h ps://doi.o g/10.1177/15248380241277274
TRAUMA, VIOLENCE, & ABUSE
1 –11
© The Au ho (s) 2024
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DOI: 10.1177/15248380241277274
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Re iew Manusc ip
Child sexual abuse (CSA) is conside ed a majo public
heal h p oblem wi hin esea ch and poli ics. The high p e a-
lence a es and de as a ing ou comes o ic ims, hei ami-
lies, and socie y make CSA a wo ying phenomenon (Ba h
e al., 2013; Hailes e al., 2019). Acco ding o da a om he
Wo ld Heal h O ganiza ion (WHO, 2022), app oxima ely 1
in 5 women and 1 in 13 men disclose expe iencing sexual
abuse be o e he age o 17 yea s p e alence o CSA has been
dispa a e when assessed using sel - epo ed and o icial
da a, wi h sel - epo ing me hods showing highe a es
(S ol enbo gh e al., 2011). A ecen me a-analy ical e iew
ound ha only abou 2% o cases a e o icially epo ed. In
con as , ic imiza ion su eys indica e ha he p e alence
a es o women who commi ed CSA a e six imes highe
han hose sugges ed by o icial da a (Co oni e al., 2017).
The e o e, many abusi e ac s go un epo ed due o some
ac o s, including ea , shame, and a lack o suppo and
unde s anding om o he s (Lemaig e e al., 2017; Tozdan
e al., 2019). Speci ically, ic ims o en pe cei e he suppo
hey will ecei e a e epo ing he c ime nega i ely
(Lemaig e e al., 2017; Tozdan e al., 2019). In ac , heal h-
ca e o jus ice sys em p o essionals o en espond inapp o-
p ia ely o hese cases based on hei s e eo ypes (Tozdan
e al., 2019).
S e eo ypically, CSA implies he image o a male who
commi ed a sex c ime agains a emale child. As esea ch in
his ield has expanded since he 1980s (Co oni, 2015), i
has been es ablished ha indi iduals o any gende , includ-
ing women, can commi o CSA (Tozdan e al., 2019). In he
pas , minimal a en ion was gi en o adi ional gende oles
1277274TVAXXX10.1177/15248380241277274TRAUMA, VIOLENCE, & ABUSESousa e al.
e iew-a icle2024
1Psychology Resea ch Cen e , Uni e si y o Minho, B aga, Po ugal
2Digi al Human-En i onmen In e ac ion Lab, Uni e sidade Lusó ona Do
Po o, Po ugal
Co esponding Au ho :
Ma a Sousa, School o Psychology, Uni e si y o Minho, Campus de
Gual a , B aga 4710-057, Po ugal.
Email: [email p o ec ed]
The E ec i eness o Psychological
In e en ion o Women Who
Commi ed Child Sexual Abuse:
An Emp y Sys ema ic Re iew
Ma a Sousa1, Cláudia Gou eia1, Bá ba a F ei as1,
Sónia Ca idade1, and Olga Cunha2
Abs ac
The opic o sex o enses commi ed by women has ecei ed ela i ely li le a en ion un il ecen decades. The sca ci y o
esea ch in his domain unde sco es he u gen need o a mo e comp ehensi e unde s anding and e ec i e in e en ions.
Women who commi ed child sexual abuse (CSA) exhibi a dis inc psychological p o ile compa ed o men, equi ing
speci ic in e en ion p og ams. The cu en sys ema ic e iew has wo aims: he p ima y aim is o analyze he e ec i eness
o psychological in e en ions wi h women who commi ed CSA, and he seconda y aim is o iden i y he in e en ion
models and s a egies used wi h hem. Six da abases we e sea ched o s udies examining he e ec i eness o psychological
in e en ions. All e ie ed pape s we e excluded a e ull- ex assessmen s as none me he p ima y objec i e. Howe e ,
eigh publica ions ul illed he seconda y objec i e o iden i ying models and s a egies ha could in o m in e en ion
de elopmen . The in e en ion p og ams p esen ed add essed speci ic a ge s ocused on c iminogenic needs highligh ed
in he li e a u e as cen al o his popula ion, as well as a ge s ha complemen he in e en ion acco ding o indi idual
cha ac e is ics. Mo eo e , he s udies equen ly emphasize an in e en ion app oach cen e ed on indi iduals’ po en ial (and
no jus hei de ici s), employing a gende pa adigm o unde pin psychological in e en ions wi h his popula ion. The esul s
o his e iew highligh a majo gap in he cu en li e a u e conce ning bo h he deli e y and e ec i eness assessmen o
psychological in e en ion o women who commi ed CSA. The s udies inco po a ed o he second objec i e elucida ed
c i ical ea men a ge s and models o in o m in e en ion s a egies, which a e subsequen ly discussed in e ms o hei
p ac ical implica ions.
Keywo ds
ea men , women who commi ed child sexual abuse, in e en ion e ec i eness, sys ema ic e iew
2 TRAUMA, VIOLENCE, & ABUSE 00(0)
po aying women as nu u ing, p o ec i e, non-agg essi e,
and non-sexual ai s hough o ende hem incapable o
ha ming a child (Deno , 2004; Jennings, 1994). As a conse-
quence, ea ly heo ies on emale sexual o ending equen ly
con ex ualized i ei he wi hin he amewo k o male coe -
cion o se e e men al heal h p oblems (i.e., psychological
diso de s o pe sonali y diso de s) (Co oni, 2015). Cu en ly,
limi ed esou ces a e also alloca ed o s udies on women who
commi ed CSA, e lec ing he ela i ely small numbe o
occu ences pe pe a ed by women (Ge ke e al., 2020).
