Psychological treatment for adult sex offenders can reduce reoffending rates but does not provide a cure, say experts in an editorial in this week’s BMJ.

Sexual offending is a public health issue and a social problem. Psychological treatment is widely used and is often mandated in the sentencing decision for sexual offenders. But just how effective are psychological treatment programmes? Are they too readily accepted uncritically?

Specialists in psychology and criminology review the evidence from published studies.

In an analysis of randomised controlled trials on behavioural treatments, they found that most studies were too small to be informative, although statistically significant improvements were recorded across some groups of offenders.

The largest, longest trial compared group therapy with no group therapy for 231 men guilty of child abuse, exhibitionism, or sexual assault. During the subsequent 10 years, a greater proportion of those allocated to group therapy were re-arrested, but this did not reach statistical significance.

However, evidence from these types of trials provides only a fraction of the knowledge needed, particularly on recidivism (used here to mean a repeat sexual offence), say the authors.

Treatment failure is associated with higher rates of recidivism, and offenders who successfully complete a treatment programme reoffend less often and less seriously (that is non-sexual reoffending) than those who do not show that they have understood and worked through the relevant psychological issues.

Paedophilia cannot always be successfully treated, they write. Better understanding of the outcomes of treatments -  either controlling and moderating or harming and worsening behaviour -  could at least focus on the most beneficial and cost effective interventions.

There is enormous political and institutional pressure to prove that treatment works. Assessment of all outcomes must take the expectations of researchers into account, and also offenders’ and therapists’ perceptions of treatment.

It should be possible to combine the strength of randomised controlled trials with the collection of good qualitative data and to ensure that psychological interventions for sexual offenders are assessed effectively, they conclude.

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British Medical Journal