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Running head: REHABILITATION STRATEGIES

Rehabilitation Strategies and Outcomes for Sex Offenders

Janelle Barton
Western Washington University

REHABILITATION STRATEGIES
Introduction
The issue of sex-offender rehabilitation may be a controversial area of study, but research on
the topic is vital in order to determine which strategies and therapies are most effective in preventing
recidivism (relapses in offending), what factors lead to a person committing sex-crimes and whether
or not sustained rehabilitation is possible. Keelan and Fremouw (2013) define sexual offenses as
any sexual interaction with person[s] of any age that is perpetrated [a] against the victim's will, [b]
without consent, or [c] in an aggressive, exploitive, manipulative, or threatening manner (p.732). In
addition, it is important to note that the occurrence of sexual offenses is not determined on race,
socio-economic status or intelligence level (Zgoba, Sager & Witt, p. 135, 2003). Understandably,
individuals who have committed sexual offenses are often regarded as a threat to public safety in our
society. Mandatory registration for sex-offenders currently exists in all 50 states, 16 of which also
have sexual violent predator (SVP) laws in place which allows for offenders to be indiscriminately
admitted to treatment centers after they serve their prison sentences (Witt, Geenfield & Hiscox,
2008). The best way to ensure public safety, however, is through developing effective treatment
methods and strategies that can provide lasting results.
Over the past two decades, considerable progress has been made in developing treatments for
sexually deviant and criminal behaviors (Witt, Greenfield & Hiscox, 2008). However, as the stigma
against individuals who have committed sex-crimes persists, the perception that sex offenders
deserve punishment and not consideration for their welfare has resulted in a reluctance to
implement constructive treatment models (Ward & Stewart, p. 353, 2003). As a result, sexoffenders are sometimes resigned to undergo therapies that are outdated or simply ineffective,
lowering the odds of program completion and sustained rehabilitation (Ward & Stewart, 2003). This
not only presents a problem for the individual perpetrators, but it also potentially puts the public at
risk because offenders that do not complete treatment have a higher chance of re-offending (Craig,

REHABILITATION STRATEGIES
Browne & Stringer, 2003). Therefore, it is essential for both the behavioral improvement of sexoffenders and the wellbeing of the public that an understanding is reached about which treatment
approaches work best.
There are a variety of sex-offender rehabilitation strategies including cognitive
behavioral/relapse prevention therapy, the good lives model (GLM), the risk-needs model, group
therapy, social skills training, and aversion therapy. Currently, risk-needs model and
cognitive/behavioral therapy remain the most widely accepted and commonly researched
rehabilitation methods (Witt, Greenfield & Hiscox, 2008; Ward & Stewart, 2003). Olver, Stockdale
and Wormith (2011) state that the purpose of sex-offender rehabilitation is to reduce the recurrence
of future criminal activity whether this be spousal assault, acts of rape or child molestation,
nonsexual assaults, murder, or nonviolent crimes such as theft or drug trafficking (p. 6). The
primary aim of sex-offender rehabilitation then, is to prevent recidivism of both sexual and nonsexual crimes. Additionally, researchers seek to determine which populations of offenders (e.g. adults
and juveniles) benefit the most from certain therapies. This review will provide an overview of the
results and findings of these studies and what they tell us about rehabilitation methods and strategies,
rehabilitation outcomes for adult and juvenile offenders, and recidivism prediction factors.
Rehabilitation Methods and Strategies
While the majority of recent studies about rehabilitation methods and strategies have
examined the effectiveness of cognitive-behavioral/relapse prevention therapy (which remains the
most widely researched treatment for sex-offenders), other approaches, most notably the recently
developed good lives model and risk-need model have shown prominence and success in treating
sex-offenders (Witt, Greenfield & Hiscox, 2008;Ikomi et al., 2009; Ward & Stewart, 2003). Because
these treatments operate on different methods, theories and principles, it is difficult to establish which

