Sexual crimes

The treatment of people who commit sex crimes is of interest to forensic psychiatrists because they often have to deal in practice with the impact of sexual offenses on children or adults who have become child sexual abuse victims.

Specialists hope that the treatment of sexual offenders will help prevent them from committing crimes in the future. The second reason is that the clinical experience with sexual offenders indicates that they have characteristic cognitions and mechanisms of psychological protection. There is evidence that psychological therapies, especially cognitive behavioral therapy, can break this protection and change distorted cognitions.

The history of the treatment of sexual offenders in the United Kingdom is shorter than in the United States. The topic of sexual abuse of children began to be discussed in society only in the late 80-ies of the XX century in connection with the events in Cleveland. However, as the judge said, under the chairmanship of which the investigation was conducted, "it was not with Cleveland that sexual abuse began in relation to children - their history goes far back in time." In the 60s and 70s, the existence of the "beating baby" syndrome was recognized and accepted. Later, he transformed into "nonrandom damage". However, before the investigation of the Cleveland case, most of the society did not know that abuses against children could be both physical and sexual. It has already been established that people who commit crimes of a sexual nature often have a history of sexual abuse experienced in their childhood, and among the criminals with the highest risk of recurrence, sexual abuse was present in all cases. Consequently, the meaning of the treatment of sexual offenders is not only to prevent sexual abuse of children on their part, but in interrupting the chain of conversion of their victims into criminals. This phenomenon was called "a vicious circle of abuse." Treatment of sexual offenders is one way to break this circle. In this connection, even the idea was expressed that the placement of sexual offenders in prison by no means solves the problem, and it is treatment, and not imprisonment, that can help reduce the level of sexual crime. Before proceeding to the discussion of sexual offenders and their treatment, it is important to understand one difference: not all forms of sexual disorders are crimes and not all sexual offenders meet the criteria for sexual dysfunction. Some people may have sexual preferences related to children, but this does not mean that they will necessarily commit crimes of a sexual nature.

Levels of sexual crimes and recidivism

Almost any scientist or clinician involved in the evaluation and treatment of sex offenders acknowledges that the official figures for convictions constitute only a very small percentage of the real figures of sexual offenses committed within one year. The evidence is a large discrepancy between the levels of sexual abuse reported in studies and the number of convictions for sexual offenses. Fisher cites data from a series of studies on the prevalence of sexual abuse of children. These figures range from 12% of women under 16 reporting abuse, to 37% of those under the age of 18 reporting "contact sexual abuse". Despite the wide variation in data on sexual abuse in childhood, even the lowest figures do not fall below 10%, which indicates the seriousness of the problem. Official data on the number of convictions for committing crimes of a sexual nature are given in the Annual Report of Criminal Statistics on England and Wales, prepared by the Ministry of Internal Affairs.

In 1996, 31,400 crimes of a sexual nature were registered in the police; of them one-fifth were raped, and a little more than half were indecent assaults. In 1997, the number of crimes of a sexual nature amounted to 33,514, that is, increased by 6.8% compared to the previous year. This was twice as high as the growth over the previous ten years. Crimes of a sexual nature account for 9.6% of all violent crimes and 0.77% of all recorded crimes.

One study of the prevalence of convictions for sexual offenses tracked a cohort of men born in England and Wales in 1953. Scientists found that by the age of 40, 1.1% of these men had been convicted of registered sexual crimes. 10% of them committed sexual crimes within the next five years. According to researchers, in 1993, 165,000 of the male population in England and Wales had a criminal record for committing a recorded sexual offense.

And what is the situation with the relapse of crime? Compared to other groups of criminals, for example, those who committed crimes against property, the level of repeated convictions for sexual offenders is lower. However, such a conclusion may not be entirely reliable, given the too short time interval used to calculate the level of repeated convictions. For most crimes, a monitoring period of up to five years is used, counting from the date of the previous conviction. But even this period may not be enough for sex offenders. Soothill & Gibbens drew attention to this fact in their frequently cited work. For the study, they chose one specific group of sex offenders. These are men who had or attempted to enter into vaginal sex with girls under the age of 13 This behavior involves three crimes: rape, incest and wrongful vaginal intercourse. Men convicted of these crimes in 1951 or 1961, were tracked until 1974. The cumulative percentage of recidivists was calculated for the next 24 years. As for standard crimes, that is crimes of all types, prosecuted on indictment, 48% of them have committed to 22 years of observation some crime. But more important was another: how many of them subsequently committed sexual or violent crimes. This turned out to be 23%, that is, almost a quarter. And it turned out that these were not trivial crimes. Only half of this group of recidivists was convicted within the first five years of observation. Therefore, when using the usual tracking period, we would receive significantly underreported data on recidivism among sex offenders. The duration of follow-up should be at least ten years, and only then can conclusions be drawn about the absence of relapses.

