3RT INTERVENTION ON COGNITIVE DISTORSIONS REGARDING THE JUSTIFICATION OF SEXUAL OFFENDERS

International Journal of Advanced Studies in Sexology 

© Sexology Institute of Romania 

Vol. 4(1), 2022, pp. 5-18 

https://www.sexology.ro/jurnal 

ISSN 2668-7194 (print), ISSN 2668-9987 (online) 

DOI: 10.46388/ijass.2022.4.1 

3RT INTERVENTION ON COGNITIVE DISTORSIONS 

REGARDING THE JUSTIFICATION OF SEXUAL OFFENDERS 

MĂDĂLINA LILIANA POP 

Babeș-Bolyai University, Romania 

*Corresponding author email: popmadalinaliliana19@gmail.com 

Abstract 

Mean-making is a very complex process, involving social, moral and psychological aspects. When it 

comes to trauma or crimes, the ability to “make sense” of the events and to find meaning in the midst 

of chaos is associated with greater psychological resilience (Chan et al., 2006). However, when it comes 

to sexual offenders, the existence of a usual stuck-point in mean-making. Specifically, given the many 

levels of the crime the offender is usually not able to access all these levels, as some are deeper than 

their awareness. At that moment, the talk therapy and cognitive behavioral therapy for developing 

adaptive skills are crucial, as they have to create a safe context, in which the person can think freely 

and explore their inner world. 

Key words: talk therapy, CBT therapy for sexual offenders, forensic psychotherapy in forensic mental 

health 

INTRODUCTION 

Psychotherapy and the field of mental 

health can not be disentangled from the topic 

of the human language. Specifically, the 

development of emotion regulation skills is 

very much dependent on the verbal abilities 

of the subject, as scholars have suggested that 

they influence each other (Cole et al., 2010). 

Many times, the therapy process is centered 

around finding the meaning of a traumatic 

experience, though talking about it. More so, 

a useful therapeutic technique is the verbal 

articulation of the patient’s inner struggles, as 

noticed by the therapist. This process is not just 

a way of improving the therapeutic relationship 

through validation and expression of empathy 

but is, in itself, a therapeutic tool. By naming 

the emotions that the client is experiencing, the 

therapist shows that the emotion is nothing 

to fear. The patient suddenly sees that the 

“entity” they have been dealing with has a 

name, and, therefore, it becomes more tangible 

and manageable. 

The question that arises then, is one of both 

practicality and ethics. The authors wonder 

about the efficacy of the therapeutic process, 

when the talking aspect of it is contaminated 

by doubt and fear and even lack of basic trust 

(i.e that the person sitting in front of you will 

not lie throughout the conversation). The 

matter of ethics is also implied in the authors’ 

question “How can we provide psychotherapy 

if we assume that the patient is not up for the 

task?”. In such instances, one might wonder if 

talk therapy is, indeed, the best course of action 

for offenders and the most efficient way of 

providing help. If such important doubts arise, 

it is our duty, as academics and practitioners, 

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to clarify the utility of those methods, before 

arguing in their favour. 

Theoretical approach 

The first part of Chapter 11 from Forensic 

Psychiatry and Psychology in Europe (Goethals, 

2018) deals with the aspect of language when 

it comes to Forensic psychotherapy. It is a 

well known fact that the outcome of therapy 

is dependent on the therapeutic relationship 

(Lambert & Barley, 2001). This relationship is 

based on mutual trust, as well as unconditional 

acceptance and the expression of empathy. 

When it comes to Forensic psychotherapy, the 

authors wonder how much of that relationship 

can be built through talking and how easily a 

therapist can develop trust when it comes to 

a patient that has committed crimes. Another 

issue that arises is how much an offender 

can trust the therapist, given their negative 

experiences with authorities and the possible 

consequences of admitting to the committed 

crimes. The topics addressed by offenders 

are often difficult for them to talk about. A 

phenomenon that may happen is the distortion of 

the events by the offender (i.e by minimizing the 

offence or by attributing more fault to the victim). 