REHABILITATION STRATEGIES
rehabilitative strategy is the overall the most effective. Therefore, establishing the best treatment
method for sex-offenders continues to be a source of debate among researchers and there are
discrepancies among their individual findings. For example, Witt, Greenfield and Hiscox (2008)
claim that cognitive-behavioral/ relapse therapy is the most generally accepted rehabilitative method
in North America, while Ward and Stewart (2003) have stated that the risk-needs model is actually
the major approach used in North America, the United Kingdom, and New Zealand ( p. 353).
Inconsistencies in findings such as this could be due to the year each study was released, the nature
and methodology of the study or the interpretation of the data. Despite the disagreements, each of
these rehabilitation strategies has demonstrated individual success in treating sex-offenders and
preventing recidivism.
As mentioned, the most commonly researched method for sex-offender rehabilitation is
cognitive behavior therapy, which has also become known as the relapse prevention model (Witt,
Greenfield & Hiscox, 2008). The aim of cognitive behavioral/ relapse prevention therapy is to reform
an individuals maladaptive thought processes and actions in a structured, distinctly educational
model (Witt, Greenfield & Hiscox, 2008; Ikomi, et al., 2009). The relapse prevention aspect of the
current cognitive behavioral therapies from sex offenders was originally developed for substance
abusers, and it serves the purpose of helping individuals to become aware of the precursors behind
their urges to commit sexual-offenses and how to manage the high-risk situations these precursors
exist within (Witt, Greenfield & Hiscox, 2008). Overall, cognitive behavioral therapies have shown
success in sex-offender rehabilitation and there is evidence that it is even more effective when used
in conjunction with other therapies. For example, Ikomi, Harris-Wyatt, Doucet, and Rodney, (2009)
found therapies that use cognitive behavioral therapy either on its own or in conjunction with either
social skills training or relapse-prevention therapy have a higher likelihood of success than therapies
that do not use it. At the same time, it must be taken into account that cognitive-behavioral therapy

REHABILITATION STRATEGIES
does not work for everyone, and therefore, in order to understand the best rehabilitation methods and
strategies for sex-offenders, research has been done to examine the effectiveness of alternative
treatments as well.
Two alternative treatment models that have been developed for the rehabilitation of criminal
offenders are known as the good lives and the risk-need models. The risk-need model aims to
prevent recidivism by helping individuals identify the risk factors and circumstances that contribute
to their offense patterns and subsequently works to eliminate them from an individuals life and
behavioral patterns (Ward & Stewart, 2003). The good lives model (GLM) operates on the premise
that offenders commit crimes in order to fulfill a desired outcome in their life (Ward & Stewart,
2003). Therefore, the GLM is a strengths-based approach, which aims to assist individuals in
discovering their potential to live a meaningful life, fulfilling their desired life-outcomes in sociallyacceptable ways (Ward & Stewart, 2003). In their research article, Ward and Stewart (2003) sought
to assess the effectiveness of both the risk-need and good lives models when used individually and in
conjunction. Their article eventually works towards and assertion that the two therapies are best used
in combination to the extent that it makes the most theoretical sense (Ward & Steward, 2003).
While Ward and Stewarts findings do not necessarily tell us the effectiveness of the good lives
model and risk-need model in relationship to traditional therapies, what it does tell us is that these
therapies could potentially have greater usefulness when used together when the positive
reinforcement aspects of the GLM can provide a larger framework for a risk-needs model. Another
issue with the study is that the term theoretical sense is vague and we are left unknowing precisely
what proportions of the two therapies we should use.
Willis and Ward (2011) also sought to examine the effectiveness of the good lives model
through looking at the primary goods attainment of released sex-offenders and whether or not this
impacts their experience re-entering society (i.e. whether or not they re-offended). In this study,

REHABILITATION STRATEGIES
primary goods are defined by the individuals goals related to health, knowledge, values,
relationships, spirituality, goals etc. (Willis & Ward, 2011). They discovered that there was a positive
correlation with primary goods attainment and a positive re-entry experience (Willis & Ward, 2011).
Also significant in their findings was that there was a positive correlation between age and primary
goods attainment, meaning that older offenders had more success than younger in acquiring primary
goods (Willis & Ward, 2011). Willis and Wards study is useful in examining the actual outcomes of
the good lives model because it not only gives us an idea of what factors pertaining to the GLM may
predict rehabilitation outcomes, but they also tell us something important about the age groups that
this therapy works best for. This brings up another issue, however, and that is the fact that juvenile
sex-offenders may react differently to therapies than adult sex-offenders. Therefore, this review will
examine outcomes for adult and juvenile offenders separately.
Rehabilitation Outcomes for Adult Offenders
Contrary to a societal belief that adult sex-offenders are a lost cause, studies have found
that they are capable of rehabilitation (Zgoba, Sager & Witt, 2003). In fact, through meta-analyses it
has been found that on average, only 12.3% of adult sex-offenders that have undergone treatment
will be re-convicted of a sexual offense (Zgoba, Sager & Witt, 2003; Craig, Browne & Stringer,
2003). Although this is a limited indication of the efficacy of rehabilitation methods because it only
takes into account perpetrators that have been convicted of a crime, it is still shows promise that
some sort of sustained rehabilitation is possible for adult sex-offenders. To understand treatment
options for adult-sex offenders in greater detail, researchers look at the outcomes of individual
methods of treatment in different settings.
For instance, McGrath, Cumming, Livingston, and Hoke (2003), sought to assess the efficacy
of prison-based, cognitive-behavioral therapy on the rehabilitation of adult sex-offenders. Because