Perhaps one of the reasons for this conclusion is that registered cases of convictions for crimes of a sexual nature are only the tip of the iceberg. It is likely that for ten years of observation the offender was not convicted, but nevertheless committed crimes. Just did not catch him. In favor of this point of view, the data of a study performed in the United States. Their sample of sex offenders confessed to committing a much larger number of crimes and with a much larger number of victims compared to the number of cases in which they were convicted. For example, pedophiles who committed crimes outside their families, on average, 23 sexual acts with girls and 280 sexual acts with boys. It is not surprising that the figures for pedophiles committing crimes within the family were lower - an average of 81 sexual acts with girls and 62 sexual acts with boys. The rapists recognized an average of seven crimes, and exhibitionists - more than 500. However, the results of this study should be approached cautiously, since very high numbers of crimes were called only a very small number of criminals. The rates of recidivism vary from study to study. At the same time, a certain pattern is observed: the lowest level of recidivism is observed in the group of persons who committed crimes against girls within their families - up to 10%, compared to 30% of sexual abuse of girls outside their own families. The highest levels of recidivism were noted among those who committed crimes against boys outside their own families, up to 40%. Along with this, Marshall (quoted in Barker & Morgan) showed that these figures may be underestimated. According to him, when working with unofficial sources, the true figures of recidivism among sex offenders turned out to be 2.4-2.8 times higher than official ones. Other researchers showed the greatest risk of relapse among men who committed crimes against boys outside their own family. Grubin & Kennedy interviewed 102 men convicted of sexual offenses, and they clearly showed a group of perpetrators of crimes against boys. This group was characterized by the following: their victims were more often unfamiliar boys, they had previous convictions for committing crimes of a sexual nature, and they suffered more than one victim. It was also characteristic for them to separate pedophilia from paraphilias.

A meta-analysis of 61 studies covering almost 29,000 sexual offenders has allowed the establishment of levels of recidivism for different groups of sex offenders. The rate of recidivism in the part of committing subsequent sexual crimes among convicted rapists was 19%; and for persons who committed crimes of a sexual nature against children, 13% with an average follow-up period of 4-5 years. Levels of recidivism in non-sexual violence were significantly higher among rapists, compared with those who committed sexual crimes against children. Most likely, these levels are underestimated due to the short duration of observation. The authors attempted to establish prognostic factors of sexual recidivism. Among the demographic variables, only the young age of the crime and the absence of a permanent partner were among the predictive factors. Among the predictors were an antisocial personality disorder and an increased number of crimes in the past. But the most powerful predictors of sexual recidivism were elevated levels of sexual deviance, in particular sexual interest in children, measured by the plethysmography of the penis. In general, the factors of the prediction of sexual crime were the same as in the population of persons who committed crimes of a non-sexual nature.

Assessment of the risk of relapse among sex offenders

The task of assessing the risk of repeat offending by a sexual offender is different from the task of assessing a similar risk in a mentally ill person. The obvious difference is that although a mentally ill person will not be convicted by the court for committing serious crimes, the peculiarities of his illness can serve in his qualification as a person with an increased risk of bodily harm to himself or others. In cases of assessing the risk of sexual offenses, it is usually necessary for a person to commit at least one crime of a sexual nature. Therefore, it is fairly simple to divide already known criminals into high and low risk categories. One of the studies shows that the levels of repeated convictions for individuals who previously committed two crimes were 15 times higher than those who had only one crime in history. In serious cases of sex offenders with the use of severe violence it is impossible to guarantee that they will never commit crimes, even if in reality the risk of re-offense can be low. In this case, even if the risk of re-offending is low, the gravity of the crime and its consequences will be high. The risk of recidivism is lower for those who committed sexual abuse against children within their own family than for those who committed the crime outside their own family. The risk of relapse has been increased for people who committed crimes against children of both sexes, both in the pre-pubertal and at its attainment. These persons are described as "polymorphically perverse".

Marshall analyzed the level of repeated convictions and the previous criminal history in a random sample of 13,000 prisoners released from prisons in 1987. He found that 402 offenders in the sample (3%) were serving a sentence for committing crimes of a sexual nature. In a sub-group of people who had previous convictions for sexual offenses, 12% subsequently committed sexual offenses within four years of their release, compared to 1% of those who never committed sexual crimes. The author suggests that committing crimes of a sexual nature in the past indicates an increased risk of committing crimes in the future. Grubin objected to this, saying that such an actuarial forecast, based only on the history of crime in the past, has limited value. And the main reason is that any forecast for a rare event (ie less than 1% of all crimes) gives too high a false positive result, and therefore is inaccurate. Obviously, such an actuarial forecast does not say anything about which criminals are curable, and at which the risk of committing a crime is increased.

