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The purpose of this paper is to review methods for evaluating the efficacy of treatment programs for sexual offenders. Even though recidivism reduction is the ultimate goal of treatment, the low base rate of detected recidivism makes this an impractical outcome criterion in many settings. In this paper, I discuss three general approaches that can be used to advance our knowledge: (1) large, well-controlled single-site research studies; (2) pooling of small studies through meta-analysis; and (3) detailed examination of within-treatment change on dynamic (changeable) risk factors. Each approach has its own strengths and weaknesses. It is only through the accumulation of consistent results from diverse studies that we are able to learn what works with sexual offenders.

In the last 10 years, relapse prevention (RP) has been adopted as the most popular framework for the treatment of sexual offenders. Although RP is conceptually similar to other forms of cognitive/behavior therapy, it has made an important contribution by focusing therapists' attention on the problem of long-term recidivism. In RP, posttreatment behavioral deterioration is not considered evidence that sexual offenders are untreatable; instead, lapses are considered as expected and workable problems. There are certain difficulties, however, with the application of RP to the treatment of sexual offenders. In some cases, RP has been interpreted so generally that it has had little real influence on preexisting practices. As well, it is not clear how some of the most distinctive concepts of RP (e.g., lapse/relapse, abstinence violation effect) should be applied to sexual offenders. Special efforts may also be required to convince sexual offenders that they are at risk before they are able to benefit from RP interventions.

The treatment outcome study by Nicholaichuk, Gordon, Gu, and Wong (2000) used a novel method for identifying a comparison group of untreated sex offenders (i.e., drawing from existing criminal history records). A potential problem with their approach is that older records would be expected to include a disproportionate numbers of recidivists. Such an artifact is identified in Nicholaichuk et al.'s (2000) study; nevertheless, their data continue to suggest a small, positive effect for treatment even after eliminating the cases in which bias is most likely.

Lack of victim empathy is often cited as a factor in sexual offending. Empathy is a complex reaction that requires both perspective-taking skills and sympathetic feelings. Some treatment programs for sexual offenders provide victim empathy training based on the assumption that increased awareness of victim suffering should inhibit further offenses. Perspective-taking deficits, however, may be irrelevant to certain offenders who are indifferent or even attracted to the suffering of their victims. In the present study a diverse group of sexual offenders and comparison subjects were administered two new measures of perspective-taking ability. The sexual offenders, in general, showed greater deficits than did the comparison subjects. As expected, deficits were most noticeable in those offenders who were not known to have used overt force and those who were not intoxicated during the commission of their offenses. The present study supports the utility of using perspective-taking measures with sexual offenders.

Presently, there are no established scales that evaluate change in risk among sexual offenders. The Sex Offender Need Assessment Rating (SONAR) was developed to fill this gap. The SONAR includes five relatively stable factors (intimacy deficits, negative social influences, attitudes tolerant of sex offending, sexual self-regulation, general self-regulation) and four acute factors (substance abuse, negative mood, anger, victim access). The psychometric properties of the scale were examined using data previously collected by Hanson and Harris (1998, 2000). Overall, the scale showed adequate internal consistency and moderate ability to differentiate between recidivists and nonrecidivists (r = .43; ROC area of.74). SONAR continued to distinguish between the groups after controlling for well-established risk indicators, such as age, and scores on the Static-99 (Hanson & Thornton, 2000) and the Violence Risk Appraisal Guide (Quinsey, Harris, Rice, & Cormier, 1998).

