Session 1: April 17 Introduction & assessment

Session 1: April 17 Introduction & assessment

Overview of JSO Training Series
Session 1 Background & development of JSO’s Initial assessment considerations & procedures Session 2 Treatment planning What does and doesn’t work Treatment approaches Session 3 Risk assessment, Recidivism & Relapse prevention Role and amenability of the family in treatment Supervision, support, & resilience

Juvenile Sex Offender Treatment Workshop
Session 1: Introduction & Initial Assessment Objectives: to overview the JSO training series to understand the current incidence & impact of JSO to explain the developmental experiences that lead to offending to describe offender typologies and cycle to know the areas of intake inquiry to know the information provided by initial assessment instruments

Beliefs about Sex Offending
The primary motive is sexual Sexual assault is impulsive Strangers are usually assaulted Victim could prevent it Offenders are mentally ill Women make false accusations Most assaults are reported Primarily women are assaulted Most rapists are minorities Only certain age groups are at risk Pornography causes rape Most offenders reoffend & recidivism is very high Primary motive is power & control 70% are planned 50-70% of offenders are known 90% involve threats or force Most appear and act normal 2-4% false report rate est. 1 in 10 reported 25-35% women, 20-3-% men 52% white Victims age 9mo to 99 years Violence is more influential, degradation may influence A small proportion are responsible for multiple offending

Who are offenders

How much of a problem is sexual offending?
1:4 girls and 1: 6 boys will be sexually assaulted before age 16 1:7 victims of sexual assault reported to law enforcement agencies were under age 6. Adolescent offenders have 7-30 victims prior to their first arrest Sixty-seven percent of all victims of sexual assault reported to law enforcement agencies were juveniles (under the age of 18); 34% of all victims were under age 12. only 12-32% of rapes are reported to police 1 assault per 1000 persons aged 12 and older Of 1 million cases of child abuse in 1997, 8% were sexual abuse

50% of Jr. & Sr. high girls reported incidents of sexual harassment
75-95% of victims know their offender 30% of teen girls know another who has been in a sexually violent relationship 30% of college students report violent date relationships annual victim costs are $127 billion (excluding child sex abuse cases) Sexual assault is the fastest growing violent crime and accounts for 7% of all violent crime Twenty-five percent of teens have had intercourse at least once by 15 years (CDC, 1994), and nearly 75 percent report doing so involuntarily In 2001 there were 240,980 reported rapes and sexual assaults in the United States (may be 7-10x as many unreported)

325,000 children are reported as being sexually exploited in the United States annually; of that figure, 121,911 ran away from home & 51, were thrown out of their homes by a parent or guardian. 40% of the girls who engaged in prostitution were sexually abused at home, as were 30% of the boys 75% of children who are victims of commercial sexual exploitation are from middle-class backgrounds. 60% of adolescent perpetrators were physically abused, 50% sexually abused, 70% neglect, and 50% combinations of these the most common emotion prior to sexual assault is anger: 88% general anger, 77% toward women Between the arrests of children under the age of 12 years old have increased 125% for sex offenses (excluding rape) and 190% for forcible rape In Vermont, reported sexual abuse by children under the age of 14 increased 300% within 10 years The average adolescent sex offender will, without treatment, go on to commit 380 sexual crimes during his lifetime

Rate going down but still serious
(and doesn’t count non-reported incidents) Bureau of Justice Statistics

Convicted Offenders: The US has a sexual assault rate 4 times higher than Germany, 13 times higher than England, and 20 times higher than Japan. In any given day there are about 234,000 sex offenders under care/control from incarcerated offenders increased by 48% convictions increase at a rate of about 15% a year 1/3 of prison inmates in some states are sex offenders the annual housing cost of sex offenders was > $2 billion in 1990 convicted offenders report that 2/3 of their victims were under age 18 about 60% of offenders are on some form of community release sexual predator confinement costs $60,000-$130,000/yr (not counting legal costs)

Highest Risk Offenders
· Early onset criminal history characterized by sex and violence convictions · Predominantly extra-familial offence types of female rape and male child sexual assault · Diverse sexual offending – different victim ages/gender/relation-ships/locations · Anti-social lifestyle, social influences and attitudes · Psychopathic personality – as measured by the Hare Psychopathy Checklist · High impulsivity, denial, cognitive distortions and emotional loneliness · Low victim empathy, emotional control, intimacy skills and problem-solving abilities · Sexually deviant arousal, fantasies and pre-occupation

Comorbidity of Disorders
70-87% of juvenile offenders have psychiatric problems 50-80% have learning problems, special education, repeat grade 45-80% have conduct disorder 55% have character disorder 65% with IQ <70 engage in inappropriate sex behavior 35-50% mood disorder 30-50% anxiety disorder 20-40% attention/hyperactivity disorder 20-30% substance abuse The Point: There are usually multiple problems, influences, and modifiers that must be considered & treated

Female Offenders < 5% (?) of offenders are females
(usually victimize children) females have a sexual abuse rate of about % for male children and 5% for female children 1:3 women will be victimized before age 10 70% of female offenses take place while baby sitting victim age 5 50-90% of female sex abusers have history of sexual victimization females are more likely to have been abused at a younger age, have multiple abusers, 3x more likely to have been abused by female Twenty percent of sex offences against male siblings are committed by sisters, compared to 21% for brothers. Violent behavior occurs earlier in females (< age 17) and decline in violent behavior is steeper The point: females are rare offenders most are victimized their victims are less likely to report

extremely rare for women to sexually offend against a stranger
Female offenders (cont’d) female offenses typically include fondling, mutual masturbation, anal and genital activities, pornography and sexual games vast majority of female sexual offenders used persuasion, manipulation and guile on their victims as opposed to physical force or threats; less likely than their male counterparts to be predatory, or to use violence, denial, or minimization. . females are more exploitative, and seizing a convenient moment or using a weakness to coerce, while males are more likely than females to use force and bribery to obtain compliance. some studies have shown 45% of adult female perpetrators as having a co-offender (male-coerced or male-accompanied offenders) once abused, they show more problems than males with self image, sexual attitudes, family relationships, vocational and educational goals, and difficulty in mastering their environment extremely rare for women to sexually offend against a stranger

The juvenile link Patterns of aggression set by age 8 often continue into adulthood Half of perpetration against <12 year-olds is by adolescents Forty percent of the offenders who victimized children under age 6 were juveniles Nearly ½ million youth each year are involved in violent crime Youths <18 account for about 10% of all sex related murders Majority of adult offenders report physical/sexual abuse as youth (19-57% sexual) ½ of all adult offenders had at least one deviant sex interest before age 18

Juveniles are responsible for 20-30% of rapes each year in the US
Nearly 15% of all sexual offenses involving teen perpetrators happen at school or on school property. Juveniles are responsible for 20-30% of rapes each year in the US 30-60% of child sexual abuse is perpetrated by juveniles 42% of pedophiles begin their sexual offending before the age of 12. Nearly 70% come from violent or dysfunctional families In 1975 there was only one program for specialized treatment of sex offenders; in 1995 there were more than 600 The Point: it’s a serious & growing problem it is formed early need to intervene early the boy becomes the man/father

…and the boy becomes the man
Of adult men who sexually assault boys, 50% recognized their interest by age 16 About half of all adult offenders began offending as juveniles 70-80% of adult offenders report physical/sexual abuse as youth ½ of all adult offenders had at least one deviant sex interest before age 18 42% of pedophiles begin their sexual offending before the age of 12. of 84 rapists & pedophiles, during adolescence 45% were voyeurs & 37% exhibitionists Rapists average 7 victims, child sex abusers average 76

Early development

How to make an offender: the development of a sex offender

The “February Man”– a case of completing developmental gaps
Using hypnotic regression and positive hallucination in four sessions, Erickson gave the woman experiences to fill in her developmental “gaps.” telling the “little girl” everything a little girl needs to hear listening to all the things every little girl needs to tell being there for all the important experiences a little girl needs to share The point: people often behave as they do for developmental reasons; it may never be too late to help complete these experiences

Attachment Theory & Offender Development

Normative Healthy Attachment
eye contact cooing crying smiling reaching grasping approaching following discomfort hot/cold hungry happy afraid angry tired wet Availability Sensitivity Responsiveness Consistency prolonged gazing kissing cuddling fondling high voicing rocking rhythmic contact seek closeness & reciprocity frustration tolerant high intimacy long lasting relationships high levels of commitment high relationship satisfaction stress resilient fewer physical & psychological problems less aggressive, more cooperative high belonging Secure attachment trust safe/secure regularity easier to comfort more affectionate

Attachment Problems mental illness postpartum depression
attachment disordered chemical abuse physical illness multiple caretakers frequent moves criminal behavior preoccupation separation/divorce death PDD Attachment Problems Unresponsive to Comforting severe illness premature birth surgeries/pain hyperactive hospitalizations colicky autistic FAS/FAE physical abuse domestic violence absence neglect inconsistency over/under stimulate over/under attentive rejecting Insecure Attachment untrusting fearful angry

Adult Attachment Scale (Collins & Read, 1990)
Secure I am comfortable depending on others I know that others will be there when I need them I do not often worry about being abandoned I find it relatively easy to get close to others I do not often worry about someone getting close to me I am comfortable having other depend on me Avoidant I find it difficult to allow myself to depend on others People are never there when you need them I find it difficult to trust other completely I am somewhat uncomfortable being close to others I am nervous when anyone gets too close Often, love partners want me to be more intimate than I feel comfortable being Anxious/Ambivalent I am not sure that I can always depend on others to be there when I need them I often worry that my partner does not really love me I find others are reluctant to get as close as I would like I often worry my partner will not want to stay with me I want to merge completely with another person My desire to merge sometimes scares people away

Developing an Offense Pattern
Social isolation & few friends Low social skills Lack female peer relations Loner/loneliness Expect/elicit rejection Lack confidence Fear closeness Devoid of pleasure Chronically deprived Insecure Attachment Anger Resentment bitterness Pornography, Popular media, Culture, Role modeling Faulty Beliefs Self-Stimulation: physical but not emotional gratification Developing an Offense Pattern Anger, bitterness resentment, cynicism Self-reinforcing cycle of escalation Masturbation fantasies: power, control, no interpersonal skill required Unsuccessful, emotionally unsatisfying relationships

Features of people with low self esteem
Self-esteem– beliefs and attitudes formed toward oneself following evaluation of one’s attributes Features of people with low self esteem see self as unattractive expect people not to like them seek poor quality partners & friends poor relationships with others lack empathy engage in cognitive distortions divert blame from themselves experience frequent emotional distress & negative affect underestimate their abilities expect to do poorly and fail set lower goals for themselves unlikely to practice scheduled tasks readily give up adherence to programs

Sexual development

Normal Sexual Development
From age 3 to 4 children may: Become aware and very curious about differences in males and female bodies. Touch themselves and learn to masturbate on their own. Play house, doctor, or explore other forms of sexual play activities Establish a firm belief that they are either male or female. Mimic adult sexual behavior. Begin to repeat curse words. Ask questions and peek under clothing of dolls or friends. Be curious about their own origins and ask, "Where did I come from?"

From age 5 to 8 children may: Continue sexual play activities and masturbation. Become curious about pregnancy and birth. Have a basic sexual orientation Engage in name-calling and teasing. Have strong same-gender friendships. Girls and boys are often socialized to communicate in very different styles. Show strong interest in stereotyped male and female gender roles. Have a new awareness of authority figures (e.g. teachers may be seen as knowing more than parents) Compare their own situation with those of peers; complain about lack of fairness. Begin to conform with peer group style of dress and speech.

From age 9 to 12 children may: Enter puberty, especially girls. Early development may be perceived more positively by boys than girls. Become more modest and express a need for privacy. Have romantic crushes on friends, older teens, music stars, teachers. Continue to attach importance to same gender friends. Feel awkward. Masturbate to orgasm. Be strongly influenced by their peer group. Have sexual or romantic fantasies. Face decision-making about sexual activity and drug-taking. Initiate sexual intercourse as early as age 12.

