Intervention programs for sexual assault offenders include both prison-based and community-based programs, and are predominantly based on a psychological approach.
It is interesting to note that, while a wide range of theoretical approaches and models exist for intervention programs targeting domestic violence offenders, intervention programs for sexual assault offenders are less varied. This may be because sex offender intervention programs are more likely to be court-mandated and have been more strongly influenced by psychological perspectives.
Psychological intervention programs for sexual assault offenders (e.g., see Chung et al., 2006; Schmucker & Lösel, 2008) include aversion therapy, systemic family therapy, schema-focused therapy, and CBT, with CBT being the most prevalent form of intervention. Intervention approaches such as relapse prevention and a strengths-based or good lives model are typically incorporated in contemporary intervention programs based on a cognitive behavioural approach (e.g., Witt, Greenfield & Hiscox, 2008). CBT programs typically seek to address denial, behavioural motivation, cognitive distortions, empathy, anger management, social skills and self-esteem (Gelb, 2007).
A more recent approach to sexual offender intervention is the good lives model, which has a more psycho-therapeutic approach. The good lives model focuses on the strengths of the offender and supports the offender to develop personal and social competence to obtain ‘human goods’ (e.g., intimacy, autonomy and knowledge) and lead an adaptive and productive life (Chung et al., 2006; Murphy & McGrath, 2008; Prescott & Levenson, 2009).
While biological interventions such as hormonal therapy and organic treatments (e.g., surgical castration and steretoxic neurosurgery) have been less commonly used for sex offenders , there is increasing interest in the use of pharmacotherapies (e.g., antiandrogenic agents and selective serotonin re-uptake inhibitors) to reduce libido among sex offenders (e.g., Greenfield, 2006). Some sex offender programs in Australia are delivered in conjunction with pharmacotherapy.
Australian States and Territories vary in the nature and range of prison-based sex offender programs (see Heseltine, Sarre & Day, 2011). In NSW, Queensland and Victoria, there are programs that specifically designed for offenders with intellectual disability (or low IQ). Programs for Aboriginal sex offenders can be found in Queensland and WA. There are also preparatory programs (i.e., programs to prepare offenders for entry into the core program) for sex offenders (in NSW, Queensland and WA). While these prison-based programs typically have a psycho-educational orientation that incorporates CBT, they vary considerably in intensity and duration. All programs involve a risk or needs assessment prior to program participation.
3.4.2Program evaluation and effectiveness
Early work to evaluate the effectiveness of single intervention programs for sexual assault offenders produced mixed findings, with no conclusive evidence on program effectiveness in reducing recidivism (e.g., Prescott & Levenson, 2009).
Recent meta-analyses, however, provided some evidence for the effectiveness of sexual offender intervention programs (e.g., Hanson et al., 2009; Schmucker & Lösel, 2008). Taken together, findings of evaluation studies suggest that CBT is the most effective psychological approach for reducing sexual recidivism (Chung et al., 2006). It is worth noting that the lack of empirical studies on more recent intervention approaches such as the Good Lives Model does not necessarily mean they are less effective relative to CBT programs. CBT approaches have a longer history and are more readily assessed in experimental or quasi-experimental designs, hence, there are also more empirical evidence relating to their effectiveness.
In a meta-analysis conducted by Schmucker and Lösel (2008), it was found that while the majority of evaluations did not employ a true experimental design to isolate treatment effects (e.g., random assignment and a comparable control group), interventions based on a cognitive-behavioural approach and hormonal treatment demonstrated relatively consistent reductions in recidivism post-treatment. Psychological approaches with a therapeutic or insight focus were not found to be effective interventions. In addition, it was found that large effects (on program effectiveness) tend to be obtained in studies with small sample sizes and a quasi-experimental design. Larger effects were also found when the researcher was involved in the delivery of intervention programs and when multiple data sources were used to assess recidivism.
A recent USA study of the Custody-Based Intensive Treatment (CUBIT) and CUBIT Outreach (CORE), which are based on CBT, showed that among those who received treatment, rates of recidivism – for both sexual and general criminal offences – was lower than the expected recidivism rates for sexual and violent offences (see Gelb, 2007; Woodrow & Bright, 2010). CUBIT was found to facilitate the use of effective coping strategies, reduce feelings of loneliness, improve offenders’ ability to form intimate relationships, and reduce thinking patterns that encourage sexual offending.
