Coercion and ‘voluntary’ admission: An examination of psychiatric patient views

This article examines coercion in voluntary psychiatric patients. Three main themes are highlighted using qualitative and quantitative data from a sample of 412 psychiatric patients surveyed in 1990 who had experienced at least one period of hospitalisation. The themes are: the extent to which the label of ‘voluntary’ was an indicator of the patients' experience of being in hospital of their own volition; aspects of admission which patients considered to be coercive; and the impact that coercion might have on patients' views about their problem, professionals and treatment. The findings suggest that a substantial number of nominally voluntary patients reported coercive aspects of their hospitalisation. The impact of feeling coerced was found to produce a more rejecting attitude towards psychiatric services. The findings are discussed in relation to British mental health legislation and care. I particularly want to thank David Pilgrim for his collaboration with the research which made this article possible and for his useful and supportive comments. I am also indebted to John Monahan for his helpful comments on an earlier draft of this paper.     

Linking Family-of-Origin Experiences and Perpetration of Sexual Coercion: College Males’ Sense of Entitlement

Sexual coercion on college campuses has become of major concern in recent decades. In recent years, researchers and policy makers have called for greater attention to this topic in order to reduce the sexual violence on college campuses. Recent research has examined the impact of family-of-origin experiences on the perpetration of sexual coercion. The current study examines the association between family-of-origin experiences, such as warmth and hostility between parents, inconsistent parenting, and overparenting during childhood, and the perpetration of sexual coercion among emerging adult males while examining feelings of entitlement as a possible mediator. Data from 326 male undergraduate students were analyzed using structural equation modeling. Results show that warmth and hostility between parents has a significant association with parenting behaviors (i.e., overparenting and inconsistent parenting) and that hostility between parents is associated with the perpetration of sexual coercion by the offspring in young adulthood for males. Also, findings suggest that while overparenting and inconsistent parenting during childhood are not directly associated with the perpetration of sexual coercion during emerging adulthood, they are strongly related to feelings of entitlement, which in turn was found to be associated with the perpetration of sexual coercion for males. These results have important implications for family life education, including relationship and parenting education, and for future research.     

Behind the Pencil/Paper Measurement of Sexual Coercion: Interview-Based Clarification of Men's Interpretations of Sexual Experiences Survey Items1

The ubiquity of self-report pencil and paper surveys in sexual coercion research is matched only by the lack of attention to respondents' individual interpretations of survey items. Our purpose in this study was to examine men's interpretations of four apparently ambiguous items from a commonly used sexual coercion research instrument, the original Sexual Experiences Survey (SES; Koss & Oros, 1982). After completing the SES, college men (N = 102) were immediately interviewed about their interpretations of 4 of the SES items. Across the interviews, the men reported a variety of interpretations of each item. Ignoring SES item interpretations when forming research conclusions has significant implications for sexual coercion research. Based on the results of this investigation, we urge caution in interpreting results of studies based on self-administered measures of coercive sexual behavior.     

Two scales for measuring patients' perceptions for coercion during mental hospital admission

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.     

Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control

Research has shown that substantial numbers of mental health patients may be coerced into 'voluntary' treatment. This article examines the concept of coercion to address the concerns of social scientists, treatment providers, and policy makers to know when coercion into treatment has occurred. This logically takes precedence over the second important question of whether or not coercion is desirable in some situations. A review of the scientific research on coercion and related topics of freedom, control, and choice leads to a theoretical framework in which coercion is defined in terms of opportunities to choose among courses of action. Implications of this analysis are drawn for mental health service delivery, mental health policy, and mental health research.     

Sexual coercion in lesbian and gay relationships: A review and critique

Sexual coercion, or pressure to engage in unwanted sexual behavior, has been a popular research topic for social scientists interested in heterosexual relationships. Only recently have researchers turned their attention to lesbian and gay couples. Several research studies are reviewed to assess rates, causes, and effects of sexual coercion in lesbian and gay relationships. Several methodological issues that limit usefulness of findings on homosexual sexual coercion are discussed as well as reasons why social scientists have been reluctant to investigate sexual coercion in lesbian and gay relationships.     

Sexually coercive tactics used by university students: a clear role for primary psychopathy

Current research suggests that people with psychopathic traits engage in sexual coercion as an alternative mating strategy. Research overlooks the relation between psychopathic traits and coercive behavior in male and female samples that engage in dating quite frequently. Male and female university students reported on their current relationship styles and their use of minor and severe sexually coercive tactics. Results indicate that primary psychopathy (using the Levenson's SRPS), but not secondary psychopathy, predicts the use of all measures of sexual coercion for both females and males, although males were more likely to exploit an intoxicated partner than females. Additionally, females with high levels of primary psychopathy were more likely to use physical forms of coercion. The findings show that the primary psychopathy features (callousness, charm, and selfishness) predict a shortterm mating strategy that focuses on gaining sex through minor forms of coercion and manipulation.     

