Treatment of sexual offenders who are in categorical denial: a pilot project

Explaining the Unexplainable: Balancing Responsibility, Expectations, and Identity in Narratives of Sexual Recidivism

When someone is caught and punished for a sexual offense, recidivism prevention is of high priority. While a growing body of qualitative research has investigated the desistance process of those who have sexually offended, few studies have examined the narratives of individuals who have sexually recidivated in order to understand how they make sense of their reoffending. This study aims to fill this gap in the literature by exploring the recidivism process and broader life stories of 16 imprisoned men through semi-structured interviews. The results demonstrate how these men explain their recent "failures," the obstacles they face when doing so, and how they attempt to overcome these obstacles in their narratives. Thus, the analysis in this study is both thematic and narrative. Finally, the findings' practical implications are discussed to show how ambiguity in narratives can be a powerful tool in correctional and clinical interventions.

Learning From Consumers of Mandated Sex-Offending Programs: "It's Not Treatment, I Wish It Was."

The purpose of this qualitative study was to explore clients' perceptions of sex-offending treatment. The sample included 291 people required to register as sex offenders in the U.S. who answered an open-ended question in an online survey asking them to describe their positive and negative experiences in mandated treatment. Using qualitative analysis, three overarching themes (with several subthemes) were identified: (1) positive and (2) negative treatment experiences and (3) the affiliation between the criminal justice system and clinical services. Experiences in sex offending treatment were viewed as positive when clients had opportunities to learn about themselves, experience group cohesion, build a positive alliance with a caring therapist, learn tools and skills for emotional health, explore the roots of offense behavior, and create healthy life plans to reduce risk for re-offending. Negative themes emerged when treatments were viewed as coercive, confrontational, or demeaning; when therapists seemed inexperienced or unqualified; and when seemingly outdated or unscientific methods were emphasized without explanation or dialogue. The entanglement between court-mandated treatment providers and the criminal justice system led to concerns about confidentiality, conflicts of interest, and role ambiguity. Drawing upon literature related to therapeutic alliance, trauma-informed care, and Risk-Need-Responsivity models, we offer suggestions for integrating client feedback to improve treatment responsivity and prevent re-offending.

Denial and minimization among sex offenders

A review of empirical studies of offenders-particularly sex offenders, and more particularly those who offend against children-demonstrates that denial of offenses and minimization of offending behavior are quite common at every stage of the criminal justice process. This is true during police interviews, during pretrial and presentencing mental health evaluations, among incarcerated offenders, among offenders seeking treatment, among offenders facing parole review, and among offenders already released into the community. This review highlights gaps in the research literature arising from inconsistencies in the definitions and measurement of denial and minimization, from the stage of adjudication or treatment at which measurements are made, and from the use of polygraphy to increase disclosures. Despite these limitations on the generalizability of empirical findings, it appears beyond dispute that many sex offenders maintain their innocence in the face of evidence to the contrary or even criminal conviction, and that many are able to recite additional crimes they have committed when they believe it is in their self-interest to do so.

Men with Sexual Convictions and Denial

PURPOSE OF REVIEW

We review the evidence base for men who categorically deny responsibility for their sexual crimes. Specifically, we consider the characteristics of these individuals and the purpose or function of the denial, whether denial leads to an increased risk of reoffending and the evidence for different treatment options available for deniers.

RECENT FINDINGS

Whilst there is some evidence that deniers differ from admitters, it appears that categorical denial is a strategy used to reduce negative consequences such as a sense of shame or the fear of losing family support. The common assumption that deniers are more likely to commit further sexual crimes is not supported by the evidence to date. There remains a lack of evidence as to the best treatment approach to use. We conclude that more research is necessary. We suggest that a lack of consideration of the function of denial or the adaptive benefits of denial could explain inconsistent findings in relation to the characteristics of deniers and why denial does not appear related to recidivism. Whilst the available evidence does not support most approaches aimed at overcoming denial, we suggest that some of the most promising approaches seem to be non-disclosure-based focusing on reducing stigma; however, it is conceded that the evidence for such approaches is still emerging.

Forensic Staff Attitudes Toward Men Who Have Sexually Offended: A General Public Comparison

OBJECTIVES

The aim of this study was to explore the attitudes toward men who have sexually offended (MSO) between the general public and professionals and paraprofessionals in forensic settings.

