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Sexual Offenders: What you need to know, and why

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1 Sexual Offenders: What you need to know, and why
Red River Children's Advocacy Conference Fargo, North Dakota May 10, 2012 Stacey Benson, Psy.D., L.P.

2 An Overview of the Day 6. Types of Sexual Crimes
1. Prevalence of Legal Sexual Compulsive Behavior 2. Types of Legal Sexual Compulsive Behavior 3. Assessment of Legal Compulsive Sexual Behavior 4. Treatment of Legal Compulsive Sexual Behavior 5. Prevalence of Sexual Crimes 6. Types of Sexual Crimes Hands On Hands Off 7. Types of Sexual Offenders Adolescent Adult 8. Assessment of Sexual Offenders Juveniles Adults 9. Treatment of Sexual Offenders

3 Prevalence of Legal Sexual Compulsive Behavior
According to the Internet Filter Review site, 40 million Americans visit Internet porn sites at least once a month (Maltz, 2008). Currently, over 60 percent of all visits on the Internet involve a sexual purpose (Schneider and Weiss, 2010).

4 Prevalence of Legal Sexual Compulsive Behavior
A record breaking 25% of employees in the United States are accessing porn at work, according to a 2008 Nielsen Online survey (Maltz, 2008).

5 Prevalence of Legal Sexual Compulsive Behavior
There are 100,000 Web sites dedicated to selling sex in some way-not including chat rooms, s, or other forms of sexual contact on the web (Cybersex Unhooked, 2007).

6 Prevalence of Legal Sexual Compulsive Behavior
In the United States, twenty million “adult” magazines are sold each month.

7 Prevalence of Legal Sexual Compulsive Behavior
The numbers of paid subscribers for selected pornography magazines are (The National Research Bureau, 1992): Penthouse – 4,600,000 Playboy – 3,600,000 Hustler – 1,200,000 Gallery – 500,000 Oui – 395,000 Chic – 90,000

8 Prevalence of Legal Sexual Compulsive Behavior
Nearly all college men and women have looked at an explicit magazine, such as Playboy or Playgirl by the time they leave high school and 85%-90% have done so in junior high school. The average college male spends about six hours a month looking at sexually explicit material and the average college female about two hours.

9 Prevalence of Legal Sexual Compulsive Behavior
December 2005: there were 63.5 million unique visitors to adult websites. As of 2006: 87% of university students polled engaged in virtual sex. Mobile porn revenue is over $1 billion. At the end of 2004, there were 420 million pages of pornography. Adults admitting to internet compulsion=10%.

10 Prevalence of Legal Sexual Compulsive Behavior
The vast majority of all the respondents reported exposure to hard-core, X-rated, sexually explicit material . Furthermore, “a larger proportion of high school students had seen X-rated films than any other age group, including adults”: 84%, with the average age of first exposure being 16 years, 11 months .

11 Prevalence of Legal Sexual Compulsive Behavior
33% of the boys versus only 2% of the girls reported watching pornography once a month or more often. As well, 29% of the boys versus 1% of the girls reported that pornography was the source that had provided them with the most useful information about sex (i.e., more than parents, school, friends, etc.).

12 Prevalence of Legal Sexual Compulsive Behavior
In an anonymous survey of 247 Canadian junior high school students whose average age was 14 years, James Check and Kristin Maxwell (1992) report that 87% of the boys and 61% of the girls said they had viewed video-pornography. The average age at first exposure was just under 12 years.

13 Prevalence of Legal Sexual Compulsive Behavior
34% of kids reported exposure to unwanted sexual material while surfing the internet. 1 in 7 report unwanted solicitation as compared to 1 in 5 in 2000. 92% of teens downloaded music online.

14 Prevalence of Legal Sexual Compulsive Behavior
Pornography has become a substantial part of the United States’ economy . No matter it’s means of access, pornography produced annual revenues in excess of $13 billion dollars in the United States. Worldwide it produced $100 billion.

15 2006 World Wide Pornography Revenue

16 Pornography’s Effects
Evidence shows that as many as one in three rapists and child molesters use pornography to become sexually aroused immediately proceeding and during the commission of their crimes (Marshall, 1989). And other studies report that 56% of rapists and 42% of child molesters reported that pornography was somehow implicated in their offense (Able, 1985).

17 Pornography’s Effects
Persons reporting exposure to pornography are 28% more likely to engage in sexually deviant behavior (such as exhibitionism or voyeurism) than the general population. Risk of engaging in sexual perpetration - that is, sexually hostile or violent behavior - was found to increase by between 21 and 30% for persons exposed to pornography.

18 Prevalence of Legal Sexual Compulsive Behavior
It is estimated that about 15 % of people in the United States using the internet for sexual purposes DO have problems with their cybersex activities (Cohn, 2010). Approximately 6% or about 9 million of these users could be classified as “sexually addicted”, and another 10% or about 15 million are using cybersex in ways that are risky and showing signs of compulsivity.

19 So, does everyone become “addicted”?
No  Research shows that the majority of people who use the internet for sexual purposes are recreational users   “Most people can use the internet (including for sexual purposes) without being obsessed and compulsive, managing their use with little difficulty while continuing to maintain a reasonably balanced life and without negative consequences” (Cohn, 2010).  Think of these people like your “social drinkers”

20 The Progression When I talk to college students, I use the analogy of drinking to help describe the problem. Some people can be social drinkers, some people can not.

