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Marshall et OF
TREATMENT/ September 2005

Working Positively With Sexual

Maximizing the Effectiveness of Treatment

Rockwood Psychological Services
University of Melbourne
H. M. Prison Service
University of Ottawa and Rockwood Psychological Services
Rockwood Psychological Services
University of Ottawa and Rockwood Psychological Services
Rockwood Psychological Services

In this article, the authors draw on literatures outside sexual offending and make sug-
gestions for working more positively and constructively with these offenders.
Although the management of risk is a necessary feature of treatment, it needs to occur
in conjunction with a strength-based approach. An exclusive focus on risk can lead to
overly confrontational therapeutic encounters, a lack of rapport between offenders
and clinicians, and fragmented and mechanistic treatment delivery. The authors sug-
gest that the goals of sexual offender treatment should be the attainment of good lives,
which is achieved by enhancing hope, increasing self-esteem, developing approach
goals, and working collaboratively with the offenders. Examples are provided of how
these targets may be met. When this is done within a therapeutic context where the
treatment providers display empathy and warmth and are rewarding and directive,
the authors suggest that treatment effects will be maximized.

Keywords: sexual offenders; good lives; hope; self-esteem; collaboration

JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 9, September 2005 1096-1114

DOI: 10.1177/0886260505278514
© 2005 Sage Publications


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Marshall et al. / CONSTRUCTIVE TREATMENT 1097

During the past several years, we have been concerned about certain aspects
of treatment programs for sexual offenders. We have no doubt that treatment
can be effective, as Hanson et al. (2002) have shown, but the sad fact is that
this is not the case for all programs. In support of this observation, Hanson
(2002) provided further detailed analysis of the data in his recent meta-
analysis, demonstrating that several of the 42 programs were ineffective.
There is no doubt that some of these variations in outcome are because of
sample differences, and Hanson (2002) made it clear that those programs
with predominately high risk offenders did tend to fail to produce positive
benefits. These analyses, however, did not account for all the failures. In
addition, even among programs that were dramatically effective, not all
treated clients avoided relapsing. Although the issues we raise in this article
may not explain all treatment failures, we believe that incorporating in treat-
ment the suggestions we outline below will reduce the number of offenders
who subsequently relapse. In a sense, our concern is with the issue of
offender responsivity (Andrews & Bonta, 1998). The responsivity principle
is concerned with a program’s ability to match the client’s learning style and
respond to the particular features of the clients.
Our general concerns about current treatment approaches can be summa-
rized as follows: (a) there is an excessive emphasis on negative issues in both
the targets of treatment and the language used by treatment providers, (b)
there is a failure to explicitly encourage optimism in clients and encourage
their belief in their capacity to change, (c) there is a general absence of an
explicit attempt to work collaboratively with clients, (d) the role and influ-
ence of the therapist has been all but neglected, and (e) there have been few
attempts to provide clients with goals that will result in them leading a more
fulfilling and prosocial life. In the sections that follow, we will address these
It has been suggested (Marshall, 1989; Marshall, Anderson, & Fernandez,
1999) that sexual offenders seek much the same goals as other people, but
they choose inappropriate pathways (i.e., sexual offending) to achieve these
goals because they do not have the skills, attitudes, and self-confidence to
achieve them by prosocial pathways. Treatment, therefore, should provide
sexual offenders with the attitudes and self-confidence necessary for them to
meet their needs in appropriate ways. To do this, we suggest that therapists
assist their clients in identifying the needs the clients are inappropriately
attempting to meet by offending, help the clients set goals that will allow
them to lead a socially acceptable and satisfying life, and create a therapeutic
climate conducive to generating optimism in the clients about their prospects
of successfully achieving these goals.

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From this perspective, the approach to treating sexual offenders should

involve enhancing many skills, instilling prosocial attitudes, and increasing
the client’s sense of self-worth. However, most programs outline their treat-
ment strategies in rather negative terms. For example, the focus is often on the
elimination of negative attitudes, the reduction of cognitive distortions, the
extinction of deviant sexual interests, and the generation of a list of people,
activities, and places to avoid (i.e., relapse prevention [RP]). In addition, as
several authors (e.g., Kear-Colwell & Pollack, 1997; Marshall, 1996) have
pointed out, too many sexual offender treatment providers appear to believe
that it is necessary to be extremely confrontative when working with these
clients. This latter notion is inconsistent with the demonstrated value of moti-
vational interviewing (Miller & Rollnick, 1991, 2002), and there is evidence
that confrontation reduces otherwise effective treatment with both sexual
offenders (Beech & Fordham, 1997; Marshall, Serran, Fernandez, et al., in
press) and addictive clients (Miller, Benefield, & Tonigan, 1993; Miller &
Sovereign, 1989; Miller, Taylor, & West, 1980). We suggest that a more posi-
tive approach to all aspects of treatment with sexual offenders will maximize
treatment benefits.
In this article, we argue that making sexual offender treatment more posi-
tive and self-enhancing for our clients is likely to increase their responsivity
to treatment. Examination of research and theory in various domains of psy-
chology reveals the existence of several ways to work more positively with
sexual offenders. In our view, the goals of sexual offender treatment should
be the attainment of good lives, which is achieved by enhancing hope,
increasing self-esteem, developing approach goals, and working collabor-
atively with the offenders. We will discuss each of these approaches in turn.


