Sexual violence offenders
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Response to sexual violence
In light of the restrictive focus on explanations, definitions and prevalence discussed above, in this section of the paper we will consider responses to stop sexual violence, and the treatment of sex offenders; recall historical approaches to responding to sexual violence and the development of sex offender programs; and examine measures aimed at the primary and secondary prevention of sexual violence.
4.1 Early responses to sexual violence outside the criminal justice system
Traditionally, the prevention of sexual violence emphasised women taking responsibility for their own victimisation; women were advised to modify their own behaviour to avoid sexual assault. Women were encouraged to avoid wearing 'suggestive' clothing, not to go into the community alone and to avoid 'risky situations' (Neame, 2003). Preventing sexual violence was the responsibility of the individual woman and not of the men who were perpetrating the violence. This implied an attitude towards sexual violence where men were not considered responsible for their behaviour; instead, women had the responsibility to not be the catalysts for men's behaviour. Women who were partnered or married in the home were not considered to be at risk of sexual violence as it was only considered to be perpetrated by strangers.
Such approaches to preventing sexual violence have been criticised by feminists for reinforcing social attitudes and myths about sexual violence that place blame with the woman for the sexual assault (Carmody & Carrington, 2000). Such approaches are also regarded as more concerned with women adopting techniques of risk management than with preventing sexual violence. As such, they do not challenge the underlying reasons or community attitudes that are fundamentally linked to sexual violence.
Neame (2003) argued that feminist campaigning in the 1970s raised awareness of sexual violence and was instrumental in revealing the extent of sexual violence women experienced and its context (that is, that predominately perpetrators were known to the victim, as opposed to the 'stranger rape' myth). Men's capacity to perpetrate sexual violence against some women was arguably reduced by this campaigning as the issues of sexual violence became recognised by mainstream society and women became more aware of their rights (Neame). As public awareness of sexual violence increased, women's liberation groups sought to work with relevant government organisations, including partnerships with legal and medical professionals to advocate reforms to policies and practices that would improve the treatment of and services offered to rape victims.
Women's resistance strategies to stop sexual violence were a key focus for some researchers in the 1980s. Neame (2003) noted that various studies examined whether resistance - verbal and/or physical - was an effective rape avoidance strategy (see Bart, 1981; Bart & O'Brien, 1984; Kleck & Sayles, 1990). Although this strategy received much attention and many studies were undertaken, the notion of women's resistance as a rape avoidance strategy was highly problematic because it perpetuated the false notion that the majority of rapes occur in public, and did not address the rape of women by men well known to them. The strategy was also criticised for holding women responsible for their own victimisation (ABS, 1996; Neame; Victorian Law Reform Commission, 2003).
In contrast to this, there were no moves towards making children responsible for avoiding being sexually abused. This quite rightly was seen as unacceptable as children could not be held responsible for their own abuse. At the same time that awareness was raised about childhood sexual abuse, general programs were being introduced, primarily in schools, which encouraged education around what could constitute protective behaviours for children to use against potential offenders. In an audit of child protection prevention programs, Tomison and Poole (2000) found that two-thirds of primary prevention school programs were based on the Protective Behaviours model, which was used both in its initial form and in forms which, over time, were tailored to suit specific target groups. The other main support in recognition of childhood sexual abuse was to encourage adults affected by such abuse to seek support for its negative effects through counselling and self-help groups.
4.2 Historical responses to sex offenders: The emergence of the medical-legal nexus
To respond to the social deviance of sex offenders, laws have been enacted related to rape. These laws have been premised on an individual psychopathology view of sex offenders. In the 1930s in North America, the so-called 'sexual psychopath' statutes were passed and Laws (2003) noted that convicted sex offenders used these statutes to their advantage. On convincing a review panel that their sex offending was the result of a mental disorder, the sex offender was then sentenced to an institution, usually a secure ward in a psychiatric hospital, and not a prison.
The justice system expanded to have three main strategies: punishment, practical help, and treatment. Punishment was seen as an individual and community deterrent (McGuire & Priestly, 1985), although this rationale was applied generally to offending behaviour and was not peculiar to sexual offending. Practical help was focused on trying to reduce recidivism. It was thought that if an offender's 'everyday life' problems, such as housing, money management, employment and family welfare, were addressed, the offender would be less likely to re-offend. To address these issues, offenders would receive counselling from social workers and/or probation officers either in prison or post-incarceration in the community.
Treatment was focused on the personality of the offender and viewed the sexual offences 'as no more than a superficial symptom of some underlying disease or disorder' (McGuire & Priestly, 1985, p. 22). The early treatment of convicted sex offenders was thus largely based on psychodynamic and psychoanalytic treatments, which were the dominant psychological interventions of the time (Laws, 2003). These treatments and associated notions of sexual psychopathy have now been disproved (Laws). Many studies since the mid-1960s (for example, see Gebhard et al., 1965) have repeatedly shown that the majority of sex offenders are not suffering from a mental disorder so severe that it predisposes them to perpetrate sexual violence (Glaser, 1997; Laws). While it is not uncommon for some sex offenders to be diagnosed with a personality disorder, this diagnosis would by no means exempt the perpetrators from taking full responsibility for their offending behaviours (Laws).
The medical/disease model, sometimes referred to as the individual pathology model, was the foundation for early responses to rape and sexual assault, in which sexual violence was seen narrowly as the result of some individual adult men who preyed upon women and children for sexual gratification. The model emphasises the need for the medical and legal systems to operate collaboratively in order for sex offenders to be identified, punished and/or treated as necessary. Such treatment approaches, regulated by medicine and the law, tended to include pharmaceutical and talking therapies. Where treatment was not successful and re-offending for sexual violence occurred, it was deemed appropriate for the perpetrator to be (re-)incarcerated. This social perspective has not changed considerably over time. However, they overlooked gender and other social power structures as having any considerable impact on sexual offending. The sexual assault of intimate partners was, until recently, considered the entitlement and biological need of the adult, heterosexual man rather than sexual violence, and continues to be a major area of under-reporting.
The evolution of treatment approaches is discussed in the following section.
4.3 Sex offender treatment approaches
Although many clinicians often fail to see the relevance of theories, the fact is all practitioners have a perspective on how sexual offending develops and what maintains it; it is simply that most clinicians rarely make their theories explicit although these theories influence what they do in assessment and treatment (Marshall & Laws, 2003, p. 102).
In relation to sex offender treatment approaches, the majority of published work in the area has been from the discipline of psychology, but treatment programs for sex offenders have evolved within criminal justice settings, as the majority of programs have been developed for convicted offenders. In this respect, the development of programs has tended to be influenced by trends in offender programs more generally. The development of treatment approaches began with aversion therapy, commencing in the 1960s. Cognitive techniques were introduced in the 1970s, which aimed at modifying the behaviour and thinking of offenders. From then on, cognitive behavioural approaches became identified with good practice, and, in the last few years, the development of a strengths-based or 'good lives' approach is emerging. Apart from the biological and aversion therapy approaches, all other approaches tend to be run as group programs.
4.3.1 Biological interventions
Biological interventions draw from individualistic medical model understandings of sexual violence. Becker and Johnson (2001) argued that biological interventions should be considered in the treatment of sex offenders. Recently, there has been a focus on hormonal therapy and its effects on sexual behaviour, and hormonal agents, including antiandrogens, are used to reduce sexual offending (Becker & Johnson, 2001; James, 1996). Antiandrogens are able to reduce offending behaviour and fantasies as they suppress libido (Becker & Johnson, 2001). However, antiandrogens and other hormonal agents are not recommended for use in sex offenders under the age of 16 years (Bradford, 1993), with the exception of 'difficult cases' and where other treatments have been unsuccessful (Becker & Johnson, 2001, p. 280). Other organic treatments, such as surgical castration and stereotaxic neurosurgery, are also employed in the treatment of sex offenders, although these treatments are not utilised in Australia (Bradford, 1990; James, 1996). Becker and Johnson argued against surgical castration for juvenile offenders, advocating instead for less invasive treatments. Biological interventions have not been considered a major policy option in the treatment of sex offenders in Australia.