Howe e , women who commi ed CSA encompass a he e o-
geneous o ensic popula ion wi h dis inc ea men equi e-
men s (Hales & Gannon, 2022). Besides, he e olu ion o
con empo a y knowledge on women who commi ed CSA
and women who commi ed c imes in gene al highligh s he
inadequacy o applying heo ies and empi ical knowledge
de eloped o males (Gannon e al., 2008). Mo eo e , he e
was a lack o isk assessmen ools o women who commi -
ed CSA, which can complica e accu a e isk assessmen
(e.g., Co oni, 2010). Risk assessmen ools de eloped o
men may o e es ima e he isk o sexual ecidi ism in
women and ail o iden i y he unique ea men needs o
women, which a e essen ial o in o ming app op ia e ea -
men plans (Co oni, 2010).
Psychological and clinical li e a u e has highligh ed key
di e ences be ween men and women who commi ed CSA
(Williams & Bie ie, 2015). Conce ning o ense pa e ns,
women who commi ed CSA ic imized mo e adolescen s
and we e signi ican ly less likely o be in oxica ed a he ime
o he c ime han men (Williams & Bie ie, 2015). The same
applies o psychological a iables, whe e women who com-
mi ed CSA show a high le el o sexual ic imiza ion, and a
high p e alence o men al heal h p oblems (e.g., pe sonali y
diso de s, subs ance use diso de s, and mood diso de s)
(e.g., Auga de & Rydon-G ange, 2022; Ch is ophe e al.,
2007; Coma in e al., 2018; Gillespie e al., 2015; Mille &
Ma shall, 2019). Al hough hey sha e some simila i ies wi h
men who commi ed CSA, he mo i a ions o he o ense
include emale-exclusi e mo i es, which a e ela ed o pe -
sonal and/o si ua ional ac o s (i.e., o ending o please a
man and being p essu ed o manipula ed by a male pa ne )
(B own & Kloess, 2020).
P epa ed wi h his knowledge, esea che s began o de e -
mine whe he women who commi ed CSA could be ca ego-
ized in o speci ic subg oups o ypologies (Ma hews e al.,
1989). Ne e heless, he a ailable ypologies a e limi ed
(Hales & Gannon, 2022). Speci ically, he ypologies a e
o en de i ed om s udies wi h small samples and selec ion
biases (Bickley & Beech, 2001). Un il e y ecen ly, he e
ha e been no heo e ical amewo ks wi hin common ypolo-
gies ha could comp ehensi ely elucida e he a ious in e -
ac ing ac o s con ibu ing o women engaging in sexual
o enses (Blake & Gannon, 2018). Then, Gannon e al.
(Gannon e al., 2008, 2010, 2012) de eloped he Desc ip i e
Model o Female Sexual O ending. This model aims o
explain how and why ce ain women commi ed CSA,
including cogni i e, a ec i e, and beha io al ac o s. As a
esul o hese model, h ee pa hways we e iden i ied: he
explici -app oach pa hway, ha is, women who demon-
s a ed a ied mo i es o hei o ensi e beha io s (e.g.,
seeking e enge o in imacy), we e no selec i e in choosing
hei ic ims and o ended agains child en and adul s, e ec-
i ely sel - egula ed, and expe ienced posi i e emo ions
linked o hei misconduc ; he di ec -a oidan pa hway, ha
is, women who we e unwilling o pa ake in sexually illegal
beha io s wi h child en bu we e coe ced in o doing so by a
male accomplice, ei he ou o ea o o es ablish in imacy,
expe iencing se e e nega i e a ec ); and he implici -diso -
ganized pa hway, ha is, women wi h di e en aims o hei
o ensi e beha io s, which we e gene ally no p emedi a ed
a ei he dis an o immedia e ime poin s, and displayed a
lack o selec i i y in choosing hei ic ims, bu o ended
agains ei he adul s o child en and expe iencing ei he posi-
i e o nega i e a ec (Gannon e al., 2008).
The ypologies and he Desc ip i e Model o Female
Sexual O ending ha e p o ided some in o ma ion abou he
key a ge s o in e en ion. Speci ically, o ense-suppo i e
cogni ions, ela ionship di icul ies (e.g., dependency), di i-
cul ies in managing emo ional egula ion and unhelp ul cop-
ing s a egies (e.g., subs ance use), and de ian o
inapp op ia e sexual in e es s need o be conside ed in psy-
chological in e en ion (Co oni & Gannon, 2013, 2016;
Wijkman e al., 2010). The Desc ip i e Model o Female
Sexual O ending and i s sub ypes o women who commi ed
CSA highligh ha some in e en ion a ge s may be a p io -
i y o some and no o o he women (Gannon e al., 2008).
As such, women who commi ed CSA in he di ec ed a oid-
an ypology may bene i om an in e en ion ocused on
imp o ing hei ela ional skills and asse i eness. On he
o he hand, women lis ed in he implici -diso ganized
app oach migh ind suppo aluable in enhancing emo-
ional egula ion and acqui ing e ec i e coping mechanisms.
Mo eo e , conside ing he cha ac e is ics o hese women,
esea che s a gue ha in e en ions need o unde s and mo e
abou how women deal wi h p e ious abusi e expe iences
and how his is ela ed o he abuse hey ha e pe pe a ed,
ocusing i s on auma ic expe iences (Co oni, 2018;
Williams e al., 2019). Fu he mo e, in e en ions should
also a ge men al heal h diso de s and subs ance addic ion
(P lug ad e al., 2018; Williams e al., 2019). Howe e ,
despi e he cu en empi ical a en ion gi en o women who
commi ed CSA o unde s and he isk and main enance ac-
o s con ibu ing o hei educ ion (Co oni, 2015), ew s ud-
ies s ill exis on he c iminogenic needs o women who
commi ed CSA, and he e a e limi ed in e en ion p og ams
ailo ed o his popula ion (Co oni & Gannon 2013, 2016).
The e o e, he p ima y aim o he p esen sys ema ic
e iew was o analyze he psychological in e en ions wi h
women who commi ed sex c imes, analyzing hei e ec i e-
ness. In addi ion, he seconda y aim was o iden i y he
Sousa e al. 3
in e en ion models and s a egies used wi h his popula ion.