There appear to be two broad models of offender rehabilitation, each com-

mitted to changing those characteristics of individuals that are associated
with criminal acts, but each has a different orientation. These models are not
typically differentiated and may even coexist to some degree. The first is con-
cerned with risk management, where the primary aim of rehabilitating
offenders is to avoid harm to the community rather than to improve the
offenders’ quality of life. From the perspective of this model, the enhance-
ment of offenders’ functioning may be viewed as desirable, but this should
not be the primary objective of program developers and policy makers. Fur-
thermore, the label risk management implies that psychological functioning

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Marshall et al. / CONSTRUCTIVE TREATMENT 1099

deficits cannot be solved or overcome, but only managed. Essentially, this is a

pessimistic model of the potential for change. In this model, the relationship
between the level of functioning of offenders and recidivism rates is an
instrumental one: It is a means to the end of reduced risk to the community. In
contrast, the second model is concerned with the enhancement of offenders’
capabilities to improve the quality of their life and, by doing so, reduce their
chances of committing further crimes. According to this model, focusing on
providing offenders with the necessary conditions (e.g., skills, values, oppor-
tunities, social supports) for meeting their needs in more adaptive ways will
reduce the likelihood that they will continue to harm themselves and others
(Ward & Steward, in press). In this model, the primary end or goal is not the
reduction of crime, but rather the enhancement of the offender’s well-being,
although it is argued that a reduced risk to reoffend will reliably follow.
The risk management model has, in recent years, dominated correctional
psychology and offender rehabilitation policy (see Andrews & Bonta, 1998;
Ashford, Sales, & Reid, 2001). Even when the focus of this approach has
been on offenders’ needs, policy makers tend to be concerned with reducing
further crimes or the incidence of disruptive behavior within prisons, and
they pay little attention to the offenders’ well-being and capabilities. For
example, Ashford et al. (2001) have distinguished between the subjective
needs of the offender and the objective needs of the justice and correctional
systems and society at large. They point out that offender needs not linked to
reduced recidivism are typically considered relatively unimportant. Ashford
et al. also argue that such decisions reflect the overarching values of the insti-
tutions in question. Another aspect of the risk management model is the
notion of criminogenic needs (Andrews & Bonta, 1998), which suggests that
only those offender characteristics associated with a reduction in recidivism
should be directly targeted in rehabilitation programs. We are not suggesting
that reducing crime is an inappropriate goal for sexual offender treatment.
Clearly, it is paramount. Having this as the sole aim of treatment, however,
leads to the development of programs that the offenders may find unengag-
ing, personally irrelevant, and even disempowering. By failing to focus on
the offender’s perspective of what is important, we may reduce the
effectiveness of our programs.
In a recent article, Ward and Steward (in press) have developed a needs-
based framework to further the understanding of the causes of crime and to
guide the assessment and rehabilitation of offenders. In their theory, the goals
and desires of individuals are partially determined by their fundamental
interests and concerns (i.e., their basic needs). These basic needs are usefully
construed as innate propensities to engage in certain activities that if not met,

