• to provide intensive training and education to parole officers and Correctional Service of Canada administrators who worked with sexual offenders;
• to collect relevant research and secure appropriate methodologies for the assessment and treatment of sexual offenders; and
• to support the development of education and training for undergraduate and graduate students in forensic and clinical psychology at universities in Nova Scotia.

The clinic had secondary objectives. It was hoped that the development of this community program and a close liaison between the clinic and the psychology departments at other federal institutions in the Nova Scotia district would spark the development of similar programs at those institutions. In addition, there are few community services for sexual offenders offered by the Nova Scotia departments of the Attorney General and the Solicitor General. It was hoped that the development of a community program by the Correctional Service of Canada and the liaison of this clinic with various provincial facilities would encourage the development of provincial services.

To garner support for the program and inform relevant parties of the clinic's role and objectives, numerous presentations were made to Correctional Service of Canada psychologists, case management officers, parole officers, county court judges, health professionals in local hospitals, lawyers, police officers and representatives of the National Parole Board.

The contract provided the clinic with funding for the assessment of 39 offenders and for the provision of three cycles of 16-week group therapy.

Sex offenders are not homogeneous.⁽¹⁾ No single factor has been identified as the causal agent inherent in, or even common among, all types of sexual offences. Indeed, even in a single subtype of sexual offences, a variety of psychological factors may be found.

The clinic did not choose to use those measures that were only useful for discriminating offenders from non-offenders. Rather, assessment in the clinic was intended to provide a comprehensive description of both the offender and the events contributing to the offence. This information was important for helping offenders to understand themselves, estimating the risk of recidivism, guiding the choice of treatment options and estimating the effect of treatment.

An 18-hour assessment procedure was standard for most participants.

The offender was provided with a brief description of the clinic and the assessment procedures. Offenders were asked to sign release forms allowing the clinic to communicate with such bodies as the Correctional Service of Canada and the courts.

A comprehensive test battery, consisting of some 22 scales and questionnaires, was administered. This included the following: Clarke Sex History Questionnaire, Michigan Alcohol Screening Test, Drug Use and Suicide Risk Test, Abel and Becker Cognitive Distortion Scale, Wilson Sexual Fantasy Questionnaire, Attitudes Towards Women Scale, Hostility Towards Women Scale, Clarke Violence Scale, Clarke Gender Identity Scale, Clarke Parent/Child Questionnaire, Minnesota Multiphasic Personality Inventory-2, Millon Clinical Multiaxial Inventory-Il, Wechsler Adult Intelligence Scale-Revised, Social Response Inventory, Social Avoidance and Distress Scale, Social Self-Esteem Inventory, Marlowe-Crowne Social Desirability Questionnaire, Short Marital Adjustment Scale, Waring Intimacy Questionnaire, Neuropsychological Screening Questionnaire, Halstead Reitan Neuropsychological Test Battery (as required) and the Wechsler Memory Scale (as required).

Level of sexual arousal was measured in response to various sexual stimuli by recording changes in air pressure in a glass tube covering the offender's penis.⁽³⁾
A sophisticated hardware and software package was used to analyse changes in penis size (including the offender's minimum and maximum response and the time it took for the offender to "recover" from the state of arousal) in response to the sexual stimuli (e.g., video material, audio material, slides) which varied the nature of the sexual activity portrayed, and the age and gender of subjects featured, etc. The program also recorded personal information about the offender (e.g., employment status, previous offences, I.Q.).

Information was gathered from victim statements, police reports, court transcripts and interviews with such relevant parties as the wife of the offender.

The interviewer's questions were intended to draw out information so that the various questions of the referring agent could be answered. One such question is "What conditions of parole will reduce this individual's risk of reoffending?" Interviews usually lasted approximately four hours.

Information gathered during the assessment is organized according to admitter status, sexual preference, substance abuse, cognitive distortions, violence/sexual history, mental status, physical health, neuropsychological status, social competence, marital dysfunction, family dynamics, risk of reoffence, appropriate treatment options and probability of success in treatment.⁽⁴⁾

Full feedback was provided to offenders before the results of the assessment were shared. Detailed reports were provided to the Correctional Service of Canada and other relevant bodies.

As assessment and treatment were considered inextricably linked, no offenders were treated before assessment. As the assessment of the offender was being completed, some aspects of treatment, such as dealing with denial, were initiated. Furthermore, while the offender was in treatment, assessment was updated regularly.

