Treatment of Sex Offenders – Part 2
Assessment
l Why should we do assessments?
l the average predictive accuracy of
professional judgment to predict sex offence recidivism is only slightly better
than chance (r=.10; Hanson and Bussiere, 1998)
l Types of assessments:
l Clinical
(structured/unstructured)
l Pencil and Paper
l Phallometric Assessment
l Behavioral Observation
l File Review
l Collateral Interview
Assessment of Sex
Offenders
l Evaluation of sex offender risk is
accomplished through the identification and assessment of variables that
contribute to sexually deviant behavior.
l Sexual offenders vary in their risk for
reoffending (Gordon & Porporino, 1990)
l Sexual offenders vary in their response to
treatment (Marques, Day, Nelson, & West, 1994).
l It is requisite to provide assessments at
various stages of the criminal justice process:
l admission
l pre-treatment
l during treatment
l post-treatment
l follow-up
l pre-release
l post-release
Assessment of Sex
Offenders
l General
Assessments
l Sex
Offender Specific Assessments
l At
each stage of the evaluative procedure, the assessment can be employed to
simultaneously predict risk and elucidate factors to be targeted for
intervention
Psychological
Tests
l Psychological tests may provide information
regarding:
l mental ability
l neuropsychological
functioning
l personality
l values and attitudes
l risk evaluations
l Admission and pre-treatment information in
these areas is often used to screen out offenders who are deemed unlikely or
unable to benefit from sex offender programming For instance,
l Many programs have exclusionary criteria
prohibiting participation of offenders who are too low-functioning or who are
actively psychotic.
Psychological
Tests
l Personality tests, such as the Minnesota
Multiphasic Personality Inventory (MMPI; Dahlstrom & Welsh, 1960) are
useful in the identification of a large array of psychological assets and
deficits.
l With sexual offenders, particularly relevant
to the determination of whether the respondent is attempting to portray himself
in an overly positive fashion
l Other tests:
l PAI
l Millon
Psychological
Tests
l subscale scores give information pertaining
to:
l characterological disturbance(s)
l depression
l anxiety
l mania
l antisocial personality
l cognitive distortions
l chronic impulsivity
l sexual identity conflicts
Phallometric
Assessment
l Physiological assessment techniques such as
phallometric evaluation render specific information regarding deviant sexual
arousal / preferences
l Phallometric evaluation is important because
the modification of inappropriate sexual preferences is central to many
treatment programs for sexual offenders
l Physiological assessment of sexual arousal
uses various (audiotapes, videotapes, slides) standardized stimuli to determine
age and gender preference, as well as interest in sexual violence relative to
consensual sexual interactions.
Phallometric
Assessment
l Application
of this technique requires a sensor or transducer to measure penile tumescence
(or vaginal swelling in female sex offenders), a recording system, and a
variety of sexual stimuli.
l The
most frequently-used transducers are circumferential plethysmographs and
volumetric devices (Abel, Lawry, Karlstrom, Osborn & Gillespie, 1994).
Phallometric
Assessment
l It has been well-documented that the use of
these instruments in physiological evaluation differentiates pedophiles from
non-pedophiles (Abel et al., 1994) and rapists from non-rapists (Lalumière
& Quinsey, 1994)
l It has been demonstrated that a higher degree
of violence and brutality in the stimulus set (i.e., the rape scenario) is
better able to discriminate rapists from men with no known history of sexual
assault (Lalumière & Quinsey 1994; Rice, Chaplin, Harris, & Coutts,
1990)
Phallometric
Assessment
l There is also some empirical evidence that,
amongst rapists, sexual and violent recidivism are well predicted by
phallometrically measured sexual interest in nonsexual violence (Rice,
Harris, & Quinsey, 1990).
l Phallometry has proven to be a useful tool in
risk prediction, where sex offenders who demonstrate more deviant sexual arousal
are more likely to commit new sex offences upon release (Quinsey, Rice, &
Harris, 1995).
