Historical developments in sex offender treatment
Historical developments in sex offender treatment
W. L. Marshall1* & Clive Hollin2 1Rockwood Psychological Services, Kingston, ON, Canada & 2Centre for Applied Psychology, University of Leicester, Leicester, UK
Abstract This paper describes our view of the important developments in the history of sex offender treatment with a particular emphasis on aspects of this growth in the UK. We begin where, in our view, treatment of sex offenders was first implemented; that is, at the Institute of Psychiatry in London. After the move across the Atlantic, we note the beginnings of more comprehensive programmes in North America which morphed into the Relapse Prevention model. The implementation of comprehensive programmes in Her Majesty’s Prisons led not only to further refinements but also offered the opportunity for researchers to explore all manner of possibilities. The more recent focus on strength-based approaches is examined, and we then spell out our hopes for the future in terms of treatment, assessment and theory.
Keywords Sex offender treatment; historical developments; treatment programs; assessments; Sex offenders
In the Departments of Psychology and Psychiatry at the University of London’s Institute of Psychiatry in the 1950s, the nascent behaviour therapy movement was beginning to emerge. Treatments for various disorders, including problematic sexual behaviours, were being developed at the institute. Clinicians/researchers like psychologist Stanley (Jack) Rachman and psychiatrists Malcolm Gelder, Isaac Marks and John Bancroft developed treatment approaches for various types of paraphilic behaviours. These early approaches, however, were mostly limited to reducing deviant sexual interests using a variety of aversive conditioning procedures (see Laws & Marshall, 2003, for a review of those early studies). These approaches were soon exported to North America (e.g., Abel, Levis, & Clancy, 1970; Bond & Evans, 1967; Marshall, 1971), where they were rapidly expanded into programmes that incorporated other targets and other strategies (e.g., Abel, Blanchard, & Becker, 1978; Marshall & Williams, 1975). These latter programmes described the first attempts in North America to assimilate the emerging cognitive behaviour therapy (CBT) movement into sex offender treatment. Subsequently, almost all treatment programmes in North America have been described by their authors as CBT with the later addition of relapse prevention (RP) components (see Pithers, Marquis, Gibat, & Marlatt, 1983). Ultimately, CBT/RP approaches
*Corresponding author. E-mail: bill@rockwoodpsyc.com Like memory, history is a reconstruction and, again like memory, this reconstruction is always from a personal point of view. Therefore, we apologise for all those who have made significant contributions, but who we have omitted to mention. We have simply tried to identify major threads in the historical record.
Journal of Sexual Aggression, 2015 Vol. 21, No. 2, 125–135, http://dx.doi.org/10.1080/13552600.2014.980339
© 2014 National Organisation for the Treatment of Abusers
mailto:bill@rockwoodpsyc.com
http://dx.doi.org/10.1080/13552600.2014.980339
came to dominate North American programmes and influenced treatment in the UK and some European countries as well as in Australia and in New Zealand.
The results of three meta-analytic studies (Hanson, Bourgon, Helmus, & Hodgson, 2009; Hanson et al., 2002; Lösel & Schmucker, 2005) of treatment outcome encouraged optimism that the treatment of sex offenders could produce reductions in subsequent reoffending and that CBT appeared to be the most promising approach. These studies, along with the development of actuarial risk assessment instruments (see review by Craig, Browne, & Beech, 2008), and particularly the identification of criminogenic factors (see a recent appraisal by Mann, Hanson, & Thornton, 2010) markedly advanced the empirical basis of both assessment and treatment. While the adoption of the actuarial risk assessment approach has been widespread, the adaptation of treatment programmes to incorporate the findings on criminogenic factors has not been as universal. As surveys of North American programmes by the Safer Society (McGrath, Cumming, & Burchard, 2003; McGrath, Cumming, Burchard, Zeoli, & Ellerby, 2010) have revealed, many still address numerous non-criminogenic targets and at the same time fail to address all criminogenic factors. Apparently, evidence takes some time to persuade treatment providers to change what they view as their tried-and-true approaches. When Hanson et al. (2009) demonstrated that Andrews’ (Andrews & Bonta, 2006) Principles of Effective Offender Treatment applied equally to sex offender treatment, a basis was provided for the emergence of a rational, empirically sound treatment approach with sex offenders. Again, however, the field has been slow to adapt.
