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Psychological Treatment of Incarcerated Sex Offenders

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<strong>Psychological</strong> <strong>Treatment</strong> <strong>of</strong><br />

<strong>Incarcerated</strong> <strong>Sex</strong> <strong>Offenders</strong><br />

Óscar Herrero<br />

Secretaría General de Instituciones<br />

Penitenciarias<br />

Spain


<strong>Psychological</strong> <strong>Treatment</strong> <strong>of</strong><br />

<strong>Incarcerated</strong> <strong>Sex</strong> <strong>Offenders</strong><br />

• Why sex <strong>of</strong>fenders should be treated?<br />

• Which are the therapeutic targets?<br />

• The Program for the Control <strong>of</strong> <strong>Sex</strong>ual<br />

Assault: Structure and Characteristics.<br />

• Evaluation and results


SEXUAL OFFENCES 31/01/11<br />

121<br />

19<br />

763<br />

SEXUAL ASSAULT<br />

SEXUAL ABUSE<br />

SEXUAL STALKING<br />

EXHIBICIONSM AND OTHER NON<br />

CONTACT OFFENCES<br />

2095<br />

SEXUAL<br />

ASSAULT<br />

SEXUAL<br />

ABUSE<br />

SEXUAL<br />

STALKING<br />

EXHIB. AND OTHER<br />

NON CONTAC<br />

MALE 2086 754 121 19<br />

FEMALES 9 9 0 0<br />

TOTAL 2095 763 121 19


What is <strong>Sex</strong> Offender treatment?<br />

• In general terms:<br />

– <strong>Psychological</strong> intervention.<br />

– Delivered in group.<br />

– Cognitive-behavioral.<br />

– Seeks to induce positive changes.<br />

– Decrease re<strong>of</strong>fending.