4.3.2 Aversion therapy
Aversion therapies were early behavioural modification treatments used for a range of 'unusual' sexual behaviours, including sex offences, child sex offences, homosexuality, transvestism and fetishism. Laws and Marshall (2003) noted that aversion therapies typically used a variety of noxious stimuli 'paired with either images of the target behavior (Pavlovian conditioning) or the enactment of the deviant behavior (operant forms of punishment)' (p. 83). These therapies included electric aversion, where an electric shock was associated with the deviant sexual behaviour, and injecting a nausea-inducing agent, such as apomorphine, where the nausea was paired with the deviant behaviour (Laws & Marshall, 2003). Laws and Marshall noted that other aversion stimuli were also investigated, including foul odours (see Colson, 1972), covert aversion images (see Cautela, 1967) and the use of embarrassment and/or shame (see Serber, 1970). Recent research has shown aversion therapies to be ineffective in producing permanent changes in sexual behaviour (see Quinsey & Earls, 1990; Quinsey & Marshall, 1983).
4.3.3 Systemic approach
Systemic approaches to sex offender treatment are based on the early systemic family therapy model. When used with a family, the model directs the focus towards how the individual family member's 'presenting problem' is a 'symptom' of what is wrong with the family as a system. Therefore, in order to address the problems of the individual family member, there must be intervention with the whole family. Vivian-Byrne (2004) describes systemic approaches as based on a notion which places 'emphasis outside the individual [offender] and on to the relational patterns of feedback around an individual's behaviour' (p. 188). This systems approach to treating sex offenders considers environmental and personal triggers and the capacity to modify individual responses to them (see Hoffman, 1993; Jones, 1993).
Once power issues are considered by the practitioner and the perpetrator, a systemic approach is thought to be useful in creating opportunities for change for sex offenders (Vivian-Byrne, 2002). Systemic approaches expand the offence cycle to include a range of influences, such as an emphasis on previous relationship experiences which are specific and important to the offender; 'for example, the perpetrator's experience of being abused him/herself, his or her relationships with parents, or his or her ability to form and maintain intimate relationships with adults' (Vivian-Byrne, 2004, p. 189). If a connection can be forged between these past experiences and the offending patterns of behaviour, then these experiences, rather than the sexual offences, can become the focus of intervention (Vivian-Byrne, 2004).
This approach, however, is highly criticised, especially by feminist theorists (Vivian-Byrne, 2002, 2004), as it is based on the assumption that the offender's behaviour is a symptom of other problems in his system of relationships. This then can apportion blame and responsibility for the offending with both victims and offenders (Vivian-Byrne, 2004). It does not look at power differentials between victim and offender and how the offender abuses his power to sexually assault the victim. Feminists argue strongly that sole responsibility lies with the perpetrator and that the victim should not be considered in any way responsible for the sexual offending. Vivien-Byrne (2002) argued that working with sex offenders in ways which examine their patterns of behaviours and relationships can be useful, provided power is taken into account, and the victim not held responsible.
4.3.4 Cognitive behavioural therapy
In the 1970s, behavioural modification interventions were expanded to include cognitive processes and social skills training (Marshall & Laws, 2003). The interventions were essentially two-fold: identifying and changing cognitive distortions, and offering alternative, pro-social behaviours which, in combination, aim to stop offending (Marshall & Barbaree, 1990). In essence, cognitive treatment was intended to 'modify deviant cognitions which precede deviant behaviour' (Mandeville-Norden & Beech, 2004, p. 200). These deviant cognitions are the ideas and beliefs of the offender, often considered to excuse or justify the offending (for example, 'the child wanted a sexual relationship', or 'the woman was game-playing and really wanted to have sex'). These cognitive distortions then become the focus of change in treatment. When such approaches began, it was important that the therapist took a confrontational approach with the sex offender to alter his cognitions and to support him taking responsibility for his actions.
Developing offenders' pro-social relating and 'dating skills' was the other focus, with the understanding that perpetrators would cease sexually offending if they could derive sexual gratification from legitimate, adult sexual relationships (Mann, 2004; Marshall & Laws, 2003). It was considered particularly important for child sex offenders to learn how to have appropriate adult relationships in order to reduce their risk of offending against children. The offenders were then offered alternative ways of behaving that were pro-social, in conjunction with distorted cognitions being challenged.
The focal points of intervention in cognitive behavioural approaches with sex offenders have been: maladaptive sexual arousal, lack of victim empathy, poor social skills and low self-esteem (Vivian-Byrne, 2004). It is argued that change in these areas is needed for there to be long-term cessation of the sexual offending behaviour (Marshall & Barbaree, 1990; Vivian-Byrne, 2004).
Cognitive behavioural treatment for sex offenders has been the most commonly adopted approach internationally. It has received considerable attention in the literature and there has been comprehensive documentation and evaluation of the approach (Lievore, 2004). The evaluation research of these programs will be reported later in this paper.
William L. Marshall has been a major contributor to knowledge about sex offenders and cognitive behavioural treatment programs. Marshall's ideas and concepts in this area continue to evolve and his influential research about sex offenders has been utilised in program development. Marshall (1993) identified sex offenders as having insecure attachment bonds with parents in early childhood, which led to the conclusion that sex offenders have therefore not learned trust and intimacy. Consequently, sex offenders do not have socially acceptable means to have relationships, are socially lonely and have 'intimacy deficits'. This lack of experience of appropriate intimacy can result in a pre-occupation with sex as the only source of intimacy, which leads to promiscuity and the potential for sexual deviance (Mann, 2004). Treatment approaches must therefore address these cognitive distortions and skill deficits of sex offenders.
One of the next developments in the treatment of sex offenders was the introduction of relapse prevention, aimed at stopping recidivism after treatment and court orders had ceased. This was part of a broader trend in relapse prevention that was being used in other areas of corrections, such as alcohol and substance abuse.
4.3.5 Relapse prevention
Marshall (1999) noted that, while cognitive behavioural treatment programs vary in content, most programs developed an emphasis on relapse prevention. Marshall and Laws (2003) argued that the most crucial development in the 1980s was the adaptation of the relapse prevention model to the field of sex offender treatment. This model was widely accepted by practitioners who were 'eager to provide their clients with a way of combating the risks and temptations they faced once direct treatment was over and they were placed back in the essentially free-operant world' (Marshall & Laws, 2003, p. 99).
Sex offenders, both juvenile and adult, make decisions that put them in high-risk situations in which they perpetrate sexual violence, and an offender's chances of sexually re-offending, or relapsing, increase when he places himself into a high-risk situation (Becker & Johnson, 2001). The role of sexual fantasies is also important to a relapse prevention framework, and Becker and Johnson noted that if the sexual offender 'fantasizes and masturbates to inappropriate sexual thoughts, he or she increases the likelihood that the abusive or deviant sexual fantasies will increase in frequency and intensity' (pp. 276-277). Cognitive distortions will eventually develop, which offenders will then use to justify their sexually offending behaviour.
Relapse prevention assumes that the probability of the relapse of sex offenders is based on a range of factors and that offenders should be aware of patterns of behaviours and decisions that can lead to sexually re-offending (Lievore, 2004). According to Marshall (1999), 'relapse prevention describes a set of procedures designed to assist the offender in maintaining the gains he has made in therapy' (p. 233). This model is underpinned by the notion that offence precursors can be identified and addressed (Becker & Johnson, 2001). Marshall noted that there are many elements to a relapse prevention framework; however, he identified the main elements necessary for an effective relapse prevention approach:
- identification of the offence cycle
- specification of the factors (such as anger, intoxication, low self-worth, stress, depressed mood) and situations (such as being alone with a child/children, driving aimlessly) that increase risk
- identifying coping skills that can reduce the risk of relapsing
- creating plans to avoid risk and high-risk situations, and unexpected risks.