In the anecdote presented by Koenraadt, 

McGauley, & Willemsen (2018), regarding 

the psychiatrist’s bias, the misunderstanding 

arises from the words chosen by the offender 

to describe his crime. When it comes to 

certain therapy protocols (i.e for treating Post 

Traumatic Stress - PTSD), an important aspect 

is the creation of a comprehensive, coherent 

and detailed narrative of the client’s life story 

or trauma. In exposure therapy for PTSD 

(Rauch & Foa, 2006), for example, the patient is 

required to retell the story of the trauma over 

and over, as well as to listen to tapes of them 

telling that story! The mechanism of change 

is the repeated exposure to those stimuli that 

once presented themselves as so horrifying 

that the client would not be able to face them. 

This exposure is facilitated by the “simple” act 

of talking. Many of our patients have never had 

anyone that they could openly talk to about 

their feelings, no one to help them sort their 

tangled ideas and make sense of them. Talking 

is, then, a curative process in many therapeutic 

instances. Let’s take coaching for example. We 

ask our clients to elaborate their goals, we ask 

them to specify their wishes and values in 

great detail, in order to create an action plan 

and a path to a satisfying life. The chapter’s 

authors mention the importance of stories and 

narratives in finding meaning and orienting 

ourselves in the world. The ability to make 

the inner world explicit is, therefore, a crucial 

element of psychotherapy. 

The use of narratives to create meaning 

is also used in Forensic psychotherapy. The 

stories told by offenders are closely linked to 

the issue of morality. When creating a story of 

the crime, the offender has to first think about 

what they did wrong and then analyse the 

causes and effects of that wrongdoing. In order 

for that to happen, moral judgment plays a central 

role. The authors suggest that the distortions in 

the stories of offenders (i.e. attributing blame 

to the victim, minimizing the crime) could be 

a phenomenon of cognitive nature, rather than 

assuming that this tendency is personalitybased. 

The authors imply that such distortions 

may represent a defense mechanism, as studies 

have shown that taking full responsibility 

for our dysfunctional behaviour could be 

detrimental to one’s mental health. In dealing 

with other kinds of issues brought by our 

clients (besides crimes), we often encourage 

them “to see the bigger picture” and to give up 

black-and-white thinking, in favor of a more 

nuanced way of viewing things. We rarely ask 

clients to take full responsibility for something 

that has happened to them, partly because 

that would be too much to tolerate! When it 

comes to offenders, by contrast, we want them 

to suddenly and quickly give up all defense 

mechanisms and fully accept their fault. That is 

very unlikely to happen. Talk therapy is useful 

in this area for analyzing moral problems and 

possible solutions from perspectives other 

than that of sex offenders, in order to replace 

attitudes and cognitive distortions about moral 

reasoning and justifications for crime. 

When considering the motives of the 

crimes, the authors suggest the crime needs to 

be understood in the context of the patient’s 

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3RT intervention on cognitive distorsions regarding the justification of sexual offenders 

life and can not be untangled from it. Freud 

believed that human behaviour is motivated by 

two drives: the sexual drive and the aggressive 

drive. He believed that the fuel for behaviour 

is the wish to satisfy the sexual and aggressive 

instincts. which are, for the most part, repressed 

into the unconscious. However, these drives 

are embodied, in the sense that they are 

acted out in the world by the body. When it 

comes to offenders, these drives usually begin 

to manifest early on, as the person shows 

aggressive tendencies throughout their life. 

This culminates with the act of the crime. The 

authors claim that the moment of the crime is 

the moment when the repressed and hidden 

parts of the person express themselves clearly, 

surpassing the self-defence mechanisms that 

had repressed them. However, since aggressive 

and sex drives are usually unconscious, it is 

very difficult for the person to fully articulate 

the motive of their crime. 

Regarding the history of Forensic 

psychotherapy, the approach used to be very 

rigid, at least in the Netherlands, the authors 

suggest. That is until the Utrecht Dr. H. van 

der Hoeven hospital was created. The new 

approach was based on Maxwell Jones’ idea 

to practice psychotherapy in small groups. 

He encouraged the hospital “to work as a 

therapeutic community”. That is, a community 

that relies on open communication and shared 

leadership. Therefore, the stigma associated 

with being a patient is decreased. As time 

passed, more hospitals embraced this idea. 

