THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 1

THERAPEUTIC TECHNIQUES PROVEN TO BE EFFECTIVE IN REDUCING
RECIDIVISM RATES IN CHILD SEXUAL OFFENDERS
by
Kimberly Paquin
BACHELOR OF SOCIAL WORK, University of Northern British Columbia

MAJOR PAPER SUBMITTED IN PARTIAL
FULFILLMENT OF
THE REQUIREMENTS FOR THE DEREE OF
MASTER OF SOCIAL WORK
in the
School of Social Work
© Kimberly Paquin 2020
UNIVERSITY OF THE FRASER VALLEY
SPRING 2020
All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other
means, without permission of the author.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 2
Name:

Kimberly Paquin

Degree:

Master of Social Work (MSW)

Title:

Therapeutic Techniques Proven to be Effective in Reducing Recidivism Rates in
Child Sexual Offenders

Examining Committee:
Dr. Leah Douglas, BSW, MSW, Ph.D., RCSW
Primary Supervisor
Faculty, School of Social Work & Human Services

Dr. Lisa Moy, BA, BSW, MSW, Ph.D., RSW
Second Reader
Faculty, School of Social Work & Human Services

John Hogg, BA, BSW, MSW, RSW
MSW Chair
Faculty, School of Social Work & Human Services

Approved: April 28, 2020

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 3
TABLE OF CONTENTS
Abstract …………………………………………………………………………………….. 5
List of Acronyms …………………………………………………………………………… 7
Introduction ………………………………………………………………………………… 9
Methods …………………………………………………………………………………….. 11
Findings ……………………………………………………………………………..………14
CSO Characteristics …………………………………………………………………………14
Implicit Theories …………………………………………………………………………… 15
Sexual Entitlement …………………………………………………………………………. 17
Offence Supportive Attitudes ……………………………………………………………… 18
Children as Sexual Objects ………………………………………………………………… 19
Cognitive Distortions ………………………………………………………………………. 20
Empathy Deficits …………………………………………………………………………… 22
Blame Attribution …………………………………………………………………………… 24
Interventions ………………………………………………………………………………… 26
Victim Empathy Work ………………………………………………………………………. 26
Client’s Personal Trauma History ………………………………………………………….. 29
Taking Responsibility ………………………………………………………………………. 31
Cognitive Behavioural Therapy …………………………………………………………….. 33
Risk-Need-Responsivity …………………………………………………………………….. 35
Surgical Castration and Hormonal Therapy …………………………………………………. 38
Therapeutic Environment ……………………………………………………………………. 40

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 4
Group vs. Individual Therapy ……………………………………………………………….. 40
Length of Treatment …………………………………………………………………………. 41
Therapeutic Alliance …………………………………………………………………………. 42
Implications for Social Work ………………………………………………………………… 42
Conclusion …………………………………………………………………………………… 43
References ……………………………………………………………………………………. 46

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 5
Abstract
This literature review compared various therapeutic techniques typically utilized in the
treatment of child sexual offenders (CSOs). Meta-analyses, literature reviews, and studies were
utilized to help determine which intervention styles could help reduce recidivism rates in CSOs.
Literature was also used to determine the demographics and cognitive processes of CSOs, and to
understand the onset of such deviant sexual behaviour. Implicit theories such as sexual entitlement, offence supportive attitudes, and the thought of children as sexual objects are risk factors
in offenders engaging in sexual deviancy towards children. Some additional risk factors are:
cognitive distortions such as empathy deficits and blame attribution. Treatments found to positively impact this demographic are: cognitive behavioural therapy (CBT), hormonal treatment,
risk-need-responsivity (RNR) model, trauma therapy for the offender, offender taking responsibility for actions, and victim empathy work. Additional factors which help the success of these
interventions such as therapeutic alliance, group therapy, and the length of treatment will be discussed. This paper also includes a discussion of the gaps in research, as well as the implications
for social work.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 6

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 7
List of Acronyms
CBT - Cognitive Behavioural Therapy
CSO - Child Sexual Offender
RNR - Risk-Need-Responsivity

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 8

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 9
Introduction
There is much controversy regarding the correctional and recidivism processes of child
sexual offenders (CSOs) in our society today. Grady and Strom-Gottfried (2010) discuss the lack
of research in this particular field, and state that it is due to a lack of researchers’ interest, a lack
of funding for such research, and the difficulty of researching numerous contributing factors
which impact the behaviour of CSOs. Some therapeutic intervention strategies have been found
to be effective when introduced individually, while other research states that such interventions
would be best offered in group settings. Some professionals believe that hormonal therapy and
castration are beneficial in reducing recidivism rates; however, others believe that such methods
are inhumane and unethical. Another controversy is whether or not it is essential for the offender
to take responsibility for their actions, as there is conflicting evidence which presents itself on
this topic. Empathy work being included in the intervention process is another controversial topic
as some believe it to be beneficial, while others state that there is not enough evidence to show
this strategy’s benefits. Although this is a topic which is undoubtedly sensitive, one must look at
the reality of the current situation with CSOs, which is that they are generally, depending on their
offences, reintegrated back into community. There is typically a requirement for CSOs to obtain
a form of therapeutic intervention upon release into community. However, this is a controversial
issue and there are conflicting reviews as to what intervention strategies are helpful to reduce
recidivism rates.
This paper introduces the research question which is: what therapeutic techniques are
proven to be effective in reducing the recidivism rates in CSOs? Some personal characteristics of
CSOs that have been found throughout the research of this review, is that they are typically

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 10
males, adults, and individuals who have experienced sexual abuse in their past. Another characteristic of CSOs is that it is common for these individuals to either be family members or acquaintances of the victim. It is also more common for females to be victims of child sexual assault than males, with the average age of victims being 14 years old (466 per 100,000 population), (Statistics Canada, 2015).
It is essential that the outcomes and validity of these therapeutic strategies are widely understood within the professionals who work with CSOs, so that therapeutic intervention strategies which are being utilized with them effectively help to reduce recidivism rates. This will
hopefully result in a reduction in incidences and the number of victims of child sexual assault.
This paper will outline factors contributing to CSOs committing child sexual assault such as
cognitive distortions and implicit theories, in the attempt to understand the emotional and cognitive processes that sometimes present within CSOs. This paper will also discuss the therapeutic
environment, specifically what factors benefit the therapeutic process. If there is the expectation
and hope that CSOs will integrate back into community with reduced rates of recidivism, it is
essential for research to demonstrate which treatment methods will best support CSOs. As noted
earlier, there is a lack of research in this area due to professional interest and funding. An area of
concern regarding this lack of research is that certain therapeutic techniques continue to be used
with sex offenders despite a lack of evidence to prove their effectiveness (Grady & Strom-Gottfried, 2010). This leads professionals to facilitate treatment with this specific population without
having proper understanding of the impacts of treatment. This means that interventions are potentially being used with CSOs that might be causing more harm than good to both the offender
and potential victims, which is an unethical way of practicing (Grady & Strom-Gottfried, 2010).

