Journal of Interpersonal Violence

The number of men in the Netherlands who were convicted of sexual offenses rose significantly between 1980 and 1994. Empirical studies of offenders are relatively scarce, although interest in the field is growing. Since the late 1980s, the number of outpatient treatment facilities for these men has increased—especially now that some child molesters are given a choice by the courts between treatment and prison sentence. Since the 1930s, sexual offenders with severe personality disorders that are held not responsible for their offenses are court-ordered to be treated in maximum security forensic psychiatric clinics. Until the mid-1980s, the treatment model for these offenders was based on a derivation of psychoanalytic and Rogerian therapy aimed at personality reconstruction. Since the 1990s, however, the focus has been on the behavior itself, and directive cognitive behavioral elements are now included in the eclectic treatment in several clinics.

This article will touch on the following topics: the law and law reforms, incidence of sexual offenses, national survey studies, treatment, and a recently started research project on psychotherapy process research at the Department of Psychotherapy at Ulm University.

Violence against women and children, be it intrafamilial or extrafamilial, is obviously a matter of major concern in Belgium. In the early 1980s, the focus of interest shifted from the victims of violence in general to the more emotionally charged sexual violence in particular. This evolution led to new penal laws on rape, pornography, and pedophilia. In the 1990s, sexual offender treatment has become acknowledged by the government as a policy priority. Several initiatives have been endorsed in order to implement the treatment of sexual abusers in prison, in psychiatric units, and in the community. In this article, some controversial issues are discussed more in depth: (a) the necessary deal therapists must make with the referring penal law authorities, (b) the role of coercion in treatment, and (c) the liability of therapists with high-risk clients.

The author describes the experiences with the comprehensive therapeutic program for sexual offenders in the Czech republic. Since 1976, specialized departments for treatment of these patients were established in psychiatric hospitals. The treatment is imposed by the court per the recommendation of forensic experts—especially for paraphilic offenders. As a rule, inpatient therapy is followed by treatment in outpatient sexological departments. The therapeutic goals are as follows: adjustment of behavior, acquisition of information, overcoming defensive mechanisms and creating insight, strengthening of conscious control, changes in attitudes and values, sexual adaptation, and social reintegration. These goals are achieved by means of a set of diagnostic, psychotherapeutic, pharmacotherapeutic, and social measures including penile plethysmography, individual and group psychotherapy (in their psychodynamic and cognitive-behavioral forms), antiandrogen suppression, and social interventions. The recidivity rate has been relatively low (less than 20%) and justifies the existence of this specialized form of treatment.

Treatment of sexually abusive youth was initially informed by what had been learned in the treatment of adults who sexually offend. However, over time, important differences in understanding the developmental progression and in treatment approaches have evolved, some of which may now be used to inform the work with adults as well.

Although sex offender treatment is an established clinical specialty, evidence regarding its effectiveness has been slow to accumulate. One ongoing treatment outcome study, California's Sex offender Treatment and Evaluation Project (SOTEP), is used to highlight several problems that are inherent in this type of research, and to illustrate that even well-designed studies make only a limited contribution to our empirical database on treatment effectiveness. SOTEP findings are also used to show that the broad question, “Does sex offender treatment work?” needs to be broken down into a number of more specific and useful questions. Given the diversity of clients and programs in this field, outcome data are from a wide range of treatment programs that vary in approach, setting, intensity, and types of offenders treated. Program managers and clinicians are urged to evaluate the impact of their services in order to contribute to our knowledge base on treatment effectiveness.