Treatment Modalities Recommended for Sexual Offenders with Intellectual Disabilities

Posted October 30, 2020 | By csponline

*The statements, views, and opinions in this article are those of the author. These statements are not the views or opinions of WA DOC or the WA DOC SOTAP.

The goal of this article to provide a brief overview of Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) and how these treatment modalities are being used to treat sexual offenders, specifically sexual offenders with intellectual disabilities (ID). As treatment programs aim to reduce sexual recidivism, they face a unique challenge to find ways to provide effective treatment to sexual offenders with ID. As such, clinicians and treatment programs are finding ways to adapt treatment for this population.

Below are some key points that individuals working with this population should know about treatment modalities being used in sex offender treatment.

Cognitive Behavioral Therapy

CBT is generally viewed as the “gold standard” among the various therapeutic approaches (Beck, 2019). CBT looks at the association between thoughts, feelings, and behaviors (Chand, Kuckel, & Huecker, 2020). Furthermore, CBT is widely used as a treatment modality for sexual offenders with ID (Marotta, 2017). Even though CBT is frequently used with this population, it is suggested that treatment programs and clinicians be responsive to the varied needs of sexual offenders with ID; some of the needs include their cognitive and emotional needs and behavioral challenges that present in these individuals (Marotta, 2017).

Dialectical Behavioral Therapy

DBT can be used in individual therapy, skills group training, and in group sessions. Research has shown that there are promising outcomes when used with individuals with ID but should continue to be interpreted with caution (Patterson, Williams, & Jones, 2020). Just as other treatment approaches have been adapted to meet clients’ needs, treatment programs can use adapted DBT to treat individuals with intellectual disabilities (McNair, Woodrow, & Hare, 2017). Notably, a tool to measure the fidelity of DBT for individuals with intellectual disabilities is lacking (Patterson et al., 2020).

Adapted Approaches

Sexual offenders with ID require treatment approaches that include role-plays, skits, and even drawing to help them learn about their risk and interventions (Blasingame, 2001; Fenrich, 2020). Flashcards and activity-based treatment can be useful for this population. Furthermore, repetition and creativity are encouraged in treatment to help sexual offenders with ID understand treatment concepts (Cohen & Harvey, 2016).


While CBT is commonly used in treatment programs, as mentioned by Marotta (2017), it is suggested that clinicians who work with this population continue to use evidence-based practices to inform treatment approaches and find ways to adapt the various treatment modalities. In addition, more research is needed on DBT and how it is used with individuals who have intellectual disabilities (McNair et al., 2017).

Author’s Biography

Amanda (Mandy) Fenrich is a Ph.D. Candidate and currently completing her degree in the advanced studies of human behavior through Capella University. Mandy obtained her Master of Arts in Human Services with an emphasis in forensic mental health and her Bachelor of Criminal Justice from Concordia University, St. Paul in St. Paul, Minnesota. Mandy is currently employed as a psychology associate for the Washington State Department of Corrections’ Sex Offender Treatment and Assessment Program (SOTAP). She provides sex offender treatment to individuals at the Special Offender Unit, a residential treatment unit for individuals with serious mental illness. She also has experience providing treatment to sex offenders with intellectual disabilities and is one of the authors creating an adapted sex offender treatment manual for this population. Her previous experience includes working as a community corrections officer, where she supervised offenders in the Special Needs Unit with various mental health needs. She is an ad-hoc reviewer and publishes on a variety of criminal justice and forensic mental health topics.


Beck, A. T. (2019). A 60-year evolution of cognitive theory and therapy. Perspectives on Psychological Science, 14(1), 16-20.

Blasingame, G.D. (2001). Developmentally disabled persons with sexual behavior problems. Treatment, management & supervision. Oklahoma City, OK: Wood ‘N’ Barnes Publishing.

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2019). Cognitive behavior therapy (CBT). In StatPearls [Internet]. StatPearls Publishing. Retrieved from:

Cohen, G., & Harvey, J. (2016). The use of psychological interventions for adult male sex offenders with a learning disability: a systematic review. Journal of Sexual Aggression, 22(22), 206-223.

Fenrich, A. (2020). Sexual offenders with intellectual disabilities: A brief overview. Forensic Scholars Today, 5(4). Retrieved from: today/sexual-offenders-intellectual-disabilities-overview

Marotta, P. L. (2017). A systematic review of behavioral health interventions for sex offenders with intellectual disabilities. Sexual Abuse, 29(2), 148-185.

McNair, L., Woodrow, C., & Hare, D. (2017). Dialectical behaviour therapy [DBT] with people  with intellectual disabilities: A systematic review and narrative analysis. Journal of Applied Research in Intellectual Disabilities30(5), 787-804.

Patterson, C., Williams, J., & Jones, R. S. (2020). DBT and intellectual disabilities: the relationship between treatment fidelity and therapeutic adaptation. Advances in Mental Health and Intellectual Disabilities, 14(3), 61-67.