4.3.6 Schema-focused therapy
Recent developments in cognitive behavioural approaches have been schema-focused therapy and the strengths model that has been entitled the good lives approach. Mann (2004) described these developments as being a shift from psycho-educational to psycho-therapeutic approaches. Cognitive behavioural approaches assume that the cognitive distortion is the offender's inappropriate or incorrect belief, understanding or interpretation about the offending, the victim and/or the effects of offending. Such cognitive distortions have been confronted and alternative cognitions offered. Mann described the change in this theory as one of examining the underlying cognitive processes in which it is considered a problem of 'faulty information processing' (p. 143). This has led researchers and practitioners to examine the underlying schema.
Young (1990) defined schema as 'extremely stable and enduring themes that develop during childhood [that] are elaborated throughout an individual's lifetime, and are dysfunctional to a significant degree' (p. 9). The underpinning schema hypothesis common among sex offenders has been called the 'suspiciousness schema hypothesis'. Mann (2004) explained that 'sexually aggressive men seem to believe that women are game-playing, deceptive people, who use aggression as a form of seduction, and who are deceitful when they behave seductively' (p. 143).
The hypothesis appears to be an accumulation of what sex offenders have said about women victims. Rather than a 'suspiciousness hypothesis' which is common to sex offenders, it can appear to the feminist eye as a description of misogyny, to which many men ascribe in order not to take responsibility for their behaviour or in order not to accept sexual rejection.
Within this approach, these schema, which are the cognitive structures dominating self-defeating and offending behaviours, need to be altered if the sexual offending behaviour is to change (Mann, 2004; Vivian-Byrne, 2004). In a reframing of previous understandings of cognitive behavioural approaches, post-hoc rationalisations and excuses by the perpetrator, which were once viewed as cognitive distortions in need of confronting, become positive indicators that the offender has insight into violating standards of acceptable behaviour and that there is the capacity for change (Mann).
Vivian-Byrne (2004) noted that in schema-focused therapy, perpetrators are regarded as being 'in need of education, and their thinking in need of restructuring or altering, by the application of techniques [which address the distorted information processing]' (p. 186). Schema-focused therapy is recognised as being a labour-intensive process which places high demands on both the practitioner and the perpetrator. The approach emphasises distorted information processing, identified primarily by the practitioner, and altering these distortions becomes the focus of intervention.
4.3.7 Strengths-based/good lives approach
In recent years, prominent authors William L. Marshall, Tony Ward, Ruth Mann and their colleagues have been advocating a shift away from the confrontational and challenging approaches of the cognitive behavioural therapist to strategies that acknowledge the strengths of the offender and his capacity to lead a fulfilling life. This essentially is a shift in approach from risk management of the offender to a supportive approach. Marshall, Ward, Mann, Moulden, Fernandez, Serran and Marshall (2005) argued that, to date, treatment has been negatively framed both in the language used to describe those who commit sex offences and in the focus of treatment. For example, they describe a concern with the negative emphasis of relapse prevention as a list of 'don'ts' and things to avoid rather than supportive goal-setting that is collaborative and supportive.
The assumption in many programs is that for offenders, avoiding relapse is the most important goal. In fact, although reducing re-offending rates is always the primary goal for the treatment provider, offenders themselves might have other priorities...Traditionally RP programs can fail to engage offenders because they impose a primary goal on them rather than negotiating and agreeing on the goal of intervention (Marshall et al., 2005, p. 1106).
The proposed good lives model works on the underlying assumption that enhancing the social functioning of the offender will decrease the offending behaviour. It is a goal-oriented approach whereby meaningful goals are set for individuals in the program, the means to achieve the goals are identified, and agentic thinking (self-efficacy) is encouraged by facilitators to ensure those goals can be met. This is similar to many social work and psychological approaches that have been employed to work with people in overcoming negative personal experiences and their effects on social functioning (Saleebey, 2002). This enables the offender to develop the knowledge, skills, social competence and personal confidence to meet his goals to lead a productive life that will inhibit offending.
Whereas previous models viewed men identifying themselves as sex offenders as a positive sign of responsibility, Marshall et al. (2005) argued that this was negative for offenders as they would then view themselves solely within this frame of reference and see themselves as unable to change. The good lives or strengths approach attempts to break down the dichotomy between sex offenders as being different from the rest of the community who are not committing such offences.
According to research on good lives, all people seek sexual satisfaction, feelings of comfort, and some degree of power and control in their lives. Nonaggressive people may not want to strike back at someone who has offended them, but they will certainly want some form of redress even if just an apology. Thus, each of the goals that sexual offenders seek in their abusive behaviours is a goal they share in common with other people, it is simply the pathways they choose to obtain these goals that are dysfunctional and hurtful to others (Marshall et al., 2005, p. 1104-1105).
However, the approach raises a number of concerns. The above quote implies that sex offenders have experienced some form of sexual rejection as offensive, they understandably want redress, and it is just their means of obtaining redress that are inappropriate. It appears from the quote that somehow victims have done sex offenders an injustice and the crimes are the redress. We are not convinced that everyone is so similar that they have universal needs in their lives. We are also concerned at the suggestion that offender programs should not include a strong focus on responsibility, for fear of it alienating the offender. Although the use of strengths-based and empowerment approaches have a long history in the human services with voluntary clients, the application of such an approach with sex offenders is more contentious and represents a shift from previous thinking. It is not clear from the literature available whether this approach considers any accountability to the victims as being relevant or desirable.
Another issue which this approach raises is the importance of the individual therapist/worker in the success of the program. Mann (2004) argued that, traditionally, the influence of the therapist on program outcomes was not considered a significant variable and that the role of the therapist was to confront the offender about their beliefs and descriptions of events, and to facilitate him taking responsibility for his offending. In the shift from psycho-educational to psycho-therapeutic approaches, such as the good lives model, the role of the therapist is evidently more critical. Mann suggested that important skills for the therapist to demonstrate in order to improve program outcomes are empathy, warmth, directive approaches, and being supportive and rewarding of offender progress.
Using this approach with sex offenders is relatively new, and it will be important for it to be evaluated, particularly as it stands against much of the previous orthodoxy on both program logic and approach to sex offender treatment.
4.3.8 Risk assessment as good program practice
As sexually violent offenders pose a threat to victim and community safety, there has been considerable effort in developing risk assessment measures to predict the likelihood of sexual violence recidivism (Abracen & Looman, 2005). There is a range of psychological risk assessment scales which have been developed in the past ten years for incorporation into treatment programs with individual participants. There are two types of risk assessment scales; 'measures that incorporate dynamic (that is changeable) as well as static (relatively enduring qualities) variables' (Abracen & Looman, 2005, p. 14). An example of a dynamic risk factor is denial and minimisation, which may change over the course of treatment. Leading authors in the area advocate the importance of the advancement of these scales in the assessment and treatment of sex offenders (Abracen & Looman; Mann, 2004). Mann highlighted the importance of using both static and dynamic risk assessment measures to ensure that the safety of potential victims and the community is foremost in treatment, as offenders' levels of risk may change over time. Risk assessment measures are increasingly being used in the assessment of offender treatment needs and as clinical data in the evaluation of the offender's progress while in the program.
This is similar to developments in domestic violence perpetrator programs, which are increasingly developing and using risk assessment tools that are specifically targeting domestic violence offender risks and their changing risk due to their situations and their types of offending (O'Leary, Chung, & Zannettino, 2004).
4.4 Evidence about the effectiveness of sexual violence treatment programs
In this section, evidence about the effectiveness of sex offender treatment programs is examined and identified good practice is discussed. Australian programs are described in terms of program content and evaluations of their effectiveness.
