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Robin J. Wilson
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Fall 2005 Forum
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Vol. XVII, No. 3
Summer 2005
Pathways to the Treatment of Sexual Offenders: Rethinking Intervention

Over the past several years, a new model of treatment has been put forward as an alternative to the relapse prevention approach that has been widely accepted and broadly incorporated in most cognitive-behavioral treatment programs for sexual offenders (Laws, 2003; Ward & Hudson, 1996).  The self-regulation model (Ward & Hudson, 1998; 2000) and, more recently, the “good lives” conceptualization (Ward, 2002; Ward & Stewart, 2003,), have the capacity to significantly improve the treatment of these offenders.  While not yet widely accepted, this model has been implemented in a number of jurisdictions, including Canada, Sweden, South Australia and the United States, as the model of treatment  for sexual offenders.  This article provides an overview of the problems inherent in the relapse prevention approach and suggests that this alternative approach to the rehabilitation of sexual offenders holds considerable promise in enhancing the treatment of sexual offenders.

 

Relapse Prevention:  Avoiding That Which Is Bad

 

Relapse prevention was originally developed as a medical model to assist alcoholic patients to maintain gains following treatment of alcohol addiction, based on observations that these patients experienced difficulty abstaining from alcohol abuse after successful treatment (Marlatt, 1982; Marlatt & Gordon, 1985).  The model assumes that individuals are underregulated with respect to problem behaviors and that they lack adequate coping skills and requisite self-control to change behavior.  Treatment, therefore, is based on developing an understanding of those circumstances which place the individual at risk and ensuring avoidance of these situations, while instilling in the client the required skills and “adaptive” mechanisms to cope with these circumstances.  Individuals are not regarded as self-directed, with life goals or with strengths upon which they can build.  Rather, individuals are assumed to be constantly attempting to abstain from the problem behavior, to set themselves up to encounter situations which will inevitably lead to failure, and to subsequently experience negative emotional states associated with this failure as a result of deficits in the ability to cope with life events. 

 

Despite attempts to apply the relapse prevention model to sexual offenders (Laws, 1989;  Laws, 1995;  Laws, Hudson, & Ward, 2000; Marques, 1982;  Pithers, 1990; Pithers, Marques, Gibat, & Marlatt, 1983;  Ward & Hudson, 2000), it has become evident to clinicians and researchers alike that this is insufficient to account for variability in sexual offending behavior and insufficiently addresses the dynamics of offending with which sexual offenders present in assessment and treatment.  For example, there is no evidence to support the notion that sexual offenders attempt to “abstain” from sexual activity or from activities associated with obtaining intimacy.  Applied to the treatment of sexual offenders, this notion has been used to justify the requirement that the offender abstain from intimate relationships and/or sexual behavior.  Obviously, this is a questionable goal at best, and an entirely inappropriate one, at worst.

 

In failing to account for the variability evident among sexual offenders, the relapse prevention model assumes a single pathway to offending behavior.  For example, all offenders are assumed to experience solely or predominantly negative affect associated with offending.  However, variability in pathways to offending is evident in the wide array of research attesting to variations in risk to reoffend, factors associated with criminal behavior, recidivism rates, and differential response to treatment demonstrated by different types of sexual offenders (e.g., Alexander, 1999; Hanson & Morton-Bourgon, 2004; Hall, 1995; Hanson, Gordon, Harris, Marques, Murphy, Quinsey, & Seto, 2002; Nicholaichuk, 1996; Nicholaichuk, Gordon, Gu, & Wong,, 2000; Nicholaichuk et al., 2000; Nicholaichuk & Yates, 2002).  Furthermore, such reliance on a single dynamic of sexual offending has led to an inflexible approach to treatment, again one which does not take into account variability in treatment needs and which does not allow for individualized interventions.

 

Importantly, in addition to the questionable applicability of the relapse prevention model to the treatment of sexual offenders, there remains an absence of research attesting to its validity and efficacy in the treatment of sexual offenders (Hanson, 1996; Laws, 2003; Marshall & Anderson, 1996; Yates 2004; Yates & Kingston, 2005).  Although research suggests that treatment of sexual offenders can be effective in reducing recidivism, the strength of this effect remains small to moderate.  It is proposed that the magnitude of these effects can be increased with a new approach to treatment.

