Does Sex Offender Treatment Work?
In a nutshell, sex offender treatment does help, but studies show varying results due to underreporting of actual reoffending, difficulties in measurement of recidivism and the variation in the ways recidivism rates are calculated.
Recidivism is defined as the reversion to criminal behavior by an individual who was previously convicted of a criminal offense. Observed sexual recidivism rates of sex offenders range from about 5 percent after 3 years to about 24 percent after 15 years.
Sex offenders have higher rates of general recidivism than sexual recidivism. This suggests they are far more likely to reoffend for a regular crime than a sexual crime (SOMAPI, n.d.).
Interview with a Prison Social Worker
This post provides you with an interview with Angela Summers*, a social worker who works with male sex offenders in a prison. She bravely discloses what it is like to work with this challenging population and how she treats them with a 7 phase cognitive behavioral relapse prevention model.
Angela also clears up some myths you may have had about male sex offenders and provides 10 important tips to take into account if you are planning to work with this population.
So without further ado, Angela, let’s start with a bit of your background. What led you to the field of social work, and specifically, to work at a male prison?
I’ve wanted to be a social worker since high school. However, life led me down a different path and I worked as a nurse’s aide in nursing homes and a psychiatric hospital in Staten Island, NY for several years. I continued to have the desire to be a social worker and I finally made the decision to go back to school in 2005. I graduated from Misericordia University with a BSW with a certificate in child welfare.
I continued on to graduate school at Fordham University where I earned my MSW in Clinical Social Work in 2011. I completed a short community service project during my undergraduate education with an AIDS Resource Center and they did groups in a female state correctional facility.
That’s where my interest began. I saw a significant need for inmates to be given the tools and encouragement they needed in order to be successful when they are released. Those who had life sentences needed to learn positive coping skills to get them through their days. I remember thinking, “How will they get through it?”
However, I started off in child welfare and moved on to mental health. While working in the state mental health system, I saw patients with significant criminal histories and wondered if there was any type of support for them while incarcerated.
I wondered if they received mental health treatment during their incarceration and if they didn’t, would that have helped them in any way once they were released. I was still interested in corrections and I pursued employment with my current employer.
I was thrilled when I got the offer. I knew there would be a culture shock, but I was ready for the challenge. And very simply, I’ve always been interested in the criminal mind.
I was first exposed working with sex offenders in the child welfare system with the sex offenders generally being the caregivers of the children who were now in foster care. The work with sex offenders at that point was indirect. They were receiving their treatment outside of our agency, but their offense was often a topic at meetings and court hearings.
During my interview at the prison, they asked me how I felt working with sex offenders. I was honest. I definitely had some apprehension and anxiety about it. This was direct work with sex offenders in a group setting where they would need to disclose even the smallest detail of their crime. Would I be able to handle that?
I was very nervous and scared on the day of my first class. There was another social worker with me to help get the group up and running. She stayed with me for quite a few weeks helping me to navigate the group process.
I was afraid to hear all the minute details of the crime. I was afraid to hear what they had done to their victims, which were often young children. I was afraid of how I would react. Initially, it was very difficult to hear how the victims were assaulted.
I began checking in with myself to make sure I was handling the stories of abuse and assault in a healthy manner. I also had to be aware of my feelings towards the inmates. They have already been judged for their crime. It’s not my job to judge. It’s my job to help them understand their offending and help them develop a relapse prevention plan to help them with not reoffending.
I’ve been doing groups for two years and it’s gotten easier. The reward comes at times when I least expect it. For example, it’s a therapeutically positive day when a sex offender realizes child pornography is not a victimless crime.
Something made the lightbulb go off in their mind and they’re able to verbalize how those children are victims. It’s those moments that I feel like they’re learning and understanding how their actions affected the children.
It’s those moments when I truly believe in people and their ability to change. I couldn’t be a social worker if I didn’t believe in people.
The Assessment of Adult Male Sex Offenders
(The California Institute for Behavioral Health Solutions)
How would you describe the Medlin Therapy approach?
Dr. Julie Medlin founded the Medlin Treatment Center (MTC), which is an outpatient counseling center that treats specializes in treating sexual deviancy. We utilize her Responsible Living program at our facility in a group setting.
There are also individual sessions that can be done; however, we do not have individual sessions as a part of this program at this institution. It utilizes a Cognitive Behavioral, Relapse-Prevention model. So, we hope to change the offender’s behavior by changing his thinking.
The inmates earn points each week for attendance, participation, and homework. Inmates need a certain amount of points to graduate from the class. If the minimum amount of points are not earned, they can fail the group.
So, I encourage inmates to actively participate and complete the homework. Homework is assigned on a weekly basis which we go over individually during group. Inmates can be removed from the group if they are denying their offense or are simply not making progress.
Can you give an example of how the Medlin Therapy is applied in your group work?
There are seven phases of treatment – Responsibility Taking, Behavioral Techniques, Emotional Well-Being, Victim Empathy, Anger Management, Sex Education, and Relapse Prevention.