Debate exists as to whether sex offender treatment programs reduce sexual recidivism (Lievore, 2004; Marques, 1999). However, a recent meta-analysis of program effectiveness showed that treatment programs can be effective in reducing recidivism (Hanson, Gordon, Harris, Marques, Murphy, Quinsey, & Seto, 2002). Given the dominance of the psychology discipline in such treatment programs, the evaluations are understandably positivist in design and are grounded in 'objective' quantitative data. Lievore outlined factors that can have an impact on judgements about the effectiveness of sex offender treatment programs:
- the measurement of recidivism (or criteria for success and failure)
- definitional differences (for example, whether recidivism is counted as reconviction or reported re-offending, as the latter will provide a higher rate of recidivism)
- measurement error in criminal justice data
- variability between official and unofficial data sources
- differences between comparison groups on important predictor variables, including offence and offender characteristics
- the duration and context of treatment provisions
- the use of appropriate statistical methods to account for differences in time at risk of offending (p. 90).
Methodological differences can also have an impact on the variability of recidivism rates when evaluating sex offender treatment programs (Lievore, 2004; Marques, 1999). Marques argued that very few studies evaluating sex offender treatment programs are well designed. Ideally, studies should compare a group of offenders who willingly agree to participate in the treatment to a control group comprised of untreated sex offenders (Lievore, 2004). However, this design, while methodologically sound, can be considered unethical, as the control group is being denied treatment. Thus, in practice, control groups usually comprise untreated offenders, non-sexual offenders and perpetrators who started the treatment program but, for whatever reason, did not complete it. Importantly, Lievore highlighted that, with the high rates of unreported sexual violence and sexual offences, some participants in the non-sexual offender control group may actually be sex offenders.
Such evaluations in the areas of gendered violence and criminology are often fraught with these methodological and ethical hurdles and challenges; however, the importance of evaluation continues to dominate debates in the area. Undertaking sex offender treatment program evaluations is important to a range of professionals and policy-makers who make decisions about sex offenders (Marques, 1999). For example, Marques noted that outcome data are required for future decision-making and policies about the sentence options to be considered, types of sentences and orders, which perpetrators are suited to which types of treatment programs, the levels of community supervision post-release from custody and which programs will continue to receive funding.
One longitudinal evaluation of a North American sex offender treatment program, the Sex Offender Treatment and Evaluation Project (SOTEP), incorporated elements of best-practice research design (Lievore, 2004) and has been implemented in California. The study sought to evaluate the effectiveness of treatment in reducing recidivism in sex offences against adults and children (Marques, 1999). The program's theoretical orientation was cognitive behaviour therapy, situated within a relapse prevention framework. The key features of the SOTEP evaluation included:
- an experimental design that included the random assignment of volunteers to either treatment or no-treatment (control) conditions and another control group of non-volunteers
- an intensive cognitive behavioural inpatient treatment program designed specifically to prevent relapse among sex offenders
- a one-year aftercare program in the community
- a comprehensive evaluation of both in-treatment changes and long-term effects (including a follow-up period in which recidivism rates for treated and untreated participants are measured for at least five years) (Marques, 1999, p. 439).
Preliminary findings for the study did not conclusively determine whether the treatment program was effective (Marques, 1999), although there were some data suggesting that treated sex offenders' subsequent re-offences were less serious. The preliminary findings also showed that treated child molesters with only male victims or with both female and male victims had a 13 per cent sexual re-offence rate, compared to 16 per cent and 29 per cent for the two untreated control groups, and their treatment appeared to be more effective than for child molesters who offended exclusively against female victims.
Hanson et al.'s (2002) meta-analytic review of treatment evaluations found recidivism rates for those in sex offender treatment programs were lower (12.3 per cent) than for those in comparison groups (16.8 per cent). The type of program was important to this outcome; specifically, they found that cognitive behavioural programs had the best results. This has been subsequently confirmed by other authors such as Abracen and Looman (2004). In the United Kingdom, Manderville-Norden and Beech (2004) reported that cognitive behavioural programs in conjunction with a probation service were more effective in reducing recidivism than probation services as the sole intervention. Importantly, Hanson et al. also found that treatment approaches implemented prior to 1980 were not valuable.
Obviously, the long-term evaluation of sex offender treatment programs is important, but costly. How recidivism is measured must be taken into account when determining a program's success, as previous research tells us that conviction rates for sexual offences are low and are therefore not an accurate indicator of actual recidivism. There has been debate among researchers about the level of sex offender recidivism. There is a strong argument for long-term follow-up of sex offenders, as there is evidence to suggest re-offending occurs for up to twenty years after incarceration and/or treatment. Cann, Falshaw and Friendship (2004), in a 21-year follow-up of convicted sex offenders, found 22 per cent had been reconvicted. It should be noted, however, that not all of these offenders had access to programs and, of those that did, programs were variable.
In short, there is evidence to suggest that treatment programs for sex offenders, particularly cognitive behavioural programs, are likely to reduce recidivism.
4.5 Australian evidence about sex offender treatment programs
In this section of the paper, we distinguish between adolescent and adult sex offenders, as the program approaches can differ for important reasons related to the development of sexual offending and subsequent risk factors..
4.5.1 Australian intervention programs with young men
Providing sex offender intervention programs for adolescents is logical, as research indicates that the majority of high-risk adult sex offenders start offending in adolescence (Abel & Rouleau, 1990; Manderville-Norden & Beech, 2004; WACRC&DR, 2001), and they often commit multiple sexual offences over a lifetime (Sapp & Vaughn, 1990). Typically, adolescent sex offenders abuse younger children and, to a lesser extent, children their own age. Recent research into the prevalence of sexual violence in Australia has highlighted the need for preventative initiatives, including treatment programs, with young men. This is particularly important, as this paper highlighted earlier, because young women are the group most likely to experience sexual violence.
Adolescence is a timely intervention point, as it is then that young people's use of violence in intimate relationships often commence (WACRC&DR, 2001). Furthermore, intervention at this stage has the capacity to reduce the acceptability of violence among adolescents and offers them strategies for change, before the violence becomes entrenched and more severe. There is also potential at this stage to offer alternatives based on non-violent, healthy relationships.
In Australia, treatment for young men who perpetrate sexual violence or who are at risk of using sexual violence has been developing since 1991, and most Australian states and territories now have programs targeting young sex offenders5 (Flanagan, 2003). The following is a summary of the ACT Young Sex Offender Program and the Victorian Male Adolescent Program for Positive Sexuality. These two programs are discussed because they have been the most rigorously evaluated and comprehensively documented.
The Young Sex Offender Program is part of the Australian Capital Territory's Corrective Services Offender Intervention Program Unit (Flanagan, 2003). The program was established in 2001 and targets young sex offenders between the ages of 12-24 years. Offenders are referred to the program from the juvenile justice system; however, the program will also accept referrals from other sources, as long as the sexually offending behaviour has been reported to the police. This program is delivered in a community-based setting (Flanagan, 2003).
Community safety and the needs of victims and potential victims are the key priorities for the Young Sex Offender Program (Flanagan, 2003). The program operates from a cognitive behavioural therapy model and utilises a group therapy format. Family therapy and individual therapy sessions are also offered by the program.
The Male Adolescent Program for Positive Sexuality (MAPPS) targets adolescent sex offenders in Victoria. It was established by the Victorian Department of Human Services in 1993 as an alternative to incarceration (Flanagan, 2003; Lievore, 2004). The program focuses on rehabilitation and is premised on the notion that incarceration is not a conducive environment in which to effect changes in the adolescent's behaviour and attitudes. Lievore noted that the program places emphasis on the offender taking responsibility for his behaviour and 'making the necessary changes for controlling his behaviour, with the goal of building an offence-free future' (p. 101).
Adolescents referred to MAPPS have been found guilty of perpetrating a sexual offence by the Victorian Juvenile Justice system (Lievore, 2004). The majority of the offenders in the program are aged between 14 and 17 years. While participation is meant to be voluntary, many offenders are required to undertake the program as a condition of their court orders. Participation is usually for 11 months of weekly sessions; however, the duration of attendance varies, depending on the individual's court order. Lievore expressed concern about the young offenders' risk of re-offending and lack of accountability when they do not participate in the program or disengage from it.
MAPPS is a group treatment program that moves through the following stages:
- basic groups
- transition program
- advanced group
- relapse prevention (Lievore, 2004, p. 101).