[1], [2]

Case Description

Mr. B. Is 40 years old, he is married, and he has two children. When B. Was somewhere in 20, he had to deal with the work of young children, and he three times committed a sexual assault on little girls in the pre-pubertal. B. Was punished by short-term imprisonment, but he was not offered any treatment. Thirteen years later he was again convicted - this time for sexual abuse against two girls in the pre-pubertal, who were in close family circle. After conviction by the court for an indecent assault, he began to attend a treatment group for sex offenders. In addition, the specialists conducted individual work with his sexual fantasies. For three years of treatment, he confessed to other crimes against little girls, but at the same time denied the sexual attractiveness of boys. Then a small boy belonging to the same family as the girls who were victims of B. Admitted that four years ago he was also sexually abused by B. Then B. Admitted that the boys also sexually attracted him and that he committed crimes in relation to boys. Despite the court's proposed treatment option in the community as part of the program for the treatment of sex offenders, he was again sent to prison for a period of three years. For three years of treatment of B. Both in the group and individually, the risk of recidivism for him was assessed as significant. However, this risk increased significantly when it became clear that, in addition to girls, he also committed crimes against pre-pubertal boys, even though this has not happened recently. The new information moved him to the highest risk category. This case shows that risk is a concept not static, and the appearance of new data can significantly change the level of risk, even if the perpetrator does not commit repeat crimes.

[3]

Risk factors

Any clinician and any researcher who participated in the examination or treatment of sex offenders is aware of the extremely pronounced degrees of denial that criminals demonstrate in the face of irrefutable evidence. Among them, it is not uncommon to deny the fact of committing a crime even after conviction by the court for committing a sexual offense, confessing their guilt and serving a term of imprisonment. Of course, denial among sex offenders is a defense mechanism whose aim is to avoid a conscious recognition of the incorrectness of one's behavior, which naturally allows them to commit repeated crimes. Denial also has different forms and degrees of expression: it is the absolute denial of the commission of a crime, and denial of the seriousness of the crime, and statements about the need for treatment. Another risk factor characteristic of sex offenders is the abnormal levels of emotional congruence. This is their distorted emotional attachment to children. There are some differences between criminals who are themselves fathers and criminals who are not. Fathers who commit sexual crimes show lower levels of emotional congruence than fathers who do not commit crimes. Conversely, criminals who are not fathers show elevated levels of emotional congruence compared to men who do not commit crimes and are not fathers. It is assumed that criminals who are not fathers could have had a developmental disability, during which they stopped at a child's level of emotional development, which is the reason for the high emotional congruence. This means that they can treat children in a way that makes it easier for them to commit crimes against them. Among fathers who do not commit crimes against children, the level of emotional congruence is adequate, and it allows them to exercise empathy for children and understand their emotional needs. The key point is that fathers who commit crimes against children do not have this ability.

As noted earlier, Grubin also proposed clinical risk factors based on an understanding of the phenomenology of sex offenders with sadistic inclinations. Among other risk factors, cognitive distortions should be noted, which will be discussed in more detail below.

One of the scales on the basis of the actuarial forecast was developed by Thornton and subsequently used by the Hampshire Police Department. This evaluation involves two primary stages and a third stage if the offender has undergone a treatment program. The scale describes three levels of risk: low (1 point), medium (2-3 points) and elevated (4+). Each score is added according to the following scheme:

1. In this crime there is a sexual component.
2. Committing crimes of a sexual nature in the past.
3. This crime includes a violent crime of a non-sexual nature.
4. Violent crimes of a non-sexual nature in the past.
5. The presence in the past of more than three convictions for committing sexual crimes.

The second stage assesses the presence of various aggravating factors: crimes of a sexual nature against males, non-contact sexual crimes, crimes against an unfamiliar person, absence of past marriage, history of treatment, substance abuse, indicator 25 or higher on the Hare Psychopathy Questionnaire Checklist) and information about deviant excitation based on the results of plethysmography of the penis. In the event of the presence of two or more aggravating factors, the risk category is increased by one level. If the offender is in prison, the risk may be raised or lowered depending on his response to treatment, especially if there is some improvement in his risk factors and his behavior in prison. An analysis of this scale showed that out of 162 low-risk criminals, 9% subsequently committed crimes of a sexual nature; of 231 criminals with medium risk - 36%; and among the 140 criminals with an increased risk - 46%.

The STEP project report divided criminals into high and low risk groups. It mentions five factors identified by the results of psychometric testing, according to which the two groups differed. Criminals from the high-risk group identified the following:

1. increased levels of social inadequacy;
2. a more pronounced lack of empathy (empathy) with respect to the victims;
3. distorted thinking;
4. increased levels of sexual obsessions;
5. abnormal emotional congruence.

As with other violent crimes, the presence of drug dependence can significantly increase the risk of relapse. On the other hand, the fact of the presence of a mental disorder did not at all indicate the commission of repeated crimes in the future. West suggested that sexual crimes are not typical for mentally ill or people with mental disorders, but they can be overrepresented in the criminal justice system, since the presence of a mental disorder increases the probability of being caught.

Classification of sexual and sexual identity disorders

Classification is usually based on forms of behavior. The classification of mental and behavioral disorders of ICD-10 lists the following forms of disorders:

Sexual Identification Disorders (P64)

• P64.0 Transsexualism.
• P64.1 The dual role of transvestism (temporary wearing of the opposite sex for pleasure without the desire to change the sex and without sexual arousal).
• P64.2 Sexual identification disorder of childhood.

