Sexual Deviation

  • Yolanda M. Fernandez
  • Ruth E. Mann
Reference work entry


Working with sexually deviant clients is a challenging and potentially anxiety provoking endeavour for any clinician. However, it is possible that clinicians working in various settings will eventually be faced with a client who discloses issues with sexual deviance. The types of problems that sexually deviant clients present span a broad range of issues and necessarily require clinicians with strong and varied therapeutic skills. Some clinicians may find this to be a clinical challenge while others may feel the required breadth of skills is an impediment to effective therapeutic intervention. This chapter will review the suggested basic competencies considered important to working with sexually deviant clients. Basic competencies include understanding normative sexual behaviours, using Socratic questioning, using behavioural techniques, generalizing changes in thinking to outside the treatment environment, using group process, and skills for co-facilitation. The chapter moves on to describe competencies that are considered more sophisticated, or “expert” to this line of work. Expert competencies include general therapeutic skill level, interpersonal skills, understanding and accepting clients, using positive language, instilling hope in clients, working collaboratively with clients and personal resilience. Finally, suggestions are made as to how clinicians might move from basic to expert competency.


Sexual Arousal Deviant Behavior Cognitive Distortion Avoidance Goal Child Molester 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abel, G. G., Becker, J. V., Mittelman, M. S., Cunningham-Rathner, J., Rouleau, J. J., & Murphy, W. D. (1987). Self-reported sex crimes of nonincarcerated paraphiliacs. Journal of International Violence, 2, 3–25.CrossRefGoogle Scholar
  2. Abracen, J. & Looman, J. (2004). Issues in the treatment of sexual offenders. Aggression and Violent Behavior, 9, 229–246.CrossRefGoogle Scholar
  3. Ackerman, S. J. & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1–33.PubMedCrossRefGoogle Scholar
  4. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  5. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev). Washington, DC: American Psychiatric Association.Google Scholar
  6. Andrews, D. A. & Bonta, J. (1998). The psychology of criminal conduct, (2nd ed.). Cincinnati, OH: Anderson.Google Scholar
  7. Annis, H. M. & Chan, D. (1983). The differential treatment model: Empirical evidence from a personality typology of adult offenders. Criminal Justice and Behavior, 10, 159–173.CrossRefGoogle Scholar
  8. Beck, A. T., Rush, P. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy for depression. New York: Guilford.Google Scholar
  9. Beech, A. (1997). Towards a psychometric typology for assessing pre-treatment levels of problems in child abusers. Journal of Sexual Aggression, 3, 87–100.CrossRefGoogle Scholar
  10. Beech, A. & Fordham, A. S. (1997). Therapeutic climate of sexual offender treatment programs. Sexual Abuse:A Journal of Research and Treatment, 9, 219–237.Google Scholar
  11. Beech, A. R. & Hamilton-Giachritsis, C. E. (2005). Relationship between therapeutic climate and treatment outcome in group-based sexual offender treatment programs. Sexual Abuse: A Journal of Research and Treatment, 17, 127–140.Google Scholar
  12. Blumenthal, S., Gudjonsson, G., & Burns, J. (1999). Cognitive distortions and blame attribution in sex offenders against adults and children. Child Abuse and Neglect, 23, 129–143.PubMedCrossRefGoogle Scholar
  13. Bouton, M. E. (1994). Conditioning, remembering, and forgetting. Journal of Experimental Psychology: Animal Behavior Processes, 20, 219–231.CrossRefGoogle Scholar
  14. Bumby, K. (1995). Assessing the cognitive distortions of child molesters and rapists: Development and validation of the RAPE and MOLEST scales. Sexual Abuse: A Journal of Research and Treatment, 8, 37–54.Google Scholar
  15. Cortoni, F. A. & Hanson, R. K. A review of the recidivism rates of adult female sexual offenders (Research Report No. R-169). Ottawa: Correctional Service of Canada.Google Scholar