Early sexual maturation– much earlier than in the past…
First age of menstruation 1700’s-- age 17 1800’s– age 15 early 1900’s– menarch declined 3 months per decade until 1960 last 30 years– age Sexual maturation girls start puberty 1-2 years before boys, over 3-5 years boys are in the process of puberty 4-6 years Early pubertal development is associated with increased likelihood for early experimentation with sexual behaviors, particularly intercourse difference in maturational times between boys and girls may lead some girls to seek older partners society does not adequately prepare or support early adolescents for the biological or emotional changes the adolescent brain (especially impulse control and judgment) does not mature until about age 20

Gender Identity Gay male adolescents report awareness of a distinct feeling of "being different" between ages 5-7, yet did not yet connect this feeling to sexuality. The median age at which lesbian and gay youth become aware that their feelings of "difference" are linked to a same-sex sexual orientation is 13 97% of students in public high schools report regularly hearing homophobic remarks from peers. 80% of gay and lesbian youth report severe social isolation. 53% of students report hearing homophobic comments made by school staff Two-thirds of guidance counselors harbor negative feelings toward gay and lesbian people

Sexual orientation in adolescence
Students in grades 7-12 describe themselves as: predominantly heterosexual 88% bi-sexual/homosexual 1% unsure of sexual orientation 11% Uncertainty about sexual orientation diminishes with age: “unsure” 12 year olds 26% “unsure” 18 year olds 5% The point: many youth who are exposed to sexual abuse are still developing their sexual identity abused youth may have identity formation complicated complicated identity may lead to acting out to confirm

Less than 20% of guidance counselors have received any training on serving gay and lesbian students
19% of gay men and 25% of lesbians report suffering physical violence at the hands of a family members as a result of their sexual orientation 26% of adolescent gay males report having to leave home as a result of conflicts with their family over their sexual orientation 45% of gay males and 20% of lesbians report having experienced verbal harassment and/or physical violence as a result of their sexual orientation during high school 42% of adolescent lesbians and 34% of adolescent gay males who have suffered physical attack also attempt suicide

Development of normative sexuality
Learning about intimacy through interaction with peers Understanding of roles and relationships in/outside family Adapting body scheme to physical changes Adjusting to erotic feelings & experiences Learning about societal standards, norms and practices Understanding reproductive processes The point: Trauma, poor role modeling, abuse, delinquent peers, and some disabilities interfere with these learnings

Green Flags: Normal Adolescent Sexual Behavior
Sexually explicit conversations with peers Obscenities and jokes within cultural norm Sexual innuendo, flirting and courtship Interest in erotica Solitary masturbation Hugging, kissing, holding hands Foreplay, (petting, making out, fondling) and mutual masturbation: Moral, social or familial rules may restrict, but these behaviors are not abnormal, developmentally harmful, or illegal when private, consensual, equal, and non-coercive. Monogamist intercourse: Stable monogamy is defined as a single sexual partner throughout adolescence. Serial monogamy indicates long-term (several months or years) involvement with a single partner which ends and is then followed by another

Yellow Flags: Marginally Acceptable Sexual Behavior
Sexual preoccupation/anxiety (interfering in daily functioning) Pornographic interest Polygamist sexual intercourse/promiscuity--indiscriminate sexual contact with more than one partner during the same period of time. Sexually aggressive themes/obscenities Sexual graffiti (especially chronic and impacting individuals) Embarrassment of others with sexual themes Violation of others' body space Pulling skirts up/pants down Single occurrence of peeping, exposing with known peers Mooning and obscene gestures

Red Flags: Problematic Adolescent Sexual Behavior
Compulsive masturbation (especially chronic or public) Degradation/humiliation of self or others with sexual themes Attempting to expose others‘ genitals Chronic preoccupation with sexually aggressive pornography Sexually explicit conversation with significantly young children Touching genitals without permission (i.e. grabbing, goosing) Sexually explicit threats (verbal or written) And Illegal Behavior: Obscene phone calls, voyeurism, frottage, exhibitionism, sexual harassment Sexual contact with significant age difference (child sexual abuse) Forced sexual contact (sexual assault) Forced penetration (rape) Sexual contact with animals (bestiality) Genital injury to others

What is sexual deviance?
Sexually deviant behavior includes the following: sexual contact with a person under the age of consent sexual contact with a person who is unable to give consent (e.g., mental capacity, drugs/alcohol, etc.) sexual contact that entails the use of force, aggression, threats, physical harm, bribes, money, etc. sexual contact that is harmful or degrading

Paraphilias Paraphilias include fantasies, behaviors, or sexual urges focusing on unusual objects, activities, or situations. Paraphilias include: Sexual urges or sexual fantasies with non-human objects Sexual behaviors with non-human objects Sexual behaviors involving humiliation or suffering of oneself or another person Adult sexual behavior that involves children or nonconsenting adults paraphilias originate in late childhood or adolescence, continue through adult life, and tend to decrease with aging the course for paraphilias is chronic and tends to be guarded

Average age of onset of various paraphilias
Paraphilias include fantasies, behaviors, or sexual urges focusing on unusual objects, activities, or situations. Average age of onset of various paraphilias Transvestism 13.6 Fetishism 16 Bestiality 17.4 Voyeurism 17.7 Pedophilia (M) 18.2 Obscene Calls 19.3 Masochism 19.3 Sadism 19.4 Frottage 20.7 Exhibitionism 21.1 Pedophilia (F) 21.6 Public Masturb. 21.8 Rape 21.8 Pedophilia (MI) 23.5 Pedophilia (FI) 27.1

More paraphilias… 1.Formicophilia--focus is on small creatures
2.Klismaphilia--focus is on enemas 3.Urophilia--focus is on urine 4.Coprophilia--focus is on feces 5.Scatophilia--focus is on sexual talk on phone 6.Vomerophilia--focus is on vomit 7.Necrophilia--focus is on corpses 8.Gerontophilia--focus is on elderly people 9.Acrotomophilia--focus is on amputated people 10.Infantilism--focus is on being treated as an infant 11.Partialism--focus on a specific part of the body 12.Pictophilia--focus on porn, pictures, movies 13.Triolism--focus on viewing partner having sex 14.Hypoxyphilia--focus on reduced oxygen intake 15. Autassassinophilia– self stages own death 16. Telephonicophilia– lewd phone calling 17. Gynemimetophilia– female impersonator partner 18. Stigmatophilia-- piercing The point: just about anything can be sexualized

http://www. currentpsychiatry

Multiple diagnoses of offenders who have more than one paraphilia
6 5 1 2 3 4 Multiple diagnoses of offenders who have more than one paraphilia 1 diagnosis: 10% 2 diagnoses: 20% 3 diagnoses 20% 4 diagnoses 12% 5-10 diagnoses: 37% 3.5 is the average number of diagnoses for 561 offenders samples 100% of fetishists, sadomasochists, and bestialists had >1 Dx The point: many offenders have extensive and complex mental health problems assessment should be very thorough treatment may need to treat multiple direct & indirect problems multiple Dx is suggestive of more serious disorders such as borderline personality disorder

Development of a Juvenile Sex Offender
Infancy FAS/FAE ADHD attachment hyperreactive “colicky” unhealthy pain Peers delinquent peers initiation attention/recognition belonging act out revenge severe community violence PROBABLE OFFENSE Pre-family poverty single unwanted MI/CD immature abused Family cohesion flexibility boundaries discipline marital relationship handle emotions poor role modeling physical, emotional, sexual abuse explicit sexuality MI/CD Personality-- What prevents you from offending? values (“It’s wrong”) empathy (“it would hurt others”) consequences (“I’d get in trouble”) ego dystonic (“that’s not me”) shame/embarrassment (“what would other think”) esteem (I’d feel awful”) identification (“wouldn’t want that to happen to me”) personal responsibility (“I would be responsible”) self monitoring & control (“I’d stop myself”) coping (“other ways to deal with tension”)

Offender typology

Problems in Developing Juvenile Sex Offender Typologies
The personalities and behaviors of youth are still undergoing development Typologies for adults may not be appropriate for juveniles Multiple disabilities make typing difficult Juveniles are just beginning their offending behavior and may not have established a pattern Typologies are based on those who are apprehended, not on the total population of offenders Very little research has been done on JSO’s, even less on the stability of typologies, and almost nothing on female offenders (3-10% of offender population) Explanations of why juveniles offend have not been sufficiently tested Long term studies of juveniles have rarely been conducted National Adolescent Perpetrator Network Uniform Data Collection System is still gathering data

Groth’s Patterns of Rape (based on adults)
Anger Rape (<40%) Power Rape (>55%) Sadistic Rape (5%) Blitz or confidence Faceless victim Excessive force Impulsive assault Anger & depression Episodic offense Abusive language Retribution Short duration assault Pervasive physical trauma Whatever force is necessary Premeditated or opportunistic assault Anxious Repetitive, compulsive with increased aggression Instructive & inquisitive language Compensatory possession for inadequacy Conquest, capture, control Extended duration Physically unharmed aside from rape trauma Eroticized force Calculated, preplanned assault Excitation from helplessness & fear Ritualistic offense Commanding, degrading language Symbolic destruction & elimination Extended duration assault Extreme physical trauma Offender likely impotent; penetrate with objects Groth, N. (1981) Men who rape. New York: Plenum

Offend Against Peers or Adults Offend Against Children
Offender Subgroups Traits Offend Against Peers or Adults Offend Against Children Victims Predominantly assault females. Assault mostly strangers or acquaintances. Females victimized at slightly higher rates. Nearly half assault at least one male. Up to 40% of victims are either siblings or relatives. Offense Patterns More likely to commit offenses in conjunction with other criminal activity. More likely to commit offenses in public areas. Reliance on opportunity and guile, particularly when victim is a relative. Trick child by using bribes or threatening loss of relationship Social and Criminal History More likely to have histories of nonsexual criminal offenses. Generally delinquent and conduct-disordered. Deficits in self-esteem and social competency are common. Often lack skills and attributes necessary for forming and maintaining healthy interpersonal relationships. Behavior Patterns Display higher levels of aggression and violence. More likely to use weapons and cause injuries to their victims. Often display signs of depression. Youths with severe personality and/or psychosexual disturbance may display high levels of aggression or violence. Center for Sex Offender Management:

Phase Typology of Adolescent Offenders (O’Brien & Bera– not validated)
Naïve experimenter/Abuser: Naïve socially adjusted child with single offense during opportunity with younger child for experimentation & curiosity Undersocialized Child Exploiter: Isolated and socially inadequate using manipulation with younger child on repeated occasions for intimacy & esteem Pseudo-socialized Child Exploiter: “normal” & older with good social skills, but previously abused, rationalizing repeated, noncoercive contacts for self indulgence Sexual Aggressive: Charming but family abuse and antisocial with poor impulse control and possible substance abuse; uses force against peers, adults or children for power or anger Sexual Compulsives: Rigid families unable to express negative emotions; engage in compulsive non-contact offenses; tension release and self control are satisfying Disturbed Impulsive: Psychological, learning, and substance problems; unpredictable, impulsive, and may be bizarre Group Influenced Offender: Strongly peer group influenced, pre-selected peer known victim, assaulted for peer pressure and/or recognition

Female Offender Typology (Matthews, Matthews and Speltz (1987-- nv)
Explorer/Exploiter 1. Female abuser tends to be 16 or younger. 2. Acting out behavior is uncharacteristic. 3. Victim is usually a young child (Birth -6) who is viewed as safe. 4. Sexual abuse is exploratory, isolated (usually 1 time), non-violent, impulsive and often occurs in a babysitting situation. 5. Treatment: Outpatient short-term, psycho-educational, family based, Teacher/Lover 1. Adult female, who views herself as an emotional equal to young adolescent males (females if lesbian) at the time of offence (regressed). 2. Recent history of abusive, conflictual, unfulfilled or failed peer relationships which has negatively impacted the women's self-esteem. 3. Victim is often a troubled or needy adolescent seeking attention/love/sex. 4. Sexual abuse is described a, a consensual ‘love affair' where the woman initially has difficulty seeing the behavior as inappropriate. 5. Treatment Outpatient female sex offender program (4- 12 months).