BACKGROUND

Existing research shows a number of different factors that appear to be important in the development, maintenance, and deterioration of attitudes toward MSO. The exploration of such factors requires further exploration.

METHOD

A convenience sample was used for the cross-sectional study. Five hundred fifty-three participants were recruited from the general public and forensic hospitals, both private and National Health Service. An online version of the Attitudes Towards Sex Offenders scale (Hogue, 1993) was distributed via email and social media.

RESULTS

Gender was not found to have any impact on the attitudes individuals held toward MSO. The general public was found to have significantly more negative attitudes when compared with those exposed to MSO at work (professional and paraprofessional staff). Duration of employment did not make attitudes any more or less positive.

CONCLUSION

The clinical and societal implications of the research are important for MSO to reduce risk within forensic establishments and be supported to reintegrate successfully into the community. Without the support from both staff and the general public at each stage of rehabilitation, desistance is less likely to be maintained. Research continues to provide varying results regarding the factors that influence the nature of attitudes toward MSO.

Relationships Between Treatment Delivery, Program Attrition, and Reoffending Outcomes in an Intensive Custodial Sex Offender Program

Retention of sex offenders to the completion of treatment is critical to program adherence to risk need responsivity (RNR) principles; however, it is also important to consider the potential interaction between attrition and treatment outcomes such as reoffending. The first aim of this study was to evaluate the influence of changes to treatment delivery in a residential sex offender treatment program (SOTP), including introduction of rolling groups and systematic emphasis on positive therapist characteristics, on likelihood of program noncompletion ( n = 652). Pooled regression modeling indicated that these operational interventions were associated with a significantly increased likelihood of program completion. We also examined whether variance in rates of participant attrition was related to reoffending outcomes for program completers ( n = 494). Incidence of attrition within completing participants' treatment cohorts had a significant negative association with hazard of sexual reoffending that was not accounted for by pretreatment risk. Results are discussed in terms of their implications for treatment delivery processes that aim to optimize both participant retention and treatment effectiveness.

Therapeutic Climate Within a Treatment Program for Categorical Deniers

The purpose of this study was to examine whether the therapeutic climate within a sex offender "deniers" program, where denial was not challenged, would be equivalent to the therapeutic climate within a conventional program where sex offenders were admitting responsibility. Using a sample of 77 sex offenders, therapeutic alliance and group climate were measured early and late in treatment. As expected, therapeutic alliance was more difficult to attain with deniers early in treatment, particularly therapeutic bond; however, by the end of the treatment, there were no significant differences in therapeutic alliance. There did not appear to be significant differences in group climate early or late in treatment except for the deniers reporting significantly lower levels of open expression of anger and disagreement within the group and, in contrast to the admitters, making significant improvements in group climate over time. Implications for the treatment of categorical deniers and further research suggestions are discussed.

Review of the Empirical and Clinical Support for Group Therapy Specific to Sexual Abusers

This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender-specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist-specifically warmth, empathy, encouragement, and guidance-can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

Sex Offending and Situational Motivation: Findings From a Qualitative Analysis of Desistance From Sexual Offending

Sex offending is typically understood from a pathology perspective with the origin of the behavior thought to be within the offending individual. Such a perspective may not be beneficial for those seeking to desist from sexual offending and reintegrate into mainstream society. A thematic analysis of 32 self-narratives of men convicted of sexual offences against children suggests that such individuals typically explain their pasts utilizing a script consistent with routine activity theory, emphasizing the role of circumstantial changes in both the onset of and desistance from sexual offending. It is argued that the self-framing of serious offending in this way might be understood as a form of "shame management," a protective cognition that enables desistance by shielding individuals from internalizing stigma for past violence.

The “Memory Recovery Technique”

This case study describes the use of a treatment technique to deal with situations where sexual offenders claim no recall of their offenses. In this case, the offender claimed his memory loss resulted from an alcoholic blackout. During treatment, he was asked to use the “Memory Recovery Technique” where he recreated the context of the day of the offense in detail and attempted to remember further offense-specific details. Treatment issues and implications are highlighted.

