Using context and difference in sex offender treatment: An integrated systemic approach

Summary

The primary objective of this paper is to promote a re-examination of the current use of cognitive-behavioural programmes in work with men who have sexually offended against children or adults and to encourage the application of ideas from the systemic field. In order to support this objective, the paper puts forward and develops the following arguments:

1. That the current content of manualised programmes in this field has been distilled too far and left behind some of the most important principles of the cognitive approach. Returning to the work of Marshall et al (1999), the need for a thorough and broad-based assessment of each individual prior to deciding treatment goals is clearly recommended. Further, there is a need to pay much more attention to differences between, as well as similarities of those who sexually offend.

2. That ideas from within the systemic therapeutic field be integrated within existing approaches to attempt to address some of the limitations of cognitive-behaviour therapy as currently employed. Evidence for the potential benefits of this comes from a broad personal experience of working directly with offenders and consulting to group facilitators.

It is concluded that all therapeutic approaches reach a ‘moment of integration’ (Pinsof, 1994), when their failures are recognised and other approaches are drawn on. It is suggested that this moment may be upon us in this area.     

Sex offender treatment is not punishment

Abstract

The treatment of sexual offenders can be fraught with ethical dilemmas. Practitioners must balance the therapeutic needs of sex offender clients alongside the risks they might pose to others. These ethical challenges include balancing community safety with the rights of the offender, the privileged therapeutic relationship and the potential for coerced treatment. In this paper, we respond to Glaser's argument that treatment is punishment and that sex offender treatment providers breach ethical codes by violating confidentiality, engaging in coercion, and ultimately causing harm to clients. We first consider whether sex offender treatment is indeed punishment. We argue that it is not, and that mandated treatment can and should be conducted in a fashion consistent with professional codes of ethics familiar to mental health providers. We then discuss the human rights model, which we agree is an essential lens through which to view the psychological treatment of sexual offenders. We attempt, as have other scholars, to illustrate the ways in which human rights principles intersect with traditional mental health codes of ethics particularly in the case of sex offender treatment. We conclude that sex offender treatment can be conducted ethically, that treatment differs from punishment in clear and distinct ways, and that ethical treatment conforms to a human rights perspective.     

Reflections on the development of the nota policy ‘working with adults and adolescents who exhibit sexually abusive behaviours: The use of sexually salient and pornographic materials’

Abstract

In 1994 the Policy and Ethics Sub-Committee of The National Association for the Development of Work with Sex Offenders developed and published a policy on the use of ‘sexually salient and pornographic’ materials in working with adults and adolescents who exhibited sexually abusive behaviours. Here, Alix Brown, one of the originators of this policy, reflects on the reasons it was brought into being and its relevance to sex offender treatment now. The policy document follows this article.     

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.     

Intimate sexual violence in the United States: Social work and family therapy interventions

Abstract

This article defines what is meant by intimate sexual violence and provides a brief historical context to this phenomenon. The incidence and impact of intimate sexual violence are clarified and discussed, as are the various factors contributing to this abusive behaviour. Current literature on intimate sexual violence in the United States is reviewed and differing approaches to responding to incidents of intimate sexual violence are identified as they might inform assessment and treatment options.

Taking intimate sexual violence seriously has implications for contraceptive counselling, abortion counselling, mental health counselling and family therapy. The article aims to inform practitioners of the essential issues surrounding intimate sexual violence, so that whenever intimate sexual violence is suspected, the social worker or family therapist can assess and intervene in a responsive and effective manner.     

Developing a therapeutic environment for boys in secure settings who have sexually offended

Abstract

The role of secure units in helping sexually abusive adolescent boys to change their behaviour and attitudes is examined. The problems presented by 23 adolescent sex offenders at Glenthorne Youth Treatment Centre were used to identify issues for management and treatment. These boys had committed a variety of non-sexual offences, and were responsible for 691 recorded crimes. Many had committed violent offences and had emotional, educational, relationship and substance-abuse problems. In contrast to the situation in community settings, the use of offence-focused groupwork and individual psychological therapy is limited in secure units. Many of these boys are not suited to this kind of work, or are not yet ready to benefit from it. Secure units also have difficulty resourcing these types of intervention. Nevertheless, the secure unit environment can be organised and structured to effect changes in behaviours and attitudes associated with sexual offending. Attention should be given to particular aspects of residential practice, including anti-discriminatory practice, organisational values, establishing behavioural boundaries, challenging unacceptable behaviour and language, reinforcing appropriate behaviour, encouraging interpersonal problem-solving, providing effective supervision based on an evaluation of risk, and education to raise victim awareness and respect for others. Liaison with community programmes for sexually abusive adolescents should be encouraged.     

A case study of a male sex offender with zoosexual interests and behaviours

Abstract

This paper reviews assessment, treatment and supervision issues in relation to a high-risk, borderline functioning, male sex offender with zoosexual interests and behaviours. Mr Z was convicted of multiple sexual offences including rape, indecent assault and indecent exposure as well as actual and threatened bodily harm. He was convicted for two counts of attempted buggery of horses and he received a Probation Order to engage in group and individual work, as deemed appropriate. Significant treatment challenges emerged due to his cognitive/intellectual difficulties, coping problems (including anger management issues) and dissimulation. Further, continuing evidence of high-risk behaviours associated with his index offence as well as previously identified patterns of offending were reported. Ongoing concerns prompted a referral for a polygraph examination to gain additional information about Mr Z's offence history and to achieve a better understanding of his treatment needs. These findings are discussed and specific attention is focused on Mr Z's zoosexual behaviours.     

2012年法医临床学研究进展

本文以中国知网为网络搜索平台,综述了2012年法医临床学研究领域的最新进展,主要包括伤残鉴定、损伤程度鉴定和医疗纠纷鉴定等。上述内容代表了法医临床学研究领域的最高研究水平。     

我国精神障碍者非自愿医疗的法律透视——以精神卫生法的出台为背景

随着精神卫生法的颁布,我国非自愿医疗法律制度初步建立,为良莠不齐的地方性立法提供了统一的依据,平等地保护了精神障碍者的合法权益。但该法律制度仍存在法律原则中缺乏明确的无病推定规定、非自愿医疗的分类标准单一、"去行政化"理念未能贯彻到位、精神障碍者与监护人利益冲突悬而未决、非自愿医疗的程序规范力度不够、精神卫生法与刑事诉讼法衔接不畅等诸多问题。为妥善解决这些问题,需要在人文主义的价值理念指引下进行完善,应当依据是否触犯刑法分类处理、畅通非自愿医疗的司法救济渠道、加强监护制度与非自愿医疗制度的耦合、细化非自愿医疗的出入院程序、强化无利益关系第三方的监督机制。     

论自愿戒毒:法规范、定位与制度创新

《戒毒条例》将自愿戒毒单独列为一章,使其成为我国的一项基本戒毒制度。但关于自愿戒毒,《戒毒条例》并不是简单地对《禁毒法》的相应规定进行细化,而是存在着严重的规范并用和冲突现象。只有对我国自愿戒毒的法律定位予以科学把握,才能发现和解决其在制度设计的相应问题。要从自愿戒毒的基本立场,即保护戒毒者的权利出发,推动我国自愿戒毒工作的开展,就必须进行相应的制度创新。一是将自愿戒毒作为首选性戒毒制度;二是加强戒毒医疗机构建设;三是推进戒毒药物维持治疗。