Section 1905.100 Treatment Methods

Section 1905.100  Treatment Methods

a)         Treatment

providers working with sexual abusers shall utilize empirically supported

methods of intervention.  Recommended methods include structured,

cognitive-behavioral, and skills-oriented treatment approaches that target

dynamic risk factors.

1)         Treatment

providers deliver services to clients using a variety of modalities, including

individual, family and group therapy, that are matched to each client's

individual intervention needs and responsivity factors.

2)         Treatment

providers assist clients with identifying and analyzing the individual's

factors (e.g., environmental, cognitive, affective and relational) that

increase the individual's vulnerability to engage in sexually abusive

behaviors.

3)         Treatment

providers use cognitive-behavioral techniques, at the earliest opportunity, to

help clients develop and rehearse strategies (i.e., avoid or escape high risk

situations, use adequate coping skills) to effectively manage situations that

may increase their risk of sexually abusing or otherwise reoffending.

4)         Treatment

providers use behavioral methods, such as education, prosocial modeling, skill

practice, rehearsal of strategies, redirection and positive reinforcement, to

teach or enhance skills that will help clients achieve prosocial goals.

5)         Treatment

providers encourage clients to practice the skills they learned in treatment

and ensure that these skills generalize to clients' environments.

6)         Treatment

providers assist clients in developing individualized strategies and plans for

effectively managing their risk of sexual abuse or other harmful or illegal

behaviors.  These plans include specific strategies for avoiding or limiting

access to potential victims, recognizing and coping with risk factors, and

building social support systems

eneralize to clients' environments.

6)         Treatment

providers assist clients in developing individualized strategies and plans for

effectively managing their risk of sexual abuse or other harmful or illegal

behaviors.  These plans include specific strategies for avoiding or limiting

access to potential victims, recognizing and coping with risk factors, and

building social support systems.

7)         Treatment

providers assist clients with identifying and enhancing prosocial interests,

skills and behaviors that the clients themselves seek to enhance or attain

(i.e., approach goals that are oriented toward a nonoffending lifestyle), as

opposed to strictly focusing on managing inappropriate thoughts, interests,

behaviors and risky situations (i.e., avoidance goals).

b)         Dynamic

Risk Factors

Treatment providers shall focus

treatment interventions primarily on research-supported dynamic risk factors that

are linked to sexual and nonsexual recidivism (i.e., criminogenic needs) over

factors that have not been shown to be associated with recidivism, as outlined

in this subsection (b).

1)         General

Self-regulation

A)        Treatment

providers assist clients in learning to self-manage emotional states that

support or contribute to their potential to sexually abuse.

B)        Treatment

providers assist clients in learning and practicing problem-solving and impulse

control skills.

C)        Treatment

providers assist clients in obtaining appropriate services for evident problems

related to the clients' mental health and substance use patterns.

2)         Sexual

Self-regulation

A)        Treatment

providers use cognitive-behavioral, behavioral and/or pharmacological

techniques to promote healthier sexual interests and arousal, fantasies and

behaviors oriented toward age-appropriate and consensual partners

clients in obtaining appropriate services for evident problems

related to the clients' mental health and substance use patterns.

2)         Sexual

Self-regulation

A)        Treatment

providers use cognitive-behavioral, behavioral and/or pharmacological

techniques to promote healthier sexual interests and arousal, fantasies and

behaviors oriented toward age-appropriate and consensual partners.

B)        Treatment

providers use cognitive-behavioral, behavioral and/or pharmacological techniques

known to be associated with:

i)          reductions

in sexual preoccupation (paraphilic and nonparaphilic) and deviant sexual

interests and arousal; and

ii)          improvements

in the management and control of sexual impulses.

C)        Treatment

providers target cognitions that are supportive of age-inappropriate and nonconsensual

sexual interest, arousal and behavior in order to assist clients in enhancing

their sexual self-regulation.

D)        Treatment

providers help clients find effective ways to minimize contact with persons or

situations that evoke or increase clients' deviant interests and arousal.

3)         Attitudes

Supportive of Sexual Abuse

A)        Treatment

providers recognize that client attitudes and beliefs that are tolerant of

sexual abuse (e.g., women enjoy being raped, children should be able to make up

their own mind about having sex with adults) are important treatment targets.

B)        Treatment

providers:

i)          use

established cognitive therapy techniques to strengthen attitudes, beliefs and

values that support prosocial sexual behaviors; and

ii)         help

clients manage or decrease those that support sexually abusive behavior.

C)        Treatment

providers are aware that, although clients may hold attitudes, beliefs and

values that are unconventional but unrelated to their risk for sexually abusive

or criminal behaviors, these attitudes, beliefs and values are not deemed

appropriate primary treatment targets

ual behaviors; and

ii)         help

clients manage or decrease those that support sexually abusive behavior.