Phallometric
Assessment
l There are some noteworthy problems with
phallometric testing:
l Over 20% of the respondents
cannot be correctly assessed because sexual arousal levels are consistently too
low (less than 10% of full erection) for accurate classification (Abel et al.,
1994; Marshall, 1996).
l most respondents, especially
convicted sex offenders, would likely want to inhibit their arousal to deviant
stimuli
l Quinsey and Chaplin (1988)
demonstrated that respondents can both inhibit and enhance sexual responding in
phallometric assessment procedures when motivated to do so
Assessment of Sex
Offenders
l Specialized
assessments for sex offenders characteristically cover
l cognitions
l social difficulties
l lifestyle problems
l sexual deviances
l all
assessments should converge on the principles of risk, need, and responsivity
(Andrews & Bonta, 1994)
Assessment of Sex
Offenders
l The
risk principle stipulates that higher intensity services should be reserved for
higher risk cases.
l This
is predicated on observations that higher risk cases respond better to more
intensive services than to less intensive services
l Lower
risk offenders fare as well or better with minimal intervention.
STATIC-99
l Hanson and Bussiere meta-analysis of the
literature on the recidivism (1998)
l reviewed 61 studies covering more than 23,300
cases of sex offenses and found that only 13.4 percent of the individuals
identified in the studies went on to commit another sex crime.
l They found that individuals who did reoffend
had committed more sexual offenses, had more deviant sexual interests—such as
sex with boys or victimization of strangers—and did not complete their
rehabilitative treatment programs
l Basis for Static-99
STATIC-99
l The Static-99 is intended to be a measure of
long-term risk potential.
l The Static-99 is a brief actuarial instrument
designed to estimate the probability of sexual and violent recidivism among
adult males who have already been convicted of at least one sexual offense
against a child or non-consenting adult.
l Based upon Static factors found to be related
to recidivism
STATIC-99
l The scale contains 10 items:
l Prior sexual offenses
l Prior sentencing dates
l Any convictions for
non-contact sex offenses
l Current convictions for
non-sexual violence
l Prior convictions for
non-sexual violence
l Unrelated victims
l Stranger victims
l Male victims
l Young
l Single
Other Static Risk
Assessment Instruments
l Several different actuarial risk instruments
have also been developed to predict recidivism among sexual offenders
l Sex Offender Risk Appraisal
Guide [SORAG] Quinsey, Harris, Rice & Cormier, 1998
l Minnesota Sex Offender
Screening Tool – Revised [MnSOST-R], Epperson, Kaul & Hesselton, 1998)
l Rapid Risk Assessment for
Sex Offence Recidivism [RRASOR], Hanson, 1997
l Thornton’s Structured
Anchored Clinical Judgement [SACJ], Grubin, 1998).
SORAG
l The SORAG (Quinsey et al., 1998) is a
variation of the Violence Risk Appraisal Guide (VRAG; Quinsey et al., 1998) for
sexual offenders.
l Like the VRAG, the SORAG was designed to
assess any violent recidivism, not just sexual recidivism.
l It contains 15 items addressing:
l early childhood behavior
problems
l alcohol problems
l sexual and nonsexual
criminal history
l age
l marital status
l personality disorders (with
a large weight on psychopathy).
MnSOST-R
l The MnSOST-R was developed to predict sexual
recidivism among rapists and extrafamilial child molesters (Epperson et al.,
1998).
l The MnSOST-R includes 16 items addressing:
l sexual and non-sexual
criminal history,
l the victims’ age and
relationship to the offender
l substance abuse
l unstable employment
l age
l treatment history
RRASOR and SACJ
l Both
the RRASOR (Hanson, 1997) and SACJ (Grubin, 1998) were intended to be
relatively brief screening instruments for predicting sexual offence
Dynamic Measures
l Dynamic
Risk factors predict general recidivism at least as well as, or better than,
static predictors.
l Factors
that are amenable to change
l Factors
that are addressed in treatment programs
SONAR
l Sex Offender Need Assessment Rating (SONAR:
Hanson & Harris, 2000)
l Based on research suggesting that men that
reoffend sexually differ on key variables from men that do no
l 5 stable dynamic variables:
l Intimacy deficits
l Negative social influences
l Attitudes tolerant of sexual
offending
l Sexual self regulation
l General self regulation
SONAR
l Also
composed of 4 acute dynamic factors:
l Substance abuse
l Negative mood
l Anger
l Victim access
Other Measures of
Dynamic Risk
l Bumby Scales (Bumby, 1996)
l RAPE and MOLEST
l Measures cognitive
distortion in sex offenders
l Hanson Sex Attitudes Questionnaires (Hanson,
Gizzarelli & Scott, 1994)
l Assesses attitiudes related
to incestuous sexual offending
l Child Molester/Rapist Empathy Measure (CMEM:
Fernandez, Marshall, Lightbody & O’Sullivan, 1999)
l Victim empathy
Treatment
Medical/Biological:
l Theory asserting that sexual offenders have a
physiological anomaly underlying their deviances
l There are three main types of medical
interventions for sexual offenders:
l surgical castration,
l antiandrogens or other
hormonal treatments (Medroxyprogesterone Acetate (MPA) and Cyproterone Acetate
(CPA))
l psychosurgery (frontal
lobes, limbic system)
Treatment
Medical/Biological:
l Bradford (1988) reviewed a series of
pertinent studies and concluded that there is sufficient evidence to support
the contention that castration reduces sexual recidivism
l In a meta-analysis of the effect of treatment
on sex offender recidivism, Hall (1995) concluded that hormonal treatments were
amongst the most effective for reducing sexual reoffending
l Psychosurgery is reputed to alter sexual
deviance through structural metastasis – the exact mechanisms through which
this is accomplished remain unknown.