REHABILITATION STRATEGIES
adult sex offenders represent one quarter of the incarcerated population, it is useful to study the
rehabilitation outcomes of cognitive-behavioral therapy within the context of prison (McGrath et al.,
2003). The study found that of the 195 prisoners in the study, 56 entered and completed treatment, 49
accepted treatment but did not complete it, and 90 did not accept treatment at all (McGrath et al.,
2003). Furthermore, the study found that after a mean follow-up period of 6 years, 5.4% of the
individuals that completed treatment were convicted of sexual re-offences, while 30% of the
individuals that completed only some treatment or no treatment were convicted of sexual re-offenses
(McGrath et al., 2003). This study is useful in understanding what works for rehabilitating adult
offenders because it shows that cognitive behavioral can be a successful treatment option when
completed. It also highlights the importance that sex-offenders complete treatment in order to
experience sustained rehabilitation. This study only addresses the efficacy of cognitive behavioral
therapy in adult sex offenders, however. In order to establish which treatment methods and strategies
are most effective for all offenders, it is important to also examine rehabilitation outcomes of juvenile
offenders.
Rehabilitation Outcomes for Juvenile Offenders
Although juvenile sex offenders are generally thought to share the same stereotyped
characteristics as adult offenders, they face unique treatment challenges as public and legal attitudes
shift towards a much more punitive approach to treatment of juvenile sex crimes and less research
has been done specifically pertaining to this population, which has yielded mixed and inconclusive
findings across different studies (Keelan & Feemouw, 2013). Nonetheless, seeking successful
rehabilitative strategies for juvenile offenders is very important because if a problem can be
addressed while a person is still young, perhaps it can be prevented in the future.

REHABILITATION STRATEGIES
In response to this issue, Hendriks and Bijleved (2008) sought to examine the therapy
outcomes (recidivism rates) of a group of 114 juvenile male offenders.

The primary research

question addressed by the study was, What percentage of juvenile sex offenders re-offend after
residential treatment, and in what ways? (Hendricks & Bijleved, 2008, p. 21). The results of this
study were that 11% of the 114 subjects were re-convicted of sexual offenses after discharge while
27% were re-convicted of non-sexual, violent offenses (Hendriks & Bijleveld, 2008). This study is
very important in that it found that if juvenile sex-offenders that have undergone treatment reoffend,
they are most likely to re-offend in non-sexual ways (Hendriks & Bijleveld, 2008). This is significant
because it shows that, on a short-term level, it is possible for juvenile sex-offenders to be
rehabilitated. Perhaps if this finding were more widely known, the stigma against those who
committed sex-crimes as juveniles could lessen. Despite the hopeful finding this study presents, it
must be mentioned that this study was limited to a small sample. Furthermore, although Hendriks and
Bijlevelds study came to a significant conclusion about juvenile rehabilitation outcomes, it did not
address which therapies are most useful.
In an attempt to understand which therapies are being used and which work best when
treating juvenile offenders, Ikomi et al. (2009) surveyed juvenile treatment centers in the South
West region of the United States. The results of the study were that out of 80 useable returned
surveys, 75 of the juvenile treatment centers surveyed said they use cognitive-behavioral therapy
with a relapse-prevention model, 70 use social skills training, 70 use a group-therapy setting, 58 use
cognitive-behavioral therapy, 7 use aversion therapy and 2 use biological therapy (Ikomi et al.,
2009). When the treatment centers were asked to provide a subjective percentage rating to represent
their perceived success rate of a therapy, cognitive behavioral therapy was ranked the highest with
a mean of 87.3%( Ikomi, et al.,2009). This study is useful because it provides a snap-shot of which
strategies are actually being used to treat juvenile sex-offenders in the field. It is limited, however,

