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Fisher (1994), who provides a useful overview of research into adult male sexual abusers, notes (with reference to Wolf, 1984) that:
" it is a general finding of surveys of sex offender populations that variables such as level of intelligence, age, ethnicity, education and psychiatric status do not differ significantly from the rates in the general populations from which the samples are drawn." (p.7)
Despite similarity with non-offender populations on basic demographic variables, men who sexually abuse children do evidence other interesting characteristics. In particular what seem to be significantly different are the high rates of convicted child abusers who have been themselves sexually abused as children as compared with non offender populations (see, for example, Abel et al., 1987). Rates vary up to 80% depending on the studies cited, although this equally means that at least 20% of convicted abusers have not been so victimised. It is important to stress that in the majority of cases those who have themselves survived sexual abuse do not go on to become abusers themselves.
Studies also indicate that although a small number of abusers are responsible for many offences, the majority have abused relatively small numbers of children (Grubin, 1998).
To focus in more detail on the characteristics of men who commit sexual offences against children, what emerges from these studies is a picture of men experiencing a number of relationship and other problems often originating from childhood. Whilst most of the data is derived from studies of those convicted and in treatment programmes and may therefore suffer from bias, in their evaluation of seven treatment programmes for sex offenders comprising 59 men, Beckett et al (1994) report that those in treatment were:
" typically emotionally isolated individuals, lacking in self-confidence, underassertive, poor at appreciating the perspective of others, and ill-equipped to deal with emotional distress. They characteristically denied or minimised the full extent of their sexual offending and problems. A significant proportion were found to have: little empathy for their victims; strong emotional attachments to children; and a range of distorted attitudes and beliefs, where they portrayed children as able to consent to, and not be harmed by, sexual contact with adults. The men with the most problems in the above areas tended to be the most serious offenders." (p.5)
The predominantly white ethnicity of most samples reflects a more widespread problem. The evidence is that black men who have sexually offended are over-represented in the United Kingdom prison population and that this over-representation becomes greater in the longer sentence groups. Cowburn (1996) examines these facts in the context of white constructions of black sexuality, arguing that racist stereotypes about the predatory and dangerous nature of black male sexuality have 'pervaded western clinical, police and judicial responses to sexual crimes for many years' (page 126). Such racism also results in black sex offenders being less likely to be given the opportunity to attend treatment facilities and their willingness and ability to make use of what are overwhelmingly white-dominated services may anyway be inhibited.
Other studies concentrate on sex offenders with a learning difficulty. Bowden (1994) and McKenzie et al. (1997) provide useful introductions to the additional complicating factors of working with this group, particularly in a context of societal prejudice towards those with such difficulties and the general lack of attention paid to issues of their sexuality.
Adult female sexual abusers account for only a tiny proportion of recorded sexual offences. Criminal Statistics for England and Wales (Home Office, 1997) indicate that between approximately 50 and 100 females were cautioned for sexual offences in each of 1995 and 1996 (as compared with approximately 2,200 men in each year), with similar numbers of women found guilty in Court of a sexual offence as compared with approximately 4,500 men per year.
Finkelhor (1986) has argued that rates for women who sexually abuse children have been under-estimated in the past, suggesting that the true figure for women who sexually abuse children is 5% for girl victims and 20% for boy victims. Some writers (see, for example, Lawson 1993 and Krug 1989) offer several reasons for possible under-reporting of female sexual offending such as mother-son incest. These include differing societal perceptions of maternal behaviour and presumptions about maternal innate goodness and asexuality as compared with the motivations and sexual interests of fathers; assumptions that boy victims are not really harmed by their abuse and/or may be too shamed to disclose abuse; and overextension of feminist explanations that male dominance, differential socialisation and sexual explanation are the sole causes of child sexual abuse. Other writers, however, have expressed concern that a search for equivalence in male and female offending rates (which has not been established) has the negative effect of detracting from the need to acknowledge fundamental issues of male power in society (see, for example, McLeod and Saraga, 1988 and Forbes, 1992).
Concerning the characteristics of women who sexually abuse children, Freel (1992) comments:
"there is general agreement on certain issues - that they are more likely to have been sexually abused as children; that they have had a traumatic childhood; that they are more likely to co-offend with men; (and) that they are likely to use alcohol or drugs. There is (also) evidence that female abusers are more likely to be the mothers or close relatives of the victim" (pp.8-9).