 

A Self-Regulation Model of Offending:  Multiple Pathways

 

Based on self-regulation theory (Baumeister & Heatherton, 1996; Karoly, 1993), Ward and colleagues (Ward & Hudson, 1998; 2000; Ward, Hudson, & Keenan, 1998) have put forward a new theoretical model of sexual offending.  Self-regulation theory holds that individuals engage in goal-directed behavior based on internal and external circumstances and events that direct behavior.  Goals are regarded as desired states or outcomes (acquisitional goals) or, alternatively, avoidance of undesired states or outcomes (inhibitory goals).  Internal and external processes and circumstances function to guide behavior, including choosing, modifying, and evaluating one’s behavior and the outcomes associated with one’s actions.  In engaging in goal-directed behavior, individuals develop cognitive scripts which direct behavior, and select strategies to achieve these goals based on these scripts, interpretation of events, their own prior history, and so forth. 

 

In sexual offenders, it is proposed that there exist four pathways that lead to offending behavior, three of which suggest problems with self-regulation and a fourth which suggests that self-regulation is intact (Ward & Hudson, 1998; 2000). 

 

The first pathway, the avoidant-passive pathway, is similar to the traditional relapse pathway and represents underregulation of behavior by the individual.  This pathway is associated with an inhibitory goal and an absence of effective strategies and effort by the individual to avoid an undesired state or outcome.  A sexual offender following this pathway, therefore, desires to refrain from offending, but does not actively attempt to do so, or simply attempts to deny urges or to distract himself.  For example, an individual who is sexually attracted to children may attempt to simply ignore these desires in the hope that they will dissipate.  When faced with a high risk situation, the individual is faced with a loss of control and a lack of strategies to avoid offending. Within this pathway, offending is hypothesized to result from disinhibition or loss of control resulting from negative affective states and/or a lack of adequate strategies that may be used to achieve the goal (i.e., to refrain from offending).  Individuals following this pathway are likely to have low self-efficacy expectations, to experience negative affective states associated with their offending behavior, and to covertly, rather than overtly, plan their offences. 

 

The second pathway, the avoidant-active pathway, is similar to the avoidant-active pathway in that the individual’s goal is to refrain from committing a sexual offence.  However, offenders following this pathway select strategies and make active attempts to achieve this inhibitory goal.  As such, the self-regulation deficiency in the avoidant-active pathway is one of misregulation, rather than underregulation, of behavior.  These individuals make active attempts to control inappropriate sexual arousal, to express arousal via methods other than offending, and to control affective states and behavior rather than to deny these states or engage in distraction.  Offending occurs when the selected strategies prove ineffective in achieving one’s goal (i.e., to avoid offending).  Paradoxically, the strategies selected may, in some instances, increase the likelihood of offending, as when the individual uses alcohol to suppress desire (thereby disinhibiting behavior), or masturbates to satisfy sexual arousal to children, by which the pairing of deviant sexual arousal and sexual gratification is reinforced and becomes further entrenched.

 

The third pathway, the approach-automatic pathway, is distinct from the avoidant pathways in a number of important areas.  In this pathway, the self-regulation deficit is also one of underregulation or misregulation, but the goal with respect to offending is an approach goal that is established impulsively.  Individuals following this pathway do not attempt to refrain from offending, but seek to achieve goals associated with offending.  The achievement of goals and strategies selected are based on well-entrenched cognitive and behavioral scripts which are activated relatively quickly, tend to be outside the individual’s attentional control, and are activated by situational cues and the individual’s perceptions of these cues.  Although not attempting to refrain from offending, offences committed by individuals following this pathway are planned only in a rudimentary manner, and behavior is impulsive.  These individuals may experience either or both positive or negative affect following offending, and their behavior is likely to be reinforced as they have successfully achieved their goals.

 

The final pathway, the approach-explicit pathway, is characterized by intact self-regulation.  Individuals following this pathway do not have deficits in self-regulation or the ability to control behavior – in fact, these individuals have very good self-regulation.  The dynamics of offending within this pathway are associated with goals which explicitly support sexual offending, such as attitudes supporting sexual activity with children or hostile attitudes toward women.  In achieving the goal to offend, individuals following this pathway tend to plan their offences explicitly and intentionally, to experience positive affect following the commission of the offence, and to be reinforced for their behavior via the successful achievement of their goals.