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 11
Social workers working with this demographic must understand which therapeutic techniques
have been proven to help reduce recidivism rates with CSOs, as this demonstrates ethical practice. This is because it is the social worker’s responsibility to ensure best practice and competency in practice with the populations with whom they work (BCASW, 2005). Grady and StromGottfried (2010) discuss the concerns regarding the lack of evidence that demonstrates which
therapeutic intervention strategies have proven to be consistently effective in reducing recidivism
rates in CSOs, and call for more research to be done in this area so that professionals can adequately support CSOs. This application of knowledge will also likely have a positive impact on
society as a whole. This is because CSOs pose as a risk to the public due to the community violence which they inflict, and if professionals have a better understanding of effective therapeutic
intervention strategies to utilize in treatment, it might help to reduce recidivism rates. This may,
in turn, result in fewer victims experiencing child sexual assault within our society.

Methods
This paper provides a thematic review of the literature on effective therapeutic interventions used with CSOs. The selected research is peer-reviewed, and was found using Ebsco Host,
an accredited post-secondary institution database. Articles from around the world were used in
this review, with the majority of the articles coming from North America and the United Kingdom. Articles published within the years of 1996 to 2017 were used in this review. Initial attempts were made to include only recent articles, from the last 5-10 years. However, due to the
limited nature of the research, the timeframe was widened in order to include a sufficient number
of articles. Articles from journals in the fields of psychology, corrections, social sciences, social

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 12
work, behavioural therapy, criminology and psychiatry were included in this review. It is important to note the reasons why there is a lack of current research outlining this topic. Grady and
Strom-Gottfried (2010) note the lack of researchers who are interested in such a topic, and state
that there is a lack of funding for such research to be conducted. It was therefore deemed necessary to include older references in order to appropriately discuss the topic. Combinations of key
terms used in the online search were “child sexual offenders”, “child molesters”, “hormonal therapy”, “cognitive-behavioural-therapy”, “offence supportive attitudes”, “implicit theories”, “characteristics”, “risk-need-responsivity”, “recidivism rates”, “therapeutic techniques”, “treatment”,
“therapeutic interventions”, “cognitive distortions”, and “empathy". The materials used to formulate this paper are meta-analyses, literature reviews, and studies, and a total of 30 sources are utilized. The articles’ abstracts were reviewed to determine their relevancy to the characteristics of
CSOs, and whether or not the material helped explain either their cognitive processes or effectiveness of treatment. It was also essential for abstracts to be reviewed to ensure the articles discussed adult CSOs, as there were numerous articles found which focused on adolescent CSOs.
The studies utilized in this design include participants who are both in custody as well as in
community. This is relevant to gain a better understanding of the cognitive processes of the offenders after their convictions, and to determine how therapeutic interventions impact offenders’
recidivism after their release. Studies which discuss recidivism rates will be included in this paper; however, as noted by Martínez-Catena and Redondo (2017), it is important to include more
than just recidivism rates, such as the methods of treatment and how such interventions help
change behaviours in CSOs. Therefore, this paper will include both statistics on recidivism rates,

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 13
as well as an overview of therapeutic techniques and how they are implemented with CSOs to
help reduce recidivism rates.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 14
Findings
There were some common themes found in the articles relating to CSOs which led to
formulating main themes for this literature review paper. The first main theme that will be discussed is in regard to the personal characteristics of CSOs. Implicit theories which are common
amongst CSOs will be the second theme discussed, with a specific focus on offence supportive
attitudes, sexual entitlement, and the viewing of children as sexual objects. Although such implicit theories do not exist within all CSOs, the theories discussed are said to be widely prevalent
in this population. Lastly, cognitive distortions will be discussed, specifically noting the topics of
empathy deficits and blame attribution. Again, such distorted thought processes may not be relevant to each and every CSO, however the distortions discussed are commonly found in the CSO
demographic.

CSO Characteristics
A characteristic which was found in the CSO population was that it is common for such
individuals to have experienced sexual abuse as a child themselves. D’Orazio (2013) states that
there is a 30-70% chance that CSOs have experienced childhood trauma, a rate that is substantially higher than the typical person. Another finding is that CSOs are typically male. Statistics
Canada (2015) states that in 2012, 97% of individuals who sexually offended a child were male,
while 3% were female. Adams (2003) suggests that men are more prone to becoming offenders
because of the way in which they are socialized in our society, adding that this socialization
causes males to lack the ability to cope with their own sexual abuse. This means that because
men are socialized to be tough and discouraged from speaking about or showing their emotions

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 15
towards sensitive topics, they are not provided with as many opportunities to cope with their own
sexual abuse in a healthy manner. When examining the population of children who experienced
sexual assault, 81% of this category consisted of males offending female children (Statistics
Canada, 2015). In terms of the statistics regarding the age of the victims, in 2012, the average
age of sexual assault victims was 14 years old (466 per 100,000 population). In terms of the age
of offenders, in 2012, one-third of sexual offences towards children were committed by another
youth, specifically occurring when the offender was 13 or 14 years of age. Furthermore, 51% of
all individuals who were accused of sexually offending a child were over 25 years of age, reaching 61% when the victims were between the ages of 0-3. It is important to consider the relationship which the offender typically has with the victim as it is common for offenders to be a family
member or an acquaintance of the victim. For example, in cases where the victim was under 12
years of age and the offender was between the ages of 12 and 17, the accused was proven to be a
family member 56% of the time, and proven to be an acquaintance 37% of the time (Statistics
Canada, 2015).

Implicit Theories
Implicit theories within CSOs are underlying offence supportive attitudes that sexual offenders posses, which predispose them to engage in deviant behaviour (Pemberton & Wakeling,
2009). Pemberton and Wakeling (2009) claim that these implicit theories are, in a sense, distorted
ways of thinking. The following section will outline some commonly found implicit theories
within CSOs. This is an important aspect to discuss because this concept can help professional’s
working with CSOs understand how an individual’s thought process may influence their deviant

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 16
behaviour. Although these implicit theories are not consistent for all CSOs, they are found to be
present in a large portion of the population.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 17
Sexual Entitlement
CSOs typically demonstrate a sense of sexual entitlement toward their sexual needs and
desires, which contributes to their sexual deviancies. Pemberton and Wakeling (2009) claim that
it is common for such individuals to feel entitled to sex, which correlates to CSOs engaging in
sexual deviant acts. Entitlement is said to be the most common implicit theory, which also contributes to the offence supportive perspectives of CSOs. These same researchers also state that
children are at increased risk when CSOs demonstrate sexual entitlement (Pemberton & Wakeling, 2009).
Pemberton and Wakeling (2009) studied CSOs who were imprisoned in an England penitentiary due to their sexual offences, in the hopes of determining how such entitled thoughts contributed to their sexual offences. The authors analyzed the thoughts of offenders during the time
of their offences with the use of inductive and deductive reasoning. The study’s participants were
involved in a CBT program, and the thoughts of the individuals at the time of their offence were
clinically documented. The study categorized the offenders into groups: rapist, sexual murderers,
extra familiar child offenders (offenders not related to their victims), and interfamilial child offenders (offenders related to their victims), to determine sexual entitled thoughts within CSOs.
Major themes appeared, and these included: sex being the right of the offender, women and children being the property of the offender, the belief that only the offender mattered to themselves,
and sex as a man’s birthright. It was found that CSOs see themselves as “superior” to others,
specifically their victims, which subsequently leads them to think that their needs should be met
when and where they wish (Pemberton & Wakeling, 2009, p. 290). This is specifically true for
incest offenders as the common perspective taken on by these CSOs is that they believe that their