The community, as a therapeutic instrument, 

fosters a sense of safety and encourages the 

patients to disclose their experience with the 

staff member and other patients. Using this 

approach allows the patient to interact with 

the demands of external reality and practice 

new behaviours in a safe setting (as opposed to 

being institutionalized). The hospital becomes 

a center for reintegration. 

Although cognitive-behavioural 

approaches are dominant in the field of Forensic 

psychotherapy, the psychoanalytic notion of 

the unconscious mind and its roles in the crime 

act adds another dimension, thus facilitating 

the understanding of the offence. The authors 

suggest that the inner worlds of forensic 

patients are often marked by fragmentation 

and lack of cohesiveness. 

Given the large number of sex offenders 

in criminal justice systems, the need to outline 

effective interventions to reduce the likelihood 

of sexual recidivism has been emphasized 

(Becker, Harris & Sales, 1993; Marshall, 2001; 

Pitherii, 1993). The meta-analysis by Losel and 

Schmucker (2008) emphasized the positive 

effect of psychological treatments in reducing 

sexual recidivism. This meta-analysis included 

69 studies (N = 22,181 sex offenders), comparing 

the recurrence rates of sex offenders who 

received treatment (N = 9,512) with those who 

did not receive such programs (N = 12,669). 

Also, the intervention programs based on 

cognitive behavioral therapy had the highest 

levels of efficiency compared to other types of 

psychosocial programs. 

The main purpose of cognitive-behavioral 

interventions for sex offenders is to replace 

maladaptive cognitions and deviant sexual 

behavior with maladaptive beliefs and prosocially 

oriented behaviors. In this sense, it 

also aims to acquire new skills and specific 

strategies for solving problems, improving 

social perspectives and managing emotional 

states (Yates et al., 2000; Becker & Murphy, 

1998; Marshall et al., 1999). Cognitive 

distortions are the main factor that favors 

the appearance of sexual aggression, because 

they allow to reduce the cognitive dissonance, 

to reduce the responsibility and the guilt felt 

towards the committed deed. Thus, the main 

mechanism behind deviant sexual behavior is 

the justifications for sexual crime (Nicholaichuk 

et al., 2000; Johnston, & Marshall, 1997). The 

main distortions identified in the case of 

sex offenders are attributing the guilt of the 

victim, minimizing the damage caused and 

rationalizing the sexual assault (Feild, 1978). 

The main purpose of therapy for sexual 

offenses is to reduce a person’s likelihood 

of re-engaging in such behavior. There is 

currently no “gold standard” for dealing with 

sex crimes. 3RT (Recidivism Risk Reduction 

Therapy) describes a cognitive-behavioral 

approach focused on behavior in sexual crime 

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(Wheeler & Covell, 2005, Wheeler, George, & 

Stephens, 2005a, Wheeler, George & Stoner, 

2005b). Regarding sexual offending behavior, 

dynamic risk factors appear to be associated 

with one of two broad categories: deviant 

sexual interests and antisocial orientation 

(Hanson & Morton-Bourgon, 2004; Hanson 

& Bussière, 1998;, Bakker, & Ward , 2002; 

Quinsey, Lalumiere, Rice, & Harris, 1995; 

Roberts, Doren, & Thornton, 2002). 3RT 

explicitly includes dynamic risk factors (DRF) 

as the dominant framework for the treatment 

of sexual offenses. Dynamic risk factors refer 

to those aspects of the client’s environment, 

lifestyle or personality that are statistically 

associated with an increased risk of recurrence 

and may change. 

The main objective of the research 

is to investigate the effectiveness of 3RT 

intervention on cognitive distorsions regarding 

the justification of sexual offenders. 

Hypotheses 

1. The experimental group that will benefit from 

the 3RT intervention will have significantly 

lower scores of the victim’s guilt compared 

to the control group (waiting list). 

2. The experimental group that will benefit from 

the 3RT intervention will have significantly 

lower scores of minimizing the harm caused 

to the victim compared to the control group 

(waiting list). 

3. The experimental group that will benefit 

from the 3RT intervention will have 

significantly lower scores of rationalization 

of sexual assault compared to the control 

group (waiting list). 

Method 

Design 

The study design is an experimental one, 

being an efficiency study. 

