Understanding service users’ and therapists’ experiences of pharmacological treatment for sexual preoccupation and/or hypersexuality in incarcerated sex offenders

This research comprises two qualitative studies understanding the experiences of (1) convicted sex offenders voluntarily receiving pharmacological treatment to reduce sexual preoccupation and (2) therapists working with these offenders. The studies form part of a research programme evaluating the use of pharmacological treatment with sexual offenders. In study one, semi-structured interviews were conducted with 13 sexual offenders receiving selective serotonin reuptake inhibitors. In study two, interviews were conducted with eight intervention staff with varying levels of experience of working with offenders taking anti-libidinals. Thematic analysis was used and in study one, two main themes emerged: (i) the impact of the pharmacological treatment on prisoners’ daily functioning; (ii) barriers to compliance/engagement. In study two, three main themes emerged: (i) offenders’ reluctance to engage with pharmacological treatment; (ii) challenges for therapists; (iii) pharmacology: ‘just another piece of the puzzle’. Findings are discussed in relation to practice and future research.     

The use of psychological interventions for adult male sex offenders with a learning disability: a systematic review†

ABSTRACT

There is a drive to attend to the specific treatment needs of sexual offenders with a learning disability (LD) and increasing recognition of treatment limitations in this group. Cognitive behavioural therapy (CBT)-based sex offender treatment programmes (SOTPs) are being increasingly adapted for the LD population. This review systematically considers the evidence base for LD adapted CBT-based SOTPs. Ten studies together comprising 358 participants were reviewed. LD adapted SOTPs were conducted in prisons, secure settings and in the community. Within-treatment findings generally indicated positive cognitive shift, improvements in victim empathy and increased sexual knowledge on psychometric measures. Whilst findings are encouraging, many of the studies have methodological limitations. In particular, all studies used pre-test post-test study designs lacking control groups therefore restricting the evaluation of treatment outcomes. The LD sex offender literature remains underdeveloped and there is a strong case for further research to establish a valid evidence base for treatment.     

Gaze patterns to child figures reflect deviant sexual preference in child sex offenders—a first glance

Abstract

Research on non-offending heterosexual participants has indicated that men's gaze allocation reflects their sexual preference. In this exploratory pilot study we investigated whether naturalistic gaze behaviour is sensitive to deviant sexual preferences. We compared gaze patterns of convicted heterosexual child sex offenders (CSOs; n = 13) with female victims to heterosexual non-offending men (n = 13) in a task of free-viewing images of clothed male and female figures aged 10, 20 and 40 years. CSOs dedicated more fixations to the upper body of the female child than male child figures. The pattern was different for the control sample, whose gaze pattern to male and female figures could only be differentiated when viewing adult figures. CSOs showed significantly greater difference in their gaze towards the upper body of male and female children than non-offenders. Our findings provide preliminary evidence for eye-tracking as a potential method of assessing deviant sexual interest.     

Sexually violent predators and civil commitment: is selection evidence based?

Sexual offenses represent an alarming proportion of crimes committed yearly. To address these concerns, several states, including South Carolina (SC), have enacted laws requiring sexually violent predators (SVPs) to be civilly committed to treatment. To date, no published study has examined sexual offenders recommended for treatment in SC. This study used a specially designed statewide database (SC-SVP research database) to determine which offender and offense characteristics were associated with increased likelihood of being recommended for civil commitment. Factors correlated with being more likely to be recommended included: being of a younger age at time of evaluation, prior sex convictions, having related and unrelated victims, a higher number of victims, frequent substance use, and a history of suicide attempts. Prior sex convictions, having both related and non-related victims, and a higher total number of victims align with characteristics associated with sexual recidivism. Frequent substance abuse and a history of suicide attempts do not mirror previous findings regarding sexual recidivism. These findings present new information regarding the civil commitment process of offenders being committed to the SC-SVP treatment program, characterize types of offenders committed to SC-SVP treatment program, and provide a foundation for using a computerized database in conducting sex offender research.     