The high intensity program includes all seven phases. The low intensity program includes phases 1, 3, 5, and 7. Sessions are held on a weekly basis.
From day one, inmates are required to provide their “layout.” This includes their name, number of victims, the deviant sexual behavior in which they engaged, red flags, and goals.
The purpose of this is to remind inmates why they are in treatment, help in taking responsibility for their offending, help others learn about their offense, review the past week and any difficulties they may have had, and discuss any red flags from the past week.
We discuss “thinking errors” inmates use to rationalize, minimize, and justify their offending and how to correct them. We do this on a weekly basis because this is a significant part of offending that many inmates do not understand.
While all of the phases are important, Victim Empathy is a phase where we spend a lot of time. Another important phase is Responsibility Taking. It is this phase where they present their “Offense Summary.”
It is a detailed account of their offense which must include the four steps to offending – Motivation, Internal Barriers, External Barriers, and Victim’s Resistance. Many inmates struggle with this because it requires them to be forthcoming and honest. Not only with the group, but with themselves.
A great part of the group process is that the inmates hold each other accountable. When the inmates recognize thinking errors in one another, they are quick to bring attention to that. The inmates who are serious about the group want everyone to be serious. They are sharing every detail of their crime with a group of people and I recognize how difficult this can be for them.
They have told me they are embarrassed to discuss their crime in detail in front of me, simply because I am a woman. As time goes on, the trust builds within the group and they begin to be more open about their crime and their feelings related to their crime which helps them tremendously. Prison is a place where they can’t trust other people. This is one place where they have told me they feel they can trust somebody.
7 Steps to Sex Offender Treatment
Could you describe what a typical day is like for you at your job? (Also, what percentage of your job is clinical vs. case management?)
My day starts off going through the metal detector at the front gate. I head toward Control to get my keys and body alarm. Control is where the lieutenants are posted and all emergencies are paged through Control. Keys are to be placed on a security clip on your belt buckle. Keys are never to be placed in pockets.
I head towards my block, which is outside of the Main Corridor. I begin checking email and complete forms necessary for any misconducts that occurred the day before. My first appointment is for 8:30 A.M. I see inmates for interviews for psychological evaluations for parole.
I also see inmates for Individual Recovery Plans, medication noncompliance checks, individual sessions, emergency situations, continuity of care for inmates who have a mental health diagnosis, and interviews for the inmates arriving at the institution.
When I am not seeing inmates, I complete the psychological evaluations and all documentation, which is done on paper and entered into the computer system. During the noon count (all inmates are counted several times per day), I go to the block to check in with the inmates on the mental health roster. It’s a simple, “How are you doing today?”
Of course, there are always things that come up that need to be addressed immediately such as an inmate having suicidal or homicidal ideations or inmates who are in crisis. So, being flexible is important. Very little of my job is case management. I would estimate 80% clinical and 20% case management.
What are the typical barriers to successful reentry into society for individuals exiting the prison, and how do you help your clients overcome these?
There are significant barriers for inmates reintegrating into society. Some inmates have served significant time. For those inmates who have served 10 years or more, they are concerned with how much society has changed since their initial reception into prison and how they will adjust to those changes.
Typical barriers include lack of support in the community, lack of employment history or skills, lack of resources in the community, and educational issues. When inmates are getting close to their release, we discuss their plan. I’m asking about their home plan, their employment plan, and who will provide emotional support to them.
I will provide resources to them in their community. For those inmates with a psychiatric diagnosis, I am setting up initial mental health treatment in their community for them. Ultimately, it is up to the inmate to seek out these services once they are released.
I provide them with the information and the appointments. It is their decision to seek out help. I encourage them to make contact with community resources immediately and not let the stress of reintegrating into society build up. I have a list of companies that will hire people with a criminal history and I provide that to them.
There are companies and people who will give inmates a second chance. They deserve it. We talk about recidivism and how they can prevent themselves from returning. My hope is that they use what they’ve learned while incarcerated to make positive choices for themselves. After all, isn’t part of social work believing in people and their ability to change?
Sex offenders probably face the biggest challenge when reintegrating into society. There are many inmates who have been parole and are still incarcerated. This is because they do not have a home plan. They don’t have family or friends to help with a place to live. Some Community Correction Centers (CCC) do not accept sex offenders.
Many inmates try to get accepted to a faith based halfway house. They have registration requirements related to the Adam Walsh Act which they must diligent with keeping track of timelines. If they are a sexually violent predator (SVP), the community is notified of their return which can pose even more problems for them.
Then there’s the employment issue. If the potential employer does a criminal background check, they see their crime and don’t want to hire a sex offender. Being empathic and realistic regarding the challenges they face is important.
Cognitive Behavioral Sex Offender Treatment
(The California Institute for Behavioral Health Solutions)
What are the aspects of your work that you enjoy the most?
One aspect of my job that I enjoy most is the interviewing for psychological evaluations for parole. It is during these interviews that I learn the most about the inmates.