Female Offender Typology (cont’d_
Predisposed - History of Abuse 1 . Female who was abused sexually and often physically and emotionally as well as neglected as a child by at least one person, often a caregiver. 2. Resulting in anger, avoidant, dissociative, acting-out, intimacy, boundary and/or esteem issues. 3. Victim is usually a close relative, neighbor or offspring. More frequently a child close to the age at which the perpetrator herself was victimized. 4. More extensive and ritualized abuse, that is linked to the females own abuse/re-enactment, resolution/thinking error. 5. Treatment: Moderate to long-term Out-patient Day or Residential female sexual offender treatment or correctional institution if in denial. Psychologically Disturbed (Organic, Affective or Severely Personality Disordered) 1 . Female acting alone or accompanied by another in offending. 2. Adolescent history of either severe psychological problems (i.e. suicide, psychosis, paranoia, depression, bipolar, schizophrenia) or conduct disorder (theft, assault, prostitution, drug addiction). 3. Crime tends to be more violent 4. Female is psychologically unstable at times of offence. 5. Treatment: Psychiatric or correctional institution, and possibly medication management

Female Offender Typology (cont’d)
Male Coerced/Accompanied 1 . Adult female who is initially coerced into abusing by a significant male. 2. Often reports a history of childhood abuse and frequently sexual and physical abuse as an adult. Hurt, non-assertive, isolated, dependent, low self-esteem, passive aggressive. 3. Victims are generally chosen by the male and include the women’s children, relatives, and adult women. 4. The male begins the offending and due to the personality characteristics above, (often with threats or force) gains the female’s compliance. 5. Treatment: Long-term outpatient, Day or Residential female sex offender treatment or correctional institution if in denial. Eventual separation from coercive male if he does not complete sex offender treatment.

Internal Working Model & Types of Attachment
Adjustment: low self efficacy, low confidence, emotionally expressive & labile, intense, too close too fast, inconsistent, dominating, controlling, unsatisfactory intimacy, jealousy, obsessive, compulsive, idealizing, oversensitive, shame prone, deficient problem solving, dislike authority & rules, self-defeating, Offenders: nonthreatening, seek immature victims, groom over time, quasi-romantic relationships, borderlines Internal Working Model & Types of Attachment Self Others + _ Secure Preoccupied Anxious- Ambivalent Avoidant- Fearful Dismissive Adjustment: self blame, not seek or accept help, fear rejection, fear disclosure & closeness, lack trust, emotionally aware but unexpressive, passive, superficial intimacy, not recall childhood, hypervigilant Offenders engage in impersonal, single contact sex, acquaintance rape, cruising Adjustment: uncaring, avoid closeness, non-disclosing, high confidence, aloof, indifferent, impatient, shallow, vain, hostile, arrogant, grandiose, reject treatment, selfish, controlling, AODA, vengeful Offenders: coercive & assaultive, no guilt, remorse, shame; narcissistic, psychopathic (Bartholomew, Shaver, et al.)

Comorbidity of Disorders
70-87% of juvenile offenders have psychiatric problems 50-80% have learning problems, special education, repeat grade 45-80% have conduct disorder 55% have character disorder 65% with IQ <70 engage in inappropriate sex behavior 35-50% mood disorder 30-50% anxiety disorder 30% antisocial personality disorder 20-40% attention/hyperactivity disorder 20-30% substance abuse The Point: There are usually multiple problems, influences, and modifiers that must be considered & treated

Role of alcohol & drugs (highly variable)
35% of violent crimes involve alcohol/ drugs (85% for rape) 23% of women college students are confronted with alcohol related unwanted sexual advances each year victims of college sexual assault report 68% of males had been drinking at the time most college men believe alcohol increases sexual arousal, legitimizes nonconsensual aggression, & women who drink are more interested in sex binge drinkers are more than twice as like to have experienced unwanted touch and three times as like to have unwanted intercourse victims and assailants who drink tend toward greater aggression alcohol impairs judgment, impulse control, and other compensatory skills for both victim and perpetrators 53% of high school students who used before or during date reported unwanted sexual contact

Offender Cycle

Socialization: Boy’s & Girls Beliefs
Boys believe… 55% of boys say sex is the most desirable thing in a date; 79% girls want a a good intellectual relationship Boys think “ownership” of a relationship entitles them to sexual rights Boys learn they have the responsibility to initiate action (e.g., asking for date) thereby reinforcing their control beliefs Boys tend to think completion of sexual action (kiss or orgasm) is more important than the process Boys learn to see girls as sexual objects to see, discuss, and touch anonymously

Socialization: Boy’s & Girls Beliefs
Girls believe… It is important to have a boyfriend Some girls learn that they can submit sex for a relationship Girls learn that boys get angry if they don’t get their way, might end the relationship, might hurt them physically, might circulate rumors Girls learn to equate these submissive behaviors with “feminine”

Faulty Beliefs: when shown a date rape scenario--
59% indicated having done something similar 33% expressed some likelihood of raping 66% believed the rape was the victims fault 40% believed that in spite of the resistance, the woman wanted forced sex 20% believed that “roughing up” sexually excites a woman 17% said that such force is the only way to arouse a “cold” woman 17% reported that going home with a man is consenting to sex 11% said that getting drunk at a party makes a woman “fair game”

Oppositional Defiant Disorder
Potential Progression in Personality Disorder PDD ADHD FAS/FAE Oppositional Defiant Disorder Antisocial Personality Disorder Conduct Disorder Psychopathic Personality Disorder Stimulus seeking Lack goals Parasitic Predatory Violent Criminal acts Impulsiveness Disregard safety Irresponsibility Lack remorse Aggression Destruction Deceitfulness Rule violation Hostile Defiant Negative Inattention Poor social skills Learning deficits

Hard core: The psychopathic personality
Glibness/superficial charm (1) Grandiose sense of self-worth (1) Need for stimulation/proneness to boredom (2) Pathological lying (1) Cunning/manipulative (1) Lack of remorse or guilt (1) Shallow affect (1) Callous/lack of empathy (1) Parasitic lifestyle (2) Poor behavioral controls (2) Promiscuous sexual behavior (T) Early behavior problems (2) Lack of realistic, long-term plans (2) Impulsivity (2) Irresponsibility (2) Failure to accept responsibility for own actions (1) Many short-term relationships (T) Juvenile delinquency (2) Revocation of conditional release (2) Criminal versatility (Hare, 1986) (T) Factor 1: Interpersonal & affective Factor 2: Lifestyle, socially deviant behaviors

Resources for additional study
web/SexOffender/SexOffenderlinks.html Training program outline Training and assessment overviews Extensive links Bibliographies

Assessment

Session 2, May 1 Treatment

Session 2: Treatment of Juvenile Sex Offenders

Tx effectiveness Effectiveness of Treatment (more in Session 3)
Juveniles tend to have lower reoffense rates overall, and lower than adults Juveniles who successfully complete treatment have recidivism rate of 7-13% over 2-5 years (25-50% for nonsexual offenses) only 5% of treated youth reoffended in 6 years compared with 18% untreated Tx effectiveness

Characteristics of effective programs
· Address developmentally generated predispositions to offend, such as dysfunctional attachments and sexual/physical/emotional abuse (“Past”); factors associated with the maintenance of sexual offending behavior (“Present”); and the development of relapse prevention skills (“Future”) · Address the development of offender insight, motivation not to offend and the skills necessary to avoid offending and achieve a non-offending lifestyle · Utilize treatment methods geared to the (criminogenic and personality) needs and (intellectual and emotional) capabilities of the offenders in treatment · Utilize combinations of milieu, group therapy and individual therapy as appropriate for different aspects of treatment and assessment

Treatment Goals & Objectives

community safety gain controls over sexually abusive behaviors increase pro-social behaviors with peers and adults prevent further victimization stop development of additional psychosocial problems develop age-appropriate relationships with peers accept responsibility for behavior develop empathy with victim cognitive restructuring (correct faulty beliefs & distortions) positive sexual identity clarification of values re abusive and nonabusive behaviors enhance impulse control & good judgement, choices dating skills resoluition of personal victimization sex education improved school performance & attendance

Amenability

Amenability to Treatment
Psychological Condition Current Motivation/ Situation Capacity IQ (retardation) Organic Brain Injury Learning Disability Attentional deficits Medical Conditions Physical Limitation DSM-IV Diagnosis (Defensiveness Distortion Delusion Dependency, etc.) Internal Treatment Modifiers willing to participate willing to formulate goals commitment to work hard level of discomfort accept personal responsibility developmental maturity emotional reactance (shame, guilt, identification, remorse) Treatment Requisites form working relationship attend sessions accept personal responsibility set goals/objectives participation self-disclosure follow through/preparation persistence response to limit setting & discipline emotional reactance (shame, guilt, identification, remorse Are there ways to compensate? (e.g., meds, environment, devices, etc.) External Treatment Modifiers Last chance Family support Court mandate Least restrictive/document attempt More aversive alternatives Increased structure, consistency New treatment approaches Health concerns No other placement alternatives Intervening Risk Factors Suicide Homicide Violence to others Sexual assault Chemical dependency Fire setting Vandalism Impulsive, reckless, accident prone Runaway Brittle physical or psychological condition Trend of response Better/worse Previous gains insight skills behavior change How is current situation significantly different from previous treatment? Previous Response to Treatment Current Treatment Decision & Plan David X. Swenson PhD LP 2000

Treatment Considerations based on Expectancy Theory & Amenability
Instrumentality Valence Motivation Belief-Expectancy that s/he has the capacity to do it Belief that effort expended will improve performance & get a better reward The outcome or reward is valued or desirable Then…you get Low Self Esteem Negative Self Concept Low Self Efficacy External Locus of Control No previous experience (no opportunity, no role model, impoverished environment) Limited Capacity (unable to plan, integrate learning, transfer or generalize learning, inattention, etc.) Treatment Strategies high structure consistency uniformity explicitness immediate consequences positive reinforcement feedback & shaping reflective learning positive role modeling & vicarious experiences positive self appraisal & talk choices reward effort and persistence reasonable goal setting identify intrinsic interests in task learn resiliency increase constructive self attribution mastery experiences verbal persuasion reduced arousal (relaxation & reframing) Reward Structure initially immediate & continual then toward variable ratio current preferences (when possible) then shift to complete positive & prosocial small wins public recognition

Family Considerations in Determining Amenability
Family Treatment Response Family acknowledges problem & concern Family acknowledged expanded involved beyond identified patient Regular attendance to meetings Participation and involvement Self-disclosure of personal information/incidents Able to set goals and objectives Contributes to plans to change behavior Follows through with agreements and assignments Asks questions to clarify Amenability Rating: Poor Guarded Fair Good Excellent Family Relationship Strengths Parents present themselves as unified Consistency in rules and discipline Communication frequency, duration, clarity Positive involvement Nurturance & support Provide structure (boundaries, rules, consequences) Low amenability does not mean inability to benefit from treatment, but usually reflects: longer and more intense treatment highly integrated program higher complications and risks external leverage highly skilled staff very high structure

Formulating Treatment Outcomes
What are reasonable behavioral goals for attainment within the structure of the facility, capacity and style of the child, and time and resources allocated? Benchmarks What degree of change has the child demonstrated before (amenability)? What level is necessary for the child to return to the desired setting? What is the degree expected for similar children? Domains for Improvement Presenting problem Stated goals and objectives Underlying or tacit goals stakeholder’s goals Final Outcome Statements Criteria for treatment objectives increase or decrease or change the contingencies for a behavior’s frequency duration intensity pervasiveness

Offender Cycle

The Offending Cycle 1. Feels OK 16. Rationalizes, “forgets”
2. Trigger event 15. Distracts self from discomfort, gets busy The Offending Cycle 3. Feels victimized, used, betrayed, helpless, powerless, tricked, abandoned, takes victim stance 14. Feels fear of getting caught, shame, guilt 4. Gets angry, depressed, anger self directed, “bad me,” “ain’t it awful” Revenge fantasy becomes boring, thrill-seeking threshold increases 13. Feels re-empowered & relief 5. Withdraws from others, becomes isolated Gets caught, feels victimized, recycles 12. Assault 6. Build’s revenge fantasies, initially reduces intensity 11. Victim grooming: seeks & arranges opportunity to assault 7. Thinking errors justify revenge fantasies 10. Self destructive 8. Acts out revenge toward others 9. Thinking errors justify acting-out

Grooming Behavior Behavior to Gain Trust Reassuring to the Family
Gradual Erosion of Boundaries Construct Secrecy With Child Working to Secure Compliance

Victim Grooming Paying attention to a child who appears emotionally needy Talking about sexual issues, showing adult magazines or films, letting the child know s/he can come to you for sexual information or concerns "Accidentally" or purposefully exposing yourself (coming out of the bath, wearing shorts that allow a view of the genitals, openly praising nudity as "normal", etc.) Giving gifts, money, taking the child places, providing alcohol or drugs Telling the child that you need to examine his/her body for some reason Physical contact such as wrestling, tickling, pats on the butt, etc.

