(4) Sexual Offender Theory and Treatment Lectures

Question 1

sexual offending why is it an issue?

Answer 1

• It is an alarmingly common type of crime
which has a large social, psychological,
financial and societal cost.
• Abuse is linked to increased risk of
psychopathology (i.e., mental illness).

Question 2

what is the prevalence of sexual abuse?
(A) Child
(B) Adult

Answer 2

o 8-31% of girls and 3-17% of boys
worldwide are sexually abused before the
age of 18.
o Similar in adults, 6-59% of women and
0.2-30% of men report they were sexually
abused in their lifetime.

Question 3

are females or males more likely to be sexually abused?

Answer 3

females (children and adults)

Question 4

What is a paraphilic DISORDER?

Answer 4

• Strong deviant sexually deviant fantasies
that are persistent and repetitive. These
“abnormal” desires are their preferred or
only way of being sexually aroused, but
they find them distressing and negatively
impact their daily functioning (i.e., clinical
disorder).
• Deviant sexual preference for an abnormal
object of sexual desire (i.e., children,
animals, humiliation, etc).

Question 5

What are (7) examples of paraphilic disorders?

Answer 5

1. Pedophilia:
    Pedophilia paraphilia is a deviant sexual
   desire towards children (i.e.,
   prepubescents) that elicits sexual arousal.
    The offender must be (5+) years older than
   the child.
2. Exhibitionism:
    Exhibitionism paraphilia is a deviant sexual
   desire where the individual gains sexual
   gratification from exposing their sexual
   organs to strangers with or without
   masturbation.
    Some offenders get off on the shock factor
   or fear in strangers.
    Others have a distorted courting ritual
   belief where they think that this sexually
   deviant behaviour will lead to a romantic
   relationship.
3. Voyeurism:
    Voyeurism paraphilia is a deviant sexual
   desire where the individual gains sexual
   gratification from watching strangers
   undress or have sex without their
   knowledge (i.e., secrecy is key).
4. Sexual Sadism:
    Sexual Sadism paraphilia is a deviant
   sexual desire where the individual gains
   sexual gratification from inflicting harm or
   humiliating others.
5. Sexual Masochism:
    Sexual Masochism paraphilia is a deviant
   sexual desire where the individual gains
   sexual gratification from receiving pain or
   be humiliated by others (i.e., rape).
6. Frotteuristic Disorders:
    Frotteuristic paraphilia is a deviant sexual
   desire where the individual gains sexual
   gratification from rubbing up against
   strangers in crowded places (i.e., buses,
   trains or malls).
7. Fetishism:
    Fetishism paraphilia is a deviant sexual
   desire where the individual gains sexual
   gratification from objects (i.e., panties,
   bras, stockings, shoes or partialism).
    These objects must belong to someone
   else to cause arousal.

Question 6

Sexual Sadism disorders and Sexual Masochism disorders are referring to…

Answer 6

it is not referring to BDSM which is consensual. Paraphilia is a clinical diagnosis that requires significant distress and disruption to daily functioning or harm to others to be a clinical diagnosis.

Question 7

What is the link between paraphilia and sexual offending?

what is the caveat?

Answer 7

o There is a causal relationship between
paraphilia and sexual offending (i.e.,
sexual preference for children increases
risk of pedophilic behaviour but is not a
perquisite for sexual offending).
o Most people who sexually offend do not
have a paraphilia disorder (i.e., deviant
sexual preference there are a multitude of
other motivations for this crime).

Question 8

what is the important distinction between sexual offending and paraphilia?

why must we keep them separate?

Answer 8

paraphilia is a psychological category that is more meaningful for treatment targets because it alludes to the heterogeneous motivations in sexual offenders which leads to an offense.

Sexual offending is a legal category, it is an offense classification used in the criminal justice system which has little utility in designing treatment because it doesn’t tell us “why” or “how” people begin to sexually offend which is needed for treatment purposes.

 We must keep them separate to ensure
that we are not labeling people with
paraphilic disorders as criminal and
prevent them from seeking medical
attention.
 1) Many people with paraphilia (i.e., you
could have all of them and not sexually
offend) do not sexually offend 2) many
who sexually offend do not have a
paraphilia (i.e., have a preference for
adults yet they still sexually assaulted a
child and had to fantasize it was an adult
to become aroused) there are many
motivations which lead to sexual
offending.

Question 9

What are (5) common problem clusters associated with sexual offending?

what does this tell us?

Answer 9

o Emotional Regulation Problems:
 Problems with the range or intensity of
emotion felt.

 Hyperactivity of anxiety or fear or hypo-
reactivity of emotions in which sexually
deviant behaviour is used as a tool to
regulate emotions and elicit arousal.

o Deviant Sexual Interests/Arousal:
 Understandings of sexuality, sexual
preference and scripts are deviant or
abnormal (i.e., children, animals, or activity-
paraphilia).

o Offences Supportive Attitudes/Beliefs:
 World views of children and adults which
make individuals vulnerable to committing
sexual offence because they justify the
behaviour.
 For example, children being thought of as
sexual agents that are consenting and
enjoy sexual activity.

o Social/Intimacy Deficits:
 Adults do not make sense to them and
they get along better with children and
view them as being “safe”

General dysregulation problems:
 Impulsivity issues
 Crime versatility

sexual offenders have the same motivations and desires as “normal” people and should not be viewed as deviant monsters. Yes, they’ve done horrible things but there is always a reason that can be sympathized
with and treated.

Question 10

What is the function of constructs, methodology, and theory?

Answer 10

o Constructs: define it
 Constructs need to be defined precisely 
   so they are both observable and 
   measurable (i.e., empathy is the 
   experience of emotion in response to 
   others distress).

o Methodology: measure it
 How can we measure the construct and
its effects?

o Theory: explain it
 Need to develop theories that describe
and explain how concepts operate (i.e.,
what triggers empathy, what mechanisms
are involved, what blocks it, what other
psychological phenomena are related to
it?)

