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Book Reviews   |    
Remaking Relapse Prevention With Sex Offenders: A Sourcebook
Reviewed by Laurie L. Guidry, Psy.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.9.1264
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edited by D. Richard Laws, Stephen M. Hudson, Tony Ward; Thousand Oaks, California, Sage Publications, 2000, 550 pages, $95

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This sourcebook, Remaking Relapse Prevention With Sex Offenders, captures the field of sex offender treatment in an unselfconscious act of self-scrutiny as it attempts to propel forward the evolution of effective treatment of sexual perpetrators. Drawing on contributions from leading experts in sex offender research and treatment, the editors provide us with an essential "re-visioning" of the popular, yet largely critically unexamined, relapse prevention approach to treating sexual abusers. Offering overviews and reviews, critiques and reconsiderations, and expansions and applications of relapse prevention to the treatment of sex offenders, the editors present an updated and well-considered reexamination of the utility of using the relapse prevention approach.

Based on addictions theory, relapse prevention is a clinical intervention that was originally formulated as a strategy to maintain behavior change. It promotes the acquisition of self-management skills for dealing with threats to abstinence. By heightening awareness of the pathways to, and the presence of, situations that increase the risk of relapse, along with facilitating access to effective coping strategies, the relapse prevention approach assumes that a motivated individual can successfully negotiate the threat of an alcohol or drug relapse.

With an emphasis on preventing the reoccurrence of problematic behaviors, the relapse prevention model was intuitively appealing to professionals in the sex offender treatment field. If substance abuse relapse could be prevented, perhaps a return to sexually deviant behavior could also be prevented. In the early 1980s, sex offender treatment professionals began to make efforts to integrate relapse prevention into the emerging cognitive-behavioral model of treatment for sexual perpetrators.

However, theoretical and conceptual differences between the substance abuse and sex offender treatment fields were left unaddressed and unreconciled. Sex offender treatment programs applied relapse prevention in a variety of idiosyncratic ways, including using it inappropriately and ineffectively as a stand-alone treatment model for sex offenders. Moreover, sex offenders often lacked the motivation necessary to maintain the behavior change.

Over the 20 years since relapse prevention was first proposed as a possible approach to treating sex offenders, its weaknesses in this application have come to light. Remaking Relapse Prevention With Sex Offenders identifies and examines these weaknesses and offers an emerging and informed reformulation of the implementation of this treatment approach with the very challenging treatment population of sexual perpetrators.

The book covers a great deal of ground, including a critique by Hanson of the relapse prevention model; a call by Mann and Thornton to sex offender treatment professionals to commit themselves to evidence-based treatment; and an efficient presentation by Haaven and Coleman of relapse prevention with developmentally disabled sex offenders.

With these and many other significant essays, this book is a valuable resource in the ongoing effort to develop an effective and fully integrated treatment approach for sex offenders.

Dr. Guidry is program director for a statewide initiative by the Massachusetts Department of Mental Health to develop assessment and treatment programming for psychiatric inpatients with co-occurring major mental illness and sexual behavior disorders.

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