Sex offender treatment programs — in which offenders follow a syllabus aimed at “normalizing” their sexual impulses and fantasies — have not been shown to reduce the likelihood that sex offenders will change their behaviour after they get out of jail, forensic psychiatrist David K. Ho argued this week in the BMJ medical journal.
The treatment centres around discussions focusing on triggers, thinking styles, impact on victims, emotional management, and intimacy skills. In the UK, sex offenders who complete 86 treatment sessions are eligible for early release from prison.
But the majority of offenders released back into society still pose the same level of risk as they did before the treatment program, according to research cited by Ho.
Ho, it bears noting, has previously advocated — based on on anecdotal evidence — for the pharmacological treatment of sex offenders, and his BMJ editorial dismissed the current therapy-based programs out of hand.
“Sex offenders are sent to prison, undergo this treatment programme, are deemed to have been somewhat rehabilitated, and are released to the public,” Ho wrote. “However, they are as likely to offend as before receiving treatment.”
Despite Ho’s misgivings, some studies have in fact shown that certain non-pharmacological rehabilitation programs, cognitive behavioural therapy in particular, could be promising. The UK’s Ministry of Justice endorsed this approach as well (a stance directly contested by Ho in another editorial).
The real problem may be that we don’t actually know what works.
In 2012, a major review of sex offender treatment programs concluded that for a regimen that has been imposed on so many prisoners, there had not been nearly enough research proving its worth. No one has done studies rigorous enough to prove that it’s useless either, though — and that lack of data is a real problem. “Not only could this result in the continued use of ineffective (and potentially harmful) interventions, but it also means that society is lured into a false sense of security in the belief that once the individual has been treated, their risk of reoffending is reduced,” the authors wrote. “Current available evidence does not support this belief.”
While Ho’s article addresses sex offender programs in the UK, activists in the US — particularly the American Psychiatric Association — have also advocated for more effective treatment of sex offenders before they are released back into society.
Currently, the Adam Walsh Child Protection and Safety Act allows the federal Bureau of Prisons to keep sex offenders in prison past their release date if it appears that they will have “serious difficulty in refraining from sexually violent conduct or child molestation if released,” according to the New Yorker. But this prolonged internment often amounts to a form of preventative detention in which prison psychologists, and not unaffiliated mental health professionals, decide to confine offenders “without a reasonable prospect of beneficial treatment of the underlying disorder,” the American Psychiatric Association has stated.
Sex offenders who receive outpatient treatment are less likely to repeat offend than those who don’t receive this treatment, but the efficacy of sex offenders’ treatment while in prison is questionable at best. “Treatment varies widely — most programs combine cognitive behavioural therapy with lessons about empathy and anger management — and, in most cases, never ends,” writes Rachel Aviv in the New Yorker.
Independent studies of the effectiveness of in-prison treatment programs for sex offenders have shown that evidence-based programs — things like cognitive behavioural therapy, which has some actual research backing it up — can reduce recidivism by up to 15%, according to a report by the Washington State Institute for Public Policy cited by the Huffington Post.
But many offenders are still released to the public without the kind of post-release supervision that would help them find housing and a job. Paul Heroux, a criminologist and Massachusetts State Representative, argues that with so much focus on treatment and rehabilitation, people often overlook basic needs like housing and a job, which are desperately needed to help sex offenders (and all offenders) remain crime-free after their release.
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