desire might be enhanced if paired with rewards or
other positive consequences. Masturbatory satiation,
for example, involves having an offender masturbate to
deviant fantasies for an extended amount of time
through the sexual refractory (i.e., postorgasm) period,
with the idea that this unrewarded and perhaps aversive
masturbatory experience will reduce or eliminate
deviant arousal. Although procedures might vary, ver-
bal satiation similarly aims to reduce deviant interest by
having an offender repeat aloud deviant sexual fan-
tasies during the postorgasm period. Aversion tech-
niques similarly aim to reduce the deviant sexual
response by pairing aversive stimuli (such as mild elec-
tric shock or foul odors) with deviant arousal. When the
arousal is followed by a shock or other aversive stimuli,
the resulting behavior (deviant arousal) is, again,
expected to decrease. Just as behavioral strategies
might be used to reduce deviant arousal, they are also
used to reinforce or enhance “normal” sexual arousal.
While there is some limited support for the use of these
pure behavioral techniques, these approaches have gen-
erally fallen out of favor in preference of more integra-
tive and comprehensive treatment interventions.
Cognitive-behavioral interventions thus combine
elements of the pure cognitive and pure behavioral
camps. Covert sensitization, for example, relies on the
behavioral technique of pairing negative stimuli with
deviant arousal, but instead of a physical stimulus
uses an imaginal (or cognitive) negative stimulus. In a
typical use of the technique, an offender might be
asked to masturbate to a deviant fantasy, pairing with
that fantasized act an imagined unpleasant negative
consequence. For example, the offender might fanta-
size about committing a deviant offense but then inter-
rupt that fantasy with a vivid and highly personalized
negative consequence, such as the offender’s wife dis-
covering the act and reporting it to the police.
Relapse prevention (RP), a model adopted from the
substance abuse literature, aims to help sex offenders
identify the emotional and situational precursors to sex
offending. In emphasizing the importance of cognitive
states and decisional processes, RP often employs a
CBT framework. RP operates under the assumption
that by identifying the emotional or contextual states
that precede offending, an offender can intervene in the
cycle and prevent a recidivistic sexual offense from
occurring. RP might typically incorporate a wide range
of treatment components, such as anger management,
social skills training, empathy enhancement, or the
aforementioned CBT techniques. Indeed, the generalfocus is on giving offenders the skills to manage their
offending behavior once they return to the community.
Thus, offenders learn their “offense cycles” and are
taught how to use this knowledge to recognize high-
risk situations, with the aim of preventing relapse (or
re-offense). Although RP is one of the most widely
used models for treating sexual offenders, there have
been mixed findings with regard to its utility in reduc-
ing sexual recidivism. More research is needed to
examine whether there is sufficient empirical support
for the continued use of this model.
Because evidence suggests that the suppression of
sexual drive will reduce sexual offending, there is gen-
eral support for a combined psychological and pharma-
cological approach to treating sexual deviancy. Such
pharmacological treatment (at times referred to as
“chemical castration”) includes anti-androgens and
hormonal agents that work to reduce sex drive, sexual
arousal, and/or sexual fantasizing. These drug interven-
tions, which diminish or alter testosterone levels, have
been shown to be related to reduced rates of re-offending.
Additionally, there has been support for the use of
selective serotonin reuptake inhibitors (SSRIs) in
reducing deviant sexual behavior. The class of SSRIs,
which have generally been used in treating obsessive-
compulsive tendencies, may have specific utility in
reducing the intrusive or obsessive sexual thoughts
often associated with sexual offending.
Finally, some mention of surgical castration
deserves mention. Although rarely used, surgical cas-
tration involves the removal of the testes, which has
the effect of reducing circulating levels of testosterone
and thereby diminishing sexual drive. While some
have expressed concern regarding the ethical merits of
this form of intervention, surgical castration has been
associated with reductions in sexual recidivism.Risk, Need, and Responsivity
Some have maintained that treatment should be
based on the principles of risk, need, and responsivity.
Risk refers to the notion that treatment should be
matched to the risk level (typically assessed through
actuarially derived risk assessment tools such as
the STATIC–99/STATIC–2002 or RRASOR) of the
offender, with higher-intensity treatment services
reserved for the highest risk offenders. The need princi-
ple distinguishes between criminogenic and noncrim-
inogenic needs, with criminogenic needs referring to
those factors that directly relate to recidivism, that is,Sex Offender Treatment——— 731S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 731