Defection, Termination, and Continuation in Family and Individual Therapy

Patients applying to a child study center over a period of one year were referred for either individual or family evaluation and therapy. The present study focused on comparative rates of defection (failure to appear for first session), premature termination (one to three sessions), and continuation (more than three sessions) of treatment. Structured interviews were conducted on the telephone to explore the reasons for termination or continued treatment. Three main findings emerged: (a) Drop-out rates for family therapy are significantly different than for individual treatment; (b) Major reasons for terminating or continuing treatment, in either modality, seem related to patients evaluations of their therapists; (c) Fathers of patients play a pivotal role in determining whether families terminate or continue in treatment.     

The ultimate femme fatale? Narcissism predicts serious and aggressive sexually coercive behaviour in females

Narcissism has been associated with persistent sexual persuasion, coercion, aggression, and rape conducive beliefs. However, the majority of research has concentrated on male samples. The present study (N = 329) investigated narcissism and sexually coercive tactics, varying in severity, in both males and females. Males scored significantly higher on total narcissism and sexual coercion. However, when narcissism was investigated in relation to sexually coercive tactics, it was found that narcissistic females were just as likely to engage in serious and aggressive sexually coercive behaviour. In addition, sexual coercion in males related to more socially desirable aspects of narcissism (adaptive narcissism), whereas in females, sexual coercion was associated with socially toxic components of the construct (maladaptive narcissism). Our results demonstrate that gender differences in narcissism can differ significantly when investigating the impact narcissism has on a specific type of behaviour such as sexual coercion. These new findings contribute to the very little we already know about narcissism in females, suggesting that both sexes should be included in future research on narcissism.     

Psychopathic traits,gender, and motivations for sex: Putative paths to sexual coercion

Evidence suggests that both men and women perpetrate sexual coercion. Psychological factors, including psychopathic traits and power motivations, have been proposed to characterize male-perpetrated sexual coercion; however, it is unclear whether these factors play a similar role in female-perpetrated coercion or whether other motivations (e.g., intimacy, affect regulation) should be considered. To improve our understanding in this area, the current study first examined relationships between psychopathic traits and sexual coercion in a sample of 1199 undergraduate students (756 women), with gender as a potential moderator of these relationships. Second, the role of motivations for sex (e.g., power, affect regulation) in accounting for the psychopathy-coercion relationship was examined in men and women. Data were collected using an online survey and analyzed using multigroup path analysis. Results implicated impulsive-antisocial traits as particularly important to male-perpetrated verbal (e.g., manipulative) and nonverbal (e.g., physical) coercion, and that this relationship was partially explained by motives for sex involving power. In contrast, psychopathic traits did not appear to play a major role in female perpetrated coercion; instead, emotional value (i.e., intimacy-related) motivations for sex were associated with verbal (e.g., manipulation) coercion in women. In sum, our results support a conceptual model of male perpetration where men who are high in impulsive-antisocial traits may engage in sexual coercion in an attempt to feel powerful. Further, the findings in the female sample suggest that factors other than psychopathy, such as gender role beliefs in regard to sexual encounters, may be particularly important to female perpetrated sexually coercive behavior.     

The Family Therapist Behavior Scale (FTBS): Development and Evaluation of a Coding System

This study evaluated the validity and reliability of a new coding system — The Family Therapist Behavior Scale (FTBS) — that was designed to identify and study clinically relevant verbal behaviors of short-term, problem-oriented family therapists. Validity was assessed by testing the scale's ability to discriminate significant, predicted differences between the in-therapy behaviors of eight beginning family therapists conducting observed interviews and eight advanced family therapists conducting supervisory interviews. All of the sessions, which were initial interviews, were videotaped. Two coders rated three five-minute samples from each of the 16 tapes with the FTBS. The validity results supported over 50 per cent of the 16 research hypotheses. The reliability analysis, based on the actual study data, indicated that the interrater reliability of the 19 category FTBS differed from chance at less than the .001 level of significance. The implications of these findings are examined and future research directions are identified.     

Parenting behaviors of women who were sexually abused as children in their families of origin.

This research explored links between a childhood history of family sexual abuse and current parenting behaviors of mothers of school-age children, using observations of family interaction and interviews with the mothers. Videotaped family interaction tasks, analyzed with Benjamin's Structural Analysis of Social Behavior, showed that women who had been sexually abused in their childhood families were more self-focused, rather than child-focused, compared to nonabused women. In interviews, the women who had been abused gave strong evidence of greater reliance on their children for emotional support. These findings lend support to theoretical and clinical impressions of highly permeable intergenerational boundaries, including parent-child role reversal, in family systems marked by child sexual abuse, even when the abuse occurred in the previous generation.     