The iden i ica ion o hese models and s a egies may aid in
he de elopmen o in e en ion esponses.
Me hod
The cu en sys ema ic e iew was conduc ed acco ding o
P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-
Analysis (PRISMA) guidelines (Mohe e al., 2010) and egis-
e ed on OSF REGISTRIES [ e e ence: 10.17605/OSF.
IO/4RCVP].
Sea ch S a egy
The sea ch was conduc ed in June 2023, wi hou any da a
es ic ions, by wo independen esea che s wi h an MSc in
Applied Psychology. The ollowing equa ion sea ch was used
o asce ain he pe inen a icles: ( ea men OR in e en ion
OR he apy OR p og am* OR psycho he apy OR ehabili a-
ion) AND (“child abuse *” OR “child sexual abuse *” OR
child po nog aph* OR child moles * OR pedophil* OR pae-
dophil* OR “in e ne sex* o end*” OR “sexually o end*”
OR “sexual o end*” OR “sexual o en*” OR “sexual
abuse*”) AND (women OR emale). The sea ch was con-
duc ed using he ollowing da abases: PubMed, ScienceDi ec ,
SCOPUS, EBSCO (PsycIn o), Web o Science, and Scielo.
Mo eo e , he e e ence lis s o sys ema ic e iews and me a-
analyses o his popula ion we e checked.
Inclusion and Exclusion C i e ia
Fo he i s aim o he cu en sys ema ic e iew, he
PICOS amewo k was used o de ine he inclusion c i e ia:
Pa icipan s (P), In e en ions (I), Compa isons (C),
Ou comes (O), and S udy Designs (S) (Thomas e al.,
2021). Inclusion c i e ia we e: s udies wi h adul women
who pe pe a ed sexual c imes agains child en (P), who
unde wen a psychological ehabili a ion p og am (I), and
ha ing o no a compa ison g oup (C). We de ine psycho-
logical ehabili a ion as any s uc u ed he apeu ic ac i i y
aimed a add essing psychological, emo ional, and beha -
io al issues in indi iduals. Mo eo e , he p ima y ou come
was he e ec i eness o psychological in e en ion,
assessed h ough clinical changes and/o ecidi ism a es
(O). We de ined clinical change as he p esence o s a is i-
cally signi ican di e ences be ween baseline and pos - es
in he dimensions assessed. All ypes o s udy designs we e
conside ed o his e iew (S). Exclusion c i e ia we e: (a)
li e a u e e iew; (b) e iews, sys ema ic e iews, and
me a-analyses; (c ) s udies ha collec ed and analyzed only
quali a i e da a (e.g., in e iew); (d) pape s no pee -
e iewed (i.e., g ay li e a u e), and (e) s udies no w i en in
English, Po uguese, o Spanish. Pape s in English,
Po uguese, and Spanish a e included because all au ho s
a e p o icien in hese languages.
A seconda y objec i e was delinea ed conside ing he
lack o pape s ha mee he inclusion c i e ia du ing ull- ex
sc eening. Fo he second aim, he inclusion c i e ia we e: (a)
empi ical s udies, books, and chap e s ha desc ibe speci ic
in e en ion models, s a egies, o p og ams o women who
commi ed CSA; and (b) we e w i en in English, Po uguese,
o Spanish. No es ic ions ega ding he yea o publica ion,
o esea ch design we e used.
Li e a u e Selec ion P ocess and Da a Ex ac ion
S udies iden i ied h ough equa ion sea ch we e impo ed
in o Rayyan so wa e (Ouzzani e al., 2016) o dele e
duplica es and sc een i les and abs ac s agains he inclu-
sion c i e ia. Two a e s independen ly sc eened a icle
i les and abs ac s, selec ing pape s o ull- ex analysis.
Disc epancies be ween he wo a e s we e esol ed
h ough discussion, wi h a hi d e iewe a ailable o
in e ene i needed.
A icles ha me he inclusion c i e ia we e e ie ed and
ully ead o each a inal decision by wo independen a e s.
Fo he i s aim o he cu en sys ema ic e iew, a codebook
was de eloped o ex ac da a om all included a icles,
including in o ma ion abou e e ence de ails (e.g., au ho s
and yea ); s udies’ cha ac e is ics (e.g., loca ion); samples’
cha ac e is ics (e.g., size, age, and e hnici y/ ace); design’s
cha ac e is ics (e.g., design ype and leng h o ollow-up);
in e en ion’s cha ac e is ics (e.g., se ing, modali y, numbe
o sessions o hou s, and complemen a y in e en ion); mea-
su emen ’s cha ac e is ics (e.g., assessmen measu es and
assessmen o ecidi ism); in e en ion’s esul s (e.g., d op-
ou /comple ion a e and e icacy).
To collec da a o he second aim, a new codebook was
de eloped o ex ac da a, including in o ma ion abou e e -
ences and he in e en ion’s cha ac e is ics (e.g., numbe o
in e en ion p og ams, name o he p og ams, numbe o
sessions, a ge s o in e en ion, models o in e en ion, and
desc ip ion o in e en ion s a egies).
Quali y Assessmen
The Quali y Assessmen Tool o S udies wi h Di e se
Designs (QATSDD) was used (Si iyeh e al., 2011) o assess
he isk o bias in he included s udies. We chose o use he
QATSDD because i was speci ically de eloped o assess he
quali y o s udies wi h he e ogeneous designs in he ield o
Psychology and is widely used in sys ema ic e iews. Despi e
some limi a ions and he exis ence o a e ised e sion, he
QATSDD has demons a ed s ong eliabili y and alidi y
(Ha ison e al., 2021). The QATSDD is a 16-i em ool, wi h
wo indica o s o quali a i e s udies and wo o quan i a i e
s udies. The i ems we e sco ed be ween 0 and 3, wi h a
highe sco e indica ing g ea e me hodological igo . Sco es
on he QATSDD can ange om 0 o 42 o quali a i e and
quan i a i e s udies o up o 48 o mixed-me hods s udies.