Disorders of sexual preference (I65)

• P65.0 Fetishism.
• R65.1 Fetishistic transvestism (wearing toilet articles of the opposite sex in order to create an impression of belonging to another sex and achieving sexual arousal).
• R65.2 Exhibitionism.
• R65.3 Voyeurism.
• P65.4 Pedophilia.
• P65.5 Sadomasochism.
• P65.6 Multiple disorders of sexual preference (more than one).
• P65.8 Other disorders of sexual preference (indecent telephone calls, frotterism (rubbing against others in crowded public places), sexual acts with animals, use of strangulation or anoxia to enhance sexual arousal, partner preference for anatomical abnormalities).

Psychological and behavioral disorders associated with sexual development and orientation (R66)

Sexual orientation by itself is not considered a disorder, but in some cases it can give rise to problems for the individual and thus be the cause of distress.

• P66.0 Disorder of puberty: uncertainty about your own sexual orientation causes anxiety and depression.
• P66.1 Egodistonic sexual orientation: distress arises from the desire of the subject to have a different sexual orientation.
• R66.2 Disorder of sexual intercourse: distress arises due to difficulties in forming relationships, due to gender identity or sexual preferences.
• P65.9 Disorder of sexual preference, unspecified. From the above classification it is clear that some of the listed forms of behavior can lead to the commission of crimes of a sexual nature, for example exhibitionism and pedophilia, and some - no, for example fetishism.

[4], [5], [6], [7], [8],

Treatment of sex offenders

Cognitive Behavioral Therapy

In the behavioral treatment of sexual offenders, emphasis was previously placed on changing sexual preferences, and the theory of the classical conditioned reflex was used as a basis. It was believed that early, often infancy, experience forms and determines the subsequent development of such paraphilia as pedophilia. Behavioral therapy meant a reduction in deviant stimulation, for example, with disgusting therapy, or through the use of unpleasant stimuli, such as electric shock or nausea, which can later be combined with deviant sexual fantasies. Clearly obvious shortcomings of an ethical nature have practically reduced the use of this method to naught. Some forms of therapy associated with a sense of disgust, still exist, for example in conjunction with a sense of shame in exhibitionists. With this treatment option, the face stands with naked genitals in front of an audience that voices its thoughts aloud. It has been suggested that, perhaps, it is more effective not to try to reduce deviant excitement, but to try to strengthen non-agitative excitement. This can be achieved through the replacement of the conditioned reflex by masturbation or through hidden sensitization. Both of these methods will be described below.

A great influence on the development of cognitive behavioral therapy of sexual offenders in the US and Britain was provided by the work of Finkelhor. His model of the crime of 4 stages is described in Fisher.

1. Motivation to commit sexual abuse. As clinical experience shows, people who commit crimes often consistently deny the sexual motive of their crime, although they readily admit the crime itself.
2. Overcoming internal constraints. Given that not all persons experiencing deviant excitement and fantasies commit crimes, and also that most sex offenders still acknowledge their conduct as unlawful, they seem to develop cognitive distortions that allow them to overcome their own deterrent factors ways of committing a crime.
3. Overcoming external constraints. The next stage involves creating a situation in which a person can commit a crime. For example, a pedophile can offer herself as a nanny for a child.
4. Overcoming the resistance of the victim. The final stage is to overcome the resistance of the victim, for example, bribing the child with gifts or the threat of violence. It is generally accepted that some criminals knowingly choose vulnerable victims who are not able to offer significant resistance.

Finkelhor's theory is based on the assumption that a sex offender can commit a sexual crime only after going through the above four stages.

This theory of crime naturally leads to treatment, as long as it involves therapeutic intervention in all four stages. The basic components of cognitive behavioral therapy for sexual offenders are described in the STEP project report - both for group work and for individual work. It describes the following treatment strategies:

[9], [10], [11],

The cycle of crime

The offender describes in detail the events that led to the crimes. This work should be done at an early stage of treatment, as it allows the criminal to admit his responsibility, that is, that the crime, as it is often claimed, does not "just happen". It is at this stage that the confrontation of the perpetrator with various levels and variants of the denial of the crime is most effective, and often confrontation is carried out by one of the members of the therapeutic group of sexual offenders.

The challenge to distorted thinking

Mechanisms of psychological defense, allowing the criminal to continue criminal activities, suggest an excuse for their actions and their justification (cognitive distortions). For example, pedophiles often claim that they simply satisfied the child's needs for sexual experience. Abusers may consider that a man has the right to have sex with a woman if she comes to see him and he pays her dinner. Change of this stereotype of thinking is most successful in the conditions of the group, when criminals point to each other for cognitive distortions.

