Treatment of non-incarcerated sexually compulsive/addictive offenders in an integrated, multimodal, and psychodynamic group therapy model

Group therapy is a widely accepted model of care for sex offenders. However, most group therapy takes place in prison utilizing a cognitive-behavioral, psychoeducational model of care. Given that over 250,000 sex offenders are in ambulatory treatment, newer models of care may need to be employed to address their specific needs. I present a naturalistic outpatient study involving my private practice of 109 consecutive sex offenders treated over a 10-year period. A multimodal model of care informed by psychodynamic theory is presented with detailed case material from one group session. Preliminary results of recidivism are presented.     

Gender constructions from a project on sex offenders

Abstract

The four-year group therapy of 16 sex offenders in prison was videotaped, and 21 sessions were carefully transcribed and analysed by means of conversation analysis and analysis of metaphor and narration. These qualitative methods are apt for verbal data and can be combined with psychoanalytic thinking in a productive way. New forms of process analysis can be developed. The results presented here are selected to relate to the topic of how the imprisoned group therapy participants constructed “gender” by ways of speaking about themselves, women, and their victims, young girls. The results show that it would be a mistake to think of these ways of speaking as if they could be ignored in favour of “deeper” motives, lying “behind” the words. Our results show how unconscious constructions of gender are not beyond language, but in language. “Doing gender” is a conversational practice.     

The Roles of Childhood Maltreatment and Psychopathy in Sexual Recidivism of Treated Sex Offenders

Abstract

The Intensive Treatment Program for Sexual Offenders (ITPSO) at the Correctional Service of Canada (CSC) provides cognitive-behavioral group treatment to federally incarcerated sex offenders. Follow-up data for 81 of these men were examined, looking at psychopathy and childhood maltreatment history as potential predictors of recidivism using Survival Analysis. Offenders who had been placed in foster care as a child were more likely to recidivate; however when PCL-R Factor 2 scores (a history of antisocial behavior) were entered, they predicted over and above foster care history. Childhood physical abuse predicted sexual recidivism; however, childhood sexual abuse and PCL-R scores did not predict sexual recidivism. PCL-R Factor 2 scores predicted violent recidivism.     

Child Sexual Abuse within Educational Settings: A Qualitative Study on Female Teachers Who Sexually Abuse Their Students

ABSTRACT

Despite growing interest, research on female sex offenders has been limited. Previous research on female sex offenders has focused on understanding behaviors, patterns, and motivations of female sex offenders overall, but only a handful of studies have specifically focused on teachers who are convicted of sexually abusing underaged students. For the present study, we examined the nature of child sexual abuse among a sample of female teachers, focusing specifically on the onset, situational context, and conclusion of these sexual abuses. We examined interviews conducted with 35 female sex offenders who used their position as a teacher to engage in a sexual abuse of underage students from 1995 to 2016 in a southern state. Based on the narratives of both victims and offenders, our findings indicated several categories of female teacher offenders including predatory, sexual friendship, and emotionally dependent. We hope the findings of the current study will help inform educational policy in efforts to prevent the occurrence of these abuses in the future.     

“Motivation” and Routine Activities Theory

ABSTRACT

This study examines the motivation aspect of routine activities theory as it pertains to sex offenders. Using logistic regression, data from 163 convicted sex offenders who participated in treatment programs between 1982 and 2000 were analyzed to determine if demographic, abuse histories, sex abuse histories, drug/alcohol use, and other “motivating” variables were predictive of in and out of the home offending. Results indicate abuse and drug use are predictive of home sex offenses while alcohol use is indicative of community offending. While the results and differences were modest, they warrant further exploration of the motivation aspect of routine activities theory.     

Preliminary Development of Trauma-Focused Treatment Groups for Incarcerated Juvenile Offenders

Summary

Most male juvenile offenders have been exposed to trauma. Many juvenile offenders have experienced both acute and chronic trauma. Trauma exposure among offenders is closely linked to their criminal behavior, yet few protocols have been developed to treat posttraumatic sequelae in a delinquent population. This article describes initial efforts to develop group therapy services for incarcerated male juvenile offenders who have histories of significant trauma exposure and current symptoms of PTSD. Four separate pilot groups were conducted in two Massachusetts Department of Youth Service secure residential facilities. The treatment included trauma psychoeducation (including the relationship between trauma and offending), therapeutic trauma exposure through discussion and expressive arts, and coping skill development. The treatment development and initial implementation as well as directions for future research are discussed.     

Are Categorical Deniers Different? Understanding Demographic,Personality, and Psychological Differences between Denying and Admitting Individuals with Sexual Convictions

ABSTRACT

The purpose of this study was to establish whether there were demographic, personality, or psychological differences between a sample of 40 incarcerated sex offenders in categorical denial and 37 sex offenders admitting responsibility in an Australian minimum-security unit. Categorical deniers had lower IQs, were older, and were more likely to be child molesters. Criminogenically, there were no differences between categorical deniers and those who admitted their offences in relation to Static-99 risk scores. Psychologically, offenders denying their offences were significantly more shame-prone, and likely to use externalization as a method of impression-management. They were also more compulsive than those admitting their offences, but less antisocial and sadistic, when compared on personality indices. The study is limited by the small sample size however implications for further research and the treatment of categorical deniers are discussed.     