Preventive detention provisions in the US and Canada assume we can identify, in advance, individuals at high risk for sexual recidivism. To test this assumption, 377 adult males with a history of sexual offending were followed for 20 years using Canadian national criminal history records and Internet searches. Using previously collected information, a high risk/high need (HRHN) subgroup was identified based on an unusually high levels of criminogenic needs ( n = 190, average age of 38 years; 83% White, 13% Indigenous, 4% other). A well above average subgroup of 99 individuals was then identified based on high Static-99R (6+) and Static-2002R (7+) scores. In the HRHN group, 40% reoffended sexually. STATIC HRHN norms overestimated sexual recidivism at 5 years (Static-99R, E/O = 1.44; Static-2002R, E/O = 1.72) but were well calibrated for longer follow-up periods (20 years: Static-99R, E/0 = 1.00; Static-2002R, E/O = 1.16). The overall sexual recidivism rate for the well above average subgroup was 52.1% after 20 years, and 74.3% for any violent recidivism. The highest risk individuals (top 1%) had rates in the 60%–70% range. We conclude that some individuals present a high risk for sexual recidivism, and can be identified using currently available methods.

A Five-Level Risk and Needs system has been proposed as a common language for standardizing the meaning of risk levels across risk/need tools used in corrections. Study 1 examined whether the Five-Levels could be applied to BARR-2002R ( N = 2,390), an actuarial tool for general recidivism. Study 2 examined the construct validity of BARR-2002R risk levels in two samples of individuals with a history of sexual offending ( N = 1,081). Study 1 found reasonable correspondence between BARR-2002R scores and four of the five standardized risk levels (no Level V). Study 2 found that the profiles of individuals in Levels II, III, and IV were mostly consistent with expectations; however, individuals in the lowest risk level (Level I) had more criminogenic needs than expected based on the original descriptions of the Five-Levels. The Five-Level system was mostly successful when applied to BARR-2002R. Revisions to this system, or the inclusion of putatively dynamic risk factors and protective factors, may be required to improve alignment with the information provided by certain risk tools.

The most commonly used risk assessment tools for predicting sexual violence focus almost exclusively on static, historical factors. Consequently, they are assumed to be unable to directly inform the selection of treatment targets, or evaluate change. However, researchers using latent variable models have identified three dimensions in static actuarial scales for sexual offenders: Sexual Criminality, General Criminality, and a third dimension centered on young age and aggression to strangers. In the current study, we examined the convergent and predictive validity of these dimensions, using psychological features of the offender (e.g., antisocial traits, hypersexuality) and recidivism outcomes. Results indicated that (a) Sexual Criminality was related to dysregulation of sexuality toward atypical objects, without intent to harm; (b) General Criminality was related to antisocial traits; and (c) Youthful Stranger Aggression was related to a clear intent to harm the victim. All three dimensions predicted sexual recidivism, although only General Criminality and Youthful Stranger Aggression predicted nonsexual recidivism. These results indicate that risk tools for sexual violence are multidimensional, and support a shift from an exclusive focus on total scores to consideration of subscales measuring psychologically meaningful constructs.

Given that sexual offenders are more likely to reoffend with a nonsexual offense than a sexual offense, it is useful to have risk scales that predict general recidivism among sexual offenders. In the current study, we examined the extent to which two commonly used risk scales for sexual offenders (Static-99R and Static-2002R) predict violent and general recidivism, and whether it would be possible to improve predictive accuracy for these outcomes by revising their items. Based on an aggregated sample of 3,536 adult male sex offenders from Canada, the United States, and Europe (average age of 39 years), we found that a scale created from the Age at Release item and the General Criminality subscale of Static-2002R predicted nonsexual violent, any violent, and general recidivism significantly better than Static-99R or Static-2002R total scores. The convergent validity of this new scale (Brief Assessment of Recidivism Risk–2002R [BARR-2002R]) was examined in a new, independent data set of Canadian high-risk adult male sex offenders ( N = 360) where it was found to be highly correlated with other risk assessment tools for general recidivism and the Psychopathy Checklist–Revised (PCL-R), as well as demonstrated similar discrimination and calibration as in the development sample. Instead of using total scores from the Static-99R or Static-2002R, we recommend that evaluators use the BARR-2002R for predicting violent and general recidivism among sex offenders, and for screening for the psychological dimension of antisocial orientation.