Not respecting the child's boundaries or privacy.
(Grooming cont’d) Intrusive questions about the child's sexual development, fantasies, masturbation habits, or giving the child more information about sex than is appropriate for the child's age or developmental level Bringing yourself down to the child's level of play (becoming the child's "buddy") Sharing inappropriate information about yourself or relationship problems, such as marital difficulties Not respecting the child's boundaries or privacy. "rules" that bedroom or bathroom doors must be open reading child's mail or diaries going through their possessions, etc. intrusive questions about the child's activities or friends beyond what is appropriate for a parent to do staring at the child or looking at his/her body in a way that makes him/her uncomfortable

Negative anticipation Power & control Thinking Errors
The Sexual Abuse Cycle Trigger Events Negative anticipation Avoidance Power & control Fantasy Sexual abuse Fugitive thinking Reframing Personalization distortion (poor me, victim stance, bad me, ain’t it awful) Hopeless distortion (it’s no use, I can’t do anything about it) Externalizing distortion (blaming others) Increased need distortion (control seeking) Offense Setup Planning Grooming, stalking Victim selection Opportunity Justification Objectification Superoptimism Decision to act Reinforcing distortion (affirm adequacy) Control distortion (I won’t get caught) Suppression distortion (it’s not a problem) Thinking Errors

Negative anticipation Avoidance Trigger Events
1: The Precipitating Phase of the sexual abuse cycle– initial cognitive and affective response to a problem, interaction, or occurrence; his sense of helplessness, dread, and hopelessness; and attempts to avoid the issue Negative anticipation (assumptions, expect the worst predictions) Avoidance (withdrawal & isolation, Stuffing, blocking out) Personalization distortion (poor me, victim stance, bad me, ain’t it awful) Hopeless distortion (it’s no use, I can’t do anything about it) Trigger Events (feel powerless, Negative self perception)

Externalizing distortion
2: Compensatory Phase of the Sexual Abuse Cycle– the youth attempts to compensate through nonsexual and sexual power-based behaviors and thoughts Sexual abuse (disclosure prevention) Externalizing distortion (blaming others, anger) Offense Setups planning victim selection grooming, stalking opportunity justification objectification superoptimism decision to act Power & control (attempts to dominate, control seeking, retaliations, must win, one-upmanship, overcompliance, intimidation, aggression, progression of control) Fantasy (retaliation fantasies, sexual fantasies, “sex would make me feel good”, mental rehearsal, sexualized perception) Increased need distortion (seeks more control)

Reinforcing distortion Fugitive thinking Control distortion Reframing
3: Integration phase of the sexual abuse cycle– youth’s efforts to assimilate the abusive behavior without self-deprecation. The process ends in suppression, which allows the youth to deny that the behavior is problematic or that he may be unable to prevent its future occurrence. Reinforcing distortion (celebration, affirming adequacy) Fugitive thinking (fear of getting caught, fear of consequences, false guilt) Control distortion (I won’t get caught) Reframing (Ambivalence, self-concern) Suppression distortion (I don’t have a problem, I’ll never do it again)

High Risk Cycle & Its Intervention
Trigger evokes lack of control or safety; helplessness, frustration, loss Express sensitive or vulnerable feelings & validate Denial– No problem Confront distortions, acknowledge reoffense risk Poor Me– Self as victim Acknowledge feeling unsafe Promises– Never again! Plan to succeed in managing behavior Hopelessness, distrust Challenge beliefs, help succeed, new experiences, teach skills High Risk Cycle & Its Intervention Anxiety– If I get caught Validate disappointment that good feelings of negative behavior don’t last Isolation, no input/feedback Closeness, listen, relaxing distractions Behavior compensatory, abusive, risk taking Label, express feeling, rules, consequences Anger masking vulnerability, control in power struggles Refuse to engage, label behavior & emotion, teach anger management, no aggressive outlets Decision, choice to offend Accountability, label bad choices, reinforce good choices Fantasy solutions of control, getting back Listen, self-nurturing & prosocial solutions Plan access & opportunity Supervise, prevent, limit access

Dealing with Denial & Minimization

Denial is functional decreases anxiety by avoiding thinking about offense, avoids social consequences (retaliation, rejection, ridicule, stereotypes) protects against legal consequences (prosecution, severity of sentencing, treatment & placement) protects against negative self perceptions (lack control, deviancy, “bad me”) protects against negative emotions of shame, embarrassment, fear, grief ego dystonic (unable to acknowledge even to self)

Tactics for reducing denial
confront offender directly about specific sexual acts demythologize stereotypes about sexual abusers support abuser’s genuine religious beliefs make fun of abusers excuses for the crime offer two incriminating choices ask specific details of the crime don’t allow time for careful reflection see denying clients at the end of the day assume the court’s verdict is correct get a detailed sexual and relationship history be sympathetic and understanding give the abuser excuses for doing the crime balance positive and negative feedback group pressure aversive behavioral rehearsal

Deniers’ Group Effects of victimization: challenge beliefs no harm was done or victim benefitted in some way Irrational beliefs about sex: information on irrational beliefs Sexual abuse in context of healthy sexual and relationship behavior: failed relationships is directly related to their deviant behavior & not external causes; there is hope for positive relationships with new skills Assertiveness skills: improve skills for getting communication and relational needs met; provides credibility for therapy How therapy works: information that Tx makes abusers feel less out of control, anxious, or fearful.

what would be compelling enough for you to disclose these details?
We all use denial You flunked a course, got a speeding ticket, got reprimanded or fired, had an affair, got caught shoplifting, used drugs, wasted money need for more important things, missed work, etc.– what was your response? what would be compelling enough for you to disclose these details?

Typical Stages of Disclosure
Disclose noncriminal information (name, grade, etc.) Recount dailt events & problems (teasing, frustrations, etc.) Admit things for which there is hard evidence (instant offense, past record) Nominal acceptance for life (admit role in deviant cycle, his half of the argument) Admit social/intellectual inadequacies (failings, weaknesses, etc.) Admit anonymous criminal behavior (past undisclosed untraceable crimes) More complete acceptance of criminal responsibility (admit choices) Admit destructive emotional, verbal, controlling behaviors & family secrets Admit profound personal vulnerability (deep fears, death, powerlessness) Fully admit personal responsibility for all aspects of life (empowerment)

denial works, only 14% of offenders feel guilt and remorse
offenders who completely deny are 3x more likely to fail treatment than those who even partially admit (Maletsky, 1991) people who fail treatment tend to reoffend at a higher rate than those who complete (MnDOC) treatment planning depends on the thoroughness of understanding of the contributing reactions and events surrounding offending denial pre-treatment is a type of treatment, and typically aids in lowering defenses and educating the person a grace period may be allowed during which time the offender may work toward acknowledgement before the alternative of more restrictive legal consequences educating family members and involving them in the alliance may facilitate disclosure

Chapter 3 – Denial and Distorted Thinking
Page 7 STRATEGIES FOR WORKING WITH OFFENDERS IN DENIAL: ・Explain the purpose of the interview and the possible outcomes. If conducting a pre-sentence investigation, inform the offender about who will have access to the report and how it is likely to be used. Explain to him that the court is typically more likely to consider probationary options for offenders who are willing to admit responsibility for their offenses than those who are not. Inform him that admitting responsibility also increases his likelihood of being accepted into a treatment program, which the judge may consider as an alternative to prison. Make sure he understands that the role of the probation officer at pre-sentence is to inform the court and make appropriate recommendations, but that the final disposition of the case is in the hands of the judge. ・If conducting a supervision interview, inform the offender that you are in a position to make ongoing decisions and recommendations about his case that will impact the degree of freedom and privileges he is allowed. Communicate a willingness to be supportive as long as Page 8 the offender is honest and willing to follow the supervision contract. Explain to him the risks/potential consequences of being uncooperative. ・Present yourself as a competent authority figure that is both knowledgeable about sexual offenders and has the power to influence court decisions and the offender’s freedom. While coercing an offender to be honest isn’t appropriate, some degree of pressure might be both helpful and necessary. ・Use your authority and communication skills to maintain control of the interview. Do not fall prey to the offender’s attempt to engage in arguments about his guilt or innocence. Stand firm that this is a legal issue and that his guilt has already been determined by the courts. If he wants to contest this he should address it with an attorney. The agent should insure that the focus of the interview is related to disposition planning and/or supervision issues. ・Communicate a willingness to listen and an understanding of offending dynamics. This will help facilitate rapport and encourage disclosure. ・Allow the offender to save face by giving him time to come back to an issue, avoiding punitive/shaming responses. If the offender has lied, communicate an expectation that he will be more disclosing and reinforce progress. ・Use written assignments and questionnaires. Offenders will often disclose information on paper that they are less willing to discuss face to face. ・Communicate a straightforward but respectful approach. Let the offender know that you want to “get down to business” and will be as direct and honest with him as you expect him to be with you. ・Start with easy, safe questions that will help to establish rapport and elicit cooperation. ・Ask open-ended questions, such as, “What happened next?”, “When did you first..?”, “How did you...?”, etc., rather than “Did you ever?”, “Was that the first time?”. ・Focus on the behavior, not the cause. How/when/where/what questions are likely to elicit information about the offender’s behavior and modus operandi. Why questions are more clinical and may compound defensiveness and externalization of blame. ・Assume more behavior than is evident at face value. Most sex offenders have a history of deviant sexual acting out which began long before they arrived at your doorstep. In addition, though offenders in denial will try to convince you that the victim is exaggerating or making things up, it is very common for victims to minimize the behavior perpetrated against them in a sexual assault. This is due to their own shame and denial. ・Discuss the use of the polygraph. One of the benefits of the polygraph is that the potential use of the polygraph raises the offender’s anxiety level and sometimes motivates the offender to “come clean” before the polygraph test is conducted. ・Explore the appropriateness of psychoeducational programming. Many treatment providers refuse to treat sex offenders in denial, claiming that there is nothing to treat if the offender is unwilling to admit he has a problem, or that the offender in denial is too great a risk to treat in a community-based program. Establishing admission criteria is the prerogative of the treatment provider. Some treatment providers however, will provide programming to offenders who deny their offenses. Typically, the type of programming provided to this population is considered pre-treatment and often includes a psychoeducational approach. This approach allows the offender to acquire a considerable amount of information about offending dynamics, defenses and sexuality, etc., with the expectation that he will benefit from the learning process and begin to lower his defenses. Often there is a grace period, after which an offender is expected to have demonstrated progress on working through his denial or face more restrictive, legal consequences. If this approach is considered, it is important that the offender understands how much time he will be allowed and what the agent’s recommendations will be, if he fails to progress in psychoeducational/pre-treatment programming.

