That assessment needs to include the patient's psychological history, his capacity for victim empathy, and his willingness to change, including compliance with treatment and the integration of all levels of recovery.
Other factors that can come into play include:
- The patient's mental health status. Is he mentally able to participate in treatment? Blocks may include psychotic breaks, levels of dissociation, and antisocial traits.
- Socioeconomic limits. Does he have a means of transportation to get to treatment?
- Organic brain damage, the causes of which may include excessive drug use or head injury.
- Cognitive functioning. Does he have the mental capacity to follow complex thought patterns and insight orientation? Is he able to connect his process to an emotional internal world?
One effective tool, "the typologies of offenders," was introduced in 1979 by Dr. Nicolas Groth. He divided sex offenders into two categories. The first is the regressed, or situational, offender. These individuals are more impulsive; their triggers for acting out are usually external and related to stress, such as getting a bad review at work or having a fight with their parent. Their offending behaviors usually fall in Level Two.
The second typology is the fixated offender. These offenders are less impulsive, planning their offenses over time. They are usually not under the influence of mood-altering chemicals, and their behaviors fall in Level Three.
The treatment outcome for the regressed, or situational, offenders who are motivated in treatment is usually positive. Often the regressed offender started acting out with legal behaviors but progressed into illegal behaviors. These patients usually have the capacity for victim empathy, can feel remorse, and, once the consequences are steep enough, are willing to work in a treatment program.
For the fixated offender, there has usually been no progression in the offending behaviors. Their offensive behaviors have remained constant over time, and often there is little to no victim empathy. The treatment modality for these clients is slightly different; the focus often is on building remorse, victim empathy, behavioral tasks, and accountability.
It is important these wounded and suffering individuals receive the treatment they need, that our culture recognize the prevalence of sexual perpetration's, and that we challenge ourselves to face the issue from an educated, rather than a purely reactive, stance. As a culture, we must collectively address these devastating behaviors, but rather challenges our paradigm, calling for continued explorations and answers that serve to promote positive and life-affirming actions.