4 TRAUMA, VIOLENCE, & ABUSE 00(0)
To ensu e accu acy, he QATSDD was de eloped o p o ide
an o e all quali y a ing exp essed as a pe cen age.
Resul s
In o al, 6,641 a icles we e e ie ed om he da a sea ches
and h ough supplemen a y sea ches. A e emo ing dupli-
ca es, 4,641 i les and abs ac s emained and we e sc eened
o ele ance. Thi y po en ially ele an s udies we e
selec ed o ull- ex analysis. Following he ull- ex assess-
men , all s udies we e excluded based on he inclusion c i e-
ia. Conside ing he main objec i e o his e iew, no
publica ions we e iden i ied ha p esen ed he e ec i eness
o psychological in e en ions o women who commi ed
CSA (see Figu e 1). S udies we e excluded because hey
add essed o ende s in gene al wi hou speci ying he ype o
c imes, did no in ol e psychological in e en ions o
in e en ion models bu a he o he ypes o in e en ions,
such as pha macological ea men s, o we e p ima ily
ocused on popula ion cha ac e iza ion.
Since he sea ch yielded no esul s, a subse o eigh pub-
lica ions was iden i ied, ocusing on a seconda y objec i e:
heo e ical discussions o psychological in e en ions,
including s a egies ha could in o m in e en ion designs.
This endea o adhe ed o he guidelines ou lined in he
Coch ane E ec i e P ac ice and O ganiza ion o Ca e man-
ual o epo ing emp y e iews (Ya e e al., 2012).
Quali y Assessmen
The QATSDD p o ides a pe cen age sco e o compa e
epo ing quali y ac oss s udies. To acili a e a icle compa i-
sons, h ee ca ego ies we e assigned: low quali y (≤50%),
accep able quali y (51%–74%), and high quali y (≥75%)
Reco ds iden i ied h ough
da abase sea ching and o he
sou ces
(n = 6641)
Reco ds emo ed be o e
sc eening:
Duplica e eco ds emo ed
(n = 2030)
Reco ds a e duplica es
emo ed
(n = 4611)
Repo s sc eened
(n = 4611)
Repo s excluded
(n = 4576)
Repo s assessed o eligibili y (n
= 35)
Full- ex , a icles excluded, wi h
easons
-did no e alua e he
e ec i eness (n = 30)
-wi hou open access (n =
5)
S udies included in he p ima y
objec i e
(n = 0)
Iden i ica ion
Sc eening
Included
Publica ions mee ing c i e ia o
seconda y objec i e (n = 8)
Figu e 1. P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analysis 2020 low diag am o new sys ema ic e iews, which
included sea ches o da abases, egis e s, and o he sou ces.
Sousa e al. 5
(C owe e al., 2011). In his sys ema ic e iew, we included
a icles o accep able quali y (n = 1) and high quali y (n = 7).
The s udy by Co oni and Gannon (2013) had he highes
quali y sco e (92%), ollowed by h ee s udies wi h an 83%
quali y sco e (Blanche e e al., 2010; Cos a e al., 2023;
P lug ad & Allen, 2019). Addi ionally, h ee s udies had a
quali y sco e o 75% (Ash ield e al., 2010; Gannon & Rose,
2008; Loinaz, 2016), and one had a sco e o 67% (P lug ad
e al., 2018).
S udy Resul s
Fou s udies p esen ed se e al in e en ion p og ams
designed o women who commi ed CSA (Blanche e e al.,
2010; Cos a e al., 2023; Gannon & Rose, 2008; Loinaz,
2016), while ano he ou p esen ed ea men models and
a ge s (Ash ield e al., 2010; Co oni & Gannon, 2013;
P lug ad & Allen, 2019; P lug ad e al., 2018).
In e en ions. The ou s udies included p esen ed nine in e -
en ion p og ams: he p og ams applied in Lucy Fai h ull
Founda ion (Blanche e e al., 2010; Gannon & Rose, 2008),
in he Counseling Ins i u e o Texas (Blanche e e al., 2010),
in he Wisdom Wo ks Counseling Se ices o Colo ado
(Blanche e e al., 2010), in Wa en Coun y P oba ion
(Blanche e e al., 2010), in Sa a oga Coun y P oba ion
Depa men (Blanche e e al., 2010), in B azil (Cos a e al.,
2023), he Canadian Sex O ende The apy P og am (Gan-
non & Rose, 2008), and he Women Sex O ende s P og am
(Loinaz, 2016). Th ee p og ams we e conduc ed in commu-
ni y/p oba ion se ices, wo in communi y and ede al ins i-
u ions, one in p ison, one in a hospi al, and one in independen
child p o ec ion agencies. One s udy did no epo in o ma-
ion abou i . Only one in e en ion p og am was di ec ed a
women who commi ed CSA, wi h he o he ocused on
women who commi ed sex c imes in gene al.
Many o he in e en ion a ge s we e common h ough-
ou he p og ams desc ibed. As such, six in e en ions
ocused on cogni i e dis o ions and/o schemas, six on
in e pe sonal issues (such as communica ion, in imacy, and
sexuali y p oblems), six on he o ense cycle, i e on ic im
empa hy, ou on sel - egula ion, h ee on elapse p e en ion
plans, and wo on sexual a ousal (see Table 1).
Fu he mo e, ce ain p og ams also exhibi speci ic cha -
ac e is ics. Fo ins ance, he Lucy Fai h ull Founda ion aims
o ul ill human needs h ough p osocial and cons uc i e
means while also add essing p io ic imiza ion expe iences
(Blanche e e al., 2010). Simila ly, he Canadian Sex
O ende The apy P og am inco po a es a modula s uc u e
wi h sequen ial phases designed o add ess c iminogenic
needs while in eg a ing gende -sensi i e objec i es. This
speci ic p og am, while add essing a ge s speci ic o sexual
o enses, also in eg a es elemen s om o he p og ams.