 

Good Lives:  Approaching That Which Is Good

 

In addition to the problems associated with the relapse prevention approach described above, this approach also derives from, and reinforces, a punitive, rather than positive, approach to sexual offenders (Ward & Stewart, 2003; Yates, 2004).  In contrast to this, recent theorizing proposes the utilization of a “good lives model” as a framework for the treatment of sexual offenders (Ward, 2002; Ward & Stewart, 2003).

 

In the good lives model, individuals are regarded as active, goal-seeking beings who seek to acquire primary human goods – those things which the individual perceives as desirable, such as intimacy (Ward, 2002; Ward & Stewart, 2003).  Risk factors and criminogenic needs represent symptoms or markers of ineffective or inappropriate strategies to achieve these goods or goals.  For example, an offender may desire intimacy, but has sought this with children, clearly an inappropriate outcome.  As such, criminal behavior results from problematic means used to achieve the goal. The aim in treatment with such an individual, therefore, is not to change the goal (i.e., intimacy), but to target the means the individual uses to achieve this goal (achieving “intimacy” with children). 

 

In the good lives model, it is proposed that treatment of sexual offenders should commence with identification of those life goals and personal identity which the individual holds and with which he identifies, in order that he may work toward both personal fulfillment and the achievement of a prosocial lifestyle.  Within this overarching framework, the focus is not only upon reducing risk to reoffend and targeting criminogenic needs, but also on enhancing the offender’s capacity to improve his life.  It is proposed that this enhancement to treatment will contribute to the reduction of risk and to the protection of society (Ward & Stewart, 2003).  Further, this approach holds greater promise of motivating the offender to change their behavior by increasing engagement with treatment via increased attention to responsivity needs and a stronger therapeutic alliance (Ward & Stewart, 2003).

 

The good lives model fits well with the self-regulation model of offending specifically and with the cognitive-behavioral approach to treatment more generally.  The focus of treatment based on these models involves the delineation of prosocial goals and strategies to achieve these goals, rather than solely on avoiding problematic or high-risk situations.  This is particularly important, since such approach goals are more easily attainable than are avoidance goals (Mann, 1998; Mann & Shingler, 2001).  In addition, identification of existing strengths and reinforcement of new skills, essential to treatment (Hanson, 1996), is also facilitated by this approach. 

 

The Future of  Sexual Offender Treatment

 

Treatment of sexual offenders based on a good lives model clearly holds promise with respect to increasing engagement with treatment, attending to individual needs within treatment, and working with offenders to achieve a prosocial, nonoffending lifestyle.  It is also evident that specific treatment methods would, and should, vary according to the type of pathway followed by an individual offender (Ward, Bickley, Webster, Fisher, Beech, & Eldridge, 2004; Yates, 2004;  Yates, Goguen, Nicholaichuk, Williams, & Long, 2000). 

 

For example, offenders following the avoidant-active pathway will need to develop behavioral control via the inculcation of absent coping strategies, and increase self-efficacy and outcome expectancies.  Behavioral methods of intervention, particularly rehearsal and reinforcement of adequate coping strategies, will be essential for these individuals, as will learning to cope with negative emotional states and loss of control.  Similarly, offenders following an avoidant-active pathway will benefit from the development and reinforcement of new strategies to avoid offending, although they are unlikely to require substantial intervention to increase behavioral control, as they have demonstrated such control via the implementation of strategies previously, albeit ineffective ones.  As both of these types of offenders hold the goal of refraining from sexually offending, treatment can build on this strength by increasing the individual’s capacity to achieve this prosocial goal, which can then be incorporated into the personal identity as a non-offending individual.

 

Treatment of sexual offenders following approach pathways requires different intervention methods than those used for offenders following avoidant pathways.  Specifically, offenders following the approach-automatic pathway require treatment designed to change attitudes and beliefs associated with acceptance of sexual offending, to alter attribution tendencies, and to develop skills to control impulsivity.  As these offenders tend to report that offending occurred “out of the blue”, they may also require intervention designed to raise awareness, to understand that their behavior is under their control, and to take responsibility for their actions.  Similarly, offenders following the approach-explicit pathway will require intervention to change attitudes supportive of sexual offending, with the aim of altering well-entrenched core beliefs that support sexually aggressive behavior.  By so doing, what constitutes a good life for these individuals involves changing goals such that offending is no longer supported.

