Volitional impairment and the sexually violent predator

This article discusses psychiatry's limited conceptualization of volitional capacity and its application to sexually violent predator laws by exploring two legal opinions critical to predator case law (Kansas v. Hendricks and Kansas v. Crane). The author reviewed pertinent psychiatric literature on impaired volition to identify potential contributions and limitations that psychiatry may offer the legal field. Assessment of the ego dystonic nature of impaired self-regulation, utilization of recent advances in self-assessment and laboratory evaluation of impulsive behavior, and dimensional categorization of a volitional capacity construct are recommended as an approach to the assessment and understanding of an inability to control concept. This paper concludes that elements of volition may be psychiatrically evaluated in a way that contributes to the Court's understanding of that capacity. However, further study is needed to operationally define volitional capacity and address issues of assessment validity and reliability.     

Mandatory reporting of sexually exploitative psychotherapists

Although there is unanimity among mental health professionals as to the unethical aspect of psychotherapist-patient sexual contact, there is disagreement as to whether subsequent treating psychotherapists should be required to report the abuse of a former therapist to a licensing agency. Such reporting may have negative effects upon the patient and upon the patient's relationship with the therapist. It may also, however, prevent further exploitation by the original abusing therapist. Three states have adopted reporting statutes designed to protect patients from this type of abuse. The current statutory enactments of California, Wisconsin, and Minnesota are compared in terms of their differing approaches to the problem.     

Normal responses to sexually anatomically detailed dolls

The behaviors and verbalizations of normal, preschool age boys and girls during interactions with sexually anatomically detailed (SAD) dolls were examined. A structured, nonsuggestive interview with each child was videotaped, and five behaviors and five verbalizations were coded for each of five phases of the interview. A two-way ANOVA (gender × phase) showed that during those phases when the dolls were undressed, both boys and girls showed more sexual exploratory play, aggressive behavior which was nonsexual, and active avoidance. Across all phases, nonsexual aggression accounted for 31% of the boys' and 22% of the girls' total responses. Behavioral and verbal sexual exploratory play represented 42% of the boys' responses and 50% of the girls' responses. In contrast, sexually aggressive behavior accounted for only 1% and 2% of the boys' and girls' responses, respectively. Girls interacted with the dolls more than did boys. Additionally, girls demonstrated more affection to the dolls than did the boys, and boys displayed more anxiety with the dolls than did girls. Investigators should be cautious as to inferences about preschoolers' interactions with SAD dolls, especially interactions of a sexual or aggressive nature which do not clearly depict fondling or intercourse.     

Psychosocial adjustment and psychopathology of men sexually abused during childhood

The purpose of this study was to evaluate psychosocial adjustment and psychopathology among men sexually abused during their childhood and arrive at a better understanding of the reasons for which, following such sexual experiences, some adult males manifest greater distress than others. In total, 64 participants were interviewed and completed eight questionnaires covering various aspects of childhood and adult life. Results suggest the existence of three types of sexual abuse scenarios. Participants in each of these three groups presented with an adult-specific adjustment. However, the methodology and multivariate analyses used in this study suggest that some of these problems were not only associated with the sexual contacts but also with other childhood experiences and with the participant's cognitive, affective, and psychological resources.     

Differences among sexually abused and nonabused youth living with HIV

Risk behaviors were compared between sexually abused and nonabused youth living with HIV (YLH). Abused YLH were significantly more likely to have attempted suicide, to have been admitted into an alcohol and/or drug treatment program, and to have engaged in crack cocaine use than were nonabused YLH and had a greater number of sexual partners. A significantly higher proportion of abused YLH had been incarcerated in contrast to nonabused youth. There were also significantly greater conduct problems among abused YLH. Finally, abused YLH had significantly higher scores on positive action and social-support coping styles than nonabused youth. Consistent with previous research, abused youth are at higher risk for a variety of negative outcomes and are also similar in many respects to sexually abused youth who are not HIV-positive. The high frequencies of two positive styles of coping among abused YLH were also observed.     