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result in harm or increased risk of harm in the future. Examples of basic needs
are relatedness, autonomy, and competency. Whether basic needs can be met
in a manner that will promote an individual’s well-being depends crucially
on the existence of specific internal and external conditions. Internal condi-
tions refer to psychological characteristics such as skills, beliefs, attitudes,
and values. External conditions refer to social, cultural, and interpersonal
factors that facilitate the development of the necessary internal conditions
and include effective parenting, education, vocational training, social sup-
ports, and the opportunity to pursue valued goals. The criminogenic needs
identified in the risk management model are associated with the distortion of
these conditions and can be viewed as the product of internal or external
obstacles that prevent basic needs from being met in an optimal and prosocial
manner. Human goods (see Emmons, 1996, for a comprehensive discussion
of these goods) reflective of a fulfilling lifestyle are derived from, or made
possible by, the meeting of basic psychological needs and the possession of
the necessary internal and external conditions. These goods include friend-
ship, enjoyable work, loving relationships, creative pursuits, sexual satisfac-
tion, positive self-regard, and a reasonably challenging environment. The
presence of internal and external obstacles results in impaired social and psy-
chological functioning and, therefore, a less fulfilling life. Rehabilitation,
according to this view, should focus on identifying the various obstacles pre-
venting offenders from living a balanced and fulfilling life and then equip
them with the skills, beliefs, values, and supports needed to counteract the
pernicious influence of these obstacles.
In a sense, when offenders agree to enter a rehabilitation program, they are
implicitly asking therapists the following question: “How can I live my life
differently?” This requires clinicians to offer concrete possibilities for living
good or worthwhile lives that take into account each individual’s abilities,
circumstances, interests, and opportunities. Ethical questions involve clini-
cians in the consideration of what constitutes a worthwhile life and are not
exhausted by issues related to their conduct. There is no discretion here;
every therapeutic intervention is buttressed by assumptions about what con-
stitutes a desirable outcome and, therefore, points to a vision of human well-
being and fulfillment. Of course, we cannot choose or live offenders’lives for
them, but we should be clear about what are reasonable possibilities and help
them acquire the requisite skills and capabilities to increase their chances of
living such lives. This does not entail ignoring the needs of the community
for security and safety; it simply reminds us that all human lives should
reflect the best possible outcomes rather the least worst possibilities.

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Human beings naturally seek primary goods, so called because they are
viewed as desirable or good ends in themselves (Deci & Ryan, 2000;
Emmons, 1996). There are three classes of primary goods derived from the
facts of the body, self, and social life and the basic human needs associated
with such facts (Kekes, 1989). The primary goods of the body include basic
physiological needs for sex, food, warmth, water, sleep, and the healthy func-
tioning of the body as a whole. The primary goods of the self are derived from
the basic needs of autonomy, relatedness, and competence. Each of these
needs is associated with a cluster of related primary goods. For example,
relatedness can be further broken down into goods of intimacy, understand-
ing, empathy, support, sexual pleasure, and sharing. The primary goods of
social life include social support, family life, meaningful work opportunities,
and access to recreational activities. A conception of good lives should be
based on these three classes of primary goods and should specify the forms
they will take in each individual’s life plan. The term good lives is preferred to
the singular good life, as there is no one ideal or preferred lifestyle for any
given individual (Rasmussen, 1999).
Once a conception of a good life has been determined for an individual
offender, a general plan can then be adapted for him or her taking account of
his or her specific capabilities (i.e., his or her particular internal and external
conditions). The specific form that a plan will take depends on the actual abil-
ities, interests, and opportunities of each individual and the weightings he or
she gives to specific primary goods. The weightings allocated to specific pri-
mary goods are constitutive of an offender’s personal identity and spell out
the kind of life sought and, relatedly, the kind of person he or she would like
to be. However, because human beings naturally seek a range of primary
goods, it is important that all the classes of primary goods are addressed in a
conception of good lives; they should be ordered and coherently related to
each other. For example, if an offender decides to pursue a life characterized
by service to the community, a core aspect of his or her identity will revolve
around the primary goods of relatedness and social life. The offender’s sense
of mastery, self-esteem, and his or her perception of autonomy and control
will all reflect this overarching good and its associated subclusters of goods
(e.g., intimacy, caring, honesty). The plan should be organized in ways that
ensures each primary good can be secured by the individual. A plan that is
fragmented and lacks coherency is likely to lead to frustration and harm to the
individual concerned, as well as to a life lacking an overall sense of purpose
and meaning.

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Goods and the Treatment of Offenders

