Treatment programs for high risk sexual offenders: Program and offender characteristics, attrition, treatment change and recidivism

The present manuscript is a review of program and offender characteristics, attrition, treatment change, and recidivism outcomes in programs targeting high risk sexual offenders. We begin by providing an overview of the characteristics of such programs within the lens of the risk, need, responsivity (RNR) model. We then review treatment outcome research from four international high intensity sex offender programs and discuss the methodological, clinical, and practical limitations of this body of work. We proceed to discuss the issue of treatment change in high risk sexual offenders, the broad methods through which change may be evaluated, and review the literature examining within-program change and its relationship to sexual and violent recidivism. A brief review of the sexual offender treatment attrition literature follows, particularly in regards to the RNR issues embedded within this clinical conundrum given that high risk sex offenders pose the greatest risk for non-completion yet also stand to yield the most benefit from services. Finally, we review the research on the therapeutic responses of psychopathic sexual offenders and discuss the clinical implications for treating and managing individuals with substantial psychopathic traits applying the RNR framework. Future clinical and research directions with high risk sexual offenders in terms of treatment, risk reduction, reducing attrition, and attempting to effect positive changes are discussed.