What We Do

The treatment techniques provided by therapists in the Clinic have received strong research support. These methods are 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 chain awareness, relapse prevention training, social skills development, and arousal reconditioning. These methods produce observable, measurable changes in thinking and behavior that are associated with a significant reduction in the risk of recidivism. Although the primary objective of treatment is to reduce the risk of sexual offense recidivism, the Clinic provides support to the families of its clients and treatment for survivors of abuse. Furthermore, whenever appropriate, family reunification is facilitated.

Research is another goal of the Clinic and data have been collected for over 25 years; members of our staff have published 16 studies, seven book chapters, and four books based upon work at the Clinic. 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 psychiatric evaluation, Dr. Steinhauser reviews police reports, the presentence investigation, and prior psychological evaluations. Then, she interviews the prospective client. At the time of the evaluation, recommendations may be made for a penile plethysmograph assessment, polygraph examination, or psychological testing. Specific treatment modalities are also identified. Thereafter, the client is referred to an Orientation Group or to a therapist within the Clinic best suited to provide individualized treatment. Both group and individual therapy are provided to most offenders, as group alone may be insufficient to address each client's needs.

The treatments used in the Clinic include a variety of arousal reconditioning methods. These are: 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. A variety of educational modules are offered as well, including: thinking errors, offense chain awareness, relapse prevention training, effects of victimization, assertiveness training, empathy training, problem solving, behavioral contracting, anger management, sex education, and social skills development. Individual treatment methods are guided by rational emotive theory and emphasize disputational techniques that effect cognitive restructuring. 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 offenders are treated individually, but many are assigned to specialized groups. Homework is always assigned, and compliance is enhanced through written assignments and tape recording.

The Clinic employs the most recent advances in computerized technology to provide evaluation and treatment services, including the Monarch plethysmograph system and computerized vicarious sensitization. Early in treatment, the penile plethysmograph is used to determine the client's sexual response pattern and the extent of deviant arousal. This state of the art penile plethysmograph simultaneously monitors the client's penile responses, respirations, and galvanic skin response to detect response faking. The system also has built-in anti-faking methodology to enhance the internal validity of the data. Data from this assessment are used to develop an individualized treatment plan and to assess risk of recidivism. Thereafter, the plethysmograph is utilized as a biofeedback instrument during arousal reconditioning sessions. Periodic plethysmograph assessments allow the therapist and client to evaluate the effectiveness of treatment in reducing deviant sexual arousal. Assessment of female sexual arousal is also provided by the Abel Assessment for Sexual Interest.

See also www.btimonarch.com and www.Northwestmedia.com.

The efficacy of treatment is verified by client self-report, feedback from significant others, polygraph testing, and pre-and post-testing on the plethysmograph. No single program exists; each client is unique and requires a blend of education, cognitive restructuring, arousal reconditioning, behavioral self-management techniques, and social support.

Clients are invited to participate in groups at no charge for as long as they feel this is helpful. Clients are also encouraged to remain in contact with their therapists so that they can discuss problems when they arise. Since maintenance of treatment gains is critical to success, clients are encouraged to participate in self-help support groups and behavioral self-management techniques are emphasized. Additionally, follow-up visits and plethysmograph evaluations are provided free of charge for discharged patients.

If a client commits a new sexual offense following the completion of treatment, the Clinic will contribute the cost of his or her treatment to the Victims Fund in the county in which the offense took place.

To graduate successfully from The Sexual Abuse Clinic the offender must:

1. Accept full responsibility for sexually deviant behaviors with no evidence of minimization or distortions.
2. 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.
3. Have promptly attended over 85% of all scheduled treatment and testing sessions.
4. Demonstrate no deviant arousal on the penile plethysmograph.
5. Have established and maintained appropriate adult relationships and completed couples group, marital, or family therapy, when appropriate.
6. 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.
7. Have developed a written plan to avoid contact with victim-aged children of the same gender(s) that he or she molested for the foreseeable future.
8. Have carried out community service as directed by his or her corrections officer and therapist.
9. Have developed a support system of people aware of his or her past deviancy and treatment requirements.
10. Demonstrate empathy for the victims of sexual abuse, and particularly for his or her victims.
11. Have completed clarification and participated in a reasonable visitation and reunification schedule with his or her family when appropriate.
12. Have completed all homework assignments.
13. Have demonstrated a full understanding of his or her individualized offense cycle.
14. Have completed all assignments in the sexual offender workbooks.
15. Have completed all components of his or her individualized treatment plan.
16. Have demonstrated a working knowledge of his or her own relapse prevention plan.
17. Have passed at least two polygraph examinations at least three months apart, the last being no more than two months before the exit interview.
18. Have completed a tour of the Oregon State Penitentiary.
19. Have participated in, and successfully completed, all adjunctive treatment modules assigned.
20. Have completed a written report of what was learned during treatment and how this can be applied thereafter.
21. Have shown no evidence of drug or alcohol abuse for at least six months prior to the completion of treatment.
22. Have completed all court and community obligations.
23. Have had an absence of any new charges, violations, or convictions for any sexual or nonsexual offenses.
24. Have completed an exit interview.
25. Have fulfilled all financial obligations incurred during treatment.

The Sexual Abuse Clinic staff consults with corrections divisions, children's services divisions, public defenders' offices, district attorneys' 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 special treatment (e.g., vicarious sensitization) and followed in conjunction with referring therapists or agencies. Once treatment is completed they return to their original counselors.

Support groups and individual therapy for sexual abuse survivors have provided an important resource for the community. The Sexual Abuse Clinic can provide a professionally supervised group or individual therapist for those who have experienced sexual abuse as children or adults.