The contract funded three 16-week, group-therapy cycles. Group sessions, lasting approximately three hours, were offered once a week. There were two therapists and six to ten participants per group. The clinic preferred to have a female and a male facilitating the groups: the first group was led by two males, a social worker and a parole officer, and the second and third were led by a male psychologist and a female parole officer.

The conditions, expectations and guidelines for the group were clearly explained to offenders. Each client signed a treatment contract outlining responsibilities of the participant and therapists as well as guidelines for confidentiality.

Participants were told that their parole officers would be contacted if they reported having engaged in assault or other criminal activity; reported plans to commit an assault; missed a meeting without having a documented and appropriate excuse; were not participating in the group; showed a clinically significant change in mental status; reported plans to commit suicide; were intoxicated when attending the group; or reported a breach of a condition of abstinence.

Treatment included individual and group therapy, broad-based cognitive and behavioural therapy⁽⁵⁾ and relapse prevention⁽⁶⁾ which clearly focused on sexual behaviour. The program was not designed to address all of the concerns identified through the assessment. For example, if the individual had an addiction problem, he was referred to an appropriate agency such as Metro Drug Dependency or Alcoholics Anonymous.

The focus of treatment in this program was specifically to:

• reduce the offender's denial and minimization of the offence,
• change the cognitive distortions relevant to the aberrant behaviour,
• increase victim empathy,
• modify deviant sexual preferences,
• improve problem-solving and coping skills,
• improve social and communication skills, and
• construct a relapse-prevention plan.

The purpose of the relapse-prevention plan is to make offenders aware of any pattern of behaviour they exhibited before committing an assault. Such behaviour may include, for example, feeling lonely and unappreciated, viewing pornographic material, watching children play in the community, or purposely seeking out places that offer the opportunity to talk with children.

Offenders learn about their own offence patterns and develop clear action plans for changing their behaviour. An action plan for some offenders may involve calling a friend when they feel lonely and meeting that person for a cup of coffee.

Part of the task of preparing an acceptable relapse-prevention plan involved writing relapse cards, which list multiple fall-back strategies. Offenders were asked to keep the relapse cards on hand at all times, to practise the interventions on a regular basis and to report problems encountered in using the cards. Offenders' parole officers and significant others were made aware of the cards and were asked to review them regularly with the offenders.

In addition to the treatment described above, three offenders were on medication. Two received a drug to reduce sex drive, and one was taking an anti-psychotic drug.

The clinic also offered a long-term maintenance group for individuals who had been treated in the program. This group met once a month for about three hours.

Program success was measured by tracking offenders and counting the number of sexual offences, non-sexual offences, technical violations of parole leading to incarceration and technical violations of parole not leading to incarceration that were committed. This information was obtained from the Correctional Service of Canada and other enforcement agencies.

No one treated by the clinic has committed a sexual or non-sexual offence since treatment. Only one offender, who had several convictions for rape, was suspended for a violation of halfway-house rules. No other offenders showed violations of parole.

Three offenders, who were assessed and identified as high risk but who were not treated, committed further offences: two committed sexual offences, and one committed theft.

Commonly, the battery of tests administered during assessment showed the presence of problematic behaviours, cognitive distortions and attitudes relevant to the offence(s). The treatment plan for each offender targetted specific cognitive, behavioural or psychological deficits.

If offenders did not improve through group therapy, they were given further assessment, individual therapy, additional group therapy or referral to other agencies. Twelve of 16 offenders were required to attend an average of 13.3 individual therapy sessions, four were required to attend a second cycle of group therapy and six were referred to psychiatrists.

All offenders were tested after treatment for psychopathology, self-esteem, anxiety in social situations and capacity to form healthy and intimate adult relationships. The only subgroup of offenders with more than five subjects was child molesters. Accordingly, test scores before and after treatment are reported only for this group of 10 child molesters.

Various post-treatment tests were administered after the completion of group therapy (see table).

The key elements that appear to characterize the clinic are the careful assessment of offenders; the linking of assessment and treatment; the interaction of professional staff and Correctional Service of Canada staff in the delivery of service; the ongoing evaluation of change; the speed with which concerns are communicated to the Correctional Service of Canada and appropriate responses given; and the variety of intervention strategies employed, including referrals for treatment to other health professionals.