*Nested model: constructs need to be
defined to guide the selection of the right
methodology and development of
theoretical descriptions and explanations of
the construct.

Question 11

A theory is only as good as the ____ that define it.

Answer 11

concepts

Question 12

Why do “good ideas” matter in clinical practice?

Answer 12

Treatment and prevention strategies are guided by theory. Thus, effective treatments require good theories with precisely defined concepts.

Ideas, concepts, and theories need to be well thought out and critically evaluated before people apply them into treatment or prevention (i.e., especially if it will waste resources, be ineffective or cause more harm than good).

Question 13

What is an example of a “bad theory”

what are the consequences of bad theory?

Answer 13

 Relapse prevention model:

• Guided by addiction theory they claim that
offending occurs because the person
loses control.
• However, it fails to account for 30-40% of
sexual offenders who do not offend due to
impulsivity issues. In fact, they meticulously
plan the offense.
 This model was applied to clinical practice
without any critical reflection of its
accuracy or utility and demonstrates how
failure to consider the importance of
theory can lead to theoretical dead ends
and ineffective treatment.

The consequences of neglecting theory:

o It gives the illusion of knowledge which
leads us into theoretical dead ends and
development and use of ineffective
treatment.

o Example:
o Depression:
 Having scales to measure a construct
gives us the illusion that we know what
causes it…we don’t.
o Dynamic Risk Factors:
 We have many factors that can be used to
predict risk of recidivism, but we do not
actually know what the causal
mechanisms of these factors are.
 Correlation is not causation!

Question 14

What is Theoretical Literacy and Illiteracy?

5. Indicators of theoretical illiteracy

Answer 14

o Literacy refers to having knowledge or
competency in an area. Therefore, people
illiteracy is having a lack of knowledge in
an area.

o What are (4) indicators of illiteracy?
o Failure to understand the role of theory 
   and its necessity
o Mistaking theory for fact
o Uncritical and dogmatic acceptance of 
   theory
o Poor critical analysis skills (i.e., not 
   evaluating a theory across multiple 
   domains)
o Ridged adherence to manuals or 
   prescribes practices

e.g., the relapse prevention model or intimacy deficits or need for dominance being causes of sexual offending for everyone.

Question 15

What is a theory used for?

Answer 15

o Theories help us identify and describe
patterns of behaviours or underlying
mechanisms from different levels of
analysis and observe their effects.
 There are different levels of theory that all
have their own job. They’re both valid and
valuable tools and you cannot expect a
theory to do the job of another.
 Everybody is unique and we need multiple
theories at various levels to build our
understanding of sexual offending and
design individually tailored treatments that
are more effective than a one-size fits all
approach.

Question 16

(2) criteria for the explanatory value of a theory?

1. (a,b,c)
2. (a,b,c)

Answer 16

1. Pragmatic Values:

a. Parsimony (scope divided by simplicity)
b. Clarity of communication
c. Fit to purpose

• An explanation of the causes of sexual offending must be simplistic and comprehendible enough to effectively communicate to patients and clinicians for it to hold clinical utility.
  2. Epistemic Values:

a. Internal cohesion (i.e., doesn’t contradict
itself and concepts are meaningfully
linked)
b. External cohesion (i.e., fits with existing
literature)
c. Scope, predictive validity, fruitfulness, etc.

*critically reflect on its scope, explain all types of sexual offenders, causal mechanisms, predicts the relevant associated outcomes, and make novel understanding with explanatory depth.

Question 17

Levels of Theory (1-3):
Tony and Ward

it is a ____
No one theory is ___ because __
Linking theories across multiple levels can help us to develop a comprehensive ___

what are the three levels of theory?

Answer 17

 classification system to distinguish levels of theories based on their level of complexity, the temporal relationship between the factors, its explanatory depth and breadth.
 better than the other. There are tools for different jobs. You cannot expect one job to do the job of another theory.
 comprehensive understanding of the factors and processes that cause and maintain sexually harmful behavior across time and contexts.

1. Multifactorial models:
   a. Most complex level of theory which
   integrated level (2) individual factors
   together to create a comprehensive
   model of sexual offending which explains
   how multiple factors lead to sexual
   offending.
   b. Synthesizes existing theory rather than
   developing theory from raw data.
2. Single-factor models:
   a. Middle level theory.
   b. Looks at individual level factors that lead
   to sexual offending.
   c. Aim to explain the mechanism through
   which these factors influence sexual
   offending from a distant temporal
   perspective.
   d. Looks for patterns in behaviour across
   groups to identify sources of variability
   that contribute to different prevalence
   factors across groups.
   e. Abductive inferences build theory from
   raw aggregated data.
3. Descriptive models:
   a. Explain the process of sexual offending
   from a micro level.
   b. Looks at offence chains or cycles.
   c. Looks at offender’s motivation,
   cognitions, behaviours and environmental
   factors which cause sexual offending.
   d. Are similar to level (1) theories because
   their multifactorial but level (3) theories
   are narrower, less comprehensive and
   have a limited temporal focus.

Question 18

Finkelhor (1984)
Identified (4) factors or motivations that cause child sexual offending.

what level theory is it?

what are the four motivations he identified for child sex offending?

what are the four preconditions or stages of Stages of Child Sexual Offending?

Answer 18

A level three theory masquerading as a level one theory. We would argue that it has too many areas of vagueness and is too focused on describing child sexual offending behavior and motivations rather than explaining distorted cognitions that contribute to the onset and maintenance of child sex offending.