Understanding the harm to the victims

This goal is often achieved through the display of criminals videotapes, in which victims of sexual crimes describe how they were affected by the crime. Such a view often causes emotions in the criminals themselves in connection with their own experience, when in the role of victims of sexual abuse in the past they were themselves. Criminals can also make excuses to their victims who are not sent, but are discussed on the group. However, the STEP report warns that such work should not be given too much time - that criminals do not start feeling humiliated, which, in turn, can have a negative impact and as a result not so much reduce, but increase the risk of recidivism. Care must also be taken in using this technique when dealing with sex offenders with sadistic inclinations that can learn how to cause their victims a long-term damaging effect. This, in turn, can lead to an increase in deviant excitement and increase the risk of committing a repeat offense.

Modification of fantasies

It is generally accepted that deviant fantasies of criminals are fixed through simultaneous masturbation. We mentioned earlier the techniques of changing such fantasies. One of the methods is hidden sensitization, in which the perpetrator is asked in detail to imagine one of his deviant fantasies, and then ask him to present an unpleasant consequence in the form of the appearance of the police. Another method is to replace the conditioned reflex through masturbation. There are two ways:

• The thematic shift in which deviant fantasies are replaced during masturbation by non-fantasy fantasies.
• Directional masturbation, when the criminal records the audio cassette for his preferred non-fiction, and then masturbates to this fantasy before ejaculation.

This work is more correct to do on an individual basis, and not in a group. Often it is conducted after the group.

Social skills and control of expressions of anger

It has long been established that sexual offenders have poor social skills. However, if it was only in them, then there would be a danger of getting out of therapy instead of reducing crime - sex offenders with improved social skills. Anger also applies to relevant factors, especially when rape occurs.

Work on the prevention of relapses

This direction has developed by analogy with the prevention of substance abuse. First, the perpetrator identifies his risk factors for 'committing a crime.' Further, he must learn to recognize, avoid and overcome situations that can contribute to his repetition of a crime. He must understand that the first stage of a possible relapse is the resumption of deviant fantasies. Work in this direction involves understanding the criminal of certain high-risk situations, which should be avoided in the future. So, for example, a pedophile should avoid on his way children's playgrounds for games, even if it's his daily road to work. These solutions are referred to in the literature as "seemingly insignificant." The starting point is that in normal life, sexual criminals can make decisions that may seem unimportant, for example, choosing the way to work. However, if such a decision leads him to a high-risk situation, for example, a playground for children, he will consciously acknowledge and choose a different path, even if he takes more time. At the heart of the work on the prevention of recidivism lies the deliberate recognition by the offender of his own risk of committing a repeated crime, the need to change his lifestyle and develop strategies applicable to a specific situation in order to avoid an increase in the risk of relapse. Psychoanalytic psychotherapy

Prior to the recognition of cognitive behavioral therapy, the most effective way to treat sexual offenders group therapy with criminals was often based on psychoanalytic theory. Most of the work in this direction was performed at the clinic in Portman. In it, individual and group analytical therapy was used to treat people suffering from social and sexual deviations from the late 30s of the 20th century. Individual psychoanalytic psychotherapy of sexual offenders is described in Zachary. As with any psychoanalytic psychotherapy, much attention is paid to issues of transfer and countertransference. Zachary admits that the effect that emerges among professionals working with sex offenders is certainly countertransference. Group psychotherapy in the clinic of Portman provided treatment for victims, as well as persons who committed incest, within the same group. Pedophiles and persons who have committed incest, do not unite in one group, as this can lead to the breakdown of group dynamics. However, as described above, the difference between sexual abuse of children within and outside their own family may not be as clear as previously thought.

Most studies on the outcome of treatment for sexual offenders through psychoanalytic therapy were performed in the United States. The most positive result of treatment of a criminal in a psychoanalytic group or individually is the ineffectiveness of therapy, and the most negative result is presented by some data on the United States, according to which sexual offenders treated with psychoanalytic psychotherapy showed higher rates of recidivism than sexual offenders who did not receive any treatment.

Physical treatment

Other treatment for sexual offenders is physical, mainly hormonal treatment. It is often called "chemical castration". This therapy is based on the hypothesis of a direct causal relationship between the commission of a sexual offense and testosterone levels in a criminal. The existence of such a connection has not been proved. There is some evidence that hormonal treatment really reduces the level of sexual desire and, therefore, it is suggested that such treatment can be more effective for people with elevated levels of sexual desire. However, hormonal therapy does not affect sexual fantasies, which are believed to constitute the core of the criminal cycle. Another problem of this therapy is that all variants of sexual desire are reduced, including normal ones. This prevents the pedophile from entering into normal sexual relations with his wife, although the therapist will recommend this. The side effects of such therapy are assessed as not very frequent, but their severity is such that makes this therapy unsuitable for long-term use. In Britain, the most common drugs that reduce libido are cyproterone acetate and medroxyprogesterone acetate. Both drugs lower testosterone levels.

Other drugs acting differently are progesterone, benzperidol and goserilin. Although it may seem logical for some to castrate sexual offenders, the point is that when this was done, it did not deter them from committing repeated crimes. Some consider it appropriate to use these drugs in very rare cases, when sexual crime is combined with hypersexuality and high levels of testosterone. But there are also serious ethical objections, especially with regard to consent and coercion, in cases where such treatment is a condition for accelerating passage through the prison system or even conditional release.