21 A word on calling it “Sexual Addiction”

22 Having Said That…… Using pornography Having affairs Sexual texting
Posting on Craig's List Etc These are Choices!!! Do not let clients or their partners excuse their behavior by calling it an “addiction”. If they chose to conceptualize the behavior from an addiction model, that can be helpful for many clients, but watch for “Its not my fault, I’m addicted” statements. It is different from alcohol and drug addiction. It shares features, but it is different

23 Assessment of Legal Compulsive Sexual Behavior

24 The Power of Cybersex: The “Cyber-Hex”
The internet has six attributes- “the Cyber-Hex”- that make it unique among all other media (Delmonico et al, 2007) These attributes make it extremely alluring for someone seeking sexual arousal and fulfillment The 6 attributes: Intoxicating Isolating Integral Inexpensive Imposing Interactive (Delmonico et al, 2007)


26 Assessment of Legal Compulsive Sexual Behavior
Extensive Questionnaire Detailed Clinical Interview Assessment instruments such as the ISST-R and others Collateral information from the spouses

27 Questions To Ask Clients
Questions that should be asked to help increase client’s awareness in order for them to evaluate their involvement with porn Is porn increasing or decreasing your self esteem and integrity? Is it upsetting or alienating your intimate partner (or harming your future chances of being in a healthy relationship)? Have you become preoccupied, out of control, dependent on, or compulsively engaging with porn? How is porn shaping your sexual thoughts, desires, and behaviors? What negative consequences could occur if you continue to use porn? (Maltz, 2008)

28 Questions To Ask Clients
How many hours a week are you on the internet in sex related pursuits? Have you accessed porn at work? Have you made attempts to control it in the past? Were they successful? Do you belong to any pay sites? How much per month do you spend? Have you ever met someone in person you met on line? Do you have a webcam? Have you engaged in cyber sex?

29 Questions To Ask Clients
Have other obligations (marital, financial, parenting, spiritual, community, job) taken a back seat to your porn use? Have you found yourself accessing more and more “unusual” sites? Do you get anxious or irritable if something interrupts your ability to go on line? Has it impacted your real life sexual life with your real life partner? What is the longest you have been on in one sitting? What is the latest you have been up on line?

30 Questions To Ask Clients
Do you use pornography as a reward after a good day? Or a pick me up after a bad day? Have you engaged in riskier behavior now than in the past? Do you hide your Internet Porn use from others? Do you think you have a problem? Do you want to stop? If your wife/partner did not find out and insist you get into treatment, would you be here? If she leaves you, will you terminate treatment?

31 Types of Online Users Recreational Users Sexually Compulsive At-Risk

32 10 Criteria for Problematic Online Sexual Behavior
1. Preoccupation with sex on the internet 2. Engaging in sex on the internet more often or for longer periods of time than intended 3. Repeated unsuccessful efforts to control, cut back on, or stop engaging in sex on the internet 4. Restlessness or irritability when attempting to limit or stop engaging in sex on the Internet 5. Using sex on the Internet as a way of escaping from problems or relieving feelings such as helplessness, guilt, anxiety, or depression

33 10 Criteria for Problematic Online Sexual Behavior
6. Returning to sex on the Internet day after day in search of a more intense or higher-risk sexual experience 7. Lying to family members, therapists, or others to conceal involvement with sex on the Internet 8. Committing illegal sexual acts online (for example, sending or downloading child pornography or soliciting illegal sex acts online) 9. Jeopardizing or losing a significant relationship, job or educational or career opportunity because of online sexual behavior 10. Incurring significant financial consequences (Delmonico et al, 2007)

34 General Recommendations
You should ask questions about sexual compulsive behavior of all new clients, regardless of their presenting problem. Its not unusual for clients to present with issues of “anger” or “relationship issues” only to tell you 45 minutes in that they have a problem with internet pornography. Try to avoid reacting with shock or disgust as they relay to you the extent of their sexual experiences. They have entrusted you with their secret shame, treat it with the respect it deserves. Do a thorough assessment of their compulsive sexual behavior. Refer when needed.

35 Treatment of Legal Sexually Compulsive Behavior

36 Treatment of Legal Sexually Compulsive Behavior
Stage 1: Precontemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Taking Action Stage 5: Maintenance Stage 6: Relapse (Delmonico et al, 2007)

37 Stages of Preparing for Change

38 Initial Suggestions for Clients:
Find a professional with experience in this area. Calculate how much your Compulsive Sexual Behavior has cost you. Change passwords to something that will be motivating. Net Nanny. Reestablish contact with positive support people. Involve family and friends in your recovery. Reestablish contact with your faith community. Find a 12 step support group. Encourage marital therapy or supportive therapy for the partner Make a commitment to change-once an “addict” you can not go back to being a “social drinker.” The person must stop all compulsive sexual behavior.

39 What were they thinking? What time of day is it?
The Next Step Clients are encouraged to keep an Internet Log, and note the antecedents to their behavior. What were they doing? What were they feeling? What were they thinking? What time of day is it?

40 Antecedents Does any kind of predictable pattern emerge?
Are there any environmental manipulations we can do based on these patterns? Can we identify risky: Feelings Thoughts Behaviors Times of day

41 HHALT Hungry Horny Angry Lonely Tired

42 Recovery Strategies Recognize what you’re missing.
Make a full assessment of the things you’ve cut down on, or cut out of your life because of your addiction to the Internet. Assess your online time. Use time management techniques. Find support in the real world. Recognize your addictive triggers. Carry positive reminder cards. Take concrete steps to address problems. Listen to the voices of denial. Confront your loneliness. (Young, 1998)

43 Treatment for Legal Sexual Compulsive Behavior
Talk about self control High Risk Situations Self control Seemingly Unimportant Decisions Problem of Immediate Gratification Abstinence Violation Effect (might as well keep doing it) Thinking Errors/Cognitive Distortions

44 Treatment for Legal Sexual Compulsive Behavior
Cognitive and Behavioral Interventions (CI’s and BI’s) Identify the true costs Understand the Cycle Make a commitment

45 Prevalence of Sexual Crimes

46 Prevalence of Sexual Offending
NCMAC reports a significant and steady increase in child pornography for the 7th year in a row as of 2005 It is estimated that there are 20,000 new child porn images online each week Child pornography has become a $3 billion annual industry They are getting younger, the abuse is more serious in nature and many of the venues appear to be domestic in nature

