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Several studies have examined the effectiveness of treatment at reducing recidivism rates in populations of sex offenders on probation (see Furby, Weinrott, & Blackshaw, 1989; McGrath, Hoke, & Vojtisek, 1998). The differences and

shortcomings in the research designs of these studies have led to mixed conclusions about the effectiveness of sex offender treatment. An earlier review of forty studies concluded that treatment tends not to be effective at reducing recidivism, but that there was not enough information available about which types of offenders benefit from treatment (Furby, Weinrott and Blackshaw, 1989). More recent reviews concluded that cognitive behavioral out-patient sex offender treatment appears to significantly reduce recidivism (Hall, 1995; Alexander, 1993; McGrath, 1995; Polizzi, MacKenzie, & Hickman, 1999; Scalora, Garbin, Roy & Blum, 1998; McGrath, Hoke, & Vojtisek, 1998).

Only two of the eight studies on the effectiveness of prison-based sex offender treatment were methodologically sophisticated to provide any conclusions, and one study found lower sexual recidivism rates from the treated group than the untreated group whereas the other study found no difference between the treated and untreated groups (Hanson, Steffy, and Gauthier, 1993; Nicholaichuk et al., 2000; Polizzi, MacKenzie, & Hickman, 1999). More recently, a small sample of 89 treated sex offenders at the

Regional Treatment Centre had a significantly lower sexual recidivism rate compared to a matched untreated group of 89 sex offenders (Looman, Abracen, & Nicholaichuk, 2000).

In Germany, a prison-based program primarily for rapists centered around relapse

prevention was reported to be so successful that the unit was made an independent social- therapeutic department (see Pfafflin, 1999).

Only one study has randomly assigned sex offenders to treatment or no treatment in a state hospital cognitive behavioral program. Findings show treatment benefits on violent recidivism and on sexual recidivism for certain groups of sex offenders (Marques, 1999). Treatment appears to be more effective for child molesters with male victims or with victims of both sexes (Marques, 1999), which is consistent with a recent review (Anderson, 1999).

Several studies suggest that intermediate treatment goals such as reducing sexual arousal to deviant stimuli can be reached. A treated group, for example, showed less sexual deviance at discharge on both the physiological and self-report measures of sexual deviance, showed shifts toward more acceptance of responsibility, and showed some skills in the relapse prevention techniques (Marques, Nelson et al., 1994). Moreover, child molesters that have molested at least five children and have mastered the relapse prevention program have significantly lower sexual recidivism (Marques, 1999). Earls and Castonguay (1989) found that targeted treatment to reduce sexual arousal to same- sex children was effective, but the sexual arousal to heterosexual pedophilic themes remained until specifically targeted in treatment. Treatment for one paraphilia, thus, does not generalize to other paraphilia that offenders may have.

The effectiveness of a treatment program is also determined by the rate at which offenders prematurely terminate or are expelled from treatment. Termination rates in the United States out-patient treatment programs have ranged from one-quarter to over one-

half (Moore, Bergman, & Knox, 1999) whereas in Beliguim the drop-out rate is less than 10% (Cosyns, 1999). Research, however, is scarce on what factors predict failure to complete treatment. Abel et al., (1988) found that the highest rate of withdrawal from treatment occurred for offenders who felt the greatest pressure to participate in treatment. Moreover, 92% of the offenders who had multiple paraphilia and molested both boys and girls dropped out of treatment. In two studies, sex offenders who were never married had lower rates of successful completion (Miner & Dwyer, 1995; Moore, Bergman, and Knox, 1999). In a study of which juvenile sex offenders did not complete treatment, juveniles with impulsivity problems and older juveniles were more likely to terminate treatment prematurely (Kraemer et al., 1998).

Research is scarce on which groups of sex offenders will benefit from treatment. Clinical anecdotal accounts have highlighted the difficulty of treating sex offenders who completely deny the offense (Schlank & Shaw, 1996), clients with co-morbidities such as substance abuse or major mental health issues (Chaffin, 1994), and clients sexually aroused by children that have multiple convictions (McGrath, 1991). One study examined whether sex offenders receiving cognitive behavioral treatment recidivated within one year following the completion of the treatment. Five pretreatment factors could correctly classify 85.7% of offenders on whether treatment failed (recidivated) or was successful (did not recidivate). The five factors that indicated a higher likelihood of reoffending were: (a) molested both boys and girls as well as children and adolescents; (b) failed to accept increased communication with adults as a treatment goal; (c)

committed both "hands on" and "hands off" sexual offenses; (d) divorced; and (e) molested both familial and nonfamilial victims (Abel et al., 1988). Two studies have

found that age, race, educational attainment, socio-economic class and prior number of criminal offenses of the offender, did not predict success or failure of cognitive

behavioral therapy (Marshall & Barbaree, 1990).

Research has shown that incest offenders (Chaffin, 1992) and sex offenders in general (Moore, Bergman, and Knox, 1999) are less likely to successfully complete treatment if they are psychopathic deviants, though one stud y did not find a difference between incarcerated psychopathic deviants and those who were not psychopathic deviants (Shaw et al., 1995). Hart and Hare (1997) in their review of the research on psychopaths concluded: “group therapy and insight-oriented programs help psychopaths to develop better ways of manipulating, deceiving, and using people but do little to help them understand themselves” (p. 31) Research also has shown that though psychopathic deviants behave well in treatment, they are more likely to commit a new serious offense; thus, psychopathic deviants’ behavior in treatment is no indication that they are

incorporating the lessons of treatment in their real lives outside of treatment (Seto & Barbaree, 1999). Psychopathic deviants also have had higher failure rates in inpatient treatment programs (e.g., Ogloff, Wong, & Greenwood, 1990; Moore, Bergman, and Knox, 1999).

In this evaluation, we examine the following questions to assess the combinations of sex offenders that may successfully benefit from treatment: (a) which groups of sex offenders are most likely to commit serious noncompliance with treatment?; and (b) which groups of sex offenders are most likely to successfully complete treatment? We also are able to address whether sex offenders that have a violation of probation petition (VOP) filed due to treatment noncompliance are more likely to commit sexual

recidivism, and for which groups of sex offenders is information about treatment

noncompliance from a VOP an indication of a high risk that sexual recidivism will occur. Because most sex offenders in the standard probation and the specialized probation

programs were ordered to undergo treatment, we could not obtain a matched untreated group; this design limitation precludes addressing overall treatment effectiveness.

Chapter II. Methodology for Identifying Groups that are at High-Risk