The clinical utility of satiation therapy with juvenile sexual offenders: Variations and efficacy

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders

“…In contrast to the previous study, in this particular study, there was no difference in outcome between offenders with a preference for female victims or male victims. Hunter and Goodwin ( 1992 ) reported on a study of 39 male adolescent sexual offenders (including a high proportion of learning disabilities and ADHD as comorbidities), who participated in a residential treatment programme, which included a minimum of 6 months of verbal satiation treatment ( Table I ). In addition, individual, group and family psychotherapy, which was non-behavioural and insight-orientated, was also used.…”

“…Mean age: 15.87 y (13–17) Previous history of sexual abuse : 80% Comorbidities : drug or alcohol abuse: 53–58% CBT (Becker et al 1988 ):Multicomponent treatment programme including:satiation therapy (extinction model) 4 sessions per week (1 h);laboratory satiation (1 h/week) (slides and plethysmography);covert sensitisation;social skills training; anger control and sex education Plus Inpatient residential programmeInsight-oriented individual psychotherapy (2 sessions per week)Insight-oriented group psychotherapy (1 session per week)Family therapy (1–2 sessions per month)Therapeutic milieuSubstance abuse counselling Duration of follow-up? Timepoints: Twice before treatmentMonthly Outcome measure : Plethysmography: Audiotape stimuli (conventional and deviant sexual behaviour) Plethysmography: Significant differences in terms of arousal (plethysmography): Female paedophiles (15): Non deviant/deviant arousal: 12% at baseline and 44% after 2-month treatmentArousal for non aggressive and aggressive sexual activity with a child decreased by respectively 32 and 35% Male paedophiles (12): Non deviant/deviant arousal: 37% at baseline and 62% after 2-month treatmentArousal for non aggressive and aggressive sexual activity with a child decreased by respectively 37 and 41% Hunter and Goodwin ( 1992 )USAOpen studyNo comparison group N =39 Males Sex offenders: 39 Victims: 18% males 38% females Type of paraphilia? Previous history of sexual abuse: 59% Mean age: 15.4 y Comorbidities: Learning disabilities +/ADHD 59%Mean total IQ: 94 Satiation therapy adapted to adolescents: Sexual thoughts and visual stimuli in conjunction with repetitive and prolonged exposure to deviant and non deviant stimuli (conditioning paradigm of extinction)4 sessions (1 h)/week Plus Individual group and family therapies insight-oriented and problem solving natureDuration of treatment: 6 months Duration of follow-up: 6 monthsAt 3 months: +15 min covert sensitisationIn 12 cases: 3 additional months of verbal plus laboratory satiation (slides and plethysmography)In 27 cases: verbal satiation for 3 additional months Timepoints: Prior to treatmentEvery month Outcome measures : Plethysmography :Auditory stimuli (conventional and deviant sexual behaviour) Plethysmography: At month 6: no differenceAt month 9:Deviant score significantly decreased as compared to baseline with verbal satiation only in 27/39 casesAge at time of admission was correlated with the deviance score at month 9 (deviant score lower in older sex offenders) Kaplan et al.…”

“…The study results indicate the following useful trends : when pre- and post-evaluation is available, it is in favour of the treatment group (as in adults), particularly in juvenile sexual offenders at moderate risk of reoffending; drop outs of treatment programmes do worse in the long term than sexual offenders who completed the programme (as in adults); differences between “older” and “younger” adolescents are suggested (Hunter and Goodwin, 1992 ); information concerning potential adverse outcomes of treatment is not available; motivation for treatment is generally not assessed. Due to the high rate of treatment non-compliance, incorporating into pre-treatment and treatment programmes strategies that minimise attrition may be helpful (Reitzel and Carbonell 2006 ).…”

Use of Satiation Therapy in the Treatment of Adolescent-Manifest Sexual Interest in Male Children

“…This suggests that its effect, at least initially, may not be specific. Here, data suggest that differential reduction of arousal to targeted deviant stimuli may not occur for several weeks or months, with some youth appearing refractory to the intervention even after 9 months of treatment (Hunter & Goodwin, 1992). Of perhaps even greater clinical concern is that the absence of an experimental design to most of the conducted studies on adolescents leaves open to question whether the introduced satiation therapy was the critical therapeutic agent responsible for the observed change.…”

“…Becker, Kaplan, Hunter, and their respective colleagues introduced adaptations of satiation therapy for use with adolescent male sexual offenders in the late 1980s and early 1990s (Becker, Kaplan, & Kavoussi, 1988;Hunter & Goodwin, 1992;Hunter & Santos, 1989;Kaplan, Morales, & Becker, 1993).…”