Combining cognitive-behavioral therapy and pharmacotherapy in the treatment of pedophilic incest offenders

Treatment programs for incest offenders traditionally do not differentiate between pedophilic and nonpedophilic perpetrators. This oversight has failed to meet the specialized needs of pedophilic incest offenders, who differ from other incest as well as nonfamilial sex offenders in important ways. This paper describes a treatment intervention combining cognitive-behavioral therapy and pharmacotherapy for the specialized treatment needs of the pedophilic incest offender. A case report is presented to illustrate the use of combined treatment and to highlight indicators for this strategy.     

The sexual preferences of incest offenders.

Inclusive fitness theory suggests that discriminative solicitude and inbreeding avoidance are important mechanisms regulating parent-children interactions. From an inclusive fitness perspective, sex with one's biological children is paradoxical. The authors hypothesized that incest can occur when these mechanisms are not activated (e.g., if a father is uninvolved in child rearing) or are overwhelmed by another factor, such as pedophilic interest. They predicted that biological fathers, who presumably have been the most involved in the rearing of their victims, would show greater phallometrically measured pedophilic interest than would other incest offenders against children (e.g., grandfathers, uncles, stepfathers). The prediction was not supported. A testable alternative hypothesis to explain biological father incest is presented and the importance of assessing pedophilic interest among incest offenders is discussed.     

The discriminative validity of a phallometric test for pedophilic interests among adolescent sex offenders against children

The authors examined the responses of adolescent sex offenders against children on a phallometric test of pedophilic interests. Participants were 40 adolescent sex offenders against children, 75 young adult sex offenders against children, and 39 young adult comparison participants. The responses of adolescents with female victims resembled those of comparison participants; adolescents with any male victims had larger relative responses to child stimuli than comparison participants. Young adult offenders, regardless of victim sex, had larger relative responses to child stimuli than comparison participants. Using a cut score of 0 (indicating equal or greater arousal to children than to adults), sensitivity was 42% for adolescents with any male victims, and specificity was 92% for the comparison participants. Results suggest phallometric testing can identify pedophilic interests among these adolescent sex offenders.     

Treatment of a four-year-old victim of incest

Abstract

A case study describing the use of behavior techniques in the treatment of a four—year—old sexual assault victim is presented. The target behaviors included eating, phobic behaviors, self—injurious behaviors, and comments made about the father (the perpetrator) and the paternal grandmother. The child's mother served as both data collector and therapist. The study demonstrates that child victims can experience a sexual assault trauma syndrome similar to that manifested by adult victims. Additionally, the findings illustrate that a simple behavioral intervention implemented by a parent can be effective in treating young sexual assault victims.     

Moral reasoning, interpersonal skills, and cognition of rapists, child molesters, and incest offenders

54 inmates were subdivided into four groups and classified according to their index offense. The groups included Rapists (n = 14), Incest Offenders (n = 9), Child Molesters (n = 11), General Offenders (n = 20). Nonoffenders (n = 20) were included as a control group. Psychometric tests including the Test of Nonverbal Intelligence, the Defining Issues Test, Survey of Interpersonal Values, Porteus Maze, and Minnesota Multiphasic Personality Inventory were administered to all inmate and control groups. Analysis showed the rapists and child molesters scored higher on moral reasoning on the Defining Issues Test; also rapists' scores were more elevated on the Psychopathic Deviate and Paranoia scales of the Minnesota Multiphasic Personality Inventory than those of other offender and control groups. These results imply that rapists and child molesters have the ability to understand moral issues; however, given their personality orientation, they ignore these interpersonal social values.     

Student mental health: A pilot study

In this country, little research has been undertaken into the difficulties faced by students and the contributory stressors. It is apparent that they have a lot with which to content. Identification of stressors, assessement of stress levels and consequences on mental health appear vital.A pilot study was undertaken of 40 studets: 10 males aged under 21 years, ten males 21–40 years, 10 females under the age of 21 and 10 females 21–40 years, The purpose was to identify the potential factors leading to student discontent, problems and stress. Students were in the professions allied to medicine. Oral semi-structured interviews and a written questionnaire were used. Results indicated that for students the major difficulties were coursework and emotional state. Finance was a recurring problem but not as troublesome to the students as the other two problems. What must be considered are ways to alleviate student unhappiness. Emphasis should be placed on prevention where possible. Ongoing counseling throughuot the educational years is desirable as are various programmes which address student concerns. Of particular value would be a Student Mental Health Service. ‘Unnecessary’ coursework could be an added burden.     