Participants 

The criteria for including participants (N = 

64), according to Gpower, are the following: to 

be sex offenders in liberty, to be over 18 years 

old, to participate voluntarily. They will be 

randomized into two groups (the intervention 

group vs. the control group represented by the 

waiting list). 

Measures 

The measured variables (pre-intervention, 

post-intervention, follow-up) are the score of 

cognitive distortion regarding the attribution 

of the victim’s guilt, the score of cognitive 

distortion regarding the minimization of the 

caused damage and the score of cognitive 

distortion regarding the rationalization of 

sexual aggression. 

Attitudes Toward Rape Victims Scale 

(Ward, 1988) and the Burt Rape Scales (Burt, 

1980) will be used to measure the cognitive 

distortion score related to attributing the 

victim’s guilt, RAPE Scale(Bumby, 1996), and 

The Abel and Becker Cognitions Scale (Abel et 

al., 1984) will be used to measure the cognitive 

distortion score related to minimizing the 

damage caused and Rape Myth Acceptance 

Scale (Payne, Lonsway, 1999) and Justifications 

Scale of the Multiphasic Sex Inventory 

(Nichols & Molinder, 1984, 2000; VRS-SO: 

Wong & Olver, 2010) will be used to measure 

the score of cognitive distortion related to the 

rationalization of sexual assault. 

Procedure 

The experimental group will be given 

the intervention Recidivism Risk Reduction 

Therapy (Wheeler, George & Stoner, 2005) 

(3RT) for 9 months to reduce the number of 

cognitive distortions regarding the justification 

of sexual offenses. The control group will be 

represented by the waiting list for 9 months. 

Measurements of dependent variables will 

be recorded at the beginning and end of the 

intervention and follow-up at 6 months. For 

statistical analysis, unifactorial ANOVA with 

repeated measurements will be used. 

Description of 3RT intervention: 

Recidivism Risk Reduction Therapy 

(Wheeler, George & Stoner, 2005) comprises 

three phases: (i) pre-treatment, (ii) treatment and 

(iii) post-treatment. The primary mechanism 

of change occurs during the treatment phase, 

while the pre- and post-treatment phases are 

designed to prepare for effective treatment and 

to develop strategies to prevent recurrence. 

The “pre-treatment” phase involves 

an assessment period in which the client’s 

characteristic dynamic risk factors are 

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identified and conceptualized as a “cluster” of 

thoughts, emotions, problem behaviors, and 

these problem behaviors become the focus 

of therapeutic change. Once a client’s DRFs 

have been identified and conceptualized as 

problematic behaviors, the goal of the 3RT 

treatment phase is to teach clients how to replace 

their maladaptive thoughts and behaviors 

with adaptive thoughts and behaviors (skills 

training). 

1. Pre-treatment phase 

Before starting the intervention, all patients 

participate in the pre-treatment phase for about 

4-8 weeks. The objectives of the Pre-treatment 

phase are: (i) obtaining the client’s informed 

consent to participate in the treatment; (ii) 

identify the resources that should be allocated 

to each client based on the recidivism 

assessment; (iii) assessing customers’ dynamic 

risk and response needs; (iv) conceptualizing 

the history of customer crimes in the 

broader context of their global operation; (v) 

formulation of the language treatment plan (to 

address the specific strengths and limitations 

of each client); and (vi) motivating customers 

to content and process. 

Input evaluation 

Assessment of dynamic risk needs. 

Main purpose is identification of stable 

DRFs of customers. DRFs are used as a 

guiding conceptual framework for describing 

problematic client behavior and formulating 

treatment goals. There are numerous resources 

for assessing DRF associated with general 

criminal recidivism (e.g., service inventory 

level - revised: Andrews & Bonta, 1995; 

Psychopathology Checklist - revised, second 

edition: Hare, 2003; revised): American 

Association of Psychiatry, 2000, Scale of Risk 

of Violence (VRS): Wong & Gordon, 2001, 

IORNS: Miller, 2006) and Sexual Recidivism 

(SONAR Hanson & Harris 2000b; 2007 and 

Acute-2007: Hanson, Harris, Scott and Helmus, 

2007; Multiphase sexual inventory: Nichols & 

Molinder, 1984, 2000; VRS-SO: Wong & Olver, 

2010). DRFs for recidivism of sexual offenses 

fall into one of two areas that are associated 

with “sexual deviance” and / or “antisocial 

behavior”. In 3RT these two broad areas are 

called erotopathic risk needs and antisocial 

risk. Each of these areas contains subcategories 

that describe the types of thoughts, emotions, 

and problem behaviors that characterize that 

area. Each subcategory includes many factors, 

each of which can be conceptualized as DRF 

that can be targeted in treatment. 