Making sense of denial in sexual offenders: a qualitative phenomenological and repertory grid analysis

Denial in sexual offenders represents the first barrier to successful treatment a clinician is likely to face. Most sex offender treatment programs devote significant time to overcoming denial, with most programs having a focus on disclosure and "accepting responsibility." This is the first study that has aimed to make sense of sexual offenders' denial through a rigorous qualitative analysis. The main objective was to explore the experiences and lived worlds of sexual offenders in denial. A qualitative phenomenological methodology combining interpretative phenomenological analysis and repertory grids was implemented. Ten incarcerated sexual offenders in categorical denial participated in the research. The analysis revealed the narrative, relational, and self-reconstructive properties of denial and discusses the role and function denial may be playing for sexual offenders. The results highlight that denial can be viewed as a form of "sense making" and that clinically relevant treatment targets can be elicited without disclosure. It is concluded that viewing denial as a barrier to treatment impedes constructive work with offenders, and implications for treatment are discussed.

Working with denial in convicted sexual offenders: a qualitative analysis of treatment professionals' views and experiences and their implications for practice

Denial in sexual offenders represents the first barrier to successful treatment a clinician is likely to face. However, there is currently no research focusing on the experiences of treatment professionals who treat and manage deniers. This study aimed to bridge this research gap and to gain an insight into the perspectives and experiences of professionals who treat and manage sex offenders in denial. The purpose was to ascertain their views on whether deniers are amenable to treatment, whether they should be offered treatment (as presently they are excluded from sex offender programmes), and what they believe may work with this population. A qualitative methodology was used, and treatment professionals were interviewed using semistructured interviews at a HM Prison in England. The main findings indicated that participants viewed denial as a barrier to treatment and that categorical deniers should be excluded from treatment. Implications for treatment are discussed, and it is concluded that viewing denial as a barrier to treatment impedes constructive work with offenders. It is argued that denial as an organising principle for treatment needs rethinking and that admittance may not be required for personal reform.

Community solutions for the community's problem: an evaluation of three New Zealand community-based treatment programs for child sexual offenders

The recidivism rate of 203 people mandated by the courts to attend three community-based child sexual offender treatment programs (175 treatment cases and 28 assessment-only cases) was assessed and compared with a probation comparison group. The recidivism rate was 8.1% for all participants treated in the community-based programs and 5.2% for participants who completed treatment. The recidivism rate for program attendees was approximately half that of those in the probation comparison group. The drop-out rate for treatment appears to be relatively high (45%) and noncompletion was associated with higher recidivism. These results indicate significantly better outcomes for offenders receiving specialized treatment and are consistent with, and toward the lower end of, recidivism rates reported in local and international evaluation studies.

An evaluation of intimate partner violence intervention with incarcerated offenders

The following study is an evaluation of the Moderate Intensity Family Violence Prevention Program (MIFVPP). The sample consisted of 298 male federal offenders who participated in the MIFVPP while incarcerated or on release within the community. Participants were assessed pre-, mid-, and postprogram using an assessment battery consisting of self-report questionnaires and facilitator-rated evaluation scales. Results of the study found uniform and significant (p < .001) improvement for pre and post program change in the self-report questionnaires and in the facilitator ratings. A positive improvement in motivation, whether assessed by the participant or facilitator, was associated with improvement in program outcomes and significant within, between, and interaction effects were found when participant program performance over time was compared among grouped postprogram ratings of motivation. The implication for the efficacy of addressing offender motivation to change in intimate partner violence (IPV) interventions is discussed.

Rape Treatment: An Overview of Current Knowledge

Sexual offending is frequently seen by the lay person as being a result of an innate abnormality that is relatively fixed and unchangeable. Accordingly, sexual offenders are seen as more likely to recidivate than other types of offenders. In fact, this is not the case, and most sexual offenders do not re-offend. Also, contemporary research has shown that treatment programs driven by cognitive behaviour therapy significantly reduce rates of sexual offender recidivism. Nevertheless, while there has been a great deal of research on the treatment of child sexual offenders, the treatment of rapists has received comparatively less attention. Thus, the main aim of this article is to summarise current knowledge of sexual offender treatment, paying specific attention to the needs of rapists. In particular, we pay attention to the content of sexual offender treatment programs, and the relevance of this content to rape. We also discuss therapeutic issues of relevance for rapist treatment that are typically ignored or underestimated in the research literature. Finally, based upon our analysis of the literature, we present a schematic overview of rape treatment and identify important areas for further research.