Treatment of juvenile offenders: Study outcomes since 1980

Past reviews of the treatment of juvenile offenders have concluded that “nothing works.” More recently, some reviewers have concluded that treatment concepts are not necessarily ineffective, but, instead, research methodology and treatment integrity have been inadequate. The present review looks at the treatment of adjudicated juvenile offenders from a computer-data-based search of the literature published from 1980 to 1987. Research outcome and methodology are summarized and critiqued. The conclusions are that treatment outcomes were positive, but that serious methodological weaknesses still exist in the literature. Improvements still need to be made in sample sizes, use of appropriate and multiple measures of recidivism, random assignment and/or use of appropriate control groups, and long-term follow-up assessment.     

Engaging families in therapy: A pilot study

Engagement is reviewed as a central component of marriage and family therapy and presented as a viable means of assessing the nature and outcome of therapy. A tentative model containing six differentiated engagement categories is described and documented with clinical data and case examples. Conclusions drawn indicate engagement has merit as a construct for evaluating marriage and family therapy and as a means of generating process hypotheses in research. Recommendations to validate, refine and revise the model are posited and further research relative to engagement is advocated.James P. Trotzer, Ph.D. is Professor of Counselor Education at the University of Visconsin-River Falls, River Falls, Wisconsin 54022, marriage and family therapist in private practice     

Reinforcement sensitivity of sex offenders and non‐offenders: An experimental and psychometric study of reinforcement sensitivity theory

This study tested predictions of Gray's Reinforcement Sensitivity Theory (RST) in subgroups of sex offenders and male non‐offenders using an experimental choice task consisting of a reward and a non‐reward phase. In addition, RST‐related psychometric measures were used. Both experimental and psychometric data were of interest to determine whether sex offenders could be reliably differentiated from non‐offenders. Paraphilic (N=50) and impulse control‐disordered (N=48) sex offenders showed greater sensitivity to continuous reward than male non‐offenders (N=51). Impulse control‐disordered sex offenders showed less behavioural adaptation under non‐reward than both paraphilic sex offenders and male non‐offenders. In addition, reward sensitivity, rash‐spontaneous impulsivity, and anxiety measures discriminated sex offenders from male non‐offenders. The results suggest that reinforcement sensitivity is a promising personality trait for differentiating subgroups of sex offenders from non‐offenders. The experimental and psychometric results illustrate that predictive accuracy in forensic settings could be improved by combining several types of data.     

Alcoholism and incest: Improving diagnostic comprehensiveness

This article is designed to underscore the similarities in characteristics between alcoholic and incestuous family operations. Hopefully, readers will develop a more acute appreciation and understanding of the frequency of occurrence of both of these behaviors in the same family. The author contends that too often alcoholism will be diagnosed, while the incest is diagnostically missed or vice versa. To best insure that recidivism of either the alcohol or incest can be avoided, the author believes it is important to comprehensively diagnose and then treat appropriately.     

The association of paternal mood and infant temperament: A pilot study

Maternal depression is associated with adverse child development, but little is known about the effects of paternal depression. This pilot study estimated the prevalence of paternal depression and mood state, and assessed the relationship between paternal mood and infant temperament. The participants in the study were 98 fathers of newborn babies. Fathers were initially screened for depressed mood (Hospital anxiety and depression scale, and Edinburgh postnatal depression scale), and at 6 months parental mood, infant temperament, couple relationship quality, alcohol use, adverse life events, parenting, and demographics were recorded. Infant fussiness was analysed in relation to paternal mood and other contextual factors using multiple regression. Of the 98 fathers, 48 (49%) completed depression-screening measures. Of these 48 fathers, 4 (8%) reported depressive symptoms above the cut-off for case definition. A total of 48% (N=19) completed measures at follow-up. In the adjusted model, higher paternal depression scores, more traditional attitudes towards fathering, and increased recent life events were related to higher infant fussiness scores; and better couple relationship quality was related to lower fussiness scores. This study showed that 1 in 12 fathers had depressed mood, and lower mood was associated with negative infant temperament. Since the findings of this feasibility study were based on a small sample size the association of paternal mood and child development merits further study using a larger sample of fathers.     

Father-daughter incest families: A theoretical perspective from balance theory and GST

This paper focuses on a theoretical explanation of how marriages adjust and remain intact in father/daughter incest families. It uses concepts of Balance Theory and General Systems Theory to outline a vascillating balance that occurs between fathers-mother-daughters in incest families. Three groups of Incest, Oppositional, and Nonclinical family units were studied using the Structural Analysis of Social Behavior (SASB) circumplex model. The study found support for the use of Balance Theory and the systems principle of homeostasis as a way to understand the interactional dynamics in incest families. Therapeutic interventions are suggested.Curtis A. Levang has spent more than 10 years working with adult offenders at Hennepin County Adult Corrections in Plymouth, Minnesota. He also is in private practice, working with individuals, couples, groups, and families at Passages Counseling Center.