47 Prevalence of Sexual Offending
There were an estimated 88,097 forcible rapes reported to law enforcement in 2009 (AARDVARC) The rate of forcible rapes in 2009 was estimated at 56.6 per 100,000 female inhabitants, a 3.4 percent decrease when compared with the 2008 estimated rate of (AARDVARC) Rapes by force comprised 93.0 percent of reported rape offenses in 2009, and attempts or assaults to commit rape accounted for 7.0 percent of reported rapes. (AARDVARC) In 2006 ND had 193 forcible rape cases, ranking us 48th in the Nation (Bureau of Justice Statistics). In 2002 ND had 222 forcible rape cases. (Attorney General Crime Report)

48 Prevalence of Sexual Offending
1 in 4 girls is sexually abused before the age of 14. Source: Hopper, J. (1998). Child Sexual Abuse: Statistics, Research, Resources. Boston, MA Boston University School of Medicine. 1 in 6 boys is sexually abused before the age of 16. More than 90% of all sexual abuse victims know their perpetrator. Almost 50% of the offenders are household members and 38% are already acquaintances of the victims. Source: US Department of Justice. (1997) and Finkelhor and Ormond. (2001).

49 Prevalence of Sexual Offending
21.6% of women who reported being raped during their lifetime were under age 12 at the time of their first rape. 32.4% of these women were years of age. Therefore, over half of all female rape victim/survivors surveyed in this study were under the age of 18 at the time of their first rape. Source: Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey, (NCJRS) 2000 ( pdf)

50 Prevalence of Sexual Offending
Persons under 18 years of age account for 67% of all sexual assault victimizations reported to law enforcement agencies. Children under 12 years old account for 34% of those cases and children under six years account for 14% of those cases Source: Snyder, Howard. “Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics.” Bureau of Justice Statistics, U.S. Department of Justice, 2000.

51 Prevalence of Sexual Offending
According to the U.S. Department of Justice, victims of rape and sexual assault report that in nearly 3 out of 4 incidents, the offender was not a stranger. Based on police-recorded incident data, in 90% of the rapes of children younger than 12, the child knew the offender. Source: Greenfield, et al, Sex Offenses and Offenders: An Analysis of Data Rape and Sexual Assault. United States Department of Justice.

52 Prevalence of Sexual Offending
2/3rds of babies born to teenage mothers were fathered by adult men, not same age male peers. Source: The Alan Guttmacher Institute, 1996 Based on a California Study

53 Prevalence of Sexual Offending
Women reported that offenses against them were committed by: Strangers: 28% Intimates/Partners: 10% Relatives: 2% Friends/acquaintences: 57% Unknown: 3% Men reported that offenses against them were committed by: Strangers: 48% Friends/acquaintences: 52% Source: AARDVARC

54 Prevalence of Sexual Offending
The statistical victim of sexual assault is white, female, and under 18 years of age. The typical offender is white, male, and over 18 years of age. 1.8 rapes or sexual assaults are REPORTED by women for each 1,000 over age 12. (That's about 248,000 per year.) .3 rapes or sexual assaults are REPORTED by men for each 1,000 over age 12. (That's about 32,000 per year.) Women reported that offenses against them were committed by: Source AARDVARC

55 Types of Sexual Crimes

56 Types of Sexual Crimes Sexual assault Rape Molestation Forcible sodomy
Hands On Hands Off Sexual assault Rape Molestation Forcible sodomy Sexual touching Exhibitionism Possessing illicit pornography Obscene telephone calls Voyeurism Sexual harassment

57 Sexual Paraphilias Exhibitionism Obscene Phone Calls Voyeurism
Frotteurism Fetishism Transvestism Sexual Masochism Hypoxyphilia Sexual Sadism Necrophilia Zoophilia Coprophilia and Urophilia Pedophilia Mysophilia

58 Online Solicitation Offenders
According to a 2011 study by Seto, Babchishin, Wood, and Flynn, men convicted of internet solicitation offenses had some significant differences from child pornography offenders . Lower capacity for relationship stability Lower sex drive/preoccupation Less deviant sexual preferences They were also different from lower risk contact sexual offenders. Higher sex drive/preoccupation Greater self-reported use of child pornography

59 What comes to mind when you think about sex offenders?
Who are sex offenders? What comes to mind when you think about sex offenders?

60 Juveniles comprise 25.8% of all sexual offenses
In Fact Juveniles comprise 25.8% of all sexual offenses

61 Also Of all sex offenses committed against juvenile victims, 35.6% are committed by juveniles.

62 Age and Sex of Juveniles Who Offend
The rate of sexual offense behavior rises sharply at the age of 12, and plateaus after age 14. The vast majority of juveniles who sexually offend are male (93%). Females who offend tend to be younger, have more victims, offend alongside peers more, have more male victims, and have more victims that are family members.

63 But! According to the U.S. Department of Justice, National Report Series from December 2011 “Contrary to the popular perception that juvenile crime is on the rise, the data reported in this bulletin tell a different story. As detailed in these pages, juvenile arrests for violent offenses declined 10% between 2008 and 2009, and overall juvenile arrests fell 9% during that same period. Between 1994—when the Violent Crime Index arrest rates for juveniles hit a historic high—and 2009, the rate fell nearly 50% to its lowest level since at least Arrest rates for nearly every offense category for both male and female and white and minority youth were down in 2009.”

64 Proportions of Crimes Committed By Youth (Most Serious Offense)

65 Additional Data The juvenile arrest rate for forcible rape in 2009 was half its 1991 peak. The 2009 rape arrest rate was at its lowest level in three decades. Juveniles accounted for 15% of all forcible rape arrests reported in 2009. More than two-thirds (68%) of these juvenile arrests involved youth ages 15–17. Not surprisingly, males accounted for the overwhelming majority (98%) of juvenile arrests for forcible rape.

