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In this chapter, we first describe the all governing principles of treatment for sexual offenders that maximise effectiveness. These are derived from Andrews and Bonta's (2006) summary of a variety of meta-analyses of outcome studies. From this source and others, we then claim that there are three elements essential to effective treatment: (1) targeting criminogenic features; (2) employing empirically sound procedures to modify these targets; and (3) delivering treatment in an effective psychotherapeutic way. Next we describe our treatment approach that emphasises these crucial elements within a strength-based programme that is motivational and provides Ward's (2002) Good Lives Model as the framework. We then challenge the broadly accepted idea that the Random Controlled Trial (RCT) is the only basis upon which inferences about treatment effectiveness can be derived. We point to methodological, practical and ethical problems associated with implementing an RCT study and offer at least two alternatives: the so-called ‘incidental design’ which compares the outcome of the treated group with a matched (but not randomly assigned) group from the same or similar setting to the treated group; and a strategy where the recidivism rate of treated group is compared with what would be expected on the basis of risk assessments of each of the treated subjects.