Tuesday 21 August 2007

Sex offender treatment programmes – Are these lowering recidivism rates or just a public placebo? By Christopher Rowe

The purpose of this essay is to explore and critically analyse the above statement giving detailed explanations of sex offender treatment programmes and to conclude if such programmes are successful in rehabilitation. The essay begins by providing a critical analysis of sex offender treatment programmes. The essay discuses three types of treatment programmes that are available to sex offenders which consists of behavioural, cognitive, and medical. Also briefly discussed here are the systems in place within the UK that deliver these treatment programmes to offenders whilst in prison, and in the community through the probation service. The essay then elapses the debate if sex offender treatment programmes lower recidivism rates, although not all research conducted around recidivism is covered both sides to the debate are analysed. The essay then discusses some of the problematic issues surrounding the act of measuring recidivism, the obstacles to treatment, and suggests what may occur in the future of treatment for sex offenders. This essay question is very significant because it examines the underlying principle of why sex offender treatment programmes are conducted, and highlights the imperfections that are apparent in the way punishment is carried out in modern society.

Resick P et al (1997) states that sexual assault is a problem of great significance; the lifetime prevalence of sexual assault has been estimated between 13.5% and 44% of women. Rape is probably the most studied single-incident crime, and has always been considered to be the most traumatic crime short of murder. It is suggested by Holmes S et al (2002) that there are many who operate outside what are now considered acceptable parameters of sex and who violate the law in process. Society has judged such individuals to be both abnormal and criminal. The underlying principle is suggested well by Lees S (1997) who states that in practice feminist researchers and activists across the world have directed a barrage of criticisms at the failure of the law to deliver justice to women who have been sexually assaulted. This promotes the question of what the criminal justice system should do with people who commit sex offences. Holmes S et al (2002) suggests that most people would imply that the criminal justice system should punish them severely; some will even go as far as suggesting castration. Others say put them to death, and a minority of people claim that these people should be treated.

The actions taken against sex offenders will always be an openly debated concept; the underlying principle that everyone will agree on is that society must be protected from such offenders. The only possible way to achieve this is as suggested by Holmes S et al (2002) that either the sex criminal must be locked away for the rest of his or her life, or change must happen. This concludes that the sex criminal must be treated and rehabilitated.

Programmes for treating sex offenders developed during the 1980’s in the wake of new legislative and intervention initiatives (Brown J et al 1999). According to Holmes S et al (2002) in general there are three types of treatment programmes available to sex offenders under state supervision, these are behavioural, cognitive, and medical.

Holmes S et al (2002) states that behavioural therapies typically use rewards and punishments to influence client behaviour. In sexual counselling, the rewards and punishments are used to change sexual patterns and scripts of behaviour. Typical methods of behavioural therapy vary; a prime example of this approach would be to monitor an offender’s physical and psychological arousal whilst encouraging the offender to discuss a favourite sexual fantasy, this can be achieved using a penile plethysmograph (PPG), which is an unobstrusive device attached to the penis of the offender. Holmes S et al (2002) states that if the offender begins to become aroused a negative reinforcement in the form of a dose of ammonia may be administered through plastic tubing fastened under the nasal passage. In controversy it can be suggested that this form of therapy is not completely conclusive and results may vary with different offenders, also it is possible that when the offender is eventually introduced back into society there will be no dose of ammonia as a form of deterrence for the offender’s sexual arousal.

Cognitive therapy encourages a sex offender to change the way he perceives his own life and the world around him as it pertains to sex and his interactions with others (Holmes S et al 2002). In an attempt to teach them empathy, they will read books and see videos from the victim’s point of view, and perhaps even meet with the victims or write letters (Welch R 1988). This enables the offender to identify the process that lead to the crimes being committed. Holmes S et al (2002) suggests that through cognitive therapy the offender may be able to be aware of his own personal danger signs. This could possibly result in the offender having the ability to divert away from situations that would have previously resulted in some type of sexual victimisation. Although this treatment maybe successful in some cases, like behavioural treatment it is not guaranteed to work for every offender.

Medical programs typically use drugs such as Depo-Provera, to lower sex criminal’s testosterone levels. It’s believed that the manifestation of sexual aggression is based on some type of hormonal imbalance (Holmes S et al 2002). The purpose of this drug is not to change the offender’s sexual preference but to decrease sexual urges and give further ability for the offender to control them. Callan J (1985) believes that the use of this drug is controversial because of the possible long-term effects that can include diabetes, gallstones, thrombosis, and even cancer. Despite this the treatment is often offered as an alternative for offenders to decrease their prison sentence. Holmes S et al (2002) states that in two states offenders are given the choice of undergoing chemical castration or the actual physical removal of the testes as a condition of release or in lieu of a prison term. In a critical analysis of this type of treatment it can be suggested that most drugs will only last as long as they are being consumed. This requires them complete motivation of the offender to be fully rehabilitated, and complete confidence for the offender to be responsible.