These include cogni i e skills de elopmen , add essing
abuse and auma, managing subs ance abuse, emo ional
egula ion, pa en ing skills, communi y in eg a ion p o-
g ams, and educa ion and employmen ini ia i es, alongside
communi y moni o ing (Gannon & Rose, 2008). In addi ion,
he in e en ion p og am applied in Wa en Coun y P oba ion
also add essed sel -es eem and consen (Blanche e e al.,
2010).
Al hough he in e en ion p og am p esen ed by Cos a
e al. (2023) has he same aims as he o he in e en ions—
s eng hen p o ec i e ac o s and educe isk ac o s o mini-
mize ecidi ism-, he in e en ion is di e en , so i will be
explained sepa a ely. The pape p esen s a p oposal o a
b ie g oup psychosocial ca e designed o adul women who
commi ed CSA, wi h eigh sessions o h ee hou s each.
This psychosocial in e en ion is guided by p ede ined
hemes and inco po a es psychod ama and a he apy
esou ces. Themes include awa eness o being in a ela ion-
ship wi h o he s; explo a ion o he concep o iden i y, ec-
ogni ion o one’s own li elong ic imiza ion and
co esponding su e ing, ecogni ion o submission p esen
in ela ionships wi h o he people, especially in ima e pa -
ne s, and e lec ion on psychosexual imma u i y. Addi ionally,
i also ocuses on p o iding in o ma ion on legisla ion (Cos a
e al., 2023).
Models o In e en ion and Cha ac e is ics o Women Who Com-
mi ed CSA. The s udies highligh ed some models o ea -
men , wi h special a en ion o models based on posi i e
psychology and gende , namely an in e en ion app oach
cen e ed on po en ial using a gende pa adigm (Ash ield
e al., 2010; Co oni & Gannon, 2013; P lug ad & Allen,
2019; P lug ad e al., 2018). On one hand, he s eng hs-
based model acili a es a collabo a i e p ocess, enabling
indi iduals o iden i y hei skills and esou ces. This indi-
idualized app oach assis s people who pe pe a e c imes in
ecognizing and de eloping hei po en ial wi hin ele an
social and ela ional con ex s, such as he communi y o
ins i u ion (P lug ad e al., 2018). Wi hin his app oach, he
au ho s highligh wo models: he Good Li es Model (GLM)
de eloped by Wa d and B own (2004) and Wa d and Mann
(2004); and he S eng hs-Cen e ed P og am c ea ed by Ma -
shall e al. (2011) (Ash ield e al., 2010; P lug ad & Allen,
2019; P lug ad e al., 2018). These models should also be
included aking in o accoun a gende - ocused app oach.
The gende pe spec i e emphasizes he inclusion o in e-
g a ed men al heal h and subs ance abuse ea men se ices.
This includes a s eng hs-cen e ed ea men model ha os-
e s sel -con idence, women-only g oups (no mixed in e ms
o gende ), gende - esponsi e sc eening, and co esponding
assessmen ools, along wi h app op ia e and indi idualized
ea men planning (P lug ad e al., 2018). This app oach
ecognizes ha women may equi e mo e social connec ions
han men (P lug ad & Allen, 2019). The au ho s poin ed ou
ha hese esul s a e consis en wi h esea ch indica ing ha
women de i e g ea e bene i s om social ela ionships and
suppo . Consequen ly, ea men in e en ions based on
6
Table 1. Syn hesis o Rele an S udies.
T ea men P og am
o Female Sexual
O enses
Counseling Ins i u e
o Texas
Wisdom Wo ks
Counseling
Se ices o
Colo ado
Wa en Coun y
P oba ion
Sa a oga Coun y
P oba ion
Depa men
Psychosocial
In e en ion
Lucy Fai h ull
Founda ion
Canadian Sex O ende The apy
P og am
Women Sex O ende s
P og am
Au ho (yea ) Blanche e e al.
(2010)
Blanche e e al.
(2010)
Blanche e e al.
(2010)
Blanche e e al.
(2010)
Blanche e e al.
(2010)
Cos a e al.
(2023)
Gannon and Rose
(2008)
Gannon and Rose (2008) Loinaz (2016)
Popula ion a ge Women who
pe pe a ed sex
c imes
Women who
pe pe a ed sex
c imes
Women who
pe pe a ed
sex c imes
Women who
pe pe a ed sex
c imes
Women who
pe pe a ed
sex c imes
Women who
pe pe a ed
sex c imes
Women who
pe pe a ed sex
c imes agains
child en
Women who pe pe a ed sex
c imes
Women who pe pe a ed sex
c imes
Modules/Phases/
sessions
(numbe )
n/a n/a 4 phases n/a n/a 8 sessions n/a 4 phases 7 modules; 59 sessions
Ta ge s Sel -managemen .
de ian a e sion.
cogni i e
dis o ions.
in imacy;
ela ionships;
social unc ioning;
empa hy and ic im
awa eness.
Cycle o o ense;
cogni i e
dis o ions;
Vic im empa hy;
Li e skills;
Decision making
and elapse
p e en ion.
P e-abuse cycle,
abuse cycle,
empa hy
le e s, and
elapse
p e en ion.
Rela ionships,
hough s, and
li e expe iences
a he ime o
o ense; cogni i e
dis o ions;
consen , w i ing
apology le e s;
sel -es eem.
His o y o sexual
o enses and
gene al his o y
o o ending.
Rela ionships,
iden i y,
ic imiza ion,
psychosexual
imma u i y.
Belie s, schemas,
sexual a ousal,
sel - egula ion,
in e pe sonal skills,
and human needs
in p osocial and
posi i e ways.
Sel -managemen , de ian
hough s and an asies,
sexuali y, in imacy and
ela ionships, empa hy and
ic im awa eness, cogni i e
dis o ions, abuse and
auma, subs ance abuse,
emo ional managemen ,
pa en ing, communi y
in eg a ion p og ams, and
educa ion and employmen .