66 Additional Data Also in 2009, there were 13,400 juvenile arrests for sex offenses other than those related to prostitution. 48% were under age 15. This is down 28% from 2000, and 10% below 2008.

67 Not all children or adolescents who sexually harm have been sexually abused. Many acted out after viewing sexual content on the Internet. Especially the younger children. They may act out the confusing images they have seen on the computer as a way to discharge their anxiety. Below 12-more of an adrenaline rush Beyond 12-more of a hormonal rush

68 Normal Sexual Behavior in younger children
Sexual play with children they know (playing doctor) Interested in sexual content in movies, tv, internet Interested in touching own genitalia Curious about sex Wants privacy when dressing Easily redirected if told “no” Intermittent sexual play that includes consent, and with youth of similar age and size, whom they know well

69 Less Common sexual behavior
Sexual contact beyond touching or looking (penetration, oral) Talks openly about sexual matters Asks for sexual contact Engages in sexual contact with someone they do not know well Chosen over other activities Is aggressive, forced or coerced Occurs with children smaller, younger or otherwise more vulnerable Does not respond to being told no

70 Kids Are Different! It is critical to understand that juveniles are VERY different from adults with regard to sexual offense behavior! The research shows that juveniles tend to offend at MUCH LOWER RATES compared to their adult counterparts, especially if treated. After treatment, children with sexual behavior problems have been found to be at no greater risk for future sex offenses as other clinic children (2% to 3%). This is a case for avoiding referring to a minor as a “sex offender.” They may never offend again, and thus it may not be appropriate for them to be thought of as a “sex offender.” Additionally, research has pointed to the adverse effects of this stigmatizing label for teens.

71 Other Differences Juveniles are more likely to offend in groups than adults (24% as opposed to 14%). They are more likely to have a male victim (25% versus 13%). They are less likely to offend at home (69% versus 80%) and more likely to offend at school (12% versus 2%).

72 Type of Sex Offense by Age Category
Juveniles’ most serious offense is less likely to be rape, and is more likely to be sodomy or fondling.

73 Additional Demographics
Juvenile’s who sexually harm are typically between the ages of 13 and 17. They are generally male. 30-60% exhibit learning disabilities and academic dysfunction. Up to 80% have a diagnosable psychiatric disorder. Many have difficulties with impulse control and judgment. 20-50% have histories of physical abuse. 40-80% have histories of sexual abuse. 80-90% will NOT sexually reoffend in adulthood.

74 Technology’s Recent Role
Most of today’s youth have access to the Internet at home, school, friends’ homes, or their cell phones. Many use text and picture messaging services via cell phones. These services have made everything more convenient

75 . . . .Including Risky Behavior
Regarding COMPUTERS: Between 40% and 60% of teens report they do not tell their parents what they do online. Between 15% and 20% of teens admit to meeting someone offline they did not previously know. 60% of adolescents report giving personal information to an acquaintance online. The average age of first online pornography exposure is eleven.

76 Computers, Continued One of every five children report being sexually solicited on the internet.

77 Risky Behavior, Continued
Regarding PHONES: Sexting is prevalent, with 40% of youth saying they have friends who carry out such a practice. Among teens aged 12 to 17, 4% have sent sexually provocative images of themselves to someone else via text message, and 15% have received such a message. Rates are higher for older adolescents than this general statistic.

78 Phones, Continued Over half (56%) of teenagers are aware of instances where images and videos were distributed further than the intended recipient. 30% of youth know people who were adversely affected by sexting. Only 24% of teens would turn to a teacher if they were affected by issues related to sexting.

79 Technology and Juvenile Sexual Offenses
Why do all those statistics about teen computer and phone use matter to our discussion of juveniles who sexually offend? Redistribution of a sexually explicit picture message is a sexual offense. Adolescents with sexual offense behaviors have often engaged in the exchange of s, text messages, and picture messages with sexual content. Youth are especially prone to become victims of crimes based on technological resources. Often, teen behavior online and via cell phone is less restricted than forms of “real life” behavior.

80 Alternative Views Not all research has yielded similar results.
Two studies from the University of New Hampshire Crimes against Children Research Center suggest that concerns about teen sexting may be overblown. One study found the percentage of youth who send nude pictures of themselves that would qualify as child pornography is very low. 2.5 percent of youth surveyed have participated in sexting in the past year, but only 1 percent involved images that potentially violate child pornography laws (naked breasts, genitals or bottoms). The other found that when teen sexting images do come to police attention, few youth are being arrested or treated like sex offenders. Researchers discovered that in most police-investigated sexting cases, no juvenile arrest occurred. Standard cases: 18% arrested. With aggravating factors: 36% arrested.

81 Recent Legislation North Dakota:
As of April 24, 2009, it is a Class A misdemeanor for a person to knowingly surreptitiously create or possess a surreptitiously created nude/nearly nude image without written consent from everybody in the image. It is a Class A misdemeanor to distribute such an image to harm or humiliate the image subject. It is a Class B misdemeanor to acquire and distribute any sexually expressive image without the consent of the image subject. Minnesota: No new legislation pertinent to juvenile sexting is known at this time. Note: Many more state laws apply to adults engaging in sexting practices.

82 Assessment of Sexual Offenders

83 Assessment of Sexual Offenders
Adults Juveniles MnSOST-R MnSOST-III Static 99R SVR-20 PCL-R Risk Matrix 2000 Stable 2007 SRA-FV PPG AASI-II ERASOR JSOAP SAVRY MEGA

84 What is a Risk Assessment?
A Risk Assessment is a comprehensive evaluation to determination a particular sex offender’s likelihood to commit a subsequent sex crime, and a determination of their likelihood to benefit from treatment

85 Predicting Who Will Reoffend - before 1996
Clinical judgment Testing “The Jerk” factor Correlated 0.10 with sexual recidivism 60% of all child molesters have no comorbid pathology

86 1996 brought changes… Civil Commitment Meghan’s Law
Psychologists started looking for some research to back up our claims

87 Problematic Issues When Assessing Base Rates for Sexual Reoffense
Sexual assaults are underreported. Problems in defining recidivism. How do you find out if the offender actually reoffended? How long should they be followed? Recidivism rates are different for different types of offenders.