To illustrate that rehabilitation programs for sexual offenders, as a matter

of fact, do allude to goods or values, we provide two examples.
Core components that typically underlie the cognitive-behavioral treat-
ment of sexual offenders include the following: modification of attitudes and
perceptions, improving relationship skills, arousal reconditioning, enhance-
ment of coping skills, increasing victim empathy, mood regulation, and the
identification of offense pathways (Marshall, 1999). Each of these modules
sets out to provide offenders with the necessary skills and knowledge to mod-
ify the particular problems that are targeted. Alongside this technical task is
also an indirect attempt to highlight certain primary goods or values,
although this is rarely explicitly acknowledged (Ward, 2002).
For example, in the module, victim empathy, the evident primary goods
concern the need to take the well-being and perspective of other people into
account when interacting with them. The putative mental states and needs of
the victim become a focus and remind the offender to value equally the well-
being of others alongside his own. In addition, there is an appreciation of the
nature of harms (related to deprivation of goods such as self-autonomy and
choice) that can be inflicted on victims of sexual offenses. Additionally, in
the module, relationship skills, the goods associated with different types of
relationships are canvassed with the focus being on establishing a link
between each individual’s need for safety and their habitual interpersonal
strategies. The aim is to provide offenders with the capacity to form deeply
satisfying intimate and supportive relationships and thus to cease using
deviant sex as a substitute for such relationships.
Our second example comes from the treatment of developmentally dis-
abled sexual offenders; more specifically the model developed by Haaven
and Coleman (2000). In this model, treatment is based roughly on the distinc-
tion between a “new me” and an “old me.” The “old me” constitutes the indi-
vidual who committed sexual offenses and encompasses values, goals,
beliefs, and ways of living that directly generate offending behavior. The
construction of a “new me” involves the endorsement of a new set of goals
that specify a good life for the individual (i.e., a life in which important pri-
mary goods are achieved in ways that are socially acceptable and personally
fulfilling). The setting of new goals and ways of living highlights the internal
(i.e., skills, beliefs, attitudes) and the external (i.e., access to resources,
opportunities, social supports) conditions necessary to achieve them. Ther-
apy, then, is based on instilling the competencies required to meet the goals,
instituting the conditions, and structuring the environment in ways consistent
with living a more fulfilling life.

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Marshall et al. / CONSTRUCTIVE TREATMENT 1103

We believe clinicians ought to explicitly construct a conception of good

lives to guide the rehabilitation of each offender. The identification of indi-
viduals’ psychological dispositions or vulnerability factors causally related
to their offending is a first step in the assessment process. This provides infor-
mation on the internal and external obstacles that are frustrating the meeting
of basic human needs and, therefore, preventing the achievement of primary
human goods. Once this is done, it is necessary to construct a conception of
good lives that is tailored to each offender’s overarching good and to inquire
about the necessary conditions required to live a different kind of life. A con-
ception of human well-being should outline the primary goods to be
instantiated in good lives and the range of specific forms they can take. The
ordering or relationship between the various goods should also be described
and the internal and external conditions necessary for their attainment
explicitly noted.
The conception of a possible good life for an offender should also include
a concrete understanding of the possible ways of living that are realistic for
him or her. It should take note of each offender’s capabilities, temperament,
interests, skills, deep commitments (i.e., basic value system and preferred
ways of living in the world, for example, as a teacher or provider), and sup-
port networks. Thus, psychological, social, vocational, and environmental
factors are all explicitly incorporated within a model of human well-being in
a rehabilitation context. The emphasis of rehabilitation should be on goals
that are associated with basic human goods and that lead to valued outcomes.
This necessarily involves the instillation in the offender of knowledge, com-
petencies, strategies, and skills and the creation of opportunities to live better
kinds of lives. A significant overarching feature of this approach to offender
treatment is the instilling of optimism and hope for the future among the


Snyder (2000) has described research on hope theory that has relevance
for working more positively with sexual offenders (Moulden & Marshall,
2002). Frank (e.g., Frank, 1989; Frank & Frank, 1991), in fact, has suggested
that the enhancement of hope is the underlying factor that produces treatment
gains for all types of therapy and with all types of clients. Hope theory identi-
fies three crucial components to successful functioning: the establishment of
goals (in the present context, this would be the definition of a personalized
“good life”), the development of pathways to achieve those goals (i.e., the
establishment of the internal and external conditions necessary to achieve

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this good life), and the person’s belief that he or she is capable of achieving
these goals. The latter is called agentic thinking and is akin to Bandura’s
(1977) notion of self-efficacy.
When a pathway to a goal is blocked for whatever reason, clients may feel
frustrated or defeated. Hopeful individuals, on the other hand, can overcome
these blocks because they typically recognize multiple routes to any given
goal, and they believe they will succeed. Clients who are low in hope readily
feel discouraged when an obstacle blocks their chosen pathway to a goal, and
they simply give up. It is necessary, therefore, to enhance clients’ sense of
hope in order for them to succeed in achieving their goals and thereby benefit
from treatment. A significant aspect of enhancing hope in dysfunctional cli-
ents is not only to provide them with the skills (behavioral and cognitive),
beliefs, attitudes and values appropriate to achieving their good life, but also
to help them identify the multiple potential pathways to each of their goals so
that obstacles will not seem so insurmountable.
The task of therapists adopting a hope theory approach is to assist the cli-
ent in identifying a set of goals (optimally, those that will produce a good life)
and then breaking these down into a set of achievable subgoals. A set of mul-
tiple pathways to each of these subgoals is mutually identified, and training in
the skills necessary to enact the pathways should then be undertaken. The
skills essential to achieving the subgoals may be rehearsed in role plays
(Mann, Daniels, & Marshall, 2002) and then put into practice under condi-
tions that optimize the chances of success. Encouragement by the therapist
for each effort is essential to increase the client’s agentic thinking (i.e., self-
As we noted earlier, it is helpful to assist offenders to identify the goods or
goals they were attempting to achieve by offending. In doing so, it is impor-
tant for clinicians to find a language for discussing goals that is accessible to
clients. Haaven’s (1990) “Old me, New me” approach exemplifies the value
of finding appropriate terms. The typical responses to questions concerning
these goals (other than the all-too-common “I don’t know”) identify sexual
gratification, striking back at someone or some group (e.g., women), secur-
ing feelings of comfort, feeling in control, or exercising power over another
person. Each of these goals can be reinterpreted to reflect normative needs.
According to research on good lives, all people seek sexual satisfaction, feel-
ings of comfort, and some degree of power and control in their lives.
Nonaggressive people may not want to strike back at someone who has
offended them, but they will certainly want some form of redress even if just
an apology. Thus, each of the goals that sexual offenders seek in their abusive
behaviors is a goal they share in common with other people; it is simply the

