Psychiatrist Martin P. Kafka of Newton, president of the Massachusetts Association for the Treatment of Sexual Abusers, is an expert in the use of drug treatment for sex offenders. (T&G Staff/BETTY JENEWIN)

Shawn, 33, another Level 3 sex offender, said the intensive therapy he has been receiving since his release from prison 18 months ago is helping him develop coping skills, something that experts say should prevent him from committing another sex offense.

While studies show that intensive therapy greatly reduces the chances that sexual offenders will repeat their behavior, it is often not mandated and is not available to all sex offenders in Massachusetts. A study released in 1999 by the federal Office of Sex Offender Management showed that sex offenders who received relapse prevention treatment had a re-arrest rate of 7.2 percent compared to a 17.6 percent re-arrest rate for untreated sex offenders.

We don’t have laws yet that allow sex offenders to be incarcerated for life, so any treatment they get is going to be helpful because they’re going to come out,” said Kim L. Dawkins, executive director of the Rape Crisis Center of Central Massachusetts. “If they get no treatment and they come out, the behavior is more likely to continue to be a problem.”

Ms. Dawkins said the key is to prevent sex offenses by teaching young boys the difference between proper and improper behavior.

Worcester District Attorney Joseph D. Early Jr. said prosecutors always recommend therapy for convicted sex offenders. “The problem is, when someone gets a prison sentence, the therapy is optional while in jail. For different reasons, they don’t take these classes,” Mr. Early said. In addition, the prison sentence is usually not long enough for a sex offender to successfully complete a treatment program, which traditionally takes from three to six years or even longer, he said. The average sentences for a sex offender range from about 12 months for indecent assault and battery on a child to about 75 months for rape of a child.

While therapy is required for sex offenders who are on parole or probation, five out of six registered sex offenders complete their sentences and therefore are not required to get therapy when they are released. Since 1996, the state Parole Board has operated the Intensive Parole for Sex Offenders program that requires therapy for sex offender parolees. Don Giancioppo, executive director of the Parole Board, said none of the 300 sex offenders who completed the IPSO program has been convicted of subsequent sex offenses.

In the program, specially trained parole officers are assigned 10 to 15 sex offenders, compared with a caseload of as many as 50 parolees for a non-IPSO parole officer. They make at least weekly visits to the sex offender’s home and place of employment.

The offender must undergo weekly therapy sessions, can have no contact with children, is not allowed to use computers and has a curfew. Every six months, the offender must submit to a polygraph about his or her compliance with the conditions of parole. Since December, all sex offenders on parole have been required to wear GPS tracking devices.

The IPSO program, originally started in the Framingham office, expanded to Lawrence, Springfield and Worcester last year. Seventy-five sex offenders are in the program at the four sites, but 45 sex offenders assigned to the Parole Board’s other four offices in Brockton, Mattapan, New Bedford and Quincy do not have access to the program.

Participation in a sex offender treatment program is a significant factor in the classification of sex offenders as to their risk to re-offend, according to Charles McDonald, spokesman for the state Sex Offender Registry Board. Of about 10,000 registered sex offenders in Massachusetts, about 5,000 are Level 2 and 1,400 are Level 3, those considered to have the highest risk of re-offending. Mr. McDonald said the board strongly favors treatment, particularly the “cognitive behavior relapse prevention” form of sex offender treatment.

That type of treatment is similar to the Alcoholics Anonymous Twelve Step program, in which the person must first acknowledge that he or she has a problem. Once the sex offender expresses regret for having committed the crime and develops empathy for the victim, the offender develops a relapse prevention plan that outlines the situations that trigger them to sexually offend and how to successfully deal with them.

Shawn, who works in Worcester, was convicted of indecent assault and battery on a child relative and is classified as Level 3. He was released from the Worcester County House of Correction in West Boylston in October 2005, after serving 14 months. Weekly group and individual therapy sessions are conditions of his probation, which he will be on for 19 years.