Understanding Intimate Partner Sexual Assaults: Findings from Sexual Assault Kits

ABSTRACT

In 2013, Cuyahoga County, Ohio, began DNA testing and investigating nearly 5000 previously unsubmitted sexual assault kits (SAKs) from 1993 through 2009. We examined case files from a sample of SAKs that were tested but not previously adjudicated (n = 429). More than 10% (n = 45) involved victims who reported to police that a former or current intimate partner sexually assaulted them. This article integrates the available data on the offenders, the victims, the initial investigation, and the specifics of the assaults to provide a more complete understanding of intimate partner sexual assault (IPSA). More than one-third of the IPSA offenders were serial sex offenders; that is, the offenders sexually assaulted an intimate partner and another person(s). Comparing IPSAs to all other sexual assaults, IPSAs more frequently involved bodily force, less frequently involved a weapon, and IPSA investigations were more frequently closed because (1) the victims stated they lied or the police doubted the victims and (2) the victims declined to prosecute. The most common sequencing of events was a demand for sex by the offender followed by a verbal refusal by the victim and the use of bodily force in the sexual assault. The findings, however, indicate a great deal of variation in the sequencing of events surrounding the sexual assault, with over 25% involving no physical confrontation before or after the sexual assault and no demands for sex. Unsubmitted SAK data provide a unique window into understanding the understudied and underreported issue of IPSA.     

Social Bonds and White-Collar Crime: A Two-Study Assessment of Informal Social Controls in White-Collar Offenders

ABSTRACT

In two studies, this paper examines age-graded informal social controls (bonds) in white-collar offenders. Using register data, Study 1 compares bonds in a sample of white-collar offenders to a matched control sample, while Study 2 uses probation data to examine bonds within a subsample of white-collar offenders of Study 1. The results show that white-collar offenders, including those who occupy executive positions and those with an adult-crime onset, were characterized by weakened bonds and that early-onset offenders had weaker bonds than adult-onset offenders. Along with the implications of these findings for theory, limitations and directions for future research are presented.     

Psychological and sexual functioning among outpatient sexual offenders against children: A Minnesota Multiphasic Personality Inventory (MMPI) cluster analytic study

Multivariate clustering procedures were used to identify homogeneous subgroups of outpatient sex offenders against children (n=110)on the basis of the Minnesota Multiphasic Personality Inventory (MMPI). Results indicated a five-subgroup solution. Two within-normal-limits and two clinically elevated profile subgroups replicated subtypes found in previous cluster analytic studies of child sex offenders. The fifth subgroup appeared similar in MMPI profile pattern and elevation to a previously identified subtype of rapists. Discriminant analyses showed that subgroups differed along dimensions of cognitive disturbance and sexual functioning. Furthermore, levels of psychopathology corresponded with levels of sexual pathology. Results are discussed with reference to previous MMPI cluster analytic studies of sex offenders and theories of sexual aggression.Portions of this paper were presented at the meeting of the Midwestern Psychological Association, 1992, Chicago, Illinois.     

The Effect of Adolescent Sex Offender Abuse History on Counselor Attitudes

Counseling students' judgments of adolescent sex offenders with sexual or physical abuse histories were examined. Sexually abused offenders were more desirable as prospective clients than were nonabused offenders. Sexually abused counselors desired to see physically abused offenders as clients over sexually abused offenders. Implications for counseling are presented.     

Qualifications for Membership in the A.G.P.A.

A model of the development of group therapists is presented. It is proposed that student group therapists proceed through a sequence of stages, each of which is marked by characteristic therapist behavior. During the initial Group shock phase, the student reacts to the novelty of group therapy stimuli with individual therapy or content-oriented approaches. Reappraisal is a period of some therapist inhibition, frustration, or self-doubt. One step behind is a phase characterized by a gradual recognition of the process level of analysis, despite difficulty supplying the interventions autonomously. Using the here-and-now is a period of active intervention about interpersonal phenomena among group members. The techniques for highlighting this material are refined in the Polishing skills phase. The usefulness of models in training is discussed.     

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.     

Integrating research into practice: The Forward-Focused Model of adolescent sexual behavior treatment

Knowledge of adolescents with sexual behavior problems has continued to grow over the past two decades, further differentiating the needs of this group from adult sex offenders. However, treatment programs based upon the current literature have yet to be fully articulated. In an attempt to address this gap between knowledge and practice, a comprehensive treatment program for adolescents with sexual behavior problems was developed: the Forward-Focused Model. The Forward-Focused Model is rooted in cognitive–behavioral theory, incorporates motivational approaches, and is developmentally-sensitive to address the unique needs of adolescents. This empirically-based model is introduced in this article.     

