Treatment for Sexual Offending

Why is treatment needed?

  • Treatment is crucial for reducing sexual recidivism rates and enhancing public safety.
  • It aims to address the underlying issues contributing to harmful sexual behavior and prevent future offenses.

Determining the rate of sexual recidivism

  • Recidivism rates are a key metric for evaluating the effectiveness of interventions.
  • Challenges exist in accurately capturing recidivism due to the "dark figure" of unreported sexual offenses.
  • Different methodologies and data sources can yield varying estimates of recidivism rates.

Overview of treatment for sexual offending in Aotearoa NZ

  • Treatment services in New Zealand are provided through community-based organizations and correctional facilities.
  • Community-based services cater to a broader population, including individuals not convicted of sexual offenses.
  • Correctional treatment programs are tailored to different risk levels and offense types.

Effectiveness of treatment for sexual offending

  • Meta-analyses and systematic reviews generally support the effectiveness of treatment in reducing sexual recidivism.
  • New Zealand-specific research also indicates positive outcomes for various treatment programs.
  • Treatment dropouts tend to have the highest rates of sexual recidivism.

The components of effective treatment

  • Effective treatment programs often incorporate cognitive-behavioral techniques, relapse prevention strategies, and strength-based approaches.
  • Key components include addressing criminogenic needs, managing offense-related sexual interests, and building emotional self-regulation skills.
  • Program orientation, delivery method, content, staffing, and setting can all influence treatment effectiveness.

Recidivism Rates in Aotearoa NZ (Ara Poutama, 2025)

  • Sexual assault offenses have the lowest recidivism rates compared to other offense types.

Recidivism Rates (Nadesu, 2011)

  • This study examined rates of reimprisonment within 5 years of release from prison, comparing individuals who sexually offended against children versus adults.
  • Recidivists were more likely to reoffend with all types of sexual offending.
  • Child sex offenders had a recidivism rate of less than 10% after the first offense.
  • Adult sexual offenders had a recidivism rate of 20% after the first offense.
  • This aligns with the theory that adult offenders often engage in other areas of crime, such as violence, while child sexual offenders are often less involved in broader antisocial behavior.

International Evidence on Sexual Recidivism Rates

  • Hanson et al. (2024) summarized previous reviews, indicating recidivism rates of 5-15% after 5 years and 10-20% after 10 years.
  • Lussier and McCuish (2024) analyzed 468 studies from the USA and Canada (N = 388,994), finding an average sexual recidivism rate of 9%, with a lower average of 5-8% in the 21st century.
  • Helmus et al. (2021) reviewed 13 studies published between 2013 and 2021 (N = 48,025), reporting a combined sexual recidivism rate of 4.2%, consistent with international evidence.

The "Dark Figure" of Sexual Recidivism (Lussier et al., 2023)

  • There are three contrasting positions regarding the reliability of official data:
    1. All estimates based on official data should be rejected.
    2. Limitations in criminal justice data should be accepted as inevitable.
    3. Data should continue to be used, but actual rates should be estimated using different techniques.
  • Kelley et al. (2022) found that "the detection rate of sexual offenses increased following an initial sanction, subsequently decreasing the proportion of undetected to detected offending."

Prioritizing Resources for High-Risk Individuals

  • If official recidivism rates appear low, resources should be prioritized for individuals at high risk of sexually reoffending, as this is where the most harm reduction can be achieved.

Treatment Services in Aotearoa

  • Harmful sexual behavior services are run by community organizations.
  • Correctional treatment is provided in prisons or as part of community sentences.

Harmful Sexual Behavior Services

  • These are community-based services, not exclusively for individuals convicted of sexual offending.
  • They offer group and individual treatment for adults, adolescents, and children.
  • WellStop's website states: "The purpose of treatment is to help clients resolve issues and understand their harmful behavior, and to develop or enhance their skills to both prevent further harmful sexual behavior and to build positive, fulfilling lives. Positive outcomes are enhanced by the strong involvement of support people."