88 Base Rates for Different Types of Offenders
Intra familial offenders 10-20% (Barbaree & Marshall, 1998, Gibbens, Soothil & Way, 1995, Gorden & Bergen, 1988, Dondis, 1965, Hanson, Steffy & Gauthieir, 1993) Extra familial child offenders over 50% (Prentky et all in press) Rapists 39% (Prentky, Lee, Knight & Cerece in press)

89 Predicting Who Will Reoffend - After 1996
Predictions are now based on characteristics of sexual offenders that have been shown to predict the likelihood of a future sex crime-using actuarial instruments

90 The Process Pre-interview regarding confidentiality and the limits there of, purpose of testing, who will see it, procedure for the evaluation etc. MnSOST-R MnSOST-III Static 99R Stable 2007 SRA: FV Background questionnaire MMPI-2 MCMI-III (?) Shipley SAI MSI ABEL screen (?)

91 The Process Review every document you can find-there is no such thing as a record that is “too old”, often old records can contain very important information that brings new light to the case, and how long such behavior has been going on. Dictate background information, questionnaire information, police records and testing results and do a preliminary score of the actuarial instruments

92 The Process Start out by explaining the process, exactly what you have been asked to do and what the limits of confidentiality are. Have the offender tell you, in his/her own words what they think they are being evaluated for, and put that quote in the report. Make sure they know the final report is going to the judge, not just their attorney, and that it will be reviewed by both attorneys. No such thing as “off the record” Get consent, written and verbal, to continue

93 What to look for in the testing/interview:
Presence of a major mental illness Presence of cognitive impairments Presence of cognitive distortions High Denial Blaming the victim Argumentative Multiple paraphillias Psychopathy Axis II Alfred Pleas Number of victims and offended across victim types (age, gender etc) No treatment No support system Probation failures

94 The Process Dictate everything Refine the actuarials
Contact Parole and Probation Work on diagnostics, summary and recommendations

95 The Content A risk assessment should be comprehensive, and include at least some information on all of the following areas:

96 The Content Reason for Referral
Administrative Procedures and Referral Time Line Family History Educational History Vocational History Military History Legal History Drug and Alcohol Use History Treatment History Sexual History Previous Psychological Evaluations Previous Sexual Crimes Previous Risk Assessments Current Sexual Crime Diagnoses Summary Recommendations

97 Assessment Ask open ended questions Use presumptive questioning Build rapport Start with more neutral questions Ask questions in unique ways, and at different times, helps get away from “rehearsed” answers Don’t help them be a better liar by pointing out inconsistencies Ask good follow up, don’t just note they have or have not done something; ask how often, height of usage, age it started etc. Remain non judgmental neutral (dog story…)

98 Trouble Shooting What do you do if the score low risk on one, medium risk on another, and high risk on a third?????? What do you do if they refuse to meet with you? What do you do with female offenders? Juvenile offenders? Offenders from other countries? First time incest offenders?

99 Typical Recommendations:
Sex Offender Treatment following legal consequences Polygraph / Plythysmograph / Abel screen No contact with children Pay for victim’s counseling (donation to rape and abuse) No pornography usage Unannounced home and work visits after incarceration period

100 J-SOAP-II Prentky and Righthand 28 items, 4 subscales
Empirically Guided Subscales are: Sexual Drive/Preoccupation Impulsive, antisocial behavior Intervention Community Stability/adjustment

101 J-SOAP-II Prior Legally charged sex offenses
Number of sexual abuse victims Degree of planning in sexual offenses Caregiver consistency Pervasive Anger School Behavior Problems Juvenile Antisocial Behavior Accepting responsibility for the offense Empathy Cognitive distortions Quality of peer relationships Management of sexual urges and desire Stability of current living situation Stability in school Evidence of support system

102 ERASOR Worling and Curwen Empirically Guided 5 domains
Sexual Interests, attitudes and behavior Historical sexual assaults Psychosocial functioning Family environment functioning treatment

103 ERASOR 1. Deviant Sexual Interest (children / violence or both):
2. Obsessive Sexual Interests/Preoccupation with Sexual Thoughts. 3. Attitude Supporting of Sexual Offending: 4. Unwillingness to Alter Deviant Sexual Interests/Attitudes: 5. Ever Sexually Assaulted 2 or More Victims: 6. Ever Sexually Assaulted Same Victim 2 or More Times: 7. Prior Adult Sanctions for Sexual Assault: 8. Threats of, or use of, Excessive Violence/Weapons During Sexual Offense: 9. Ever Sexually Assaulted a Child: 10. Ever Sexually Assaulted a Stranger: 11. Indiscriminate Choice of Victims: 12. Ever Sexually Assaulted a Male Victim: 13. Diverse Sexual Assault Behaviors:

104 ERASOR 14. Antisocial Interpersonal Orientation:
15. Lack of Intimate Peer Relationships/Social Isolation: 16. Negative Peer Associations and Influences: 17. Interpersonal Aggression: 18. Recent Escalation in Anger or Negative Affect: 19. Poor Self Regulation of Affect and Behavior (Impulsivity): 20. High Stress Family Environment: 21. Problematic Parent/Offender Relationship/Parental Rejection: 22. Parents Not Supporting Sex Offense Specific Assessment/Treatment: 23. Environment Supporting Opportunities to Sexually Reoffend: 24. No Development or Practice of Realistic Prevention Plans/Strategies: 25. Incomplete Sex Offense Specific Treatment:

105 OBrian and Bera Naïve Experimenters Under Socialized Child Exploiters
Sexual Aggressive Sexual Compulsive Disturbed Impulsive Peer Group Influenced

