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.