Con ex o he c ime; belie s;
emo ion managemen ;
sexuali y; communica ion;
ela ionships and unc ioning
in he communi y.
Addi ional
a ge s
n/a n/a n/a n/a n/a n/a p io ic imiza ion n/a n/a
Models o
in e en ion
CBT, posi i e
psychology,
gende -sensi i e
app oach
n/a CBT n/a n/a Psychod ama and
A The apy
n/a n/a n/a
Se ing Communi y and
ede al ins i u ions
Communi y n/a Communi y Communi y Hospi al Independen child
p o ec ion agency
P ison Ins i u ions and communi y
Coun y Uni ed S a es Uni ed S a es Uni ed S a es Uni ed S a es Uni ed S a es B azil Uni ed Kingdom Canada Canada
Sousa e al. 7
ela ional models ha e been shown o be e ec i e, enhanc-
ing imp o emen s in women’s o e all unc ioning and s ess
managemen .
To a lesse ex en , he au ho s also poin ou ha he Risk-
Need-Responsi i y model is also impo an o women who
commi ed CSA (Ash ield e al., 2010; P lug ad & Allen,
2019). In addi ion, hey highligh he ole o he he apeu ic
alliance. Gende sensi i i y ensu es ha he pe son who
commi ed c imes eels hea d, espec ed, and suppo ed.
Es ablishing emo ional and collabo a i e bonds, in oducing
he possibili y o change, and se ing ealis ic sha ed goals
a e key s a egies. Fu he mo e, auma- ocused heo y and
Mille ’s ela ional heo y a e emphasized. T auma- ocused
heo y helps unde s and ecu ing ela ionship and amily
dynamics hemes (Ash ield e al., 2010).
The s udies also iden i y speci ic a ge s o in e en ion,
including de eloping and main aining skills such as empa-
hy, mo al de elopmen , and os e ing posi i e ela ionships.
Co oni and Gannon (2013), as ci ed in P lug ad e al.’s
(2018) pape , p opose ha ea men should add ess i e key
a eas: cogni i e p ocesses, emo ional p ocesses, in imacy
and ela ionship issues, sexual dynamics, and psychosocial
unc ioning. Simila ly, Co ing on and Bloom (2006) empha-
size he impo ance o c ea ing a he apeu ic en i onmen ,
implemen ing di e se in e en ions, add essing p ac ical
needs, os e ing he de elopmen o educa ional and p o es-
sional skills, and p o iding pa en al educa ion. Mo eo e ,
Co oni and Gannon (2003) highligh he signi icance o
conside ing women’s cogni i e, pe sonali y, and lea ning
s yles, as well as addi ional esponsi eness ac o s such as
he p esence o anxie y o low sel -es eem, pas ic imiza ion
expe iences, and gene al psychological dis ess. These ac-
o s can signi ican ly in luence hei abili y o bene i om
ea men and should he e o e be conside ed.
Discussion
While mo e a en ion has been di ec ed owa d women who
commi ed CSA in ecen decades, he e is less in o ma ion
a ailable compa ed o men who pe pe a e CSA (e.g., Co oni
& Gannon 2013, 2016). Addi ionally, limi ed knowledge
exis s ega ding psychological in e en ions o women who
commi ed CSA and hei e ec i eness. Thus, he cu en
sys ema ic e iew aimed o analyze he e ec i eness o psy-
chological in e en ions o women who commi ed CSA.
Mo eo e , i sough o iden i y he in e en ion models and
s a egies used wi h his popula ion as a seconda y aim.
The ini ial planned e iew ound no s udies on psycho-
logical in e en ions wi h women who commi ed CSA ha
e alua ed hei e ec i eness. Sea ches ac oss mul iple da a-
bases yielded 4,611 publica ions, which unde wen double
sc eening esul ing in 35 publica ions ha did no mee he
c i e ia. Al hough he empi ical li e a u e on cha ac e is ics
and ypologies o women who commi ed CSA has g own in
ecen yea s (Co oni e al., 2017; McLeod, 2015; Williams
& Bie ie, 2015), hese esul s sugges a lack o esea ch
in es men di ec ed owa d psychological in e en ions o
women who commi ed CSA. A he same ime, hese esul s
a e also consis en wi h he lack o empi ically alida ed isk
assessmen ins umen s o sexual iolence, which a e essen-
ial o guiding in e en ion design (Co oni, 2010). These
indings a e conce ning o se e al easons. Fi s , hey may
sugges ha in e en ions aimed a men ha e been mis ak-
enly applied o women as well. Howe e , hese g oups ha e
di e en cha ac e is ics and, consequen ly, di e en in e -
en ion needs, such as men al heal h p oblems (i.e., pe son-
ali y diso de s, subs ance use diso de s, and mood diso de s)
(e.g., McLeod, 2015; Mille e al., 2009; Williams & Bie ie,
2015). Second, i ein o ces he absence o empi ically ali-
da ed he apeu ic esponses, which could esul in ea men s
ha , while well-in en ioned, migh no achie e he desi ed
e ec and could po en ially ha m pa ien s. Consequen ly,
ea men p o ide s wo king wi h women who commi ed
CSA lack su icien in o ma ion abou e ec i e in e en-
ions o in o m hei p ac ice.
The seconda y objec i e e iew encompassed eigh pub-
lica ions ele an o he opic. These publica ions p esen ed
in e en ion p og ams ailo ed o women who commi ed
o CSA. The in e en ion p og ams ou lined in ou s udies
a ge ed common needs o ea men , including cogni i e
dis o ions and/o schemas, in e pe sonal issues, o ense
cycle, ic im empa hy, sel - egula ion, and sexual a ousal.