"But I didn't do it!": ethical treatment of sex offenders in denial

This article addresses ethical questions and issues related to the treatment of sex offenders in denial, using the empirical research literature and the ethical codes of American Psychological Association (APA) and National Association of Social Workers (NASW) to guide the ethical decision-making process. The empirical literature does not provide an unequivocal link between denial and recidivism, though some studies suggest that decreased denial and increased accountability appear to be associated with greater therapeutic engagement and reduced recidivism for some offenders. The ethical codes of APA and NASW value the client's self-determination and autonomy, and psychologists and social workers have a duty to empower individual well-being while doing no harm to clients or others. Clinicians should view denial not as a categorical construct but as a continuum of distorted cognitions requiring clinical attention. Denial might also be considered as a responsivity factor that can interfere with treatment progress. Offering a reasonable time period for therapeutic engagement might provide a better alternative than automatically refusing treatment to categorical deniers.

Perceptions of sex offenders about treatment: satisfaction and engagement in group therapy

Surveying the views of sex offender clients can help ensure that treatment is relevant and responsive to client needs. The purpose of this exploratory study is to elicit sex offender clients' perceptions of their experiences in treatment in order to better understand the components of treatment perceived to be helpful in preventing reoffense. Samples (N = 338) of male sex offenders in outpatient group therapy are found to be generally satisfied with treatment services and have positive perceptions of treatment effectiveness. Offenders in treatment value the role of group therapy, and they find accountability, victim empathy, relapse prevention, and "good lives" concepts to be most helpful in managing their behavior. Their engagement in group therapy is assessed using the Group Engagement Measure, and a positive correlation is found between engagement and treatment satisfaction. Eliciting client opinions about the helpfulness of program content and process, and adjusting treatment protocols accordingly, is consistant with the principles of risk, need, and responsivity, a model recommended for therapeutic interventions with criminal offenders.

Treatment Engagement With a Sexual Offender Who Denies Committing the Offense

This case study describes a strategy for treating a sexual offender who categorically denies committing the offense. These offenders usually refuse to participate in treatment or are deemed ineligible or unsuitable for sexual offender treatment on the basis of their denial of responsibility. The treatment approach outlined in this case study reflects an adaptation of conventional sexual offender treatment such that the focus is on the problems in the offender's life that led to him or her to be in a position where he or she could be “accused” of an offense. This case study demonstrates how an offender who is categorically denying responsibility for his offending was therapeutically engaged in treatment. Treatment implications of this approach are discussed.

Denial predicts recidivism for some sexual offenders

This study examined whether there were variables that moderated the relationship between denial and recidivism among adult male sexual offenders. The first study (N = 489) found that the relationship with sexual recidivism was moderated by risk (as measured by the Rapid Risk Assessment for Sexual Offense Recidivism) but not by psychopathy (as measured by the Psychopathy Checklist-Revised). Contrary to expectations, denial was associated with increased sexual recidivism among the low-risk offenders and with decreased recidivism among the high-risk offenders. Post hoc analyses suggested that the risk item most responsible for the interaction was "relationship to victims". For incest offenders, denial was associated with increased sexual recidivism, but denial was not associated with increased recidivism for offenders with unrelated victims. These interactions were substantially replicated in two independent samples (N = 490 and N = 73). The results suggest that denial merits further consideration for researchers as well as those involved in applied risk assessment of sexual offenders.

Recovering memories of the offense in "amnesic" sexual offenders

This paper describes a technique designed to assist sexual offenders to recover memories of their offense. We have consistently observed that some sexual offenders present as having no recall of their offense although they are able to remember other events of the day of the offense. This failure to recall offense details prevents the offenders from making an appropriate disclosure which, in turn, blocks attempts to identify their offense pathways and develop relapse prevention plans. The memory recovery technique we describe is based on experimental literature on memory and we outline its use with 22 clients, 20 of whom showed satisfactory recovery of their memories.