Rationale for resolving denial
Helping victims. Acknowledgement of a crime helps victims and can remove the accusation that the offender is lying, and reduce guilt or stigma by taking responsibility Willingness to change. Acknowledgement shows willingness to change and indicates motivation to participate in treatment Admitting need for help. Acknowledgement shows need for help such that personal weaknesses, addictions, emotional instability, lack of social skills, and irrationality are revealed Standard for evaluation. Resolving denial helps evaluate progress and efficacy of Tx plan.

In a survey of 114 convicted rapists: Admitters (41%) Deniers (59%)
Victim meant “yes” though said “no” 25 33 Victim eventually relaxed & enjoyed the assault 20 69 Victims unsavory sexual reputation as excuse 22 Excused by alcohol intoxication 77 84 Emotional problems due to childhood abuse or unhappy marriage 40 D. Scully and J. Marolla, "Convicted Rapists' Vocabulary of Motive: Excuses and Justifications," Social Problems, 31 (1984):

Social/sexual desirability 26.09 29.75 Sexual obsessions 2.86 5.70
Average Scores on Subscales of the Multiphasic Sex Inventory (MSI) Before & After Treatment Subscales Pre-Tx Post-Tx Social/sexual desirability 26.09 29.75 Sexual obsessions 2.86 5.70 Lie scale 8.61 5.00 Cognitive distortions & immaturity 5.45 5.68 Justifications 3.70 1.97 Treatment motivation 3.88 5.50 N=22

No denial or minimization
Denial & minimization at Pre- and PostTreatment among men who denied their offence before treatment Pre-Tx (n=22) Post-Tx (n=22) Denial Denial of any interaction Denial interaction was sexual Denial interaction was offense 22 14 16 15 2 1 Minimization Of responsibility Victim blame External attributions Irresponsible internal attributions Of extent Frequency # previous convictions Force used Intrusiveness Of harm No long term effects 5 4 No denial or minimization

Controlling the offender’s external environment
electronic monitoring restriction from victim pool areas (elementary school playgrounds) nighttime curfew

Native vs. Non-native offender characteristics

denial hides, distorts, misrepresents, or falsifies problems thereby interfering with their resolution without truthful acknowledgement, the basis for the therapeutic relationship is lacking without acknowledgement there is no reason for the offender to change or participate even when acknowledgement occurs, cognitive distortions can have the same effect on resistance to change no one gives up denial until appreciating that truth is more advantageous understanding and accepting denial as a first stage is therapeutic never debate about who is right or wrong; instead identify the social & legal sanctions for sexual behavior

Basic guidelines for measuring treatment success include:
Offender ability to identify factors that contribute to the offending cycle Positive changes in or resolution of contributing factors of sexually abusive behavior Demonstration of empathy for victims Ability to manage stress and handle negative feelings Improvement in self-esteem Increase in positive sexuality Prosocial interactions and involvement with prosocial peers Openness in examining thought processes, fantasies and behaviors Ability to reduce and maintain control of deviant sexual arousal Reduction of deviant fantasies Ability to counter irrational thinking and thinking errors Ability to interrupt offense cycle and seek help when destructive, high-risk patterns of behavior occur Resolution of personal victimization or loss issues Ability to experience pleasure in normal activities Ability to communicate and understand behavior patterns in treatment and can carry them over to behavior in the home and the community Families’ ability to recognize risk factors (in youth’s offense cycle) and help the adolescent to seek help before he or she reoffends

Specialized needs for treatment
An individualized assessment and treatment plan Assistance in the acceptance of responsibility for their offenses An understanding of the sequence of thoughts, feelings, events, circumstances and arousal stimuli that makes up his/her "offense syndrome" Learning how to intervene in or break into one’s own offense pattern at the very first sign and call upon the appropriate methods, tools, or procedures that will suppress, control, manage and stop the behaviors from occurring again Replacement of antisocial thoughts and behaviors Building a positive self-concept based on new attitudes and expectations for self Learning new social and sexual skills to help cultivate positive, satisfying and non-threatening relationships with others A prolonged period of treatment that allows safe testing of new skills without the potential for affronting or harming members of the wider community Access to a post-treatment intervention for long-term maintenance of treatment gains

Why generic approaches won’t work
Erroneous treatment assumptions that include any of the following: The client is self-motivated (sex offenders tend to minimize, lie, and resist treatment more than other types of offenders) Families will make referrals for members in need of help (family self-presentation for sex offender treatment is rare) Outpatient treatment at the beginning of therapy is effective (the offender lacks the external controls to keep from reoffending) An individual approach to treatment is effective (individual therapy for sex offenders does not foster disclosure nor communication about their being accountable for their actions) Juvenile sex offenders are inappropriate for group therapy (confrontation by peers is essential to facilitating honest disclosure by the offender) The therapeutic relationship ends at the door to the therapist’s office (lack of collateral contacts increases the chances of relapse) Treatment should terminate when it is evident that the offender is unwilling to cooperate (leaves potential victims unprotected while the offender lacks the external controls to resist reoffending) Sex offenders can easily gain insight into their behaviors (sex offenders have more difficulty in understanding their behavior, in taking responsibility for their behavior, and in connecting their own sexual victimization and personal needs with why they are acting out in a sexually aggressive manner)

Treatment of Attachment Disorder
The earlier the intervention the better Self-soothing: breathing, relaxation, positive self talk Self-efficacy: strength identification Self esteem: positive attribute identification Empathy training: Discomfort tolerance Anger management Communication skills: assertiveness, listening Relationship skills: sharing, reciprocity, respect Caretaker holding & eye contact (controversial) Receive attention, value, respect, understood, responded to

Meds many medications used with adults produce adverse side effects and negative effects on normal growth and development in youths dysthymia & depression may have been present for years or reactive to adjudication. Consider whether reactive emotions should be reduced. Consider Cognitive Behavior Tx and antidepressant medication tricyclics have many side effects SSRIs may have sexual dysfunction side effects such as suppressed sexual desire and delayed ejaculation Wellbutrin: seizure risk (1%), good for ADHD & OCD (Zyban) Effexor: usually safe, no lab work, given bid Remeron: all at night, sedating, safe Trazodone: all at night, sedating & safe, priaprism risk, good combination with SSRI

Sex Education

offender knowledge is deficient on std’s, AIDS and safe sex

Deception & Lying

What do we know about lying?
60% of people lie, males more than females (3x), average 25 times a day Officers and general public hold misconceptions about lying behavior Uncovering lying is easier for younger, women, trained people Actors are better than non-actors, and practice improves lying Good liars may use details to make their stories believable, but may have to search for details, be inconsistent, or elaborate over time

Possible verbal indicators of lying
Expand contractions, stressing full-form verbs, such as "did not" and "could not," to convince people they're speaking the truth. Deny lying, making emphatic claims to be telling the truth, such as "I have no reason to lie." Pause and use nonword sounds during hesitations in their speech ("uh," "er" and "ah" are examples). Make speech errors and more frequent gaffes than people who speak the truth. Errors can include grammar, tense and losing thought in midsentence. Stutter, stammer and become tongue-tied. Clear their throats and make other noises. Use qualifiers and modifiers, explanatory words, such as "however," "sometimes" and "generally."

Possible nonverbal indications of lying
Avert their gaze, trying to avoid eye contact. Close their hands/interlock their fingers. Cross their arms as if creating a barrier. Drink and swallow more often than those who tell the truth. Use fewer hand gestures, staying stiff, controlling the movements of their hands. Shrug their shoulders and flip their hands over in an "open" (palms up) fashion. Perform hand-to-face grooming, touching their face, ears and hair. Handle objects, such as pens, papers and eyeglasses. Blink less than people who tell the truth. Do less finger pointing. Lean and shift — leaning forward, resting their elbows on desktops or their knees. They also shift often when sitting. Lick their lips often. Pucker and tighten their lips. Sigh and take deep breaths. Smile more and laugh inappropriately. Touch, scratch and rub their nose frequently.

NLP– the “eyes” have it Visual Constructed Image Visual Memory Self-Talk Recall Feelings Sensations Recall Sound

Analysis of Clinton’s testimony regarding Lewinsky affair
21 of the 23 indicators were clearly present, half the signs increased by more than 100% during truthful portions he did not lean at all, but during lying he leaned many times during a 16 minute segment of truthful testimony Clinton never touched his nose, but did so repeatedly while lying speech errors (1733%), stuttering (1444%), modifiers & qualifiers (402%), drinking & swallowing (355%), reduced blinking (268%), hand to face touching (250%), averting gaze (219%), expanded contractions (117%), leaning (100%), denials (63%),

How good a judge of lying are you?
Specially trained FBI, CIA, military agents– 56-73% Psychologists regarding safety– % Judges– 56-62% Officers– 56% General public– 50% Most people are not that much better than chance!

Obtaining confessions
Feigned sympathy and friendship. Appeals to God and religion. Blaming the victim or an accomplice. Placing the suspect in a soundproof, starkly furnished, room. Approaching the suspect too closely for comfort. Overstating or understating the seriousness of the offense and the magnitude of the charges. Presenting exaggerated claims about the evidence. Falsely claiming that another person has already confessed and implicated the suspect. Other forms of trickery and deception. Wearing a person down by a very long interview session.

False confessions 80% of crimes are solved due to obtaining a confession, but 5-11% are wrongful convictions 80% of suspects waive their right to have lawyer present during questioning, & innocents are more likely if you put somebody in a situation they believe is hopeless, and give them a choice between two bad options, you can get him to say just about anything repeated direct questioning of children can impose false memories of events (e.g., McMartin School abuse case) long interrogations involving deprivation of sleep, food or breaks, repeated & leading questions, use of threats, intimidation, and promises or incentives, use of profanity, derision and name-calling, officers' unyielding expectation of guilt and refusal to accept contradictory information.

More confessions… People who are mentally ill may confess for attention, unrelated guilt, confusion, intimidation People who are developmentally disabled, learning disabled, illiterate, retarded, very young, often have a strong desire to please authority figures and are easily influenced

The type to confess? In 1995 a study was conducted to see just who would confess to an offense they didn’t commit: Students were asked to type letters as fast as they could be pronounced by the speaker, but avoid the ALT key that would crash the system. One minute into the study it was made to crash– and the students were blamed– told that the researcher had seen them hitting the key. The researcher gave them a hand written confession and told them to sign, the result being a serious verbal reprimand from their senior advisor. 69% signed the confession 65% believed they were guilty 35% created erroneous details to fit their admission 28% believed they were guilty

Sex, lies, and…treatment
persons who are frightened, impressed by authority figures, vulnerable, mentally ill, or developmentally disabled are more subject to false confessions juveniles have confessed to assaultive behaviors and deviant fantasies in order to obtain discharge (Chaffin & Bonner, 1998)

Cognitive Restructuring

Yochelson & Samenow’s Tactics to Avoid Responsibility
1. Continually points out staff inadequacies 2. Builds self up by putting others down 3. Tells others what they want to hear rather than the truth 4. Lies by omission, by distorting the truth and by disclosing only what benefits self. 5. Is Deliberately vague 6. Diverts attention away from self be introducing irrelevant material and by invoking racial issues 7. Attempts to confuse others 8. Minimizes the situation, "I just got into a little trouble." 9. Agrees or says "yes" without meaning it. 10. Silence. 11. Pays attention only when it is self-satisfying. 12. Makes a big scene about minor points. 13. Puts off any obligation by saying "I forgot." 14. Puts others on the defensive by degrading, quibbling over words, trying to embarrass and using anger as a weapon. 15. Totally inattentive 16. Accuses others of misunderstanding. 17. Claims having changed by doing something right once.

