Psychotherapy and behaviour therapy

This treatment approach is beyond the scope of this study. Psychotherapy is an

important aspect of treatment, although debate exists concerning its overall
effectiveness for long term prevention of new offenses. Several studies have
reported that the best outcomes in preventing repeat offenses against children
occur when pharmacological agents and psychotherapy are used together (Mc
Conaghy 1998; Hanson and Morton Bourgon 2005). Psychotherapy can be
divided into individual and group/family therapies. Most commonly it is a
combination of individual and group therapies. Individual therapy is
represented by insight-oriented, cognitive behavioural and supportive
psychotherapies. There could be as many definitions of psychodynamic or
psychoanalytic therapy as they are studies. In a recent review about
psychological interventions in sex offenders, Brooks-Gordon et al. (2006)
evaluated adults who have been convicted or cautioned for sexual offences or
who sought treatment or were considered to be at risk of sexual offending.
They gave interesting definitions of psychotherapies used in sex offender
populations. They suggested that “ well-defined ”cognitive behavioural
therapy occured when the report made explicit that the intervention involved:
(1) recipients establishing links between their thoughts, feelings and actions
with respect to target symptoms; (2) correction of person’s misperceptions,
irrational beliefs and reasoning biases related to target symptoms and (3)
either or both of the following: recipients monitoring their own thoughts,
feelings and behaviours with respect to target symptoms and/or promotion of
alternative ways of coping with target symptoms. Psychoanalysis was defi ned
as regular individual sessions with a trained psychoanalyst. Analysts were
required to adhere to a strict defi nition of psychoanalytic technique.
Psychodynamic psychotherapy was defined as regular individual therapy
sessions with a trained psychotherapist or a therapist under supervision.
Therapy sessions were based on a psychodynamic or psychoanalytic model.
Sessions could rely on a variety of strategies, including explorative insight-
oriented, supportive or directive activity applied fl exibly. Therapists should
have used a less strict technique than in psychoanalysis. The general strategy
toward psychotherapy with paedophiles is a cognitive behavioural approach
(addressing their cognitive distorsions) combined with empathy training,
sexual impulse control training, relapse prevention and biofeedback (Hall and
Hall 2007). In almost all published studies, cognitive behavioural therapy was
used. Sex offenders employ distorted patterns of thinking which allow them to
rationalize their behaviour, including beliefs such as children can consent to
sex with an adult and/or victims are responsible for being sexually assaulted.
Behavioural therapy programs for sex offenders seek to tackle and change
these distorted attitudes as well as other major factors which can contribute to
sexual offending, including inability to control anger, inability to express
feelings and communicate effectively, problems in managing stress, alcohol
and drug abuse, or deviant sexual arousal. In North America, cognitive-
behavioural therapy is the standard treatment for paraphiliacs who are not at
high risk of victimization. In summary, the effi cacy of cognitive behavioural
therapy for sex offenders is such as to indicate a modest reduction in
recidivism (Losel and Schmucker 2005), but this is doubted by studies with
longer follow-up periods (Maletzki and Steinhauser 2002; Kentworthy et al.
2004) (Level C of evidence).The other approaches (insight-oriented treatment,
therapeutic communities, other psychosocial programs) do not seem to reduce
recidivism (No level of evidence).Moreover, the longer the observation
periods, the higher the recidivism rates, leaving the impression that the
durability of psychological therapies is limited. Furthermore, most of these
studies were not conducted with the most dangerous sex offenders which
means that they cannot be generalized to all sex offenders. Well conducted
studies, randomised controlled trials with longer follow-up durations are
needed.

Pharmacotherapy with psychotropic drugs.

Pharmacological treatments are used in order to decrease the general level of
sexual arousal.