Does treatment for sexual offending behavior increase or decrease the likelihood of reoffending?

In most jurisdictions in the United States, a person convicted of a sex crime is mandated to treatment.  This treatment tends to be group therapy with the primary modality being Cognitive Behavior Therapy, also known as CBT.  As a community of treatment provider0,s we are always striving to improve our practices, use evidenced based treatment modalities and use the interventions best suited to our clients to help decrease their risk of recidivism.  So the question of whether or not what we are doing is helpful or harmful comes up, we need to pay attention.

The keynote address Thursday morning at this year’s ATSA conference was by Dr. Teresa Gannon.  She presented her recently published meta-analysis of the effectiveness of sexual offender treatment.  This article was recently published in Clinical Psychology Review and is open access.  The study looked at all types of violent offending but Dr. Gannon spoke this morning specifically about treatment for sexual offending.

There have been some studies that have been published that have provided a grim picture of treatment.  Most specifically, Dr. Gannon points to a 2017 report from the UK Ministry of Justice that stated that people who had committed sexual crimes and had treatment had a 25% increase in their rates of recidivism.  To those of us who do this work, that is a shocking number.  No treatment provider wants to do more harm than good and none of us would ever knowingly do anything that would increase the risk of harm to anyone. 

Enter Dr. Gannon and her colleagues.  They embarked on a meta-analysis of 70 studies on offending behavior.  Specifically they also looked at variables that could influence treatment outcomes.  Their work asked three specific questions.  1). Does offense specific treatment influence recidivism risk?   2). Is a trained psychology professional needed?  And 3). What program variables are important for success.  Again, if you want to read the full journal, you can obtain it free from the journal Clinical Psychology Review. 

The results of the meta-analysis were both encouraging and enlightening.  The results indicated that over a 6 year follow up period, those individual who engaged in sex offender specific treatment reoffended at a rate of 9.5% and those individuals who did not attend sex offender specific treatment reoffended at a rate of 14.1%.  This means that those who attended treatment were 32.6% less likely to reoffend than those individuals who did not attend treatment.  This result is the encouraging part.

The next set of results elucidated what program variables were important for reductions in recidivism.  The first important question involved the presence of a licensed psychology professional.  Was there a licensed professional involved in provision of treatment?  This was broken down into unclear/none meaning that a psychology professional was not directly involved with providing treatment or it was unclear.  The other categories were inconsistent and consistent.  The results indicated that treatment is more effective when a psychology professional is consistently hands on in the treatment process. 

The last set of factors that were investigated involved actual variables in the treatment program.  It was found that offenders who attended group only had better outcomes than those who attended group and individual therapy.  Those programs where there was supervision by a licensed psychology professional had better outcomes.  Programs that used arousal conditioning had lower recidivism rates and those programs that did not use the polygraph had better outcomes than those programs that did use polygraph testing. 

This meta-analysis posits that when providing treatment for people who have sexually offended, we need to think about several key elements shown in this study to improve outcomes and reduce recidivism.  The most effective treatment programs had the following characteristics:  A licensed psychology professional with expertise in treating sexual offenders, who is hands on and consistent in the treatment.  Inappropriate sexual interest is addressed.  It is group based and supervision by a psychology professional is provided.  The polygraph is not used in treatment. 

On a side note, the study indicated that the countries with the best outcomes for treated offenders were Canada, New Zealand and Australia. 

This is the most up to date meta-analysis of sexual offender treatment efficacy published.  It is the first to provide some evidence for the efficacy of arousal conditioning.  It also indicates that it is not just treatment that is effective but treatment provided by individuals with expertise in the field and offer supervision to treatment providers. 

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