(4) Motivations:

1. Emotional Congruence:
    Sex with children is emotionally satisfying
   to the offender.
2. Sexual Arousal:
    Men who offend are sexually aroused by
   children (i.e., common in pedophillia).
3. Blockage:
    Men have sex with children because they
   are unable to meet sexual needs in
   socially appropriate ways (i.e., common in
   incest).
4. Disinhibition:
    Men become disinhibited and behave in
   ways contrary to their normal behaviour
   (i.e., increase of context specific instances
   of rape during war).
   o Factors (1-3) are causes of deviant sexual
   preferences.
   o Factor (4) explains who sexual offending
   the result of sexually deviant preferences.

(4) Preconditions or Stages of Child Sexual
Offending = a nested model so the steps
must be completed in sequential order
(i.e., stage 3 can not be completed
unless 1-2 have been)

1. Motivation:
    They must be motivated to sexually abuse
   a child (i.e., motivations 1-3; emotional
   congruence, sexual arousal, and
   blockage).
2. Overcoming Internal Inhibitions:
    Alcohol, impulse disorder, senility,
   psychosis, severe stress and socially
   entrenched patriarchal attitudes
   overcome internal self-regulation and
   impulse control systems that help them
   resist their sexually deviant desires (i.e.,
   motivation 3, disinhibition).
3. Overcoming External Inhibitors:
    Overcoming external barriers to sexual
   offending such as parental supervision,
   parental domination, unusual sleeping
   conditions, maternal illness or social
   isolation of the family (i.e., can be
   sophisticate acts of grooming or crime of
   opportunity).
    i.e., grooming or planning.
4. Overcoming Resistance of Child to the
   abuse:
    Giving gifts, desensitizing child to sex,
   establishing emotional dependence and
   using threats of violence

Question 19

Example Level 1 Theory (Evolutionary Rape Theory)

Answer 19

 McKibbin et al. (2008) produced a theory
that argued that rape is the by-product of
or is in itself a biological adaption that has
been selected for due to its ability to
increase reproductive success.
 Rape is claimed to be best understood as
a conditional mating strategy. There are
three main mating strategies:

1. Honest courtship
2. Dishonest courtship (i.e., males say
   they’re interested in females but are lying
   in order to have sex).
3. Rape (i.e., a violent mating strategy used
   when all other strategies fail).

 They claim there are (5) types of rapists
with specific psychological modules that
are triggered by environmental factors:
1. Individuals rape because they have no
other successful strategy for having sex.
2. They simply have deviant sexual interests
(i.e., sadistic, domination and degradation
of women).
3. They’re opportunists that are taking
advantage of contexts where there are
more opportunities for sex (i.e., war).
4. Psychopathic males who like domination
and have no empathy.
5. Males who are deeply insecure or
anxious and rape within the context of
relationship problems.

Question 20

Example Level 2 Theory: Empathy

Answer 20

(i.e., single-factor theory)

 Two different definitions of Empathy:
1. Single-Factor:
a. Empathy as an emotional response to
other people’s experiences which is a
psychological skill that facilitates healthy
intimate relationships and stronger
communities (i.e., emotional congruence,
imitation and perspective taking).
b. Deficit model which views sexual
offenders as having a psychological
deficit in empathy otherwise they wouldn’t
be able to commit such an act.
c. Should we focus on understanding
empathy if it has been demonstrated to
not influence recidivism?
i. There is a key distinction between theory
and prediction.
ii. Just because it does not predict
recidivism does not mean that issues with
empathy may not play a role in the onset
and maintenance of sexual offending and
that understanding empathy is not useful
to understanding sexual offending.

2. Two-Factor:
   a. Empathy as 1) a cognitive or emotional
   understanding of another person’s
   experience 2) an emotional response to
   others experiences which requires the
   perception that the person is worthy of
   compassion and respect.
   b. You can be good at one and not the other
   (i.e., psychopaths are good at perspective
   taking but do not elicit an emotional
   response).
   c. Predicts (5) sets of processes converge to
   create an empathetic response:
   i. Emotional response to others experiences
   distress (i.e., motivated to elevate negative
   emotions in others).
   ii. Perspective taking (i.e., understanding
   how you would feel in their situation).
   iii. Compassion and respect (i.e., seeing
   others as equal to us and worthy of
   empathy).
   iv. Contextual factors (i.e., situational factors
   that disinhibit empathy -state factors like
   anger, fear, intoxication, abuse or arousal).
   v. Ability to manage own distress (i.e.,
   emotion regulation, or natural tendencies
   where you inhibit your empathetic
   response because you’re mad).

Question 21

Example Level 2 Theory: Cognitive Distortions

Original Cognitive Distortion Theory vs. Intuitive theories theory

main difference?

what are the (5) intuitive theories?

Answer 21

(i.e., single-factor theories)

the main difference between these two theories is that the original cognitive distortion claims that they act as a posthoc justification for their offense by the intuitive theories theory claims that cognitive distortions act as a schema that biases how they perceive themselves and the world which leads them to sexually offend against children - sexual offenders use these schemas to explain, predict and interpret interpersonal phenomena relevant to sexual offending.

e.g. (5) Intuitive Theories:

1. Children as Sexual Objects:
   children have agency, can consent,
   desire sex and enjoy sex.
2. Nature of Harm:
   Minimizes the harm is done to the child,
   not considered abuse, harmful but rather
   beneficial for them or that it could have
   been worse.
3. Uncontrollability:
   the belief that they can not control their
   desires for you, blame it on the alcohol or
   external stressors and your presence that
   they had no hope.
4. Entitlement:
   that they’re entitled to have sex with
   children (i.e., incest, brother on younger
   siblings, parents on children, etc.).
5. Dangerous World:
   perceive that it is a dangerous world and
   that children are a safe haven, are the
   only ones who understand them, etc.

Question 22

Example Level 3 Theory: The Self-Regulation Model

The four goals offenders hold and the nine pathways

child sexual offending is the results of ___

Answer 22

 Argues that people have goals which
motivate their behaviour (i.e.,
acquisitional/approach goals) and inhibitory
goals (i.e., goal to a avoid negative
outcomes).