Effectiveness of treatment

Nagayama-Hall performed a meta-analysis of twelve different studies to evaluate the effect of therapy on relapse, and to identify the most effective treatments. The study showed that among sex offenders who received a full course of therapy, 19% subsequently committed crimes of a sexual nature - compared with 27% in the control group who did not receive treatment. Studies that tracked criminals for more than five years showed a slightly greater effect of therapy compared to studies with a follow-up period of less than five years. It was suggested that, using more effective methods of treatment, the Soothill & Gibbons study was disproved, in which during the first five years of observation only 50% of the recidivism manifested itself. Treatment was more effective in community-based programs than institutional programs. The best results were observed among adolescents who committed crimes of a sexual nature. The most effective therapies were cognitive behavioral and hormonal. However, up to two-thirds of the study participants refused hormonal treatment, and 50% of those who started it subsequently fell out of therapy. With cognitive behavioral therapy, the number of failures and fallouts was one third. In this regard, the conclusion is made about the benefits of cognitive behavioral therapy compared with the intake of hormones. These figures are even higher if we take into account the side effects of hormone therapy. According to the research, purely behavioral programs proved ineffective.

The effectiveness of cognitive behavioral therapy was also evaluated in the STEP study, when sex offenders were sent to seven different treatment programs. Only 5% of the sample of people who underwent treatment committed sexual crimes in the next two years, compared to 9% in the sample of untreated sex offenders who were placed under supervision of the probation service in 1990. It should be noted that the observation period is not long enough to draw conclusions about the effect of treatment, and repeated studies will be performed in five and ten years. The study concludes about the impact of cognitive behavioral therapy on behavior associated with the commission of crimes of a sexual nature.

[12], [13], [14]

Treatment programs for sex offenders

Treatment programs for sex offenders are available locally and are often managed by local probation services in conjunction with other agencies, such as social health services and the voluntary sector. A number of prisons have their own treatment programs.

Community Based Treatment Programs

During the STEP project, a number of local programs for sexual offenders in England, as well as one resident program (that is, living with individuals in a particular institution) were analyzed. The results of the analysis of the treatment outcome show that more than half of the criminals who received the treatment had no therapeutic effect. At the same time, it caused some concern that a quarter of the criminals had become more zealous in accusing their victims. The report describes several different treatment programs based on the cognitive behavioral model. The shorter duration of the program - up to 60 hours of total time - was used for men who were more willing to admit their crimes and their sexual problems and who were less justified and showed less distorted thinking. More long-term programs were more effective on extremely deviant persons. The effectiveness of a short-term program in 60% of cases can be explained by the features of the population in the program, in particular, the low level of deviance among the participants in therapy. To assess the persons who participated in various programs, a variety of scales were used. They measured the following characteristics:

• degree of negation or minimization of the committed crime;
• arguments justifying the commission of a person's sexual assault;
• the degree of empathy towards their victims;
• level of assertiveness;
• level of self-esteem;
• the extent to which guilt is shifted to external factors, such as the behavior of victims or other problems in their lives (locus of control);
• the degree of development of the ability to maintain close relationships with adults (it is known that sexual offenders often endure "emotional loneliness");
• cognitive distortions;
• emotional congruence with children;
• The presence of the offender in the course of treatment of the strategy he developed for the prevention of relapse;
• An attempt to measure whether a sex offender is attempting to substitute his or her true attitude to the object or his beliefs with socially acceptable answers.

The STEP project report outlines important recommendations for the treatment of sex offenders in the community.

• The important role of systematic evaluation of a person undergoing treatment is emphasized: this should be done before, during and after treatment. At the same time, the authors acknowledge that the evaluation scales used require considerable involvement of psychologists.
• It is necessary to improve the training of specialists performing group therapy.
• Part of the program should be work on changing fantasies.
• Criminals must understand the basic ideas conveyed to them in the group, and not just master the terminology and concepts.
• The goal of treating sex offenders is to reduce crime by reducing the level of negations, excuses for committed crimes and cognitive distortions, by increasing the feeling of empathy towards the victims and reducing the levels of their deviant outcry and deviant fantasies. Even more important for the offender, in the opinion of all treatment groups, is to realize the risk that they may present in the future and in what specific situations.
• Work on empathy in relation to the victim is possible only after it becomes clear that the offender is able to cope with the consequences of his recognition of the committed by him. Since these persons have a reduced self-esteem, they can first become worse: they can give protective reactions and in anger to increase accusations against their victims. It is recommended that before starting work on empathy towards victims, they should increase their self-esteem and teach them coping skills (overcoming difficult situations).
• It is necessary to work more in the direction of prevention of relapses.
• If there is no possibility to increase the number of treatment programs in the country, more attention should be given to selecting the appropriate criminals for the relevant programs and giving priority to the work on the prevention of relapse.

Other recommendations dealt with the duration of the programs and the need for supportive care after the completion of such a program.

