Treatment varies for sexual offenders

Clinicians who treat sexual offenders tailor treatment to the offense.

Throughout her career Susan Rudman, Ph.D., Northern Regional representative for the Massachusetts Psychological Association, member of the MPA board of directors, forensic psychologist and private practitioner in Salem, Mass., has treated hundreds of males, and a handful of females, who present with various underlying reasons for sexually offensive behavior.

From a chaotic family life as a child and “male rage” to the need to exert power over another and “distortion issues,” such as poor social skills, each offender has usually experienced some sort of trauma, she said.

Most of Rudman’s clients have been incarcerated and have already undergone some therapy. In most cases, this therapy involved a “relapse prevention model,” which looks at what led the person to offend and explores thoughts, feelings and behavior that occurred before the offense. “You have to break it all down and find an exit, a way out of the cycle,” she said.

Group therapy, which Rudman emphasizes is “crucial,” helps the offender develop emotional regulation and a sense of empathy.

“They have to realize the effect they’ve had on the victim and the victim’s family, which could be lifelong,” she said, noting that she uses The Good Lives Model to build capabilities and strengths.

“I look at relationships and how to get needs met without hurting others. I do a lot of work with coping strategies. I start out by taking a thorough history and don’t focus on the offense but on past history. I focus on the person, family history and their victimization and then pull the offender part into the discussion. I see the offender as a whole person.”

David Greenfield, Ph.D., private practitioner in West Hartford, and assistant clinical professor in the department of psychiatry at the University of Connecticut School of Medicine, pointed out that interventions typically depend on the type of offender.

“If a person has a sex addiction, you have to treat the urges and cravings. If the person is compulsive, you have to put blocks on access to sexual content on the Internet,” he said.

“Treatment also often looks at how they soothe themselves. Do they use sex as a drug? It can be as powerful as cocaine on the pleasure center in the brain. My job as a therapist is motivational enhancement. I take a psychosocial history that includes sexual development and education and any victimization they’ve experienced. They could have been exposed to inappropriate sexual behavior or have poor role models.”

Societal mores and the proliferation of pornographic Internet sites have lowered the threshold for sexually deviant behavior, according to Greenfield.

“We have a very skewed culture about sexuality. We promulgate open sex discussions by putting it in movies and other entertainment. But internally or covertly, we are still Puritanistic. For instance, only fifty percent of municipalities and schools have sex education,” he said.

While pornography is harmful for adults, this medium is particularly damaging for adolescents.

Greenfield explained that many adolescents, who have underdeveloped frontal lobe capacity, poor executive functioning and increased levels of hormonal stimulation, have smartphones and easy access to the Internet.

“Most 15 or 16-year-olds have seen a vast amount of porn online. They are mimicking online sexual behavior,” he said.

Like their adult counterparts, youths who commit sexual offenses have different motivational factors. The sexually aggressive youth wants to put people down; it’s all about power, according to Kimberly A. Shaunesey, Ph.D., COO, Boys and Girls Village in Milford, Connecticut.

“Another type is the under-socialized child. He goes to younger kids because they accept him. Others are influenced by the group and some are exposed to inappropriate sexual behavior. This is the way they learn to relate to others. They become sexually reactive and act out as they try to understand how to behave.”

Boys and Girls Village features several different levels of care for youths from the age of nine to 18 who have committed sexual offenses, Shaunesey said. The agency offers inpatient and outpatient care and conducts 15 to 20 psychosexual evaluations annually, she explained.

One of its most intensive programs, Multisystemic Therapy for Problem Sexual Behavior (MST-PSB), is a grant-driven, evidence-based program for girls and boys age 9 to 17-1/2 who live with their family of origin or who have lived with a family a long time, said Shaunesey.

Master’s level clinicians go to the home three to five times a week and use family therapy to address issues that allow abuse. We come up with a safety plan, goals and objectives and find community-based support. If the youth assaulted a younger sibling, we would figure out what to set up to protect the child,” she said.

Safe Haven at Boys and Girls Village, a 12-bed residential facility for boys between 12 and 18 years old, follows the Tim Kahn Pathways program, which is based on relapse prevention. “We do a lot of work on social skills and anger management,” Shaunesey said. “There is lots of family work, as kids might have witnessed domestic violence or an abusive sexual relationship.”

Boys and Girls Village’s newest in-home program, funded by a grant from the Court Support Services Division, will serve youth at two different levels, which the court determines based on severity of the offense.

“Level one offenders will get sex education and case management. It’s a one-to-three month program,” Shaunesey said. “Level two offenders will get sex education, case management and individual therapy. These youth have committed more serious offenses. The program is three to 12 months. It’s similar to the residential Tim Kahn model and has a Healthy Families component. We use it as a guide to work with families on sexual offenses and provide other services.”

Greenfield emphasizes that just because someone commits sexual offenses, it doesn’t mean that person is permanently disabled and can’t live a normal life. “There is a good prognosis if you have good treatment,” he said.