REHABILITATION STRATEGIES
because it only looked at 60 treatment centers from the same area in the United States and its
findings are based upon subjective observations. To evaluate the efficacy of treatment, then, it would
be more useful to look at recidivism prediction factors on a larger scale.
Recidivism Prediction Factors
The key limitation of studies that have sought to evaluate the efficacy of treatment programs
based on recidivism rates is that most of the research is based upon re-conviction rates of previously
convicted offenders, while the majority of sexual offenses generally go unreported (Craig, Browne &
Stringer, 2003). Nonetheless, what is known about recidivism prediction factors in convicted sex
offenders may act as a vanguard in understanding what might prevent offenses within at-risk groups.
The primary method researchers conduct studies about recidivism are through meta-analyses
or re-evaluating the data of existing research. In the study they conducted, Bench and Allen (2013)
looked across existing studies at pre-established predictor measurements of recidivism in sexoffenders and endeavored to find a more accurate and comprehensive recidivism predictor through
utilizing a multi-measurement approach in relationship to arrest-conviction incidents. The results of
this study were first, that 75% of recidivism in subjects was for non-sex offenses (Bench & Allen,
2013). In the end, there were only four variables that had significance in predicting recidivism in
individuals: age at first arrest, technical violations whether the inmate failed treatment and
whether the offender was intoxicated at the time of the offense (Bench & Allen, p.419, 2013). In
addition, the overall percentage of recidivism predicted correctly by the model was 70.2% (Bench
& Allen, p.419, 2013). The model was also found to be more accurate in prediction instances of
recidivism than non-recidivism (65% correct predictions) (Bench & Allen, 2013). Furthermore the
study found that 83% of offenders had no further convictions after their first sex-offense, 7.7% reoffended sexually, and 9.3% re-offended with non-sexual crimes (Bench & Allen, 2013). Finally, the

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study established that the measurement of static factors (characteristics about a person that are
thought to remain the same over time. E.g. personality, disposition etc.) predicted risk or recidivism
more than dynamic factors (characteristics about a person that are thought to change over time).
(Bench & Allen, 2013). This study is useful because it establishes which factors put a previously
convicted offender most at risk for re-offending and it provides one method of predicting recidivism.
Another factor that has been shown to have an influence on recidivism rates is whether or not an
offender completes therapy.
In order to examine the effects that program attrition have on the recidivism rates, Olver,
Stockdale and Worinith (2011) conducted a meta-analysis to analyze which factors determine why
some offenders do not finish treatment, and the connection between treatment attrition and
recidivism. To do this, the researchers pulled data from previously conducted studies to look for
trends about treatment and recidivism rates in offenders of a variety of crimes. The results of the
research found that the overall attrition rate across studies was 27.1% across all programs and
27.6% for sex-offenders specifically (Olver, Stockdale & Worinith, p. 6, 2011). The study also
concludes that offenders who do not complete treatment have a higher risk of re-offending and
attrition rates from all programs significantly predict several recidivism outcomes ranging from
rw=.08-.23 (Olver, Stockdale & Worinith, p. 6, 2011) This study is significant because it examines
the likelihood of offenders completing treatment and links this directly to recidivism rates. All in all,
it can be said that studies like these have made substantial progress in the efforts to understand
recidivism rates and prediction factors in sex-offenders.
Conclusion
The issue of sex-offender treatment and rehabilitation remains to be a controversial and
complex one. While predominantly negative attitudes towards sex-offender rehabilitation have

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persisted in our society, significant progress has been made in discovering therapies and treatment
strategies only within the last two decades. Therefore, we still have a long way to go in establishing
with certainty which rehabilitation strategies and methods are possible, what distinctions exist
between the treatment of adult and juvenile offenders and, perhaps most importantly, which factors
predict recidivism. The final frontier in addressing this issue might potentially be to discover how to
prevent sexual offenses from occurring in the first place. To ensure that progress continues to be
made, further research must be done in this area, especially pertaining to larger study samples and
over longer periods of time. Hopefully, establishing the best treatment for these individuals will not
only make their rehabilitation and potential return to society possible, but it will also make our
society safer and more tolerant place.

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treatment. Journal Of Sexual Aggression, 14(1), 19-32. doi:10.1080/13552600802133852
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