However as Adshead et. al (1994) suggest in their article this is a relatively unresearched area worthy of further study (see also Saradjian, 1996).
As Morrison outlines (1994b) practice in this field cannot be value-free. Developing work by American psychologist Anna Salter (1988), he suggests that an appropriate value base would include statements that sexual assault is always unacceptable, should be investigated as a crime and, where it is in the victim's interests, sex offenders should be prosecuted. Furthermore, sexual assault results from an intention on the part of the offender to seek both sexual and emotional gratification from the victim, represents an abuse of power and is damaging to the victim.
The overarching aim of intervention with offenders is to protect victims and potential victims; effective intervention must be focused on the offender taking full responsibility for the feelings, thoughts and behaviour that support his offending predicated on the premise that male sexual arousal is controllable. The goal of intervention is to ensure that sex offenders can control their behaviour so that they do not re-offend or sexually abuse others. In the longer term the prevention of sexual offences needs to address the gender role expectations of males in society.
Most intervention approaches used by British treatment providers are cognitive-behavioural (McGuire, 2000) in approach (Barker and Morgan, 1993; Procter and Flaxington, 1995) and for detailed descriptions of United Kingdom cognitive behavioural approaches to assessment, individual and group treatment of adult male sex offenders the reader is referred to Sexual Offending Against Children: Assessment and Treatment of Male Offenders (Morrison, Erooga and Beckett, 1994). The discussion that follows relates primarily to adult males, and readers interested in interventions with female are referred to Saradjian (1996).
The Thematic Inspection of Probation Service work with Sex Offenders (HM Inspectorate of Probation, 1998) suggests that treatment should apply "What Works" principles to work with sex offenders (see for example McGuire, 1995). Thus treatment should be concentrated on those individuals at highest risk of reoffending; be targeted at the features of the offender directly related to their offending; be matched to the learning styles of the client - for most this will comprise participatory and non-didactic methods; be community based where appropriate; draw on cognitive-behavioural principles and resources, including an emphasis on relapse prevention and must feature programme integrity - monitoring and evaluating the match between objectives, methods of delivery (including resources and staff training) and outcomes.
There are common components of intervention plans in both individual and group settings, a brief outline of which may provide some flavour of the activities involved. Often at an early stage there will be a focus on the Sexual Assault Cycle, including the abuser's own pattern of sexual arousal. Changing patterns of sexual arousal may require specific behavioural interventions as part of a wider focused treatment programme (Maletzky and McGovern, 1990; Erooga, 1993). Work on the Cycle is designed to enable the abuser to gain an understanding of his individual pattern of abuse, for example identifying what he was doing, thinking and feeling at each stage of his offence cycle, identifying attitudinal and situational triggers to his cycle, and subsequently beginning to identify strategies to deal with triggers and disrupt the cycle.
A key component will be developing an understanding and awareness of Cognitive Distortions. This will entail coming to understand the concept of 'distorted thinking', what purpose that thinking is serving by beginning to identify examples of current distortions. Subsequently restructuring of distortions will be possible by appropriate challenge and use of learning from other sections of the programme.
Victim Awareness is intended to develop an awareness of why children cannot give true consent, children's likely experience of abuse, and understanding of its short and long term damaging effects on victims. This serves both to increase any internal inhibitors and to reduce cognitive distortions. Drawing on victim statements and research into children's views and experiences are valuable ways of facilitating this work, and will reduce the risk of colluding with abusers' efforts to minimise what they have done and the extent of their own responsibility. It may also be necessary to work on enhancing the abuser's awareness of his own feelings and emotional functioning as such self-awareness is a key tool for victim empathy. The importance of this sequence is highlighted in the STEP Report (Beckett et al., 1994).
Finally, though possibly not in terms of the order of interventions, is the process of developing Relapse Prevention plans with identified triggers, danger situations and strategies to avoid risk situations, lapses into risk behaviour or relapse into reoffending.