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 18
daughters or stepdaughters are their own property, or that they deserve something in return for
taking on a parenting role. This subsequently means they feel entitled to inflict the sexual abuse
upon their victims. The study determined that practitioners who treat CSOs must incorporate
treatment that addresses implicit theories such as entitlement because such belief systems are
what contribute to attitudes supportive of deviant behaviour. The hope is that through such
treatment, the attitudes of CSOs will be challenged and their justifications to their criminal behaviour will be addressed. Without addressing the concept that a CSO is entitled in the treatment
process, such individuals are less likely to succeed at refraining from engaging in deviant criminal activity when reintegrating back into community (Pemberton & Wakeling, 2009). This leads
us to believe that addressing these feelings of entitlement with CSOs could benefit the therapeutic process as it will allow the individual to observe their own perspectives and how such thought
process might impact their victims.

Offence Supportive Attitudes
Helmus and colleagues (2012) conducted a meta-analysis of 46 samples of quantitative
studies to determine predicting factors of recidivism within CSOs. It was determined that there
was a correlation between recidivism rates of CSOs and the attitudes towards sexual offending.
More specifically, it was found that there could be a prediction of recidivism in offenders who
displayed “attitudes supportive of sexual offending” (Helmus et al., 2012, p. 42). This means that
individuals who have attitudes that minimize or are in favour of criminal behaviour, termed offence supportive attitudes, are more likely to re-offend. The meta-analysis also found that individuals who held attitudes which were supportive of sexual offending were also found to have

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 19
additional “offence-related constructs, such as deviant sexual interests, general pro-criminal attitudes, and hostility towards women” (Helmus et al., 2012, p. 47). It is therefore suggested by
Helmus and colleagues (2012) that the treatment process of CSOs should include discussions and
interventions surrounding offence supportive attitudes.
There are distinct factors mentioned by the authors that underpin offence supportive attitudes, including “the belief that sex with children is harmless and the belief that some children
are sexually provocative” (Hempel et al., 2015, p. 36). The authors state that these offence supportive attitudes are a predicting factor for recidivism within CSOs, specifically noting that offence supportive attitudes are more widely present within CSOs than they are within non-offenders. It is also mentioned that these offence supportive attitudes lead CSOs to justify their sexual
offending behaviour. This offending behaviour will likely continue to happen if the individual
does not recognize how their behaviours impact and harm their victims (Hempel et al., 2015).
Adams (2003) states that these distorted views towards child sexual abuse are typically addressed in treatment with the goal of reducing the chances of re-offending.

Children as Sexual Objects
Offenders have certain implicit theories about their victims regarding their wants and
needs which can be wrongfully interpreted (Burn & Brown, 2006). These false impressions of
the victim’s preference can be what leads offenders to follow through with their deviant behaviour (Burn & Brown, 2006). Ward and Keenan (1999) second this concept as they suggest
that these implicit theories “enable individuals to make inferences about what another person is
probably experiencing and to predict his or her future actions” (p. 833). For example, the authors

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 20
state that CSOs often view their victims as sexual objects. CSOs also often believe that the victims are benefiting from the sexual deviant behaviour by thinking that the victim is enjoying the
sexual act. The implicit theories that children are sexual objects cause CSOs to be selective with
processing information in that they disregard any other interpretations of sexual deviant behaviour. In other words, CSOs will categorize children based on their implicit theories, which
contributes to how the CSO treats their victims, and how they believe their victims to be feeling
(Ward & Keenan, 1999). It is suggested that deciphering these implicit theories in the treatment
process can be helpful, as these underlying beliefs are what often lead CSOs to assault their victims, and justify their actions (Gannon et al., 2007; Ward & Keenan, 1999).
Another example is that CSOs often believe that their actions did not cause the child any
significant harm (Gannon et al., 2007). Furthermore, Hempel and colleagues (2015) suggest that
CSO’s “offence supportive cognition and levels of empathy” are contributing factors to such misinterpretations (p. 355). Such implicit theories have said to “facilitate decision making in the direction of sexual offending behaviour at an unconscious level” (Kamphuis et al., 2005, p.
1352). These unconscious decisions can occur as a result of an offender developing a certain theory about the victims, as well as themselves (Kamphuis et al., 2005). Ward and Keenan (1999)
explain this further by saying that a CSO who believes their actions do not cause harm to children, is more likely to offend.

Cognitive Distortions
Significant research has shown that cognitive distortions are very much relevant in the
perceptions held by CSOs. The following section will outline a variety of cognitive distortions

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 21
that typically present themselves within adult male CSOs, and how such interpretations contribute to sexual offences. Burn and Brown (2006) state that the cognitive distortions that are
present within CSOs are formed by such theories about their victims, themselves, and their overall worldview.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 22
Empathy Deficits
Empathy is a topic that is widely controversial within the professionals working with this
population. Some researchers believe that CSOs lack the ability to express empathy, while other
researchers state that empathy is situational within CSOs. For example, Burn and Brown (2006)
state that CSOs do not demonstrate empathy in incidences involving the individuals they have
sexually offended; however they can demonstrate empathy towards an accident victim.
Another example is that CSOs have shown an ability to demonstrate sensitivity towards their victims with respect to grooming; however this is done in a way that benefits themselves, not the
victim. These examples allow us to see that CSOs’ ability to demonstrate empathy is situational,
meaning that it is typically only applied when it favours the CSO.
Martínez-Catena and Redondo (2017) also discuss the concept of empathy and state that
CSOs typically have difficulty accurately determining the perspectives of their victims, specifically their wants and feelings, which are key aspects of empathy. These kinds of perspectives can
also be said to contribute to CSOs experiencing difficulty determining what other people, specifically victims, are realistically thinking and feeling, which can undoubtedly contribute to acting
in ways which could potentially harm the victim (Martínez-Catena & Redondo, 2017). For example, CSOs’ inability to feel empathy towards their victim’s pain and trauma from the assault,
contributes to them having the ability to be sexually aroused by children (Burn & Brown, 2006).
This is because, the offender is not considering the negative impacts that their behaviours are
having on the child, therefore allowing permission for such arousal to occur instead of resisting
such thoughts and behaviours. In other words, if a CSO were to demonstrate empathy towards