C)        Treatment

providers are aware that, although clients may hold attitudes, beliefs and

values that are unconventional but unrelated to their risk for sexually abusive

or criminal behaviors, these attitudes, beliefs and values are not deemed

appropriate primary treatment targets.

4)         Intimate

Relationships

A)        Treatment

providers assist the client in the development of skills that can enable the

experience of prosocial intimate relationships with adults.  Treatment

providers orient their interventions so that they build on strengths in the

client's existing relationships, when appropriate.

B)        Treatment

providers aim, when possible and appropriate, to include adult romantic

partners in treatment in order to maximize treatment gains and enhance

prosocial lifestyles.

5)         Social

and Community Supports

A)        Treatment

providers encourage and assist clients in identifying appropriate, prosocial

individuals who can act as positive support persons.

B)        Treatment

providers encourage family members and other support persons to actively

participate in the treatment process and to help clients achieve and maintain

prosocial lifestyles.

C)        Treatment

providers assist clients who are transitioning to the community or are already

in the community to develop and maintain stable prosocial lifestyles, which are

characterized by stable and appropriate housing, employment and leisure

activities.

D)        Treatment

providers recognize that developing a support network may be contraindicated

with clients who have a history of violence toward support persons and have not

been violence-free for a significant amount of time

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in the community to develop and maintain stable prosocial lifestyles, which are

characterized by stable and appropriate housing, employment and leisure

activities.

D)        Treatment

providers recognize that developing a support network may be contraindicated

with clients who have a history of violence toward support persons and have not

been violence-free for a significant amount of time.  Hence, treatment

providers encourage clients to make small and gradual changes and closely

monitor these changes to ensure clients are receiving or have received

interventions to address these issues and reduce the risk for violence.

6)         Treatment

providers may, as warranted for a given client based on a comprehensive

assessment, also include treatment targets that are not clearly established by

research to be dynamic risk factors (e.g., denial and minimization, low

self-esteem) but that, when addressed, enhance therapeutic alliance, treatment

engagement and treatment responsiveness.

c)         Treatment

Engagement and Goal Setting

1)         Treatment

providers shall strive to foster clients' engagement and internal motivation at

the onset, and throughout the course of, sexual abuser-specific treatment,

recognizing that these process-related variables enhance treatment

responsiveness and outcomes.

2)         Treatment

providers recognize that, although many clients present for sexual

abuser-specific treatment as direct result of legal or other mandates, external

motivators alone are generally insufficient for producing long-term change

among clients.

3)         Treatment

providers provide services in a respectful, directive and humane manner and

facilitate a therapeutic climate that is conducive to trust and candor.

4)         Treatment

providers recognize that client engagement may increase, and resistance may

decrease, when the treatment provider and client are in relative agreement

about treatment goals and objectives

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among clients.

3)         Treatment

providers provide services in a respectful, directive and humane manner and

facilitate a therapeutic climate that is conducive to trust and candor.

4)         Treatment

providers recognize that client engagement may increase, and resistance may

decrease, when the treatment provider and client are in relative agreement

about treatment goals and objectives.  To the extent possible, treatment

providers involve clients in the development of their treatment plans and in

the identification of realistic goals and objectives.

5)         Treatment

providers clarify, at the onset of sexual abuser-specific treatment, the client's

understanding of the problems for which the client referred to treatment and

that primary treatment objectives are often specific to modifying deviant

sexual attitudes, interests, arousal and behaviors.

6)         Treatment

providers are aware that clients present with differing levels of internal

motivation to change (and varied types and levels of denial and minimization

related to sexually abusive behavior, interests, arousal and attitudes and

beliefs), but that such characteristics do not preclude access to treatment.

7)         Treatment

providers recognize that denial and minimization may impact the client's

engagement in treatment, but that the influence of denial and minimization on

sexual recidivism risk has not yet been clearly established and may vary among

client groups.

8)         Treatment

providers support the client in being honest in discussing the client history

and functioning, but acknowledge that it is not the role of treatment providers

to attempt to determine or verify a client's legal guilt or innocence or to

coerce confessions of unreported or undetected sexually abusive behaviors

not yet been clearly established and may vary among

client groups.

8)         Treatment

providers support the client in being honest in discussing the client history

and functioning, but acknowledge that it is not the role of treatment providers

to attempt to determine or verify a client's legal guilt or innocence or to

coerce confessions of unreported or undetected sexually abusive behaviors.

9)         Treatment

providers are aware that attempting to provide treatment for problems that a

client persistently denies having results in limitations in making reliable

clinical recommendations about the individual's treatment progress and re-offense

risk, and that this has ethical implications.

10)        Treatment

providers routinely seek and explore the client's perspectives and offer

feedback on the client's engagement, motivation and progress in treatment, or

lack thereof.