 Developed (4) pathways to sexual
offending:

o The avoidant-passive:
 Individuals have a desire to avoid sexual
offending but make no active attempts to
avoid enacting their desires.

o The avoidant-active:
 They have a desire to avoid engaging in
sexually deviant behaviour and makes
attempts to avoid offending but their often
poor or maladaptive coping strategies.
 E.g., collecting child pornography.

o The Approach-Automatic:
 Individuals want to engage in sexually
deviant behaviour but do not plan to offend
and are more opportunistic in their
offending.

o The Approach-explicit:
 Individuals want to engage in sexually
deviant behaviour and make active
attempts to plan and arrange the offence
(i.e., grooming).

The (9) Pathways sexual offenders’ cycle through:

1. Life Event:
   a. A major life event or stressor triggers
   emotional response and activates deeply
   held beliefs and schemas.
2. Desire for Deviant Sex or Activity:
   a. These triggered emotions, memories or
   beliefs create a desire to sexually offend
   and other related behaviours as a
   maladaptive coping mechanism (i.e.,
   substance abuse).
3. Offence-Related Goals are Established:
   a. Desires become more consciously relevant
   to offence goals.
   b. Whether approach or avoidant depends on
   people’s sills, affect, cognition, beliefs and
   temperament.
4. Strategy Selection:
   a. Individual decides on the strategies they
   will use to meet their sexual deviance goals
   (avoidance or approach goals).
   b. Implicit or explicit choice.
5. High Risk Situation is Entered:
   a. Individuals make contact with a potential
   victim through their successful approach
   goal strategy or ineffective avoidance goal
   strategy.
   b. Arousal and sexual fantasies both increase
   and produce emotions of shame and
   anxiety which make impulse control harder.
6. Lapse:
   a. Intention to commit offense is developed
   and they engage in behaviours which allow
   for the offence to happen (i.e., grooming).
7. Sexual Offence:
   a. Engages in crime and its severity will
   depend on the beliefs, skills or emotional
   desires and previous behaviour.
8. Post-Offence Evaluation:
   a. Offender engages in an introspective
   reflection on their emotional responses to
   their actions:
   i. Avoidance elicits shame and guilt.
   ii. Approach elicits sexual gratification.
9. Attitude Toward Future Offending:
   a. Offenders’ self-evaluation triggers a
   feedback loop to phase (1) and some may
   adapt their strategies (approach or
   avoidant) or maintain the same strategies
   to better offend or seek help.
   b. May keep same strategy, adapt strategy to
   fulfil same goal or switch to a different goal
   (approach or avoidance).

*Child Sexual offending tends to be the result of unsuccessful avoidance goals and adult sexual offending the result of successful approach goals.

Question 23

Future Directions based on the two etiology of sexual offending lectures:

Answer 23

 The presence of problematic explanatory
constructs such as dynamic risk factors or
protective factors that do not suit an
explanatory role, they focus on prediction
rather than explaining causal mechanisms.
o i.e., too broad, do not explain what causal
mechanisms increase risk, have competing
or conflicting risk factors.
 The need to clearly outline the explanatory
targets for etiological theories to ensure
we are not expecting a theory to do a role
it’s not designed for.
 Offence categories and subcategories
such as types of sexual offenders too
heterogenous to function as good
explanatory targets (i.e., classification
systems are too broad to be good
explanatory targets).
 Classification: offence types, risk bands,
risk factors, or motivational systems and
associated tasks are too broad to function
as good explanatory targets because it
assumes that behaviour is caused by the
same motivations and is overly simplistic
and produces ineffective one size fits all
treatments.
 Unified explanations rather than pluralistic
explanations in theory construction.
 Theoretical pluralism is a useful strategy in
situations of relative ignorance and opens
us space for critique and theory
development.

Question 24

The usefulness of different levels of theory

Answer 24

o Level I multifactorial theories are important
for understanding the broader motivations
and contexts in which sexual offending
occurs.
o That said, Level II single-factor theories
and Level III descriptive process theories
also play a vital role in understanding the
contribution of individual factors and
situations to this behaviour, and therefore
where the ‘offence chain’ or ‘offence
cycle’ might be broken by targeted
intervention

Question 25

sexual offending as an offense classification is differentiated by what two factors?

Answer 25

o Offence types: 
 Contact vs. Non-contact.
 Different behaviours (i.e., child porn, 
   abuse, rape).
 Different contexts.

o Victims:
 Boy or girl.
 Age (i.e., adult or child).
 Relative or non-relative

Question 26

Prevalence of sexual offending and recidivism?

Answer 26

 Prevalence from Online surveys:
o 4.1% reported they had sexual fantasies
involving prepubescent children (i.e.,
contextual factors or no preference and
are attracted to both children and adults).
o 3.2% reported sexual offending.
o 0.1% reported pedophilic preference (i.e.,
preference for children only is rare).

 Sexual recidivism is low:
o 10-15% recidivism rate after 5 years (i.e.,
untreated).

Question 27

Risk Issues:
Most sexual offenders do or do not reoffend?
Is it more likely to be a sexual or nonsexual offense?
If the base rate is so low why do people reasearch it so much?

Answer 27

 Most sexual offenders are not reconvicted
for a sexual offence or any new offence
(i.e., 10-15% sexually reoffend).
 If they do reoffend it is more likely to be a
non-sexual offence than sexual offence.
 If the rate of recidivism is so low for this
offence type, then why is sexual offending
one of the most researched area in
forensic psychology with better
explanatory theories than other offences?
o This is because sexual offending has a
moral element to it.
o You’ll find even rapists who do not believe
their crime was wrong will still perceive
themselves to be better than child sexual
offenders and view them as being
repulsive.
o This demonstrates a moral element to
child sexual abuse relative to other forms
of harm like child neglect or abuse.
o People view child sexual offenders as
being violations to ethics of divinity (i.e.,
purity) which elicits universal emotions of
disgust and perceive such actions to be
worthy of stricter punishment than other
violent offences.