Mapping child molester treatment progress with the FoSOD: denial and explanations of accountability

A continuing challenge in the treatment of sexual offenders involves the identification of measurement instruments that can be used to monitor treatment progress. This paper provides evidence that the Facets of Sexual Offender Denial (FoSOD; pronounced "façade") Scale maps critical aspects of treatment progress, yet avoids problems typically associated with self-report measures. Fifty-three child molesters completed the FoSOD twice with an 18-month interval between administrations. The Time 1 and Time 2 FoSOD scores were analyzed as a function of advancement through a court-sanctioned sexual offender treatment program. Results demonstrated not only that advancement in treatment corresponded with predictable changes in FoSOD scores, but also that FoSOD component scores, representing denial associated with refutation, minimization and depersonalization of the offense, revealed critical patterns indicative of the issues with which offenders contend at various points within treatment. These results are discussed within a conceptual framework that recognizes the relationships between denial in its various forms and the explanations that offenders develop to limit their accountability for alleged offenses, associated thoughts or behaviors, and deviant predispositions.

Engagement, denial, and treatment progress among sex offenders in group therapy

This study investigates the relationship between engagement, denial, and treatment progress among a sample of 61 male sex offenders in outpatient group therapy. Three hypotheses were posed: (1) that denial is inversely related to engagement in group therapy; (2) that denial is inversely related to treatment progress, and (3) that engagement is correlated with treatment progress. Results revealed a strong correlation between engagement in group therapy, measured by the Group Engagement Measure, and sex offender treatment progress, assessed by the Sex Offender Treatment Rating Scale. Denial, measured by the Facets of Sexual Offender Denial Scale, demonstrated a strong inverse relationship to treatment progress. Engagement and denial were also strongly inversely related. Together, engagement and denial explained a significant amount of the variance in treatment progress. The findings provide support for current standards of practice that maintain that admitting to a sex crime is a necessary condition for progress and engagement in treatment. Strategies for increasing engagement and treatment progress, and reducing denial, are discussed.

Understanding denial in sexual offenders: a review of cognitive and motivational processes to avoid responsibility

Treatment of sexual offenders is routinely complicated by the presence of denial. This article examines how denial is related to the willingness to take responsibility for offense-related thoughts and actions and how conceptualizations of denial have developed and changed over time. Multiple facets of denial are described in detail, along with an assessment of how different forms of denial undermine acceptance of responsibility throughout treatment. Evidence is presented to show that resistance and denial often hinge on cognitive and motivational processes that are commonly accepted as fundamental treatment targets rather than treatment obstacles. The authors propose that denial may be best understood as the acceptance of explanations that reduce accountability and are reinforced by distorted beliefs and self-deceptive thinking processes. The article concludes with a discussion of the rich clinical information embedded in different expressions of denial and the benefits of treatment strategies designed to assess and work through them.

Principles and techniques for maximizing the effectiveness of group therapy with sex offenders

Group-based interventions are widely used as the preferred method for the treatment of sexual offenders. However, little attention has been given to the vital interpersonal processes within groups, which contribute to their therapeutic effect. This paper describes specific principles and techniques of group therapy that will help sex offender treatment practitioners take full advantage of this unique modality and thereby maximize the positive impact of treatment. In contrast to an individual-focused style that characterizes many sex offender treatment groups, group-focused interventions involve all group members and use the social/relational energy that is essential to the group modality.

Measuring motivation to change in sexual offenders from institutional intake to community treatment

Changes in motivational levels occurring during various stages of treatment (institutional and community) were measured among 101 federally sentenced sexual offenders in the Ontario region. Motivation was conceptualized as a dynamic process that can be construed from behavioral referents and more global evaluations of internal features/readiness/psychological stance. Five motivational indices were examined: acceptance of guilt for the offense; acceptance of personal responsibility for the offense; disclosure of personal information; motivation to change behavior; and participation in treatment. Offender scores on these indices were evaluated using the Goal Attainment Scaling protocol (T. Hogue, 1994), at four stages of the treatment process: (1) at institutional assessment, (2) following institutional treatment, (3) upon conditional release to the community, and (4) following a 12-week period of community treatment. Results showed that motivation to change sexually deviant behavior was higher at the end of institutional treatment relative to the initial assessment. However, levels of motivation decreased upon conditional release to the community, with few offenders making significant rebounds following 12 weeks of community treatment. Admission of guilt and acceptance of personal responsibility (measured at community treatment) were both significantly associated with treatment outcome.