The treatment of sex offenders in prison has changed a lot over time. In the past, especially under Sigmund Freud’s psychodynamic approach, sex offenders were often viewed as untreatable. Because of this belief, treating them was not considered a priority. However, research and practice gradually challenged this idea, leading to new and more structured treatment approaches.


Early Developments in Treatment

In the 1960s, behavioural therapies began to offer more hope and showed better results than earlier methods. Later, during the 1980s, the situation became more serious. In the UK, the number of sex offenders in prison increased by about 50% within one decade (Fisher & Beech, 1999). Despite this rise, there was still little real effort to reduce reoffending. Serious and organized treatment efforts only began in the 1990s, when Cognitive Behavioural Therapy (CBT) became the main approach for treating sex offenders.

Cognitive Behavioural Therapy (CBT) as the Main Approach

CBT became the most widely used treatment for sex offenders. According to Jennings and Deming (2013), although it is called “cognitive behavioural therapy,” in practice it focuses more on the cognitive (thinking) side than on behaviour. The therapy aims to help offenders improve self-disclosure, develop empathy, and manage deviant or unhealthy thoughts.

Even small details matter in CBT-based treatment. The therapy environment is carefully designed. The room should be comfortable, clean, quiet, and free from distractions. Seating is usually arranged in a circle so that no one dominates the discussion. Therapists organize the space to promote respect, safety, and active learning.

The Sex Offender Treatment Programme (SOTP) in the UK

The UK prison system developed the Sex Offender Treatment Programme (SOTP) (Beech, Fisher & Beckett, 1998). It became one of the most well-documented programmes in the world and influenced similar programmes in other countries. However, after nearly 30 years, the UK government discontinued it. New evidence suggested that offenders who completed the programme were slightly more likely to reoffend than those who did not (BBC News, 2017). Even so, the SOTP remains important for understanding how sex offender treatment programmes were structured and delivered.

 

Key Decisions in the SOTP

Several important decisions shaped how the SOTP worked.

  • Where: The programme was offered only in selected prisons with enough resources.
  • Who: Priority was given to high-risk offenders, identified through formal risk assessments. Some individuals were excluded, such as those with severe mental illness, very low IQ, language barriers, high suicide risk, or severe personality disorders.
  • When: Treatment took place during sentences of two years or more, allowing enough time to complete the programme.
  • By whom: Therapy was delivered by a multidisciplinary team, not just psychologists. Prison officers, teachers, and chaplains were also involved, all trained in CBT principles and group work.

Structure of the Therapy

Therapy in the SOTP was delivered mainly through structured group work. Each group usually had eight offenders and two therapists or tutors. A detailed treatment manual guided the sessions. The focus was on changing thinking patterns related to offending, building motivation to avoid reoffending, and teaching relapse prevention skills. The programme typically included 20 blocks or sessions, covering two main areas: cognitive modification and relapse prevention.

 

METHODS USED IN GROUP THERAPY

The SOTP used a variety of group-based techniques, some general and some specific to sex offending:

  • Brainstorming & group discussion: Offenders share ideas, often recorded on a board or flip chart.
  • Focus on the individual: One person’s thoughts or actions are examined and discussed by the group.
  • Homework: Offenders keep diaries or complete written tasks between sessions.
  • Role-playing: Offenders and sometimes tutors act out situations. Observers provide feedback and participants reflect on their experience.
  • Smaller or “buzz groups”: Offenders work in pairs or small groups to practice communication, assertiveness, and empathy before sharing with the larger group.
  • Videos: Films, especially about victims’ experiences, are shown to build awareness and empathy. Discussions follow to explore offenders’ reactions and understanding.

 

SEX OFFENDER TREATMENT PROCEDURE

Sex offender treatment is done through several structured steps. Each step focuses on changing thoughts, emotions, and behaviours that are linked to offending. Together, these steps aim to reduce the risk of reoffending and help offenders take responsibility for their actions.