Increasing access to psychological therapies for people with psychosis: predictors of successful training

BackgroundCognitive behavioural therapy for psychosis (CBTp) is recommended for people with schizophrenia, but routine delivery remains limited. Obstacles to increasing access include inadequate training, organisational support and supervision, resulting in low levels of staff competence and confidence. This study is a preliminary evaluation of a CBTp training programme, designed to overcome these obstacles and to increase routine delivery of competent CBTp.MethodTraining outcomes for a pilot group and for the first three cohorts to complete training were analysed to identify predictors of successful completion and of therapy delivery after training.ResultsObjective competence was attained by 37 students (out of 58), who delivered therapy to over 160 service users. Successful completion was associated with previous CBT therapy experience. Delivery after one year was associated with working in a therapy rather than a care co-ordination role.ConclusionsThe programme succeeded in training therapists to deliver competent therapy. Our results suggest that preliminary training in CBT for other disorders may improve success rates in CBTp. Despite extensive service liaison, delivery remained problematic for care co-ordinators without role change and provision of dedicated time. The findings should inform future implementation strategies.     

Pathways in the offending process of sex offenders who target marginalised victims

Prior literature shows that although marginalised populations are at a high risk of severe violence and homicide, research has focused on their offenders as if they constituted a homogeneous group. On the basis of a sample of 213 sex offenders who targeted marginalised individuals (i.e., sex trade worker, homeless individual, and severe drug user), we investigate the different pathways that these offenders take both prior to and during the commission of their crimes. Results of 2‐step cluster analysis regarding the offender's development, criminal history, crime context, and modus operandi revealed 3 distinct pathways of the offending process. The coercive pathway was characterised by the amount of violence used against the victim. The explosive pathway was defined by offenders who were in a state of rage at the time of the offence. Finally, offenders in the situational pathway committed their crimes out of opportunity and used very little violence. Differences between pathways were investigated with regard to characteristics of the index offence.     

Unravelling Crime Series Patterns amongst Serial Sex Offenders: Duration,Frequency, and Environmental Consistency

Crime linkage and the investigation of behavioural consistency amongst serial offenders has been a flourishing field of research over the past decade or so, especially with respect to serial sex offenders. The emerging research in this field has often portrayed serial sex offenders as a single, distinct, and homogeneous group. Such an assumption, however, has never been empirically examined. Using a criminal career approach and a sample of 72 serial sex offenders who have committed a total of 361 sexual assaults on stranger victims, the current study aims to examine and describe subgroups of crime series patterns amongst serial sex offenders in terms of duration and frequency of offending. The level of environmental consistency display (i.e. offender's choice of crime location and characteristics of the crime site selected) across subgroups of crime series patterns is also examined. Study findings suggest the presence and heterogeneity of crime series patterns amongst serial sex offenders, advocating for the consideration of subgroups of crime series patterns when studying serial sex offenders. Moreover, the offenders' level of environmental consistency varies across the different crime series patterns identified, allowing for the identification of subgroups of offenders showing a higher or lower level of environmental consistency. Copyright © 2014 John Wiley & Sons, Ltd.     

Observations on the Meaning of Behavior in Groups of Chronic Schizophrenics

Abstract

In the United States, there is currently an increase in admissions to psychiatric hospitals, diagnostic heterogeneity, briefer stays, and a lack of inpatient research. Most traditional group therapy models are constructed for longer-term homogeneous patients. Diagnostically homogeneous groups even outperform heterogeneous groups. However, changes in health care have created a clinical dilemma in psychiatric hospitals where groups have become characterized by brief duration, rapid turnover, and diagnostic heterogeneity. A literature review offered little in the way of treatment recommendations, let alone a model or empirical basis, for facilitating these types of groups. Common factors from group therapy studies were extracted. Based on an integration of these studies, a process-oriented psychoeducational (POP) treatment model is recommended. This model is theoretically constructed and outlined for future study.     

Sexually Violent Predators: Toward Reasonable Estimates of Recidivism Base Rates

The sexual recidivism rate of sex offenders is a controversial issue. Perhaps as controversial is the sexual recidivism rate of the select group of sex offenders who are examined pursuant to sexually violent predator (SVP) statutes. At present, reliable estimates of SVP recidivism are unavailable. We propose that reasonable estimates of SVP recidivism can be reached by considering three available pieces of data: (i) a likely recidivism rate of the general population of sex offenders; (ii) procedures typically followed by jurisdictions that civilly commit sex offenders; and (iii) classification accuracy of procedures. Although sexual recidivism rates vary across jurisdictions, the results of our analyses suggest sex offenders referred for examination pursuant to SVP statutes recidivate at substantially higher rates than typical sex offenders. Our results further suggest that sex offenders recommended for commitment as SVPs recidivate at even greater rates than SVP respondents who are not recommended for commitment. We discuss practice and policy implications of these findings. Copyright © 2013 John Wiley & Sons, Ltd.