Question 28

Treatment Targets:
What should treatment target?

Problems with theory, meeting offender population needs, administration of treatment
… should instead focus on…

Answer 28

 Predominately sexual offending treatment
has focused on criminogenic needs (i.e.,
dynamic risk factors) which are targeted in
order to produce the largest impact on
reducing the risk of recidivism.
o There are different sets of risk and need
factors which vary across offence type (i.e.,
offence specific; predict future behaviour).
o Some are generalizable to all offence
types.
o Problem of heterogeneity in sexual
offending category. Risk/Need factors are
too generalizable, they focus on predicting
risk based on offence type and applying it
to the whole group without taking into
account its heterogeneity (i.e., variations in
motivations that lead to sexual offending,
i.e., anger, intoxication, deviant sexual
preference etc.).

 Problem with sexual offending treatment:
o It takes a one size fits all approach.
o Provides a large set of modules which
focuses on a specific dynamic risk factor or
motive which are given to everyone.
o It acknowledges that individuals will not
have a need to complete all the modules
but by making everyone complete the
same program its more cost effective and
is broad enough to meet the needs of the
group.

*what do we need other that problem clusters (i.e., dynamic risk factors) to act as targets for treatment? We need to understand the causal mechanisms of sexual offending. How do these risk factors lead to offending and what other factors motivate sexual offending?

Question 29

Dynamic Risk Factors (Specific to Sexual Offending)
 (4) Supported by Evidence:
 (4) Not Supported by Evidence:
 Psychologically Meaningful Risk Factors
Must be —- and —-
This is important because…

Answer 29

Dynamic Risk Factors (Specific to Sexual Offending)
 Supported by Evidence:
o Sexual deviancy.
o Emotional Identification with Children (i.e.,
emotional congruence).
o Antisocial Orientation (i.e., general
tendency for ASB, where sexual offending
is just one part of their versatile criminal
history).
o General self-regulation difficulties (i.e.,
impulse control issues).

 Not Supported by Evidence:
o Lack of victim empathy (i.e., yet still a part
of most treatment designs).
o Denial of sexual offence (i.e., treatment
can still be effective even if they deny
their crime).
o Minimization (i.e., minimization of harm to
child, or impact of crime).
o Lack of motivation for treatment.

*why can treatment work if they deny the crime? Due to social learning can teach offenders that sexual offending behaviour is immoral, socially unacceptable or punishable behaviour without admitting that they themselves have engaged in such behaviour.

Psychologically Meaningful Risk Factors:
 Mann, Hanson & Thornton (2010) argue
that the most psychologically meaningful
risk factors have:
a. Plausible explanations for how they cause
sexual offending.
b. Strong empirical support that it predicts
sexual recidivism.
 Risk factors notoriously predict future
behaviour but do not explain how these
factors increase the risk of recidivism or
cause future offending (i.e., prediction vs.
explanation tasks).
 This is important for treatment design
because why do we use dynamic risk
factors as treatment targets when they
only predict offending rather than explain
it? This is a really important issues when
they whole point of treatment is to target
the causes of sexual offending.

Question 30

People who commit sexual offences against children:

 Are all offenders who commit sexual
offences against children pedophiles?
 Are they all looking for intimacy? Do they
all believe that it is okay to have sexual
contact with children? Do they all have a
problem regulating their behaviour?

Answer 30

 Are all offenders who commit sexual
offences against children pedophiles?
o No. Pedophilia (i.e., paraphilic disorder) is
relatively rare among sexual offenders.
Most who sexually offend against children
do not have a paraphilic disorder. Neither
does having a paraphilic disorder make
you more likely to commit a sexual
offence. Albeit having a paraphilic disorder
does increase your risk (i.e., DRF).
 Are they all looking for intimacy? Do they
all believe that it is okay to have sexual
contact with children? Do they all have a
problem regulating their behaviour?
o No. the motivations for sexual offending
against children is highly heterogenous.
Whilst these are common motivations for
the collective of sexual offenders there will
be large variability of motivations across
individuals who sexually offend (i.e., some
will be motivated with a desire for intimacy
and others not etc.).

Question 31

(2) Domains of risk that are Specific to Sexual Offending are:

1. Sexual and interpersonal risk (5)
2. Cognitive and self regulation (1)

Answer 31

Sexual and Interpersonal Risk Domains

1. Sexual preoccupation (i.e., high sex drive
   and use of sex as a coping mechanism or
   mood regulation strategy).
2. Sexual Deviance (i.e., pedophilia or other
   paraphilic disorders)
   a. Important to note that there is a difference
   between having a deviant sexual
   preference or interest and their behaviour!
   Around 50-65% of those convicted would
   be diagnosed with pedophilia. Meaning
   that not all those offend have a sexual
   deviant preference or that all those who
   have a sexual preference offend!
3. Specialization
   a. There are a sub-group of child sexual
   offenders who only commit sexual
   offending. They tend to use more
   sophisticated grooming strategies, are
   well respected members of society with
   good interpersonal skills which make
   them hard to detect in society, will read
   criminology or psychology studies on
   sexual offending to get better at being
   undetected.
4. Social isolation, intimacy deficits, lack of
   intimacy with other adults.
5. Emotional congruence with children (i.e.,
   children are viewed as being safe and
   accepting, they understand me better and
   are viable partners).

Unique Features of Sexual Offending
Cognitive and Self-Regulation Risk Domains
1. Cognitive Distortions that are specific to
sexual offending.
a. Sexual offenders hold distorted attitudes
and beliefs that cause sexual offending.
b. But cognitive distortions do not mean that
sexual offending will occur! Psychological
category doesn’t equal a behavioural category.

