While this discussion might encourage a degree of scepticism over the state of our knowledge about the effects of treatment on recidivism
rates, it is nevertheless important to develop approaches to evaluating the benefits that might accrue from therapy. Given that any sort of therapy costs money, time and other resources, it is possible to subject treatment to a cost-benefit analysis. The level-playing-field approach requires that whatever comparisons are made, all measurable economic costs are included. So, for example, although it is impossible to put a price on grief and suffering, it is feasible to calculate the monetary cost of treating the victim. Usually, the cost of an offence has to include those of processing the offender through the legal system and imprisonment. These are alarmingly expensive.
A cost-benefit analysis of the rehabilitation of child molesters was carried out at the Massachusetts Treatment Center (Prentky and Burgess, 1990). Using a group of inpatient child molesters for whom recidivism data were available, it was possible to compare the recidivism of this group with that of untreated offenders.
The sample was generally of long-term offenders, since a third had a juvenile record and 90% a previous adult record. Over a five-year follow-up period, 25% of the treated group offended again. This recidivism rate was based entirely on the number of criminal charges made. A small number of so-called nuisance sex charges involving non-contact offences such as voyeurism and obscenity were all excluded.
Finding an appropriate non-treated group causes difficulty. A randomly selected, non-treated sample from the same offender population would be ideal but this is not easily done for court-referred offenders required to take treatment by court. Instead, by using the findings of another study (Marshall and Barbaree, 1988), it was decided that the appropriate recidivism rate for a similar group of non-treated offenders was 40%. The authors regard this figure as conservative. It goes without saying that the non-treated recidivism rate is a crucial element in the calculation of the benefits of therapy.
Seven years of incarceration before review for probation was taken as the likely minimum average. Imprisonment formed the bulk of the cost, with victim-related costs a fraction of this. At the time, the monetary cost of each new offence by an untreated offender was close to a quarter of a million dollars. The figure for members of the treated control group was 71% of this:
Notwithstanding the limitations of the data, this reflects a rational approach to therapy. The better the results achieved in therapy in terms of recidivism, the greater the savings. Unfortunately, most therapies have not been evaluated in this way. As things stand, the available data applies at best to certain therapies in a criminal justice system giving substantial prison sentences to paedophiles.
It is possible that Prentky and Burgess were being generous in their estimates of non-treated recidivism. Finkelhor (1986) reviewed the available recidivism studies of paedophiles, and appears somewhat scornful of their worth, especially their relatively short follow-up periods. The 10 studies reviewed gave figures of between 6 an 35% for sex offence recidivism. While these studies involved various mixtures of treated and untreated offenders, quite obviously the range is sufficient to imply that treatment may not be so cost effective as Prentky and Burgess imply.
It is not very meaningful to draw conclusions about therapy for paedophiles. The reasons for this are as much to do with the lack of in-depth research into therapy as they are to do with the varied ideological bases of therapy.
Modern treatment for paedophilia is multifaceted. No modern therapist is on record as recommending a single psychological treatment technique even for an individual offender, although this was done in the case of the early behaviour therapies. Programmes that cover virtually every conceivable deficit in the knowledge, skills and thinking of offenders are the current recommendation.
The question of why programmes have come to dominate therapy has not been answered, especially at the level of. demonstrated effectiveness. No doubt the failure of research to reach consensus over a single explanation of offending has had considerable impact. Research on paedophilia itself has done little to focus therapy away from the multi-modal programme. Instead, as we have seen, causal explanations of offending stress multi-determination. It would be harsh to describe modern therapy as "shotgun", but the lack of research specifying which parts of the programmes work best invites such suggestions.
It is possible that the attraction of the treatment programme can be explained by professional and institutional requirements as much
as by proven therapeutic success. A programme can facilitate the cooperation of therapists coming from a variety of ideological-cum-theoretical positions on approaches to therapy. This applies both within and between professions. Psychologists, psychiatrists, medical staff, social workers, probation officers and prison officers are among the range of professions that might be represented in a team involved with therapy. Each of these differ in terms of their skills as well as their broad professional ideologies. The programme provides a variety of niches in which different individuals may operate as part of the team. This smooths the path of interdisciplinary cooperation.
Prendergast (1991) provides a true/false self-assessment quiz which includes the following items:
FALSE is the correct answer in both cases, according to Prendergast. Some might be more inclined to wonder how confident one can be in this. What do "work better" and "positive results" mean in this context? It would appear that there is a long road to travel before we see all of the implications of the questions, let alone provide definitive answers.