The role of formulation-based treatment for sexual offenders

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical problems and t o provide clear treatment targets. A key but neglected issue in the area of sexual offending concerns the role of individual case formulations in the determination of offenders' treatment needs. In this paper, we investigate the relative strengths and weaknesses of manual-based treatment (MBT) and f ormulation-based treatment (FBT) for sex offenders. On the one hand, FBT ha s the advantages of greater flexibility and a more individualistic focus, a nd arguably is better equipped to deal with more complex clinical presentat ions. On the other hand, MBT has the advantages of standardisation and less reliance on clinicians' (flawed) judgement, and may be a more efficient us e of scarce resources. We conclude that clinicians should initially provide manual-based treatment rather than that based on individualised case formu lations. However, we also suggest that there are at least four situations w here FBT represents a valuable strategy, namely when confronted with partic ularly complex or unusual cases, when standardised treatment has failed, or when there are significant threats to the therapeutic relationship. Finall y, we briefly discuss some possibilities for research, and caution that our mixed model is only proposed as a temporary solution and that ultimately a ny model concerning treatment selection needs to be empirically based and c onceptually defensible.