ 20667 offenses 5891 assaults on children 213 rapes on women

36. More still; this time with polygraph Colorado DOC, 1998 36 sex offenders on average 2 victims by official records 165 victims after first polygraph 185 victims after second polygraph

37. More yet Ahlmeyer et. al., (2000) Incarcerated sex offenders (average) Official records 2 victims 5 offenses After second polygraph 110 victims 318 offenses

38. Crossover; gender, age and relationship • Emerich and Dutton (1993, JSO) 55% assaulted both boys and girls, 47% acknowledged multiple victim relationships • O’Connell (1998, community based ASO) 64% of ‘rapists’ had assaulted a child, 59% of ‘incest fathers’ admitted to victims outside of home.

39. Ahlmeyer, 1999. 143 ASO Inmates, Polygraph and TX • 89% crossover by relationship, gender or age • 82% child molesters and 50% of rapists crossover by age • 58% ‘male victim ASO’ and 22% ‘female victim ASO’ crossover by gender • 86% of sample had victims in 2+ relationship classes

40. Contact with children: high risk behavior increased • Davis et al, (1993) Of 143 incarcerated child molesters studied only 3% of those not allowed contact masturbated about a known child as compared to 60% offenders permitted contact. • 66-99% of incarcerated ASO with permission to visit kids in DOC waiting room masturbated about those kids. (Colorado DOC, 1999).

41. Sex offenders, even in treatment, are dangerous Tanner (1998) 128 ASO in first year of community based treatment and supervision 31% had sexual contact with child 25% had unauthorized contact with a child 12% had forced someone to have sex 86% was participating in new high risk behavior and/or new crimes

42. When to Increase Intensity of Supervision • Offender in stress or crisis • Offender in high risk situation • Offender will have contact with potential victims • Offender shows high or increased denial • Offender works with internet • Active treatment or probation ending soon

43. The Four Domains of Treatment • Sexual Interests • Distorted Attitudes • Interpersonal Functioning • Behavior Management

44. Sexual Interests—The First Domain of Treatment • Deviant sexual arousal is sexual arousal to: • Non-consenting partners • Non-age-appropriate partners • Acts that are abusive in nature • For many sex offenders, a strong motivation to commit sexual assaults is deviant sexual arousal • Not all offenders have deviant sexual arousal • AROUSAL DOES NOT EXPLAIN BEHAVIOR

45. For Offenders with Deviant Sexual Arousal If such arousal can be decreased, the likelihood of future sex offending will be decreased Treatment goals include: • Reduce deviant sexual arousal while increasing non-deviant sexual arousal • Increase reactions to the offender’s deviant behavior as non-offenders react—with disinterest or revulsion

46. Behavioral Intervention to Reduce Deviant Sexual Arousal • Based on the idea that deviant sexual arousal is “learned” behavior and can be unlearned • Substitutes non-deviant thoughts for deviant thoughts • Connects deviant thoughts with non-arousal

47. Types of Behavioral Interventions • Covert Sensitization • Ammonia (aversive) conditioning • Masturbatory reconditioning

48. Can offenders sabotage this? Who is this best suited for? Is this technique essential? Can this technique be used exclusive of others? Yes—but they’re only hurting themselves Offenders with significant deviant sexual arousal No—but some intervention must address deviant sexual arousal No Common Questions about Behavioral Interventions

49. Goals of Covert Sensitization • To reduce the attractiveness of sexual assault by having the offender focus on the negative social consequences he faces • To have offenders explore all of the consequences of their actions—in particular the negative consequences which offenders so often refuse to recognize

50. Methods of Covert Sensitization • Offenders identify the chain of thoughts that lead them to offense behavior • Offenders are taught to deliberately interject vivid scenes of the negative consequences they will face during that chain of thoughts • Audiotape homework provides structured practice sessions for this technique that can be reviewed by the treatment provider