Responsible Living Treatment Program

© 1998 Medlin Training Institute

Editor: Julie C. Medlin, Ph.D., Director

TABLE OF CONTENTS: Volume 1

Section Starting Page #

Authors ix

Foreword xi

Introduction xii

Overview of Program 1

Cognitive-Behavioral Relapse-Prevention model 1

Program Structure 2

Behavioral Point System 5

Pre-Treatment Evaluation 7

Polygraph 8

Penile Plethysmograph 9

Graduating from Treatment 10

Theory & Research 13

Paraphilias 14

Child Molesters 16

Rapists 27

Sexual Sadists 33

Exhibitionists 37

Voyeurs 41

Frotteurs 44

Other Paraphilias 45

 

TABLE OF CONTENTS: Volume 1

Section Starting Page #

Other Paraphilias 45

Fetishism 45

Transvestic Fetishism 48

Zoophilia 53

Telephone Scatologia 54

Coprophilia & Urophilia 55

Recidivism among Sex Offenders 56

Factors that Predict Recidivism 57

Brief Risk Assessment 59

Effectiveness of Treatment 60

Use of Penile Plethysmograph 62

Use of Polygraph 65

Other Clinical Issues 68

Psychopharmocological Treatment 68

Sex Offender Registration 71

Starting Your Program 74

Practical Considerations 74

Treatment Policy Forms 77

Treatment Update Form 93

Release of Information Form 95

Points Update 96

 

TABLE OF CONTENTS: Volume 1

Section Starting Page #

Clinical Advice 97

Starting a Group 97

Working with Deniers 97

Working as a Treatment Team 100

Working with Probation 102

Working with Difficult Clients 103

Total Denier 104

"No Show" Client 108

Religious Client 111

Chaotic Client 113

Angry Client 114

Dangerous Client 116

"Good Guy" Client 118

Legal Client 120

Silent Client 122

"Victim" Client 123

Transference 126

Sexual Transference 126

Counter-Transference 128

References & Bibliography 132

TABLE OF CONTENTS: Volumes 2-8

Phase 1: Responsibility-Taking………………………………… Volume 2

Orientation to the Program

Treatment Policy

Group Layout

Feeling Statements

How to Confront Denial

List of Excuses to Offend

Thinking Errors

Levels of Denial

Reasons to Admit or Deny

Clients' Sexual History

Four Steps to Offending

Offense Summary

Grooming & Planning

Red Flags

SUDs & HRFs

General Thinking Errors

Offense Cycle

Other Unhealthy Cycles

Phase 2: Behavioral Techniques……………………………… Volume 3

Covert Sensitization

Directed Masturbation

Masturbatory Satiation

Verbal Satiation

Olfactory Aversion

Minimal Arousal Conditioning

Other Arousal Control Techniques

Group Mini-Layout

Recognizing Deviant Thoughts

Behavioral Chain

Correctives

Awfuls & Shoulds

Stress Reduction

Relaxation Exercise

Imagery

ABCDE

Impulse Control

Covert Sensitization Protocol

Covert Sensitization Scripts

Plethysmograph Results

Appropriate vs. Inappropriate Fantasies

Sexual Urges & Cravings

Phase 3: Emotional Well-Being………………………………… Volume 4

Addressing the Client’s History of Abuse

Looking Back at Childhood

Dysfunctional Families

Healthy vs. Unhealthy Family

Autobiography

Negative Messages in Families

Family Patterns

Boundaries in the Family

Rules in the Family

Roles is Dysfunctional Families

Abuse & Trauma in Childhood

Feelings About Abuse

Healing from Abuse

Letters to Abusers

Addictions

Family Tree

Codependency

Changing Unhealthy Behaviors

Building Healthy Relationships

 