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 23
their victims, the empathy would prevent the deviant behaviour from occurring, as they would
have a better understanding of the pain and trauma caused by the assault (Burn & Brown, 2006).
Brown and colleagues (2013) conducted a study which aimed to determine how empathy
correlates to the cognitions and sexual offending behaviours of CSOs. The study took 50 interview transcripts of male participants who were serving time in custody for committing a child
sex offence which were gathered from a previous study. The study used thematic analysis to help
the researchers analyze the collected data, and found a common theme to be that participants created “psychologically comfortably positions that enabled them to offend and continue with their
offending” by rationalizing their offending behaviour (Brown et al., 2013, p. 279). It is suggested
that offenders “shift some of the responsibility for their actions” contributing to them having
this “psychologically comfortably position” and inflicting a “role reversal, creating themselves as
victims” (Brown et al., 2013, p. 280). This means that offenders would victimize themselves in
an attempt to justify their actions instead of taking ownership for the damage they were causing.
The authors state that CSOs would not only justify and rationalize their behaviour by viewing
themselves as the victim, but also by seeking external factors such as being intoxicated at the
time of the event. This does not necessarily mean that offenders lack the ability to express empathy, but instead that the need to use empathy is reduced due to the perceptions that offenders
have towards their own behaviour (Brown et al., 2013). Adams (2003) takes a different perspective on empathy deficits, and states that such distorted perceptions “are maintained by the inability to feel empathy, or imagine what the victim is experiencing” (p. 82). Furthermore, if CSOs
demonstrate an inability to use empathic responses in their human interactions, it is considered to
be a contributing factor to them engaging in deviant sexual behaviour (Covell & Scalora, 2002).

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 24
Wood and Riggs (2008) also conducted a study based on empathy, and utilized two
groups to do so; one included 61 CSOs on parole, and another was comprised of 51 individuals
in community who had not been convicted of any type of crime. The study confirmed that empathy deficits predisposed individuals to become a CSO. Interestingly enough, the study indicated
that CSOs might be faced with more challenges in demonstrating empathy for victims regardless
of the treatment they receive. This could be because offenders demonstrate empathy deficits towards victims as a form of self-protection. In other words, demonstrating low levels of victim
empathy through the use of denial or guilt can be a mechanism which offenders use to protect
themselves from the contradictory feelings that might come up regarding their offending behaviour. It is suggested that CSOs should not be labelled as non empathetic because any development of empathy skills that an offender makes in treatment can then be viewed as progress.
Wood and Riggs (2008) state that more longitudinal studies need to be implemented in order to
help us see how deficits in empathy relate to CSOs. It is also suggested that larger samples of
CSOs be included for professionals to have a better understanding of how deficits in empathy are
represented in this population (Marshall & Maric, 1996).

Blame Attribution
Blame attribution is a process in which the offender justifies their actions by placing blame
on factors which prevents them from taking responsibility for their actions (Blumenthal et al.,
1999). Blame attribution factors that exist in CSOs are; external factors such as the victim, mental element attribution such as a mental illness, or guilt feeling attribution. These three factors
will be discussed in the following section. Blame attribution is said to be different than simply

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 25
having offence supportive attitudes. With blame attribution, the offender is acknowledging the
deviancy of the act, but they are distancing themselves from the offence (Helmus et al., 2012).
However, a correlation may exist; as more CSOs justify sexually offending children, there is a
higher likelihood that they will blame the victim for the offence (Blumenthal et al., 1999).
Guilt feeling attribution is when the offender reports remorse, guilt or regret that they offended (Blumenthal et al., 1999). In order to reduce feelings of guilt or anxiety, the offender instead places blame on the victim. CSOs demonstrate a higher guilt feeling attribution than adult
sexual offenders, due to the fact that sexual assaults against children carries more social disapproval. This means that the more an offence is judged by society, the more guilt feeling attributions the offender will have. External attribution, the process of offenders placing blame on their
victim, is also seen to occur within CSOs. For example, offenders justify their actions by stating
that the sexual experience was beneficial for the child, or that the child wanted to engage is such
acts (Blumenthal et al., 1999). Gannon and colleagues (2007) discuss this process further and
state that CSOs often make the statement that the child played a role in instigating the sexual
acts. This means offenders place themselves in a psychologically comfortable position as they
have distanced themselves from the offence and the negative feelings associated with it (Brown
et al., 2013). Mental element attribution occurs when an offender blames their behaviour on a
mental illness, or a loss of self control (Blumenthal et al., 1999). Offenders who blame their offences on mental factors do not experience a reduction in feelings of guilt, however, when an offender blames external factors, a reduction in guilt is experienced (Blumenthal et al., 1999).
Blumenthal and colleagues (1999) suggest that there may be such a high amount of distorted thinking in CSOs, and that they are not able to recognize societal expectations regarding

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 26
appropriate sexual behaviour. Research surrounding prevention therapy for CSOs shows that
treatment to reduce cognitive distortions has been proven most effective. Further, CSOs have
been known to have a high level of cognitive distortions as they typically do not view sexual encounters with children to be inappropriate (Blumenthal et al., 1999). It is important for professionals to have a thorough understanding of these underlying implicit theories because the distorted perceptions that CSOs have toward what their victims are thinking or wanting may lead
them to behave in ways that might be harmful to the child.

Interventions
The following section will include a variety of therapeutic interventions such as victim
empathy work, addressing the offender’s personal trauma, techniques which focus on the offender taking responsibility for their offences, cognitive-behavioural therapy (CBT), risk-need-responsivity (RNR), surgical castration and hormonal therapy. Through the analysis of meta-analysis and studies, this section will discuss how these methods are proven to be effective in reducing
recidivism rates with CSOs.

Victim Empathy Work
Empathy is described as a skill which allows an individual to understand the feelings and/
or the experience of another person. It is also the ability to appropriately provide a response
based on what the feelings of the other person might be. Victim empathy work for CSOs is the
process of imagining the trauma that the child is experiencing as a result of the sexual assault
(Mathews & Collin-Vézina, 2016). Regardless of the findings which indicate that there is not a

