Hope in treating sexual offenders

In this readable and succinct book, formidable clinician and scholar Craissati breaks down myths about sexual offenders and addresses the central issue of what works to reduce risk. She is pragmatic, insightful and informed in her approach, and makes the important point that while not addressing victims directly, she always has victims in mind, and a central aim of her clinical and research work is to reduce risk.

Significantly, Craissati considers the great value of addressing failure in interventions. More than success, failure informs practitioners how best to modify their therapies to target the difficulties offenders present. She describes the Challenge Project, a community-based intervention for sex offenders, which had its main success in reducing recidivism in the higher risk group. This group was then targeted, leading to more failures in treatment since higher risk and more complex men are less likely to complete treatment; they are more often recalled to prison for other problematic or antisocial behaviour, or for low level sex offences such as internet pornography.

Models for understanding high risk offenders are presented in a comprehensive and straightforward way. The book focuses on offenders who can be described as complex – presenting with a combination of relatively high likelihood of recidivism, persistent and pervasive psychological difficulties, and/or deviant sexual interests or perversions. Each of these strands of complexity is described in terms of theoretical underpinning. Although devoted to the highest risk offenders, and predominantly to males because of their far greater prevalence in this population, the book has relevance to work with all sexual offenders.

Craissati offers a clear and concise account of attachment theory and its relation to sexual offending and other disturbances in intimacy. A simple diagrammatic model is used to explain formulation that first comes from psychoanalysis and has attachment at its heart. She uses triangles, first devised by the psychoanalyst David Malan, to illustrate how early relating plays out in later life. They show how men who offend transfer relationships with parents and others onto their partners, victims and the professionals who work with them. 

What is most impressive about this book is Craissati’s explanation of complex theory in simple terms, including ideas from psychoanalysis: she highlights how relationships and disturbed relating are at the heart of all sex-offending. Psychoanalytic concepts are relevant to understanding the psychological functions that sexual offending can serve for individuals who have experienced often unresolved and unexpressed trauma earlier in life. 

Although not a psychoanalyst herself, Craissati is aware of the ways in which sexual offending can cover up and reveal earlier attachment disturbances and unconscious wishes to recreate a fantasy relationship. She notes that in the research relating to men in The Challenge Project, almost none had disclosed their own abuse history. A child sexual abuser may view those they offend against as an ideal version of themselves, seeking through contact with them to be in touch with innocence, beauty, and a childhood they didn’t have. This contact might be associated with experience of being abused, and consequent confusion of sexual interest with love and care. Offenders would not necessarily be able to articulate this without help and understanding.

Chapters on treatment and desistance offer hope and ways forward in a field that is often fraught with nihilism and despair. The book offers limited reference to the impact of racism on the lives of men who offend sexually; an unfortunate omission, as Craissati does discuss the social aspect of the ‘biopsychosocial model’ of the development of personality disorder (a term Craissati courageously sticks to, while acknowledging its controversy).

Minor inaccuracies here and there are small distractions in a thorough account of risk assessment practice, offering both theoretical insights and useful practice tips. This is Craissati’s characteristic blend of wisdom and pragmatism, and an elegant approach that makes the most complex risk assessments look simple by breaking them down into easy to follow steps. This well-written and concise text offers a wealth of information, in an engaging and readable style. It is a must-read for all practitioners in the field. 

Reviewed by Anna Motz
Consultant Clinical Psychologist, Offender Care Pathway, CNWL NHS Foundation Trust