The most commonly used method of treatment is best described as cognitive-behavioural therapy (CBT). CBT is developed from a combination of both cognitive and behavioural approaches to therapy, which have been individually discussed above. Beech A et al (2004) believes that CBT is the most effective method of treating offenders and has based this assumption on research evidence supported by Alexander M (1999).

Cavadino M et al (2000) states that for some advocates of rehabilitation, optimism about reforming offenders has included the sentence of imprisonment, with incarceration being seen not as a retributive or deterrent but as an opportunity to provide effective reformative training and treatment. The British prison service has over the last ten years been at the forefront of developing a largely group-based treatment programme for sex offenders in an attempt to reduce recidivism (Thornton D et al 1993). This has developed into a national Sex Offender Treatment Programme (SOTP). SOTP is currently running in 26 prisons in England and Wales, with around 1000 men completing treatment every year (Beech A et al 2004). The main criteria for this programme consists of treatment methods in which engage the offender’s active participation in targets, skills, behavioural treatment, criminogenic needs, and ongoing evaluation, which all relate to the prevention of future offending. SOTP aims to treat all types of sex offender, whether they have committed offences against adults or children (Beech A et al 2004).

Treatment provision within the community in the UK is relied upon by three programmes consisting of the West Midlands Programme, the Tames Valley programme (TV-SOGP) and the Northumbria Programme. To be critical of these programmes, it is suggested by Beech A et al (2004) that the probation programmes have to cater for a wide range of offenders (exhibitionists, rapists and child abusers) with only one programme, whereas as suggested above the prison service is able to provide a range of programmes to suit the needs of different offenders. The limited resources within the probation service only allow one programme to be run, this causes discrepancies regarding offenders attending a number of modules according to there needs. Beech A et al 2004 states that there is also a need for flexibility so that offenders can repeat modules as necessary.

The review of literature surrounding the success of sexual offender treatment programmes and recidivism is contradictory. Holmes S (2002) suggests that older studies found that sex offenders seldom were reported to have committed new sex crimes, and they were not considered a danger to themselves or to others. However, research has developed somewhat in recent years, providing new and improved methods of treating offenders direct needs. Further to this criticism it has been suggested by Furby L et al (1989) that sex offenders could not be treated. Holmes S (2002) criticises this study suggesting that the authors methods and reliability of data have been called into question whilst also stipulating that in the conclusion of this study it is stated that the evidence was inconclusive regarding whether psychological treatment was indeed effective in preventing recidivism for sexual offenders. Despite this the study by Furby L et al (1989) has been widely used by politicians and those working for mass media outlets to suggest that sex offender treatment programmes cannot be used successfully to treat or rehabilitate offenders. This has raised doubt in the minds of many and possibly contributes the debate of whether sexual treatment programs lowering recidivism rates is just a public placebo.

More recently there are lots of studies that have been conducted which are in favour of sex offender treatment programs, and provide evidence that these treatments lower recidivism. In a study by Alexander M (1999) it states that the majority of sex offender treatment programs report more positive than negative findings. This study was completed using an analytic technique where researchers study the results of a series of projects, and make generalisations as to the likelihood of an outcome. This is called a meta-analysis. Holmes S et al (2002) has criticised this technique stating that it does not allow us to examine the strengths and weaknesses of each program, however of the 356 studies analysed by Alexander M (1999) it does indicate to the author that the treatment examined in this study does have a positive impact. Further to this Hanson R et al (1998) conclude a meta-analysis of sex offender recidivism from 98 reports, which consisted of 28,805 sex offenders. The sexual recidivism rates were examined over a 4/5-year period. The results showed that the sexual offender treatment programmes made an outstanding positive effect. The study showed that sexual reconviction rates were 18% for rapists and 13% for child molesters compared with general recidivism rates of 47% for rapists and 37% for child molesters over the same period. This study is of high significance relating to the success of sex offender treatment programmes, but can however be criticised by the lack of information given relating to the extent of which the treatment effected offenders and there motivation to complete the programme.

