Kinderpornografie

The quantity and distribution of child abuse material (“child pornography”) has substantially risen since the advent of the internet facilitated access. Due to the international character of the associated delinquency prosecution is confronted with several difficulties. In 2003 the European Union established a framework agreement to legally combat child pornography. The market for child abuse material is profitable, as production is comparably cheap. The number of convictions for relevant crimes varies but is generally still on a high level, even though reporting of relevant contents is decreasing. Providers and users might have switched to less controllable internet platforms. The physical and/or psychological sequelae for victims of child pornography are serious and ongoing. Studies show that compared to hands-on-offenders users of child exploitation material are generally younger, better educated and less often have a criminal record. Some of them (10–25?%) fulfill the diagnostic criteria of pedophilia. A child pornography offender’s risk of committing a hands-on-offence seems to be increasing with the diagnosis of pedophilia and antisocial personality traits. According to existing data, individuals whose only criminal record refers to illegal pornography seem to be at low risk for future offending with child abuse (0.2–6.6?%). Offenders who were already convicted for child abuse have a higher risk for re-offending when consuming (deviant) pornography. Several cognitive behavioral treatment manuals exist, however accurate diagnostic assessment and indication are required.     

Anpassungsleistung und Täuschung in der forensischen Therapie

The term adaptation is often used in forensic interventions in a negative sense to describe courses of treatment without a real modification of thinking and behavior. In many cases adaptation means only a superficial problem adaptation with a risky process. This article describes and explains that in many cases adaptation can be a fundamental performance of development in a positive sense.Finally, key questions for the assessment of different adaptations and a typology of adaptations are presented. Additionally, the difference between a positive or rather desirable adaptation and deception will be defined.     

Psychopathie,antisoziale Persönlichkeitsstörung und Sexualdelinquenz

In today’s field of forensic psychiatry, psychopathy is seen as a subtype of antisocial personality disorder and includes manipulative behavior, egocentric and arrogant characteristics, high-risk behavior as well as a lack of empathy. Empirical data on the prevalence of psychopathy and antisocial personality disorder among offenders greatly vary depending on the study design and the composition of the sampled population. Offenders who committed both violent and sex offenses seem to have antisocial traits with a higher probability than offenders who committed only violent or only sex offenses. In the context of criminal responsibility and risk assessment for sex offenders, antisocial and psychopathic traits have a negative impact on the prediction of recidivism. Many study results, even though not all, additionally indicate that the combination of psychopathic traits and sexual deviance (i.?e. for example a paraphilic disorder such as sexual sadism) in sex offenders may be associated with a particularly high risk to reoffend. Due to the specific interpersonal characteristics (e.?g., dominant, provocative behavior, exaggerated self-esteem), therapeutic treatment of sex offenders with antisocial and psychopathic traits is often difficult. The regular supervision by the therapist is considered to be crucial to avoid harmful relationship dynamics or distorted perception of the therapist.     

Die Behandlung paraphiler Störungen mit GnRH-Agonisten unter besonderer Berücksichtigung ethischer und rechtlicher Aspekte

Current guidelines recommend the use of antiandrogenic medication in addition to psychotherapeutic procedures in the treatment of patients and sexual offenders with severe paraphilic disorders and a high to very high risk of committing severe sexual offences. This article provides an overview about the current state of research concerning the effectiveness and possible side effects of antiandrogens and discusses the legal and ethical basis of using antiandrogens in the therapy of paraphilic disorders with a focus on gonadotropin-releasing hormone (GnRH) agonists. Meanwhile, a great deal of empirical evidence exists with respect to the effectiveness of GnRH agonists for lowering paraphilic sexual fantasies and behaviors; however, GnRH agonist treatment also still has a risk of mild to severe undesired side effects, e.?g. hypertension, hyperlipidemia, liver damage, bone demineralization and depression. Nevertheless, in German forensic psychiatric institutions a not insignificant proportion of patients are treated with antiandrogens and furthermore, in the last few years treatment with GnRH agonists has become more important. In Germany, GnRH agonists can only be used on a voluntary basis; however, in some European countries and North American states legal statutes for compulsory treatment also exist. This is clearly contrary to the recommendations of current international guidelines. In light of the fact that GnRH agonist treatment could violate basic human rights, the need for an ethically sound approach is even more important in the decision for therapy with GnRH agonists. This article provides some proposals for a treatment approach that is in line with current ethical and legal requirements.     

