Treatment of Sexually Aggressive Behavior

by Gordon C. Nagayama Hall - Kent State University

Sexual aggression is a serious societal problem that demands an effective solution. Between 1 in 10 and 1 in 4 adult women are raped or sexually assaulted during adulthood (Koss, 1993) and prevalence figures are similar for child victims of sexual aggression (Finkelhor, 1984). The effects of such victimization in some cases can be severe and lifelong.

Most treatment interventions have focused on helping victims cope with and prevent trauma. Such interventions address the effects of sexual aggression but not necessarily the cause. Treatments directed toward perpetrators of sexually aggressive behavior more directly address the cause of sexually aggressive behavior (Hall, in press-b).

What are the prospects of reducing sexually aggressive behavior via psychological treatment? The pessimistic conclusion of an influential literature review was that there was no evidence that treatment effectively reduces recidivism (Furby, Weinrott, & Blackshaw, 1989). However, it has been contended that more recently developed comprehensive treatment programs are more effective than those programs reviewed by Furby et al. (1989), which were more limited in scope (Marshall, Jones, Ward, Johnston, & Barbaree, 1991).

After considering 92 studies on treatment outcome with sexual offenders that were published since the Furby et al. (1989) article, Hall (in press-a) selected 12 studies in which treatments for male sexual offenders were compared with a comparison treatment or with no treatment, in terms of effects on reducing subsequent arrests for sexually aggressive behavior.

Eleven of these 12 studies involved sexual offenders over the age of 17 and one involved adolescent sexual offenders. Offenses perpetrated by these males included voyeurism, exhibitionism, child molestation, and rape. Treatment effects were examined via meta-analysis, which is a quantitative method of summarizing results across studies.

The major findings of the Hall (in press-a) study were:

1. Treatment for sexual offenders is effective. Over 27% of the sexual offenders who received comparison or no treatment were rearrested for sexual offenses, whereas 19% of those who completed treatment were rearrested.
2. Treatment was more effective with sexual offenders in outpatient settings than for those who were institutionalized. This finding suggests that treatment is more effective for less severely pathological sexual offenders.
3. Treatment was not differentially effective based on the type of sexual offender being treated. Specifically, treatment was no less effective for males who had raped women than it was for males who had perpetrated other sexual offenses.
4. Cognitive-behavioral and hormonal treatments were more effective than behavioral treatments. Cognitive-behavioral treatment programs focus on reducing sexual arousal to inappropriate situations (e.g., rape, child molestation), modifying cognitive distortions about sexual aggression (e.g., victims are not harmed by or even enjoy forced sexual activity), and improving social skills (Marshall & Barbaree, 1990).

   Hormonal treatments involve drug injections to reduce androgens, which are associated with sexual arousal and behavior. Behavioral treatments primarily focus on reducing sexual arousal to inappropriate situations. Rearrest rates for sexual offenses were 13% following cognitive-behavioral treatment (vs. 24% following comparison or no treatment), 13% for hormonal treatments (vs. 27%) and 32% following behavioral treatment (vs. 34%).

Is a net reduction in sexual offending of 8% (27% rearrested following comparison or no treatment vs. 19% following treatment) important? In terms of harm to victims and costs to society, any reduction in recidivism may be significant (Marshall et al., 1991; Prentky & Burgess, 1990; Quinsey, Harris, Rice, & Lalumiere, 1993). Therefore, treatment of sexual offenders may have a significant impact on reducing sexually aggressive behavior in society.

References:

Finkelhor, D. (1984). Child sexual abuse: New theory and research.New York: The Free Press.

Hall, G. C. N. (in press-a). Sexual offender recidivism revisited: A meta-analysis of recent treatment studies.
Journal of Consulting and Clinical Psychology.

Hall, G. C. N. (in press-b). Theory-based assessment, treatment, and prevention of sexual aggression. New York: Oxford University Press.

Koss, M. P. (1993). Rape: Scope, impact, interventions, and public policy responses. American Psychologist, 48, 1062-1069.

Marshall, W. L. & Barbaree, H. E. (1990). Outcome of Comprehensive Cognitive-Behavioral Treatment Programs. In W. L.

Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of Sexual Assault (pp. 363-385). New York: Plenum Press.

Marshall, W. L., Jones, R., Ward, T., Johnston, P., & Barbaree, H. E. (1991). Treatment outcome with sex offenders. Clinical Psychology Review, 11, 465-485.

Prentky, R. & Burgess, A. W. (1990). Rehabilitation of child molesters: A cost-benefit analysis. American Journal of Orthopsychiatry, 60, 108-117.

Quinsey, V. L., Harris, G. T., Rice, M. E., & Lalumiere, M. L. (1993). Assessing treatment efficacy in outcome studies of sex offenders. Journal of Interpersonal Violence, 8, 512-523.

About the Author:

Gordon C. Nagayama Hall received his Ph.D. in 1982 from the Graduate School of Psychology at Fuller Theological Seminary. From 1983-88 he worked as a psychologist in the Sex Offender Program at Western State Hospital. Since 1988 he has been a faculty member in the Department of Psychology at Kent State University, where he has developed theory and research on sexual aggression. Dr. Hall is President of the American Psychological Association Society for the Psychological Study of Ethnic Minority Issues.