Table Of Contentebook
THE GUILFORD PRESS
TreaTing Sex OffenderS
Treating
Sex Offenders
A n E v i d E n c E - B A s E d M A n u A l
Jill D. Stinson
Judith V. Becker
THe gUiLfOrd PreSS
New York London
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About the Authors
Jill D. Stinson, PhD, is Assistant Professor in the Department of
Psychology at East Tennessee State University. Dr. Stinson formerly
served as the Sex Offender Treatment Coordinator at Fulton State Hos-
pital with the Missouri Department of Mental Health. She has worked
with sexual offenders with serious mental illness, intellectual/develop-
mental disabilities, and personality disorders, as well as with sexually
violent predators. Her research focuses broadly on psychopathology and
sexual offending, self-regulatory processes in persons with a history of
sexual offending and violent behavior, and specialized assessment and
treatment needs of forensic populations. Dr. Stinson is a member of the
Association for the Treatment of Sexual Abusers and the American Psy-
chology–Law Society.
Judith V. Becker, PhD, is Professor in the Department of Psychol-
ogy at the University of Arizona. Dr. Becker is a past president of the
Association for the Treatment of Sexual Abusers and the International
Academy of Sex Research, has served as editor of Sexual Abuse: A Journal
of Research and Treatment, and continues to serve on a number of edito-
rial boards. Her clinical research has focused on both adolescent and
adult sex offenders as well as victims of sexual abuse and aggression. Dr.
Becker is the author or coauthor of over 100 published journal articles
and book chapters in the professional literature. She also consults on
both criminal and civil forensic cases.
v
Preface
W
hy do people commit sex offenses, and what do we do with
them? These questions continue to be of major concern to our society.
We have viewed sexual offenders strictly as criminals—they commit sex
offenses because of a personal choice, prompted by some combination of
personal and situational variables—and unworthy of rehabilitation. At
other times, sexual offenders have been viewed more sympathetically,
through a lens of sexual and mental disorder, and attempts have been
made to provide treatment and rehabilitation. At present, what we do
with sex offenders seems driven primarily by social control policies that
have been enacted in an effort to make society safer. Mandatory sentenc-
ing, sex offender registration and notification, indeterminate civil com-
mitment, and other current practices emerge from this mindset. Yet the
effectiveness of such policies in reducing the rate of sexual crime has not
yet been empirically validated.
Although policies focused on control and safety have predominated
over the years, there have also been attempts at treating sex offenders.
Early treatment approaches utilized psychoanalysis, nonspecific group
process therapy, and aversive conditioning (to decrease sexual arousal),
among other models. During the 1970s and 1980s, a more comprehen-
sive treatment approach was introduced, one based on principles of
cognitive-behavioral therapy as well as relapse prevention, a treatment
adapted from the substance abuse literature. The majority of such pro-
grams were designed as “one-size-fits-all” group therapies, seldom tak-
ing into account the heterogeneity of the population and specific needs
an offender may have (e.g., intellectual or developmental disabilities,
complex behavioral problems, serious mental illness). Disappointing
results of outcome research from these models led to modifications in
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viii Preface
how offenders are classified. For example, the risk–needs–responsivity
(RNR) model has gained in popularity partly because of its recognition
of differing levels of risk, treatment need, and response to treatment
among sex offenders. The more recent introduction of the positive psy-
chology movement has led to the development of the good lives model
and revisions to standard relapse prevention protocols.
In our previous book (Stinson, Sales, & Becker, 2008) we criti-
cally reviewed and evaluated existing etiological explanations for sex-
ual offenses and developed one of our own based on the idea that self-
regulation and self-regulatory deficits underlie sexual offending as well
as other types of maladaptive or problematic behavior. This model—the
multi-modal self-regulation theory—has undergone preliminary analy-
sis and continues to demonstrate empirical validity. From this theory,
we have developed a corresponding intervention approach, called safe
offender strategies (SOS). This treatment has been in the pilot stages at
three sites since the fall of 2007, with client populations consisting of
forensic mental health inpatients, persons with intellectual and develop-
mental disabilities, and high-risk sex offenders. For such challenging cli-
ent cases, SOS has maintained a consistent theoretical framework while
allowing for individualized differences in client need.
As treatment providers, we see ourselves as consultants to the
patients; our role is to help motivate them, help them identify areas of
potential change, and help them work through complex, interactive areas
of need. Our basic philosophical premise is that people can change, and
that our clients can reach the readiness to change in an environment of
collaboration that will facilitate such a process.
Our treatment model consists of 10 modules, discussed in detail
in this book. We provide not only the foundation for the approach we
use but also the necessary tools and strategies to help clinicians with
individualized treatment planning and the development of a productive
and beneficial therapist–patient relationship. Key elements of this treat-
ment include developing adaptive self-regulation skills, self-monitoring
and self-management, forming healthy and normative interpersonal
boundaries and social bonds, and addressing important life needs like
emotional stability, balanced thinking, and a sense of self-control. Such
needs cannot be met without compassionate and involved clinicians. Sex
offender treatment is challenging for both clients and treatment provid-
ers. With this book we hope to help you with this task.