106 Worling Antisocial/Impulsive Over Controlled Reserved Unusual/Isolated
Confident/ Aggressive

107 Toni Cavanaugh Johnson
Group I: Natural and Healthy Sexual Play Group II: Sexually Reactive Behaviors Group III: Extensive Mutual Sexual Behaviors Group IV: Children who Molest

108 Amenability to Treatment

109 Will Treatment help anyway?
Early Conclusions “There is no evidence that treatment effectively reduces sex offense recidivism.” (Furby 1989) 1. Lack of control groups 2. Small N 3. Unreliable reporting methods 4. Other

110 Will treatment help anyway?
Later conclusions: Sex offenders who completed treatment, are less likely to reoffend (Nagayama Hall 1995) When current treatments are evaluated with credible designs, there is a reduction in both sexual recidivism & general recidivism (Hansen etal: 2000)

111 So, Lets send all offenders to treatment, right?
Wrong: “If the offender starts treatment subsequently quits, is kicked out, drops out, etc., he is statistically at a higher risk to reoffend than if he never entered treatment at all.” (Hanson and Bussierses 1996)

112 Treatment of Sexual Offenders
Adults Juveniles

113 Treatment of Sexual Offenders
Identify risk factors associated with lifestyle High Risk Situations Triggers Thoughts/Feelings and Behaviors that lead to reoffending SUDS Grooming behavior Cognitive and Behavioral interventions Counter conditioning methods Amends Denial Taking Responsibility

114 Treatment of Sexual Offenders
Accepting Responsibility Making a Commitment to Treatment Denial Denial of the facts Denial of intent Denial of impact Denial of responsibility Denial of the need for treatment

115 Treatment of Sexual Offenders
Managing your behavior Coping with Deviant arousal The Sex Offense Cycle Seemingly Unimportant Decisions Abstinence Violation Effect (Giving ) Behavioral alternatives at each level of the cycle Avoidance/Escape Minimal Arousal Conditioning Ammonia Control Covert Conditioning Coping with Anger Anger log Anger autobiography Taking responsibility for your anger Changing how you express anger

116 Treatment of Sexual Offenders
Understanding Yourself Childhood What we learned about ourselves Family Dynamics What we learned about Rules Roles boundaries Sexual autobiography

117 Treatment of Sexual Offenders
Victim Impact How sexual abuse affects victims Victim Empathy Thinking errors about victims Empathy role plays Clarification letter

118 Treatment of Sexual Offenders
Relationship and Communication Skills Understanding relationships Understanding your role in relationship failures Basic beliefs that interfere in relationships Self defeating styles of relating to others Assertive Aggressive Passive Aggressive Effective communication techniques The Characteristics of bad communication

119 Treatment of Sexual Offenders
Thinking, Feeling, Behaving Automatic thoughts/feelings Self statements Thinking feeling link Distorted thinking Styles of distorted thinking All or Nothing Rationalization Minimization Catastrophizing Personalization Overemphasizing one detail Etc., etc., etc. Restructuring distorted thinking

120 Treatment of Sexual Offenders
Thinking, Feeling, Behaving Emotions Expressing emotions Situation and Setting Symptoms Behavior chains Building offense chains The imaginary relapse scenario

121 Treatment of Sexual Offenders
Thinking, Feeling, Behaving Positive/Negative Consequences Changing Poor choices Problem Solving Behavior chains Building offense chains The imaginary relapse scenario

122 Treatment of Sexual Offenders
Sexually Compulsive Behavior related to child pornography requires different treatment Minimal Arousal Conditioning Ammonia Aversion Masturbatory Reconditioning Traditional Sex Offender Treatment

123 Treatment: Juveniles Very few studies have evaluated the efficacy of sex offender treatment for juveniles. Currently, there are no evidence-based treatment guidelines for this population.

124 Treatment: Juveniles The guidelines that exist are based on expert opinion and accepted practice. National Task Force on Juvenile Sexual Abuser Treatment Association for the Treatment of Sexual Abusers (in process) So what can be done for the treatment of this youth?

125 Treatment Psychoeducation Autobiography Fantasy work
Healthy sexuality Appropriate boundaries Self-regulation Autobiography Fantasy work Medication (sometimes) SSRIs: setraline, fluoxetine, paroxetine Antiandrogens/hormonal agents: medroxyprogesterone acetate Luteinizing hormone-releasing hormone agonists: leuprolide acetate, goserelin acetate

126 Treatment: Juveniles What is consent and who can give it
Legal vs. illegal sexual behavior Understanding anger Identifying problems Disclosing Denial Thinking Errors Who I hurt What I did How I did it How I planned it Victim’s Reactions Victims Feelings Who is Responsible Pathways: A guided workbook for youth beginning treatment by Tim Kahn

127 Treatment: Juveniles Myths of Sexual Abuse Who is a victim Direct
Indirect Pathways: A guided workbook for youth beginning treatment by Tim Kahn

128 Treatment: Juveniles Why did I do it? Motivation (urges)
Emotional Needs Sexual Arousal Blockage Internal Barriers External Barriers Victim Resistance My Sensitivity to Victim Resistance Pathways: A guided workbook for youth beginning treatment by Tim Kahn

129 Treatment Goals 1. Accept full responsibility for any sexually inappropriate and or criminal or harmful behaviors 2. Develop a clear understanding of and sensitivity to the impact of my behavior on the people I have hurt 3. Develop an understanding of the thoughts and feelings that led to my inappropriate behaviors and identity the factors that contributed to my poor choices 4. Learn to develop healthy and legal relationships that don’t hurt other people 5. Learn to have healthy sexual thoughts, feelings, actions and behaviors and learn to control and eliminate unhealthy sexual thoughts, feelings actions and behaviors. 6. Identify high risk situations that could lead to committing sexually inappropriate behavior. 7. Develop a strong network of people who will support me in making healthy choices 8. Develop a healthy living plan that other people in my support system will read and sign 9. Learn and demonstrate the four key treatment challenges, responsibility, honesty, sensitivity and integrity. From: Pathways: A guided workbook for youth beginning treatment by Tim Kahn

