David S. Prescott, LICSW

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Book Reviews:

Treating Sex Offenders: An Introduction to Sex Offender Treatment Programmes
by Sarah Brown


Offending Identities: Sex Offenders’ Perspectives on their Management and Treatment
by Kirsty Hudson

Reviewed by David Prescott, Forum Editor
Appeared in The ATSA Forum Newsletter, Winter 2006

Two books by Willan Publishing, available at www.willanpublishing.co.uk, and info@willanpublishing.co.uk

Willan Publishing has developed into a strong international publisher. Featuring primarily British authors and editors, Willan designs its books to suit an international audience. The results are informative and provide diverse perspectives to readers.

Treating Sex Offenders: An Introduction to Sex Offender Treatment Programmes
by Sarah Brown, 2005
282 pages, $32.50 USD

Although describing itself as “an introduction to sex offender treatment programmes, designed for students and practitioners coming to this field”, experienced practitioners will also find much to ponder. Ms. Brown provides a comprehensive literature review and presents the various sides of controversial issues (e.g., treatment effectiveness) with refreshingly plain language and without partisanship. In most cases, she accomplishes this by quoting leading researchers and practitioners, often at their boldest. The result is a worthwhile introduction to some of our field’s most thoughtful dialogue, one that lets readers draw their own conclusions or chart their own further study.

After a basic introduction covering the basics of the sex offender populations and the criminal justice systems response to them, Ms. Brown provides a chapter on the development and history of treatment programmes. From the “sexual psychopath” laws of the late 1930s, through Martinson’s “Nothing works” essay of 1974, and its subsequent reappraisals, to the more recent treatment meta-analyses, Brown gives a comprehensive synopsis of key elements of our field’s history, concluding with the rise of cognitive-behavioral treatment.

Brown next addresses the basics of cognitive-behavioral treatment and describes its use in programs in Canada, the USA, the UK and Ireland, Australia, New Zealand, and elsewhere around the world. This chapter will be very informative to American readers, who all too often have little access to information about what is unfolding elsewhere. Although intended as introductory, the differences in development and organization among programs are thought provoking in themselves. A chapter on the theoretical underpinnings of programmes follows, with a succinct focus on the theories and models of such authors as Hall and Hirschman, Marshall and Barbaree, Finkelhor, Wolfe, and Ward and Siegert. Although resembling a similar overview in Ward, Laws, and Hudson’s 2003 “Sexual Deviance: Issues and Controversies”, Brown seeks to highlight the conclusions of others rather than draw the reader in any particular direction.

Brown next provides a chapter on “treatment ethos and effects on staff”. While this topic has attracted much interest on the ATSA list-serve, members will notice that it draws more heavily on British studies. A chapter on basic treatment goals follows, and includes discussion around such topics as denial and minimization, empathy, sexual arousal and fantasy, and cognitive restructuring.

The centerpiece of this volume is three chapters on whether programs are effective. One chapter focuses on the inherent difficulties in program evaluation. This includes a helpful overview of various design studies and their limitations, and areas of controversy. Evaluation problems such as the effects of treatment refusal and dropouts receive consideration, as well as discussion around defining recidivism. The next chapter examines outcome studies in North America, the UK, Australia, New Zealand, and the various meta-analyses to the present. A final chapter discusses “what works”, from cost-benefit analyses to which populations seem to show the most benefit. Offender characteristics, treatment compliance, group cohesion, and therapist characteristics are among the topics discussed.

“Treating Sex Offenders” provides a strong emphasis on evidence-based practice without pursuing a specific agenda. As an introductory text, there are areas that experienced professionals will miss, including sexological perspectives and applied skills such as therapeutic engagement. The references to psychiatric comorbidity, while helpful, do not necessarily open the way for practitioners to develop methods for balancing treatment needs and establishing a stable environment conducive to change. Hopefully, Ms. Brown can address these and other aspects in future volumes.

Offending Identities: Sex Offenders’ Perspectives on their Management and Treatment
by Kirsty Hudson, 2005
204 pages, $55.00 USD

This book explores the self-reported attitudes of 32 men convicted for sex offenses and attending three treatment programs in the UK: The prison-based Sex Offender Treatment Programme, the Behavior Assessment Programme (a program for those denying their offenses), and the community-based Sex Offender Groupwork Programme. The author seeks to promote an understanding of the subjects’ perceptions of their treatment and management to add to our field’s knowledge of “what works.” As in other areas, the use of self-report both helps and hinders in this project.