 

While evidently not exhaustive, the above indicates some of the dimensions upon which the treatment of sexual offenders would vary depending on the type of pathway evident in the offence process.  It is also evident that the self-regulation/pathways model is consistent with cognitive-behavioral treatment, at present the most effective method for the reduction of recidivism among sexual offenders (Hanson et al., 2002).  The overlay of the good lives conceptualization can further enhance treatment by addressing risk, need, and responsivity within a prosocial, approach-oriented framework and by enhancing essential therapeutic alliance in treatment (Marshall, Anderson, & Fernandez, 1999; Yates et al, 2000).

 

While there has been minimal research to date on the application of the self-regulation model to intervention with sexual offenders, research has provide some preliminary support for the various pathways (Bickley & Beech, 2002; Proulx, Perreault, & Ouimet, 1999; Ward, Louden, Hudson, & Marshall, 1995; Webster, in press) and for the differential relationship between pathways and static and dynamic risk to reoffend (Yates, Kingston, & Hall, 2003).  Such evidence has yet to be forthcoming in support of the relapse prevention model applied to the treatment of sexual offenders. 

 

In addition, the self-regulation/pathways model is consistent with current best practice on intervention with sexual offenders – that is, the principles of risk, need, responsivity, and professional integrity (Andrews & Bonta, 1998).  It has long been known that intervention is most effective, when it is tailored to the risk level posed by an individual offender, targets factors known to be associated with the commission of offending, is matched to fit the personal learning styles and abilities of offenders, and exercises professional integrity in the application of informed clinical judgment.  The self-regulation model meets all of these criteria, is consistent with research indicating differential treatment effects for different types of sexual offenders, and avoids the “one size fits all” approach inherent in the relapse prevention model and in many existing treatment programs for sexual offenders.

 

Some preliminary research on this model suggests that pathways do, in fact, vary with risk and criminogenic need.  Specifically, in one study, offenders following different pathways were found to differ significantly from each other in static risk to reoffend, with offenders following approach pathways being at higher risk (Yates, Kingston, & Hall, 2003).  This study also found offenders following the two approach pathways were significantly different from each other, and significantly different from the avoidant-passive pathway on the dynamic risk factor of general criminal tendency.  In addition, pathway membership differentiated between types of sexual offenders (rapists, extrafamilial child molesters with male victims, extrafamilial child molesters with female victims and intrafamilial child molesters).  These results taken together suggesting that different types of offenders have different criminogenic needs and different pathways to offending and support the best practice of intervention with respect to risk, need, and responsivity.

 

Finally, the self-regulation model is amenable to the best practice of risk assessment, which has become an integral part of the treatment of sexual offenders.  In addition to varying intensity of treatment based on level of risk posed by the offender, treatment and supervision of the offender should be based on dynamic risk factors that can be changed through intervention, in order to provide the best type of intervention possible for each offender.  The self-regulation approach clearly allows practitioners to achieve this goal, while the good lives model allows for intervention that adequately addresses risk and protection of society in the achievement of a non-offending lifestyle. 

 

The pathway to the future of effective intervention with sexual offenders is before us.  We need only choose to follow it.

 

Editor’s Note: For further information on the Pathways model, please see Dr. Yates’ book review of The Self-Regulation Model of the Offense and Relapse Process, also in this issue.

 

References

 

Alexander, M.A. (1999).  Sexual offender treatment efficacy revisited.  Sexual Abuse: A Journal of Research and Treatment, 11, 101-116.

 

Andrews, D.A., & Bonta, J. (1998).  The psychology of criminal conduct.  Cincinnati, OH:  Anderson Publishing Co.

 

Baumeister, R.F., & Heatherton, T.F. (1996).  Self-regulation: An overview. Psychological Inquiry, 7, 1-15.

 

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Yates, P.M., Kingston, D.A., & Hall, K.  (2003).  Pathways to sexual offending:  Validity of Ward and Hudson’s (1998) Self-regulation Model of and Relationship to Static and Dynamic Risk Among Treated Sexual Offenders Paper presented at the 22nd Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, St. Louis, MO, October, 

 

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