Outcome Evaluations<br />

Meta-analysis <strong>Treatment</strong> Change in recidivism<br />

Reitzel & Carbonell,<br />

2006<br />

Gallagher et al. 1999<br />

Hanson et al. 2002<br />

Young sex <strong>of</strong>fenders -46%<br />

Adult and young sex<br />

<strong>of</strong>fenders<br />

Adult and young sex<br />

<strong>of</strong>fenders<br />

-36%<br />

-28%<br />

Lösel & Schmucker,<br />

2005<br />

Adult and young sex<br />

<strong>of</strong>fenders<br />

-24%<br />

Hall 1995<br />

Adult and young sex<br />

<strong>of</strong>fenders<br />

-24%


Outcome Evaluations<br />

Meta-analysis <strong>Treatment</strong> Change in recidivism<br />

Aos et al 2001 Young sex <strong>of</strong>fenders -12%<br />

Aos et al 2001 Adult sex <strong>of</strong>fender -10%<br />

Schmucker & Lösel,<br />

2008<br />

Young and adult sex<br />

<strong>of</strong>fenders<br />

-37%


Redondo & Garrido, 2008<br />

Therapeutic<br />

Gain 5-10%<br />

80%<br />

untreated no<br />

recidivist<br />

10-15% High<br />

Risk <strong>Offenders</strong><br />

20% untreated<br />

recidivist


Risk factors (I)<br />

Family<br />

Background<br />

•History <strong>of</strong><br />

child abuse.<br />

•Aggressive<br />

behaviour.<br />

•Insecure<br />

attachment<br />

style.<br />

<strong>Sex</strong>ual<br />

Behaviours<br />

•Early sexual<br />

interest<br />

•Impersonal sexual<br />

life<br />

•<strong>Sex</strong>ual<br />

preocupation<br />

•Deviant sexual<br />

arousal<br />

Cognitions<br />

•Cognitive<br />

distortions<br />

•Deviant sexual<br />

fantasies<br />

•Low IQ


Risk Factors (II)<br />

Emotions<br />

•Negative<br />

emotions<br />

•Lonelyness and<br />

inadequacy<br />

feelings.<br />

•Emotional<br />

poverty<br />

•Empathy deficits<br />

Lifestyle<br />

•Drugs &<br />

alcohol<br />

•Intimacy<br />

deficits<br />

•Absence <strong>of</strong><br />

regular habits<br />

Personality<br />

traits<br />

•Impulsivity<br />

•Antisocial<br />

traits


Static risk factors are<br />

unmodificable characteristics <strong>of</strong><br />

the individual<br />

Dynamic risk factors (i.e.<br />

criminogenic needs) tend to be<br />

stable but are amenable to change


The <strong>Sex</strong>ual Aggression Control<br />

Program


General Characteristics<br />

• Group therapy.<br />

• Voluntary.<br />

• Relapse prevention.<br />

• Long and intensive.<br />

• High commitment.<br />

• Non-pathological conceptualization <strong>of</strong> the<br />

<strong>of</strong>fender.<br />

• Oriented to self-control.<br />

• Oriented to the community.


Between 2006 and 2010, 810<br />

inmates have participated in the<br />

sex <strong>of</strong>fender program.<br />

The program is delivered in 33<br />

prisons.


The main therapeutic goal is to<br />

reduce re<strong>of</strong>fence rates among the<br />

treated <strong>of</strong>fenders<br />

This goal is reached through<br />

intermediate therapeutic goals


Therapeutic Goals<br />

• Increase empathy levels.<br />

• Reduce cognitive distortions.<br />

• Help the <strong>of</strong>fender to understand his<br />

own process <strong>of</strong> re<strong>of</strong>fence.<br />

• Training in coping strategies.<br />

• Decrease deviant sexual drive and<br />

fantasies.


Inclusion Criteria<br />

• Sentenced inmates.<br />

• <strong>Sex</strong>ual <strong>of</strong>fence (adult or child victims).<br />

• About two years away from conditional<br />

release.<br />

• Without major mental disorders o<br />

intellectual disabilities.<br />

• Literate in Spanish.


Therapeutic Team<br />

• Psychologist.<br />

• Social Worker.<br />

• Social Education Pr<strong>of</strong>essional.<br />

• Specific training in sex <strong>of</strong>fender<br />

treatment.


Structure<br />

• Biographical Analysis.<br />

• Emotional management.<br />

• Cognitive Distortions.<br />

• Empathy Training.<br />

• Lifestyle Change.<br />

• Deviant <strong>Sex</strong>ual Arousal.<br />

• <strong>Sex</strong>ual Education.<br />

• Relapse Prevention.


Avoidance and Approach goals<br />

Avoidance <strong>of</strong> risk<br />

factors such as<br />

drug and alcohol,<br />

pornography,<br />

negative emotional<br />

states, distorted<br />

thoughts, deviant<br />

sexual stimulus,<br />

inpersonal sex.<br />

Approach to protective<br />

elements like positive<br />

and significant<br />

relationships, healthy<br />

habits, sense <strong>of</strong> mastery<br />

and control over their<br />

lives


Case Formulation<br />

• In the last phase <strong>of</strong> the program the<br />

therapist builts:<br />

– An individual explanation <strong>of</strong> the <strong>of</strong>fence<br />

process.<br />

– An individual relapse prevention plan.


Marital Rape<br />

• <strong>Sex</strong>ual coercion is a common behavior<br />

in a spousal abuse situation.<br />

• The specific Intimate Partner Violence<br />

program includes a Marital Rape unit,<br />

where these behaviors are addressed.


Evaluation<br />

• Complex Design.<br />

• Involves several groups <strong>of</strong> inmates<br />

(treated and non treated sex <strong>of</strong>fenders).<br />

• Conducted by an independent team <strong>of</strong><br />

researchers (University <strong>of</strong> Barcelona).<br />

• Pre-post self-report measures and<br />

longitudinal follow-up <strong>of</strong> re<strong>of</strong>fence<br />

rates.


The <strong>Sex</strong>ual Aggression Scale<br />

• Self-report scale designed to measure<br />

the core psychological aspects <strong>of</strong><br />

sexual <strong>of</strong>fenders.<br />

• Subscales <strong>of</strong> Empathy, Cognitive<br />

Distortions, Self-Esteem, Social<br />

Inadequacy, Self-Control and <strong>Sex</strong>ual<br />

Anxiety.


