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Of Relapse in Sex Offenders If you have issues viewing or accessing this file contact us at NCJRS.gov. ! • ., " PREVENTION OF RELAPSE IN • SEX OFFENDERS • D. Richard Laws, Ph.D. Project No.1 R01 MH42035 • National Institute of Mental Health • 102319 • U.S. Oepartment of Justice Nalionallnstltute of Justice This document has been reproduced exaclly as received from the person or organization originating it. Points of view or opinions stated In this document are those of the authors and do not necessarily represent the official position or policies of the National Institute of Justice. Permission to reproduce this o~JTigMed material has been • granted by Public Domain National Institute of Mental Health to the National Criminal Justice Reference Service (NCJRS). Further reproduction outside of the NCJRS system requires permis­ • sion of th~l:lt owner. PREVENTION I OF RELAPSE IN • SEX OFFENDERS ~~ ..". • • • • D. Richard Laws, Ph.D. • Project No. 1 RO 1 MH42035 National Institute of Mental Health • • • • Table of·Contents Research Plan General ov~rview of the research ................................ l Specific aims •••• "' •• ,,"" '1"" .. ""."""""""""""""""""""""""""""""""",,.1 Preliminary studies""." '" " " .. " " .. " fI " " " " " " " • " " " " " " " " " • " " " • " " " " " " " " " " 3 Physiological assessment procedures ........................ 9 • Self-report assessment procedures ......................... 14 Behavioral treatment procedures .............•............. 23 Cognitive treatment procedures .....................•...... 30 Methods I. Participants and admission criteria ..............•... 40 II. Apparatus."""."" .. """"" .. """""""",,.,,"""""""""""",, .. ,,"" .41 • III. Procedure.""""".""" .. "" .. ,,"""""",, ... ,,"""""""""""""""""" .43 A. Design. " " " " " " . " " " . " . " " . " " . " " " " " " " " " " " " " " " " ,,43 B. Staff training."""""""""""""""""""."""",,.,, .46 C. Behavioral and psychological assessment" .• " " " " " " " " •. " " " " " " " " " " • " " " " " . " " ,,50 Between-group outcome measures ........ 52 D. Treatment effectiveness ................•... 56 • Treatment integrity ................... 62 E. A theoretical model of sex offense prevention: Assessment ..•.................. 65 F. A theoretical model of sex offense prevention: Treatment ...................... 76 G. Prevention of relapse in sex • offenders ............. " " .... " ............. " " " " .... " .. " .. " " " " " "86 H. Prediction of reoffense .•.................. 97 I. Long-term follow up ..•..•................. 100 IV. Statistical analysis of data ..........•.............. lOl V. Human subjects.""""" ... """"""".,,,,,,;,,,,,,,,,, .. ,, .... ,, .. ,, ............... 106 • Appendices I. References ............................ _ ............... 110 II. Figures, informed consents, predictor scale • • I ~~_... r t: • . ...... ........ ..,. .. I,. • • • General Overview of the Research There is no comprehensive and testable theory of sexual deviance in the psychological literature. What we have instead are personality-based or trait accounts of various types of sex offenders, speculative typologies used to separate subvarieties of offenders, or isolated descriptions of experiential factors or single processes of learning • which are said to contribute to a sexually deviant orientation. All of these, while useful to a limited degree, are ultimately unsatisfactory. There has been little or no effort to gather together what is known empirically and theoretically into a single explanatory system to account for the genesis and modification of sexual • deviance. Our contention is that sufficient, if not abundant, information presently exists to make the initial steps toward such a comprehensive theory. This program statement is our contribution to that process. The theory statement proposed herein is intended to serve only as the guiding framework for a series of evaluative and therapeutic operations intended to bring • sexually deviant behavior under control and then prevent relapse in treated outpatient sex offenders. The empirical/ theoretical paradigm we propose is a learning model with its roots in conditionin0 theory and social learning theory. The theoretical statement is deductive, reasoning from general principles about human behavior, to specific propositions about human sexual behavior in general or • deviant sexual behavior in particular, to specific hypotheses about sexual deviants. The theory is intended to comprehend how deviant behavior is acquired, how it may be modified, and how its recurrence may be prevented. The model is potentially applicable to any sexual deviation. The major advantage of having such a guiding theory is that it clearly defines its goals and explicitly specifies a • set of operations for forthrightly