  16. Cox, W. M., Klinger, E., & Blount, J. P. (1991). Alcohol use and goal hierarchies: Systematic motivational counseling for alcoholics. In Miller, W. R. & Rollnick, S. (Eds.), Motivational interviewing: Preparing people to change addictive behavior (pp. 260–271). New York: Guilford.Google Scholar
  17. Craissati, J. & Beech, A. (2003). A review of dynamic variables and their relationship to risk prediction in sex offenders. Journal of Sexual Aggression, 9, 41–55.CrossRefGoogle Scholar
  18. Crawford, D. (1981). Treatment approaches in pedophiles. In Cook, M. & Howells, K. (Eds.), Adult sexual interest in children (pp. 181–217). London: Academic.Google Scholar
  19. Davin, P. A., Hislop, J. C. R., & Dunbar, T. (1999). Female sexual abusers. Brandon, VT: Safer Society Press.Google Scholar
  20. Deci, E. L. & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determina-tion of behavior. Psychological Inquiry, 11, 227–268.CrossRefGoogle Scholar
  21. Drapeau, M. (2005). Research on the processes involved in treating sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 17, 117–125.Google Scholar
  22. Egan, G. (1970). Encounter: Group processes for interpersonal growth. Pacific Grove, CA: Brooks/Cole.Google Scholar
  23. Egan, G. (1998). The skilled helper: A problem-management approach to helping. Pacific Grove, CA: Brooks/Cole.Google Scholar
  24. Emmons, R. A. (1996). Striving and feeling: Personal goals and subjective well being. In Gollwitzer, P. M. & Bargh, J. A. (Eds.), The psychology of action (pp. 313–337). New York: Guilford.Google Scholar
  25. Falls, W. A. (1998). Extinction: A review of theory and the evidence suggesting that memories are not erased with nonreinforcement. In O’Donohue, W. (Ed.), Learning and behavior therapy (pp. 205–229). Boston, MA: Allyn & Bacon.Google Scholar
  26. Fink, P. J. & Tasman, A. (Eds.). (1992). Stigma and mental illness. Washington, DC: American Psychiatric Press.Google Scholar
  27. Firestone, P., Bradford, J. M., Greenburg, D. M., Larose, M. R., & Curry, S. (1998). Recidivism factors in convicted rapists. Journal of the American Academy of Psychiatry and Law, 26, 185–200.Google Scholar
  28. Fisher, D., Beech, A., & Browne, K. (1993). Locus of control and its relationship to treatment change and abuse history in child sexual abusers. Legal and Cri-minological Psychology, 3, 1–12.CrossRefGoogle Scholar
  29. Frank, J. D. (1971). Therapeutic factors in psychotherapy. American Journal of Psychotherapy, 25, 350–361.PubMedGoogle Scholar
  30. Frank, J. D. (1989). Non-specific aspects of treatment: The view of the psychotherapist. In Sheppherd, M. & Satorius, N. (Eds.), Non-specific aspects of treatment (pp. 95–114). Toronto, Canada: Hans Huber.Google Scholar
  31. Garlick, Y., Marshall, W. L., & Thornton, D. (1996). Intimacy deficits and attribution of blame among sexual offenders. Legal and Criminological Psychology, 1, 251–258.CrossRefGoogle Scholar
  32. Gebhard, G. H., Gagnon, J. H., Pomeroy, W. B., & Christenson, C. V. (1965). Sex offenders: An analysis of types. New York: Harper & Row.Google Scholar
  33. Gollwitzer, P. M. & Bargh, J. A. (Eds.). (1996). The psychology of action. New York: Guilford.Google Scholar
  34. Groth, A. N. (1979). Men who rape: They psychology of the offender. New York: Plenum.Google Scholar
  35. Hanson, R. K. (2000). Treatment outcome and evaluation problems (and solutions). In Laws, D. R., Hudson, S. M., & Ward, T. (Eds.), Remaking relapse prevention with sexual offenders (pp. 485–499). Thousand Oaks, CA: Sage.Google Scholar
  36. Hanson, R. K. & Bussière, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348–362.PubMedCrossRefGoogle Scholar
  37. Hanson, R. K., Gizzarelli, R., & Scott, H. (1994). The attitudes of incest offenders: Sexual entitlement and acceptance of sex with children. Criminal Justice and Behavior, 21, 187–202.CrossRefGoogle Scholar
  38. Hanson, R. K. & Harris, A. J. R. (2000). Where should we intervene? Dynamic risk predictors of sexual offence recidivism. Criminal Justice and Behavior, 27, 6–35.CrossRefGoogle Scholar
