Pharmacological Treatment

The pharmacological treatment of the paraphilias with antiandrogens and hormonal agents is successful in reducing recidivism through the reduction of sexual fantasies, sexual drive, sexual arousal, and sexual behavior.[1] The Institute for Sexual Wellness will utilize antiandrogens (Medroxyprogesterone) and hormonal agents (Lupron) to target problematic sexual behavior.

In addition to the treatment of paraphilias, the clinicians at the Institute for Sexual Wellness are skilled in the treatment of commorbid psychiatric disorders. When present, the treatment of commorbid psychiatric disorders, such as Attention Deficit Hyperactivity Disorder (ADHD) and Dysthymia decrease sex offender recidivism.

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington:American Psychiatric Publishing. 2013.

Psychological Treatment

The Institute for Sexual Wellness recognizes the importance of working collaboratively with clients to identify treatment goals and implement individualized treatment services.  ISW strives to provide treatment in a respectful and thoughtful manner and individuals are invited to be actively involved in decisions about their treatment, even when mandated to treatment. Treatment modalities include individual therapy, group therapy, psychoeducational materials and/or classes, and behavioral treatment. ISW recognizes the value of collaboration with probation officers, parole officers, and other supervisory personnel, when applicable. Individuals are fully informed of the nature of ISW’s relationships with supervisory personnel.

Sex offender treatment services at ISW are provided through a cognitive-behavioral approach within the framework of the Risk Need Responsivity model. Strengths-based approaches to treatment are utilized with the goal of assisting individuals in managing their risk while also meeting their needs in healthy and prosocial ways. Clinical services offered are commensurate with risk levels, individual treatment needs, and effective styles of intervention.

Behavioral Treatment

Behavioral Treatment is a type of treatment offered by ISW that is recommended for those who have sexually problematic thoughts or behaviors that are distressing or destructive to them or to others. Behavioral treatment focuses on identifying and managing problematic thoughts or behaviors in a healthy, effective way.  Behavioral treatment is generally offered as a way to augment the therapy process. Patients will have the opportunity to work with specialists who can help them replace deviant or inappropriate sexual thoughts and behaviors with appropriate and healthy sexual thoughts and behaviors. Behavioral treatment is individualized and may be presented in the form of aversive therapy, covert sensitization, masturbatory reconditioning or other types of techniques.

Psychoeducation and Sex Education

Psychoeducation courses are offered by ISW to provide a combination of counseling and education on specific treatment targets. Courses help patients gain knowledge, learn skills, and develop interventions relevant to their treatment goals. Effective management techniques and supportive interventions are aspects that are incorporated into the psychoeducation courses at ISW.  Psychoeducation courses are generally offered as a way to augment the therapy process.  ISW provides a number of different psychoeducation courses that include but are not limited to Sexual Interests, Sex Education, Arousal Management, Effective Communication, Healthy Interpersonal Relationships, Boundaries, and Understanding Empathy.

Assessment Instruments

The Institute for Sexual Wellness offers a variety of assessment services including risk assessment, personality assessment, malingering assessment, cognitive assessment, and objective measures of sexual interest. Measures of static and dynamic risk are commonly incorporated in the evaluations to provide a comprehensive understanding of historic and current risk. 

The following instruments are used at the Institute, although the list is not exhaustive:

Risk Assessment Tools

  • Static-99R, Static-2002R
  • Stable-2007, Acute-2007
  • Assessment of Risk and Manageability for Individuals with Developmental and Intellectual Limitations who Sexually Reoffend (ARMIDILO-S)
  • Structured Assessment of Protective Factors for violence risk (SAPROF)
  • Hare Psychopathy Checklist- Revised (2nd)
  • HCR:20 (3rd)
  • Level of Service Inventory

 

Psychological Testing

  • Minnesota Multiphasic Personality Inventory (MMPI-2)
  • Millan Clinical Multiaxial Inventory (MCMI-III)
  • Personality Assessment Inventory (PAI)
  • Rorschach
  • Thematic Apperception Test (TAT)
  • Beck Scales

 

Cognitive, Neuropsychological & Adaptive Functioning Testing

  • Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV)
  • Wechsler Individual Achievement Test – Third Edition (WIAT-III)
  • Vineland Adaptive Behavioral Scales
  • Skills of Independent Behavior-Revised (SIB-R)
  • General Assessment Measure for Adults (GAMA)
  • Cognistat
  • Neuropsychological Screening Tools

 

Physiological Based Measurement

The physiological based measurements are utilized to understand an individual’s sexual preferences as well as measuring an individual’s response to treatment. For example a comparison of a pre-treatment PPG with a post-treatment PPG provides valuable information regarding the effectiveness of treatment.

  • Penile Plethysmography (PPG): PPG is an objective measure of sexual interests and arousal. The results of PPG assessments assist in treatment planning and determinations of risk. 
  • Abel: The Abel test is a means of assessing an individual’s sexual interest based on visual reaction time.
  • Polygraph: The polygraph is an objective measure of truthfulness and deception. Polygraph evaluations may be used to assess sexual history, monitor treatment compliance, monitor compliance with conditions of supervision (e.g. probation or parole), and examine other treatment related issues.

 

Note: Baseline laboratory tests are required to evaluate an individual’s general physical health. The Institute for Sexual Wellness does not provide primary care services such as physical examinations, blood tests, EKG, or bone density scans. Individuals will be referred to their primary care physician or a community hospital to obtain medical tests.   The ISW will work in collaboration with primary care physicians to ensure the health of individuals who undergo testosterone lowering treatments.