An assessment for attitudes consistent with sexual offending for use with offenders with intellectual disabilities

Background . Over the past 10 years, the focus of assessment and treatment for sex offenders has changed from the assessment of skills and deviant sexual preferences to the assessment and treatment of cognitions that might be considered to encourage or justify inappropriate sexual behaviour. There have been a few assessment measures of deviant sexual cognitions developed for adults in mainstream sex offender populations but none in less able populations. The present study describes an assessment questionnaire consisting of 7 scales for cognitions associated with rape, voyeurism, exhibitionism, dating abuse, stalking, homosexual assault and offences against children, designed to be used by sex offenders with intellectual disabilities. Method . Four groups of subjects were employed in this study – sex offenders, non‐sexual offenders, non‐offenders all with mild intellectual disabilities or borderline intelligence and a further group of normal men. All subjects completed the questionnaire and 86 subjects provided reliability data. Results . Each item was subjected to 3 tests of reliability. Retained items were required to achieve an item‐to‐total correlation of at least 0.4. Of the 7 scales, 5 achieved an internal consistency coefficient of 0.8 or greater. All scales successfully discriminated between groups even when the normal controls were eliminated because their scores were so low. Conclusions . It is possible to develop scales to assess cognitions related to types of offences which discriminate between sex offenders and other groups with intellectual disabilities. The final scales have robust statistical properties and can be used for clinical and research purposes. Some caution was noted in the use of attitudinal assessments for sex offenders.     

Treating offenders with mental illness: a research synthesis

The purpose of this research synthesis was to examine treatment effects across studies of the service providers to offenders with mental illness. Meta-analytic techniques were applied to 26 empirical studies obtained from a review of 12,154 research documents. Outcomes of interest in this review included measures of both psychiatric and criminal functioning. Although meta-analytic results are based on a small sample of available studies, results suggest interventions with offenders with mental illness effectively reduced symptoms of distress, improving offender's ability to cope with their problems, and resulted in improved behavioral markers including institutional adjustment and behavioral functioning. Furthermore, interventions specifically designed to meet the psychiatric and criminal justice needs of offenders with mental illness have shown to produce significant reductions in psychiatric and criminal recidivism. Finally, this review highlighted admission policies and treatment strategies (e.g., use of homework), which produced the most positive benefits. Results of this research synthesis are directly relevant for service providers in both criminal justice and mental health systems (e.g., psychiatric hospitals) as well as community settings by informing treatment strategies for the first time, which are based on empirical evidence. In addition, the implications of these results to policy makers tasked with the responsibility of designating services for this special needs population are highlighted.     

Empathy in sexually sadistic offenders: an experimental comparison with non-sadistic sexual offenders

Previous studies suggest that severe sexual sadism and psychopathy are phenotypically different, although both are characterized by deficits in emotional processing. We assessed empathic capacity in a sample of 12 sexual sadists in comparison with 23 non-sadistic offenders using the Multifaceted Empathy Test (MET). All participants were forensic patients under mandatory treatment orders who had committed sexual offenses. The MET is a computerized rating task that differentiates and measures cognitive and emotional components of empathy, or perspective-taking versus compassionate components. To identify the effects of possible empathy deficits caused by psychopathic traits, we controlled both samples for psychopathy as a covariate, measured by the Psychopathy Checklist-Revised (PCL-R). According to our results, sexual sadists did not differ from non-sadistic sexual offenders with regard to emotional empathy for either positive or negative stimuli. The results suggest that severe sexual sadism is a distinct, pathological sexual arousal response, not a deficit in emotional processing.     

Sexual and nonsexual offenders with intellectual and learning disabilities: a comparison of characteristics, referral patterns, and outcome

This article reports an evaluation of a community intellectual disability offender service over the period from 1990 to 2001. Men who committed sex offenses or sexually abusive incidents (n = 106) and men who committed other types of offenses and serious incidents (n = 78) are compared on personal characteristics, referral sources, forensic details, and outcome up to 7 years after referral. The cohorts are older than one would expect from the criminology literature, and, at about 33%, the incidence of mental illness is consistent with some previous studies. A greater proportion of sex offenders had criminal justice involvement and a formal disposal from court. Fire raising was not overly represented as an offense. There was a higher rate of reoffending in the nonsexual cohort, which persisted up to 7 years. Investigating only reoffenders, there was a considerable amount of harm reduction recorded up to 7 years, statistically significant up to 5 years following initial referral.     