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 27
strong link between recidivism and deficits in victim empathy, 90% of treatment centres for
CSOs incorporate victim empathy work (Martínez-Catena & Redondo, 2017). This is an interesting finding and it is worth questioning why so many programs incorporate such perspectives.
Empathy could help in the therapeutic process because “it is strongly correlated with self-esteem,
shame, and cognitive distortions, possibly influencing each other in treatment
improvement” (Martínez-Catena & Redondo, 2017, p. 43).
Martínez-Catena and Redondo (2017) conducted a study of 153 participants who were
inmates in a Spanish penitentiary as a result of committing sexual offences. The goal of the study
was to determine effective therapeutic interventions within this specific population. It was found
that these individuals typically had difficulty accurately determining the perspectives and feelings of their victims, and that interventions utilized in therapy act to address these perspectives in
order to “restructure cognitive distortions and crime justifications” (Martínez-Catena & Redondo, 2017, p. 43). Overall, treatment which addressed empathy deficits demonstrated positive results in terms of treatment effectiveness, as the “recidivism rate of treated sex offenders ranged
from 9% to 11% compared with a rate of around 17% for untreated sex offenders” (MartínezCatena & Redondo, 2017, p. 43). Blumenthal and colleagues (1999) add that in order to expect to
see a decrease in recidivism within child sex offenders, it is important to implement “distorted
attitudes and beliefs” in therapy with these individuals (p. 130).
Worling and Curwen (2000) conducted a study in Canada examining treatment used with
CSOs which included 58 offenders who received treatment and 90 offenders who did not. Treatment methods including CBT, as well as methods to address sexual attitudes, denial, victim empathy, and accountability, were implemented in treatment consisting of at least twelve months.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 28
Offenders who completed treatment, demonstrated to have a 72% reduction in sexual recidivism
compared to participants who did not complete treatment. Specifically, incorporating victim empathy work in the treatment of CSOs was found to help reduce recidivism rates (Worling & Curwen, 2000).
Mathews and Collin-Vézina (2016) also discuss empathy work in treatment, and specifically mention that the incorporation of empathy work is recommended in order to reduce sexual
assault against children. It is also said that CSOs can learn victim empathy with appropriate supports and that it is an essential component for practitioners to use in therapeutic intervention with
this population (Mathews & Collin-Vézina, 2016). Covell and Scalora (2002) state that aggression and anti-social behaviour correlate to empathy, leading to the belief that incorporating empathy work with sex offenders helps to reduce “aggressive behaviour and hostile responses, and
increases the occurrence of prosocial behaviour” (p. 253). Considering the relationship that aggression has with empathy, an increase in empathy could support the reduction of CSO offending
as it would lead to them “resisting the impulse to abuse a child” (Mathews & Collin-Vézina,
2016, p. 309). This is because an increase in empathy within CSOs would likely help them to
recognize the trauma that the sexual offence would inflict on the child (Mathews & Collin-Vézina, 2016).
An interesting point is made by D’Orazio (2013) in regard to the perceptions that practitioners have towards CSOs. It is recommended that practitioners consider their own perceptions
of these individuals to ensure that they have empathy for the offender. D’Orazio (2013) claims
this approach to be necessary for a practitioner to take because; “offenders will not see themselves differently until we do” (p. 6). Thus, it is valuable for the practitioner to place importance

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 29
on the emotional processes of the client in order for the client to feel understood and for them to
be able to develop their ability to express empathy (D’Orazio, 2013).
Covell and Scalora (2002) state that there are some limitations in the implementation of
empathy work. One concern is that it might lead offenders to simply understand how to portray
empathy based on new awareness of the societal expectations. Another limitation is that it is unclear if implementing empathy work will actually “increase an offender’s ability to get close to
his victims and ultimately facilitate the offence process” (Covell & Scalora, 2002, p. 264). Although empathy work is clearly a large part of the therapeutic process with CSOs, it is evident
that more research must be conducted in order for professionals to determine the effectiveness of
such interventions.

Client’s Personal Trauma History
Adams (2003) discusses the importance of empathy for not only the victim, but for the
CSOs themselves, as it is common for such offenders to have also experienced childhood sexual
assault. Adams (2003) highlights the relationship that exists “between a person’s capacity to experience and express their own painful emotions and the capacity to respond sympathetically to
the emotional pain of another person” (p. 82). This means that, without addressing their own
trauma, CSOs are unable to feel empathy for their victims as there is a barrier to understanding
the emotional impacts that childhood sexual assault can have on an individual (Adams,
2003). D’Orazio (2013) states that there is a 30-70% chance that CSOs have experienced childhood trauma. Martínez-Catena and Redondo (2017) add that CSOs “have more varied and atypical sexual experiences at an early age than is the norm, including violent pornography or actual

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 30
childhood experiences of physical or sexual abuse” (p. 42). These experiences can contribute to
CSOs preferring violent sex as well as having deviant sexual thoughts. There is also a correlation
between empathy deficits within CSOs and their early sexual experiences such as sexual abuse or
violent pornography (Martínez-Catena & Redondo, 2017).
Worling and Curwen (2000) agree that in order to see a decrease in sexual offending in
CSOs, it is essential for the offenders themselves to have a reduction in their own trauma-related
distress. Without addressing such trauma, treatment meant to prevent relapse in CSOs will not be
effective (D’Orazio, 2013). Utilizing a trauma-informed perspective, D’Orazio (2013) states that
trauma stays in the individual’s body causing “excessive self-focus and dysregulation greatly impacting the structure and function of the brain” (p. 5). The author claims that an individual who
has not yet been able to deal with the abuse that they have experienced, will then turn these unmet needs and conflicting feelings into aggression, therefore making them the abuser. An effective therapeutic approach in addressing such issues within abusers is to respond in an empathic
way to the individual’s trauma so as to build trust in the helping relationship and to help foster
acceptance of the individual. With these techniques in mind, it is thought that the client will become less psychologically defensive and be less prone to denying or avoiding the topic at hand.
D’orazio (2013) believes that when these therapeutic techniques are used, the individual often
displays more empathy for others, which then facilitates motivation to change abusive patterns.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 31
Taking Responsibility
In the beginning stages of treatment, a common approach is for CSOs to take responsibility for the sexual offences they have been convicted of (McGrath et al., 2010). Offenders commonly deny their deviant sexual behaviour, and this denial is viewed at by professionals as a barrier to providing treatment. CSOs accepting responsibility for their sexually abusive behaviour is
an approach used in treatment as there is the belief that an individual must admit that there is a
problem before the problem can be addressed (McGrath et al., 2010). CSOs typically place
themselves in psychologically comfortable positions which supports their belief that the victim is
not being harmed and consents to the acts (Helmus et al., 2012). This allows the offender to separate themselves from the deviant sexual behaviour and not take responsibility for it (Helmus et
al., 2012, p. 35). Treatment geared towards helping the offender take responsibility for their actions is important because individuals who minimize their offending behaviour are actually at a
higher risk of reoffending (McGrath et al., 2010).
Yet, conflicting evidence presents itself within this discussion. As mentioned above, taking responsibility for sexual offences is considered by some clinicians and researchers to be helpful, or even essential, in the treatment process. However, Marshall and colleagues (2011) state
otherwise, noting that individuals who take responsibility for their sexual offences actually have
a higher likelihood of reoffending than individuals who make excuses for their offences. A study
was conducted in Canada which included 58 offenders who received treatment and 90 offenders
who did not, in order to examine the effectiveness of treatment provided to CSOs (Worling &
Curwen, 2000). Treatment included CBT, as well as methods to address sexual attitudes, accountability, victim empathy, and denial. It was found that the group of offenders who completed