Also it is important to suggest that re-conviction rates are not necessarily conclusive evidence that such sex offender treatment programmes work. If it were possible for researches to directly measure sex offenders that commit further sex related crimes it would of course be done. As suggested by Doren D (2002) the problem is that we do not have any direct way of knowing which offenders repeat such crimes even within a specified follow-up time period because not all of them are caught, and certainly, not all of them self-report. Measuring sexual recidivism rates through reconviction rates can be very problematic. In a study by Doren D (2002) it is stated that under a polygraph, sex offender reported crimes are far greater than their history of having been rearrested, no less convicted. Dobash et al R (1995) states that arrest remains an infrequent response to domestic violence in Britain; recent research indicates that despite new policies and practises only a small portion of call outs result in arrest and prosecution. This research suggests that sexual recidivism rates will be incorrect when based on reconviction rates because offences are being committed without conviction. The use of meta-analysis through reconviction rates to measure sexual recidivism relies heavily on the criminal justice system and its ability to investigate and re-arrest sex offenders, and the decision to reconvict being correct. Hanson et al (2002) states that when the specific goal is to prevent sexual offence recidivism, there is almost no empirical foundation for identifying treatment targets or determining whether interventions have been successful. Although this is clearly the case all those who conduct assessments for sexual offenders must identify the factors they believe are related to sexual offender recidivism.

Contrary to public perception, the heterogeneity of sex offenders has an impact regarding the response of offenders to treatment. Incest offenders, extrafamilial child molesters, rapists, and exhibitionists all respond to treatment in different ways. Not only could differences in individuals or treatment modalities precipitate the likelihood that a person will succeed in treatment but also the type of fantasies that these offenders entertain and carry out. For instance incest offenders are consistently found to have lower sexual recidivism rates than other listed types of offenders (Doren D 2002). This can be for many reasons not necessarily associated with treatment, such as the family members being unlikely to report further offending, or a loss of access to their most recent victims. Holmes S et al (2002) states that some studies have concluded that exhibitionists were arrested twice as many times as sexual assaulters with regard to sex related offences. Further to this it also states that sexual assaulters commit as many non-sex crimes as they do sex crimes. Treatment appears to cut the risk of recidivism in half for exhibitionists and child molesters, however there is little difference in a rapist’s likelihood of recidivism from those who had undergone treatment and those who had not (Holmes S et al 2002). This is a significant difference when compared with the success of the reconviction rate of rapists in the study by Alexander M (1999) and stipulates further the problematic issues in measuring recidivism.

It is also important to remember that some studies use different criteria for sexual recidivism, for example a study by Maletsky B (1998) includes being charged with a sexual offence, dropping out of treatment, failing a polygraph test or producing a sexually deviant penile plethysmograph result as means of treatment failure. This makes measuring the rate of recidivism as a result of sex offender treatment programmes a difficult task. This calls for a more long-term analysis of sexual recidivism.

There is also evidence to suggest that some treatments are more effective than others, for example the rates of recidivism can differ in large margins dependant on different hospitals that issue the treatment. Holmes S et al (2002) suggests three possible reasons for this. Firstly rates of recidivism can sometimes be measured in different ways, for example success may be determined if the offender commits a further offence whether it is a sexual crime or not. Another consideration would be the time frame in which recidivism is measured; some studies are done over a longer period of time, which can result in different results. Further to these points the calibre of the sex offender will also play a part, for example a program, which admits manly minor sex criminals, will have an increased chance of long-term success.

This essay provides evidence if somewhat debatable that sexual offender treatment programmes can do more good than harm, however there are obstacles that exist which may prevent offenders from receiving such treatment. These obstacles can be as simple as lack of resources to provide the treatment for sex offenders. Many believe that it costs too much money to treat offenders and that such offenders are somewhat undeserving of such attention (Holmes S 2002). The financial burden of sex offender treatment programmes is a large problem; any type of individualised treatment is expensive, and in some cases this is also added to the cost of having the offender in custody. Holmes S et al (2002) suggests that a low cost alternative to housing these offenders and providing them with treatment in secure facilities is to provide outpatient treatment. Many believe that because of the risk of victimisation in prison and the low likelihood of recidivism behaviour whilst they are under close scrutiny, intensive supervision probation programmes are a lower cost alternative (Holmes S et al 2002). A significant obstacle to this however, is that many people understandably do not wish to allow sexual offenders to live in residential areas.

The future is unclear for how the public perceive sex offenders, the more research that is conducted on sex offenders the more people believe that they are somewhat different from normal offenders, the author perceives this believe as to be a form of sickness. It is more than likely that behavioural, cognitive, and medical treatments will continue in the future because a greater understanding of the best practices and most successful programmes shall be obtained through further research. Holmes s et al 2002 believes that it is unlikely to foresee any treatment approach being better than another for all people, but research generally supports the notion that time under treatment is a key indicator of success. With this in mind it is quite possible that retribution and incapacitation will be reduced to make way for longer sentences involving treatment.