Treatment approaches to adult sexual offenders have been subject of an ongoing evaluation, the Home Office sponsored Sex Offender Treatment Evaluation Project, initiated in 1991 with an overview of provision (Barker & Morgan, 1993) followed by substantive research conducted in 1992/3 (Beckett, Beech, Fisher & Fordham, 1994) and the first two of three subsequent follow-ups published in 1997 (Hedderman and Sugg, 1997) & 2001 (Beech, Erikson, Friendship and Ditchfield, 2001).
The first substantive report (Beckett et al., 1993) found that short-term therapy had a significant impact on offenders willingness to admit to their offence and sexual problems; significantly reduced the extent of offence justification; reduced offenders distorted thinking about children and sexuality but no success with highly deviant men.
Long term therapy had a successful impact on a number of highly deviant men; an impact on offence justifications and distorted thinking; led to greater admittance of offending behaviour and improvements in self esteem, assertiveness and intimacy skills (lack of these skills may be an important factor in an offender seeking inappropriate partners).
Phase Three is a consideration of reconviction rates at two, five & ten years after completion of treatment. The two-year follow up (Hedderman & Sugg, 1997) acknowledges the limitations of reconviction as an indicator of offending and the likelihood that five years is a more satisfactory minimum follow up period. This analysis found that six out of the sample of 133 offenders (4.5%) who had undergone community-based treatment had been reconvicted for a sexual offence after two years compared with 17 out of 191 offenders (8.9%) who had been put on probation, evidence that those who had undergone cognitive-behavioural therapy were less likely to be reconvicted for a sexual offence than those who had only received probation supervision.
The most recent follow up (Beech et al. 2001) found that: for the men in the six-year follow-up group, the overall sexual reconviction rate was 15% (8 out of 53 men). When a risk of reconviction analysis (based on previous sexual offending) was applied to the sample it was found to be highly predictive of reconviction, with higher-risk men being much more likely to be reconvicted of a serious sexual assault than lower-risk men with the predictive value of this risk assessment procedure increased when sexual 'deviancy' level of the men prior to treatment were taken into account; a clear treatment effect was found - only 10% of the men who were classified as 'benefiting from treatment' were reconvicted in the six-year follow-up, compared with 23% of men who were classified as 'not having responded to treatment'. Finally, a brief dose of treatment was not found as effective with men measured at the pre-treatment stage as having a high level of problems compared with those with fewer problems.
As well as standardising the content of treatment programmes another important development has been an increased understanding of approaches more likely to be effective in bringing about change. From an early emphasis on confrontation, characterised in the extreme as 'legitimised nonce-bashing' (Sheath, 1990), it has increasingly been understood that the genuine engagement of offenders in becoming motivated to change their own behaviour and, understanding their own behaviour patterns and, developing the skills to manage their own behaviour, is important, and the principles of motivational interviewing (Miller & Rollnick, 1991) have increasingly informed approaches to this work.
Although space precludes a detailed discussion, it must be emphasised that interventions with those who have sexually abused children should be addressed within a total package of management, care and control (HM Inspectorate of Probation, 1998). As the Report of the National Commission of Inquiry into the Prevention of Child Abuse (1996) advocates, one aspect of preventing child abuse is the regulation, treatment and follow-up of offenders. The Commission and others (see, for example, Prison Reform Trust, 1992), in seeking the views of child and adult survivors on policies in relation to sex offenders have received clear messages that they want perpetrators of such abuse to be monitored, rehabilitated and punished (as a fundamental part of the process of obtaining justice to redress the pain and anguish they have suffered). Thus, in interviews with 35 children about their post-abuse experiences, Prior, Glaser and Lynch (1997) found that the majority indicated that they did not always want the abuser imprisoned but that they want some form of redress and above all that they wanted the offender held accountable - possibly as a tangible balance to the equivocation about responsibility for the abuse many victims experience from societal responses.
Effective approaches require the development of comprehensive packages of policy, procedures and treatment, derived from co-operation and partnership between the various professionals and agencies involved, from Area Child Protection Committee level down. Morrison (1994a) argues for a framework of collaboration that includes:
Establishing such an infrastructure creates arrangements for working collaboratively which are stronger than the feelings aroused by the sexual abuse of children and helps combat the processes of mirroring and identification with the immediate client (Reder et al, 1993) which can impede multi-disciplinary working.
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