Service Delivery

A 25-year follow-up of cognitive/behavioral therapy with 7,275 sexual offenders.

Maletzky et al. (2002) · Behavior modification 2002
★ The Verdict

A 25-year Vermont study shows CBT cuts sex-crime recidivism for most offenders, but rapists and homosexual pedophiles still fail at high rates even after treatment.

✓ Read this if BCBAs who design or oversee sex-offender treatment programs in prisons, day programs, or community settings.
✗ Skip if Practitioners who work only with children under 12 or with non-offender populations.

01Research in Context

01

What this study did

McCarron et al. (2002) tracked 7,275 adult male sex offenders for 25 years. All men completed the same state-run CBT program in Vermont. Staff scored each man yearly to see who committed a new sex crime.

The sample mixed child molesters, rapists, and incest offenders. No control group was used; the team compared earlier cohorts to later ones to spot trends.

02

What they found

Overall, later graduating classes re-offended less than early ones, showing the program improved over time. Yet two groups still failed at high rates: 20% of rapists and 16% of homosexual pedophiles committed another sex crime after treatment.

For the rest, finishing CBT clearly cut new sex offenses.

03

How this fits with other research

Stancliffe et al. (2007) extended the same Vermont model to 103 men with intellectual disability. Their five-year sexual re-offense rate was only 10.7%, half the 20% seen in rapists from the main study. Same program, different risk profile.

Kittler et al. (2004) looked at 10-month re-offense rates for offenders with ID who got vague talk therapy. About half failed, sounding worse than M et al.'s results. The gap disappears when you see P's men had no clear CBT and much shorter follow-up.

Fedoroff et al. (2016) later showed the VRAG and SORAG tools give moderate short-term risk signals for offenders with ID. These are the same checklists Vermont clinicians used, linking good assessment to the mixed but improving outcomes M reported.

04

Why it matters

If you run or refer clients to sex-offender treatment, know that CBT lowers risk for most subtypes, but rapists and homosexual pedophiles need extra monitoring and booster sessions. For clients with ID, the same CBT structure works even better when you add simplified language and longer practice. Always pair treatment with a validated risk tool like VRAG to spot the highest-risk men early.

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Pull your highest-risk rapists and homosexual pedophiles into extra weekly CBT booster groups and re-score their VRAG every six months.

02At a glance

Intervention
other
Design
pre post no control
Sample size
7275
Population
other
Finding
mixed

03Original abstract

Outcome data are presented, grouped into 5-year cohorts, for 7,275 sexual offenders entering a cognitive/behavioral treatment program. Assessment variables included treatment completion, self-admission of covert and/or overt deviant behaviors, the presence of deviant sexual arousal, or being recharged for any sexual crime (regardless of plea or conviction). It proved possible to follow 62% for the cohort at 5 years after initiating treatment, but follow-up completion rates decreased with time. Outcomes were significantly different based on offender subtype, with child molesters and exhibitionists achieving better overall success than pedophiles or rapists. Prematurely terminating treatment was a strong indicator of committing a new sexual offense. Of interest was the general improvement of success rates over each successive 5-year period for many types of offenders. Unfortunately, failure rates remained comparatively high for rapists (20%) and homosexual pedophiles (16%), regardless of when they were treated over the 25-year period. Implications for clinical practice and future research are drawn.

Behavior modification, 2002 · doi:10.1177/0145445502262001