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Marshall et al. / CONSTRUCTIVE TREATMENT 1105

pathways they choose to obtain these goals that are dysfunctional and hurtful
to others.
Reframing offending behavior as the selection of inappropriate pathways
helps offenders to see themselves as distinct from their specific abusive acts,
which shifts their feelings of shame (i.e., I am a bad person) to feelings of
guilt regarding these specific behaviors (i.e., I have done bad things).
Tangney and Dearing (2002) have shown that feelings of shame block
attempts at behavior change (“I am a bad person and therefore unchange-
able”), whereas guilt motivates change (“I did a bad thing, but I can stop
doing it”). Reframing offending behavior in this way encourages agentic
thinking, which is essential to the generation of hope and to the achievement
of treatment-defined goals.
Another way of looking at this issue is in terms of attribution theory. There
is considerable evidence (for a review, see Snyder & Higgins, 1988) that
internal, stable, global attributions (e.g., “I am a pervert”) are less likely to
lead to successful behavior change than are external, variable, specific attri-
butions (e.g., “I was drunk and angry”). Traditionally, sexual offender treat-
ment providers have encouraged offenders to see themselves as motivated in
their offending behavior by internal, stable, psychological drives. This may
not be the best way to facilitate behavior change.


Related to enhancing agentic thinking, and thereby instilling hope, is the

need to improve the client’s self-esteem. Agentic thinking, self-efficacy, and
self-esteem are psychologically related, although distinct, states. Because
they are related, however, we would expect that enhancing one would facili-
tate the enhancement of the others.
In a series of studies, Marshall and his colleagues (Marshall & Christie,
1982; Marshall, Christie, Lanthier, & Cruchley, 1982) developed a set of pro-
cedures for enhancing self-esteem. These procedures include increasing the
client’s frequency and range of both social and pleasurable activities, and
having them generate, and then repeatedly rehearse, a list of positive qualities
about themselves. In these early studies, nonoffending volunteers were
recruited from the community who complained of very low self-esteem.
Each of the procedures, both individually and collectively, produced dra-
matic increases in self-esteem after a brief 6-week period of practice. When
these procedures were collectively applied to a group of 81 child molesters,
whose self-esteem scores were over one standard deviation below the norma-

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tive mean, clear benefits were evident (Marshall, Champagne, Sturgeon, &
Bryce, 1997). As a result of these interventions, the self-esteem scores of
these child molesters approached the normative mean. In addition, it was
found that these improvements in self-esteem were significantly correlated
with reductions in deviant sexual interests as assessed by phallometry (Mar-
shall, 1997), greater empathy, enhanced intimacy, and lowered feelings of
loneliness (Marshall, Champagne, Brown, & Miller, 1997), as well as
improvements in the ability to cope with stress (Marshall, Cripps, Anderson,
& Cortoni, 1999). Clearly, increasing sexual offenders’ self-esteem has a
facilitating effect on most of the primary targets of sexual offender therapy.