Phase 4: Victim Empathy………………………………………. Volume 5

Victims’ Accounts

Empathy & the Sex Offender

Victim Scrapbook

Identifying Victim’s Feelings

Stages of Grief & Loss

Immediate & Long-Terms Effects of Sexual Abuse

Practicing Empathic Understanding

Role Play

Letter to Victim

Phase 5: Anger Management…………………………………… Volume 6

Anger Sequence

Anger Journal

History of Anger

Anger & Sexual Offending

Offense Sequence

Anger in Childhood

Cognitive Restructuring

Effects of Anger Expression

Three Behavior Styles

Levels of Anger

Active Listening

Assertive Confrontation

Anger Cycles

Relaxation Techniques

Bodily Reactions to Anger & Stress

Progressive Muscle Relaxation

Visualization

Practicing Anger Management

Phase 6: Sex Education………………………………………… Volume 7

Male Sexual Anatomy

Male Reproductive System

Sexual Myths

Sexual History

Sexual Timeline

Female Sexual Anatomy

Four Phases of Sexual Arousal

Female Reproductive System

Sexual Messages from Childhood

Sexually Transmitted Diseases

Safe Sex

Appropriate Sexual Behavior

Birth Control

Having a Child

Intimate Relationships

Sexual Development

Sexual Relationships

Sexual Needs

Attachment & Bonding

Sexual Dysfunction

Changing Deviant Sexual Behavior

Healthy Sexual Relations

Homosexuality

Sexual Morality

Getting Needs Met

Sexual Addiction

Pornography

Choosing A Partner

Phase 7: Relapse Prevention……………………………………. Volume 8

Relapse Prevention Plan

High-Risk Factors

Escape & Avoidance Strategies

Offense Cycle

Stopping the Offense Cycle

The Problem of Immediate

Gratification

Pervasive Risk Factors

Negative & Positive Self-Talk

Coping Responses

Decision Plotting

Cues for Reoffending

Abstinence Violation Effect

Assessing Relapse Prevention Plans

Cravings & Urges

Point of No Return

Lifestyle Changes

Support Network

High-Risk Evaluation

Setting Life Goals

Assessing Risk for Reoffending

Review of Treatment Progress

Planning for Aftercare

Program Evaluation

Phase 7: Relapse Prevention……………………………………. Volume 8

Graduation Exam

Aftercare………………………………………………………… Volume 8

Purpose of Aftercare

Structure of Aftercare Sessions

Aftercare Log

Julie Medlin, Ph.D., Editor

Dr. Medlin obtained her B.A. in psychology from Harvard University and her M.S. and Ph.D. in Clinical Psychology from the University of Florida. Dr. Medlin completed her clinical internship in a joint program at the U.S. Bureau of Prisons and University of North Carolina at Chapel Hill. Dr. Medlin trained in several forensic facilities including state prisons, a forensic hospital, and the federal prison system. She received specialized training in the Sex Offender Treatment Program at the Federal Correctional Institution in Butner, North Carolina.

Dr. Medlin founded the Medlin Treatment Center (MTC), an outpatient counseling center that specializes in treating sexual deviancy. MTC offers treatment programs for sexualized children, children who molest, adolescent sex offenders, and adult sex offenders. MTC has 2 offices in metro Atlanta and currently has a staff of 9 therapists. Dr. Medlin provides professional training and workshops for various agencies, including the Georgia Department of Corrections. Dr. Medlin founded the Medlin Training Institute (MTI) which is dedicated to training counselors in the area of sex offender treatment.

FOREWORD

There are simply not enough therapists who are trained to provide sex offender treatment. And, there are very few graduate programs or institutions that offer this type of training. Yet, there is a tremendous need for this service. When this service does not exist, sex offenders simply go without treatment while living in our communities. Or, untrained counselors try to meet the need by providing general psychotherapy to the sex offenders which we know does not work. Either way, the result is more victims.

I founded the Medlin Training Institute with the goal of training counselors to provide sex offender treatment. The training is based on the latest theory and research in the field, as well as the principles set forth by the Association for the Treatment of Sexual Abusers (ATSA). Hopefully, by training more treatment specialists, we can provide more treatment and better treatment that results in fewer victims.

Julie C. Medlin, Ph.D.

Director, Medlin Training Institute

INTRODUCTION

This treatment manual is designed to provide a step-by-step guide for therapists implementing a sex offender treatment program. This manual was developed and refined by therapists who work in the Sexual Deviancy Program at the Medlin Treatment Center. Thus, it was written by clinicians who use this material successfully in a clinical setting.

This manual includes an overview of the treatment model and a review of the latest theory and research in the field. The treatment program includes 7 phases of treatment. We have included outlines for 75 group therapy sessions, along with 75 individual therapy sessions. Ideally, we recommend that clients attend group and individual therapy each week. However, the manual has been written so that therapists can use group only, if needed. This manual includes detailed outlines for the sessions as well as homework handouts for the clients. We also offer workbooks that include all of the handouts for the clients.

This program can be implemented in an outpatient or inpatient setting. It can also be implemented within a treatment or correctional setting. For those therapists without specialized training in this area, we strongly recommend that you receive training before implementing this program. We offer a 24-hour intensive training workshop for clinicians who plan to implement this program. We also offer professional consultation and support services to help professionals implement this treatment program. For more information about these services, please call MTI at (770) 507-5283.