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From Inside Out to Outside In - 
Working With Teen Sex Offenders With A Multimodal Approach

By Kristi Messer MSW, MPH

Children and adolescent sexual offenders tend to repeat behaviors which are familiar, often with little frame of reference for alter-native non-abusive interactions, according to Mark Schwartz, Clinical Director of Masters and Johnson Sexual Trauma Program (Schwartz, 1992). It is therefore important to provide comprehensive treatment which focuses on the original trauma while encour-aging the expression of the intense affect imbedded within these memories. The therapy of choice for Masters and Johnson's Sexual Trauma Program includes a multi-modal approach which integrates the conceptual framework of post-traumatic stress disorder with that of cognitive-behavioral, systemic, relapse prevention, and addictive behavior treatment strategies. 

In this approach it is necessary to assess and modify the internal cognitions and belief systems that interfere with one's capacity for intimacy. Successful treatment of sex offenders also requires a focus on teaching supportive social skills which enable the individual to establish and maintain healthy relationships. Dr. Schwartz encourages appropriate social skills by teaching new behavioral skills, reducing anxiety in heter-osexual socialization, restructuring nonserving belief systems, and encouraging the coding of environmental feedback related to improvement in self-esteem (Schwartz, 1992). 

Techniques of relapse prevention in treating sex offenders utilize a cognitive-behavioral approach to teaching self-management and self-control with the goal of teaching sex offenders how to anticipate high risk situations and to increase their awareness of choices regarding behavior through the development of functional coping skills. Barbara Scwartz, Program Director of the state of Washington's comprehensive sex offender program, has found that relapse-prevention strategies are particularly helpful when a wide range of support persons,
including family, friends, employers, and probation/parole officers are knowledgeable about the patterns of relapse and can reinforce appropriate supports and interventions (Schwartz, 1992). Washington state's treatment standards for treating sexual offenders are similar in theory to that proposed by Masters and Johnson. Both propose that treatment goals for sex offenders should include at a minimum the following issues:

• Address deviant sexual urges and fantasies as necessary to prevent sexual reoffense;
• Educate clients and the individuals who are part of their support systems about the objective risk of reoffense;
• Teach methods of self-control to avoid sexual reoffending;
• Consider the effects of past victimization as factors in reoffense potential; 
• Modify thinking errors and cognitive distortions where possible;
• Educate clients about the effect of sexual offense upon victims, their families, and the community;
• Assist clients in developing a sensitivity to the effects of sexual abuse as well as empathy;
• Address client's personality traits and personality deficits that are related to reoffense potential;
• Address client's social deficits and inadequate coping skills; and 
• Include and integrate the client's family into the therapy process where appropriate
  (Washington Administrative Code 246- 930-220, 1991)

It is widely recognized by experts in the field of sexual offenders that sexual deviance is a complex combination of physiological, cognitive, affective, social, cultural, and even spiritual issues" (Schwartz, 1992). This requires the utilization of multimodal, integrated therapeutic techniques which are individualized to meet the complex needs of individual sex offenders. Family Trauma Service's Sexual Offender Treatment Program was developed as a multimodal therapy which combines trauma-based, cognitive-behavioral, and relapse prevention strategies to assess and treat the myriad of issues presented by adolescent sexual offenders. Treatment for sex offenders is accomplished through the provision of individual therapy, group therapy, home-based family therapy, and home-based mentoring. The FTS Treatment approach utilizes many of the techniques previously reviewed, including addressing the core trauma issue, self-monitoring and self-control, social skills, relapse rehearsal, modifying cognitive distortions, coping, and anger management. Family, friends, probation and parole officers, and other community supports are routinely utilized as key persons to reinforce appropriate interventions. 

References:

Schwartz, M. F. (1992), Sexual compulsivity as post traumatic stress disorder: treatment perspectives, Psychiatric Annals, 22 (6).

Schwartz, B. K., (1992), Effective treatment techniques for sex offenders, Psychiatric Annals,