State of the Art Treatment Options for Actual and Potential Sexual Offenders and New Prevention Strategies

Abstract

Sexual violence is a significant and devastating issue for men and women throughout the world. Its consequences are not only disastrous for victims of sexual violence but are also extremely costly (estimated cost of $41,000 per rape) for society. Successful treatment of sexual offenders is therefore an important goal for society as well as for victims and offenders themselves. Over the years, multiple treatment approaches for sex offenders have been developed. Treatment programs range from the risk-need-responsivity (RNR) model, which focuses on providing tailored treatment for high-risk and low-risk offenders, to psychodynamic models. This article presents an overview for clinicians of state-of-the-art offender treatment, describing the most common treatment approaches, in particular the RNR model, cognitive-behavioral programs (relapse prevention programs, sexual offender treatment programs), psychodynamic approaches (transference-focused psychotherapy, mentalization-based therapy), the Good Lives Model, as well as pharmacological options. In addition, it provides an evaluation of the various treatment programs. However, given the fact that most acts of sexual violence will never be reported to the police, the question arises if treating convicted perpetrators is enough. Do we need rather—in terms of preventive work—a program for potential sexual offenders and men with delinquent sexual fantasies? Given the prevalence of sexual violence and its impact on victims, society, and the medical community, it would be remiss not to try to reach potential/unconvicted perpetrators. This article offers novel ideas and a project the goal of which is to prevent sexual offenses against women by introducing the “I CAN CHANGE” program from Hannover Medical School.

How the Good Lives Model Can Complement Mentalization-Based Treatments for Individuals Who Have Offended With Anti-Social Personality Disorder and General Forensic Mental Health Needs: Practice Update

“…The field of forensic interventions for individuals incarcerated for violent and sexual crimes has historically been heavily weighted toward interventions adopting a cognitive-behavioral approach (Gibbels et al., 2019; Yakeley & Williams, 2014). The last decade has seen an increase in other therapeutic approaches, but this has led to limited advances or novel initiatives in the treatment of ASPD.…”

A narrative review of research on clinical responses to the problem of sexual offenses in the last decade

“…These treatment approaches originate mainly from treatment of patients with severe personality disorders, especially BPDs. Therapeutic techniques include transference‐focused psychotherapy (Briken, ; Gibbels, Kneer, Hartmann, & Krueger, ) and mentalization‐based psychotherapy (Bateman & Fonagy, ). The latter has been used in patients with antisocial personality disorder (Bateman & Fonagy, ).…”

Avaliação e tratamento do Transtorno Pedofílico / Assentment and treatment of Pedophilic Disorder

“…Segundo Gibbels et al (2019), os pacientes portadores desse transtorno devem ser tratados a partir da terapia cognitivo-comportamental (TCC), a qual possui o objetivo de reestruturar as cognições distorcidas do indivíduo e ajudá-lo a aprender novas habilidades cognitivas, gerando, portanto, a capacidade de controle do impulso sexual. Nesse sentido, existe na atualidade dois programas de prevenção específicos para a pedofilia que utilizam a TCC como base: o Programa de Terapia para Dissexualidade de Berlim (BEDIT) e o Programa ao Abuso Sexual.…”

“…A terapia proposta utiliza a TCC, os inibidores seletivos de recaptação de serotonina (ISRS), os antiandrogênicos e os análogos de GnRH. Ademais, é importante destacar que a escolha da medicação depende de cada caso e, para aqueles ligados a agressores sexuais, está indicada, em alguns países, a "castração química", que no Brasil não é autorizada (GIBBELS et. al, 2019).…”

“…Sua relevância se torna ainda mais explícita ao se avaliar os dados revelados pelo último relatório Out of the Shadows de 2019, que coloca o Brasil na décima primeira posição do ranking mundial de abusos sexuais em crianças e adolescentes. Dessa forma, o diagnóstico e tratamento bem sucedidos dos agressores é um objetivo importante para a sociedade, para as vítimas e para os próprios portadores desse transtorno (GIBBELS et. al, 2019).…”