In the future the prevention and reduction of recidivism through the use of sex offender treatment programmes would be widely supported and achievable, however no matter what this essay has proved, the subject will always be politically discussed as to the view of the public. Holmes S et al (2002) suggests that one proposal that garners political and public support is the notion of a law allowing the physical castration of all violent sex offenders. The best we can hope for is that researchers and clinicians will be able to identify the best treatment mechanisms and match them with the types of offenders with which they are most likely to succeed (Holmes S et al 2002). If this could be done in a way that is proven beyond doubt there would no longer be a debate surrounding successful sex offender treatment programmes being a public placebo.
The essay question is quite widespread and can be interpreted in different ways, this essay has argued and demonstrated that sex offender treatment programmes are successful to some extent in lowering recidivism rates and are not just a public placebo, although it is very difficult to provide hard evidence of this because of the problematic issues surrounding the difficulty of measuring sex offender recidivism. Three main types of sex offender treatment programmes have been critically discussed. Behavioural therapy involves using rewards and punishments to influence the behaviour of the offender, this method can be effective in some cases however is not conclusive. The essay suggests that this is also the case with cognitive therapy. Medical treatment has been discussed namely with reference to the drug Depo-Provera which is used not to alter the offenders sexual preference but to reduce his physical urges. The drug is controversial because it possibly causes long-term illness. The drug is criticised in this essay because the effects of the drug only last whilst it is being consumed and have no long-term effect on the sex offenders self control. However, when considering rates of recidivism this essay provides evidence suggesting that almost all sex offender treatment programmes have as their explicit or implicit aim the reduction of sex offending from what it would have been without treatment. Although this is arguably the case there are problems with how recidivism is measured, the essay has argued that using reconviction rates to access sexual recidivism is highly controversial because it is heavily reliant on the inconsistency of the criminal justice system, and there is no guarantee that every sex crime is concluded with a conviction. The use of meta-analysis techniques among success rates of hospitals often do not give programmes the opportunities to show their real strengths and weaknesses. This possibly fuels the argument that sex offender treatment programmes as a success are perceived as a public placebo. The future of treatment for sex offenders has been deemed as unclear. However, the author strongly believes that behavioural, cognitive, and medical treatments will continue and that incapacitation will be reduced in favour of a more long-term treatment programmes.

References:

Alexander M (1999) ‘Sexual abuse: A Journal of Research and Treatment’ Sexual Offender Treatment Efficiency Revisited, Volume 11, No 2, pp 101 – 116

Beech A, Fisher D (2004) ‘Treatment of Sex Offenders in the UK in Prison and Probation Settings’ in Kemshall H, Mclvor G (eds), Managing Sex Offender Risk, London, Jessica Kingsley Publishers

Brown J, Blount C (1999) ‘Journal of Managerial Psychology’ Occupational Stress Among Sex Offender Treatment Mangers, Volume 14, No 2, pp 108 – 120

Callan J (1985) ‘Corrections Compendium’ Depo-Provera for Sex Offenders, Volume 5, No 2, pp 6 - 8

Cavadino M, Dignan J (2000) The Penal System An Introduction, London, Sage Publications

Dobash R, Dobash E, Cavanagh K, Lewis R (1995) ‘Evaluating Criminal Justice Programmes for Violent Men’ in Dobash, R, Dobash E, Noaks L (eds) Gender and Crime, Cardiff, University of Wales Press

Doren D (2002) Evaluating Sex Offenders: A Manual for Civil Commitments and Beyond, London, Sage Publications

Furby L, Weinrott M, Blackshaw L (1989) ‘Psychological Bulletin’ Sex Offender Recidivism: A Review, Volume 105, No 3

Hanson R, Bussiere M (1998) ‘Ministry of the Solicitor General of Canada’ Predictors of Sexual Offender Recidivism: A Meta-analysis

Hanson R, Harris A (2002) ‘Where should we Intervene? Dynamic Predictors of Sexual Offense Recidivism’ in Holmes R, Holmes S (eds) Current Perspectives on Sex Crimes, London, Sage Publications

Holmes S, Holmes R (2002) Sex Crimes Patterns and Behaviour Second Edition, USA, Sage Publications Inc

Lees S (1997) Ruling Passions, Sexual Violence, Reputation and the Law, USA, Open University Press

Maletzky B (1998) Treatment Outcome, Technique Efficacy, and Assessment of Risk: A Five to Twenty-five Year Follow-up of 7,500 Sexual Offenders. Paper presented at The Association for the Treatment of Sexual Abusers Conference

Resick P, Nishith P (1997) ‘Sexual Assault’ in Davis R, Lurigio A, Skogan W (eds), Victims of Crime Second Edition, USA, Sage Publications Inc

Thornton D, Hogue T (1993) ‘Criminal Behaviour and Mental Health’ The Provision of Programmes for Imprisoned Sex Offenders: Issues, Dilemmas and Progress, Volume 3, pp 371 - 380
Welch R (1988) ‘Corrections Compendium’ Treating Sex Offenders, Volume 13, No 5, pp 1 - 10

No comments: