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The therapist encourages openness and honesty on the part of the patient. This parent-like role gives the therapist the power to influence the patient positively, and to interpret his self-defeating behavior and distorted beliefs about reality. The patient must be able and willing to profit from it. Since offenders are assumed to suffer from denial, lack of motivation to change, and unwillingness to cooperate with voluntary treatment, individual psychotherapy is generally thought to be ineffective. Suspicion and lack of rapport in the criminal justice context also interfere with effective use of the method. There are few reports on individual psychotherapy with sex offenders against children.
Group psychotherapy gives members the opportunity to share experiences, gain insight, learn to control unacceptable impulses, and find acceptance. Although used more commonly than individual psychotherapy, the effectiveness is unknown. There have been no replicable, controlled studies. One review found that studies were based on contradictory premises, could not be replicated due to vague descriptions, were not based on any theoretical understanding of adult-minor sexual behavior, did not include sufficient follow-up, and included vague assessments of effectiveness. There is as yet no evidence that sexual attraction of any sort can be altered.
An Analyzation of Both Approaches
Some studies suggest that sex offender treatment use multiple methods since offenders tend to have many problems (Langevin, 1983). No controlled studies have been conducted, and.
A blanket use of the same method on all offenders is ineffective because offenders differ according to their reasons for offending. Therefore, improved assessment is necessary.
The major goal of treatment for sex offenders is the prevention of sexual offenses in the future. However, there has been little evidence that treatment reduces recidivism. The type of treatment most likely to succeed is an individually tailored approach that includes careful assessment and uses many different cognitive-behavioral techniques to support individual behavior change. Unfortunately, there is little evidence for the effectiveness of many commonly used treatment approaches.
The most common approach to psychoanalytical therapy is group therapy that relies heavily upon punitive and hostile confrontation and a nonsystematic blend of psychoanalytic concepts and traditional talking therapy. There is often little or no effort to provide a theoretical base for the program. The result is a procedure that is essentially highly moralistic and reflects the judgmental emotional response of the society. Treating people with disordered behavior patterns as morally defective and requiring a change in moral commitments has a long history (Siegler & Osmond, 1974). Psychotherapy is a venture much studied and researched and there is an extensive literature on psychotherapy processes and outcomes (Siegler & Osmond, 1974).
VI. The Effectiveness of Therapeutic Treatment
The effectiveness of therapeutic treatment is often measured by its contribution to restoration of emotional health and normal functioning along with the subjective sense of well being of the individual. Normal behavior may be defined either by reference to the applicable social norms or by statistical frequency. Subjective well being or conformity to generally accepted norms in other areas is not sufficient to measure treatment outcomes. Some research has pointed out the negative effect of the therapy process. When a person is sentenced to sex offender treatment as part of a plea bargain or sentencing, the therapy itself may become punishment (Langevin, 1983). The person is ordered to attend treatment with an indeterminate sentence and usually cannot select the therapist or the program; therapy programs must be approved by the agencies in control (Langevin, 1983).
The therapist who provides such court-ordered treatment for sexual offenders must make regular reports to parole officers, judges, and child protection workers. The therapist is given the power to judge when the treatment has been successfully completed and discharge is granted.
If an admission of guilt is required before being admitted into a program, additional complications and potential hindrances to successful treatment are generated. There are no empirical data to demonstrate that a threshold admission of guilt has any relationship to outcomes.
The most important goal of treatment for sex offenders is that they refrain from committing sex offenses in the future. This goal is more important than emotional health or adjustment, self-esteem, feelings of well being, self-actualization, reported satisfaction with therapy, or improvement as measured by psychological tests. A review of the literature concludes that there are no studies wherein the empirical data provides strong evidence in favor of the positive effects of treatment (Finkelhor, 1983). These studies found little consensus about the continuance of sexual offenses following treatment and conclude that there is no evidence that clinical treatment effectively reduces recidivism (Finkelhor, 1983). Also, there are no data at present for assessing the relative effectiveness of treatment for different types of offenders.
Groups are seen as necessary and appropriate for all sexual offenders, regardless of their individual personalities and the factors underlying their abusive behavior.
The expression of feelings is absolutely required. Cognitive, learning theory-based approaches therefore may be seen as a way of allowing the accused to avoid dealing with feelings of remorse, guilt, or shame which are considered to be essential parts of treatment. Common treatment goals include bringing the perpetrator to the point where he admits all of his abusive behaviors, expresses guilt and remorse for them, and is willing to admit and apologize to the victim.
Conclusion & Final Analysis
The therapy modalities that have been used in treating sex offenders include cognitive behavior therapy and psychoanalytical therapy. The research clearly indicates that use of cognitive behavioral therapy is the superior methodology. Research has indicated that sexual preference is a powerful and persistent feature of human behavior and there is no evidence that therapy in any form can change it (Langevin, 1983). Since a key factor in the success in any treatment of sex offenders is motivating them to change, most offenders are resistant to giving up a sexual behavior pattern that they perceive as positive and rewarding.
Although there are little outcome data on treatment for sexual offenders, the approach that is most supported by what data are available is cognitive behavioral (Langevin, 1983). A large number of specific techniques and methods are included in the therapy possibilities that learning theory and a cognitive-behavioral strategy generate (Langevin, 1983). Cognitive behavioral techniques such as aversive conditioning, cognitive restructuring, covert sensitization, satiation, role playing, social skills training, and relaxation training are used in relapse prevention. Offenders learn to identify and anticipate high-risk situations, control their urges, develop more effective coping skills, maintain a more balanced lifestyle and gain a sense of control and self-efficacy. Through this process, it is hoped that they will be less apt to relapse and recommit a sexual offense. The relapse prevention model appears to be a promising treatment approach, although more data are needed in order to generalize the results of this outcome study.
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