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 32
treatment consisting of at least 12 months, displayed a 72% reduction in sexual recidivism compared to the participants who did not (Worling & Curwen, 2000). This helps us see the positive
impact that taking accountability for one’s actions can have in the treatment process with CSOs.
Marshall and colleagues (2011) explain that those who tend to make excuses for their offences
are acknowledging that their behaviour is deviant. Thus, some researchers presume that CSOs
who deny their crimes are displaying protective factors, placing individuals who admit their
crimes in a higher risk category. This means that individuals may not feel compelled to make excuses for their behaviour because such deviant acts are parallel to their usual characteristics. Furthermore, research states that when determining the number of CSOs who reoffend after treatment, those who deny their crimes are said to have lower recidivism rates than individuals who
admitted their offences (Marshall et al., 2011).
Interestingly enough, Brown and colleagues (2013) mention how it was a common theme
for participants to admit their wrong-doings only after they had been convicted instead of during
the process of offending, leaving one to see how they are only accepting responsibilities based on
their convictions. Brown and colleagues (2013) question whether or not offenders state that their
behaviour is inappropriate only after being labelled as a sex offender in the hopes of following
through with what responses would be deemed acceptable by society. This contradictory evidence signals that there is a need for more research to be conducted in order to have a better understanding on the role of taking responsibility and whether or not this is something that should
be incorporated into treatment with CSOs.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 33
Cognitive Behavioural Therapy
In discussing cognitive distortions and therapy to address such implicit theories, it is essential that we examine aspects of CBT and how such interventions might help to reduce recidivism rates in CSOs.
Yates (2013) states that the utilization of CBT in the treatment of CSOs is the most widely used therapy that has the most empirical evidence in terms of reducing recidivism rates. The
author states that a CBT lens views sexual deviancy as the result of thoughts, emotions, and behaviours which have been learned through observation, implicit theories and attitudes towards
sexual deviancy. The goal in utilizing CBT with CSOs is for such thoughts and behaviours to be
altered and “replaced with adaptive, non-deviant, pro-social responding” (Yates, 2013, p. 90).
Polizzi and colleagues (1999) evaluated 21 CSO treatment programs, which were offered
both in-prison and non-based prison settings in the United States. It was found that the programs
based outside of prison that incorporated CBT interventions helped to reduce recidivism rates for
CSOs, however the prison-based treatment programs did not demonstrate enough evidence to
prove that such interventions are effective. It was also determined that only 50% of treatment
programs demonstrated findings that were in favour of therapeutic intervention strategies such as
CBT. Another finding was that 4.7% of CSOs who had received CBT while in custody reoffended once released into community, in comparison to the control group which demonstrated a 6.2%
reoffending rate (Polizzi et al., 1999).
Martínez-Catena and Redondo (2017) claim that the initial goal of clinical interventions
for CSOs is to facilitate “internal changes” within the individual (p. 43). The authors state the
ways in which CBT works to change the offenders’ perceptions, is by improving their level of

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 34
empathy, their assertiveness and their self-esteem. This form of therapy also changes the individual’s interpretation of the crimes they committed to one that is more realistic, in that it works to
help the offender recognize the impact that their behaviour has on their victim (Martínez-Catena
& Redondo, 2017).
Aytes and colleagues (2001) conducted a study to determine the effectiveness that CBT
has on CSOs, and obtained data from individuals who had participated in group therapy for an
average of two to three years at a treatment centre in the United States. The study included a
group of sex offenders who did not receive treatment, and a group of nonsexual offenders. This
was a mandated program operated through a community corrections department. The study’s
goal was to determine if CBT would help reduce recidivism rates in CSOs. The program utilized
aspects of CBT with the hopes of addressing deviant sexual thoughts and behaviours and implementing elements of control which the individual could then utilize to maintain any behavioural
changes that occurred through treatment. It was determined that individuals who completed the
treatment had reduced rates of reoffending in comparison to the group which did not receive any
treatment. More specifically, individuals who stayed in the treatment program for over one year
demonstrated even lower recidivism rates. The author claims that implementing a longer treatment process, which is naturally more intense, could potentially help to increase the chances of a
reduction in recidivism rates within CSOs. It is important to mention that individuals who
dropped out of the group process demonstrated higher rates of recidivism than those who remained in the group (Aytes et al., 2001).
Mpofu and colleagues (2016) conducted a literature review of the effectiveness that CBT
has on reducing recidivism rates within CSOs who were seen as moderate to high risk. A moder-

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 35
ate to high risk offender is an offender who has anti-social personality traits and who engages in
lifestyle risks such as being exposed to criminogenic settings, having negative peer associations,
or substance abuse. The review included 10 studies which implemented CBT approaches with
male CSOs, and the discussion of comparative interventions in the attempt to determine CBT’s
effectiveness. It was found that there were lower recidivism rates within groups which utilized
CBT approaches, specifically that such groups demonstrated a recidivism rate of 10.25% whereas compared groups demonstrated a sexual recidivism rate of 17.67% (Mpofu et al., 2016). The
findings from this study speak to the impact that CBT can have on the treatment process of
CSOs, as such interventions clearly have an impact on reducing recidivism rates in this demographic. Kamphuis and colleagues (2005) also state that addressing the cognitive process within
CSOs could play a role in reducing recidivism in CSOs; however, it is noted that more research
must be completed in order to prove this hypothesis. More research needs to be done with CSOs
to help them recognize their own thought processes as well as how to address their cognitive
processes and distortions in order to prevent the individual from re-offending.

Risk-Need-Responsivity
Another intervention with CSOs is risk-need-responsivity (RNR). RNR is a model used
to develop recommendations on how offenders should be assessed and treated in order to reduce
recidivism rates. Risk, the first principle of the model, is when treatment programs offer intensive interventions to clients who demonstrate to be moderate to high risk (Hanson et al., 2009).
Some factors that impact the behaviour of high risk offenders are anti-social personality traits,
negative peer associations, unstable employment, substance use, and propensity to hostility