130 Treatment: Juveniles Identifying Grooming and Maintenance Behaviors
Understanding the chain of events that lead to offending Creating and Following a Relapse Prevention Plan Seemingly Unimportant Decisions (SUD’s) High Risk Situations (HRS’s) Controlling and expressing my sexual feelings in a positive way Covert Sensitization Vicarious Sensitization Pathways: A guided workbook for youth beginning treatment by Tim Kahn

131 Treatment: Juveniles Accountability Plans
Making things clear and apologizing for my behavior Clarification letters Pathways: A guided workbook for youth beginning treatment by Tim Kahn

132 Treatment: Juveniles S.T.O.P. plans
Support Through On Going Prevention Pathways: A guided workbook for youth beginning treatment by Tim Kahn

133 Group Rules The worth of every member is universal, intrinsic and unquestioned. Start and end of time Be respectful of all members No electronics Confidentiality Excused Absences only

134 Who might NOT be a good group candidate
Low iq, learning disabled, FASD Major mental illness Active CD issues Psychopathic Autistic Very low risk When the offense is such that group may reject them When the offense is such that they may reject the group

135 Safety Plans Who is an informed supervisor? Access to pornography?
A sober, awake, adult, who knows what the child did, provides line of sight supervision and is willing to call treatment team if safety plan is violated Access to pornography? Parental controls, computer in central location, password protected In positions of authority over younger children? No babysitting-ever Alarms on bedroom doors? Offenders door alarms, siblings door chimes

136 Safety Plans What about school and community activities?
Who needs to know? Balance community safety and social stigma Contact with potential victims in the community? Over the Phone? Via Social Media? No babysitting Need to check other things individually such as church, camp, sporting events, public pools Sleepovers?

137 Factors to Consider Individual factors in the youth
Families overall health and functioning Do they minimize what their child did? Do they think this was all blown out of proportion? Do they blame the victim? Do they keep secrets Degree of potential harm Youths risk level of reoffense Treatment behavior/progress

138 Some reasons why they fail
Child is hypersexual Child is impulsive Families not willing to follow the plan as written Do not monitor adequately Do not see the need for the plan Are afraid to report violations

139 Treatment for Sexually Abusive & Sexually Inappropriate Behavior in Children & Adolescent
The stages of Accomplishment Model The model is designed as a means of youths to demonstrate and to recognized for their accomplishments in learning, not as a measure of “success” or treatment “progress,” or as a “level and privilege” system. With accomplishment of each stage, the youths with whom we work are thus able to show themselves, their families, and others that they are learning important ideas about treatment, and are able to use these ideas in their everyday life (Rich, 2009).

140 STAGE 1 & 2 Stage 1, An Introduction to Treatment
Learn about treatment, and about oneself and why one is in treatment Understanding sexually abusive and sexually inappropriate behavior is addressed Goals of treatment are identified Stage 2, Understanding Yourself Learn more about oneself—including feelings, attitudes, & ideas Examine how these responses sometimes can come together to contribute to sexually abusive or sexually inappropriate behavior

141 Consent is Not Simply Saying Yes!
The definition of a sexual offence often revolves around consent. In simple terms, it's all about permission (or agreement). Kahn (2011) outlines that “True Consent” is Only established when the following 5 criteria are met… True consent requires that both people are emotionally and intellectually equal True consent requires honesty True consent requires understanding True consent requires permission to disagree or to refuse without penalty or harm True consent requires that both people really understand what is going to happen

142 STAGE 3 Stage 3, Understanding Dysfunctional Behavior
Learn to understand problematic behaviors, and the impact one’s behaviors have on others Dysfunction behavioral cycle and phases of the dysfunctional behavior cycle High-risk situations and behaviors Behavior management, staying safe, & preventing relapse

143 STAGE 4 Stage 4, Hitting the Target: Making Change Permanent
Learn how to better understand and connect with others, make amends for one’s sexually abusive or inappropriate behavior, relate & give back to the community, & build stronger relationships with others Examine how these responses sometimes can come together to contribute to sexually abusive or sexually inappropriate behavior Empathy ,caring, and victim awareness Learning to communicate active listening & non-verbal communication assertiveness vs. aggression Healthy and unhealthy relationships power & control in relationships recognizing boundaries Recognizing healthy & unhealthy sexual relationships

144 Lowering Reoffense Risk
Increase non-delinquent social involvement Sports Clubs Church activities Non-delinquent friends Stabilize living situation and school involvement Monitor for alcohol and drug use Manage anger

145 Lowering Reoffense Risk, Continued
Restrict contact with negative influences Parental controls for television Examine movie and video game ratings Eliminate access to offense opportunities Password-protect computer, phone Do not allow unsupervised contact with prior victims or similar individuals

146 Lowering Reoffense Risk, Continued
Parental Involvement!! Our program relies heavily on parental involvement and we have a separate group that meets for the parents. It is based on Tim Kahn’s “Pathways Guide for Parents” and covers things such as Where to turn, understanding the legal issues, evaluation and treatment, overcoming your own denial Direct vs. indirect victims Understanding the sexual offense cycles, grooming and maintenance behaviors and relapse prevention From: “Pathways Guide for Parents” by Tim Kahn

147 Parents Group Discuss the importance of parents showing interest in the their child’s treatment, becoming comfortable discussing sexual issues, showing respect for boundaries at all times, demonstrating responsible thinking and emphasizing positive reinforcement. From: “Pathways Guide for Parents” by Tim Kahn