l Psychosurgery has rarely been employed since
it cannot be sanctioned on ethical grounds, and its value in the treatment of
sex offenders remains questionable
Treatment
Risk, Need and Responsivity
Risk
l Characteristics of offender and circumstances
that are associated with likelihood of engaging in criminal behavior
l Can be changed
l Static and dynamic risk
l Risk is predictable and can be changed with
treatment (dynamic)
Treatment
Risk, Need and Responsivity
l Risk
(cont)
l Treatment
intensity should be directly related to offender’s risk
l Most
change seen with high risk offenders as compared to low risk (floor effect)
Treatment
Risk, Need and Responsivity
Need Principle
l The most effective interventions are those
which target the criminogenic needs of offenders
l Necessary for effective treatment
l Criminogenic needs are factors associated
with risk for reoffending
l Ex. Attitudes, cognitive distortions, deviant
sexual arousal
Treatment
Risk, Need and Responsivity
Responsivity
l The
tailoring of interventions to meet risk and need levels of offenders as well as
their individual characteristics
l The
interaction between the client, the intervention
l Tailoring
intervention for differing populations i.e. American Indian, Cognitively
Impaired
Treatment
Cognitive Behavioral Model
l Predominant
Model used in SO treatment
l Research
has demonstrated that CBT treatments have been effective in reducing recidivism
l Currently
the most research done on CBT treatments
l Multi-faceted
treatments – involve multiple components
Treatment
Cognitive Behavioral Model
l Cognitive
Distortions
l Intimacy
and Social Functioning Deficits
l Problems
with Emotion Regulation
l Empathy
and Victim Awareness
l Deviant
Sexual Arousal
l Self
Management/ Relapse Prevention
Treatment
Cognitive Distortions
l Attitudes
and beliefs influence our behavior
l Attitudes
and beliefs have a direct influence on sexual offending behavior
l Constant
interaction between person (self-talk) and behavior
l First
step: getting individuals to monitor their “self talk”
Treatment
Cognitive Distortions
l Use ABC Model
l Demonstrate how changing thoughts can change
behavior
l Cognitive distortions: learned assumptions,
sets of beliefs and self-statements about deviant or aggressive sexual
behaviors
l Underlying attitudes and beliefs lead to
distorted thinking which supports sexual offending behavior
Treatment
Cognitive Distortions
Goals:
l Define and explain: self
talk, automatic thoughts, attitudes, values, beliefs and cognitive distortions
l Demonstrate how cognitive
elements influence behavior
l Demonstrate that cognitions
are under offenders control and can be changed
l Demonstrate how our
interpretation of our environment is determined by cognitions and these
interpretations can be accurate or distorted.
Treatment
Cognitive Distortions
Goals:
l Demonstrate how cognitive
distortions are developed and maintained and the negative impact they have on
behavior
l Define and explain the
process of cognitive restructuring
l Assist offender in
identifying personal risk-to-offend cognitive distortions
l Assist client in developing
skills necessary to challenge beliefs and adopt alternative thinking styles
Intimacy,
Relationships and Social Functioning
l Long believed that sex offenders lack social
skills
l Little research conducted – social skills
training focused on assertiveness and communication skills
l More recent research indicates that social
functioning deficits more specific
l Specifically in areas of
l Intimacy and attachment
difficulties
l Self esteem
l Alleviation of loneliness
Intimacy,
Relationships and Social Functioning
l These difficulties arise based upon (generally) patterns of childhood attachment
with parents
l Generally characterized by estrangement from
parents or abuse
l Attachment style inadequate and result in
inability to relate to others
l Therefore may develop apprehension toward
relationships which may lead to loneliness
Intimacy,
Relationships and Social Functioning
l Sex offenders against children describe their
desire to offend as motivated by a need for affection, intimacy and closeness
l This is supported by research
l Offenders tend to blame women for their
relationship problems
l Self-esteem also significantly lower in SO
l Improvement in self esteem after treatment
directly related to changes in treatment targets
Intimacy,
Relationships and Social Functioning
Goals:
l Help offender understand
intimacy and understand the strengths and deficits in their own relationships
l Help offenders understand
that intimacy exists along a continuum and that they can have intimacy in a
variety of different relationships (friends, family, co-workers etc..)