  39. Hanson, R. K. & Morton-Bourgon, K. (2004). Predictors of sexual recidivism: An updated meta-analysis. Research report 2002–02, Public Safety and Emergency Preparedness Canada.Google Scholar
  40. Jennings, J. L. & Sawyer, S. (2003). Principles and techniques for maximizing the effectiveness of group therapy with sex offenders. Sexual Abuse: A Journal of Research and Treatment, 15, 251–267.Google Scholar
  41. Kazdin, A. E. (1978). History of behavior modification: Experimental foundations of contemporary research. Baltimore, MD: University Park Press.Google Scholar
  42. Kleinke, C. L. (1994). Common principles of psychotherapy. Pacific Grove, CA: Brooks/Cole.Google Scholar
  43. Knight, R. A. & Prentky, R. A. (1990). Classifying sexual offenders: The development and corroboration of taxonomic models. In Marshall, W. L., Laws, D. R., & Barbaree, H. E. (Eds.), Handbook of sexual abuse: Issues, theories, and treatment of the offender (pp. 23–52). New York: Plenum.Google Scholar
  44. Kohlenberg, R. J. & Tsai, M. (1994). Functional analytic psychotherapy: A guide for creating intense and curative therapeutic relationships. New York: Plenum.Google Scholar
  45. Kohut, H. (1990). The role of empathy in psychoanalytic cure. In Langs, R. (Ed.), Classics in psychoanalytic techniques (rev. ed., pp. 463–473). Northvale, NJ: Aronson.Google Scholar
  46. Lambert, M. J. (1983). Comment on “A case study of the process and outcome of time-limited counselling”. Journal of Counseling Psychology, 30, 22–25.CrossRefGoogle Scholar
  47. Lambert, M. J. (1989). The individual therapist’s contribution to psychotherapy process and outcome. Clinical Psychology Review, 9, 469–485.CrossRefGoogle Scholar
  48. Langevin, R. (2006). Acceptance and completion of treatment among sex offenders. International Journalof Offender Therapy and Comparative Criminology, 50, 402–417.CrossRefGoogle Scholar
  49. Langstrom, N. & Hanson, R. K. (2006). High rates of sexual behavior in the general population: correlates and predictors. Archives of Sexual Behavior, 35, 37–52.PubMedCrossRefGoogle Scholar
  50. Laws, D. R. & O’Donohue, W. T. (2008). Introduction. In Laws, D. R. & O’Donohue, W. L. (Eds.), Sexual deviance: Theory, Assessment and Treatment (2nd ed., pp. 1–20). New York: Guilford.Google Scholar
  51. Leicht, S. K. C. (2008). The impact on professionalsof working with sex offenders. In Houston, J. & Galloway, S. (Eds.), Sexual offending and mental health (pp. 263–279). London: Jessica Kingsley.Google Scholar
  52. Levenson, J. A. (2004). Reliability of sexually violent predator civil commitment criteria. Law and Human Behavior, 28, 357–368.PubMedCrossRefGoogle Scholar
  53. Logan, C. (2008). Sexual deviance in females: Psychopathology and theory. In Laws, D. R. & O’Donohue, W. L. (Eds.), Sexual deviance: Theory, Assessmentand Treatment (2nd ed., pp. 486–507). New York: Guilford.Google Scholar
  54. Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive/expressive treatment. New York: Basic Books.Google Scholar
  55. Malamuth, N. M. & Brown, L. M. (1994). Sexually aggressive men’s perceptions of women’s communications: Testing three explanations. Journal of Personality and Social Psychology, 67, 699–712.PubMedCrossRefGoogle Scholar
  56. Maletzky, B. M. (1993). Factors associated with success and failure in the behavior and cognitive treatment of sexual offenders. Annals of Sex Research, 6, 241–258.CrossRefGoogle Scholar
  57. Maletzky, B. M. (1998). The paraphilias: research and treatment. In Nathan, P. E. & Gorman, J. M. (Eds.), A guide to treatments that work (pp. 472–500). New York: Oxford University Press.Google Scholar
  58. Maletzky, B. M. (1999). Groups of one. Sexual Abuse: A Journal of Research and Treatment, 11, 179–181.Google Scholar
  59. Mann, R. E. (2000). Managing resistance and rebellion in relapse prevention intervention. In Laws, D. R., Hudson, S. M., & Ward, T. (Eds.), Remaking relapse prevention with sex offenders (pp. 187–200). Thou-sand Oaks, CA: Sage.Google Scholar
  60. Mann, R. E. (2005). An investigation of the role, nature and influence of schemas in sexual offending. Unpublished doctoral dissertation, University of Leicester.Google Scholar
