Early Treatment Change in Perpetrators of Sexual Versus Non-Sexual Violence

• Published date: 01 August 2023
• DOI: http://doi.org/10.1177/0306624X211065578
• Author: Marije Keulen-de Vos,Massil Benbouriche
• Date: 01 August 2023
• Subject Matter: Articles

https://doi.org/10.1177/0306624X211065578

International Journal of

Offender Therapy and

Comparative Criminology

2023, Vol. 67(10-11) 1061 –1078

© The Author(s) 2021

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DOI: 10.1177/0306624X211065578

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Article

Early Treatment Change in

Perpetrators of Sexual Versus

Non-Sexual Violence

Marije Keulen-de Vos1,2

and Massil Benbouriche3

Abstract

The purpose of this study is to assess treatment change at both a group and individual

level in a sample of 81 Dutch male patients who received mandated care for either

violent (non-sexual) behavior or sexual violent behavior. Psychiatric nurses rated

patients’ social skills, insight, hostility, physical violence with the BEST-Index every

6 months over the course of 2 years after patients were admitted to hospital.

Mixed analysis of covariances and the reliable change index indicated that patients,

irrespective of offense type, showed treatment change over time with exception of

physical violence. This study shows that general treatment may be useful in the first

18 month for risk factors common to different types of offenses, but that specialized

treatment is needed to establish further change.

Keywords

treatment change, sexual offense, violent offense, clinical change, BEST-index, general

risk factors, risk relevant behavior

According to the World Health Organization (WHO, 2002, p. 4), violence refers to

“the intentional use of physical force or power, threatened or actual, against oneself,

another person, or against a group or community, that either results in or has a high

likelihood of resulting in injury, death, psychological harm, maldevelopment or depri-

vation”. Most common types of violence are homicide, sexual aggression, intimate

partner violence, and self-directed aggression. Each year, more than a million people

1De Rooyse Wissel, Venray, The Netherlands

2Radboud University, Nijmegen, The Netherlands

3Université de Lille—PSITEC, France

Corresponding Author:

Marije Keulen-de Vos, De Rooyse Wissel, P. O. Box 433, Venray 5800 AK, The Netherlands.

Email: MKeulen-deVos@derooysewissel.nl

1065578IJOXXX10.1177/0306624X211065578International Journal of Offender Therapy and Comparative CriminologyKeulen-de Vos and Benbouriche

research-article2021

1062 International Journal of Offender Therapy and Comparative Criminology 67(10-11)

lose their lives or suffer non-fatal injuries as a result of violence. Higher rates of vio-

lent behavior are found in institutionalized and secure settings (Huitema et al., 2021).

This is not surprising because aggressive behavior is often the reason why patients are

institutionalized or admitted to a secure setting in the first place. The cost of violence

translates into billions of US dollars in annual health care expenditures worldwide,

and billions more for national economies in terms of law enforcement and mandated

care.

Establishing treatment change is consequently of particular importance for practi-

tioners working in forensic settings as ineffective treatment has the potential to be

detrimental for patients or elicit adverse outcomes for society (e.g., increased violence

risk) (Mallion et al., 2020; Mews et al., 2017). Accordingly, (a) the overarching aim of

mandated treatment is the reduction of risk-relevant behavior, which ultimately leads

to a low risk for recidivism and (b) recidivism is one of the primary outcome measures

in most studies and meta-analyses on treatment change of patients with offense

histories.

General Risk Factors as Clinical Targets

Evaluations of treatment programs for persons with violent offenses in general show

moderate reductions in reconviction rates after release (Henwood et al., 2015; Jolliffe &

Farrington, 2004). For example, a review of psychological treatment for adults with

violent offense histories reported a relative reduction of 23% in the proportion recon-

victed for any offense (Henwood et al., 2015) after completing cognitive behavioral

therapy. Focusing on treatment for sexual violence, meta-analyses indicate some level of

treatment change (Olver et al., 2020; Schmucker & Lösel, 2015), although some studies

report insufficient evidence (Dennis et al., 2012; Langstrom et al., 2013). For example,

Schmucker and Lösel (2017) reported a significant reduction in recidivism rates in

treated patients compared to patients receiving no treatment; the sexual recidivism rate

was 10.1% versus 13.7%.

Treatment approaches that demonstrate the largest impact on reducing recidivism

tend to adhere to the Risk-Need-Responsivity principles (RNR; Andrews & Bonta,

2017) with staff receiving regular supervision (Gannon et al., 2019; Hanson et al.,

2009; Olver et al., 2011). The RNR framework underlines resources ought to vary in

dose according to risk and should be aimed at reducing risk factors while being respon-

sive to patient characteristics (e.g., intelligence, motivation). Amongst those general

risk factors, four are particularly relevant to violent behavior. First, violent behavior in

itself is a risk factor for future physical violence (Krupp et al., 2013). For example,

offenders with an early age of arrest onset and more total arrest charges are more likely

to commit serious criminal behavior (e.g., perpetrate rape, and murder) (Drury et al.,

2017). Second, aggressive behaviors are believed to result from hostile cognitions and

attributions (Eckhardt et al., 2004; Elmquist et al., 2016) that refer to a tendency

toward negative judgment and dislike of others (e.g., denigration) (Birkley & Eckhardt,

2015; Norlander & Eckhardt, 2005). Hostility is not only in itself linked to violent

behavior and recidivism (Garofalo et al., 2016; Kingston et al., 2009; Novo et al.,