Consistent with the literature on hope theory is the idea that future plans
for sexual offenders should be specified in terms of approach goals. Tradi-
tional relapse prevention has taken the form of specifying a list of “don’ts.”
Typically, relapse prevention plans consist of a list of people, places, and
activities to be avoided. Although it makes intuitive sense to direct child
molesters to avoid places where access to children is likely and to proscribe
alcohol use for a rapist whose offending was facilitated by intoxication, it
might be more effective to assist these offenders in designing an enjoyable
and productive lifestyle that is exclusive of drunkenness or contacts with
children. If child molesters are simply required to avoid children, then all we
have done is take away their only pathway to the goals they were achieving by
sexual offending without providing them with alternative prosocial pathways
for meeting their needs.
Mann (2000) has described her concern with traditional applications of
RP strategies. She noted that they fail to appeal to many sexual offenders (and
even produce resistance, in some cases) because of the apparently exclusive
focus on avoiding relapse. The assumption in many programs is that for
offenders, avoiding relapse is the most important goal. In fact, although
reducing reoffending rates is always the primary goal for the treatment pro-
vider, offenders themselves often have other priorities (Jones, 2002). Tradi-
tional RP programs can fail to engage offenders because they impose a pri-
mary goal on them rather than negotiating and agreeing on the goal of the
The psychology of goal-directed behavior (Emmons, 1996; Higgins,
1996) stresses that for a person to have maximal chances of achieving their
goals, certain conditions must be met. First, goals are easier to achieve if they
are ideal rather than “ought” goals (Higgins, 1996). Ideal goals are intrinsic

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Marshall et al. / CONSTRUCTIVE TREATMENT 1107

aspirations linked to the individual’s personal value base, whereas ought

goals are typically imposed from without and adopted by an individual in an
attempt to avoid criticism or disapproval. Second, “approach” goals are eas-
ier to achieve than are “avoidance” goals (Emmons, 1996). Approach goals
are positive aims people strive to achieve, whereas avoidance goals involve
strategies of denial. For example, “not putting on weight” would be an avoid-
ance goal, whereas “eating healthily” would be an approach goal. Persons
with a mainly approach goal orientation to life tend to be psychologically
healthier than are persons with a mainly avoidance orientation (Emmons,
Goals are also easier to achieve if the person believes they have what it
takes to be successful (Carver & Scheier, 1990). When obstacles are encoun-
tered on the path to goal achievement, the process is interrupted and the per-
son must reevaluate their chances of success if they continue working toward
the goal. Confidence or hopefulness is necessary for the effort toward the
goal to be sustained (Snyder, 2000). Such confidence is instilled when initial
attempts at goal achievement are structured so that the likelihood of success
is maximized. A positive success expectancy is linked to positive affect, such
as optimism, happiness, or hope; whereas a negative success expectancy is
likely to lead to negative affect, such as frustration or depression (Carver &
Scheier, 1990).
In addition, goals are easier to achieve if the person sees the learning pro-
cess as part of the goal, rather than equating success only with the final
achievement of a goal (Dweck & Leggatt, 1988). Thus, if a person attempting
to climb a mountain is thwarted by bad weather, they might be more likely to
make a second attempt if they consider the first to have been useful experi-
ence in their mountain-climbing career. The person who considers a thwarted
day to have been a pointless day, because they did not make it to the top, is
perhaps less likely to make a second attempt.
Bearing these considerations in mind, Mann (2000) suggested several
ways in which RP interventions could be reformulated in practice. The first
reformulation should be to change the term relapse prevention, which in
itself implies an avoidance goal. More approach-focused terminology would
be to emphasize what it is being achieved, such as self-management or
respectful living. Another example of how this principle can be applied is to
rename the modification of deviant arousal component of treatment to the
healthy sexual functioning component.
Other changes to RP should involve encouraging clients to select their
own, personally meaningful goals, in line with our earlier remarks con-
cerning personal goods and good lives. We have found that even the most
treatment-resistant sexual offenders will align themselves with goals such as

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“developing more successful intimate relationships.” Personal goods (as ear-

lier defined) are incompatible with offending, so that striving toward them
will inevitably mean striving away from offending. However, some offenders
(particularly adolescents) may need to be steered away from simply selecting
material goods as their primary goals. As we noted earlier, the definition of
primary goods needs to be comprehensive or the achievement of a personal-
ized good life will not occur. Again, Haaven’s “New me, Old me” approach
with developmentally delayed sexual offenders is an excellent example of an
approach-focused program (Haaven & Coleman, 2000; Haaven, Little, &
Petre-Miller, 1990).
A positive approach to RP also involves helping clients set subgoals and
celebrate their achievement. In addition, therapists must convey a sense of
hope and optimism for all their clients to encourage the development of self-
efficacy (agentic thinking) and a positive success expectancy about change.


