Treatment of High-Risk Sexual Offenders

Treatment of High-Risk Sexual Offenders addresses concrete management strategies, from initial intake to community treatment programs, and describes a detailed program for high risk offenders which has been developed, tested and refined for over 15 years.

• Provides a thorough review of contemporary theory and research relating to complex, challenging populations, and translates it into a comprehensive system of assessment and treatment for high risk sexual offenders
• Offers detailed coverage of setting and staff requirements, the importance of the therapeutic alliance, and how to balance individual therapy with group components in order to develop social and self-management skills
• Builds on the principle of integrative care, drawing on the established Risk-Need-Responsivity (RNR) model for offender assessment and rehabilitation but adding new components of CBT and motivational interviewing
• Includes a complete assessment battery and strategies for managing serious mental illness and comorbidity

Acknowledgements vii

Introduction viii

1 Background and Definitions 1

2 The Regional Treatment Centre High Intensity Sex Offender Treatment Program (RTCSOTP): Description of Group Characteristics and the Treatment Program 8

3 Treatment Outcome for High‐Risk Violent and Sexual Offenders 19

4 Therapist and Setting Characteristics 48

5 The Integrated Risk–Need–Responsivity (RNR‐I) Model 69

6 Etiological Factors: Attachment Theory and Complex Post‐Traumatic Stress 72

7 Combining Attachment Theory and Complex Post‐Traumatic Stress Disorder and Theories of Sexual Offending: The Integrated Risk–Need–Responsivity (RNR‐I) Model 83

8 The Good Lives Model and Sexual Offending 97

9 Therapeutic Orientation and Relevance to Assessment 106

10 Self‐Management Component 117

11 Social Skills and Individual Therapy 126

12 Alcohol Abuse, Drug Abuse, and Sexual Offending 154

13 Deviant Sexual Arousal 163

14 The Integrated Risk–Need–Responsivity Model (RNR‐I): Practical Applications for Assessment and Treatment of Sexual Offenders with Substance or Alcohol Abuse Disorders 177

15 A Model for Community Management 186

16 Summary and Conclusions 216

References 223

Appendix I: Decision Matrix 246

Appendix II: List of Pre‐ and Post‐treatment Measures 247

Appendix III: Goals for Professional Growth and Development 252

Index 255

Dr Jeffrey Abracen is Chief Psychologist with Central District Parole, Correctional Service of Canada. He was previously clinical director of the community based Methadone Maintenance Treatment Program, and until late 2011 was co-director of the Relapse Prevention Maintenance Program offered to sexual offenders in the Central District of Correctional Service of Canada. He has provided training related to the community treatment and supervision of sexual offenders to a variety of audiences and has more than thirty publications in peer-reviewed journals, as well as many conference presentations.

Dr Jan Looman is a psychologist working on the Forensic Unit of Providence Care Mental Health Services in Kingston, Canada, and was previously Clinical Manager at the Regional Treatment Center Ontario, a psychiatric hospital serving the Federal Prison system in Ontario. From 1997-2011 he was Program Director of the Regional Treatment Centre Sex Offender Treatment Program. For the past six years he has conducted Sexually Violent Predator assessments in Washington State. He has carried out training regarding the assessment and treatment of sex offenders at various conferences and workshops and has more than thirty peer-reviewed publications in this area.

The treatment and management of sexual offenders is a topic of great interest, but while much has been written about the treatment of sexual offenders generally, little has been written about the comprehensive treatment of groups of specifically high risk sexual offenders. Treatment of High-Risk Sexual Offenders addresses concrete management strategies, from initial intake to community treatment programs, and describes a detailed, complete program for high risk offenders which has been developed, tested and refined over 15 plus years, and has a strong empirical basis.

The model, which is based on the principle of integrative care, draws on the established Risk-Need-Responsivity (RNR) model for offender assessment and rehabilitation but adds new components of CBT and motivational interviewing. It gives specific consideration to the role of mental disorder and complex trauma in the development and maintenance of offending behaviour, areas which can often be neglected. Given the complex nature of this population, treatment focuses on both traditional criminogenic needs not specific to sexual offenders (e.g. substance abuse, criminal thinking styles) and sex offender specific issues (e.g. deviant arousal, intimacy deficits) in an integrated approach. A variety of outcome data related to two sex offender treatment programs managed by the authors, and described in detail, is included in the text.