[15], [16],

Treatment programs in prisons

The Sexual Crimes Treatment Program (BOTP) was introduced in the prison service of England and Wales in 1992. It is based on a cognitive behavioral treatment model and is implemented in 25 prisons. The pre-medical examination includes psychometric testing, a clinical interview, and in five prisons - also PPCR. The task of the survey is to exclude groups of sex offenders who do not benefit from such treatment in prison. These are mentally ill people with high risk of self-harm, persons with severe paranoid personality disorder, prisoners from 10, below 80 and people with organic brain lesions. The program for the treatment of sexual offenders consists of four parts:

• basic program,
• a program on thinking skills,
• extended program,
• program of relapse prevention.

The basic program is obligatory for all participants of BOGR. It sets the following goals:

• increase the sense of responsibility of the offender for the crime committed by him and reduce the level of negation;
• increase the motivation of the offender to avoid committing repeated crimes;
• to strengthen his degree of empathy with respect to the victim;
• help him develop skills to avoid committing a repeated crime.

The basic program consists of 20 blocks and involves 80 hours of treatment. The Thinking Skills program aims to improve the ability of the offender to see the consequences of his actions and to consider in the future alternative strategies of behavior. It is believed that such skills are needed so that the perpetrator can understand, develop and use strategies for preventing relapse to prevent the commission of repeated crimes in the future.

The expanded program is a therapeutic group that includes at present the topics of anger management, stress management, interpersonal skills and behavioral therapy. The last variant of therapy is carried out individually and includes work on sexual fantasies, deviant sexual arousal and victimology.

Criminals who have undergone the basic program and other elements of the program for the treatment of sexual offenders must start working in the program for the prevention of relapses one year before release. It requires that they successfully complete other parts of the program, otherwise visiting the groups for the prevention of relapse will not be effective. During the group sessions, participants should offer strategies for the prevention of relapse, which they will work out before they go free.

Due to the need for long-term follow-up, the effectiveness of the sex offender treatment program in prisons will not be established before 2005. At the same time, changes in criminals due to the results of psychometric tests and the activity of therapeutic groups are already being noted. There are also some data on changes in levels of negation, the degree of minimization of the committed crime and cognitive distortions. Another option for the treatment of sexual offenders is part of the therapeutic regime in Grendon Prison.

Legislation on sex offenders

In the 90 years of the XX century, many legislative norms were introduced, which became a reaction to the public's concern with sexual offenders. The first rule was included in the Criminal Justice Act of 1991 and allowed longer imprisonment for sex offenders.

The Criminal Justice Act of 1991

Within the framework of this law, the principle of proportionality of punishment, that is, the correspondence between the length of the term of imprisonment and the gravity of the crime, has been changed to a considerable extent. This law allowed the courts to pass a sentence of longer than usual imprisonment for violent and sexual offenders, if this was "necessary to protect society from causing serious harm to this criminal". Serious harm in this case implies severe psychological and physical damage. However, then the duration of punishment may reflect the perceived risk that violent and sexual criminals may present in the future. Consequently, the criminal could be sent to prison not for what he actually did, but in order to protect society in the future. This act also imposes on the court the duty established in the law to request a psychiatric report if it appears that the accused "suffers from a mental disorder". An analysis of the first 35 cases sent to the Court of Appeal, in which the courts imposed a punishment longer than usual, showed the role of these psychiatric reports in the imposition of penalties. It turned out that the Court of Appeal paid special attention to the psychiatrist's opinion about the identity of the perpetrator, the possibilities of curability of any disorder and its assessment of the risk of relapse in the future. The researchers hypothesized that psychiatric reports were used to justify prolonged imprisonment, although they were originally required for a completely different purpose.

The Criminal Justice Act also increased the duration of supervision of sexual offenders after release and equated it in length to the time of imprisonment appointed by the court.

Protection of society

In 1996, the government published a strategic document entitled "Protecting the Public" ("Protecting the Public"). It included sections on convictions of sexual offenders and their supervision, as well as on automatic life imprisonment for crimes of a violent and sexual nature. This strategy was based on sentences of imprisonment for sex offenders in order to protect society. The document also pointed to the need to continue working with sexual offenders after their release from prison and, consequently, to increase the term of supervision over them. On the basis of the document, a number of laws appeared, which were, among other things, aimed at strengthening control over sexual offenders. In particular, this is the Law on Crimes (sentences) of 1997; The Sexual Criminals Act of 1997; Law on Criminal Evidence (Amendment) of 1997; The Law on Protection from Harassment of 1997 and the Law on Sexual Criminals (Closed Materials) of 1997.

Law on sentences for crimes of 1997

As mentioned earlier, the Criminal Justice Act of 1991 increased for a sex offender who was sentenced to imprisonment a period of statutory supervision after leaving prison from 3/4 to the full term of the sentence imposed. This law went further in terms of supervision, setting a minimum of 12 months and a maximum of 10 years in all but exceptional cases. The duration of supervision is determined by the judge making the sentence, and it is based on the peril of the offender for society. In addition, the post-release surveillance order may include special conditions, such as visiting a local program for sexual offenders and living in a probation service hostel. It can also include restrictions on leaving the house at certain times, which involve the wearing of an electronic "tag". Failure to comply with these conditions may result in criminal prosecution and imprisonment if the court finds such a measure necessary for the protection of society.