Question 32

Standard Treatment Moduel order for sexual offenders

9 modules over 33 weeks

Answer 32

Treatment Occurs in Modules:

Week Content
1-2 Clinical Assessment:
 Clinical assessment is carried out by a
trained clinician.
 They develop a case formulation which
outlines the specific offenders’ motivations,
risk factors, targets for treatment (i.e., within
a group setting).
 Is shared with the offender.

3-4 Orientation to Group Therapy:
 This focuses on making the offender
comfortable in a group therapeutic setting,
building trust and responsivity to treatment,
and outlining the rules of no judgement,
turn taking, and honesty.

5-11 Offense Mapping:
 Clinician maps the criminal behaviours for
each offender.

12-13 Sexual Arousal Reconditioning:
 Managing/mitigating sexual arousal elicited
by sexual deviancy.

14-17 Victim Impact and Empathy:
 Educate offender on harm caused to child,
and build empathy skills.

18-21 Relationship and Sexuality:
 Important for re-entry where to help
offenders facilitate maintaining strong
interpersonal relationships, solve
interpersonal problems, build social skills
and educate them on sexuality.

22-25 Mood Management:
 Coping with stress and depression.

26-29 Release Planning:
 Planning life after release.

30-33 Clinical Reassessment:
 Clinician does a final assessment of the
offender to see if the treatment was
effective, what they current risks are and of
they’re ready to be released back into
society.
 Is shared with the offender.

 Therapeutic Modules:
o Everyone is given the same modules to
work through regardless of whether their
clinical assessment identifies if the module
is relevant to their specific offence map or
not.
o Each module targets a specific risk factor.
o Sexual arousal reconditioning, victim
impact and empathy, relationship and
sexuality, mood management, and release
planning are specific modules to sexual
offending treatments.

Question 33

 Why is victim empathy included in almost all sexual offender treatments even though it is not empirically supported risk factor?

Answer 33

o Just because it is not shown to directly
increase the risk of sexual recidivism it is
associated with other behaviours that are
important to recidivism.
o Empathy may be a moderator variable that
is linked to cognitive distortions or
motivations that cause sexual offending
behaviour.
o Furthermore, just because empathy does
not influence risk does not mean it is not a
useful skill to teach offenders. For
example, learning empathy will improve
their interpersonal relationships and life
satisfaction. This illustrates the need for
treatment to focus on rehabilitation and
reducing risk.

Question 34

5. Treatment can be

Answer 34

group-based or individualized
general or specialized 
strength-based or avoidance-based
prison-based or community-based 
pharmacological, cognitive or behavioral therapy.

Question 35

o High levels of personal disclosure are
needed for these treatment programs
where the offender must overcome deeply
ingrained deviant beliefs/preferences/risks
which require trust between patient and
therapist.
o How do we overcome these individual
barriers to treatment?

Answer 35

 It is the way we frame risk factors; a
deficit-based approach is not going to
encourage people to join and complete
treatment. Taking a more strength-based
approach that focuses on what skills you
can provide offenders to meet their
goals, be more individualized to their
own experiences and needs, more of a
relationship with therapist will be more
effective!

Question 36

 Therapeutic Alliance:

Answer 36

o Focuses on building positive relationships
between the practitioner and the client.
o This is especially important when working
with child sex offenders.
o More collaborative approach to
confronting and challenging distorted
beliefs, attitudes and behaviour.
 Pragmatically, it provides better treatment
outcomes that risk reduction-based
programs. From an ethical or moral
standpoint this approach is respectful and
focuses on rehabilitating the offender
rather than punishing them, which leads to
better rentry into society, and living more
meaningful lives.

Question 37

Strength-Based Approach: GLM

Ward & Maruna, 2007

Answer 37

Strength-Based Approach: GLM
(Ward & Maruna, 2007)
	Strength-based approach.
	It adds to the RNR model rather than replacing it!
	It has two aims (i.e., dual aims):
o	Reducing risk of recidivism.
o	Promoting “good lives”

 Assumptions:
o It assumes everyone has an implicit “good
life plan” i.e., goals associated with what
they perceive to be a ‘good” life. This plan
guides behaviour towards valued
goods/needs.
o Problems within offenders’ good lives plan
can lead to offending (i.e., 4 problem
clusters).
o Offending is goal-directed behaviour to
meet normative primary human goods or
needs.
o It results from the use of harmful or
dysfunctional secondary instrumental
goods (means).
 The goal of treatment is to provide people
with the resources and skills to meet their
primary human needs in an adaptive,
prosocial manner as opposed to their
current maladaptive (i.e., sexual offending).

Need for Consistent Treatment:
 Developing an individualized “good lives”
plan:
o Primary human goods are prioritized
(scope)
o Secondary goods are successful
(strengths) and linked with offending (risky)
(i.e., successful means of meeting primary
human goods with offending behaviour).
 Forms approach goals: capacities (linked
with risk)
 Building resources to meet goals on
prosocial and healthy ways.
 Language, respectful, upholds dignity.
 Structured but not ridged or manualized.

Question 38

The (11) Primary Human Goods as supported by literature:

Answer 38

1. Life:
   a. Healthy living and functioning.
2. Inner Peace:
   a. Freedom from emotional turmoil and
   stress.
3. Excellence in Play:
   a. Hobbies and interests.
4. Spirituality:
   a. In the broad sense of finding meaning
   and purpose in life.
5. Pleasure:
   a. Feeling good in the here and now.
6. Knowledge:
   a. How well informed one feels.
7. Creativity:
   a. Expressing oneself through alternative
   forms.
8. Community:
   a. Connection to wider social groups.
9. Excellence in Agency:
   a. Autonomy, power, self-directedness.
10. Excellence in Work:
    a. Including mastery experiences.
11. Relatedness:
    a. Including intimate romantic and familial
    relationships.

