The treatment of sex offenders is a controversial subject because of the potential pain and suffering that can be inflicted on others if the offender commits a repeat offense. Briken and Kafka (2007) state, "Sexual offences, especially those against children, invoke a public outcry for methods ranging from effective psychotherapeutic treatment modalities to stricter community support (including global position monitoring) and even to lifetime incarceration." Society demands that sexual predators need to either be completely rehabilitated or permanently incarcerated to prevent them from committing additional offenses.
Because of the financial and emotional costs of long-term incarceration, however, the concept of life sentences for all sex offenders is impractical. Adams (n.d.) argues that it is unreasonable to "keep serious sex offenders in prison for many years, providing them with no treatment and exposing them to violence which makes them more dangerous, and then spend million of dollars evaluating and "treating" them as sexually violent predators." It is neither fiscally sound nor constitutionally legal to permanently imprison sexual offenders or to place them under permanent house arrest (Adams, n.d.). In the end, therapy is the most promising solution for reducing the rates of repeat offenses by sexual predators.
Unfortunately, there is no one-size-fits-all treatment plan that is guaranteed to reduce recidivism among sexual offenders, and there is no way to determine who will commit repeat crimes after treatment. There are, however, several treatment options available. One method is a cognitive-behavioral approach, which seeks to change the thoughts and behaviors of an individual. Another widely used treatment method is the psychoeducational approach. This type of treatment attempts to correct deviant thoughts and behaviors by educating the individual about his or her motives for committing sexual crimes. Last, pharmacological treatments can be used to reduce the sexual drive of offenders through hormone therapy and serotonin inhibitors.
Cognitive Behavioral Approach
Cognitive behavioral therapy is a form of treatment that works to "change sex offenders' belief systems, eliminate inappropriate behavior, and increase appropriate behavior by modifying reinforcement contingencies so that offensive behavior is no longer reinforced" (Grossman et al., 1999). Grossman et al. (1999) indicate that the cognitive behavioral approach is widely used because it incorporates relapse prevention as part of the treatment program. The offenders receive explicit training in how to recognize high-risk situations as well as how to recognize the steps that precede a relapse, and they are taught strategies that will help them to resist their urges. These techniques can help reduce the rates of recidivism in the long-term.
One technique that is used in cognitive behavioral therapy is aversion therapy. The offender and the therapist work together to compile a list of the offender's deviant sexual fantasies, and as the fantasies are read aloud and discussed, a mild shock or a repugnant odor are released. The sexual offender begins to associate the fantasy with the shock or the odor, and the fantasy eventually loses its appeal. Another method is covert desensitization. Like aversion therapy, it pairs a deviant sexual fantasy with a less pleasant feature, such as an additional fantasy involving unpleasant consequences (Grossman et al., 1999).
Another approach that is commonly used in behavioral and cognitive therapy is called cognitive restructuring. Many sexual offenders rationalize their actions to alleviate their guilt over their offense, such as suggesting that their victims enjoyed the sexual activity or that the actions were consensual. Cognitive restructuring causes the sex offender to examine their misguided beliefs and to develop empathy for their victims (Grossman et al., 1999).
Studies have shown that behavioral and cognitive therapy has positive results for many offenders and significantly reduces the rates of recidivism. Kokish (n.d.) states,
"Given available data, it appears that out patient programs do much better than 11-14% offense reduction. In fact, it does not seem unreasonable to assume we reduce offences by a third or more, that we teach offenders empathy, encouraging them to treat others better in non-sexual ways as well, and that we make a significant contribution to their social functioning."
Psycho education is not a treatment program in itself, but instead, it is a component of a comprehensive cognitive behavior program. Psycho education is often used as an introduction to treatment. According to Zgoba et al. (2003), many relapse prevention programs are presented using psycho education modules. Psycho education is often presented in a classroom format. Therapists act as instructors who use textbooks and assign homework or other assignments to groups of individuals. These instructional sessions often include an introduction to the characteristics of sexual offenders. In psycho education classes, the therapist and patients discuss subjects such as the motives of people who commit sex crimes. The therapist also makes them aware of the different types and levels of sexual offenders. In addition, the module helps the offenders to understand what sort of therapy they will be receiving during the program. The psycho education modules may also contain such topics as anger management, sexual assault triggers and cycles, self-awareness, social skills training, and drug or alcohol abuse awareness. The theory is that by becoming more self-aware, individuals will become more responsible for their actions and more able to control their impulses (Zgoba et al. (2003).