These a eas o ocus a e consis en wi h he in e en ion
guidelines p esen ed in ypological s udies o women who
commi ed CSA (Co oni & Gannon, 2013, 2016; Wijkman
e al., 2010) as well as he guidelines p esen ed in he o he
s udies included in his e iew on his subjec (e.g., P lug ad
e al., 2018). In addi ion, some p og ams supplemen ed he
in e en ion by add essing speci ic cha ac e is ics o women
who commi ed hese c imes, such as expe iences o ic im-
iza ion and/o subs ance abuse (e.g., Gannon & Rose, 2008).
The li e a u e has indica ed ha women who commi ed
CSA ha e highe p e alence a es in hese dimensions com-
pa ed o men, wi h s udies poin ing ou ha a his o y o p io
sexual abuse is associa ed wi h he mos se e e and iolen
o enses agains a child (Co oni, 2018; Williams e al.,
2019). Au ho s highligh ed ha ad e si ies in childhood
es ablish a g oundwo k o a ious in e pe sonal issues and
ine ec i e coping mechanisms esul ing om endu ing
ela ional de iciencies and dis o ed cogni i e amewo ks
conce ning onesel and o he s (Le enson e al., 2015).
P ac i ione s migh mis akenly a ibu e clinical ea u es
like la ened a ec , hos ili y, esis ance, o manipula i e-
ness o low mo i a ion o change when in eali y, hese
beha io s could ha e se ed as c ucial p o ec i e ac o s in
na iga ing auma. In such cases, auma-in o med
app oaches can p o e highly bene icial in he ea men o
women who commi ed CSA (Le enson e al., 2015;
Williams e al., 2019). Indeed, auma- ocused psycho he a-
pies, such as Eye Mo emen Desensi iza ion and
8 TRAUMA, VIOLENCE, & ABUSE 00(0)
Rep ocessing and Cogni i e Beha io al The apies, ha e
been implemen ed wi h men who ha e commi ed sex
c imes and could po en ially be adap ed o use wi h women
(e.g., Ricci & Clay on, 2017). Howe e , he p oposal p e-
sen ed by Cos a e al. (2023) in oduces a new app oach ha
does no ollow he es ablished guidelines o in e en ion
wi h his popula ion, speci ically he use o psychod ama
and a he apy. The e o e, conduc ing an analysis o he
e ec i eness o his app oach h ough hyb id ials would
be ex emely impo an .
Mo eo e , a po en ial- ocused and gende -sensi i e
app oach was he mos a ge ed models o guiding in e -
en ion p og ams, wi h he GLM (Wa d & B own, 2004;
Wa d & Mann, 2004) and Ma shall’s po en ial- ocused
model (Ma shall e al., 2011) eme ging as op ions. The
GLM has been p oposed o in e en ion wi h women who
commi ed c imes, g ounded in he p emise ha “o ende s
wan be e li es no simply he p omise o less ha m ul
ones” (Wa d e al., 2007, p. 106). This app oach se es as an
al e na i e o he isk-need- esponsi i y (RNR) model,
which o en iews indi iduals as collec ions o p oblems o
isk ac o s, po en ially exace ba ing s igma iza ion and
exclusion (Oko ie & Ques , 2013). Mo eo e , he au ho s
a gue ha by ixa ing on de ici s, he e is a isk o o e look-
ing wha is signi ican o he women hemsel es, he eby
neglec ing c ucial a ibu es, skills, and esou ces ha could
acili a e he ehabili a ion p ocess (Van Damme e al.,
2017). To he bes o ou knowledge, only one ecen sys-
ema ic e iew has speci ically examined he ou comes o
in e en ions consis en wi h he GLM, wi h o e hal o he
included s udies ocusing on indi iduals who commi ed sex
c imes. I concluded ha such in e en ions we e a leas as
e ec i e as s anda d p og ams (Mallion e al., 2020).
Speci ically, some s udies in ol ing indi iduals who com-
mi ed sex c imes ha e indica ed ha he GLM app oach has
a posi i e, u u e-o ien ed impac (Ha kins e al., 2012).
Fu u e s udies should conside hese guidelines o build
in e en ion p og ams, being awa e, howe e , ha hey lack
empi ical da a on hei e ec i eness in e ms o educing
ecidi ism. I would, he e o e, be impo an o e u n s udies
ha es i s e icacy and e ec i eness. To es ablish he impac
o an in e en ion unde op imal condi ions, e icacy ials
a e o en he i s s ep. Al hough hese ials migh exagge -
a e he in e en ion’s success in eal-wo ld clinical o heal h-
ela ed en i onmen s, hey a e c ucial o con i ming whe he
an in e en ion has any e ec a all. The esul s om hese
ials can hen guide subsequen esea ch ocused on imple-
men a ion, such as mo e ex ensi e e ec i eness ials.
Pa icula ly ele an a e hyb id ials, which concu en ly
assess he in e en ion’s e ec i eness and he ou comes o
i s implemen a ion. Howe e , e alua ing in e en ion p o-
g ams wi h his popula ion can be a di icul ask. In he i s
place, a clinical ial p esen s nume ous e hical and p ac ical
p oblems since i demands ha pa icipan s be andomly
assigned o a ea men g oup o o a con ol g oup wi hou a
he apeu ic app oach. Howe e , a clinical ial wi h a wai ing
lis con ol g oup could be an op ion o examine i s e ec i e-
ness. Second, al hough esea ch in his a ea is gaining in e -
es , he e is s ill a lack o empi ically alida ed ins umen s
o his popula ion ha can assis in ca ying ou psychologi-
cal assessmen s and e alua ing change be ween ea men s
(P lug ad & Allen, 2019).
Despi e he signi ican conclusions, he e a e inhe en
limi a ions. The clea limi a ion o his e iew is e iden in
i s ailu e o yield any s udies ha me he inclusion c i e ia
and o mally add essed he esea ch ques ion. I is impo an
o no e ha his esul does no necessa ily indica e o e ly
na ow inclusion c i e ia; a he , i sugges s ha he ield o
esea ch on his opic emains unde explo ed. This unde -
sco es a signi ican gap in ou unde s anding o he e ec i e-
ness o psychological in e en ions o women who
commi ed CSA. Mo eo e , da a collec ion was limi ed o
s udies, books, and chap e s w i en in English, Spanish, o
Po uguese ha we e a ailable online, po en ially excluding
aluable insigh s om o he languages and sou ces wi h
es ic ed access.