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 36
(Hanson et al., 2009). Yates (2013) describes the risk aspect of the model to emphasize the need
for certain interventions with CSOs to be relevant to the level of risk which the offender is at.
This is because offenders are at a greater risk of recidivism if the level of intensity of the treatment does not align with the level of risk of the offender. This means that if an individual is at a
higher risk of offending, it is essential for treatment to be lengthier and offered at a higher intensity level than if an individual was deemed to be low risk. It is suggested that the best way to ensure there is a reduction in recidivism rates in CSOs, is for those who are at moderate risk of reoffending to receive moderate intensity intervention, and for those who are at high risk of reoffending, to receive more intensive treatment intervention. This would appropriately align the
needs of the offenders with the most suitable treatment offered (Yates, 2013).
Need, the second principle, is based on criminogenic needs, meaning the characteristics
of an individual that predispose them to offending and reoffending (Hanson et al., 2009). Examples of some needs are limited social skills, cognitive delay, substance use, and/or deviant sexual
desires (Hanson et al., 2009). Other criminogenic needs could also be malevolence towards
women, impulsivity and intimacy deficits (Martínez-Catena & Redondo, 2017). Some perspectives toward treatment focus on reducing risk factors in order to determine how to reduce recidivism risk. However, the authors suggest that the focus should instead be on the criminogenic
needs of the individual as this is what is typically associated with an increased risk in offending.
For example, Martínez-Catena and Redondo (2017) state that when issues such as self-esteem or
loneliness get addressed in treatment, there is a correlation to decreased aggression and poor impulsivity, which are specific criminogenic needs. Houtepen and colleagues (2016) conducted a
study including 15 participants who self-disclosed as pedophiles, and it was found that risk fac-

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 37
tors of offending included offenders not being able to self-regulate, as well as a lack of healthy
coping strategies that help prevent them from engaging in such actions.
Yates (2013) also discusses the criminogenic needs that tend to increase risk in offending,
and adds that having an “antisocial lifestyle” and presenting with “deviant sexual interests” are
two of the most prevalent predictors of such reoffending (p. 90). Again, this means prioritizing
criminogenic needs potentially leads to an increase in healthy behaviour which could subsequently lead to reduced risk (Martínez-Catena & Redondo, 2017). The need principle of the
model can be attributed to clients who are either mandated for treatment, or who are voluntarily
accessing such supports. For example, Lösel and Schmucker (2005) discuss the effectiveness of
voluntary treatment and state that recidivism rates are lower amongst such groups of CSOs.
Those who are mandated to seek treatment are at a higher risk of reoffending, often because the
goals of the group do not fit the needs of the client (Lösel & Schmucker, 2005).
The last aspect of the RNR model is responsivity, which is when treatment programs are
designed to meet the learning styles and cognitive abilities of the offender so that all program
participants have an equal opportunity to understand and retain treatment materials (Hanson et
al., 2009). Lösel and Schmucker (2005) state that recidivism rates have been said to increase
when CSOs drop out of the treatment program, which speaks to the importance of the treatment
process needing to fit the needs of the individual. Lösel and Schmucker (2005) encourage this
risk of reoffending to be viewed as a result of the program not meeting the needs or motivations
of the individual instead of blaming the individual for not cooperating or succeeding at not reoffending again. For example, it has been found that group therapy for CSOs is not suitable for individuals who are experiencing psychosis, have low cognitive functioning, or who are disruptive

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 38
to the group behaviour (McGrath et al., 2010). In such cases, a therapeutic process catered to the
ability of individuals might be of more benefit.
Hanson and colleagues (2009) conducted a meta-analysis of 23 recidivism outcome studies to determine the usefulness of RNR in treatment programs, and found that recidivism rates
were lower in individuals who received interventions which followed the RNR model, than that
of comparison groups. The meta-analysis concluded that when a treatment plan follows all three
principles of the RNR model, there is an increase of treatment effectiveness. Furthermore, the
meta-analysis found that when treatment interventions followed some but not all principles of the
RNR model, treatment effectiveness decreased. This speaks to the need for the whole model to
be followed during treatment, and not just aspects on their own. It was also found that programs
which focus on criminogenic needs such as substance use and criminal attitudes, have a higher
likelihood of reducing recidivism rates in CSOs (Hanson et al., 2009). Furthermore, programs
which implement a level of skill development such as developing insights toward prosocial behaviours and practicing certain strategies which have been modelled to them, have higher success with reducing recidivism rates (McGrath et al., 2010). More specifically, Martínez-Catena
and Redondo (2017) state that programs which offer CBT methods formulated with the RNR
model in mind, prove to be the most effective in treatment with CSOs.

Surgical Castration and Hormonal Therapy
Surgical castration and hormonal therapy also impact an individual’s sexual deviant behaviour and their likelihood to reoffend. McGrath and colleagues (2010) discuss such hormonal
aspects in CSOs, and state that these individuals often struggle with sexual arousal problems

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 39
which contribute to a higher sex drive, and are often aroused by deviant sexual activities. Lösel
and Schmucker (2005) mention that while it has been proven that male CSOs do not have higher
than usual male sex hormones, taking specific hormonal medication such as Medroxyprogesterone Acetate or Cyproterone Acetate significantly reduces levels of sexual arousal. McGrath
and colleagues (2010) add that in addition to the above listed medications, Luprolide Acetate and
Selective Serotonin Reuptake Inhibitors are commonly used to treat CSOs as they help to decrease their sex drive as well as lessen the intensive sexual thoughts that they may have. Kim and
colleagues (2015) add that Depo-Provera is sometimes used with CSOs as this medication has
proven to help with reducing the physiological aspects which help drive individuals from involving themselves in such sexual deviant behaviour.
Lösel and Schmucker (2005) created a meta-analysis of studies comparing treated and
untreated sex offenders, specifically evaluating CBT, surgical castration and hormonal treatment.
It was found that when individuals received a combination of psychological and medical modes
of treatment, they demonstrated 37% less reoffending rates than individuals who did not receive
treatment. More specifically, the authors state that such interventions proved to help reduce recidivism rates in CSOs more so than alternative psychosocial treatments. Interestingly
enough, Lösel and Schmucker (2005) found that hormonal therapy was found to have more of an
impact on reducing recidivism rates than did psychosocial treatments, however when combined,
these two interventions proved to be the most promising. Kim and colleagues (2015) mention
that surgical castration along with hormonal treatment has proven to reduce recidivism rates in
CSOs. McGrath and colleagues (2010) suggest that such medications can help to “regulate
mood, reduce sex drive, and reduce sexually obsessive thoughts” (McGrath et al., 2010, p. 74).

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 40
It is important to mention however, that such medications can have negative side effects
which can cause CSOs to drop out of the treatment process (Lösel & Schmucker, 2005). This can
subsequently lead to increased risks of reoffending, so it is suggested that such an intervention
only be used in conjunction with other therapeutic interventions such as CBT, and when there are
concerns of deviant sexual arousal (Lösel & Schmucker, 2005). McGrath and colleagues (2010)
second this statement, as it is mentioned that while such medication can help CSOs obtain some
amount of control over their sexual urges, it is not seen to be an effective treatment plan without
the help of psychosocial treatments. Kim and colleagues (2015) call for more studies to determine the effects of castration and hormonal treatment for CSOs, specifically because such interventions are viewed at by many as unethical. This is because such treatment methods can be seen
to violate human rights as well as take on more of a punitive role, rather than a treatment role
(Kim et al., 2015). As we can see, more research is needed in the area of hormonal treatment and
surgical castration to determine the effectiveness this has on reducing recidivism rates in CSOs,
and whether or not this is a suitable form of intervention for this demographic.