Sexual Offenders Act 1997

This law consists of two parts. The first part obliges sexual criminals to register with the police and notify her about the change of residence and the new address. The second part allows the courts to prosecute those who committed crimes against children while in another country. The law contains a list of crimes that are subject to registration. In principle, these are the same crimes that were mentioned at the beginning of the chapter. The duration of registration in the police depends on the length of the prison sentence and varies from 5 years to unlimited. According to existing estimates, in 1993, 125,000 men who had previously committed crimes were covered by the registration standard.

The Ministry of the Interior issued a circular containing instructions for handling information received under this law. The document included the requirement to assess the risk of recidivism by the police before disclosing this information to a third party. Evaluation should take into account the following:

• nature and pattern of the previous crime;
• compliance with the requirements of previous sentences or court orders;
• probability of a crime in the future;
• the alleged harm from such behavior;
• any manifestations of predatory behavior that may indicate the likelihood of a repeat offense;
• potential objects of harm (including children or especially vulnerable persons);
• potential consequences of disclosure of information on the case for the offender and his family members;
• potential consequences of disclosure of information on the case in the broader context of law and order.

At the same time, the issue of information disclosure is resolved in each case separately, and no general rule has been established here. In a number of cases, reports of cases that provoked public outcry forced sexual offenders to leave their homes because of community pressure.

The 1996 Crime and Disorder Act

This law includes an order for sexual offenders, which has been in effect since December 1, 1998. This is a new civil warrant, which is imposed by the court, but is executed by the police, and only if there are two basic conditions:

1. A person must have been previously convicted or warned of committing a crime of a sexual nature; and
2. The person behaved in such a way that such an order is necessary to protect the public from the risk of serious harm on his part.

The definition of serious harm does not differ from the definition contained in the previously mentioned Criminal Justice Act of 1991. This order is used by magistrates' courts. The warrant - for the purpose of protecting society - prohibits the perpetrator from appearing in certain places. The court determines the specific time and place, for example, it can be a playground for children in a certain place and at certain times of the day. The offender is also required, in accordance with the Sexual Criminals Act 1997, to register with the police. The minimum duration of this order is 5 years. It can be applied to any criminal at the age of 10 years and older, and therefore applies to children and adolescents. Breach of the warrant is a criminal offense and entails an arrest. The minimum penalty in case of conviction by the court for violation of order requirements is five years of imprisonment.

The draft instruction of the Ministry of the Interior suggests that in assessing the risk of a sex offender, several factors should be taken into account. In principle, these are the same factors that were described earlier in the section on the Sexual Offenders Act 1997, plus an assessment of the correctness of information about that person and compliance with the requirements of the treatment program, and its outcome. The Ministry of the Interior recommends that other services, such as the probation service, social services and health services, be used to increase the accuracy of the risk assessment of relapse.

The legislation is another step in the search for new forms of treatment for sex offenders in the community. It is designed to fill a niche in existing norms. As far as this is possible, it will only become clear when these orders begin to be applied.

Other legislative acts

Below are listed other laws relevant to the topic under discussion:

• The Criminal Evidence (Amendment) Act 1997 allows you to take DNA samples, except in intimate places, with a variety of violent crimes, including sexual ones. Samples will be used to create a national DNA database.
• The Sexual Offenders (Closed Offenses) Act, 1997 restricts access to victim testimony if the offense is sexual.
• The Law on Protection from Harassment of 1997 included the possibility of imposing a injunction to prevent behavior that could be considered an assault by a potential or actual sexual offender.

Recent changes in the legislation have yet to be fully appreciated. It is the matter of time. It will take many years to see how successful the government's efforts to protect society from sexual offenders will be.

Sexual crimes in terms of law

Most sexual crimes are grounds for prosecution on indictment, with the exception of indecent exposure, which refers to offenses prosecuted in summary production. Only the first are included in crime statistics and are considered recorded crimes. This is anal intercourse with a man or woman (under certain conditions) or sexual intercourse with an animal (English buggery), indecent assault on a man, obscenity between men, rape of a woman, rape of a man, indecent assault on a woman, illegal sexual intercourse with a girl younger 13 years, illegal sexual intercourse with a girl under 16 years of age, incest, pimping, abduction of a woman against her will with intent to marry or unlawful sexual intercourse, biblical and gross obscenity towards the child

The crimes that the psychiatrist has to deal with more often are rape, indecent exposure and sexual crimes against children.

Rape of men

This crime was not contained in the law until 1994. Crimes of this kind were qualified as anal intercourse with a man (under certain conditions). The composition of the rape of a man was introduced by the Criminal Justice and Public Order Act of 1994. In 1997, 340 such crimes were registered in the police, although it can be assumed that, as with all crimes of a sexual nature, the true figures may be much higher.