Four-and-a-half years after its inception, MAPPS underwent an evaluation (Curnow, Streker, & Williams, 1998). In comparing those who completed treatment with non-completers, the evaluation showed that the treatment reduced sexual recidivism rates in convicted adolescent sex offenders. Of the 138 offenders who completed treatment between 1993 and 1998, 5 per cent committed further sexual offences, and treatment completers were found to be eight times less likely to re-offend compared to adolescents who did not complete the program. The evaluation also reported that offenders who completed the program were more likely to take responsibility for their offending behaviours (Curnow et al., 1998).
While the evaluation results are encouraging, Lievore (2004) cautioned against drawing causal links between MAPPS and reduced sexual recidivism rates. She suggests that the evaluation could be strengthened by:
- increasing the follow-up period
- comparing recidivism rates with those of a randomly assigned control group
- further examination of the differences between the offenders who completed the program compared to non-completers (p. 102).
In comparison to the Australian findings, an evaluation of a North American adolescent sexual offender treatment program (SOTP) compared the effectiveness of the SOTP with another therapy intervention (not solely focused on sex offending) (Lab, Shields, & Schondel, 1993). In terms of further sexual offending, the results were similar for both the experimental and control groups: one of the 46 perpetrators (2.2 per cent) assigned to the SOTP sexually re-offended, and four of the 109 offenders (3.7 per cent) who undertook a treatment not specific to sexual offences sexually re-offended. For all cases of recidivism, both sexual and non-sexual, eleven juveniles (24 per cent) assigned to the SOTP re-offended, compared to 18 juveniles (18 per cent) assigned to a treatment not specific to sexual offences who re-offended. The evaluation results suggested that the SOTP was no more effective at reducing recidivism for juvenile sex offenders than a treatment not specific to sexual offences (Lab et al., 1993).
The evaluation results differed for a range of reasons, which have previously been outlined in terms of considering differences across methodologies and programs (Lievore, 2004). However, when using recidivism rates that are based on re-convictions for sexual offences, low rates could either be a promising result or could be a sign of offenders not getting caught again. However, given that research shows that when sexual violence offending begins at an early age, there is a higher risk of offending in adulthood, treatment efforts for sexually violent adolescent males should be continued and evaluated.
4.5.2 Australian treatment programs with adult male sex offenders
Treatment programs with adult men aim to reduce their sexual recidivism and to protect the community and potential future victims. Thus, treatment programs are victim-centred, with the welfare of the offender regarded as secondary to the interests of the community (Howells, Heseltine, Sarre, Davey, & Day, 2004; Lievore, 2004). These programs target men known to have perpetrated sexual violence against women and/or children and are delivered in prisons6 and within the community.7 A conviction is often required to compel offenders to attend treatment, so participation in treatment is generally part of an order or sentencing conditions. The following is a summary of two treatment programs delivered by the New South Wales Department of Correctional Services, as well as the Sexual Offender Treatment Program (SOTP), which is run by the Queensland Department of Corrective Services.
The New South Wales Department of Correctional Services delivers both prison- and community-based programs to convicted sex offenders (Lievore, 2004). Two different prison-based programs are offered: Custody-based Intensive Treatment (CUBIT) and Custody-based Intensive Treatment Out Reach (CORE). Both programs offer modules of varying lengths covering offence-related and offence-specific topics, including anger and stress management (Lievore, 2004).
CUBIT is run over eight months (moderate-intensity program) or ten months (high-intensity program) and is targeted to offenders assessed as being of moderate to high risk (Lievore, 2004). The program is predominately run in a group setting and administered by a multidisciplinary team, including psychologists, human service workers and custodial workers. During the program, the offenders are accommodated in a self-contained unit at the Long Bay Correctional Centre. Lievore argued that this physical environment is more conducive for the offenders to work on long-term behaviour and attitude change.
The CORE program is for convicted sex offenders assessed as being low risk and covers the same educational modules as the CUBIT program (Lievore 2004). CORE is facilitated in a group format and is run on two half-days per week, over a period of approximately five months. During the program, prisoners continue their regular institutional activities (that is, education and work duties).
Mammone, Keeling, Sleeman, and McElhore (2002) evaluated the impact of the therapeutic intervention of the Australian CUBIT and CORE programs, based on 55 offenders who completed either of these programs in New South Wales between 1999 and 2002. Therapeutic interventions utilised in both CORE and CUBIT target cognitive distortions, and offenders are required to undertake a range of psychological tests upon entering and exiting the program to facilitate program evaluation (Mammone et al.). The results of the evaluation showed that offenders' general and offence-specific cognitive distortions were significantly lower at the post-treatment stage, compared to when the offenders entered the program (Mammone et al.).
The evaluation found that the residential environment in which moderate- to high-risk offenders undertook the CUBIT program facilitated a reduction in cognitive distortions (Mammone et al., 2002). Offenders in the non-residential CORE program, who remained in the general prison population for the duration of the treatment program, also exhibited significant reductions in their cognitive distortions. Mammone et al. reported that sex offenders' risk of sexually re-offending may be decreased if their reduced cognitive distortions can be maintained long term. Further research is required to evaluate the long-term impact of the CUBIT and CORE programs on convicted sex offenders upon their release from prison and following their parole period.
Another prison-based sex offender treatment program in Australia is the Queensland prison-based Sexual Offender Treatment Program. SOTP provides pre-release assessment and treatment for adult male sex offenders and is facilitated by a multidisciplinary team, including psychologists, educational officers, activities officers and program support workers (Schweitzer & Dwyer, 2003). The program is offered over 45 weeks and is divided into three phases: assessment and treatment phase (15 weeks), treatment planning phase (5 weeks) and intensive treatment phase (25 weeks). Using a group therapy format, the following modules are undertaken by offenders during the intensive treatment phase:
- effective relationships (including a focus on inappropriate communication styles)
- cognitive distortions
- control of deviant sexual arousal
- social issues
- victim issues
- relapse prevention (Schwietzer & Dwyer, 2003).
The programs described are based on the cognitive behavioural approach, which emphasises changing cognitive distortions and developing pro-social skills and behaviours that aim to reduce sexual re-offending.
An evaluation of the Queensland SOTP was undertaken by examining the sexual recidivism of convicted adult male sex offenders who undertook some or all of the SOTP while in prison. The offenders were released from custody between 1992 and 2001 and were monitored for recidivism for five years and one month post-release into the community (Schweitzer & Dwyer, 2003). The sample consisted of 445 men: 196 SOTP completers, 85 SOTP non-completers and 164 matched controls.
The outcomes of the SOTP evaluation showed that there was no statistically significant reduction in sexual recidivism following participation in this treatment program (Schweitzer & Dwyer, 2003). In this evaluation, recorded past histories of violent crimes and sex crimes were the strongest predictors of recidivism. The evaluation did not show that the program effects were statistically significant; however, Schweitzer and Dyer noted that this should be considered in light of a considerable amount of missing data for the evaluation, and variations and limitations in follow-up periods post-release. They asserted that evaluations of sex offender treatment programs need to continue to be undertaken.
Similar to the results on adolescent sex offender programs, the Australian evaluation findings on programs for adult sex offenders are mixed. The small sample size of Australian studies limits what can be concluded about the effectiveness of programs at present.
4.5.3 Good practice in sex offender treatment programs
In relation to good practice, program evaluation findings have had mixed results. Cognitive behavioural therapy has been the most commonly used model of treatment for sex offenders and the evaluations of such treatments showed mixed results. The Australian evaluations of sex offender treatment programs have shown that some have been successful, others less so; however, evaluations from North America and the United Kingdom, with larger samples, indicate that they have been effective (Hanson et al., 2002; Manderville-Norden & Beech, 2004). Lievore (2004) argued that international best-practice treatment programs for sex offenders are based on cognitive behaviour therapy that incorporates relapse prevention. Interventions underpinned by cognitive behaviour therapy focus on altering sexual behaviours and attractions, modifying cognitive distortions and addressing social difficulties (Marshall & Barbaree, 1990). In relation to relapse prevention, Pithers (1990) asserted that it provides offenders with 'tools' to enhance internal self-management skills for dealing with high-risk situations. The intention of relapse prevention is to promote not offending beyond the intervention period.
