Term Paper on "Cognitive Behavioral Therapy vs. Psychoanalytical Therapy in Sex Offender Treatment"

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Cognitive Behavioral Therapy vs Psychoanalytical Therapy in Sex Offender Treatment

The overall goal of sexual offender treatment programs is to reduce the likelihood that the offender will engage in future acts of sexually abusive behavior. Research has proven this goal an unenvious task because the variables leading to sexual abuse are not yet fully understood and there is often considerable resistance on the part of the offender to become engaged in the treatment process. Cognitive behavioral therapy has been the modality of choice for sex offender treatment, however recent studies indicate an increase in the acceptance of psychoanalytical therapy. This article will describe the benefits and limits of psychoanalytical and cognitive therapy while contrasting the use of these theories in treating sex offenders.

Background of Cognitive Behavioral Therapy & Sex Offender Treatment

Clinical interest in issues of denial and accountability in sexual offenders can be traced as far back as the 1960s and 1970s (Cowden & Morse, 1970). The origin of cognitive behavioral therapy dates back to the late 1970's, as the dominant approach to the treatment of sexual offenders (Marshall & Barbaree, 1990). The overall aim of cognitive behavioral treatment is to strengthen sex offenders with the self-management skills necessary to manage or avoid situations that increase their risk of recidivism.

To successfully accomplish this, offenders are trained to alter their views in a pro-social direction, attend to negative consequences of their actions both for themselves and others, establish a less distorted view of their deviant behavior, develop more acceptable responses to meet their needs, and learn strategies to control deviant sexual arousal (Marshall, & Barbaree, 1990). As with any remedial measure in individuals, the effectiveness of these approaches rests in part on the offender's cooperation and dedication to the treatment process.

Recent studies indicate that sex offenders often deny any involvement in the sexual offense, and may even continue to deny critical aspects of their offense after conviction (Denton, Konopasky, & Street, 1994). As a result, offenders are likely to show resistance to accepting treatment and quick to succumb to the denial of their sexual deviations (Brake & Shannon, 1997). Accountability and denial are interrelated and should be approached as treatment targets rather than treatment obstacles. These basic principles laid the foundations for the acknowledgment of the role of cognition in explaining sexual abuse (Finkelhor, 1984). Research on cognition supported the contention that offenders must overcome both internal and external inhibitions as well as the resistance of the victim in order for abuse to occur (Finkelhor, 1984).

Further research indicated that that the personality constructs commonly used to differentiate sexual offenders were less useful to clinicians than problem focused dimensions such as denial, sexual arousal, sexual fantasies, cognitive distortions, social sexual deficits, and other psychological and social problems (Conte, 1985). Other studies conceptualized cognitive distortions to consist of rationalizations developed by offenders prior to and during offending to justify their continued abuse of children (Murphy, 1990).

II. The Role of Denial in Cognitive Behavioral Therapy

In the late 1980s and throughout the 1990s, several classes of denial were created primarily based on clinical observations of different types and degrees of denial (Brake & Shannon, 1997). More recently, studies have been conducted to verify the existence of these various forms of denial through the creation of a self-report measure (Schneider & Wright, 2001). Using factor analytic techniques, empirical support was found for virtually all of the different components of denial (Schneider & Wright, 2001). Some research centered on the differentiation of two levels of accountability which were represented by absolute denial and various forms of minimization.

Refutation provides a mechanism for completely alleviating the offender from having to take any responsibility for the offense (Terry & Tallon, 2002). Refutation involves complete denial that an offense occurred, along with claims that nothing harmful happened to the alleged victim and that the offender is the victim (Terry & Tallon, 2002). The research also states that occasionally an offender admits that something did occur, but insists that the event was not sexual or harmful and thus should not be construed as an offense (Pollock & Hashmall, 1991).

Empathy training is an important component in many cognitive behavioral treatment interventions (Schneider & Wright, 2001). Denial by minimization typically involves blaming and other justifications. The research contends that such forms of denial were systematically related to measures of cognitive distortions (Schneider & Wright, 2001).

Cognitive behavioral therapy focuses on the modification of the offender's denial in the early stages of treatment (Conte, 1985).