Medical approaches to sexually deviant behavior are not a recent phenomenon. The practice of surgical castration for sexual offenders has been used for many years to prevent sexual predators from committing repeat offenses. However, there are ethical and human rights issues involved in the practice of surgical castration. An alternate approach to treating sexual offenders is by using pharmaceuticals that diminish sex drive or decrease an individual's ability to become aroused. The pharmacological approach to treatment for sex offenders is based on the theory that the behavior is motivated by sexual desires and that the behavior will change if the desire is lessened. To date, pharmacological treatments are showing promise in reducing deviant preferences in pedophiles. The most common pharmacological treatments in use are hormone therapy and serotonin inhibitors (Bradford, n.d.).
Hormone therapy is designed to reduce the amount of testosterone being produced in the body. This in turn reduces the sex drive. Two types of hormone treatments are Gonadotropin Releasing Hormones (GnRH) and Medroxyprogesterone Acetate (MPA). As well as reducing testosterone, these anti-androgens have a feminizing affect and can result in breast development, facial and bodily hair loss, and weight gain (Gillman, n.d.).
Serotonin specific reuptake inhibitors are otherwise known as SSRIs. This common antidepressant is often used to treat patients with obsessive compulsive disorder, but it is also showing promise as a form of treatment for sexual offenders. SSRIs work by lessening mood and anxiety issues, by decreasing stress, by reducing impulsivity, and by diminishing an individual's ability to be sexually aroused (Kafka, 2006).
In recent years, pharmaceuticals have been used in a process called chemical castration. Unlike surgical castration, chemical castration renders no irreversible physical alterations to the body. Instead, it reduces sexual urges through medical treatment. Birth control methods such as Depo-Provera are often used in the process of chemical castration (Meisenkothen, 1999).
Additional Ethical Issues
Many members of society believe that sexual offenders should be permanently incarcerated. Others suggest such extreme measures as physical castration for offenders. The treatment and rehabilitation of sexual offenders is a controversial social issue. The debate over their care extends to members of the psychiatric community. Some researchers believe that although sex offender programs may help individuals, the programs violate the rules of mental health treatment ethics. Many sexual abusers are motivated by external forces such as criminal prosecution or a court order that requires them to enter a treatment program. Many of these patients are not internally motivated to seek treatment. The lack of internal motivation can significantly increase the patient's chances for future recidivism. Secondly, the well-being of the offender is considered secondary in importance to the well-being of the community, which limits the offender's right to patient-therapist confidentiality and reduces the possibility of developing a trusting relationship between the patient and therapist, which is an important component of any treatment program (Glaser 2005).
The goal of treatment is to rehabilitate sex offenders and to return them to their communities. Although many members of the public at large feel that sexual offenders cannot be rehabilitated and that they should be permanently incarcerated, it is financially irresponsible and illegal to permanently remove individuals from society. In the end, treatment options such as behavioral and cognitive therapy, psycho education, and pharmaceutical intervention hold the most potential for the treatment of sexual offenders.
Adams, J. (n.d.). Expanding sex offender treatment. California Coalition on Sexual Offending. Retrieved January 31, 2010 from http://www.ccoso.org/newsletter/ExSOTx.doc
Bradford, J. & Kaye, N. (n.d.). The pharmacological treatment of sex offenders. Psychopharmacology Committee Newsletter Column. Retrieved January 31, 2010 from http://www.courtpsychiatrist.com/pdf/pharmacological%20treatment%20sex%20offenders.pdf
Briken, P. & Kafka, M. (2007). Pharmacological treatments for paraphilic patients and sexual offenders. Current Opinion in Psychiatry. Abstract retrieved January 31, 2010 from http://www.medscape.com/viewarticle/564897
Gilman, H. (n.d.). Antiandrogen treatment of sex offenders. Retrieved January 31, 2010 from http://www.nasmhpd.org/general_files/meeting_presentations/08%20Forensics/AntiAndr%20Tx%20Sex%20Off%20-%20Pitt.Gilman.pdf