Treatment of Sexual Offenders: Effective Elements and Appropriate Outcome Evaluations

• Date: 21 May 2012
• Pages: 71-94
• Published date: 21 May 2012
• DOI: https://doi.org/10.1108/S1474-7863(2012)0000013008
• Author: W.L. Marshall,L.E. Marshall

TREATMENT OF SEXUAL

OFFENDERS: EFFECTIVE

ELEMENTS AND APPROPRIATE

OUTCOME EVALUATIONS

W. L. Marshall and L. E. Marshall

ABSTRACT

In this chapter, we f‌irst describe the all governing principles of treatment

for sexual offenders that maximise effectiveness. These are derived from

Andrews and Bonta’s (2006) summary of a variety of meta-analyses of

outcome studies. From this source and others, we then claim that there are

three elements essential to effective treatment: (1) targeting criminogenic

features; (2) employing empirically sound procedures to modify these

targets; and (3) delivering treatment in an effective psychotherapeutic

way. Next we describe our treatment approach that emphasises these

crucial elements within a strength-based programme that is motivational

and provides Ward’s (2002) Good Lives Model as the framework. We

then challenge the broadly accepted idea that the Random Controlled

Trial (RCT) is the only basis upon which inferences about treatment

effectiveness can be derived. We point to methodological, practical and

ethical problems associated with implementing an RCT study and offer at

least two alternatives: the so-called ‘incidental design’ which compares the

outcome of the treated group with a matched (but not randomly assigned)

Perspectives on Evaluating Criminal Justice and Corrections

Advances in Program Evaluation, Volume 13, 71–94

Copyright r2012 by Emerald Group Publishing Limited

All rights of reproduction in any form reserved

ISSN: 1474-7863/doi:10.1108/S1474-7863(2012)0000013008

71

group from the same or similar setting to the treated group; and a

strategy where the recidivism rate of treated group is compared with what

would be expected on the basis of risk assessments of each of the treated

subjects.

INTRODUCTION

The treatment of sexual offenders is beset by controversy. For example,

there is a debate about the need to include relapse prevention elements in

treatment (Carich, Dobkowski, & Delehanty, 2009;Yates & Ward, 2009)or

at least how extensive these elements should be if they are included (W. L.

Marshall, Marshall, Serran, & O’Brien, 2011). There is disagreement about

the value of detailed treatment manuals (see Mann, 2009;Marshall, 2009,

for differing points of view). While many clinicians and researchers (e.g.

Abel, Becker, & Cunningham-Rathner, 1984;Bumby, 1996;Carich &

Calder, 2003;Salter, 1988) point to the need to modify what are called

‘cognitive distortions’, some claim that such an approach is unnecessary

since the majority of distortions are not related to the propensity to reoffend

(W. L. Marshall, Marshall, & Kingston, 2011;W. L. Marshall, Marshall, &

Ware, 2009). Perhaps more importantly, some have claimed that the

treatment of sexual offenders has not yet been shown to be effective

(Quinsey, Harris, Rice, & Lalumie

`re, 1993;Rice & Harris, 2003;Seto et al.,

2008), while others (W. L. Marshall, Marshall, Serran, et al., 2011) suggest

there is suff‌iciently convincing evidence of its eff‌icacy.

In this chapter we will outline the effective principles of treatment, then

we will describe what we believe to be an effective approach to treating

sexual offenders, and f‌inally we will consider how treatment programmes for

sexual offenders can be satisfactorily evaluated.

THE PRINCIPLES OF EFFECTIVE TREATMENT

Andrews and Bonta (2006) have integrated the vast body of research

appraising treatment effectiveness with offenders of various types. In

particular they report the results of several meta-analyses conducted by the

Carleton Criminology group (Andrews & Dowden, 1999;Andrews, Zinger

et al., 1990;Dowden & Andrews, 1999a, 1999b, 2003, 2004;Dowden,

Antonowicz, & Andrews, 2003) plus the meta-analyses of other researchers

W. L. MARSHALL AND L. E. MARSHALL72