  61. Mann, R. E., Hanson, R. K., & Thornton, D. (2008, October). What should be assessed in sexual offender risk assessment? Paper presented at the conference of the Association for the Treatment of Sexual Abusers, Atlanta, GA.Google Scholar
  62. Mann, R. E., Webster, S. D., Schofield, C., & Marshall, W. L. (2004). Approach versus avoidance goals in relapse prevention with sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 16, 65–75.Google Scholar
  63. Mann, R. E., Webster, S. D., Wakeling, H. C., & Marshall, W. L. (2007). The measurement and influence of child abuse supportive beliefs. Psychology, Crime & Law, 13, 443–458.CrossRefGoogle Scholar
  64. Marques, J. K., Wiederanders, M., Day, D. M., Nelson, C., & van Ommeran, A. (2005). Effects of a relapse prevention program on sexual recidivism: Final results from California’s Sex Offender Treatment and Evaluation Project (SOTEP). Sexual Abuse: A Journal of Research and Treatment, 17, 79–107.Google Scholar
  65. Marshall, W. L. (2006). Diagnostic problems with sexual offenders. In Marshall, W. L., Fernandez, Y. M., Marshall, L. E., & Serran, G. A. (Eds.), Sexual offender treatment: Controversial issues (pp. 33–43). Chich-ester, UK: Wiley.Google Scholar
  66. Marshall, W. L., Anderson, D., & Fernandez, Y. M. (1999). Cognitive behavioral treatment of sexual offenders. Chichester, UK: Wiley.Google Scholar
  67. Marshall, W. L. & Fernandez, Y. M. (2003). Phallometric testing with sexual offenders: Theory, research, and practice. Brandon, VT: Safer Society Press.Google Scholar
  68. Marshall, W. L. & Hambley, L. S. (1996). Intimacy and loneliness and their relationship to rape myth acceptance and hostility toward women among rapists. Journal of Interpersonal Violence, 11, 586–592.CrossRefGoogle Scholar
  69. Marshall, W. L., Kennedy, P., Yates, P., & Serran, G. A. (2002). Diagnosing sexual sadism in sexual offenders: Reliability across diagnosticians. International Journal of Offender Therapy and Comparative Criminology, 46, 668–676.PubMedCrossRefGoogle Scholar
  70. Marshall, W. L. & Marshall, L. E. (2000). The origins of sexual offending. Trauma, Violence and Abuse, 1, 250–263.CrossRefGoogle Scholar
  71. Marshall, W. L., Serran, G., Fernandez, Y. M., Mulloy, R., Mann, R., & Thornton, D. (2003). Therapist characteristics in the treatment of sexual offenders: Tentative data on their relationship with indices of behavior change. Journal of Sexual Aggression, 9, 25–30.CrossRefGoogle Scholar
  72. Marshall, W. L., Serran, G., Moulden, H., Mulloy, R., Fernandez, Y. M., Mann, R., & Thornton, D. (2002). Therapist features in sexual offender treatment: Their reliable identification and influence on behavior change. Clinical Psychology and Psychotherapy, 9, 395–405.CrossRefGoogle Scholar
  73. Maruna, S. & Mann, R. E. (2006). A fundamental attribution error: Rethinking cognitive distortions. Legal and Criminological Psychology, 11, 155–177.CrossRefGoogle Scholar
  74. McConaghy, N. (2005). Sexual dysfunctions and disorders. In Maddux, J. E. & Winstead, B. A. (Eds.), Psychopathology: Foundations for a contemporary understanding (pp. 255–280). Mahwah, NJ: Erlbaum.Google Scholar
  75. McGuire, R. J., Carlisle, J. M., & Young, B. G. (1965). Sexual deviations as conditioned behavior: A hypothesis. Behavior Research and Therapy, 3, 185–190.CrossRefGoogle Scholar
  76. McMurran, M. (2002). Motivating offenders to change: A guide to enhancing engagement in therapy. Chichester, UK: Wiley.CrossRefGoogle Scholar
  77. Miller, W. R. & Rollnick, S. (Eds.). (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford.Google Scholar
  78. Nisbett, R. E. & Ross, L. (1980). Human inference: Strategies and shortcomings of social judgment. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  79. Piper, W. E., Doan, B. D., Edwards, E. M., & Jones, B. D. (1979). Cotherapy behavior, Group therapy process, and treatment outcome. Journal of Consulting and Clinical Psychology, 47, 1081–1089.PubMedCrossRefGoogle Scholar
  80. Roger, D. (1995). Emotion control, coping strategies and adaptive behavior. Stress and Emotion, 15, 255–264.Google Scholar
  81. Rogers, C. R. (1975). Empathic: An unappreciated way of being. Counseling Psychologist, 5, 2–10.CrossRefGoogle Scholar