CRIMINAL<br />

CARREER<br />

INITIAL<br />

ASSESMENT<br />

POST-RELEASE<br />

FOLLOW UP<br />

PRE INTERVENTION POST<br />

BEHAVIORAL<br />

TESTS<br />

EPAS<br />

REOFFENCE RATES


Self Report results


Research Design<br />

• Pre-post design.<br />

• Experimental and control groups<br />

• Non randomized assignment<br />

• Data collected in 37 prisons.


PRE<br />

POST<br />

TG-Adult <strong>of</strong>fenders<br />

N=211<br />

TG-Adult <strong>of</strong>fenders<br />

TG-Child molesters<br />

N=133<br />

TG-Child molesters<br />

CG-Adult <strong>of</strong>fenders<br />

N=122<br />

CG-Adult <strong>of</strong>fenders<br />

CG-Child molesters<br />

N=113<br />

CG-Child molesters


Demographic Data<br />

• Mean Age: 39.<br />

• Family background <strong>of</strong> substance abuse<br />

and mental disorders: 32%<br />

• History <strong>of</strong> Child <strong>Sex</strong>ual Abuse: 10%.<br />

• History <strong>of</strong> substance abuse: 50%.<br />

• Intrafamiliar victim: 23%


PRE<br />

POST<br />

TG-Adult <strong>of</strong>fenders<br />

TG-A pre ≠ TG-A post<br />

TG-Adult <strong>of</strong>fenders<br />

TG-A pre = CG-A pre<br />

TG-A pre = TG-CH pre<br />

TG-A post = TG-CH post<br />

TG-A post ≠ CG-A post<br />

TG-Child molesters<br />

TG-CH pre ≠ TG-CH po<br />

TG-Child molesters<br />

CG-Adult <strong>of</strong>fenders<br />

CG-A pre = CG-A post<br />

CG-Adult <strong>of</strong>fenders<br />

TG-CH pre = CG-CH pre<br />

TG-CH post ≠ CG-CH post<br />

CG-Child molesters<br />

CG-CH pre = CG-CH post<br />

CG-Child molesters


Adult <strong>Offenders</strong><br />

(<strong>Treatment</strong> – Control PRE)<br />

Sig = .4


Child Abusers<br />

(<strong>Treatment</strong> – Control PRE)<br />

Sig = .3


Adult <strong>Offenders</strong><br />

(PRE-POST)<br />

Sig = .000


Child Abusers<br />

(PRE-POST)<br />

Sig = .000


Adult <strong>Offenders</strong><br />

(Control – <strong>Treatment</strong> POST)<br />

Sig = .000


Child Abusers<br />

(<strong>Treatment</strong> – Control POST)<br />

Sig = .3


Adult <strong>Sex</strong> <strong>Offenders</strong><br />

(Subscales)<br />

• Significant differences were found for:<br />

– Self-esteem.<br />

– Cognitive distortions.<br />

– Self-control.<br />

– Empathy.


Child Abusers<br />

(Subscales)<br />

• Signifficant differences were found for:<br />

– Self-esteem.<br />

– Cognitive distortions.<br />

– Loneliness feelings.


Recidivism rates in the<br />

community


<strong>Sex</strong>ual recidivism<br />

• Sample 1:<br />

– 40 treated sex <strong>of</strong>fenders<br />

– 5 years follow up in the community<br />

– 17.5% (5) <strong>of</strong> non sexual recidivism<br />

– 5% (2) <strong>of</strong> sexual recidivism


<strong>Sex</strong>ual recidivism<br />

• Sample 2:<br />

– 60 treated sex <strong>of</strong>fenders<br />

– 2 years follow up in the community<br />

– 8.4% (5) <strong>of</strong> non sexual recidivism<br />

– 5% (3) <strong>of</strong> sexual recidivism


EMPIRICAL RECIDIVISM<br />

5% Treated &<br />

recidivist High<br />

Risk<br />

<strong>Offenders</strong><br />

95% treated non recidivist


Conclusions<br />

• There is a growing empirical evidence that<br />

supports the treatment <strong>of</strong> sex <strong>of</strong>fenders.<br />

• This program is implemented in near 50% <strong>of</strong><br />

the Spanish prisons.<br />

• Initial results suggest a positive<br />

psychological change in treated samples.

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