Question 39

Are the primary goods valued the same for everyone?

Answer 39

 These primary human goods will differ in
their value of meaningfulness across
offenders.
 Treatment should focus on identifying the
specific goals of each individual and
provide them with the necessary resources
and skills required to meet their good live
plans.
 An exemplarily good live plan would have
all (11) primary human needs to some
degree.
 Includes approach goals and indirectly
encompasses avoidance goals through its
focus on approach goals.

Question 40

Problems Faced in Meeting the Human Needs and Good Lives Plans

Answer 40

1. Capacity (Lacks resources):
   a. Poor coping, low self-control, lack of social
   skills etc.
   b. Internal and external barriers they face
   (i.e., emotional regulation, sexual desires
   vs. friends, work or education
   opportunities).
2. Means (harmful, abnormal):
   a. Sex with children as a means to achieve
   pleasure, intimacy, mastery and control.
   b. Meet their primary human needs via.
   Maladaptive strategies and are often
   disappointed by their inability to meet
   their desires.
3. Conflict (blocks other goods):
   a. The use of sexual abuse to meet their
   needs results in prison, isolation, and
   blocks need for autonomy and life.
   b. For example, using substances to cope
   with emotions can hinder workplace
   opportunities and quality of life.
4. Scope (prioritizing certain needs over
   others, range of goods/needs not
   present):
   a. Prioritizing pleasure over connection to
   others, leading to intimacy deficits and
   relational problems.
   b. The focus of meeting workplace needs
   and neglecting social and physical needs.

 These (4) problems with completing good
life plans can be conceptualized as being
dynamic risk factors for sexual offending.
 Important to remember that our primary
human goods and barriers we face will
shift overtime across the life-course.
 These (4) problem clusters overlap within
behaviours, dynamic risk factors or
offending behaviours.

Question 41

Pharmacological Sexual offender Interventions:

Answer 41

 There is debate around whether or not
pedophilia can be “cured”, the evidence
suggests no.
 Medications such as SRRO’s and
antiandrogens can be used to reduce or
manage sexual drive and sexual urges (i.e.,
chemical castration) when the urges are
almost constant and quite distressing.
 Comes with lots of side effects, may get rid
of it all together or weaken them to make it
more manageable.
 Only works for a small percentage of
people.
 Voluntary treatment for men with sexual
deviance/preoccupations (i.e., offender
must agree to be chemically castrated).
 Gannon et al. (date) found that we cannot
“cure” their deviance urges but they can
manage them. Furthermore, treatments
with chemical castration or arousal
reconditioning were more effective.

Question 42

Recidivism, Reentry and Desistance

Answer 42

 Most people who actually desist from
crime (i.e., do not reoffend) do not go to
therapy and have more education or
employment opportunities.
 Most people who reoffend do so because
they did not have any support systems in
place.

Desistance:
 Process from active offending to reduction
and eventually to a no offending lifestyle.
 Can occur without intervention (i.e.,
maturation, adolescence-life limited).
 Theories:
o Turning points in people’s lives or social
bonds such as marriage or employment
opportunities.
o Changes in identity and cognitive
transformation (i.e., knifing off their
antisocial lifestyle).
 Treatment should aim to provide the
resources to engage in the desistance
process.

*redemption scripts held by the offenders vs. the condemnation script

Question 43

Programme Evaluation: How do we know if it works?

Answer 43

Programme Evaluation: How do we know if it works?
 RCT is the golden standard of experimental analysis to determine treatment effectiveness but is not do able in these circumstances. It would be unethical to withhold treatment from those who are in equal need of treatment and could lead to children or adults being harmed.
 To address these researchers, try to use matched groups analysis (i.e., matching offenders on demographic variables or risk and them comparing treatment and non-treatment groups).
 Recidivism is generally measured as no reoffending coded as treatment success and recidivism as a failure. Measuring recidivism will always be flawed to some degree.
 Primary goal is to demonstrate there is a significant difference in recidivism rates between treated and non-treated offenders.

Question 44

Challenges to Measuring Treatment Effectiveness:

Answer 44

 It is inappropriate to make general
statements about the effect or failure of
sex offender treatment.
 Treatment heterogeneity and integrity:
o CBT can take many forms (i.e., Relapse
Prevention Model or GLM)
 Interventions are complex:
o it is hard to know if the benefits of
treatment are due to specific sexual
offender modules or general CBT or
therapeutic principles.
 Differentiate between aspects of
treatment which moderate change:
o Theories underlying treatment (i.e., weak
or strong), context (i.e., prison or
community based) and therapist
characteristics (i.e., trained professional,
supervised or not).
o Makes it hard to ascertain if affects are
due to treatment design or the
implementation of the intervention (i.e.,
treatment integrity).
 We cannot assume causality! RCT’s are
not used so we cannot ascertain the
direction of the effects, rule of confounds
or identify mechanisms of change in
recidivism.

*treatment heterogeneity is it logical to roughly provide the same set of modules to all sexual offenders when we know they’re a heterogeneous group? This is done for cost-effectiveness purposes and is achieved by presenting a treatment with a large enough scope, covers most common risk factors, to ensure that despite variability everyone’s needs in the group are met.

Question 45

Challenges for Determining your Outcome Measures:

Challenges in Methodology:

Answer 45

 What do we measure as being indicative
of successful treatment?
o Treatment failure (recidivism or drop-out).
o What types of recidivism do you measure?
(i.e., sexual, general, violent)
o Do you use official records which
notoriously underreport the actual rate of
crime? Do you use self-report data?
Where there is important information
missing and severity of crime in not
included.
o Low base rates of sexual recidivism even
without treatment which effects the length
of follow up measure needed to have
enough statistical power to identify
meaningful differences between
treatment and non-treatment groups (i.e.,
needs to be 5+ years).

