Learning Objectives

1. Learning Objectives Participants will be able to: • Summarize research • Outline treatment components • Identify reasonable expectations of treatment provider • Identify treatment provider qualifications • Outline collaboration strategies CSOM Long Version: Section 4

2. Effectiveness of Treatment • Difficult to study • Poor data • Programs and definitions vary • Design 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 offender • Greater reductions found in more recent studies • Treatment 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. Offender-focused Targets reduction in anxiety/inadequacy Individual counseling Usually voluntary Victim/community safety focused Targets accountability and thinking errors Primarily group setting Often mandated Traditional vs. Sex Offender Treatment Traditional Sex Offender Specific CSOM Long Version: Section 4

11. 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 vs. Sex Offender Treatment (cont.) Traditional Sex Offender Specific CSOM Long Version: Section 4

12. Means of Reducing Recidivism through Treatment • Accepting responsibility and modifying cognitive distortions • Developing victim empathy • Controlling sexual arousal • Improving social competence • Developing relapse prevention skills • Establishing supervision conditions and networks • Clarification 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 work • Community safety • Limited confidentiality • Incorporates evaluation • Also: Experience and/or recent specialized training CSOM Long Version: Section 4

22. Monitoring Treatment and Providers • Written reports • Case conferences • New cases • Specific offender issues • System problems CSOM Long Version: Section 4

23. Monitoring Treatment and Providers (cont.) • Observation • Content • Process • Emergency case reviews • Community feedback • Graduation Criteria CSOM Long Version: Section 4

24. Domination Manipulation Anger Aggressive outbursts Depression Self-defeating behaviors Variety of skill deficits Family education Victim issues Ongoing risk assessment Treatment Providers Must Deal With: CSOM Long Version: Section 4

25. Collaboration Between Treatment and Supervision • Probation/parole may offer classes • Complementary treatment and supervision plans • Probation/parole participate/observe in treatment sessions • Written treatment plan exchanged with probation • Joint understanding of offense cycles CSOM Long Version: Section 4

26. Primary Goal of Treatment -- Reduce Future Victimization The following are means to that end: • Reducing cognitive distortions • Accepting responsibility • Developing victim empathy • Controlling sexual arousal • Improving social competence • Developing relapse prevention skills • Establishing 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 CSOM Long Version: Section 4