Collaboration has not traditionally been seen as an effective way to work

with sexual offenders. Indeed, one influential clinical text has expressly
rejected such a notion, recommending that the therapist must impose the
goals of treatment (Salter, 1988). Although we agree that sexual offenders
often start treatment with goals quite different from those of the treatment
provider, we see collaboration as such an important element of a positive
approach to working with sexual offenders that we recommend it be adopted
at every stage of the assessment and treatment process. It should be clear that
defining the overall goal of a good life for each offender cannot be achieved
by the imposition of the therapist’s notion of what constitutes the good life.
Only by the collaborative effort of the client and therapist can such a person-
alized good life, as the goal of the therapy, be achieved.
Mann and Shingler (2001) have reviewed three relevant clinical litera-
tures (relapse prevention, cognitive therapy, and motivational interviewing)
and concluded that collaboration is, or should be, an essential component of
each approach. The term collaboration is defined as a practice in which the
therapist works with the client to define together the nature of the client’s
problems and to agree on a process for working toward solutions to the prob-
lems. It is our recommendation that the collaborative approach be adopted
right from the initial contact with the client.
We will illustrate this in the unlikely context of risk assessment. We say
unlikely context because most risk assessments are completed without the
client’s participation except as a potential source of information. It is only the

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Marshall et al. / CONSTRUCTIVE TREATMENT 1109

assessor who makes all the decisions and who comes to the conclusions
regarding risk.
Mann and Shingler (2001) offered a set of principles for applying the col-
laborative approach to risk assessment. These involve explaining the purpose
and methodology of risk assessment clearly, explaining and discussing how
the assessment could be beneficial to the client, explicitly stressing the asses-
sor’s commitment to working collaboratively, addressing negative reactions
openly, and asking the client to assess himself or herself. It is, of course,
important for assessors adopting this approach to be prepared to be transpar-
ent about their methods and nondefensive about their motives. Finally, in car-
rying out risk assessments and reporting on risk, assessors often forget to
describe the offender’s strengths and admirable qualities, or they are only
mentioned in a cursory way, while emphasizing risk factors and deficits.
Related to this is the need for assessors to be considerate in the language they
use to describe an offender. Referring to deficits, deviance, or dysfunctions
will alienate offenders, and such terms can be easily replaced with more neu-
tral alternatives, such as behavioral descriptors (e.g., “fantasies about sex
with children” rather than “deviant sexual fantasies”). Clinicians who have
followed Mann and Shingler’s principles have commented (sometimes with
surprise!) that these approaches revolutionized their relationships with
clients, including some of the most difficult or litigious men.


In putting all the above principles into practice, and for the effective
implementation of all facets of treatment, it is essential that the therapist
embodies those personal features or styles shown to maximize treatment
effectiveness. Although there is an extensive body of literature detailing the
features of effective therapists across all therapeutic orientations and for all
problem behaviors (Marshall, Fernandez, et al., in press), very little research
on these issues has been done within the context of sexual offender treatment.
Recently, however, attempts have been made to determine the influence of
therapist characteristics on treatment changes with sexual offenders. Beech
and Fordham (1997), for example, have shown that therapists adopting a
nonconfrontational, but nevertheless, challenging style, produce greater ben-
efits in their sexual offender clients than do those who are aggressively
In a series of studies, Marshall and colleagues (Marshall, Serran,
Fernandez, et al., in press; Marshall, Serran, Moulden, et al., in press; Serran,
Fernandez, Marshall, & Mann, in press) examined the relationship between

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various features of the style of sexual offender therapists and also the behav-
ior and attitude changes induced by treatment. These researchers were fortu-
nate to have access to videotapes of all treatment sessions conducted in vari-
ous English prisons during the past several years. Each program in each
prison followed the same detailed treatment manual, and the delivery of each
program was rigorously monitored by both in-house staff and an interna-
tional accreditation panel. In addition, each program employed the same set
of pre- and posttreatment measures that assessed a variety of relevant features
of the clients, such as attitudes, cognitive distortions, relationship styles,
loneliness, self-esteem, denial and minimizations, and other important char-
acteristics. Thus, the only feature of these programs that could vary was the
way the therapists delivered the program, although even this was constrained
in the degree to which it could vary by the monitoring processes. Neverthe-
less, sufficient variability was evident in the therapists’ behavior to allow an
examination of the influence of various features of the therapists on the
treatment-induced changes.
From Marshall et al.’s (as cited above) studies, clear evidence that con-
frontational styles had a negative impact emerged. The therapist features that
clearly facilitated change on the measures were displays of empathy and
warmth by the therapist, encouragement and rewards for progress, and some
degree of directiveness. Of course, these are just the features we would
expect to facilitate the enhancement of the clients’ self-esteem, hope, self-
efficacy, and the identification of a positive future lifestyle that includes
pathways to the good life.


We believe that if sexual-offender therapists adopt a positive therapeutic

style (empathic, warm, rewarding, and directive) within the context of col-
laboratively developing a good-lives plan with their client, treatment benefits
will be maximized. We propose that within such a program, instilling hope in
the clients, enhancing their self-efficacy (or agentic thinking) and their self-
esteem, and developing approach goals will further facilitate treatment bene-
fits and thereby reduce the future likelihood of reoffending.