1. Describing the Offence

One important part of therapy is helping offenders give an active account of their crime. Offenders often try to excuse themselves or describe the incident in vague ways. A passive account allows the offender to avoid responsibility by being unclear. For example, saying “Maybe I did, maybe I didn’t” creates doubt and avoids admitting guilt. In contrast, an active account involves a clear and direct explanation of what actually happened, including what actions were taken, how the offence was planned, and how the offender tried to stop the victim from telling others. Encouraging an active account helps offenders take responsibility and face the truth of their behaviour.

2. Challenging Distorted Thinking

Many offenders hold distorted beliefs that justify their crimes. Some may think that children are sexually interested in adults, while others may believe that rape victims secretly want to be assaulted. In therapy, these beliefs are challenged by asking offenders to provide evidence for their thoughts. Group members and therapists then point out the weaknesses and errors in this thinking. This process helps to break down harmful assumptions and replace them with more realistic views.

3. Victim Empathy Work

Sex offenders often show a lack of empathy toward their victims. Treatment therefore focuses on helping them understand the harm they have caused. Videos and guest speakers, including survivors of abuse, may be used to show the deep emotional and psychological pain experienced by victims. Role-play is also used, where offenders take the role of the victim in their own offence. In addition, personal reflection is encouraged, as many offenders were themselves victims of abuse. Connecting with their own past experiences can increase empathy and emotional understanding, which helps reduce the risk of repeating the crime.

4. Fantasy Modification

Sexual fantasies play an important role in sexual offending. Therapy aims to reduce harmful fantasies using different behaviour modification techniques. In aversive therapy, the fantasy is paired with something unpleasant. Masturbatory reconditioning involves switching to healthier fantasies during sexual arousal until those become stronger. In satiation, the offender repeatedly fantasizes until the fantasy loses its power to create arousal. Covert sensitisation requires offenders to imagine the negative consequences of their fantasies, such as being arrested or imprisoned. These methods are designed to weaken dangerous sexual thoughts.

5. Social Skills, Assertiveness, and Anger Control

Some offenders lack basic social and communication skills, while others, especially rapists, struggle with anger control. Therapy focuses on building healthier relationships with adults, learning to read body language and social cues correctly, and developing non-aggressive ways of dealing with conflict. Role-playing social situations is used to practice assertiveness and appropriate behaviour. These skills help offenders function more positively after release.

6. Relapse Prevention

The final stage of treatment prepares offenders for life outside prison and is known as relapse prevention. Offenders learn to identify warning signs that could lead back to offending, such as depression, anxiety, or the return of deviant fantasies. Risk situations are also identified, including certain jobs or living conditions that may increase temptation or opportunity. Finally, offenders are taught coping strategies to avoid or manage these risks. This stage is crucial for long-term prevention of reoffending.

 

Similarities and Differences in Prison Treatment Programs

The treatment programme in New Zealand prisons is very similar to the one used in the UK. There are only a few small differences.

 

DOES THERAPY REDUCE REOFFENDING?

One important question is whether therapy actually stops offenders from committing new crimes. Studies have looked at the programme’s success, but most only measure things like cognitive distortions (thinking errors). Reducing these errors is helpful, but it is only one step toward reducing recidivism (reoffending).


Therapy Outside of Prison

Most sex offender therapy happens in prison or after conviction in the community. This leaves out an important group: men who know they might be at risk of harming children but have not yet committed a crime.

The Berlin Prevention Project Dunkelfeld (PPD) in Germany is one attempt to reach these men. It worked like this (Beier et al., 2009):

  • A media campaign (posters, billboards, TV spots, cinema ads) encouraged men to seek help.
  • 286 men completed a telephone screening over 18 months (about 60% of those who started finished).
  • Most participants were then interviewed by a clinician.
  • Results: 58% had sexual interest in pre

    pubescent children.     28% had interest in pubescent minors. 11% preferred mature adults.The rest could not be categorised.
  • 70% of participants felt strong or very strong distress about their feelings.
  • About half had already sought professional help before, and a similar number had confided in friends.

The major challenge with such prevention projects is that if an offence is reported during therapy, the therapist is legally required to inform the police.