The need for erotopathic risk refers to any 

thoughts, feelings, behaviors, and relationships 

that are associated with the client’s problematic, 

inappropriate, or otherwise maladaptive 

sexual / romantic relationships. The erotopathic 

domain is divided into three categories. The 

first deficits in sexual self-regulation include the 

risk needs related to the deficient expression of 

sexual impulses. The second lack of intimacy 

refers to the ability to form and maintain 

close and intimate relationships with sexual 

partners of the same age. The third attitude 

that supports the sexual crime is the one that 

excuses, allows or condemns such behavior, 

including justifications, rationalizations and 

minimizing the consequences of the crime. 

Orientation sessions 

3RT covers a wide range of topics to 

help clients understand what to expect from 

treatment and why treatment will be beneficial 

to them. The purpose of these groups is to 

help clients understand that treatment is not 

something that happens to them, but is a process 

in which they are active participants and 

collaborators. These explanations lead to the 

active involvement in the client’s therapeutic 

process, increasing the credibility of therapists 

and strengthening the therapeutic alliance. 

Topics in the guidance include: the history 

of sexual offenses treatment, an overview of 

dynamic risk factors, CBT and DBT. 

Orientation sessions can be conducted 

individually or in groups, depending 

on available resources and customer 

response needs. Because these groups are 

psychoeducational in nature and patients are 

not required to disclose personal information, 

guidance groups may be “mixed”; that is, 

two or more clients could be placed together 

9


in a target group, regardless of clinically 

significant differences in their history of crime, 

demographic characteristics, dynamic risk 

factors, etc. 

2. Treatment phase 

The treatment phase uses CBT interventions 

focused on the acquisition of skills and their 

generalization, in order to target dynamic 

risk factors. Dynamic risk factors are used in 

conceptualization and the main goal of the 

treatment phase is to eliminate them. In other 

words, by the end of the treatment phase, 

clients should have developed new ways of 

thinking and behaving that would be expected 

to mitigate the risk of repeating them in the 

future. The treatment phase includes two 

therapeutic modalities: skills training sessions 

and individual therapy sessions. 

Training skills in 3RT: Conceptualizing 

DRF as skills deficits 

In some traditional approaches to the 

treatment of sexual offenses, emphasis has 

been placed (clearly) on attracting clients to 

stop exposing problematic thoughts, emotions 

and behaviors (eg, stop your deviant fantasies). 

In 3RT, the goal of all treatment interventions is 

to reduce / eliminate problematic behavior and 

replace it with adaptive behavior. If the client 

does not learn and practice a new response, 

it is expected that his old behavior will recur, 

especially when the client is under pressure 

or a state of increased arousal (eg anger, 

sexual arousal). During the treatment phase, 

clients participate in two rounds of training in 

cognitive-behavioral skills (for European and 

antisocial needs). Each competency training 

round lasts approximately 6 months and is 

organized into four problem-solving skills 

training modules: (i) thoughts, (ii) emotions, (iii) 

behaviors and (iv) relationships. In this study, 

attention is paid to the pathophysiological 

needs, so there will be a single round of skills 

training. Similar to the orientation sessions 

provided in the Pre-Treatment phase, the skills 

training sessions are mostly didactic, and clients 

do not have to disclose personal information 

about their history. These sessions are practical 

psychoeducation rather than a therapy group. 

However, they are integrated into therapies, as 

these sessions are a vital aspect of facilitating 

prosocial change through modeling. 

To facilitate this boundary between 

individual therapy sessions and skills training 

sessions, it is very important that competency 

training sessions be as separate as possible 

from individual sessions. This separation 

can be accomplished in several ways, such as 

using a skill trainer who is not the individual 

therapist, holding competency sessions on a 

different day / time than individual sessions, 

or holding competency training sessions on 

a different day. room than the therapy office. 