Thinking Errors Irresponsibility is fostered by ten thinking errors. These errors exist in varying degrees in various individuals. The more extreme the degree of irresponsibility the more thinking errors are involved. Closed Thinking is not receptive is not self critical makes no self disclosures lies by omission is good at pointing out and giving feedback on the faults of others Victimstance views self as a victim (but not as the victimizer) Blames others (his/her family, childhood, social conditions, the past, etc.) Viewing Self As A Good Person focuses only on own positive attributes fails to acknowledge own destructive behavior builds self up at the expense of others Lack Of Effort is unwilling to do anything found boring or disagreeable Uses "I can't" which really means "I won't" Lack Of Interest In Responsible Performance finds responsible living to be unexciting and unsatisfying responds only if netting an immediate payoff no sense of obligation

6. Lack Of Time Perspective
does not use the past as a learning tool expects otheres to act immediately on demand decisions are made on assumptions, not facts 7. Fear Of Fear has irrational fears but refuses to admit them has a fundamental fear of injury or death has a progound fear of put downs experiences "zero state" (feels worthless when held accountable) 8. Power Thrust has a compelling need to be in control of every situation uses manipulation and deceit refuses to be dependent unless someone can be taken advantage of 9. Uniqueness thinks of self as different and better than others expects of others that which s/he fails to do cuts fear of failure with superoptimism quits at the first sign of failure 10. Ownership Attitude Perceives all people, places, and things as objects to possess Has no concept of the ownership rights of others Uses sex for power and control, not intimacy

Irrational Ideas Common misconceptions that lead to anxiety and hostility.
I must be loved and approved by everyone in my community, especially by those who are most important to me. I must be perfectly competent, adequate, and successful in achieving before I can think of myself as worthwhile. I have no control over my own happiness. My happiness is completely in the control of external circumstances. My past experiences and the events of by live have determined my present life and behavior. Therefore, the influence of the past cannot be eradicated. There is one right and perfect solution to each of my problems. If this is not found it will be devastating for me. Dangerous or fearsome things are causes for great concern. I must be prepared for the worst by constantly dwelling on and agonizing over the possible calamities. I should be dependent on others and must have someone stronger than myself on whom I can rely. If my life does not work out the way I had planned, it will really be terrible. It is easier to avoid certain difficulties and responsibilities than to face them. Some people are bad, wicked, villainous. They should be blamed and punished. One should become upset over the problems and disturbances of other people.

Self-Defeating Beliefs
Thoughts - Feelings Irrational thinking causes and sustains emotional disturbances. Rational thinking contributes to feeling good. Self-Defeating Beliefs Rational Beliefs #1: I have to feel the way I feel. And that's it. That's just me. I have no choice in the matter. #1: In any situation, I can choose to feel the way I want to feel. I do have a choice in the matter. #2: I can't accept myself without the love and/or approval of those I want it from. #2: I can accept myself without the love or approval of anyone. : If I don't do everything exactly right, or if I'm not the first, that proves I'm a worthless slob. #3: I can calmly accept myself regardless of whether or not I behave the way I want. #4: Other people or things outside of me make me feel the emotions I feel. #4: I, and I alone, cause all my emotional feelings so I'll just cause me to feel as good as I want. #5: If I don't like a job or the people or institution that requires me to do the job, they have no right to be mad at me or to punish me if I mess the job up or refuse to do it all together. #5: If I do well the jobs I don't like I'll keep myself out of trouble and help myself get some things I want.

Self Defeating Beliefs
Rational Beliefs #6: My way is the only "right," "correct," or "just" way to do things. #6: My way is just that, my way. Other people have their way and have a right to their way just as I do. #7: I should use all my abilities fully and achieve as much as I can. If I don't, I should feel guilty. #7: I freely choose to develop any of my abilities and to pursue any personal goals that I think I may enjoy #8: The way I act tells me what type person I am. (If I act foolishly then I am a fool.) #8: I am a human being.Our behavior does not define who we are #9: I have to feel bad if the person I love leaves me or dies. My willingness to suffer proves how much I loved that person. If I don't feel bad, that proves I never really loved that person in the first place. #9 My being upset over a loved one leaving me or dying only proves that I have upset myself. My being upset has nothing to do with how much or how little I loved that person.

Self Defeating Beliefs
Rational Beliefs #10: I can't accept myself unless I'm married, have friends or am loved by really worthwhile people or unless I'm involved in a cause that's greater or more worthwhile than I am. #10: I can calmly accept myself regardless of who I am, who I'm married to, going with, or who I know. I'm with other people just some of the time. But I can't ever get away from me. #11: I just have to be upset if people (especially those close to me) don't behave the way they should. #11: I can calmly accept the fact that each person should follow his or her own mind because that's all they can do. If others disagree with me, then I can try to influence them to change their minds and I'll usually do a much better job of influencing them if I refuse to get upset, angry and depressed. I don't have to get upset if others don't change their minds.

Double Messages Double messages we received growing up in alcoholic/dysfunctional households.
LOVE vs.EJECTION: "I love you but don't bother me." In adult life we are attracted to relationships where we are rejected, because we equate love with rejection. We are used to being abandoned either emotionally or physically. YOU CAN COUNT ON ME vs.DISAPPOINTMENT: "I'll be there for you... Next time." Our parents wanted credit for their good intentions, but didn't want their disappointing behavior to count. We learned not to want or expect things. We deny our needs because we don't want to be disappointed when our needs aren't met. We don't depend on others. ALWAYS TELL THE TRUTH vs.I DON'T WANT TO KNOW: We were told to tell the truth...as long as it was what our parents wanted to hear. Truth became an ideal, lying the reality. In adult life we lie automatically (without guilt) even when telling the truth would be easier, or we become super honest. EVERYTHING IS FINE vs.A SENSE OF HOPELESSNESS: We were told that everything was fine or would be alright, but the family atmosphere was one of hopelessness, depression, and anxiety. Everything is not alright. We now suffer from distortions in our perceptions of reality, we feel powerless over our lives and are often depressed and distrust our own judgment. BLAME THE ALCOHOLISM vs.EXCUSE THE BEHAVIOR: The alcoholic parent did some negative or irresponsible behavior, like embarrassing us in front of our friends, and we were told by others not to get mad at the parent. "It wasn't his fault. He was just drunk." Or, "He just has a disease." We learned that "If I am drunk, I can do whatever I want." MY DAD IS WONDERFUL vs.MY DAD IS A DRUNK: Friends told me how lucky I was to have such a fun father. They never saw him angry or abusive, and they didn't believe me when I tried to tell them. I AM RESPONSIBLE vs.I AM NOT RESPONSIBLE: We were told that if we were good our parents wouldn't have to drink. But even when we were as good as we knew how, it didn't work.

What Characteristics Distinguish Single and Repeat Sex Offenders?
Poor social skills Learning problems Deviant sexual experience Deviant sexual fantasies Cognitive distortions

Time-bomb tactics in Thinking Errors
Shifts Blame or Focus 1. Attempts to confuse 2. Points out others’ faults 3. Builds self up by putting others down 4. Makes a big scene over minor issues 5. Accuses others of misunderstanding 6. Uses anger as a weapon to control others 7. Argues over “words” to avoid the real issues 8. Introduces irrelevant issues (race/gender) 9. Puts others on the defense by embarrassing Lies and Deceives 10. Deliberately vague 11. Avoids obligations (by saying “I forgot”) 12. Tells others what they want to hear not the whole truth 13. Omits facts; reveals only what pleases self 14. Says “yes” without meaning it Ignores obligations 15. Does not pay attention 16. Chooses only what is self-gratifying 17. Refuses to communicate or participate – silence 18. Minimizes behavior (I just got into a little trouble) 19. Says “I’m changed” after one right thing Time-bomb tactics in Thinking Errors (Spon, 1999, p.35)

Effectiveness of Corrective Thinking
High risk clients 66% reduction in crime for those who completed the program. 33% reduction in crime for those who entered but did not complete. 48% of all clients pursued no new crime. 29.4% exhibited a decrease in crime. 6.4% showed no change. 15.6% exhibited an increase in crime. Average number of criminal charges: Reduced by slightly over 50% for all clients who entered the program. Reduced approximately 66% for those who completed the program. Reduced by approximately 33% among clients terminated before completion. Reduced 79.17% for those who completed and had no previous arrests. Reduced 36.36% for those who terminated prior to completion with no prior arrests. Truthought's Corrective Thinking Treatment Model includes four studies done by University of Wisconsin, US Department of Justice National Institute on Corrections, US Department of Justice Bureau of Justice Assistance ( )

Covert Sensitization Clearly identify the target scene: Client imagines himself engaging in the undesirable behavior. Identify the aversive imagery: When vivid, inappropriate imagery is switched to an aversive consequence associated with the behavior Parental shock & hurt Police arrest Court trial Peer rejection The purpose is to build up an aversion to what previous was an attractive stimuli The client does not have to engage in the behavior, only imagine it

Sample self-talk during covert sensitization imagery
"I call her over to my car. She doesn't see what I'm doing. I say 'Can you please help me with this?' She looks down and sees my erection. It's hard and she's really shocked. Her face looks all kinds of distorted. I quick drive away. As I drive away I see her look back. I think 'Oh, shit, she's seen my license plate!' I begin to worry that she might call the police....I get home and I'm still worried. My mom keeps saying 'What's wrong?'...As we all sit down to dinner I hear a knock on the door. I go open it, and there are four police officers. They come charging in and throw me up against the wall and say 'You're under arrest for indecent exposure!' My mom starts to cry and says 'This is it! This is the last straw!'" can be effectively used in pedophilia, paraphilias, sadistic, and exhibitionistic behaviors effects have been maintained up to 8 weeks after treatment (may be undone by continuing inappropriate imagery); 75% success rate

Olfactory Aversion / Assisted Covert Sensitization
Identify target imagery When imagery is vivid expose client to ammonia or similar aversive odor capsule Paired presentation of aversive odor and imagery makes imagery aversive Vicarious sensitization Auditory or video tape of deviant arousal (rape) to evoke deviant arousal Followed immediately with audio/videotape of aversive video vignette (negative social, emotional, physical, legal consequences of behavior) 300 trials over 25 sessions showed JSO’s reduced arousal over 3-month follow-up Wallet cards with labels of 31 aversive vignettes were used to remind clients if they became inappropriately aroused elsewhere

Masturbatory Satiation
Client is instructed to masturbate to appropriate imagery Following orgasm and during resolution phase, continue masturbation to imagery of very narrow but highly arousing deviant fantasy. Deviant fantasies become associated with boredom and lack of sexual pleasure Masturbatory or Orgasmic Reconditioning Initially aroused by inappropriate imagery During high arousal and orgasm, switch to appropriate imagery Appropriate imagery becomes associated with pleasure

Empathy

Emotional Intelligence Skills (Goleman)
Self Awareness: Knowing one’s internal states, resources, and limitations Emotional awareness: recognizing one’s emotions and their effects Accurate self assessment: knowing one’s strengths and limits Self confidence: strong sense of self worth and capabilities 2. Self Regulation: Managing one’s internal states, impulses and resources Self control: keeping disruptive emotions and impulses in check Trustworthiness: Maintaining standards of honesty and integrity Take responsibility for personal performance Adaptability: Flexibility in handling change Innovation: Being comfortable with new ideas 3. Motivation: Emotional tendencies that guide or facilitate reaching goals Achievement drive: striving to improve Commitment: aligning with the goals of the agency or group Initiative: Readiness to act on opportunities Optimism: Persistence in pursuing goals

Empathy: Awareness of others’ feelings, needs, perceptions and concerns
Understanding others: Sensing others’ feelings and concerns Identifying their development needs: bolstering their abilities Service orientation: recognizing and meeting users’ needs Political awareness: Reading a group’s emotional currents and power relationships 5. Social Skills: Ability to induce desirable responses in others Influence: ability to persuade Communication: listening openly Conflict management: negotiating and resolving disagreements Change catalyst: Initiating and managing change Building bonds: nurturing key relationships Collaboration and cooperation: working with others towards shared goals Team capabilities: Creating group energy in pursuing collective goals

Essential Components of a Moral Self Core
Empathy (2-7 yrs): see from other’s perspective Sympathy: sorrow for another person’s distress Remorse: regret & sadness at one’s role in another’s pain Anxiety (5-11 yrs): apprehension about violation of other’s standards Guilt (3-4 yrs): signal to repress impulses so not to offend or upset another; includes regret over actions Shame (1-2 yrs): Inner sense of not meeting expectations Embarrassment (3 yrs): expansion of shame involving standards of others and fear of judgment