The needs and experiences of women in sexually integrated prisons

Three issues were considered in this evaluation of the usefulness of co-corrections: violence, over-management and policies about sexuality. A study of one sexually integrated prison showed that co-corrections has both advantages and disadvantages for women. Inmates and staff were included in the research. Survey and anecdotal data were collected. The strengths of co-corrections were described from the data along with some suggestions for overcoming the weaknesses.     

The use and acceptance of sexually aggressive tactics in college men

This study extended the findings of Cleveland, Koss, and Lyon's (1999) research on rape tactics to a sample of college men by examining the use and acceptance of sexually aggressive tactics. Participants included 297 male undergraduate students who filled out instruments assessing for a history of sexual aggression and other personality characteristics. In addition, a measure was created to assess acceptance of sexually aggressive tactics, the Sexual Strategies Questionnaire, and a principal components analysis indicated the presence of two components: overt and covert tactics. Although the overt and covert tactics are comparable to those found by Cleveland and colleagues, the former may provide a greater level of discrimination between general and tactical alcohol usage. Finally, a regression analysis demonstrated that a history of sexually aggressive behavior and increased hypergender ideology were found to predict acceptance of sexually aggressive tactics. Directions for future research are discussed.     

Intervention with sexually abusive young people in Australia and New Zealand

Abstract

Research into the treatment of sexual offenders with an intellectual disability has increased over the past decade. This research can be used to investigate the efficacy of treatment; however, empirical limitations of the research make generalizations difficult. Marques has provided a framework for examining treatment efficacy that emphasizes the contribution of researchers and clinicians to report treatment outcomes rather than a strict reliance on rigorous empirical investigations, such as controlled outcome research. This review uses Marques’ framework to present an overview about group treatment for sexual offenders with an intellectual disability using nine identified studies. This paper attempts to consolidate our knowledge about specific treatment issues, while demonstrating the varied outcomes that are reported in the literature. In employing this framework, the literature suggests that our knowledge can be substantially improved by research addressing specific areas of treatment.     

Consulting to residential programmes for sexually aggressive delinquents

Abstract

Delinquent adolescent boys, especially those looked after in residential settings, often have a long history of coercive antisocial behaviour. Many have a history of aggression and violence, including serious sexual offences such as rape and indecent assault. In light of the Criminal Justice Act 1991 the residential care sector will come under more pressure to accommodate sexually aggressive recidivistic delinquents. However, few staff who work in residential settings with delinquents have received training in the management and treatment of sexually aggressive behaviour. Time spent in residential care settings may therefore do little to reduce the risk of sexual aggression. This paper proposes that the assessment and management of risk is central to the effective rehabilitation of this group of young people. Based on work carried out at Glenthorne Centre a risk assessment strategy is presented consisting of several different strands: an analysis of organisational decision-making; identification of sources and types of information to inform decisions; the development and implementation of a risk assessment protocol; and staff training. A case example is used to illustrate the use of the protocol at Glenthorne.     

Paradoxical and double-bind communication in treatment for people who sexually offend

Abstract

At its most fundamental structural level, treatment for people who sexually offend has inherently paradoxical elements. These involve questions about efficacy, the balance of community safety and client autonomy and responsibility for meaningful change. These elements can create further forms of paradoxical and double-bind communication within the treatment experience itself. This paper explores this communication and its potentially harmful effects on clients, therapy and community safety, particularly in light of the schemas, implicit theories and cognitive deficits exhibited by people with histories of sexually offending behaviour. It is intended to suggest topics for consideration in solving clinical dilemmas and preventing harm to therapeutic relationships.     

