Treating Sex Offenders

This book serves as an update to its 13-year-old predecessor, Treating Sex Offenders in Correctional Institutions and Outpatient Clinics: A Guide to Clinical Practice. As in the original, the author outlines the principles he has extracted from his decades of experience in treating sex offenders and illustrates them in hundreds of actual case examples. The first eight chapters are devoted to the characteristics by which the author purports to “identify” sex offenders. Written from a reportedly eclectic perspective, with strong psychodynamic undertones, chapters include such topics as “inadequate” personality, negative self-image, need for control, relational problems, and identity confusion. Chapters 9 through 20 examine treatment, ranging from basic (e.g., clinical interviewing, group versus individual therapy, his “five C’s” of sex offender treatment) to more advanced topics (e.g., differential treatment foci of pedophiles, incestuous fathers, and rapists). In the revision, the author makes additions and changes to some of his techniques, provides updates on the case reports, and incorporates suggestions from readers of the first edition. In addition, in each chapter, he now follows the discussion of adult sex offenders with a consideration of adolescent offenders, and he provides suggestions for early identification and prevention. Similarly, he includes a timely discussion of religious personnel who sexually offend.

According to the author, the book reflects material he teaches at workshops and courses for professionals, survivors of sexual abuse, and sex offenders. The book is written for these audiences. He further intends that the book be read by adolescents and adults who may already be “on the road to becoming sex offenders” and/or by parents, families, or relatives of these potential abusers, “that they will be motivated to seek treatment and prevent further victimization” (p xix). Thus, the book is written appropriately in a simple, accessible manner. He readily acknowledges that it “may not be as scholarly as some would prefer” (p xviii), and he makes no apologies about this fact. Nevertheless, with its many case examples, it is an interesting, easy read. Moreover, his humble presentation of not only his successes but his mistakes is reassuring for those new to the field, while it emphasizes the reality that sex offender treatment is still in its infancy and that programs and techniques must be adjusted to reflect the developing knowledge base.

This book has the potential to function as a decent primer for professionals and laypersons new to the area of sex offenders. However, despite its anecdotal value, there is too much missing from this book for it to be considered an integral tome. First and foremost, the author rarely references any research or outside works (even those of major contributors to the field), nor does he provide any empirical evidence of the effectiveness of his proposed treatment. The little support he does provide apparently is based on informal interviews, with no information reported on the sample characteristics, selection factors, and/or systematized data collection methods. Next, there are no chapters on assessment, which forms the cornerstone of case conceptualization and treatment. Moreover, certain noteworthy topics are not even mentioned (e.g., plethysmography, cognitive distortions) or are mentioned only cursorily (e.g., chemical castration).

Of even more concern is the fact that the author makes many strong assertions that are not grounded in the research literature. Dr. Prendergast repeatedly asserts that 90 percent of sex offenders were themselves sexually abused. Although it is widely believed in the treatment community that a significant proportion of offenders are, in fact, victims of abuse, such a substantial finding has not been unequivocally confirmed in the research literature. Similarly, a major premise of his theory is that offenders’ memories of their own sexual traumas are often repressed and not available to conscious recall. Nevertheless, he does not acknowledge the highly controversial nature of the phenomena of repressed memories. In addition, various pieces of information are presented in such a way (e.g., charts, lists in special inset gray boxes) as to give the impression that they constitute exhaustive lists and/or are based on research, rather than on anecdotal notes. Most worrisome is the use of questionable and potentially dangerous techniques. In particular, he openly chronicles in several case examples the use of leading techniques to “uncover” early traumas:

I then asked him to tell me about his own sexual molestation. He immediately began to deny it, saying it never happened to him, and I simply kept asking the same question for the next fifteen to twenty minutes. Suddenly, he sat up and yelled, “Oh, my God! It did happen! I remember!” [p 79].

I was equally troubled by the use of a group body image technique that involved self-confrontation by the sex offender while in the nude! (This is particularly disconcerting if one assumes that in fact 90% of sex offenders have a history of being sexually abused themselves.) These misrepresentations and/or questionable techniques, if adopted by well-intentioned yet misinformed novice sex offender treatment providers, may be countertherapeutic and even potentially damaging.

Because of the questionable nature of some of the author’s assertions and espoused practices without documented support, I am reluctant to recommend this book. Nevertheless, I commend the author for his purpose and his approach: to write a readily accessible book that can inform not only professionals but the lay public, including potential sex offenders, their families, and their victims, with the ultimate purpose of preventing future sexual abuse. Indeed, such a book, complete with both clinical and empirical support, would be an invaluable contribution to the field.

• American Academy of Psychiatry and the Law