Up the slippery slope: Groupwork with sex offenders with a learning disability

Abstract

Techniques developed for work with sex offenders are not always applicable to or appropriate for sex offenders with a learning disability due to the cognitive and social difficulties which such individuals may have. This paper describes an attempt to adapt and combine a number of psychological and art therapy techniques in group work with sex offenders with a learning disability. The aim was to identify areas relevant in sexual offending behaviour and to adapt treatment approaches for the above client group.     

Assessing crossover in a sample of sexual offenders with multiple victims

Purpose . This study examined the proportion of sexual offenders in England and Wales who exhibited ‘crossover’ in their choice of victim, as defined by age, gender and relationship to the offender. It subsequently aimed to identify criminal and demographic variables predictive of crossover. Method . The sample comprised 1,345 adult male sexual offenders. All had offended against multiple victims and had been discharged from custody in England and Wales between 1992 and 1996. Offence summaries within police records were used to collect victim details for each sexual conviction for each offender, and criminal conviction histories were obtained from the Offenders Index for the sample. Results . A quarter of the sample (24.5%, n = 330) demonstrated crossover behaviour in regard to at least one of the victim dimensions examined (i.e. age, gender or relationship). Using the risk predictor Static‐99, these offenders were found to be significantly riskier than those who did not display crossover behaviour. Multinomial regression failed to identify reliable variables predictive of crossover. Conclusions . The findings from this study are likely to represent an underestimate of the prevalence of crossover within sexual offenders in England and Wales. Reasons for this are discussed, and the implications of crossover for offender risk assessment, treatment, community supervision and policing practices are explored.     

Working positively with sexual offenders: maximizing the effectiveness of treatment

In this article, the authors draw on literatures outside sexual offending and make suggestions for working more positively and constructively with these offenders. Although the management of risk is a necessary feature of treatment, it needs to occur in conjunction with a strength-based approach. An exclusive focus on risk can lead to overly confrontational therapeutic encounters, a lack of rapport between offenders and clinicians, and fragmented and mechanistic treatment delivery. The authors suggest that the goals of sexual offender treatment should be the attainment of good lives, which is achieved by enhancing hope, increasing self-esteem, developing approach goals, and working collaboratively with the offenders. Examples are provided of how these targets may be met. When this is done within a therapeutic context where the treatment providers display empathy and warmth and are rewarding and directive, the authors suggest that treatment effects will be maximized.     

Motivational interviewing with offenders: A systematic review

Purpose. Offender motivation is one specific responsivity variable in offender treatment and motivational interviewing (MI) is commonly used by corrections personnel. Although evidence for the effectiveness of motivational interviewing is accruing overall, a review of MI specifically with offender populations is required. Method. Relevant databases and websites were searched using terms relating to MI with offenders. Results. In total, 13 published studies and 6 dissertation abstracts were identified. MI is most evaluated in relation to substance misusing offenders (N=10). Other applications are with domestic violence offenders (N=3), drink‐drivers (N=5), and general offending (N=1). In these populations, MI is used to enhance retention and engagement in treatment, improve motivation for change, and change behaviour. Conclusions. MI can lead to improved retention in treatment, enhanced motivation to change, and reduced offending, although there are variations across studies. To advance the study of MI with offenders, a theory of change needs to be articulated on which testable hypotheses may be based. The integrity of treatment in its application needs to be assured. Based on these foundations, more outcome research is needed to examine who responds to what type of MI in relation to treatment retention, readiness to change, and reconviction.     

Optimizing risk mitigation in management of sexual offenders: a structural model

Sexual violence is an insidious and pervasive problem that insinuates itself into all aspects of contemporary society. It can neither be mitigated nor adequately controlled through current socio-legal practices. A more promising approach must embrace four integrated elements: (1) public policy, (2) primary prevention, (3) statutory management, and (3) secondary intervention. In the present paper we tackle the 3rd and 4th elements by proposing an integrated model for reducing and managing sexual violence among known sex offenders. Relying on the highly effective Risk-Need-Responsivity (RNR) model as the core of our Sex Offender Risk Mitigation and Management Model (SORM³), we draw together evidence based practices from clinical interventions and risk assessment strategies. Developed by Andrews & Bonta (2006), RNR has a strong empirical track record of efficacy when applied to diverse samples of offenders, including sex offenders (Hanson, Bourgon, Helmus, & Hodgson, 2009). We offer a detailed structural model that seeks to provide a more seamless integration of risk assessment with management and discretionary decisions, including a primary focus on RNR-based post-release aftercare. We end with the mantra that sex offender treatment alone will never effectively mitigate sexual violence in society, since the problem is not confined to the handful of offenders who spend time in prison and are offered some limited exposure to treatment. Any truly effective model must go well beyond the management of those known to be violent and embrace a comprehensive and integrated approach that begins by recognizing the seeds of sexual violence sown by society. Such a public health paradigm places victims - not offenders - at the center, forcing society to come to address the full gamut of hazards that fuel sexual violence.     