Starting with an overview of methods put into place for the management and treatment of men who have sexually abused in the UK, Hudson recounts a number of local events, such as the “Name and Shame” campaign of a Sunday tabloid that resulted in disorder and vigilantism. She then focuses on the changing purpose of the criminal justice system, away from pure rehabilitation and towards community safety and reduced risk. For American audiences coming to terms with the recent changes in notification and registration, this section provides both parallel and alternative perspectives towards the interaction of treatment and policy. Unfortunately, Hudson does not explore this area deeply. Given the numerous lenses through which professionals can view the problem of sexual abuse (e.g., criminological, psychological, sexological) and the process of change (e.g., cognitive, behavioral, emotional, etc.), deeper exploration could both inform and challenge.

Acknowledging the discrepancy between internal and external motivations for change (e.g., wanting to improve one’s self versus wanting to improve one’s restrictions), Hudson demonstrates how external factors can encourage treatment participants to appear engaged without fully changing their thoughts and behaviors, and highlights the dangers involved in mistaking outward appearance for inward change. Startling examples include self-reported attitudes towards victim empathy letters. While many in the survey felt that the empathy sections had the greatest impact on their desire to change, others produced seemingly meaningful letters to their victims, while privately acknowledging their lack of investment in the process. For example, one participant stated:

“With any interrogation, torture, whatever you call it, you’re going to break and say whatever the interrogator wants you to say. It’s just human nature, you can’t hold out indefinitely.” (p. 112)

Another participant was more succinct:

“I’ll sit up and bark as long as they give me the biscuits.” (p. 113)

These stark observations aside, Hudson provides useful information about what participants found most helpful in becoming engaged in treatment, including the consistent use of two facilitators, preferably of both genders. Participants were able to recognize that prison officers were not present solely as authoritarian figures, and reported feeling listened to, supported, and respected by facilitators.

A later chapter focuses on two case examples of men who sexually abused again while in treatment. Both men had apparently done well in community-based treatment. Hudson initially reiterates others’ concerns that change in prison remains unproven until tested by community reintegration, and notes that the external rewards of treatment participation, such as reduced supervision, are a strong inducement to hide aspects of their true risk for re-offense. Nevertheless, information obtained in treatment could have been instrumental to others’ recognizing imminence in at least one, if not both of those who re-offended. A review of the participants’ statements regarding registration calls its utility as a risk reduction measure into question.

Hudson concludes by reviewing three barriers that prevented participants from investing themselves more fully. These include the extrinsic factors involved in treatment participation, the tendency to say only those things that will enable a person to move through treatment, and the tendency to conceal risk in order to move through treatment. Hudson notes that the Behavior Assessment Program for deniers, while not including disclosure of offenses, may actually avoid many of these pitfalls by enabling participants to discuss strategies for reducing risk with less potential for self-incrimination.

Very few authors have examined sexual abusers perceptions of their treatment, and fewer still have provided self-report quotations. There is clear benefit to readers interested in populations outside their own, looking at treatment from a different perspective, or who are interested in the structure of self-report statements. In many instances, these reports clarify where professionals can improve their skills at creating an environment conducive to change and using data collected to facilitate the beginnings of future self-management. Many of Hudson's observations are astute, and she is clearly exhaustive in her interview process.

On the other hand, readers will want to prepare for a number of shortcomings. In many instances, there is less discussion of the participants’ statements than might be useful. Although Hudson occasionally cautions that many of the statements could reflect ongoing efforts to manipulate or deceive, there are many times when it is unclear whether the statements are little more than defensive attempts to deflect responsibility. There is little accounting for the participants’ willingness to distort information. Practical application is problematic: Is the reader profiting from where other programs fall short, or seeing in print many of the same evasive responses that are commonplace in treatment? In some cases, the statements appear profoundly antisocial, but implications for practice are lacking. Should treatment providers target antisocial attitudes early in the treatment sequence, or throughout the process? Unfortunately, the study makes few recommendations beyond calling attention to the contextual barriers that interfere with treatment, often as the result of policy.

Hudson’s approach will appeal to those concerned with policy and treatment. While not entirely reflective of extensive clinical experience, the study’s observations and subsequent areas for further inquiry will interest to those providing treatment under increasingly challenging legal and societal circumstances.

David S. Prescott, LICSW – PMB 210 - 190 US Route 1 – Falmouth, ME 04105
Email: DSP@DavidPrescott.net

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