Exploring the Relationship Between Childhood Sexual Abuse and Adult Sexual Perpetration

Empirical findings indicate that many adult sexual offenders experienced sexual abuse during childhood. It has been suggested that characteristics of offenders' sexual perpetrating behaviors may resemble their own victimization experiences, although there has been minimal empirical investigation in this area. The purpose of the present study was to provide preliminary data on the relationship between childhood sexual abuse and characteristics of sexual offending behavior. A sample of adult male sexual offenders with histories of sexual abuse completed the Sexual Victimization Survey as well as a measure on their sexual offenses. Such characteristics as the nature of sexual activities, duration and frequency of experiences, and age and relationship of participants were examined. Results showed trends in the hypothesized direction and revealed a variety of similarities between childhood sexual abuse and adult sexual perpetration. Findings of this exploratory study suggest the importance of addressing the nature of victimization in the treatment of sexually abused boys and offenders with histories of sexual abuse.     

Wise mind—risky mind: A reconceptualisation of dialectical behaviour therapy concepts and its application to sexual offender treatment

Abstract

This paper aims to introduce a reconceptualisation of dialectic behaviour therapy (DBT), “wise mind–risky mind”, and its application to sexual offender treatment. This reconceptualisation holds some promise in addressing issues around general, affective, cognitive and sexual dysregulation, and may provide an alternative way of thinking about sexual offender treatment. The wise mind–risky mind dialectical construct helps clients and therapists utilise a common language that captures and validates the experiential difficulties that clients go through in effectively managing their risk for sexual offending. The incorporation of DBT principles in standard sexual offender treatment programmes can assist clients in effectively managing problems with dysregulation in various domains. It can also afford a more integrated treatment framework when working with sexual offending dynamics. The authors discuss this new construct and its possible applications within the broader forensic mental health field.     

Sexual offenders’ parental and adult attachments and preferences for therapists’ interpersonal qualities

ABSTRACT

This study explored sex offenders' parental and adult attachment difficulties and assessed the extent to which these were associated with preferences for therapists' interpersonal qualities. One-hundred and twelve adult male child sexual offenders were invited to provide self-report data on their attachment histories, adult attachments and preferences for therapists' interpersonal qualities. A weak relationship between childhood and adulthood secure attachment was found, suggesting that attachment at the time of offending may be more relevant than childhood attachment to the aetiology of sexual offending. Participants valued a range of therapists' qualities previously identified as important for positive treatment change. Therapist trust and genuineness were perceived as particularly important by those with attachment difficulties, demonstrating the need for these qualities in offender programmes where attachment difficulties would be expected. There were some differences in the preferences for therapists' qualities between participants with different adult attachment types, highlighting the importance of responsivity factors in treatment.     

The impact of sex offender’s interpersonal style,treatment readiness and the therapeutic alliance on treatment gain

The impact of internal responsivity factors and therapeutic process variables on intra-individual within-treatment gain in sex offenders has received little empirical attention. This study examined how (1) internal responsivity factors, including treatment readiness and interpersonal style, and (2) therapy process variables, including the therapeutic alliance and the presence of ruptures in the therapeutic relationship, impacted intra-individual within-treatment gain. Participants comprised 71 sex offenders who participated in group-based sex offender treatment programmes in prison or the community. Results showed that offender hostile-dominance and the affective and interpersonal characteristics of psychopathy, as measured by the Psychopathy Checklist: Screening Version Factor 1 score, negatively impacted treatment gain. Pre-treatment readiness, client ratings of the therapeutic alliance and whether or not there were ruptures in the therapeutic relationship had no association with within-treatment gain. The strength of the therapeutic alliance later in treatment did not moderate the relationship between offender interpersonal style, or psychopathy, and treatment gain.     

A follow-up study of sex offenders treated by Thames Valley Sex Offender Groupwork Programme, 1995–1999

The following paper is a reconviction study of 183 sex offenders treated by the Thames Valley Project between 1995 and 1999. Some demographic details are provided about the sample. Subjects were monitored for a mean of 3.9 years. A total of 10 subjects (5.4% of total) were reconvicted for a further sexual offence. A further 19 men (10.3%) either had allegations made against them or committed a behaviour that may have involved or been the preparation for further sexual offending, defined here as “recidivism”. Details about post-treatment behaviour were drawn from three sources: two national police databases which indicated any formal sexual reconviction and the files kept on each sex offender registered with Thames Valley Project (TVSOGP), a multi-funded community-based sex offender treatment programme. The pre-treatment re-conviction risk status of each man was calculated using part one of the Risk Matrix 2000 algorithm (static factors). Risk levels were compared for those where reconviction, re-offending or recidivism was identified and those where it was not and a correlation was found in the predicted direction although this was not statistically significant. The advantages and limitations of this kind of follow-up study are discussed, together with some recommendations for future research.