A COMPARISON OF MALE AND FEMALE COLLEGE STUDENTS' EXPERIENCES OF SEXUAL COERCION

Research comparing men's and women's experiences of sexual coercion has typically assessed differences in prevalence rates and risk. We extended this line of research by comparing the contexts of sexual coercion and reactions to sexually coercive experiences in an attempt to understand the meanings that men and women attribute to these events. Participants were 433 randomly selected college students who responded to an anonymous survey. In line with past research, more men than women reported being sexually coercive, and more women than men reported being sexually coerced in the preceding year. There was a great degree of correspondence between men's and women's reports of the contexts within which sexual coercion occurred. According to their reports, sexual coercion occurred primarily within the heterosexual dating context. Compared to men, however, women reported more negative reactions and stronger resistance to the use of sexual coercion. These findings emphasize how comparisons of prevalence rates alone may obscure important differences in the phenomenology of sexually coercive incidents for men and women. Findings are discussed in terms of implications for the development of education and prevention programs and the need to reevaluate current approaches to interpreting prevalence reports.     

Police,courts, and corrections: Experiences of procedural injustice among Black adults

Racial disparities and a corresponding lack of trust have been documented within the criminal legal system. In response, criminal legal system actors have sought to strengthen the legitimacy of their agencies. However, legitimizing these agencies can be problematic. Some argue that the current criminal legal system continues the legacy of slavery and Jim Crow as Blacks are disproportionately policed and incarcerated. As a framework, procedural injustice can offer a unique backdrop and interrogate ways in which the criminal legal system engages in delegitimizing actions that provoke noncompliance and enable social control. Using a procedural injustice lens, this study examines how justice-involved Black adults experience mistreatment by justice system actors. Semistructured interviews were conducted with 84 Black adults in Newark and Cleveland. Study findings offer a comprehensive account of how participants experience procedural injustice as arrestees, defendants, and incarcerated persons. More specifically, participant narratives describe deliberately antagonistic, abusive, and dehumanizing treatment by justice-system agents—often depicted as racially motivated. Participant accounts also describe this mistreatment as occurring in a context of coercion and powerlessness and as being institutionally sanctioned. Implications for the preservation of racial hierarchies, research, practice, and community psychology are discussed.     

Parents' and preschool children's choices of disciplinary childrearing methods

Forty preschoolers individually were shown a videotape containing six 30-second scenes depicting common parent/child conflicts. The children were asked to tell the experimenter what they would do if they were the parent on the tape, and what their own parents would do if this happened at home. In addition, 15 mothers of these children were selected randomly to view the same scenes and to indicate their choice of conflict resolution methods. Taped responses of parents and children were then coded as verbal/physical coercion or no coercion. Results indicated that preschoolers tended to choose disciplinary actions in accordance with their perceptions of their parents' manner of dealing with the same situation, and also revealed a high congruence between parent and child on consequences for discipline. The implications of these findings are discussed in relation to the development of childrearing methods at an early age and the intergenerational transmission of family violence.     

Innovations in Family Support: What Are We Learning?

As family support programs develop across the United States through grassroots efforts by families, state demonstration projects, and local initiatives, new opportunities have become available to examine the experiences of families with service delivery systems. In this study, the research team examined key principles of innovative family support and their effects on families with children at high risk for out-of-home placements. The research team used a multi-case study design with indepth participant observation and semi-structured interviews with a purposeful sample of families. The findings on agency implementation and the families' perspectives are described, together with implications for agency change in family support. The findings point to the need for a re-examination of the emerging approaches to family support innovations, including in the context of national policy reform and the agency-based, service delivery system.     

Stressors, Stress Mediators, and Emotional Weil-Being Among Spouses of Soldiers Deployed to the Persian Gulf During Operation Desert Shield/Storm

The Family Factors Field Study of Operation Desert Shield/Storm (ODS) was designed to collect data on the impact of the Persian Gulf deployment on soldier/family well-being, and the effectiveness of Army and community resources in assisting and supporting families of deployed soldiers. In October 1990, a task force was assembled, and multi-agency research teams visited several Army installations. Informal individual and group interviews were conducted with spouses, unit family support leaders, unit rear detachment personnel, garrison leaders, and local Army program/service providers. The questions were aimed at identifying key stressors which spouses and children experienced in relation to the sudden deployment, as well a stress mediators such as social supports and personal coping skills. Anecdotal information collected during the site visits, combined with findings from previous research on Army families, was used to develop a questionnaire designed to quantify those variables which emerged as relevant to a study of stressors and stress mediators in the context of the ODS deployment.     

Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. In-person interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.     

Strategies and Dispositional Correlates of Sexual Coercion Perpetrated by Women: An Exploratory Investigation

This research tests whether theoretical constructs typically associated with male perpetrators of sexual coercion are predictive of women who perpetrate sexual coercion. We administered a questionnaire that contained measures of sexual experience, social dominance, ambivalent sexism, sex roles, attitudes toward sexual harassment, and lovestyle approaches toward intimate relationships to a sample of women undergraduates. Results found 18% of women to report engaging in sexually coercive behaviors. Coercive women exhibited higher tolerance of sexual harassment, and were significantly higher in femininity than noncoercive women. Coercive women were also found to embrace a ludic (manipulative, game-playing approach toward love) lovestyle significantly more than noncoercive women, while pragma (a logical approach toward love) was negatively associated with coercion. Lastly, a significant difference was found between coercive and noncoercive women and self-reported victimization. Eighty-one percent of women who reported using coercive strategies in their relationships also reported having been sexually victimized.