The treatment techniques provided by therapists in the clinic have strong research support. Specifically, we are guided by the Good Lives and Self-Regulation-R Models, along with methods derived from behavioral, cognitive, biological and social learning theories. Indeed therapists in the clinic endorse a holistic approach to the treatment of sexual behavior problems that includes: offense progression, self-regulation, social skills development, and arousal reconditioning. These methods produce observable, measurable changes in thinking and behavior that are associated with a significant reduction in risk.
Although the primary objective of treatment is to reduce the risk of sexual offense, the clinic also provides support to the families of its clients. Assessment and treatment for survivors is also provided. Whenever appropriate, family reunification is facilitated.
An additional objective is to provide education to the public about sexual abuse and the treatment of offenders. This is accomplished through public speaking engagements and seminars.
_When an individual is referred to the clinic, he or she is seen for an initial evaluation by Dr. Steinhauser. In preparation for the psychosocial evaluation, Dr. Steinhauser reviews police reports, the pre-sentence investigation, and prior psychological evaluations. Then, she interviews the prospective client, develops a treatment plan and assesses risk and motivation. The final report may include recommendations for a penile plethysmograph assessment, viewing time test, polygraph examination, psychological testing or psychiatric evaluation.
Thereafter, the client is referred to an orientation group, a specialized group or to a therapist within the clinic best suited to provide individualized treatment. Both group and individual therapy are provided to most clients as group alone may be insufficient to address his or her unique needs.
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Treatment at the clinic is guided by the Good Lives and Self-Regulation-R Models:
The first phase of treatment includes providing information about, and preparation for treatment, as well as activities designed to improve self-management.
The second phase consists of helping clients identify relevant and formative life events that shape their beliefs, attitudes, emotions, cognitive schemas, and behaviors. One or more of these factors may have predisposed the individual, “the old me”, to offend. Additionally, the therapist will assist the client in exploring his or her goals and values, with a focus on self-regulation capacity, “the new me”.
The third phase of treatment consists of identifying the client’s offense progression. Specifically, the client needs to identify what he or she hopes to obtain through offending. The therapist may then help the client manage factors that contributed to offending and to practice healthy alternatives.
The final phase of treatment involves monitoring the implementation of the Good Lives and Self-Regulation-R Models. This entails identification of dynamic risk factors and the development of positive goals for living an offense-free life. Above all, in order for treatment to be effective, it must be relevant to the individual client.
Some of the treatments employed in the clinic include cognitive and behavioral methods. Educational modules include identification of thinking errors and dysfunctional schemas, cognitive restructuring, offense progression, self-regulation, effects of victimization, assertiveness training, empathy training, problem solving, behavioral contracting, anger management, sex education, and the development of social competence.
Behavioral methods are a vital part treatment as well and target the association between inappropriate sexual fantasies and behavior. These interventions may include assisted covert sensitization; aversive conditioning using foul odors, tastes and visual stimuli; minimal arousal conditioning; plethysmographic biofeedback; masturbatory satiation; masturbatory fantasy change; vicarious sensitization; sexual impulse control training; alternative behavior completion; thought-stopping and rational disputing; and negative practice.
Although our treatment methods are guided by cognitive-behavioral theory, we do not rigidly adhere to these techniques. In practice, we are flexible and utilize a wide variety of interventions. For example, some clients respond better to a supportive approach while others may need family counseling or assistance with referrals to community agencies. Most clients participate in a combination of individual and group therapy. Group assignment is based upon the client’s risk, needs, responsivity and type of offense.
The clinic employs the most recent advances in computerized technology to provide evaluation services, including the Monarch-21 ™ plethysmograph system (www.btimonarch.com) and the Abel Assessment for sexual interest-2 ™ (www.abelscreening.com). Results from these assessments are used to develop an individualized treatment plan.
Early in treatment, the plethysmograph or Abel Assessment may be used to determine the client’s sexual response patterns and the extent, if any, of deviant arousal or interest. The state-of-the-art plethysmograph simultaneously monitors the client’s penile responses, respirations and galvanic skin response to detect response suppression. The system also has built-in anti-faking methodology to enhance the internal validity of the data results and more accurately assess the risk of recidivism.