Categorical denial is an approach that rests on the assumption that it is not necessary for offenders to take responsibility for their deviant sexual behavior at any time (Brake & Shannon, 1997). The research indicates that the decisive departure from established treatment goals and implies that motivational issues are not essential targets of offense-specific sexual offender treatment -- at least for categorical deniers (Brake & Shannon, 1997). The rationale for the effectiveness of this approach in the absence of accountability needs to be made clearer.

This approach suggest the use of indirect strategies to reduce resistance to treatment rather than relying on confrontational techniques that may provoke additional opposition or yield only compliant behavior (Marshall & Barbaree, 1990). Empirical evidence shows that various forms of denial are critically linked to treatment progress in both early and advanced stages of treatment (Schneider & Wright, 2001). Cognitive distortions have been described as biased accounts stemming from preexisting beliefs, whereas denial has typically referred to deliberate excuses and justifications intended to deceive. Studies suggest that there may be a relationship between distortions and denial, arguing that cognitive distortions are likely to make it easier for offenders to misconstrue their behavior and its consequences (Conte, 1985).

Both denial and distortions are likely to be the products of a combination of intentional deceit and biased reasoning processes that serve to protect offenders from facing their responsibility for committing sexual offenses. Explanations by offenders in which they deny their actions are critical to progress in treatment. These explanations represent a dynamic factor maintained by ongoing cognitive processes, both intentional and implicit. Changes in explanations are useful because they reflect reductions of both intentional deceit and cognitive distortions that prevent offenders from taking responsibility for their offenses.

Sex Offender Treatment

Sex offender treatment attempts to change sexual arousal patterns through behavior conditioning techniques, but places little or no emphasis on emotional health. Most offenders undergoing this kind of treatment have been court-mandated for treatment, so the approach is primarily adversarial. Cognitive behavioral sex-offender treatment is usually provided by private, hospital, and university clinics that work in concert with the criminal justice system.

Their goal is to prevent sexual re-offending, rather than to change sexual attraction or to promote the development of mental health. Since the development of sexual attraction is not understood, sex offender treatment uses approaches that are chosen for their effectiveness at reducing illegal behavior, without necessarily understanding underlying causes.

Behavioral methods have as their goal the reduction or elimination of deviant arousal and the increase of non-deviant arousal. All behavioral methods are based on the idea of conditioning, or associating pleasant feelings with desired behavior, and associating unpleasant feelings with undesired behavior. Cognitive methods are based on findings that many sex offenders in general exhibit aggressive sexual behavior, manipulate others, lack empathy for their victims, and minimize, deny, and rationalize their abusive behavior. Cognitive methods assume that their sexual behavior is addictive and results from incorrect beliefs, anti-social attitudes, maladaptive thoughts, a lack of sexual knowledge, and impaired communication and social skills.

Social skills training may help offenders learn to develop peer relationships rather than turn to children as sexual partners. Social skills are also seen as crucial for the offender to successfully implement his newly acquired normal sexual arousal to adults. They are often taught through role-playing. Offenders learn how to interact with women and how to express feelings and thoughts while respecting the rights of others. Sex education includes information about sexual deviancy. I t is thought that sexual ignorance may increase anxiety toward normal adult sexuality.

Cognitive methods usually rely on the relapse prevention model to help offenders cope with situational variables that may lead to offending, such as negative emotional states, interpersonal conflicts, and tempting environmental factors. This model has been adapted from addiction recovery models, based on the assumption that the offender's sexual behavior is addictive and compulsive. Offenders are taught to think of their thoughts that may lead to offending as deviant, temporary, controllable, and stoppable, and to develop the ability to recognize and intercept them. They are taught to recognize and avoid situations that may increase temptation, and to turn away from decisions which may lead to increased exposure to such situations.

Psychoanalytical Therapy in Sex Offender Treatment Programs

Psychotherapy differs from cognitive behavioral therapy in that it is intended not to decrease or change sexual arousal, but to help the patient understand and control his behavior.

In individual psychotherapy, the therapist should maintain a helping role modeled… READ MORE

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