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William L. Marshall is a professor emeritus of psychology and psychiatry at Queen’s

University, Canada, and the director of Rockwood Psychological Services, Kingston,
Ontario, which provides sexual offender treatment in two Canadian federal penitentia-
ries. He has 35 years experience in assessment, treatment, and research with sexual
offenders. He has more than 300 publications, including 16 books. He was president of
the Association for the Treatment of Sexual Abusers from 2000 to 2001, and he was
granted the Significant Achievement Award of that association in 1993. In 1999, he
received the Santiago Grisolia Prize from the Queen Sophia Centre in Spain for his
worldwide contributions to the reduction of violence, and in 2000, he was elected a Fel-
low of the Royal Society of Canada. In 2003, he was one of six invited experts who were
asked to advise the Vatican on how best to deal with sexual abuse within the Catholic

Tony Ward, Ph.D., M.A. (Hons), DipClinPsyc, is a clinical psychologist by training and
has been working in the clinical and forensic field since 1987. He was formerly the direc-
tor of the Kia Marama Sexual Offenders’ Unit at Rolleston Prison in New Zealand and
has taught both clinical and forensic psychology at Victoria, Canterbury, and Melbourne
Universities. He is currently the Director of Clinical Training at Victoria University of
Wellington. His research interests fall into five main areas: rehabilitation models and
issues, cognition and sex offenders, the problem behavior process in offenders, the impli-
cations of naturalism for theory construction and clinical practice, and assessment and
case formulation in clinical psychology. He has published more than 150 journal arti-
cles, books, and book chapters.

Ruth E. Mann leads the sex offender assessment and treatment strategy for H.M. Prison
Service. She is responsible for program design, implementation, monitoring, and
research. She has 18 years experience of developing treatment services for sexual offend-
ers. Her research interests include dynamic risk assessment, cognitive factors in sexual
offending, and positive and motivational approaches to treatment.

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Heather Moulden is currently completing her doctoral degree in clinical psychology at

the University of Ottawa in Ontario, Canada. She is also employed at Rockwood Psycho-
logical Services where she provides treatment to sexual offenders. Her research interests
include social competence and sexual offending, the impact of preparatory programs for
sexual offenders, and effective treatment intervention.

Yolanda M. Fernandez graduated with a Ph.D. in clinical and forensic psychology in

2001 from Queen’s University in Kingston, Ontario. As a registered psychologist, she
currently holds the position of regional coordinator of Sexual Offender Treatment Pro-
grams within Correctional Services of Canada at the Millhaven Assessment Unit. Previ-
ously, she spent a year working as a psychologist in the maximum-security unit at
Millhaven Institution. She has also worked as the clinical director of Rockwood Psycho-
logical Services and the clinical director of the Sexual Offender Treatment Program
located at Bath Institution (a medium-security federal penitentiary). In 1999, she
designed a training package to teach effective therapist skills to clinicians working with
sexual offenders. She has provided this training within Canada, the United States, and
several European countries. In addition to her clinical work, Yolanda is an active
researcher who currently has several presentations at international conferences and has
more than 20 publications. Her publications include an edited book, two coauthored
books, and three coedited books. Her research interests include therapeutic process in
sexual offender treatment, empathy deficits in sexual offenders, and phallometric testing
with sexual offenders. She has been an active member of the Association for the Treat-
ment of Sexual Abusers since 1996, including 2 years as the student representative to the
Board of Directors.

Geris Serran, Ph.D., graduated with a doctoral degree in clinical psychology from the
University of Ottawa in 2003. She is currently employed at Rockwood Psychological Ser-
vices where she works as the senior therapist of the Bath Institution Sexual Offenders’
Program. In addition to her clinical work, her research interests include therapeutic pro-
cess, coping strategies, and treatment of sexual offenders. She has authored several book
chapters, journal articles, and presentations at international conferences in these

Liam E. Marshall received his master’s degree in psychology from Queen’s University in
Kingston, Canada. He is currently enrolled in the doctoral program in the Department of
Psychology at Queen’s University. He has been the graduate student representative on
the Queen’s University Psychology Department Ethics, Headship, and Departmental
committees. He has worked directly with sexual offenders in correctional settings for
more than 9 years. He is the lead therapist for the Millhaven Institution Sexual Offenders’
Preparatory Program and is also a therapist for the Bath Institution Sexual Offenders’
Moderate-Intensity, Deniers, and Maintenance programs. He has trained therapists in
the delivery of sexual offender programming for the British, Scottish, Australian, New
Zealand, and Canadian prison services. He is currently on the editorial board of the
Journal of Sexual Addiction and Compulsivity. He has a number of publications, includ-
ing an in-press book and an edited book, on a variety of issues relevant to sexual

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