A 25-Year Follow-Up of Cognitive/Behavioral Therapy with 7,275 Sexual Offenders

Abstract

Outcome data are presented, grouped into 5-year cohorts, for 7,275 sexual offenders entering a cognitive/behavioral treatment program. Assessment variables included treatment completion, self-admission of covert and/or overt deviant behaviors, the presence of deviant sexual arousal, or being recharged for any sexual crime (regardless of plea or conviction). It proved possible to follow 62% for the cohort at 5 years after initiating treatment, but follow-up completion rates decreased with time. Outcomes were significantly different based on offender subtype, with child molesters and exhibitionists achieving better overall success than pedophiles or rapists. Prematurely terminating treatment was a strong indicator of committing a new sexual offense. Of interest was the general improvement of success rates over each successive 5-year period for many types of offenders. Unfortunately, failure rates remained comparatively high for rapists (20%) and homosexual pedophiles (16%), regardless of when they were treated over the 25-year period. Implications for clinical practice and future research are drawn.

The Oregon depo-Provera Program: A Five-Year Follow-Up

“…MPA or other such medications, are only indicated for the most dangerous of such men, identified through an evaluation of both static (Nunes et al, 2002) and dynamic (Dempster & Hart, 2002) risk factors. The majority of sexual offenders will, in all likelihood, never require such medication because of the advances made in treatment programs (Aytes et al, 2001;Maletzky & Steinhauser, 2002) and the relative lack of immediate risk that they pose. It is also essential to recognize that medication such as MPA is most often administered on an involuntary basis and will almost certainly be discontinued once the offender gains release from parole.…”

“…Such men may have molested more than one child or may have committed a single rape. With proper supervision and treatment, their risk to reoffend within the first year following release is low (Looman, Abracen, & Nicholiachuk, 2000;Maletzky & Steinhauser, 2002). However, there remains a crucial population of men at immediate risk who might benefit from medical treatment to rapidly reduce sexual drive.…”

“…Therefore, recognizing that certain sexual offenders may pose a risk to reoffend following their release from prison and before they fully benefit from community-based treatment, the Oregon State Legislature in 1999 passed House Bill 2500, the first such program nationwide to establish a plan to evaluate inmates prior to their release to determine if they are appropriate for medical treatment. The Legislature realized that, although advances have been made in the cognitive and behavioral treatment of sexual offenders (Aytes, Olsen, Zakrajsek, Murray, & Ireson, 2001;Maletzky & Steinhauser, 2002), the majority of these offenders do not receive such treatment in state prisons. While treatment programs may be mandated for these men upon release, psychological approaches cannot be expected to reduce risk quickly.…”

“…Clinical experience also seems to indicate that these antidepressants do not reduce sexual drive to the same extent as do hormonal agents such as MPA and leuprolide (Maletzky & Steinhauser, 2002;Rosler & Witzum, 2000). Thus the choice of MPA has seemed to withstand the test of time, although newer agents may still be developed in the future.…”

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

“…While there is little information about the epidemiology of the paraphilic disorders, it is clear that a substantial proportion of those committing sexual offenses have such disorders. In a sample of 5223 sex offenders treated over a 25-year period in North America, 43% were diagnosed as being pedophiles (Maletzky, 2002), and Seto (2004) reported that “Conservatively, the prevalence of pedophilia among men who commit sexual offenses against children is around 50%, depending on the criterion used to identify pedophilia” (p. 8), and Seto suggested (2008) a prevalence rate of 1–3% for pedophilia in the male population. Eher, Rettenberger, Matthes, and Schilling (2010) found that of a sample of 114 males who were incarcerated for child molestation in the Austrian prison system, 74% had at least one paraphilic diagnosis, and 67% had a diagnosis of pedophilia.…”