Therapeutic Environment
Group vs. Individual Therapy
It is important to note the effectiveness of group therapy as McGrath and colleagues
(2010) state that the majority of treatment programs utilize group therapy when working with
CSOs. Some of the advantages of group therapy as outlined by the authors, is that offenders are
more likely to be receptive to feedback from group participants than they are from therapists
alone. Another advantage of group therapy is that group dynamics simply are more economically

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 41
friendly than individual therapy. A third advantage of group work with CSOs is that it gives participants a chance to practice social skills, something that has been noted to be typically lacking
in CSOs. It is important to note that at times CSOs can negatively influence each other. For example, low risk offenders can at times be placed in the same group as high risk offenders, which
as discussed earlier can pose as a risk due to there being a variety of criminogenic needs requiring to be met through just one method. It is therefore essential for professionals to recognize the
needs of the client before introducing a treatment plan (McGrath et al., 2010). This means that
although group therapy may be the form of treatment that is most widely offered, it does not necessarily mean that it is what fits everyone’s needs. Mpofu and colleagues (2016) note that while
group therapy is widely offered within the demographic of CSOs, some studies show that when
group interventions are combined with individual interventions, the therapeutic process can actually be more effective. These same authors suggest that more research be conducted to determine
the helpfulness of combining group and individual therapy in the treatment of CSOs (Mpofu et
al., 2016).

Length of Treatment
As discussed earlier, it is essential to ensure that the forms of treatment align with the
particular needs of the offender if one hopes to have successful outcomes from treatment. This
leads to discussions surrounding the length of treatment and what has been effective for such a
demographic. Yates (2013) states that determining the length of treatment relies on where the individual presents in terms of risk. Individuals who are at a higher risk of reoffending typically
benefit from 300 contact treatment hours (combination of psychological and medical treatments).

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 42
Those who are at a moderate risk benefit from 200 contact treatment, and CSOs who are at a low
risk of reoffending have proven to benefit from 100 contact treatment hours (Yates, 2013).
Again, it is essential for practitioners to determine the level of risk that the individual presents
with, and also effectively determine the criminogenic needs of the client before proceeding with
treatment if there is the expectation that treatment will help to reduce recidivism rates in CSOs.

Therapeutic Alliance
Yates (2013) discusses the importance of establishing a healthy therapeutic alliance, and
adds that the characteristics of a therapist are extremely important in determining treatment outcomes. Characteristics that have said to be impactful are; genuineness, warmth, empathy, demonstrating interest in the therapeutic process with the client, as well as demonstrating respect to the
client. Furthermore, CSOs can be more cooperative with the treatment process and motivated to
participate and stay in treatment if the environment is healthy and motivating. It is important that
aspects of the therapeutic environment are taken into consideration as this can influence an individual’s willingness to complete the treatment program. Creating a treatment program which motivates CSOs to participate and complete is essential as individuals who complete treatment are
at a lower risk of reoffending than individuals who drop out of treatment (Yates, 2013).

Implications for Social Work
Understanding which therapeutic intervention strategies are effective in reducing recidivism rates with CSOs is essential for social work practice because there are professionals in the
field who work directly with this population both in custody and in community. In order to en-

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 43
sure best practice, it is important that social workers utilize interventions which are evidence
based with this population. Providing treatment which is not evidence based, means social workers could be inflicting more harm than good to both the offender as well as society. This is because if offenders are released into community without proper treatment, they can pose as a risk
to community members. According to the BCASW (2005) Code of Ethics, it is the social worker’s responsibility to ensure best practice and competency with the populations with whom they
work, and ensuring that evidence based research makes up the foundation of intervention strategies aligns with this principle. As mentioned in this review, there appears to be a significant
amount of conflicting research for this population in general. This allows us to see how important it is for social workers to recognize the need for more research in this particular area, as this
will help determine the effectiveness of current or potential intervention strategies with CSOs.
This aligns with the BCASW (2005) Code of Ethics as this demonstrates advocating for change
in the best interest of the client and overall society.

Conclusion
In examining the thought process of CSOs, one can see that cognitive distortions, offence
supportive attitudes, empathy deficits, blame attribution, entitlement, and implicit theories contribute to deviant sexual behaviours. Treatments which have found to be helpful with such a demographic are: RNR, the client’s taking responsibility for their own offences, victim empathy
work, addressing the client’s own trauma history, castration and hormonal therapy, and CBT. A
major theme that surfaced is the perception that CSOs have towards sexual assault and how this

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 44
perception impacts their likelihood of reoffending. These cognitive distortions are said to heavily
impact an individual’s likelihood of reoffending, however numerous studies demonstrate the
need for more research on this. Another theme was the importance for professionals to determine
the needs of the individual before establishing a treatment plan in order for interventions to be of
benefit to the individual.
Empathy deficits in CSOs proved to be a large contributing factor to the likelihood of
sexual offences towards children, although there appears to be some discrepancies as to whether
or not incorporating empathy in the treatment of CSOs is effective. It was found that more research is needed in order to determine the presence of empathy deficits in CSOs, and whether
implementing empathy work helps to reduce recidivism rates in this demographic. Some researchers recommend that in order to accurately determine this, larger sample sizes are needed,
along with more longitudinal studies. Strategies such as ensuring CSOs take responsibility for
their crimes also has conflicting evidence as to whether such interventions are risky or beneficial.
More research needs to be done to determine if this would be a helpful focus of treatment with
CSOs. Combining intervention strategies such as CBT as well as empathy therapy appear to be
the most common form of treatment for CSOs, however further exploration using longitudinal
studies which incorporate both of these perspectives is essential in order to have more conclusive
statements about the efficacy of these approaches. Surgical castration and hormonal therapy have
proven to be effective in reducing recidivism rates, however there is controversy with these topics due to ethical concerns. Professionals could benefit from research which outlines the outcome
and impacts of such intervention strategies.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 45
The therapeutic environment was also something that was said to be something that impacts recidivism rates, specifically the length of treatment, the therapeutic alliance, as well as
treatment being offered in a group or individual setting. More research could be done to determine the effectiveness of combining group and individual therapy with CSOs. More research is
also recommended to determine the theories of sexual offending, as it is mentioned that having a
better understanding of this will help with the assessment and intervention process of working
with CSOs. Overall, it can be determined that more research is needed in order to see how such
techniques could benefit treatment programs and help prevent CSOs from reoffending. It is essential for social workers to utilize therapeutic intervention strategies that are evidence based, as
not doing so is not only unethical, it could inflict more harm to the client and society than good.
This is because if offenders are released into community without proper treatment, they can pose
as a risk to community members. As controversial as the topic of CSOs are, social workers must
continue to advocate for more research that helps to determine which intervention strategies best
help to reduce recidivism rates with this population as this is in the best interest of the client and
society overall.

THERAPEUTIC TECHNIQUES AND RECIDIVISM RATES IN CHILD SEX OFFENDERS 46
8. References
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