Screening for Psychopathy: Validation of the Psychopathic Personality Inventory-Short Form with Reference Scores

The current study reports validation results for the Psychopathic Personality Inventory (PPI) and its subscales, and for a newly developed PPI-Short Form (PPI-SF) in forensic and non-forensic populations. We also provide criterion reference scores for the PPI and the PPI-SF. In Study 1, we used PPI data from 1,065 participants and supplementary PCL-R data from a subsample of 91 forensic offenders. Mokken scale analysis was used to construct the PPI-SF. In Study 2, PPI-SF and PCL-R data were collected from 60 participants. The study yielded promising but preliminary support for the construct validity of the PPI and the PPI-SF. The PPI-SF is of interest for risk assessment because of its (a) strong relationship with the PCL-R total score and (b) subscales known for their predictive value for violence and criminal recidivism.     

A bifactor approach to modeling the structure of the psychopathy checklist-revised

To date, models of the structure of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) have taken a higher-order approach in which the factors of the PCL-R are modeled as correlated elements of a higher-order psychopathy construct. Here, we propose an alternative structural model of the PCL-R, the bifactor model, which accounts for the covariance among PCL-R items in terms of a general factor reflecting the overlap across all items, and independent subfactors reflecting the unique coherency among particular groups of items. We present examples of how this alternative structural model can account for diverging associations between different subsets of PCL-R items and external criteria in the domains of personality and psychopathology, and we discuss implications of the bifactor model for future research on the conceptualization and assessment of psychopathy.     

Zukunftsperspektiven sexualforensischer Psychotherapie

There is a controversial discussion on to what extent sexual forensic psychotherapy has a positive influence on the legal probation of sexually delinquent people. From this the question arises on how treatment with a perspective for success could be structured. This article assumes that such a perspective can only succeed through close cooperation between science and psychotherapeutic practice. Through the analysis of a methodologically elaborate study, considerations on the motivation and the influence of empirically ascertained risk factors are developed and each placed in relation to scientific and therapeutic practice. In this way various problems are tackled, which range from insufficiently described interventions via too little therapeutic flexibility up to limitations in the scientific evaluation. Finally, possible barriers for the development of such a perspective are discussed and the connection to the so-called risk-need-responsivity (RNR) model is explored.     

Factor structure and behavioural correlates of the Psychopathy Checklist-Revised [PCL-R] in a Brazilian prisoner sample

The present study examines the reliability, factor structure, and criterion-related validity of Hare (2003) Revised Psychopathy Checklist [PCL-R] in a Latin American forensic context. Brazilian male inmates (124) were administered the PCL-R, along with relevant subscales of an inventory of normal personality [Personality Factorial Inventory], an intelligence scale [Standard Progressive Matrices], and a semi-structured interview based in DSM IV. Criminal offence records were obtained from prison files. Several theoretical factorial structures for the PCL-R were tested and compared. A bifactor model with three factors, one general factor reflecting the overlap across all items, and two independent subfactors reflecting the unique covariation among particular groups of items, shows the better fit. Overall scores on the PCL-R correlated with the number of criminal offenses committed by participants. No significant correlations were found between PCL-R scores and personality or intelligence measures. It was concluded that the PCL-R is a reliable and valid instrument for the assessment of psychopathy in the Brazilian male forensic population.     

LAC-Depressionsstudie

The study on long-term therapy of chronic depression (LAC depression study) is one of the first prospective studies to compare psychoanalytic with cognitive behavioral long-term treatment and also investigates the impact of patient assignment by randomization and preference. This comprehensive multicenter study combines a naturalistic and a randomized controlled approach. The long-term follow-up is based on a broad spectrum of quantitative and qualitative research methods and is expected to contribute to the further development of psychotherapeutic treatment methods in this hard to treat patient group as well as to research on the effectiveness of long-term treatment. The background, design and current state of the assessment are presented. A total of 402 patients with chronic depression were included in the trial and the 1 and 2?year follow-up results are currently being analyzed.     

Assessment of Anxiety in Older Adults: Translation and Psychometric Evaluation of the German Version of the Geriatric Anxiety Scale (GAS)

Anxiety occurs frequently among older adults, and can have deleterious impacts on the quality of daily life. Due to the dearth of well-validated elder-specific anxiety screening instruments available in the German language, this study aimed to translate the Geriatric Anxiety Scale (GAS), a reliable and valid 30-item self-report screening instrument for assessing anxiety based on DSM-IV-TR diagnostic criteria (Segal et al. Journal of Anxiety Disorders, 24(7), 709–714, 2010a), into German, and to validate the new measure. The German version of the GAS was developed through a translation and back translation process, with careful attention paid to culturally-sensitive expressions of anxiety in the German older adult population. The final version of the German GAS was tested in a sample of 242 community-dwelling older adults (M_age?=?72.0 years, SD?=?6.9 years; 59 % women) who completed either an online (26 %) or a paper-pencil (74 %) version of the questionnaire. The findings confirmed the successful translation of the GAS into German and provided psychometric support for the new measure. The validation of the factor structure based on confirmatory factor analyses was in support of a unidimensional structure of the GAS-G. Correlational analyses with inventories measuring anxiety related and non-anxiety related personality traits additionally confirmed the convergent and discriminant validity of the GAS for use as an assessment measure for anxiety among German older adults.     