The plethysmograph may be utilized as a biofeedback instrument during arousal reconditioning sessions, including computerized vicarious sensitization. Periodic plethysmographs or Abel Assessments allow the therapist and client to evaluate the effectiveness of treatment in reducing deviant sexual arousal or interest.
No single program exists, however; each client is unique and requires a blend of education, cognitive restructuring, arousal reconditioning, behavioral self-management, and referrals to community-based social support systems. The efficacy of treatment is verified by client self-report, feedback from significant others, polygraph testing, pre- and post-plethysmograph and Abel Assessment results.
_After-care and Follow-up
_Following the completion of active treatment, clients are required to participate in a monthly after-care group for one year. Certain clients may chose to, or may be more appropriate for individual after-care. Thereafter, clients may chose to participate in continued after-care at no charge. Since maintenance of treatment gains is critical to continued success, clients are also encouraged to continue participation in support groups such as Sex Addicts Anonymous (www.sexaa.org) or Sexaholics Anonymous (www.sa.org) where behavioral self-management is emphasized.
_Not every treatment program is right for every individual. Therefore we encourage you to discuss programming with several other providers who specialize in the assessment and treatment of sexual behavior problems. Please see our Links page for how to contact these other providers.
To graduate successfully from the Sexual Abuse Clinic the
Accept full responsibility for sexually deviant behaviors
with no evidence of minimization or distortion.
Make full disclosure about all prior deviant behaviors to
his or her therapist, group and all significant others in his or her life as appropriate.
Have promptly attended over 85% of all scheduled treatment
and testing sessions.
Demonstrate no deviant arousal on the penile plethysmograph.
Have established and maintained appropriate adult
relationships and completed couples, group, marital or family therapy, when
Have avoided contact with victim-aged children of the same
gender(s) that he or she molested throughout the course of treatment, except as
allowed by officers of the court, corrections division or therapists.
Have developed a written plan to avoid contact with
victim-aged children of the same gender(s) that he or she molested for the
Have carried out community service as directed by his or her
corrections officer and therapist.
Have developed a support system of people aware of his or
her past deviancy and treatment requirements.
Demonstrate empathy for the victims of sexual abuse and
particularly for his or her victims.
Have completed clarification and participated in a
reasonable visitation and reunification schedule with his or her family when
Have completed all homework assignments.
Have demonstrated a full understanding of his or her individualized
Have completed all assignments in the sexual offender
Have completed all components of his or her individualized
Have demonstrated a working knowledge of his or her Good Life
Have passed at least two polygraph examinations at least 3
months apart, the last being no more 2 months before the exit interview.
Have completed a tour of the Oregon State Penitentiary, if
Have successfully completed all adjunctive treatment modules
Have completed a written report of what was learned during
treatment and how this can be applied thereafter.
Have shown no evidence of drug or alcohol abuse for at least
6 months prior to the completion of treatment.
Have completed all court and community obligations.
Have completed an exit interview.
Have fulfilled all financial obligations incurred during
_Interface with Community Agencies
The Sexual Abuse Clinic staff consults with corrections divisions, departments of human services, children’s services divisions, public defender’s offices, district attorney’s offices, municipal, county and state police, private attorneys, and mental health professionals. An extensive network of contacts has been developed with county correctional divisions and facilities throughout the Northwest. Often clients are referred to us for specialized treatment, such as plethysmographic testing or biofeedback, or vicarious sensitization, while being followed by referring therapists or agencies. Once that phase of treatment is completed they return to their original counselors. Please feel free to contact us with any questions or for further information about these specialized services.
_Treatment for Victims and Families
_Support groups and individual therapy for sexual abuse survivors and families affected by sexual abuse have provided a valuable resource for the community. The Sexual Abuse Clinic can provide a professionally-facilitated group or an individual therapist for those who have experienced sexual abuse as children or adults. The clinic director has provided expert testimony in civil cases on behalf of sexual abuse victims. You may contact us for a list of attorneys representing survivors of sexual abuse.
Please feel free to contact us for a free initial appointment to see if our therapists are the right match for your problems. (Note: This does not apply to individual evaluations or testing for professionally-referred cases).
Sexual Abuse Clinic sponsors free annual workshops for related
professionals focusing on the assessment and treatment of sexual
offenders. We are happy to provide education, training and consultation
to your organization or group as requested.