Development of Empathy
Year 1: Global Distress chain reaction when other infants cry Year 1-2: Egocentric Empathy Imitative distress & behavior of another child; concern for others & try to comfort them Year 2-3: Empathy for Other’s Feelings Empathy with distress, disappointment, fear, surprise, sadness, anger, enjoyment Year 3-8: Empathy for Other’s Life Conditions Imagine pain/pleasure of remote persons & groups

Parental contribution to empathy
Secure attachment & nurturing: responsiveness to infant, available, sensitivity, consistency Take children seriously: respect feelings, preferences, questions Practice cooperating: demonstrating collaboration rather than competition Guiding & explaining: value sharing, caring, helping, explain why prosocial behaviors are important and appreciated, how aggressive and selfish behaviors harms others, intervening when child is selfish or cruel, explain how others feel Modeling: generosity, charitable to others, practice what preached, small acts of kindness Promoting and praising prosocial self image: encourage opportunities to experience caring & helping, view self as caring and helping, volunteering, internal rather than external locus of control for altruism

Impact of sexual assault on victims
36% require medical attention; 19-22% have genital trauma, 25-45% nongenital trauma over half lose 1-5 days of work (10% 6-10 days) up to 40% contract STD’s 1- 5% get pregnant (32,000 annually) more likely use of alcohol, tobacco, cocaine unhealthy weight control coping, eating disorders (26% bulimics) 9 months later 30% still present PTSD engaging in promiscuity & risky sexual behavior more vulnerable to STD’s prone to anxiety & depression seriously considering and attempting suicide (13x) 4-6 times more likely to become pregnant increased level of sexual dysfunction increased physician use (18% during, 56% 1 year later, 31% second year) 25-50% receive some type of mental health treatment chronic shame, guilt compulsive behaviors relationships distancing & mistrust Rape survivors 3.4 times more likely to use marijuana, 6x cocaine, 10 times other major drugs

In order to experience empathy:
must be aware of other’s as persons rather than objects awareness and labeling of other’s reactions and associated feelings value and care about the other person identify and see things similarly to the other person consider similar feelings in yourself feeling response to other persons Empathy Training recognition and labeling of facial expressions & feelings identifying situations that elicit feelings locate physical feelings and their expression in the body role taking with others: what is it like through their experiences watch movies and explore the feelings explore empathic responses: how to express compliments, sympathy, support, encouragement, reassurance, calming, etc.

Teenage Pregnancy and Sexual Assault
62% of pregnant and parenting adolescents had experienced contact molestation, attempted rape, or rape prior to their first pregnancy. 61% of pregnant teenagers had had an unwanted sexual experience. 74% of women who had intercourse before age 14 report a history of forced sexual intercourse. Between 11% and 20% of girls were pregnant as a direct result of rape. 23% of women who were victimized were pregnant by their perpetrator. Girls victimized prior to their first pregnancy were more likely than girls not abused to: have voluntary intercourse earlier use or have problems with drugs/alcohol or have sex partners who use drugs/alcohol have sex partners who are older have had an abortion have second and third pregnancies have been in a violent relationship have experienced emotional abuse or physical maltreatment in childhood have experienced repeated victimization in the past year have had a sexually transmitted disease (Boyer & Fine, 1993)

Treatment Attachment Disorder

Internal Working Model & Types of Attachment
Adjustment: low self efficacy, low confidence, emotionally expressive & labile, intense, too close too fast, inconsistent, dominating, controlling, unsatisfactory intimacy, jealousy, obsessive, compulsive, idealizing, oversensitive, shame prone, deficient problem solving, dislike authority & rules, self-defeating, Offenders: nonthreatening, seek immature victims, groom over time, quasi-romantic relationships, borderlines Internal Working Model & Types of Attachment Self Others + _ Secure Preoccupied Anxious- Ambivalent Avoidant- Fearful Dismissive Adjustment: self blame, not seek or accept help, fear rejection, fear disclosure & closeness, lack trust, emotionally aware but unexpressive, passive, superficial intimacy, not recall childhood, hypervigilant Offenders engage in impersonal, single contact sex, acquaintance rape, cruising Adjustment: uncaring, avoid closeness, non-disclosing, high confidence, aloof, indifferent, impatient, shallow, vain, hostile, arrogant, grandiose, reject treatment, selfish, controlling, AODA, vengeful Offenders: coercive & assaultive, no guilt, remorse, shame; narcissistic, psychopathic (Bartholomew, Shaver, et al.)

Treating Impaired & Disabled Offenders
If ability to benefit from treatment is moderated by a condition, first treat the condition (e.g., ADHD, depression, psychosis, etc.) When ability to benefit from standard treatment is moderated by a capacity limitation, accommodate to the limitation (FAE/FAE, low IQ, PDD, etc.) Very limited clinical and research information is available regarding developmentally delayed offenders in general: recognize the specific limitations (e.g., not read social & facial cues, not generalize from situation to situation, etc.) concrete examples and demonstrations repetition, repetition, repetition behavioral approach rather than insight oriented protect vulnerabilities from others use of environmental structure & supports

Session 3, May 15 Relapse, family, and therapist considerations

Ethical considerations for Therapists
Risk of burnout discomfort in dealing with intimate issues concern about risk/litigation working outside knowledge area elicitation of personal issues how to tell when it’s getting to you dreams, thoughts about client avoidance of people or topics intense feelings (disgust or arousal) fatigued going to work doing more for one client than others sick days, feel unwell variable work quality intense feelings personal crises similar to client issues use of supervision & peer consultation self care & stress management

Therapist considerations

147 children treated in University of Oklahoma Health Sciences Center Program
pubs/otherpubs/childassessment/

Juvenile Offender Relapse & Recidivism
Recidivism ranges from 10-40% with average of 10-20% What is the likelihood that a specific offender will commit subsequent sex crimes? Under what circumstances is this offender least likely to reoffend? What can be done to reduce the likelihood of reoffense?

Family & FACES

Effective intervention with juveniles & families is essential:
Only 2-4% of adolescents are responsible for most sexually assaultive behavior Nearly ½ million youth each year are involved in violent crime About 63% of youthful sex offenders have committed nonsex offenses 40% of the offenders who victimized children under age 6 were juveniles Youths <18 account for about 10% of all sex related murders; 27% of child sex homicides JSO’s are responsible for about 20% rapes & 60-80% of child molestation Adolescent offenders often have a history of multiple victims prior to their first arrest. The average number of victims is 7 with some offenders having as many as 30 or more victims in their past. Adolescents who have been physically abused are 7.6 times more likely to rape or sodomize other children compared to sexually abused adolescents Patterns of aggression set by age 8 often continue into adulthood

Note: low ratings on these does NOT mean a person is Untreatable—
Estimating Amenability: engagement in treatment Acknowledgement: acknowledges that a problem exists Accountability: accepts personal responsibility for offense Goal setting: defines well-formed goals/outcomes Goal attainment: can identify benefits of previous interventions Self disclosure: discloses relevant personal information Attendance: regularly attends treatment; timely Participation: contributes relevant comments, reactions, insights, Insight: identify connection between events, motives, and behavior Affective response: shows guilt, remorse, embarrassment, shame, etc Limit setting: responds to directives and imposed restrictions Planning: formulates and follows recommended behavior change Positive role taking: provides support, encouragement, confrontation to others Feedback: listens to, considers, and experiments with feedback Follow through: completes behavioral assignments thoroughly and on time Note: low ratings on these does NOT mean a person is Untreatable— just that they will likely require more time, effort, skill, and staff to effectively treat.

Ability: capacity, intelligence, deficits (FAS/FAE, PDD, ADHD, etc…
Amenability to Treatment: To what extent is a client able & willing to productively participate in treatment? High Limited: Willing but Unable Motivated: Willing & Able Motivation: willingness, enthusiasm, initiative, follow though, disclosure, effort, risk taking, etc… Incapacitated: Unwilling & Unable Resistant: Unwilling but Able Low Low High Ability: capacity, intelligence, deficits (FAS/FAE, PDD, ADHD, etc…

Treatment considerations based on expectancy theory & amenability
Then…you get Impulsive ACT! Motivation Rational Expectancy + Instrumentality + Valence Belief that effort expended will improve performance & get a better reward The outcome or reward is valued or desirable Belief-expectancy that s/he has the capacity to do it Low self esteem Negative self concept Low self efficacy External locus of control Treatment Strategies high structure consistency uniformity explicitness immediate consequences positive reinforcement feedback & shaping reflective learning positive role modeling & vicarious experiences positive self appraisal & persistence choices reward effort & persistence reasonable goal setting identify intrinsic interests in tasks learn resiliency increase constructive self attribution mastery experiences verbal persuasion reduced arousal (relaxation & reframing) Reward Structure initially immediate & continual toward variable ratio current preferences (when possible) then shift to complete positive & prosocial small wins public recognition No previous experience (no opportunity, no role model, impoverished environment) Limited capacity (unable to plan, integrate learning, transfer or generalize learning, inattention, etc.) Victor Vroom, Expectancy Theory

Olson’s Circumplex Model of Family Systems
Cohesion Adaptability Disengaged Separated Connected Enmeshed Rigid Structured Flexible Chaotic Chaotically Enmeshed Disengaged Rigidly Balanced Families

Behavioral Aspects of the Circumplex Dimensions
Cohesion Behavioral Aspects of the Circumplex Dimensions Disengaged Separated Connected Enmeshed individual decisions separate spaces low interaction little consideration emotional detachment unaware of others separate lives low loyalty in each others business limited outside family speak for each other emotional contagion no privacy over dependency subordinate to group excessive loyalty lack leadership role ambiguity role shifts labile emotions inconsistent decisions erratic discipline too much change no accountability autocratic leadership strict discipline role rigidity too little change unaware of development rigid control imposed decisions dogmatic limited consequences Rigid Structured Flexible Chaotic Adaptability

Treatment Strategies for the Circumplex Dimensions
Cohesion Treatment Strategies for the Circumplex Dimensions Disengaged Separated Connected Enmeshed To decrease disengagement: build shared goals cooperative tasks family meals, activities current updates appreciate styles family album To decrease enmeshment & foster independence: teach limits define & enforce privacy outside friendships drive wedges speak for self individual differences distinguish differences conflict and controversies To reduce chaos & increase order: clear & consistent roles explicit & written rules clear decision hierarchy parental unity accountable for behaviors Rigid Structured Flexible Chaotic Adaptability To reduce rigidity & increase flexibility: distribute power & decision making substitutes & neutralizers discuss & vote discuss consequences of imposed rules new family rules paradoxically overcontrol

Making the best of a worst situation
Poor response to intervention by family Apprehension & Fear Skill Needed Psycho- pathology Personality Disorder reassurance encouragement patience third party worse future parenting communication conflict stress style marriage counseling personal counseling medication mgt. anger group CD treatment Court order parents to Tx contact conditional on Tx supervised contact in-home Tx clear, explicit, written rules & consequences incident monitoring (“paper trail”) revised visitation Termination of Parental Rights (TPR) increase involvement with positive role models outside of family (e.g., sports, church, clubs, etc.) increase out of family activities extra-family support system orient toward future goal attainment remove child (foster placement, extended family) help child understand limitations, personality, adjustment problems of family members Parents Making the best of a worst situation Juvenile

Treatment complicating and interfering factors of families of JSO’s
parental limitations: developmental, intellectual, physical, psychological disabilities parental criminal lifestyle not believe in treatment or medication may have inappropriate stimulating material in home (e.g., porn, overt sexuality) marital conflict, side-taking, manipulation unstable adult/parent figures (e.g., passed around, multiple live-ins) resistance to & mistrust of intervening agencies inconsistent parenting style alcohol/chemical abuse not acknowledge child’s needs or behavior problem not acknowledge their role in contributing to or resolving the problem blaming the child and denying focus on their personal or marital problems minimizing the significance of the offense passive compliance (agreeable in meetings but not follow through) continuing emotional, physical, sexual abuse at home threaten or guilt child into non-disclosure about family problems defensive stance due to pending court action Note: be careful of over/under-pathologizing families