dealing with a pervasive social problem. The theory is parsimonious, employs the smallest number of empirical and theoretical assumptions for support, makes assertions which are grounded in observable events, and proposes hypotheses which are falsifiable. This potential for disconfirmation is essential in that it • provides a corrective feedback function which demands revision of the theory statements as experience accumulates. Specific Aims The intent of this program is to evaluate, treat, and prevent relapse in a group of outpatient sex offenders seen • in a community-based setting. The program is guided by the specific assertions of a theoretical statement which describes (1) how deviant sexual behaviors are originally acquired, (2) how, once acquired, deviant behavior is sustained in the face of more appropriate alternatives, (3) how deviant behavior, its accompanying social styles and • • 2 deviant cognitions can be altered, and (4) how those changes can be maintained, i.e., relapse prevented. • The following are the primary aims of the program: 1. An examination of the explanatory adequacy of the first half of the theoretical·model. The first, two sections of the theory, acquisition and maintenance of··deviant , • behavior, describe the influence of~conditioning and social learning experiences' on sexual and social development. By means of a lengthy self-report instrument, offenders will retrospectively report on the relative importance of these factors. Data so obtained cannot be used to directly sUbstantiate the theoretical statements, and it is recognized that a proper test of the theory's assertions • would be a longitudinal study. However, the accumulation of retrospective data is considered here the initial investigatory step necessary for formulating the thrust that such a longitudinal study should take. 2. A test of the practical utility of the second half of the theoretical model. a. The third section of the theory describes the • modification of deviant sexual responsiveness by use of behavior therapy techniques, and the modification of deviant cognitions by rational-emotive therapy. We will determine here if a modest but directive package can substantially bring major features of deviant behavior under control. b. The fourth section of the theory, relapse prevention (short-term) is intended to follow and reinforce • the basic treatment. Here we use stress inoculation, a cognitive-behavior therapy, to teach impulse control and anger management in crisis situations. The phase closes with clients being taught the rudiments of the individualized relapse prevention procedures. 3. The final section of the theory, relapse prevention (long-term) is the key element of the program and will be • implemented as a long term follow up period. Unlike most follow up programs for sex offenders, we require a high level of participation by the client in a very long and interventionistic program. • • • • 3 • preliminary Studies Introduction. Two of the major dependent variables in this program are the response of penile erection and subject self-report. Both of these measures periodically come under attack by critics as being open to subject influence, the latter more often than the former. It is therefore necessary to briefly review what is known about the nature • and extent of these purported problems. Sexual arousal assessment. Of the potentially relevant physiological responses, that of penile erection has repeatedly been demonstrated to be the single best index of male sexual arousal (Abel, 1976; Bancroft & Mathews, 1971; Barlow, 1977; Freund, 1963; Masters & Johnson, 1966; Rosen & Keefe, 1978; Rosen & Rosen, 1981; Zuckerman, 1971). The • response is highly specific, occurring in the presence of sexual stimuli and not in the presence of nonsexual stimuli. When the erection response has been measured concurrently with other possibly relevant physiological variables (e.g., Bancroft & Mathews, 1971), it has been the only one which was discriminative of sexual arousal. It is therefore the • best available dependent variable for our purposes. Physiological assessment of sexual arousal is now a commonly accepted procedure. Sexual arousal is assessed by means of a device called a penile transducer, a very small unit which the subject wears around his penis. The device can detect changes in the circumference of the penis, and these are expressed as changes in electrical resistance. These minute resistance changes are amplified, converted, and finally shown most commonly as a pen tracing of the response or a periodic digital readout (LEDs) or printout. Since the response has absolute 0% and 100% limits, intermediate values may conveniently be described as some percentage of the maximum response, e.g., 55% of a full erection. All
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