  82. Rutan, J. S. & Stone, W. N. (1993). Psychodynamic group psychotherapy (2nd ed.). New York: Guilford.Google Scholar
  83. Safer Society Press. (2000). North American survey of sexual abuser treatment and models summary. Brandon, VT: Safer Society Press.Google Scholar
  84. Saunders, M. (1999). Clients’ assessments of the affective environment of the psychotherapy session: Relationship to session quality and treatment effectiveness. Journal of Clinical Psychology, 55, 597–605.PubMedCrossRefGoogle Scholar
  85. Seghorn, T. & Cohen, M. (1980). The psychology ofthe rape assailant. In Cerran, W., McGarry, A. L., & Petty, C. (Eds.), Modern legal medicine, psychiatry, and forensic science (pp. 533–551). Philadelphia, PA: F.A. Davis.Google Scholar
  86. Seligman, L. (1990). Selecting effective treatment. San Francisco, CA: Jossey-Bass.Google Scholar
  87. Serran, G., Fernandez, Y., Marshall, W. L., & Mann, R. E. (2003). Process issues in treatment: Application to sexual offender programs. Professional Psychology: Research and Practice, 34, 368–374.CrossRefGoogle Scholar
  88. Seto, M. C. & Lalumiere, M. L. (2001). A brief screening scale to identify paedophilic interests among child molesters. Journal of Sexual Abuse and Treatment, 13, 15–25.Google Scholar
  89. Shingler, J. & Mann, R. (2006). Collaboration in clinical work with sexual offenders: Treatment and risk assessment. In Marshall, W. L., Fernandez, Y. M., Marshall, L. E., & Serran, G. A. (Eds.), Sexual Offender Treatment: Controversial Issues (pp. 225–239). Chichester, UK: Wiley.Google Scholar
  90. Snyder, C. R. (2000). Handbook of hope: Theory, measures, and applications. New York: Academic.Google Scholar
  91. Spiegler, M. D. & Guevremont, D. C. (1998). Contemporary behavior therapy (3rd ed.). Pacific Grove, CA: Brooks/Cole.Google Scholar
  92. Tangney, J. P. & Dearing, R. L. (2002). Shame and guilt. New York: Guilford.Google Scholar
  93. Thornton, D. (2002). Constructing and testing a framework for dynamic risk assessment. Sexual Abuse: A Journal of Research and Treatment, 14, 139–153.Google Scholar
  94. Thornton, D., Beech, A. R., & Marshall, W. L. (2004). Pre-treatment self-esteem and posttreatment sexual recidivism. International Journal of Offender Therapy and Comparative Criminology, 48, 587–599.PubMedCrossRefGoogle Scholar
  95. Underhill, J., Wakeling, H. C., Mann, R. E., & Webster, S. D. (2008). Male sexual offenders’ emotional openness with men and women. Criminal Justice and Behavior, 35, 1156–1173.CrossRefGoogle Scholar
  96. Ward, T. (2002). Good lives and the rehabilitation of offenders: Promises and problems. Aggression and Violent Behavior: A Review Journal, 7, 513–528.CrossRefGoogle Scholar
  97. Ward, T. & Hudson, S. M. (2000). A self-regulation model of relapse prevention. In Laws, D. R., Hudson, S. M., & Ward, T. (Eds.), Remaking relapse prevention with sex offenders: A sourcebook. Thousand Oaks, CA: Sage.Google Scholar
  98. Ward, T. & Marshall, W. L. (2004). Good lives, aetiology and the rehabilitation of sex offenders: A bridging theory. Journal of Sexual Aggression, 10, 153–169.CrossRefGoogle Scholar
  99. Ward, T. & Stewart, C. A. (2003). Good lives and the rehabilitation of sexual offenders. In Ward, T., Laws, D. R., & Hudson, S. M. (Eds.), Sexual deviance: Issues and controversies (pp. 21–44). Thousand Oaks, CA: Sage.Google Scholar
  100. Williams, S. (1995). Sex offender assessment guidelines. In Leis, T. A., Motiuk, L. L., & Ogloff, J. R. P. (Eds.), Forensic psychology: Policy and practice in corrections (pp. 122–131). Correctional Services of Canada, Ottawa, Ontario.Google Scholar
  101. Wilson, R. J. (1999). Emotional congruence in sexual offenders against children. Sexual Abuse: A Journal of Research and Treatment, 11, 33–47.Google Scholar
  102. Yalom, I. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic Books.Google Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • Yolanda M. Fernandez
    • 1
  • Ruth E. Mann
    • 2
  1. 1.Millhaven InstitutionBathCanada
  2. 2.National Offender Management ServiceLondonUK

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