Medical examination of sexually abused children: medico-legal value

The Department of Forensic Medicine (forensic pathology and clinical forensic medicine), Aarhus, Jutland, Denmark, performs examinations of children suspected to have been sexually abused when reported to and requested by the police in Jutland, Denmark. Jutland covers an area of 210,000 km2 with about 300,000 inhabitants in Aarhus. A colposcope initially equipped with an Olympus camera, but now with a video camera attached has been used since 1994. Since 1994 the department has performed more than 100 examinations of children suspected of having been sexually abused. A preliminary study was taken to evaluate all cases from 1995 including the legal outcome. RESULTS: The material included 34 cases with three boys, mean age 11 years, and 31 girls, mean age 8 years, at the time of the examination. The sexual abuse events were fondling including penetration of the vagina, vaginal (14), anal (7), and oral (5) intercourse as well as cunnilingus and nontouching abuses. The medical examination was most often performed more than a week after the abuse. The examination revealed normal findings in 23 cases, nonspecific findings including erytherma in 13 cases, and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of ane and were family members or someone known to the child. Nine perpetrators were convicted at court, of whom three admitted having abused the child. CONCLUSION: A medical examination in cases of sexual child abuse seldom provides a legal proof of sexual abuse. The most important is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.     

Young people who sexually abuse: the Scottish context

This paper describes the policy and legal context in Scotland in respect of alleged young sexual abusers and considers the challenges encountered by decision-makers, particularly reporters operating in the Scottish children's hearings system. These include the nature of the problem, resources, child witnesses and corroboration. It is argued that reporters, in considering whether or not to refer an alleged young sexual abuser to a children's hearing or to take no action, encounter influences in both directions, but on balance there appear to be more obstacles in the way of a referral to a hearing.     

Medical confidentiality and partner notification in cases of sexually transmissible infections in belgium

Research has shown that HIV-positive patients sometimes refuse to take precautionary measures against sexual transmission as well as to notify their sexual partner(s) of their status. Faced with such a situation, physicians find themselves in a dilemma as they are forced to choose between honouring their duty of professional confidentiality and protecting their patients' partner(s). Recent advice from the Belgian Medical Council (BMC) for the first time accepts that physicians can exceptionally, and under certain conditions, invoke necessity to breach confidentiality and inform usual and occasional sexual partners of HIV-infected patients who refuse to take precautions against transmission. This article sketches the ethical evolution of this position from 1987 up to now in Belgium, and examines whether or not the BMC's opinion on the matter corresponds to the applicable substantive criminal law provisions and whether or not partner notification could also be defended for other sexually transmissible infections (STIs). A case study of the situation in Belgium illustrates how discussions about STIs can deeply influence the evolution of legal and ethical rules about medical confidentiality.     

The stop and think group: Changing sexually aggressive behaviour in young children

Abstract

Until recently, relatively little attention has been paid to young children who are sexually aggressive to other children. In this paper, cognitive-behavioural group techniques which have been used in the treatment of aggressive, impulsive behaviour in young children were applied in a small group setting to the sexually aggressive behaviour of pre-pubescent boys. The boys initially learned a ‘Stop and Think” model for general interpersonal problem-solving, which was then used to work on their difficulties with verbal and physical sexual aggression. Observation of the children's behaviour, reports from carers, school staff and social workers indicated that the group programme increased the children's ability to inhibit impulsive, aggressive behaviour. In the nine months after the group finished there were no known incidents of sexual aggression. In the context of certain limitations discussed in the paper, this positive outcome suggests that these methods have potential for reducing the likelihood of sexually aggressive behaviour becoming habitual.     

Differences in trauma symptoms and family functioning in intra-and extrafamilial sexually abused adolescents

This study investigated to what extent abuse-related symptoms and family functioning are related to intra- or extrafamilial sexual abuse. One hundred adolescents (12 to 18 years old) were recruited shortly after disclosure of the abuse. Information from the participants was obtained through self-report questionnaires and a semistructured interview. Fifty-three percent of the adolescents reported clinically significant symptoms. Data did not support the idea that intrafamilial sexually abused adolescents report more symptoms than extrafamilial sexually abused adolescents. Type of abuse did not account for the differences and variety of reported symptoms or for differences in family functioning. Family functioning-in particular, lack of cohesion- was an independent contributor to internalizing trauma-related problems.