Beziehung und Exposition

In the treatment of anxiety disorders both psychodynamic and behavioral therapeutic methods have proved successful. Linking the two methods in one treatment is usually avoided by therapists, although there is evidence for using such an approach. There is a lack of a regulatory framework for the integration of the various procedures. Taking anxiety treatment as an example, a contribution to such a regulatory framework is developed: the use of exposure (as a cognitive behavioral element) and the examination of the transference aspect of the therapeutic relationship by the therapist (as a psychodynamic element) are systematically placed in relation to each other, whereby the understanding of the therapeutic process is deepened.     

The interpersonal measure of psychopathy: construct and incremental validity in male prisoners

The authors examined the construct and incremental validity of the Interpersonal Measure of Psychopathy (IM-P), a relatively new instrument designed to detect interpersonal behaviors associated with psychopathy. Observers of videotaped Psychopathy Checklist-Revised (PCL-R) interviews rated male prisoners (N = 93) on the IM-P. The IM-P correlated significantly with the PCL-R total score. Moreover, the IM-P was preferentially related to the interpersonal rather than the affective and antisocial lifestyle features of psychopathy. IM-P scores were significantly correlated with age, antisocial behaviors, and self-reported fear, anxiety, and socialization (in reverse). Hierarchical multiple regression analyses demonstrated that although the IM-P exhibited incremental validity beyond the PCL-R total score in detecting self-reported fear, anxiety, and several personality traits, it did not exhibit much incremental validity beyond PCL-R Factor 1. These findings raise questions concerning the unique assessment contribution of the IM-P beyond PCL-R Factor 1. Potential reasons for these findings and alternative means of enhancing the interpersonal assessment of psychopathy are discussed.     

Behandlungsmotivation und Indikation von Psychotherapie

Concepts and results of research into treatment motivation under psychotherapy are discussed with regard to the question whether decisions for indications on the basis of the motivational characteristics of patients are reasonable. Established concepts and broader theories of treatment motivation as well as diagnostic tools for the assessment are presented. Subsequently, empirical results for the effects of motivational factors on the maintenance and success of psychotherapy are briefly sketched. Approaches aimed at the enhancement of treatment motivation before and during psychotherapeutic processes are then illustrated. Finally, it is emphasized that, in turn, features of individual therapeutic processes may provide a basis for the indication of motivational enhancement interventions, thus supporting the notion of a dynamic nature of treatment motivation.     

Four-facet PCL-R structure and cognitive functioning among high violent criminal offenders

High violent inmates (N = 126) were administered the Psychopathy Checklist-Revised (PCL-R; Hare, Clark, Grann, & Thornton, 2000; Hare et al., 1990) and neuropsychological measures. No significant correlations were present between the overall PCL-R score and 14 cognitive measures. A violence score, computed as the total number of violent acts across all situations and types, was significantly correlated with the PCL-R total score and Facet 2 but not with the other three facets. Our data suggest that Facet 2 elevations may prove relevant to violence risk assessment; this link, however, needs further exploration with larger samples.     

Pathologisches Glücksspiel und Delinquenz

Pathological gambling is characterized by excessive gambling behavior which influences the life and well-being of a person in a dysfunctional way. It often leads to severe consequences in social and family life, career and material matters. This can also include illegal acts. In the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) excessive gambling was classified under impulse-control disorders but was renamed as gambling disorder (GD) and reclassified under the category “substance-related and addictive disorders” in DSM-5, due to parallels to substance use disorders in the clinical characteristics as well as genetic and neurobiological factors. In Germany, approximately 0.5?% of the adult population suffer from GD. Especially gambling machines are associated with an increased risk of gambling-related problems. Common comorbidities are substance-related and affective disorders. The most important risk factors are young age, male gender, a history of migration, gambling-related problems in the family, unemployment, a low educational level and low household income. Delinquent behavior was not considered to be a sufficiently discriminative factor for GD, although there is a correlation between delinquency and gambling behavior. In addition, those GD subjects who show delinquent behavior also show a specific risk profile. Thus, mental health professionals should be aware of possible psychosocial consequences in GD, such as illegal acts, and this should be addressed in the effective treatment strategies, such as cognitive behavioral therapy. Moreover, it is necessary to improve the access routes for affected people into healthcare system in order to ensure early detection and treatment of the disease.     