The negative emphasis of the RP model seemed to many treatment providers to fit well with Salter’s (1988) confrontational approach. In combination, these two models encouraged a negative view, not just of the criminal behaviours of sex offenders, which we all consider to be repulsive, but of the offenders as human beings, as if they had no saving graces and as if they were devoid of any strengths. Therapists following these models aggressively challenged clients at the outset and pressured them to agree with every detail provided in the victim’s statement and the police reports; not the usual way therapy is done with other Axis 1 or Axis 2 disorders. Good therapists work initially to establish confidence in their clients and to develop a positive and respectful relationship before moving on to more difficult issues. We might ask why did so many sex offender treatment providers decide that years of research in all other fields of therapy was irrelevant to dealing with sex offenders; fortunately some did not. For example, Tony Ward’s (2002) Good Lives Model (GLM) has spurred at least some treatment providers to think differently about their clients. What Ward’s GLM suggested was that the model advocated by Salter (1988), which had come to dominate programmes in the USA, was ill-founded and was more likely than not to reduce the effects of treatment.
What follows in this paper is our personal view of the important developments in the sex offender field. For convenience, we will break this into three parts: (1) developments in North America; (2) developments in Britain; and (3) speculations about the future.
Developments in North America
We will not provide a comprehensive history of sex offender treatment in North America as that has already been described in two papers by Laws and Marshall (Laws & Marshall, 2003; Marshall & Laws, 2003). We will do our best to summarise the most important features of this history.
While there were numerous attempts in the late 1960s and early 1970s in North America to treat sex offenders, the US psychiatrist, Gene Abel, was the pioneer in the USA for the application of CBT to these problematic offenders. After publications describing early programmes (Abel et al., 1970; Marshall, 1971, 1973), Abel put together a series of meetings.
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These small conferences were aimed at expanding the scope of assessments and treatments. Early treatment descriptions (Abel et al., 1978; Marshall & Williams, 1975) outlined the first comprehensive CBT programmes in North America. It was a long time, however, before any programmes were evaluated for their long-term benefits. In fact, the debate about effective- ness, and how to properly determine effectiveness, continues to this day (see debates between Marshall & Marshall, 2007, 2008; and Seto et al., 2008).
Recently, RP has lost some of its appeal as a result of Marquis’ well-designed evaluation of California’s programme showing no overall effects (Marques, Weideranders, Day, Nelson & van Ommeren, 2005). These results led Yates (2007) to call for the abandonment of RP, although this appears not to have happened in most programmes. Yates took the view that RP should be replaced by either the self-regulation model outlined by Ward and Hudson (2000) or Ward’s (2002) GLM, and there is recently emerging evidence supporting the efficacy of these two approaches (Bickley & Beech, 2002; Harkins, Flak, Beech, & Woodhams, 2012; Kingston, Yates, & Olver, 2013).
While it is always bad science to generalise from one study to all programmes employing the same title, there may be good reasons to fault an excessive adherence to the early RP model. It is, for example, a decidedly negative approach to treating people, and there is now substantial evidence (see Linley & Joseph, 2004; Snyder & Lopez, 2005 for various reports) showing that with all human problematic behaviours a more positive orientation, particularly one that incorporates features facilitating a therapeutic alliance and group cohesion (see Marshall & Burton, 2010; Marshall, Marshall, & Burton, 2013), is likely to be far more effective. In any event, there appears to be a move away from thinking of sex offenders as simply characterised by a series of deficits. Strength-based approaches to both assessment (Craig et al., 2008) and treatment (Marshall, Marshall, Serran, & O’Brien, 2011) are emerging and appear to offer a more hopeful agenda.
Developments in the UK
Other than work at the Institution of Psychiatry, much of the early psychologically informed treatment of sex offenders in the UK took place in prisons rather than in the community. The undoubted reason for this situation was that by far the majority of psychologists within the criminal justice system were employed by the Prison Service. Laycock (1979) noted that at the time there were 93 psychologists employed in the Prison Service for England and Wales, with most being based in penal institutions. Laycock suggested that most of them were likely to be involved in the delivery of some type of treatment with prisoners. While not all of the treatment was…