l Help offenders understand
their own attachment style and what development factors contributed to this
style
Intimacy,
Relationships and Social Functioning
Goals:
l Help offenders understand
how their attachment style has influenced their thoughts, feelings and
behaviors in their adult relationships
l Help them understand healthy
and unhealthy relationships
l Help them rehearse
relationship and intimacy skills through contact with individuals outside the
group
Emotion Management
l Generally found that individuals ability to
cope with their emotions is related to their well-being
l Although not true with all offenders, many
have trouble regulating their emotions
l Many programs focus exclusively on anger
management, but research indicates that focusing on emotions in general more
beneficial
Emotion Management
l Affective
dyscontrol linked to sexual offending behavior
l Both
negative and positive affective states can increase the likelihood of offending
l Some
offenders driven by negative emotions and some by positive emotions
l High
levels of stress can precipitate and offense.
Emotion Management
l Offenders
need to identify the emotions that put them at risk
l For
some, especially rapists, anger is involved in offense behavior
Goals:
l Define and explain emotions
l Demonstrate how thoughts
influence thoughts, behaviors and physiological arousal
Emotion Management
Goals:
l Demonstrate that emotions
are largely under our own control
l Show that by changing
cognitions and behavior, emotions can change
l Define and explain negative
emotions like depression, shame, anger, guilt and anxiety
l Help the offender to
determine what role emotions played in their offence (s)
Emotion Management
Goals:
l Show ineffective and
effective ways of managing emotions
l Help and encourage offender
to rehearse and practice key elements of managing and expressing emotions
Empathy and Victim
Awareness
l Empathy described as ability to understand
and identify with another person’s perspective and emotional capacity to
experience the same feelings as another
l Generally empathy is considered to be a
learned behavior
l Demonstrate that many offenders lack empathy
for their victims
l Recent evidence (Hanson 2003) suggests that
development of empathy in treatment decreases risk for reoffence
Empathy and Victim
Awareness
l Child
abusers often don’t view what they are doing as “bad” therefore they do not
feel the child is being hurt and they lack empathy for them
l Although
offenders generally have empathy deficits it doesn’t mean that they lack the
capacity to feel empathy
Empathy and Victim
Awareness
Goals:
l Help offender understand empathy and understand why
empathy is important in relationships
l Help them understand that by
experiencing empathy they will decrease their risk of victimizing people in the
future
l Provide client with skills
to feel empathy
l Model appropriate empathy
reactions and encourage offenders in therapy
Empathy and Victim
Awareness
Goals:
l Help the offender develop
empathy for their own victims
Deviant Sexual
Arousal
According to social learning
theory:
l developmental factors,
observational learning and modeling are influential in the development of
thoughts, feelings and behaviors about sexuality
l Deviant sexual behavior continues if it is
rewarding (reinforced)
l If deviant behavior related to fantasy and
masturbation this increases its positive value and thus increases the
likelihood that it will happen again
Deviant Sexual
Arousal
l Thought
to originate from pairing of deviant stimuli with sexual arousal and subsequent
reinforcement of this arousal
l Behavioral
strategies for extinguishing deviant arousal have included:
l Aversion therapy
l Masturbatory satiation
l Sexual arousal
reconditioning
Deviant Sexual
Arousal
l Deviant arousal per se doesn’t explain sex
offending behavior – but it could contribute
l Measured using phallometrics
l Varies by types of offender
l More relevant for pedophiles against boys,
violent rapists
l Not recommended for all offenders – but
instead those for whom deviant arousal is a major contributor to sexual
offending behavior
Deviant Sexual
Arousal
l Behavioral techniques have shown good results
and have been found to decrease recidivism
l Needs to be done with trained phallometrician
Goals:
l Help offender understand the
role of deviant sexual arousal in their sexual offending behavior
l Support clients that are
undergoing phallometric assessments
l Develop treatment plan to
target deviant fantasies