Qualitätskriterien forensischer Ambulanzen des Strafvollzugs

In 2007 the legal reform concerning the supervision of conduct established forensic aftercare as mandatory for patients released from forensic commitment hospitals and offenders released from penitentiaries. Therefore, in the past 10 years forensic outpatient departments have evolved all over Germany in a state-specific manner according to the legal mandate of treating and managing released offenders. Some of these outpatient departments were newly founded and some were long established units for treating and managing offenders that expanded their services for offenders under supervision of conduct. During the past years these heterogeneous outpatient departments have formed a federal network targeting professional exchange, commonalities, discrepancies and distinct characteristics in realizing the legal mandate. Following the debate on minimum requirements in forensic psychiatric aftercare departments of forensic commitment hospitals in 2014, this federal network developed quality criteria. Despite diverse state and trusteeship-specific conditions, these quality criteria emphasize common content and formal factors for a successful forensic outpatient treatment. This article presents the result of a discussion process along with the agreed quality criteria in the categories of the quality of structure, process and results.     

In 300 Stunden um die Welt

The time frame of psychoanalytic long-term treatment depends on the therapy goals and the means by which these are expected to be reached. A core element for this is the concept of working through. In Freud’s view working through deals with resistance towards the acceptance of an interpretation regarding unconscious conflicts. Also, in classical terms there is a working through of the transference neurosis. Conceptual intertwining with the work on mourning (in terms of libidinal decathexis) brings a difficulty to light, namely the potential danger of misusing long-term treatment and the therapeutic working relationship for avoiding termination and separation. The basic concept of working through can be maintained for patients with non-neurotic disorders as well as regarding modified psychodynamic psychotherapies with fewer sessions and lower session frequency, albeit in consideration of the theory of therapeutic change for each form of treatment; however, a three-fold meaning of working through in contemporary psychoanalysis (i.e. working through of resistances, working through of transference neurosis and the structurally changing inner work of the patient) indicates the need to discuss the necessary duration of long-term treatment neither from a viewpoint of economic efficiency nor from a standpoint of mere professional policy but to base this on the logic of the dynamics of a disorder and the treatment planning.     

Merleau-Ponty’s phenomenology in the light of Kant’s Third <Emphasis Type="Italic">Critique</Emphasis> and Schelling’s <Emphasis Type="Italic">Real</Emphasis>-<Emphasis Type="Italic">Idealismus</Emphasis>

In this paper I offer a selective, systematic rather than historical account of Merleau-Ponty’s highly complex relation to classical German philosophy, focussing on issues which bear on the question of his relation to transcendentalism and naturalism. I argue that the concerns which define his project in Phenomenology of Perception are fundamentally those of transcendental philosophy, and that Merleau-Ponty’s disagreements with Kant, and the position he arrives at in The Visible and the Invisible, are helpfully viewed in light of (1) issues which Merleau-Ponty identifies as raised by Kant’s Critique of the Power of Judgement, and (2) Schelling’s conversion of Kantian idealism into a Real-Idealismus. Finally I address the question of whether, and on what basis, Merleau-Ponty’s claim to have surpassed systematic philosophy can be defended.     

The role of psychopathic personality disorder in violence risk assessments using the HCR-20

Antisocial and psychopathic traits are essential to evaluate when assessing risk for violence using the HCR-20. The role of the PCL-R on the HCR-20 was investigated using a series of meta-analytic tests. Across 34 samples in which both tools were rated, AUCs for violence were similar (～.69), and exclusion of the psychopathy item (H7) did not reduce the HCR-20's accuracy. Quantitative synthesis of results from multivariate analyses conducted in 7 raw datasets that used both tools demonstrated that the average probability of observing violence for every point increase on the HCR-20 (without H7), while controlling for the PCL-R, was 23%, whereas for the PCL-R it was -1%. The HCR-20 (without H7) added incremental validity to the PCL-R, whereas the converse was not true, and only the HCR-20 (without H7) possessed unique predictive validity. Results suggest the HCR-20's predictive validity was not negatively impacted by excluding the PCL-R. Areas for future study are discussed, including research on various ways to assess and incorporate into risk assessment personality traits related to violence.