Correctional Treatment

  • There are three main intervention types:
    • Medium-intensity group treatment (prison only) for individuals at average risk of sexual reoffending.
    • High-intensity group treatment (prison only) for individuals at above-average risk of sexual reoffending.
    • Two prison-based Special Treatment Units for child sexual offending (Kia Marama and Te Piriti).
    • One program for adult sexual offending.
    • Individual psychological treatment (in prison and community).
  • Adult sexual offenders often participate in programs for general violent offending, as it is often part of a broader pattern of violence. Child sexual offenders, in contrast, often have other low-level offenses.

Kia Marama and Te Piriti

  • Kia Marama (KM) was established in 1989, and Te Piriti (TP) in 1994.
  • They are similar in many ways to high-intensity violent offending programs.
  • A thorough assessment is completed before treatment.
  • The program is a 9-month group program with individual sessions as required.
  • There are three 3-hour sessions per week.
  • Groups consist of 10 participants with 2 therapists.
  • The units operate as communities of change.
  • Programs primarily draw from CBT and relapse prevention but incorporate Māori concepts.
  • There is a strong focus on building strengths.
  • Some differences from the violent offending programs exist (e.g., rolling/open groups).

Rockwood Strength-Based Treatment Program

  • Phase 1: “Engagement”
    • Identify personal strengths
    • Early life
    • Identify problems to be addressed
    • Discuss life 3-6 months prior to offending
  • Phase 2: “Criminogenic targets”
    • Challenge attitudes and cognitions
    • Build enhanced emotional self-regulation
    • Work on relationship issues
  • Phase 3: “Self-management”
    • Plan for the future
    • Generate self-management plan
    • Develop approach and avoidance goals
    • Identify warning signs
    • Engage with support people

Treatment of Sexual Interests

  • "Treatment should not be seen as a way of permanently eliminating offense-related sexual interests, but rather as a set of tools that enable the participant to manage offense-related sexual thoughts and arousal when they occur and work towards the development of healthier sexual fantasies, and more effective intimate relationships" (UK Healthy Sex Programme Theory manual).
  • The focus is on managing thoughts rather than shifting thoughts.

Effectiveness of Treatment: Meta-Analyses and Systematic Reviews

  • Schmucker & Lösel (2015): Meta-analysis of 27 psychological intervention studies (N = 10,387) showed treatment linked to a significant reduction in sexual recidivism (10.1% vs 13.7%).
  • Gannon et al. (2019): Meta-analysis of 47 psychological intervention studies (N = 41,476) showed treatment linked to a significant reduction in sexual recidivism (9.5% vs 14.1%).
  • Sousa et al. (2023): Systematic review of treatment for men convicted of sexual offenses against children across 12 studies (mostly using within-group designs) found that "treated" individuals had sexual recidivism rates of 0-9%, while "untreated" individuals had rates of 14-16%.

Effectiveness of Treatment: New Zealand Evidence

  • Limited research mostly supports the effectiveness of treatment.
  • Significant reductions in sexual recidivism have been found for:
    • Te Piriti (Nathan et al., 2003)
    • Kia Marama (Bakker et al., 1998; Beggs & Grace, 2011; Moore, 2012)
    • Community treatment programmes (Lambie & Stewart, 2003; Lambie 2007)
  • Finney et al. (2024): Systematic review of 8 studies on young people in Australia and New Zealand showed treatment groups had lower sexual recidivism in all but one study, and treatment “dropouts” had the highest sexual recidivism rate.

Components of Effective Treatment (Tyler et al., 2021)

  • Several meta-analyses have examined moderators of treatment effectiveness (Gannon et al., 2019; Schucker & Lösel, 2015).
  • There is still a lack of evidence of causal factors.
  • Moderating variables include program orientation and delivery method, program content, program staffing, and treatment setting.

Prehabilitation: A New Approach?

  • Prehabilitation involves intervention for adults with a sexual attraction to children who haven’t offended.
  • It is "the bridging of therapeutic services typically offered as rehabilitation…with an earlier preventative approach" (Christofferson et al., 2020) and was pioneered in Germany.

Ethical Challenges of Prehabilitation

  • "Stand strong walk tall" is a controversial approach.
  • Ethical challenges exist around this area.
  • If a client expresses risk or children are in their care or around them, psychologists must disclose this information as part of their responsibility.