In general, treatment based on cognitive behaviour therapy within a framework of relapse prevention are delivered by a multidisciplinary team consisting of, but not limited to, social workers, psychologists, legal practitioners and workers from correctional services (Lievore, 2004).
Lievore (2004) outlined three common core issues which should be addressed in cognitive behavioural treatment programs for sex offenders:
- Challenging beliefs that support offending. Offenders are required to:
- identify and challenge cognitive distortions and factors associated with offending
- acknowledge and take responsibility for the offending behaviour. This requires full and open disclosure of sexual offending
- understand offending in the broader life context and gain insight into the cycle of offending, the precise nature of the problem, its antecedents and its consequences.
- Developing empathy. As affective deficits facilitate offending, it is essential that offenders:
- understand the impact of sexual offending and its consequences for victims, offenders and the community
- develop victim empathy.
- Relapse prevention. To control offending behaviour, offenders must:
- learn to manage inappropriate sexual fantasies, thoughts and arousal patterns
- develop relapse prevention plans to manage the risk of future offending. This is a highly individualised approach to therapy that involves identifying high-risk situations and offence precursors and forestalling the threat of relapse by implementing coping responses or avoidance strategies (p. 78-79).
Group therapy is preferred over individual therapy sessions. Lievore (2004) argued that group therapy is more effective and cheaper compared to individual therapy.
Some of the strengths of group therapy in working with sex offenders are:
- group formats break the secrecy of sexual violence. Offenders are no longer in a position where they can justify, defend and rationalise their offending behaviour, as others become aware of the sexual violence they have perpetrated
- groups can provide a richly therapeutic environment in which group members are able to comment and provide insight into other members' problems. This can facilitate group members to utilise the opportunity to implement new ways of thinking and interacting
- group formats, when facilitated by a female and male worker, provide workers with the opportunity to model desirable ways of relating, thus facilitating attitude change in the offenders (Lievore, 2004, p. 79).
Abracen and Looman (2005) argued that individual approaches to treatment are relevant in cases where the offender has a serious mental illness or intellectual disability that impairs their capacity to operate in a group and therefore requires individual intensive treatment. Importantly, they noted that the use of individual treatment does not imply that they are higher-risk offenders. Rather, it is the result of being assessed as being unsuitable for a group program.
Lievore (2004) argued that sex offender treatment programs should aim to provide detailed and integrated systems of assessment, management and intervention. Similar arguments about the importance of the integration of services to ensure a comprehensive approach that promotes safety have been made for the organisation of domestic violence services (Shepard & Pence, 1999). Domestic violence services appear to have developed further in this regard, by involving justice agencies, corrections, women's support services, legal services and others. A key purpose of such approaches is to collaboratively promote the safety of women and children. Further collaboration in sexual violence responses could provide closer integration in developing both treatment and prevention approaches to sexual violence, which currently tend to run independently of each other.
Cognitive behavioural approaches to treatment programs have been identified as the most effective of the psychological approaches to date, based on much evaluation research. Unlike the field of domestic violence, which contains a mixture of treatment programs ranging from psychological psycho-therapy to pro-feminist psycho-educational programs, the sex offender treatment field has been narrower in its range of approaches. The pro-feminist psycho-education approaches adopted in domestic violence perpetrator programs are unlikely to have any influence on the treatment of sex offenders, given the dominance of psychology in this field of intervention. Relevant gender theory concepts in the area of sexual violence include: heterosexual dominance, gendered power relations and the social construction of masculinity. Concepts such as these provide insight into the link between the occurrence of sexual violence in the community and its impacts on both offenders and victims of such gendered violence.
Such concepts have been usefully utilised in the treatment and support of victims of sexual assault and adult survivors of child sexual assault (Reavey, 2003). A consideration of how these concepts impact on the behaviour, identity and the ways in which men relate to both women and other men can provide useful insights into the treatment of sex offenders (Flood, 2002-2003; Pease, 2004-2005). This would also lead to a closer alliance in approach between sexual violence services that support victims and those that treat offenders. However, the difference in the mandates of such organisations is acknowledged as being critical to how they work with victims or offenders. This is highlighted by Lancaster and Lumb (1999) in describing social workers' practice with male child sex offenders in the United Kingdom's Probation Service:
All practitioners we have spoken to recognise the socio-cultural influence within their work, but, in terms of what they can achieve on a day-to-day basis with individual offenders, they utilise techniques of intervention which are based on increasingly sophisticated knowledge of the psychological processes involved in effecting change in someone's behaviour (p. 125).
The dilemma of social structural explanations not being able to provide a readily translatable link to individual work on behaviour change has been documented. However, to focus solely on the individual psychology of men convicted of sexual offences ignores some important facets of the problem of sexual violence: it provides no theory for its primary prevention, it does not consider the social conditions, values and mores which determine what gets counted as sexual violence and who gets convicted, and it does not necessarily provide accountability to the victims of sexual violence.
In the next section on the prevention of sexual violence, the greater use of gender-based explanations of sexual violence will be examined, as will be the shift away from psychological underpinnings in the approach.
4.6 Prevention of sexual violence
This section of the paper describes some of the various education programs and campaigns that have been developed to prevent and stop sexual violence. Prevention programs aimed at stopping sexual violence generally target young men and women of particular age groups and within particular institutions, such as schools. These programs often include activities such as education programs, public awareness campaigns and programs to challenge attitudes. They tend to be universal in their approach in as much as they do not often target young people considered to be 'at risk' of either offending or being victims of sexual assault. Venues for such programs have traditionally been schools, universities and sporting clubs. Unlike sex offender treatment programs, many of the prevention programs have not been developed within a correctional or criminal justice setting. They have tended to emerge from partnerships with women's, youth and health services that have a concern with the prevention of sexual violence in order to stem the large numbers of women seeking help for sexual assaults.
4.6.1 Approaches to sexual violence prevention
Recent research indicates the urgent need for primary prevention initiatives related to sexual violence for young people (Mulroney, 2003). Adolescence is a unique time for primary prevention, as it is the stage when young people are working out their identities and values and beginning their own intimate relationships (Mulroney; Smith, Huxley, & McKernan, 2004).
The Western Australia Crime Research Centre and Donovan Research (2001) conducted a national study of young people's attitudes and experiences of domestic violence involving 5000 participants. One in three young people revealed that violence occurred within their own relationships. Fourteen per cent of young women reported they had been sexually assaulted. The study also found that 14 per cent of young women reported that their partner had attempted to force them to have sex. One in twenty of the young people considered forcing a partner to have sex was part of normal conflict in relationships. Due to the high prevalence of sexual violence reported in young people's relationships, the researchers concluded that sexual violence in young people's relationships should be a primary concern of governments.
International literature confirms sexual violence is a common experience among young people. For example, Sundermann and Jaffe (1995) reported that 23 per cent of American female high school students revealed that sexual violence was part of their dating relationships. Therefore, primary prevention is required with young people to address sexual violence and the development of healthy intimate relationships (Carmody, 2003a, 2005; Mulroney, 2003).
One approach to sexual violence prevention that emerged in the 1980s was the popularly known 'Just Say No' approach. This approach encouraged women to take responsibility for stopping male sexual violence by individually telling men that they did not want sex with them. This prevention strategy was limited in many respects. Firstly, it placed responsibility on the woman for controlling and stopping the man's behaviour. Secondly, it inadvertently blamed women for not being able to communicate clearly, which conflated the issue of sexual violence with sexual intimacy. In regard to the rationale of the 'Just Say No' approach, Kitzinger and Frith (1999) stated that sexual violence is often presented as a result of miscommunication between a man and a woman, where the man does not understand that the woman is refusing sex.
