Un programme de traitement cognitif-béhavioral offert en communauté à des agresseurs sexuels: L'efficacité évaluée selon le type de victimes

For several years, the programs of cognitive-behavioral approach have been most prevalent in the area of sexual offending for the treatment of abusers. But while many studies have attempted to assess whether these programs help reduce recidivism, little effort seems to have been made to ascertain whether changes occur among participants during the program as for the treatment targets decided on at the outset.

We thus evaluated the short-term effectiveness of a cognitive-behavioral treatment modified in 2000, for a follow-up sample of 83 sex offenders, classified according to the age and sex of the victims. Released from the federal establishments where they were incarcerated, they all present a high risk of recidivism. Participants completed the one-year program between 2000 and 2006. The main goals of this treatment—whose importance is supported by the literature relating to the factors associated with the risk of recidivism—are the deviant sexual interests and the cognitive distortions. Several components of the program referred to them. The assessment of the changes in these risk factors were evaluated with two measuring instruments: the phallometric assessment and the Bumby Cognitive distortion scale. Some of the potentially moderating variables impacting on the effectiveness of the treatment were also examined.

The results indicate that these measuring instruments were not able to detect any significant impact of the treatment on the three groups of sexual offenders we compared. It appears however that none of the participants reoffended in the course of the treatment. Noting furthermore that the participants in the program demonstrated low deviant sexual interests, as measured by plethysmography at the start of the treatment, which corresponds with their exit from the penitentiary, further tests were conducted to deepen our understanding of the results. The results suggest that the more deviating participants had improved significantly. The results of other analyses also corroborate a distinction supported by the literature: the participants who gave up the treatment differ from those who wrapped it up.

In light of these results, questions are raised about how to conceptualize or operationalize the change and about the ability of the measuring instruments to detect the change when the short-term effectiveness of a treatment program must be evaluated.

Alternate abstract:

Depuis plusieurs annees, les programmes de traitement d'approche cognitivebehaviorale sont les plus repandus dans le domaine de la delinquance sexuelle pour le traitement des agresseurs. Or, meme si de nombreuses recherches ont tente d'evaluer si ces programmes contribuent a reduire la recidive, peu d'efforts semblent avoir ete consentis a verifier si des changements surviennent chez les participants en cours de programme quant aux cibles de traitement fixees au depart.

Nous avons done evalue l'efficacite a court terme d'un programme de traitement cognitif-behavioral modifie en 2000, pour un groupe de 83 delinquants sexuels, categorises en fonction de l'age et du sexe de leurs victimes. Liberes des etablissements federaux ou ils etaient incarceres, ils presentent tous un risque eleve de recidive. Les participants ont complete le programme d'une duree d'un an entre 2000 et 2006. Les principales cibles de ce traitement — dont 1'importance est appuyee par la litterature portant sur les facteurs associes au risque de recidive — sont les interets sexuels deviants et les distorsions cognitives. Plusieurs des composantes du programme s'y rapportent. Les changements quant a ces facteurs de risque ont ete evalues a partir de deux instruments de mesure : 1'evaluation plethysmographique et I'Inventaire cognitif de Bumby. Certaines variables moderatrices potentielles de l'efficacite du traitement ont aussi ete examinees. 

Les resultats indiquent que pour les trois groupes d'agresseurs sexuels compares, il n'a pas ete possible de deceler l'impact du programme de traitement a partir des instruments de mesure utilises. Cependant, aucun des participants ne parait avoir recidive au cours de la periode de traitement. Constatant en outre que les participants de l'echantillon presentaient de faibles interets sexuels deviants tels que mesures par plethysmographie a 1'amorce du traitement, qui coincide avec leur sortie du penitencier, des analyses supplementaires ont ete effectuees afin d'approfondir notre comprehension des resultats obtenus. Les resultats suggerent que les participants les plus deviants se seraient ameliores de facon significative. Aussi, les resultats d'autres analyses corroborent une distinction qui est soutenue par la litterature: les participants qui ont abandonne le traitement different de ceux qui l'ont complete.

Eu egard aux resultats obtenus, des questions sont soulevees sur la facon de conceptualiser ou d'operationnaliser le changement et sur la capacite des instruments de mesure a reveler les progres lorsque 1'efficacite a court terme d'un programme de traitement doit etre evaluee.