“Therapy is helping,” said Shawn, who like Michael asked that his full name not be used. “It helps me deal with everyday problems. If stress is building up, I can talk about it instead of letting it build up and I have no release. It also helps to know that there are other people out there dealing with the same things I am. I try every day to try to right the wrong that I did by being a good person, going to work every day and trying to build up relationships that I let slip with my mom and dad.”

When Michael was convicted in 1984 of rape of a child with force, there was no treatment for sex offenders. Michael said he spent 60 days in the state prison in Concord for that conviction. He said he was convicted in 1994 on a child pornography charge out of Michigan, for which he served 28 months in a treatment center in North Carolina. He said he got little benefit from that program. The state Sex Offender Registry does not list the 1994 conviction.

In 2004, Michael was convicted of indecent assault and battery on a child under 14 and purchase or possession of child pornography. He was sentenced to three years at the Worcester County House of Correction. He said he was credited for two years he spent in jail awaiting trial and served the rest of his sentence at Bridgewater State Hospital. Michael said he was not there long enough to complete a treatment program.

“People tell you that treatment is a minimum of three years. I kept getting in there with these one-year-left-to-go things,” said Michael. He said he is now paying for therapy.

The National Association of Criminal Defense Lawyers says sex offender treatment should be mandatory in legislation to combat sexual violence. Most pending sex offender-related legislation in Massachusetts, however, does not include treatment. State Rep. Karyn E. Polito, R-Shrewsbury, said she did not include mandatory treatment in her bill because of the cost. But treatment is an area the state could do more and she is willing to explore it, she said.

According to the state Department of Correction, $2.85 million is budgeted for sex offender treatment this fiscal year. But a large portion of the funding is allotted for treatment of the sexually dangerous at Bridgewater State Hospital.

“I think treatment is important both in prison and post release, but it needs to be forever. They are like any other addict,” Ms. Polito said.

Mr. Early said he would like treatment to be required for all convicted sex offenders. One of the problems, he said, is that the Truth-in-Sentencing Law did away with split sentencing that would have given an inmate some prison time and some probation. Therapy and a GPS system are often conditions of probation, he said. If an offender on probation fails to successfully complete therapy, he or she can be sent back to prison.

“If they don’t have the split sentence, the day they are released from jail they are put back into society without these classes. We don’t have any hooks or claws into the person to make them cope with the problem,” Mr. Early said. “If these people are functioning with the sword hanging over their head, so to speak, it would help make society safer.”

Psychiatrist Martin P. Kafka and psychologist John Cusack are members of the Massachusetts Association for the Treatment of Sexual Abusers. Both work at McLean Hospital, a nationally renowned psychiatric hospital in Belmont. Mr. Cusack said mandatory therapy does not work, because you cannot force someone to do treatment against their will. But treatment for sex offenders is effective, and significantly more so for juvenile offenders, Mr. Cusack said. In addition, being arrested and having to go through the courts is a serious enough deterrent to keep most juveniles from re-offending, he said.

Dr. Kafka, president of the association, is an expert in the use of drugs to treat offenders with sexual compulsive disorders and is an associate professor of clinical psychiatry at Harvard Medical School and McLean Hospital. He uses two testosterone-lowering drugs in some extreme cases. Neither has been approved by the U.S. Food and Drug Administration. In an Oregon study from 2000 to 2004, 275 sex offenders took the drug Depo-Provera and none of the men committed new sex offenses, he said.

An emerging method of pharmacological treatment for sex offenders is identifying whether the sex offender has psychiatric disorders. Dr. Kafka said more studies need to be done, but many sex offenders have mood disorders, attention deficit disorder, fetal alcohol spectrum disorder, Asperger syndrome, schizophrenia and substance and alcohol abuse problems that also need to be treated.

Contact reporter Elaine Thompson by e-mail at ethompson@telegram.com.