The miscommunication idea is highly problematic on a range of levels: it asserts that the woman is responsible for controlling the man's behaviour and for stopping the sexual violence; it is ignorant to the gendered power relations within heterosexual relationships; it ignores power differences between the genders; it assumes that the man will act respectfully to the woman's request to not engage in sexual intercourse/sexual activities; and it presents men as not being responsible for their behaviour and actions. Kitzinger and Frith (1999) further critiqued the 'Just Say No' strategy and its notions of miscommunication by arguing that in Western cultures, refusing invitations and requests is generally difficult, especially when there is a vested interest in continuing the relationship and where there is a power imbalance. However:
both men and women have a sophisticated ability to convey and to comprehend refusals, including refusals which do not include the word 'no', and we suggest that male claims not to have 'understood' refusals which conform to culturally normative patterns can only be heard as self-interested justifications for coercive behaviour (Kitzinger & Frith, p. 295).
In contrast to the severe limitations of this approach, Moira Carmody (2003a, 2005) conceptualised an important advancement in sexual violence prevention approaches and argued that people should think about alternative prevention education initiatives to sexual violence, namely ethical sexuality. To date, much focus and efforts into sexual violence prevention have been on tertiary intervention with 'known' sex offenders (Carmody, 2003a, 2005). The continued high prevalence rates of sexual violence suggest that these tertiary initiatives are having little impact on preventing the sexual violence from occurring (Carmody, 2005). Carmody argued for shifting the 'focus from teaching refusal skills and awareness-raising to a focus on promoting and developing ethical non-violent relating' (p. 478).
Carmody's (2003a, 2005) alternative approach focuses on providing the space to highlight both the pleasures and dangers in intimate sexual relationships and to discuss sexual negotiation. Young people's experiences of sex and of sexual negotiation are complex issues, due to the many forces that shape sexual negotiation (Smith et al., 2004). Young people may have a limited understanding of consenting to sex and of the differences in consent, including giving free consent, forced or coerced consent and non-consent (Smith et al., 2004). This approach centres on creating an understanding of ethical negotiation in all aspects of intimate relationships, both sexual and non-sexual (Carmody, 2003a). Carmody stated that this enables a shift from punitive education initiatives which 'achieve prevention through threat of punishment or controlling risk and promotes a pessimistic view of gender relations with men as always dangerous and women as passive victims' (p. 4).
4.6.2 School-based sexual violence education programs
A recent approach to sexual violence has been the development of prevention/education programs in Australian schools (Keel, 2005). School-based programs target young people who are at the stage of developing intimate relationships; the orientation is universal, with all students included (Urbis Keys Young, 2004). Most recently, an anti-violence education resource pack has been developed by the Australian government and distributed to all secondary schools (Australian Government Office for Women [AGOFW], 2005). This pack is aimed at students in Years 11 and 12 and equips teachers with the information and strategies for teaching about healthy relationships and identifying abusive behaviours (Keel, 2005). While the primary focus is physical violence, Keel noted that issues of sexual violence are discussed. Young men are primarily targeted by this prevention strategy, with the intention of encouraging them to take responsibility for their behaviour and to act appropriately in the context of intimate relationships (AGOFW, 2005; Keel, 2005). Carmody's (2005) work on ethical sexuality is more comprehensive than the approach described above as she includes the critical step of ethical and healthy alternatives, which moves beyond just letting people know what is unacceptable.
Another school-based prevention strategy specifically aimed at sexual violence prevention is offered in the north-west region of Melbourne by the Centre Against Sexual Assault (CASA) (Keel, 2005). The program involves workers from CASA attending schools and conducting an initial 90-minute session with staff and between three and five workshops with students from years 9, 10 and 11. The staff session focuses on introducing the topic of sexual violence and aiding the staff to appropriately respond to disclosures of sexual violence.
Initially, CASA offered students one session aimed at education about sexual violence (Keel, 2005). Findings from evaluations of the program have led to extending the program to include three to five sessions. Topics covered in the sessions include:
- an introduction to sexual violence
- the meaning of consent and social pressures that influence communication
- the impact of sexual violence on victims
- social action strategies to prevent sexual violence, including an opportunity for the students to create banners and slogans for a mock anti-sexual violence campaign (Keel, 2005, p. 22).
Female and male students are separated during the workshops until the final session, when they are brought together and encouraged to discuss their opinions with each other (Keel, 2005). While the curriculum is not dissimilar for male and female students, evaluations of the program revealed that separating the students into single-sex groups allowed students to communicate better with their facilitator. Keel noted that CASA does not initiate contact with schools; rather schools approach CASA, and the curriculum is tailored to suit the needs of each individual school. To date, 700 students and 200 teachers have participated in the program.
A criticism often directed at primary prevention programs is that the evaluation of their effectiveness is often inadequate (Schewe & O'Donohue, 1993; Weisz & Black, 2001). In comparison to treatment program evaluations, prevention evaluation is at an early stage of development. Some of the reasons accounting for the inadequacy of the evaluations have been small sample sizes, lack of medium- to long-term follow-up, high attrition rates in follow-up, reliance on the male participants to self-report behaviour, and the evaluation design not being able to exclude other variables which influence sexual violence attitudes and behaviours.
A large North American evaluation of a dating violence prevention initiative, the Safe Dates Program, overcame many of these limitations. The Safe Dates Program was conducted in fourteen schools in North Carolina and involved 33 agencies (Foshee, Bauman, Arriaga, Helms, Koch, Linder, & Fletcher, 2004). The program comprised a 10-session curriculum, with various activities directed at young people, parents and service providers, and the study had a four-year follow-up period, with a sample of 460, including 201 controls. Data were collected at post-intervention intervals of one month, one year, two years and four years. The evaluation indicated that Safe Dates was successful in reducing aspects of physical and sexual victimisation and perpetration of dating violence, with '56% to 92% less dating violence victimization and perpetration at follow up' (Foshee et al., p. 623). A smaller study by Weisz and Black (2001) evaluating a dating violence and sexual assault prevention program also showed an increase in knowledge and improved attitudes at the six-month follow-up stage. A weakness of both studies was the reliance on self-report data to identify changes.
4.6.3 University-based sexual violence education programs
Published studies of sexual violence programs in universities have been based on North American experiences and have indicated that sexual violence on North American college campuses is a significant problem. Koss, Gidycz, and Wisniewski (1987) found that 54 per cent of college women had been subjected to some form of sexual violence. More recent studies have reported even higher victimisation rates. For example, a survey of 1160 college women found that 59 per cent had been subjected to sexual violence (Abbey, Ross, McDuffie, & McAuslan, 1996). In this study, 8 per cent of women reported experiencing attempted rape and 23 per cent of women reported having been raped.
In response to studies highlighting the prevalence of sexual violence on college campuses, many North American colleges and universities have initiated sexual violence prevention programs (Breitenbecher & Scarce, 1999; Heppner, Neville, Smith, Kivlighan, & Gershuny, 1999). Breitenbecher and Scarce outlined common features of such prevention programs:
- provision of information regarding the prevalence of sexual assault among college students
- debunking of rape socialisation practices
- identification of risk-related dating behaviours
- discussions of dating expectations and communication of sexual intentions
- induction of empathy for rape survivors (p. 460).
Breitenbecher and Scarce (1999) evaluated the effectiveness of a sexual assault education program delivered to university students, focusing on two domains: increasing knowledge about sexual assault and decreasing the incidence of sexual assault during a seven-month follow-up period. Of the 275 women recruited from the university student population to participate in the study, 224 (82 per cent) returned for the follow-up session seven months later. The women were randomly assigned to either the treatment or control groups. The evaluation found that the sexual assault education program was effective in increasing the women's knowledge about sexual assault, but was found to be ineffective in reducing the women's risk of being subjected to sexual assault during the seven-month follow-up period.
Breitenbecher and Scarce (1999) suggested four reasons for the ineffectiveness of the program in reducing women's risk of being subjected to sexual assault during the follow-up period. Firstly, the one hour initial session may not have been 'powerful enough to change women's risk-related behaviors or responses to unwanted sexual advances' (Breitenbecher & Scarce, 1999, p. 471). Secondly, the authors argued that the ineffectiveness of the program may be attributed to the program content. Thirdly, the program's focus on potential victims' cognitions and behaviours was linked to the program's failure to reduce the incidents of rape among the women. The program focused on women reducing their risk of sexual victimisation by altering their own behaviours. It could be argued that the program would have been more effective at reducing the incidence of sexual victimisation if the program had been targeted at male students, addressed potential perpetrators' cognitions and behaviours, and challenged their behaviours.