Skills training sessions can be conducted in 

individual or group formats, depending on 

available resources. These should be “closed” 

groups, so that all members of the group start 

and finish each module together (because 

each session is based on what was covered 

in the previous session). The members of the 

new group could join an existing group at the 

beginning of each of the four modules. Training 

sessions can be led by a therapist, but if there 

are adequate resources, it is recommended that 

these sessions be organized by a skills coach (or, 

ideally, two competency trainers per group). 

5 or 6 weeks are allocated per module, which 

means that all four modules will be completed 

in about 6 months, assuming weekly sessions. 

Adapting DBT skills training for 3RT 

A useful set of skills training techniques 

are those provided in the Skills Training 

Manual for Dialectical Behavioral Therapy 

(DBT, Linehan, 1993). DBT has demonstrated 

empirical success in reducing the maladaptive 

behaviors of people with borderline personality 

disorder (Linehan et al., 1991), and with other 

clinical populations (Dimeff & Koerner, 2007). 

More recently, increased attention has been 

paid to the applicability of DBT skills to the 

treatment of sexual offending behavior (Hover, 

1999, Hover & Packard, 1998, 1999; Wheeler 

et al., 2005b). In addition, Quigley (2000) and 

Shingler (2004) provide a detailed analysis 

of the theoretical and practical compatibility 

between DBT treatment and sexual offenses. 

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DBT models address treatment needs 

that are directly relevant to DRFs associated 

with sexual offending behavior, including 

problematic thoughts (“deviant” sexual 

fantasies, antisocial attitudes, attitudes that 

support sexual abuse, sexual rights) sex/ 

arousal, loneliness, anger/hostility, suspicion/ 

mistrust), problematic behavior (sexual 

dysregulation/hypersexuality, use of sex 

as a coping strategy, aggression/violence, 

impulsivity, antisocial behavior, substance 

abuse, unstable/parasitic lifestyle, breaking the 

rules) and problematic relationships (emotional 

identification with children, instability/lack of 

romantic relationships, intimacy deficits, social 

isolation, proximal relationships with peers 

with the same traits and lack of concern for 

others). 

Specifically, it is recommended that the 

first round (approximately 6 months) of skills 

training in 3RT involve “standard” training in 

DBT skills, without mentioning in particular 

the specific treatment needs of sexual offenses. 

For clients who have difficulty discussing 

or openly admitting their deviant sexual 

behavior, or for clients who may be resistant 

to participating in sex-specific therapy, the 

motivational interview may be used to be 

willing to make changes in their lives, but 

not they are still ready to solve their specific 

needs. It can facilitate changes in attitudes or 

tolerance towards vulnerability, which allow a 

willingness to explore more directly and / or 

address issues specific to sexual deviance and 

risk needs. 

Sex-offense-specific skills training 

Despite its theoretical and practical 

compatibility with the needs of this population, 

DBT does not address some of the specific 

treatment needs of clients who have engaged 

in sexual offenses. For example, DBT does not 

specifically include interventions to manage 

problematic / antisocial sexual thoughts, 

emotions, and behaviors. Therefore, 3RT 

includes a skills training program that is based 

on DBT skills training, but specifically modified 

to meet customers’ dynamic risk needs. As 

previously described, erotopathic risk needs 

(i.e., maladaptive sexual / romantic behaviors) 

and ansocial risk needs (i.e. maladaptive social 

behaviors and lifestyle) form the foundation 

of skills training sessions. Thus, skills training 

sessions are taught through the Competence 

Handbook for Dialectical Behavior Therapy 

(Linehan, 1993), aided by additional teaching 

notes, discussion points, and activities 

specifically designed to address these types of 

dynamic risk factors. Clients can be assigned 

to one or both types of skills training sessions. 

3RT-E skills training sessions 

In erotopathic 3RT (3RT-E) skills training 

sessions, clients learn arousal monitoring 

skills, reduce problematic thinking patterns, 

and replace these maladaptive thoughts 

and behaviors with more effective methods 

of self-monitoring and regulation. sexual. 