 Use quasi-experimental designs to
compare an existing group exposed to
treatment.
 Matched control or comparison group is
needed to demonstrate a meaningful
difference or can be used as a way to
estimate their risk pre-treatment as a
comparison. How do we know if we’ve
matched them on all the important
variables? Selection pressures? Attention
effects?
 How do we deal with dropouts? Do we
use a intention to treat design where
drop-outs are marked as treatment failure
or do we remove them from the data set?
Intention to treat design is better!

Question 46

Hanson, Bourgon, Helmus & Hodgson (2009)
Looked at effectiveness of treatments
which adhered to the RNR Principles on Recidivism outcomes.

Is sexual or non sexual reoffense more common?
Is RNR treatment effective in reducing sexual amd nonsexual recidivism?

Answer 46

 Looked at effectiveness of treatments
which adhered to the RNR Principles.
 Recidivism:
o Sexual Recidivism: 10.9% (treated) 19.2%
(untreated)
o General Recidivism: 31.8% (treated) 48.3%
(untreated)
 Sexual offenders are more likely to
reoffend with a non-sexual offence than
sexual offence (with and without
treatment

Question 47

RNR and SO Treatment

Hanson et al. (2009)

Answer 47

 Adhering to the three RNR principles
produced the largest reductions in
recidivism.
 The more RNR principles treatment
adhered to the larger the effects.
 The most important RNR principles in the
need principle.
 80% of treatments used need principles
not linked to recidivism.
 Only 2/3’s of treatments adhered to all
three principles.
 Effects of treatment were larger in weaker
studies. This is because they do not
control for bias like higher quality studies
can, so their effect sizes are inflated.
 No conclusive evidence that sexual
offending treatment reduces recidivism.

Question 48

Kim, Benekos, & Mario (2018)

Meta-analysis on treatment effectiveness

Answer 48

 Reviewed Meta-analysis to date.
 They found that treatment is more
effective for adolescents, community-
based, biological interventions (i.e.,
hormonal medications) more effective than
psychological.
 This suggests that CBT is the preferrable
model of treatment although it is not as
effective as hormonal medications (i.e.,
chemical castration or arousal
reconditioning).

Question 49

Alternative Evaluations:

Answer 49

 Traditionally people compare treated with
untreated.
 Instead, we can compare within treatment
to identify who responds differently to
treatment (i.e., who is it more effective for,
who stays who drops out, is their recidivism
different).
 Proximal measures can also be used such
as dynamic risk factors but must also
choose appropriate targets and measures.
 Looks at other qualitative outcomes such
as attrition, motivation, experience of
treatment and integration.

Responders vs. Non-Responders:
 9% of treated vs. 15% of non-responders
were reconvicted for a sexual offence in
2- 4 years.
 The fact that those who undergo
treatment still reoffend illustrate it may be
more effective for some than others.

Question 50

Qualitative comparison of the standard relapse prevention (CBT-RP) with GLM

Answer 50

 GLM condition is much more likely to
complete the program and is describes by
therapists as being more motivated.
 Both GLM and RP treatments improved
need measures.
 GLM produced significantly better
improvements on coping skills and
problem-solving, and more likely to have
social support systems in place after
treatment.

 Non-completers perceived treatment as:
ineffective, unnecessary, repetitive, boring,
intrusive, stressful, challenging,
patronizing, and incompatible with their
own personally meaningful goals.
 GLM attrition rates were lower than CBT-
RP’s. Offenders experienced more
autonomy, therapists felt more positive
about treatment as effective following
simple changes to treatment
implementation.
 GLM performed as well as RP, participants
and therapists favored GLM.
 GLM is better at meeting the Responsivity
Principle!

 Research indicates that experiencing one
of (4) problem clusters (i.e., capacity,
scope, means and conflict) are commonly
experienced by offenders (42-47%).
 Participants demonstrated problems
operationalizing their good lives, difficulty
in obtaining one or more goods prior to or
during offending and for some offending is
seen as a means.

Question 51

What can we conclude?

Answer 51

What can we conclude?
 There is insufficient research that has been conducted to sufficient high enough quality to draw any reliable conclusions about sexual offender treatments effectiveness.
 Our knowledge of its effectiveness is inconsistent and incomplete.
 The third is finding that consistently emerges is that treatment sometimes work.
 Sexual offending treatment is guided by the same principles as general offending treatment (i.e., RNR, CBT).
 Unique risk factors for Sexual Offending exist (i.e., Sexual and interpersonal, cognitive and self-regulation).
 The benefits of GLM are its dual aims, strength-based to fulfill good lives plan and manage risk.
 Desistance is the norm (i.e., most do not reoffend) and we need to provide them with the right resources to support this process.

But what are we treating?
 Sexual offending is a legal and behavioural category which does not make a good psychological category. Thus, they do not make good treatment targets. The need to be psychology based in order address the heterogeneity in motivations which lead to sexual offending. We need to build on their strengths rather than focusing solely on reducing their risk of recidivism.

Other Conclusions:
 There is a gap between research/theory and treatment. Treatment is based of risk factors and do not adequately address the existence of explanatory theories which are more beneficial for treatment than risk factors.
 Due to methodological weaknesses, it is hard to tell if a treatment works but generally it has a moderate positive effect (i.e., small effect size).
 Significant variation across studies due to poor quality which produces conflicting findings.
 CBT remains the treatment of choice despite the variation in its shown effectiveness and is mainly due to their being the most research on CBT relative to other treatment options.
 Risk factors are too imprecise, vague and provide messy categories which are not sufficient to design effective treatments (i.e., predict rather than explain).

Question 52

Is desistenece the norm?

Answer 52

Yes

Question 53

Is there a gap between literature and practice?

Answer 53

Yes
Cost effectiveness
Theoretical illiteracy
Time and monetary constraints