148 Answering common questions such as:
How to tell the difference between normal sexual behavior during childhood and what is cause for concern? How do I know my child is making progress? How long will treatment last? How do I talk with my child about their sexual behavior problem? Who do I have to tell? Principal? Pastor? When will I be able to trust my child around children again? Does this mean they will become an adult sex offender? Can our child go to parks or playgrounds alone? Can our child go to Boy Scout meetings? Can our child sleep overnight at another child’s house? From: “Pathways Guide for Parents” by Tim Kahn

149 Parents Group Parents are taught the same “treatment lingo” as their child, and are kept up to date on what their child is learning in treatment so that they can ask specific questions, instead of general “how is it going” or “what are you learning?” We work on getting through denial and minimization, and thinking errors. We spend a lot of time on parental responsibility. From: “Pathways Guide for Parents” by Tim Kahn

150 Parents Group Such as limiting TV, video games and computer times.
Encourage sports, reading, family games. Monitor what your child is watching on TV and computer. Watch for sexual and violent themes, use the parental controls available to you Encourage physical activity. Supervision and monitoring, especially if younger children are present-no unsupervised contact with children. Supervisors should be adults. No unsupervised access to community spaces. From: “Pathways Guide for Parents” by Tim Kahn

151 Parents Group Parental discretion when it comes to sexual behavior.
Try keep a regular routine (bedtimes, mealtimes etc.). Pay attention to hygiene. Pay attention to appropriate dress. No TVs in the bedroom too hard to monitor content encourages isolation Watch sexual language, jokes, TV shows in the house. From: “Pathways Guide for Parents” by Tim Kahn

152 Parents Group We also spend time on the siblings of adolescents with sexual behavior problems-these children, if neither victim or perpetrator, often get overlooked. It is important to avoid secrets as a family and to let them know as much as it is developmentally reasonable for them to know. Try to keep life for the sibling as normal as possible and not allow what has happened to keep them from engaging in normal activities (such as sleepovers, etc.). Try spend time one on one with them, and consider some counseling as well if this seems like it is needed. From: “Pathways Guide for Parents” by Tim Kahn

153 Parents Group Situations where a chaperone is needed, and not needed.

154 If the victim is a family member
Each should have their own separate counselor Review the clarification and restitution letters your abusing child will write in treatment Often parents feel torn, conflicting loyalties come into play. Encourage construction communication and appropriate affection. From: “Pathways Guide for Parents” by Tim Kahn

155 If the victim is a family member
Lastly, family reunification, if this is feasible. This comes only after a through assessment of both the victim and the perpetrator, and successful completion of treatment. Ideally the child’s PO has done a home visit, and all members of the family have agreed to the rules. The child is slowly integrated back into the home, starting with brief visits, moving towards overnight visits, then weekend visits etc. Meetings are held periodically during this process to assess how it seems to be going. From: “Pathways Guide for Parents” by Tim Kahn

156 If the victim is a family member
Several house rules may be in place such as Where the bedrooms are and whether the doors will have alarms on them. Video monitoring, intercoms, etc.

157 What Does NOT Appear to be Helpful
Placing children on public sex offender registries. Segregating children with sexual behavior problems from other children. Such as when foster homes, agencies, and facilities form policies excluding children with a history of sexual offenses. An exception is if the child’s behavior is out of control or poses an acute and substantial risk for serious harm to other children. These policies offer little to no actual community protection. These practices make youth vulnerable to stigma and social disadvantage (which could indirectly increase risk of reoffense).

158 A Shameless Plug

159 Benson Psychological Services
Benson Psychological Services, PC offers the following services Individual and Group therapy for Legal Sexually Compulsive Behavior Group Therapy for adult sex offenders Group Therapy for adolescents who have sexually harmed others Partners to offenders group Parents group Partners of those who have problems with legal sexually compulsive behavior You can refer clients by having them call and speaking with our intake person, Alyssa, ext 153

160 Thoughts…Comments

161 References Association for the Treatment of Sexual Abusers, Task Force on Children with Sexual Behavior Problems. (2006). Report of the Task Force on Children with Sexual Behavior Problems. Retrieved from Report-TFCSBP.pdf Barbaree, H. E., & Marshall, W. L. (Eds.). (2006). The juvenile sex offender, second edition. New York, NY: The Guilford Press. Concerns about teen sexting overblown, according to new UNH research. (2011, December). University of New Hampshire Media Relations. Retrieved from Kahn, Tim. (year). Pathways: A guided workbook for youth beginning treatment. Brandon, Vermont: Safer Society Press. Phippen, A. (2009). Sharing personal images and videos among young people. Retrieved from SW Grid for Learning Website: Sacco, D. T., Argudin, R., Maguire, J., & Tallon, K. (2010). Sexting: Youth practices and legal implications. Retrieved from the Berkman Center for Internet and Society at Harvard University Website: Seto, M.C., Babchishin, K. M., Wood, J. M., & Flynn, S. (2011). Online solicitation offenders are different from child pornography offenders and lower risk contact sexual offenders. Law and Human Behavior, no journal number specified, Wollert, R. (2012). The implications of recidivism research and clinical experience for assessing and treating federal child pornography offenders: Written testimony presented to the U.S. Sentencing Commission. Child Pornography Offenders, no journal number specified, Zimring, F. E. (2004). An American travesty: Legal responses to adolescent sexual offending. Chicago, IL: University of Chicago Press.

162 Sources sex addiction workbook: proven strategies to help you regain control of your life - Tamara Penix Sbraga, William T. O'Donohue Stages of Accomplishment - Phil Rich, EdD, MSW Pathways - Timothy Kahn Road to Freedom - John Morin, PhD & Jill Levenson, MSW Adult Relapse Prevention workbook - Charlene Steen, PhD, JD Treating Nono ffending Parents in Child Sexual Abuse Cases: Connections for Family Safety - Jill Levenson & John Morin A L.I.F.E. Guide - LIFE Ministries - Mark Laaser, PhD Manual for Structured Group Treatment with Adolescent Sex Offenders - Jacqueline Page, PsyD and William Murphy, PhD

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