Clients develop skills to develop and maintain 

adaptive, satisfying intimate relationships 

with partners of similar age. (Hanson et al., 

2007), the following stable erotopic dynamic 

factors were associated with an increased risk 

of sexual recurrence: 

• Deviant sexual interests (sexual interest 

in children, any paraphilic interest, sexual 

concern) 

• Deviant sexual preferences (any deviant 

sexual preference, sexual preference for 

children) 

• Lack of romantic partner (no relationship or 

history of unstable relationships) 

• Deficiencies of intimacy (loneliness/ social 

isolation, emotional identification with 

children, conflicts with intimate partners) 

• Attitudes that support sexual offenses 

(attitudes that support rape, attitudes that 

support sexual offenders, sexual rights) 

When conceptualized as deficits, we 

need to direct the client to develop skills to 

maintain satisfying and prosocial intimate / 

sexual relationships. The purpose of the 3RT-E 

competency training groups is to help clients 

develop at least some of the skills described 

below. To improve sexual self-monitoring skills, 

participants learn skills to monitor their own 

arousal processes (sexual thoughts, subjective 

arousal, sensory perceptions and physical 

sensations) and objective perception of stimuli 

11


in their environment (description of sexual 

stimuli without interpretation or judgment). 

These skills are specifically designed to target 

maladaptive patterns of sexualized thoughts 

and behaviors that contribute to inappropriate 

sexual self-regulation of offenders and to 

replace them with more effective methods for 

sexual self-control. 

To improve their sexual/emotional 

regulation skills, participants learn skills to 

identify, label, monitor, and control their sexual 

impulses, as well as the emotions inherent in 

engaging in romantic relationships (jealousy, 

insecurity, mistrust, anger). Participants 

learn to monitor sexual arousal and other 

physiological reactions and then label them. 

They also learn to reduce their vulnerability 

to certain emotional states, including sexual 

arousal as desirable. To reduce the misuse of 

sexual thoughts and behaviors as a coping 

strategy, participants learn skills to identify 

their maladaptive sexual adaptation strategies 

and replace them with more effective coping 

techniques. In addition to developing skills for 

acute coping responses, 3RT-E skills include a 

broader focus on how to reduce overall stress 

in the client’s life, by increasing the number of 

behaviors (non-harmful and non-sexual) that 

the client engages in. finds them enjoyable or 

rewards them in some other way. To diminish 

romantic/sexual relationships and their 

interactions, clients learn and practice the skills 

to engage in prosocial interactions and intimate 

relationships. Ideally, these skills directly 

target those skills needed to form and maintain 

healthy romantic relationships (dating, ending 

relationships, building intimacy, obtaining 

mutual consent). These skills are modeled and 

repeated in groups (in role-playing games) 

and in vivo (through home missions or group 

trips). 

3RT: Individual therapy sessions 

The purpose of individual therapy sessions 

is to provide clients with the opportunity 

to address their specific needs in terms of 

risk and to apply the skills they learn for 

their functioning (using weekly diary books, 

activity diaries). In addition, individual 

sessions provide a format for clients to address 

significant life events and crises as they occur 

(and conduct functional analysis of problem 

behavior) and opportunities for behavioral 

rehearsals and feedback (i.e., role-plays). 

A therapeutic activity/intervention that 

actually takes place during individual sessions 

is a functional analysis of a client’s problematic 

behavior. Specifically, the client can learn in 

depth the thoughts and emotions associated 

with their behavior and how each one interacts. 

This information is essential to help clients 

understand their own vulnerabilities and 

identify intervention needs. 

Another therapeutic activity that best suits 

individual sessions is the creation, assignment 

and subsequent review of home practice 

activities (activity journals). Each week, the 

therapist reviews what important competencies 

the client is focusing on and develops activities 

to increase the client’s opportunities to practice 

these skills between sessions. The activity is 

clearly explained to the client and is explicitly 

related to their treatment needs. Before 

concluding the session, the therapist and client 

engage in certain prevention issues to identify 

possible barriers to completing assignments 

and how they can be minimized or completely 

eliminated. Most importantly, therapists then 

review the client’s progress toward completing 

this activity in the next therapy session, 

while continuing to address any barriers to 

completing assignments and implementing / 

practicing skills outside of formal treatment 

sessions. 

