Religious, legal and other social sanctions, in addition to physical interventions such as surgical castration, have been implemented for thousands of years in an attempt to contain sexual behaviour. During the second half of the last century specific pharmacotherapies and psychotherapies were introduced in the treatment of sexual disorders and the management of sex offenders, with varying degrees of success. Testosterone lowering medications and selective serotonin reuptake inhibitors have largely replaced surgical castration and are now successfully used to suppress sexual drive, thereby assisting patients in controlling deviant sexual behaviours. At the same time, several different types of psychotherapy have been utilised, with a form of Cognitive Behavioural Therapy based on Relapse Prevention (developed initially to treat addictive disorders) now being the predominant psychological treatment for sex offenders within criminal justice systems with at best limited evidence to date supporting its effectiveness. With the recent introduction of preventative detention legislation for sex offenders in several jurisdictions including Australia, the various treatment options available for sex offenders and the impact of these treatments on issues of risk assessment and risk management must inevitably come under greater scrutiny. This paper critically evaluates the current evidence for the effectiveness of the pharmacotherapies and specific psychotherapies used alone and in combination for sex offenders and patients diagnosed with a paraphilia. Implications of this evidence on policy, including the funding and structure of treatment programs for sex offenders, will be discussed. Ethical issues in the delivery of these treatments within the criminal justice system will be considered. Future directions of much needed but ethically challenging research in this area will be proposed.
Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007
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