Effect sizes in the treatment of sexual offenders

This article considers the benefits of sexual offender treatment in terms of the magnitude of the effect size produced by these interventions. Comparisons are made of the effect sizes with those generated by treatment of other offenders, by treatment for mental health problems, and by treatment for physical health problems. In all cases, effect sizes with sexual offenders are comparable to (and in some cases better than) effect sizes for the treatment of the other groups. As a final note, it is suggested that using a harm reduction index to estimate effect sizes for treatment with sexual offenders would produce more meaningful results.     

Developments in the assessment and treatment of sexual offenders: looking backward with a view to the future

This article provides a brief review of a number of key developments within the area of sexual offending over the past two decades. In addition, several directions for future research are discussed. The review presents information concerning several well-validated risk assessment instruments that are available. As well, some of the accumulating evidence concerning the efficacy of contemporary approaches to treatment with sex offenders is mentioned, as are theoretical developments within the field.     

Issues in the treatment of asian sexual offenders

Abstract

This aper considers the scant literature in the field of child sexual abuse in Asian families, and reports the authors' involvement with four male Asian sexual offenders. The therapeutic approach used with the offenders is described, and clinical themes arising from their treatment are identified. Issues and difficulties in therapy are discussed, in particular personal issues arising for the therapists. It is concluded that Asian sexual offenders are a group who have been neglected in the literature and in treatment, partly, perhaps, because they are infrequently referred to treatment services in comparison with non-Asian sexual offenders. Particular therapeutic issues relating to the treatment of immigrant Asians who do not speak English are raised and further research needs are identified in relation to this patient group.     

Elderly sexual offenders: two unusual cases*

The aim of this case report is to describe two cases of sexual abuse by elderly subjects for which the Judge commissioned an expert psychiatric-forensic opinion. The elderly are generally believed to commit nonviolent crimes, whereas the two cases we observed feature forcible rape committed by elderly offenders, who showed no form of mental disease and had rationally planned their offense. They had never previously committed similar acts and had no history of homosexuality; both had been married for many years before the death of their wives and had adult children. Finally, no previous episodes of rape emerged in their personal histories during interrogations. The sociocultural context in which the crimes were committed was identical and arouses interest as regards both the method employed and how the crimes were discovered. The legal authorities then commissioned accurate investigations including medicolegal and psychiatric-forensic evaluations of the offenders and their victims.     

In-prison treatment for sexual offenders in Taiwan

The present study was designed to investigate the current status of mandated treatment in prison for sexual offenders in Taiwan. The information-gathering methods were composed of two parts: questionnaires and interviews. The results showed the difficulties of mandated treatment in prison, including poor client adherence, the lack of consistent disciplines for the therapists, a standardized algorithm, and explicit laws and rules, the safety concerns of the therapists, and a shortage of staff. The development of mandated treatment in prison of sexual offenders in Taiwan is still in its early stage, and the treatment models have not yet been integrated. A cooperative and collaborative center for the mandated treatment in prison of sexual offenders and an integrated rule and treatment model should be set up in the future.     

Shame and guilt in child sexual offenders

In this article, the authors build on previous discussions of the possible role of shame and guilt in sexual offending. They review the general psychological literature on shame and guilt and conclude that the distinction between internal and external shame is an important one in considering sexual offenders. The effects of shame and guilt on victim empathy and relapse are discussed, and it is proposed that the phenomena of shame and guilt have implications for treatment beyond those identified in previous studies. Shame is a salient feature in the initial presentation of many sexual offenders against children. Furthermore, aspects of the treatment of sexual offenders can be characterized as a shift from shame toward guilt. Implications of shame and guilt for treatment of sexual offenders are described.