Mentalization-based treatment for individuals convicted of a sex offense: a proof of principle study

While cognitive-behavioral therapy is the standard treatment for individuals who committed a sex offense, individual outcomes vary. Mentalization-based treatment (MBT), aimed at strengthening participants’ capacity to mentalize, may prove a useful alternative. This study aimed to evaluate the feasibility, acceptability and preliminary effectiveness of MBT in persons sentenced to clinical treatment after perpetrating a sex offense. A proof of principle design was used, combining quantitative and qualitative methods. Study 1 (n = 21) assessed changes in self-reported emotion recognition, empathy and interpersonal reactivity over 12 months of MBT. Additionally, changes in practitioner-rated recidivism risk were evaluated. Study 2 evaluated MBT among 21 patients and 11 staff members through semi-structured interviews analyzed using Colaizzi’s phenomenological approach. Quantitative results using self-report measures showed no significant improvements over time. However, practitioner-rated recidivism risk decreased significantly (p < 0.05). Qualitative findings indicated that MBT was generally well-accepted, with patients and staff reporting perceived benefits such as improved emotional expression, communication skills and therapeutic relationships. Challenges included mandatory participation, difficulties for individuals with autism spectrum disorder and potentially reduced feasibility with patients showing high levels of socially desirable behavior. MBT treatment may offer a valuable and practical addition to the currently available treatment protocols for the treatment of individuals who have committed sexual offenses. To the best of the authors’ knowledge, this is the first study to systematically examine MBT in a sex-offender population. Findings suggest that MBT is feasible and acceptable in forensic settings treating sex offenders and although no significant changes were perceived via self-reported measures, may reduce recidivism risk as assessed by practitioners.