I learn more about their crime and the circumstances surrounding it. I learn about their childhood and what it was like for them. They are often sharing things with me that they’ve never shared with anyone else.
Sometimes, they are able to express how they got to where they are now. This is all insight into the person who they are and I don’t get to see that very often. I don’t think anybody really does.
I enjoy working in the infirmary where the psychiatric observation cells (POC) are located. Inmates are placed in these cells when they are determined to be a danger to themselves or others. They are on constant watch to ensure their safety.
It’s a very different place than the general population blocks. In this area, we see the most troubled individuals. It is a busy place with addressing crisis situations, preparing mental health commitments, addressing initial placement concerns, and any immediate safety concerns.
One of the most challenging parts of my job is trying to help these men see they can change their lives. So many of these men don’t believe they can because the cycle of crime and incarceration is too familiar to them.
I hear a lot of “this is how I was raised,” or “I don’t know anything else,” or “How will I survive when I get out there because I’ve never held a job?” There are those men who express the desire to change their behavior but do not know where or how to start. Sometimes, it’s hard to engage because they don’t trust me, which isn’t surprising. So, engagement is a skill I am continuously trying to hone.
Then there are the inmates who are resistant. They don’t want to do their programs or come to their appointments. I notify the inmates they have a scheduled appointment with me via memo and they are also on a list we call the “callout.”
They check the list the night before so they know ahead of time, by two means, that they need to come to my office the next day. I do this twice and they are marked as a refusal if they don’t come the second time.
Some want nothing to do with the psychology department at all. Some make the choice to go to yard instead of coming to their appointment. No matter the reason, working with inmates who are resistant is a challenging part of my job.
Another part is working with the security staff. Prison has the potential to be a dangerous place. I’d be lying to you and myself if I told you otherwise. Security staff’s job is to ensure the safety of inmates and staff, first and foremost.
While my job is to ensure inmate and staff safety as well, my job is to provide mental health treatment. Sometimes, security staff and treatment staff don’t always see eye to eye. But, we work together to ensure everyone’s safety.
What are a few typical myths that people tend to hold regarding sexual male offenders (that need clearing up)?
1. Treatment doesn’t help. Research shows treatment DOES help. Research also shows recidivism rates among sex offenders are shown to be lowered with treatment, along with age.
- Treated sex offenders rate of recidivism vs. untreated sex offenders was [lower] 12% vs. 22%.
- Cognitive behavioral/relapse prevention treatment was found to be effective (based upon the most rigorous studies).
- The average recidivism rate for treated offenders was 9%, compared to 21% for untreated offenders.
2. Most men who sexually offend do not know their victim. – Nearly 90% of victims know their offender and nearly half of those are family members.
3. They were probably abused themselves as children. – This is not true! Most sex offenders were not abused as children and most children who were abused do not grow up to sexually offend others.
4. Sexual offenders loiter around schools and playgrounds to find their victims. – While this can be true, most offenders offend children they know and the offending happens in the offender’s or victim’s home. (I have not yet met a sex offender who offended a child whom he met at a school or playground).
What ten tips would you give to new social workers considering employment in a prison and/or work with former sex offenders?
- Make sure to take care of yourself. Hearing about the crimes some of these men have committed is sure to affect you emotionally. Whether it is a sex offense, a murder, or a drug conviction – make sure to check in with yourself.
- You must become security minded as well as treatment minded. Always be aware of your surroundings and remember where you work. Your safety is the number one priority.
- Do not become complacent. The potential for the safety of staff and inmates to be compromised increases when staff become complacent.
- Be true to yourself. Prison is hard for staff as well as the inmates – just in a different way. Because it is a negative environment, it can be easy to get pulled in to the negativity. Always remember why you became a social worker, especially on the hard days.
- Do your research! Research sex offending and recidivism. Become familiar with the treatment modality used and ask questions. Understanding sexual offending and the offense cycle is important in working with sex offenders.
- Documentation skills are important in all aspects of this job. If this is a skill with which you struggle, be sure to practice.
- Working with sex offenders is not for everyone. If you’re struggling, seek out help whether it’s from your supervisor or a therapist. You’ll be better at your job if you take care of the concerns you have for yourself.
- You must be comfortable being locked in everywhere. Nearly every door is locked. If this makes you uncomfortable, you may want to consider if this is something with which you would be able to become comfortable.
- Be flexible. You can have your whole day planned out and you’re ready to go when you get the call that someone attempted suicide.
- Working in a prison is emotionally taxing. Leave your home life at home and your job at work.
Thanks so much, Angela, for giving us such a detailed view of your work, and an introduction to the cognitive behavioral relapse prevention model!
Note: *Angela Summers chose to use a pseudonym in order to feel completely comfortable in responding to these questions.
Sex Offender Management Assessment and Planning Initiative (SOMAPI, n.d.). Chapter 5: Adult Sex Offender Recidivism.
Images from Pixabay [cartoon of person in jail and barbed wire]