Other college sexual assault programs focus on date rape prevention. These programs, while acknowledging that men are always responsible for their sexually offending behaviour, have also been developed to educate women about lowering their risk of victimisation (Hanson & Gidycz, 1993). These date rape prevention programs generally include such features as consciousness-raising information about sex-role stereotyping and debunking rape myths, films depicting acquaintance rape scenarios and education regarding available rape counselling and crisis services (Parrot, 1991). Literature on rape prevention education highlights a need for further evaluations of the effectiveness of these programs (Hanson & Gidycz; Schewe & O'Donohue, 1993).
In response to the dearth of evaluations of college acquaintance rape education programs, Lonsway, Klaw, Berg, Waldo, Kothari, Mazurek and Hegeman (1998) evaluated the Campus Acquaintance Rape Education (CARE) program. The CARE program is a detailed course, offered in a large midwestern North American university, that trains undergraduate students to facilitate peer workshops in various campus settings. The program curriculum includes debunking rape myths from a feminist perspective, providing sexuality education, generating participant interaction and teaching non-confrontational approaches.
The evaluation collected pre- and post-test data on a range of attitudinal measures, which showed that CARE program participants experienced comprehensive attitude changes towards anti-rape ideology (Lonsway et al., 1998). The results also suggested that both male and female students who undertook the CARE program became 'more willing and able to directly express themselves and assert their needs in ways that facilitated increased sexual communication' (Lonsway et al., 1998, p. 73) and were less accepting of rape myths.
The North American university campus programs documented are a mix of awareness raising, education and prevention. The prevention approach has often been very literal in its interpretation, as it has presumed that sexual assault will be perpetrated by men and cannot be stopped, and that it is only through changing the behaviour of women that it can be reduced. This type of approach - while it may seem 'common sense' and practical - can come close to victim-blaming and viewing men's sexual violence as normal. It does not seek to address the social factors that ignore or condone sexual assault; rather, sexual violence is presented as a problem of individuals and that individuals should learn to avoid being sexually victimised.
4.6.4 Sexual violence education and sport
Recent reports of sexual violence perpetrated by high-profile male sporting identities have added to the call for education programs. Sporting associations have introduced player conduct codes and compulsory education programs. To some extent, these measures have also focused on how men can avoid allegations of sexual violence rather than substantially challenging aspects of masculine culture that support the sexual exploitation of women. Media coverage of police action against sporting identities has raised the profile of debates concerning the prevention of sexual violence. However, rather than viewing male sporting identities as more at risk of committing sexual crimes, there is a need to see these incidents of male violence as representative of an all-too-common occurrence in the wider community. It will be interesting to see whether this remains an issue for education and 'risk management' in professional sporting associations or a quick fix to 'bad press'.
4.7 Conclusions about sexual violence treatment and prevention approaches
The evaluations of sex offender treatment programs indicate that cognitive behavioural approaches are, to date, the most effective compared with other intervention approaches. The Australian programs described in detail earlier in this paper are all based on cognitive behavioural approaches and incorporate relapse prevention. In this respect, the programs are drawing on approaches deemed to be most effective in the published literature.
The majority of sexual violence prevention initiatives have originated from women's organisations and gender specialists in mainstream services that have histories of responding to the needs of victims of sexual assault. A component of many of these initiatives still include an emphasis on the historical approach of women avoiding the risks of sexual victimisation. Education initiatives have been targeted at females and males to dispel rape myths, to make women more aware of the threat of sexual assault, to provide women with information about support services if they are needed, and to educate men and women about the effects of sexual violence.
Overall the evaluation evidence of such initiatives indicate that knowledge and awareness of sexual assault and its effects are increased; however, this does not necessarily lead to a decrease in sexual assaults.
Most prevention initiatives rarely offer alternative ways for young people to enjoy ethical sexuality and healthy relationships (Carmody, 2003b). It could be argued that a major limitation of most prevention has been that the sources of the problem - both individual men who sexually assault women and the social conditions that overlook or minimise it - are not addressed by such initiatives. In examining the theoretical underpinnings of the prevention of sexual violence, Michael Flood (2002-03) argued that, ultimately, sexual violence reduction lies in undermining those aspects of culture that lend social support to violence; in particular, the ways in which masculinity is positively associated with a sense of entitlement, dominance and power. While Flood has been critical of many of the current initiatives for merely promoting the idea that violence against women is unacceptable, he has argued that prevention must be an essential component in the overall response to sexual violence:
Formal prevention and control strategies such as sound laws and integrated criminal responses are important. They can make a difference to victims' recovery and to the likelihood of perpetrators' recidivism, and they have symbolic value. But formal control strategies have little to work with in a climate where women and men do not formally report abusive events, most survivors remain silent...and dominant beliefs about violence convince many women that their experience was not rape or assault at all or that it was their fault...' (p. 25).
One of the most advanced approaches to prevention in Australia at present, which takes account of such complexities and previous criticisms, are the ethical sexuality concepts being developed by Moira Carmody (2003b, 2005). They represent a significant shift in the approach to sexual violence prevention for a number of reasons:
- the approach does not assume women are responsible for the prevention of their own sexual victimisation
- it moves beyond condemning those that commit sexual assault to developing alternatives which are non-violent and respectful, thus offering the development of a new cultural script to young people for relationships
- the underlying assumption is a positive view of sexuality for women and men which profoundly differs from sexual violence, and is not merely perceived as being about men's inability to communicate and inappropriate attempts at intimacy (Carmody, 2003b, 2005).
Finally, it is evident that there are very different theoretical ideas and concepts which underpin victim services and prevention initiatives compared with treatment programs for sex offenders. Whereas the sex offender treatment programs are heavily influenced by the individual psychology of sex offenders, prevention has frequently been based on a feminist analysis of sexual violence, which implies that sexual offending is an abuse of male power and act of gender inequality. It does not tend to pathologise either the victims or perpetrators of sexual assault and is based on the assumption that the social structures that privilege masculinity will continue to influence what is named as sexual violence and how those perpetrating it and who are victimised by it are consequently treated. In a further elaboration of Table 1 presented earlier in the explanations section of the paper, Table 2 below shows how the theoretical explanations of sexual violence have influenced prevention and intervention in stopping sexual violence.
|Explanations and examples of approaches||
|Treatment of sex offenders||Prevention and education on sexual violence||Treatment and support of victims|
|Biological interventions, aversion therapy, cognitive behavioural, strengths-based-good lives approach||Men in correctional and mandated programs||Women in the mental health system and private psycho-therapy|
|Early feminist, social and structural explanations|
|Imbalances of power between men, women and children, social learning and socialisation||Public campaigns such as 'Reclaim the Night'||Early rape crisis centres and women's health centres|
|Feminist theory, post-structural/postmodern and constructivist explanations|
|Gendered social relations and institutions, heterosexual dominance, critical studies in masculinity||Private narrative and constructivist therapies||Community-based youth education and prevention programs||Sexual assault services and counselling programs|
* The darkness of the shading represents the strength of the explanatory influence in the area.
As Table 2 shows, there is, overall, a considerable gulf - theoretically and in practice - between the treatment of sex offenders and initiatives aimed at the prevention of sexual violence. Similarly, a theoretical gulf exists in sexual assault services for women victims and programs for sex offenders. These gaps restrict the levels at which a coordinated intersectoral response to sexual violence can effectively develop.
6 Prison-based sex offender treatment programs are offered in most Australian states and territories. Currently, the Northern Territory, Tasmania and South Australia do not offer prison-based programs to incarcerated sex offenders. Lievore (2004) asserted that these states and territory are actively lobbying for government support to implement prison-based sex offender treatment programs.