An example of practicing home skills that 

therapists can assign each week is an activity 

card/journal. These are sheets that identify 

each day of the week and specific tasks to be 

recorded or documented daily. For example, 

therapists may ask clients to keep track of 

the skills they use each day, how they spend 

their time on an hourly basis, or to record 

the frequency of their sexual thoughts and 

behaviors (e.g., an “arousal diary”). The 

purpose of these journals should be clearly 

explained to the client and the journals should 

be reviewed with the client in the next session. 

For some clients, the purpose of keeping such 

12


records may be to help them develop a more 

accurate assessment of how often they engage 

in certain activities, while for other clients it is 

possible to increase responsibility for how they 

engage. I spend time. What is most important 

is that the therapeutic rationale for keeping the 

journal is clear to the client and that the journal 

is reviewed after it has been completed. 

3. Post-treatment phase 

In 3RT, the post-treatment phase can be 

performed in the form of weekly individual 

sessions or in the form of facilitator-led groups 

(4 weeks). This stage may involve less time face 

to face with therapists. Community transition 

planning applies to clients participating 

in community treatment. This phase can 

integrate other adjuvant groups, services 

and interventions. The two main objectives 

of clients in the post-treatment phase are: (i) 

to finalize a PR Plan that includes their acute 

DRFs and (ii) to identify the basic logistical 

needs of the community (and / or away from 

professional support and supervision); and 

their Community transition plan to meet these 

needs (residential, employment, financial, 

social / emotional). Clients should be provided 

with sketches and guidelines for the completion 

of both the PR plan and the Community 

transition plan, and the differences between 

each plan should be clearly explained. Creating 

a routine and a structured day is a therapeutic 

instrument used with all kinds of patients, 

as it is well-known that having a purpose is 

associated with well-being (Reker, 1989). 

Outcomes 

Following the validation of the intervention 

in other studies (Wheeler & Covell, 2005; 

Wheeler, George, & Stephens, 2005a; Wheeler, 

George, & Stoner, 2005b, Tafrate & Mitchell, 

2013), a priori we expect that the experimental 

group that benefited of 3RT intervention has 

significantly lower scores of victim attribution 

compared to the control group. We also expect 

that the experimental group that benefited from 

3RT intervention has significantly lower scores 

of minimizing harm to the victim compared to 

the control group, and that the experimental 

group that benefited from 3RT intervention 

has significantly lower scores of rationalizing 

sexual assault. compared to the control group. 

Limits and future directions of research 

In the case of Recidivism Risk Reduction 

Therapy (Wheeler & Covell, 2005) with sexual 

offenses, the notion of completing treatment is 

complex, primarily because patients who will 

be released during the program will artificially 

stop treatment. Terms such as graduation and 

completion can be misleading, contributing 

to the false impression that therapy is like a 

“class” with a clear beginning and end and / 

or that there is a fixed and terminal nature of a 

client’s risk and ability / need to change so that 

they are no longer at risk of engaging in sexual 

behavior problems. 

Indeed, clients’ progress, their change, 

and the nature and extent of their individual 

risk needs vary and are influenced by their 

current circumstances. Consequently, we are 

aware that changes will continue to occur with 

clients and that they will encounter or create 

situations and circumstances that are risky for 

them, which may require a return to treatment. 

CONCLUSIONS 

When it comes to practice, an advantage 

of Forensic psychotherapy’s psychoanalytic 

influences is the fact that it provides a 

framework through which practitioners can 

better understand the offenders. By looking at 

the crimes through a psychoanalytic perspective 

and talk therapy for offenders perspective, the 

practitioner can help the patient understand 

the unconscious motives of the crime, as well 

as the way in which these unconscious drives 

shape and influence the environment around 

the offender. 

It is also known that cognitive behavioral 

therapy is the best scientifically validated 

therapeutic approach for inmates. 3RT is a 

cognitive-behavioral approach to treating 

sexual crimes. 3RT uses dynamic risk factors 

as an organizational framework for treatment 

planning and delivery and draws on existing 

CBT techniques, such as DBT skills, to target 

these risk factors. 3RT is an extremely flexible 

approach, which can be easily adapted to the 

13


needs of clients, including adults and minors, 

men and women, in hospitals and outpatients. 

In this way, 3RT offers therapists a direct and 

empirical approach derived to reduce the risk 

of recurrence in patients with a history of 

sexual offenses. 

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