In Australia, five evaluation studies of adult sex offender programs have been undertaken (for a review, see Heseltine, Sarre & Day, 2011; Macgregor, 2008). Notably, the majority of these programs incorporate a range of approaches, including CBT, Good Lives Model, gendered analysis, empathy, and relationships and emotion management.
An evaluation of the NSW CUBIT and CORE Outreach program (Hoy & Bright, 2008, cited in Macgregor, 2008) showed a reduction in recidivism among offenders who completed the CUBIT program compared to the predicted sexual recidivism rate of 26%. It is important to note, however, that there was no control group. The 2007 evaluation of the Sex Offender Programs (SOP) unit in Victoria (Owen et al., in press, cited in Macgregor, 2008) found that high risk offenders were more likely to reoffend sexually than those categorised as medium or low risk. Program completers were also found to reoffend at a lower rate compared to those who dropped out. While no matched control group was used for comparison, recidivism for treatment completers was 4%, which is substantially lower than the figure obtained for most programs nationally and internationally.
In contrast, the 2002 evaluation of the Western Australian Sex Offender Treatment Unit (SOTU) (Greenberg, Da Silva & Loh, 2002, cited in Macgregor, 2008) indicated that there was no significant difference in sexual recidivism between treated and non-treated offenders. However, this finding might have been the results of systematic differences between treated and non-treated (control) groups (i.e., non- equivalence) in terms of offender characteristics such as sentence length and Aboriginal status (Lievore, 2004).
The evaluation of the Queensland Sexual Offender Treatment Program (SOTP; Schweitzer & Dwyer, 2003) showed no significant differences in recidivism among program completers, dropouts and a matched control group. A history of violent sexual offences was, however, related to recidivism. The researchers suggested that considerable missing data and limited and inconsistencies in follow-up periods might have contributed to the lack of program effects.
A recent review of the South Australian Sexual Behaviour Clinic (both prison- and community-based) undertaken by the Department of Correctional Services (Proeve, 2010) found that program content was largely in line with current literature on best practice. Additionally, it was found that although facilitators sometimes included activities that were outside the program manual, these activities had a logical rationale or were designed to engage program participants. Program attendance and completion rates were found to be high, with completion rates being higher among non-Aboriginal perpetrators and perpetrators with child victims. No difference in completion rates were found between those who denied and those who admitted to their offences. Program completers showed small to moderate reductions in risk of sexual recidivism following program completion. The overall rate of recidivism was found to be low among program completers.
Recommendations made by this review highlighted the need to:
assess the intellectual ability of offenders prior to program participation
individualise case formulations for those with mental health issues, female offenders and those with conviction for child pornography offences
address attitudes of sexual entitlement and deviant sexual fantasy (the need for facilitators to be able to identify the presence of, and have the skills to address, these attitudes and fantasies)
develop and implement guidelines for referrals
ensure facilitators have knowledge and skills in group processes
develop a treatment framework that includes a focus on pro-social identity and pro-social goals
It can be seen that evaluations of Australian sex offender intervention programs have produced inconsistent findings. Although there are some evidence of program effectiveness in reducing recidivism, it is unclear what program components are responsible for the behavioural change, and there are also methodological limitations to existing evaluations.
It is noteworthy that the RNR principles have been much more widely articulated in the design and evaluation of sexual assault than domestic violence offender intervention programs. These principles are widely endorsed by researchers in sexual offender treatment as best practice elements, and intervention programs that have greater adherence to the RNR principles were found to be more effective in reducing recidivism (e.g., see Hanson et al., 2009; Murphy & McGrath, 2008).
Murphy and McGrath (2008) identified a set of best practice principles in offender treatment:
a clear, evidence-based model of change (e.g., the Good Lives Model)
provide staff appropriate training and supervision
conduct ongoing program monitoring and evaluation.
While there is increasing argument for the need to match interventions to offender characteristics (i.e., intervention at the individual level), it is also important to address the socio-structural factors that perpetuate domestic and sexual violence (i.e., intervention at the societal level).