The Glass is Half Something, But What? Thoughts on the Does-Treatment-Work Debate

2-27-2013 National:

At the beginning and end of each day, all professionals in our field want to prevent sexual violence. How successful we are is debatable, and sorting out our priorities can be confusing to both the public at large and ourselves (Hindman, 2007). The only thing that is clear is that doing nothing with people who have sexually abused is unacceptable.

Recent discussions among treatment providers for persons who have sexually abused have again focused on whether our treatment programs are actually successful at reducing sexual recidivism among adults clients. Concerns include that while people who complete treatment programs re-offend at lower rates than those who don’t, professionals still don’t have data from randomized trials showing that the actual treatment we are providing works. In fact, some studies of apparently good treatment programs seem to have produced few effects (e.g., Marques, Wiederanders, Day, Nelson, & van Ommeren, 2005; Hanson, Broom, & Stephenson, 2004).

A meta-analysis by Karl Hanson and his colleagues (Hanson, Gordon, Marques, et al., 2002) found that people who completed treatment programs tended to have lower sexual re-offense rates (by about 25%) than comparison groups. The authors noted the limitations of the studies and that these figures don’t account for those who refuse or drop out of treatment. For many, this simple fact is a deal-breaker; our numbers simply don’t add up to optimism about our efforts. Three years later, the long-awaited randomized clinical trial (RCT) by Janice Marques and her colleagues found no difference between those who completed the treatment program and those in the control group. However, the authors concluded that those treatment participants who “got it” and meaningfully completed their treatment goals really did re-offend at lower rates. This single study has been used as a source of optimism for many, and for others remains the ultimate proof that we still don’t know whether we can effectively treat sexual aggression. Spirited debate followed. Marshall and Marshall (2007) argued that RCTs are not the final word in scientific evidence. A host of others (e.g., Seto, Marques, Harris, et. al., 2008) disagreed. The end of the last decade saw the most recent treatment outcome meta-analysis (Hanson, Bourgon, Helmus, & Hodgson, 2009) suggesting that programs adhering to the principles of risk, need, and responsivity have the greatest effect on sexual re-offense.

Significant questions remain: What about those people who do complete treatment programs? Should our research and practice efforts be focused on creating what Marques et al., referred to as those who “got it”? Elsewhere, Prescott and Levenson (2009) have asked whether our field is actually asking the right questions. For example, beyond does treatment work, there are questions regarding with whom it works, under what conditions, with what kinds of providers, etc.? More recently, Prescott (2011) suggested shifting the focus to building willing partners in treatment programs. That is, what can professionals do to create programs in which those at risk for refusing treatment or dropping out do to “get it” and meaningfully change? Whatever the case, it’s important to remember that treatment attrition is a serious problem in all of criminology. Olver, Stockdale, and Wormith (2011) found an overall attrition rate of 27.1 percent and ...continued... by David S. Prescott, LICSW