Conclusions
The sys ema ic e iew aimed o add ess he c i ical gap in
esea ch on he e ec i eness o psychological in e en ions
o women who commi ed CSA and iden i y in e en ion
models and s a egies used wi h his popula ion. The e is a
sca ci y o da a in his ield. Al hough hi y publica ions
we e iden i ied h ough a ull- ex e iew, only eigh add ess
ea men a ge s and models ela ed o women who commi -
ed a sex c ime agains a child in his a ea. None o hese
s udies e alua ed he e ec i eness o in e en ion p og ams
in his speci ic c ime o women who commi ed CSA.
This e iew signi ican ly con ibu es o his a ea o
esea ch by highligh ing he impo ance o e ec i e in e -
en ions ailo ed o add ess he speci ic and o en indi idual-
ized o ending beha io o women who commi CSA, gi en
i s po en ial o ecidi ism and signi ican ha m o ic ims
and socie y as a whole. The impo ance o his e iew lies in
he ac ha women who commi ed CSA a e o en unde e-
po ed due o a ious ac o s, such as ea , shame, and lack o
suppo , as iden i ied in p e ious esea ch. Consequen ly, he
ue p e alence and impac o CSA commi ed by women on
socie y may be unde es ima ed. I also unde sco es he u gen
need o e hink and e alua e o he inno a i e in e en ion
app oaches/models and o encou age clinical ials ha can
a es o hei e ec i eness (see Tables 2 and 3).
O e all, his sys ema ic e iew had implica ions o p ac-
ice, policy, and esea ch. Fi s , his sys ema ic e iew p es-
en s some a ge s and models ha can guide he design o
psychological in e en ions, especially o add essing sex
c imes commi ed by women. P ac i ione s should conside
he isk le el o pa icipan s and gende di e ences when
designing in e en ion p og ams, as his helps de e mine he
app op ia e ea men dosage and ou comes. Fu u e esea ch
should also place g ea e emphasis on aligning se ices and
Sousa e al. 9
suppo s wi h indi idual needs o enhance he p ac ical appli-
ca ion o he RNR model and imp o e ein eg a ion ou -
comes. Second, he indings o his sys ema ic e iew
highligh he need o he de elopmen o andomized con-
olled ials o es he e ec i eness o hese a ge s and
models in changing he isk ac o s and, consequen ly, he
isk o sexual ecidi ism. Speci ically, esea che s should
use bo h ecidi ism a es and p e- and pos - ea men changes
because i helps o know i ea men educes ecidi ism,
p omo es changes in c iminological ac o s, and wha kind o
changes lead women o desis om o ending. Thi d, go e n-
men s should suppo and in es in ongoing esea ch ocused
on he cha ac e iza ion and in e en ion o women who ha e
pe pe a ed CSA. Consequen ly, mo e public se ices and
agencies o women who pe pe a ed CSA should be p o-
ided (see Table 3).
Au ho s’ No e
Olga Cunha is also a ilia ed o Olga Cunha is cu en ly a School
o Psychology, Psychology Resea ch Cen e , Uni e si y o Minho,
B aga, Po ugal.
Decla a ion o Con lic ing In e es s
The au ho (s) decla ed no po en ial con lic s o in e es wi h espec
o he esea ch, au ho ship, and/o publica ion o his a icle.
Funding
The au ho (s) disclosed eceip o he ollowing inancial suppo
o he esea ch, au ho ship, and/o publica ion o his a icle: This
wo k was unded by he Founda ion o Science and Technology –
FCT (Po uguese Minis y o Science, Technology and Highe
Educa ion), unde he g an UIDB/05380/2020. This wo k was also
conduc ed a CIPsi, School o Psychology, Uni e si y o Minho,
suppo ed by Fundação pa a a Ciência e a Tecnologia (FCT;
UID/01662/2020) h ough he Po uguese S a e Budge . Ma a
Sousa was unded by a Doc o al esea ch g an om he Po uguese
Founda ion o Science and Technology, g an numbe 2020.06634.
BD. Cláudia Gou eia was also unded by a Doc o al esea ch g an
om he Po uguese Founda ion o Science and Technology, g an
numbe 2023.03217.BD.
ORCID iDs
Ma a Sousa h ps://o cid.o g/0000-0003-3258-9932
Sónia Ca idade h ps://o cid.o g/0000-0003-0387-7900
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Table 2. Key Findings o he Sys ema ic Re iew.
Key Findings
The e exis s a pauci y o da a wi hin his domain.
None o hese s udies assessed he e icacy o in e en ion p og ams o women who commi ed CSA.
This e iew emphasizes he dis inc ions and unique cha ac e is ics o emale c iminali y, unde sco ing he necessi y o in e en ion
p og ams ailo ed o hese speci ics.
S udies unde sco ed a ocus on indi iduals’ po en ial, employing a gende -in o med pa adigm o shape psychological in e en ions o
women who commi ed CSA.
No e. CSA = child sexual abuse.
Table 3. Implica ions o Resea ch, P ac ice, and Policy.
Implica ions
Fu he esea ch is equi ed o e alua e psychological ea men s and/o de elop no el in e en ions o women who commi ed CSA.
In e en ions ocused on he speci ic cha ac e is ics o his popula ion mus be de eloped, based on he po en ial- ocused and gende -
sensi i e app oach.
Resea che s should use ecidi ism a es and p e- and pos - ea men changes o de e mine ea men e ec i eness and iden i y ac o s
ha help women desis om o ending.
Go e nmen s should suppo and in es in he ea men o women who ha e pe pe a ed child sexual abuse.
Mo e public se ices and agencies should be p o ided o women who ha e pe pe a ed child sexual abuse.
No e. CSA = child sexual abuse.