Treatment complicating and interfering factors of families of JSO’s
parental limitations: developmental, intellectual, physical, psychological disabilities parental criminal lifestyle may have inappropriate stimulating material in home (e.g., porn, overt sexuality) poor marital relationship, conflict, side-taking, manipulation unstable adult/parent figures (e.g., absentee, passed around, multiple live-ins) resistance to & mistrust of intervening agencies inconsistent parenting style alcohol/chemical abuse not acknowledge child’s needs or behavior problem not acknowledge their role in contributing to or resolving the problem blaming the child and denying focus on their personal or marital problems minimizing the significance of the offense passive compliance (agreeable in meetings but not follow through) continuing emotional, physical, sexual abuse at home threaten or guilt child into non-disclosure about family problems defensive stance due to pending court action

Recidivism & Relapse

The problem with Base Rates in determining recidivism
The overall rate of recidivism for a known entire group of offenders (e.g., if a group has a base rate of 40%, without any other information one could predict a 40% chance of recidivism) There is very wide variability in results of recidivism studies Lack of reporting, or underreporting, is higher in crimes of sexual violence than general criminal violence To a large degree, differences can be explained by variations in the sample of sex offenders involved in the studies A low recidivism rate would be very difficult to improve There may be higher base rates among certain types of offenders The time over which recidivists are monitored may affect rates

Treatment Attritrition Rates– High and a predictor of recidivism
Becker (1990) found that only 27.3 percent of her sample attended 70 to 100 % of scheduled therapy sessions and only 45.4 % completed at least half of the sessions. Kraemer, Salisbury, and Spielman (1998) reported that completion rates for residential juvenile sex offender programs in Minnesota appeared to range from % Rasmussen (1999) found that only half of the subjects in her sample completed the initial stage of their treatment and 33% failed to complete the full course of treatment once began Schram, Milloy, and Rowe (1991) found that most offenders terminated treatment as soon as their sentence or court order ended. Only 39 % of their sample completed treatment. Hunter and Figueredo (1999) reported that more than 50 % of the subjects in their sample terminated or were terminated from treatment during the first year; more than 75 % were terminated because they were noncompliant with attendance and therapeutic directives.

Duration of follow-up in determining recidivism is also important– Over short term, rapists appear to offend more; over time, child molesters have a higher failure rate than rapists

different types of sex offenders
Falling off the wagon: Recidivism Rates for different types of sex offenders Rapists ranged between 7 and 35 percent. Incest offenders ranged between 4 and 10 percent. Child molesters with female victims ranged between 10 and 29 percent. Child molesters with male victims ranged between 13 and 40 percent. Exhibitionists ranged between 41 and 71 percent. Juvenile rates in specialized programs 7-13% over 5 years Juveniles respond well to cognitive-behavioral & relapse prevention with re-arrest rates of 7% over 5 years Juvenile nonsexual recidivism rates are higher than sexual recidivism by 25-50%

Janus and Meehl (1997) report a 25-40% lifetime sexual re-offending rate. Prentky et al (1997) describe a follow-up period of 25 years with a subject pool of 251 sex offenders, in which 39% of the 136 rapists and 52% of the 115 child molesters in the study were charged or convicted of a sexual offence over the 25 year followup. Soothill and Gibbens (1978) estimated a 23% reconviction rate over 22 years. Static – historical and unchanegable, such as previous offence history · Dynamic (stable) – potentially changeable but relatively stable, such as personality characteristics · Dynamic (acute) – features which can change rapidly such as mood or intoxication Fisher and Thornton (1993) reported a simple but powerful algorithm for predicting sexual recidivism for convicted sex offenders which combined four elements: · Any previous sexual convictions · Four or more previous convictions of any kind · Any conviction for non-sexual violence · Sexual convictions involving three or more different victims · High score on the Psychopathy Checklist – Revised (PCL-R) (Hare,1991)

House Rules & Boundaries for Offenders
no unsupervised access to children & avoid usual play places offender has his own sleeping room offender will not have company in his room without supervision bathroom door is closed when occupied & offender not allowed in everyone will be completely dressed before leaving bathroom all family members will model acceptable rules of touch hugs will be asked for with the opportunity to decline grabbing or touching private parts is unacceptable wrestling, tickling, back rubs and sitting must all be supervised

Hare’s Psychopathy Checklist
Abel et al (1988) found five predictive factors for child molesters: · Assaulting both boys and girls · Committing both contact and non-contact abuse · Assaulting both family and non-family members · Failure to accept increased communication with adults as a goal · Being divorced Quinsey and Harris (1991) found five predictors for extrafamilial child molesters follow up for an average 6.3 years of opportunity to offend: · offender ever having been married · previous prsion admissions · previous property convictions · diagnosis of personlity disorder · deviant sexual preference for children (using PPG) In summary sexual reoffending is associated with: · static predictors within the criminal history – number and type of offences and victims · stable dynamic predictors, most powefully psychopathic personality as measured by the PCL-R, and deviant sexual arousal as measured by PPG · acute dynamic predictors, notably negative emotional states, poor interpersonal/self management and poor social support

Therapist considerations

Wanted : Sex Offender Therapist
To work extensively with a sex offender caseload. q Listen to the darkest stories of humanity. q Deal with ongoing criticism from the media, the community and co-workers Open yourself up to lawsuits. q Prevail with dishonest and manipulative clients, dysfunctional families, scared and distressed victims as well as perpetrators. q May be subject to unwanted and intrusive deviant thoughts and dreams. q May have other toxic effects on psyche, not described above.

Identifying Manipulation
q When you think someone is doing well in treatment - take a closer look q When the offender asks you to something that he could do himself q When the offender tries to be your buddy or co-therapist q When you think you are the only therapist / provider who can deal with the offender q When you think an offender won’t hurt you or will protect you q When you advocate lessened consequences for an offender’s behavior q When you give in to an offender’s demands in order to get him off your back q Anytime you depend on an offender for help q When you allow an offender to “shop” for a therapist q When your decisions are influenced by a lawsuit or potential lawsuit q When you question the offender’s conviction q When you accept offender’s version of an unfair situation without checking with others q When the offender compliments you - “You’ve helped me so much.” q When you believe the victim or family bears some responsibility for the offender’s behavior q When you think the offender is more dependable than staff q When you think you can predict what the offender will do q When you think the offender will not re-offend q When you think certain parole conditions should not apply to a sex offender

households and many had families with substance abuse and mental health
problems. One study of male adolescent sex offenders found that: 53 •97% had never been hospitalized for a psychiatric disorder; •72% were never arrested for non-sexual crimes; •79% had been arrested for a prior sex offense; •63% were pedophiles; •18% were sexually abused as children. A study of 1,616 youths who were recognized or had a record as sexually abusive to other youths found: 54 •41% reported they had been victims of physical abuse; •39% reported they had been victims of sexual abuse; •68% of these abuses involved penetrating and/or oral-genital behavior; •62% expressed little or no sympathy for their victim; •51% expressed no remorse or guilt; •91% of the victims were 3-6 years old, with an average age of 7.7 years; •38% were relatives of the abuser; •33% blamed the victim for the offense. Approximately 50% of adult sex offenders report their sexually deviant behavior began in adolescence.55 Mothers of adolescent incest perpetrators were significantly more likely to have been sexually victimized as children than other mothers.56 Adolescent offenders seem to show all of the same variations of sexually abusive behaviors, as do older offenders.57 In general, less violence is used by adolescent sex offenders than by adult sex offenders. A victim of an adolescent offender is 1/3 as likely to have had a weapon To be formatted Between the arrests of children under the age of 12 years old have increased 125% for sex offenses (excluding rape) and 190% for forcible rape.35 In 1992, the State of Washington’s Department of Social and Health Services published a report identifying 691 sexually aggressive youth in state custody, 33% of whom were under the age of In Vermont, reported sexual abuse by children under the age of 14 increased 300% within 10 years. More than 40% of known child abusers that came to the attention of authorities were under the age of In a Utah survey of all sexual abuse perpetrators, 43% were youth under the age of 18, with 18% being under the age of 40% of all sexual abuse of children is committed by youth under the age of 30% of sexual assault of adults is committed by offenders under the age of The arrest rate for year olds accused of sexual assault doubled between 1976- 86. 41 Adolescent sex offenders had committed an average of 6.8% sexually abusive acts.42 Most adolescent sex offenders (61%) abuse more than one victim.43 The average adolescent sex offender abuses seven victims, with some juveniles disclosing as many as 30 or more victims. Many perpetrators abuse the same victim more than once.44 26% of adolescent sex offenders had been victims of, or witness to sexual abuse in their families. This abuse included incest, prostitution, and forced observation of sex between adults.46 In a study at one prison: 47 •57% of incarcerated incest offenders were sexually abused as children; •14% were abused by at least one parent; •17% were sexually abused by a sibling; •9% were abused by another relative; •17% were abused by some one outside the family; •37% cited a climate of violence in their childhood homes. Pedophilic youth molest children, usually female, who are significantly younger than they, and commit their first offense between ages 6-12. •Adolescent sex offenders tend to molest females closer to their own age and usually commit their first offenses between ages 13-15; 60% of the youths were white; 59% came from lower socioeconomic settings; 78% of the sexual assault offenders and 44% of the pedophilic offenders came from single parent

Risk Level Determination
Low Risk: Reference offense: non-violent, non-threatening, noninvasive; 1-3 incidents within 6 months Criminal history: none or minor property or status offenses (e.g., shoplift) Psychosexual: exploratory, immature, poor social skills, impulsivity, unplanned, no paraphilic interests, not hostile toward females, age appropriate sexual interests, youth acknowledges, takes responsibility, and motivated to participate in program Other psychological problems: no other pervasive, serious, or long-standing problems; mild to moderate depression/anxiety; may have learning or impulse problems Family system: family stressed but not dysfunctional; parents support & cooperative with treatment; supervision may be a problem Previous sex offender treatment: none Prognosis for community-based care: good

Moderate Risk Reference offense: involved trickery or mild verbal or physical coercion, but nonviolent & no injury; no planning; involved exposure, fondling, oral sex, or simulated/attempted intercourse; victim was family member or acquaintance; 6-12 month duration with multiple incidents; youth may not admit or take full responsibility, but willing to participate in treatment Criminal history: may have prior arrests for non-violent, non-sexual offenses Psychosexual profile: poor social skills & competencies; age-appropriate interests with no paraphilias or anger toward females; empathy not well developed; offense began during adolescence Other psychological: more pervasive psychological problems but less severe & short duration; impulse control & judgment problems; conduct disorder, AODA experimentation; few friends or less serious delinquent peers Family system: moderately dysfunctional, maltreatment, antisocial or violent exposure; parent(s) with AODA, parents minimize behavior or feel overwhelmed to control; parents acknowledge problem & generally supportive Previous sex offender treatment: none Prognosis for community-based care: fair to good depending on degree of problem, availability of family and community supports, & attitude to treatment

High Risk Reference sexual offense: invasive with threats or force, planned, multiple incidents, use of weapon, victim injury, victim stranger, no remorse or guilt; denial, no responsibility, no motivation for treatment Criminal history: prior aggressive sexual or nonsexual arrests Psychosocial profile: long standing paraphilias and aggression; pedophilic & compulsive behavior; rape myths & misogynistic fantasies; multiple victims starting at early age; progression in severity & frequency; diminished empathy & evidence of psychopathy Other psychological: serious longstanding pervasive maladjustment; long history of delinquency & aggression starting in early childhood; repeated mistakes & not learn from experience; poor impulse control & judgment; conduct disorder; superficial, loner, or delinquent peers Family system: highly dysfunctional; exposed to violence at early age; parental AODA or criminal behavior; support youth’s denial with low motivation to support treatment or cooperation Previous sex offender treatment: none or unsuccessful treatment Prognosis for community-based care: poor to guarded

Koerner & Fawcett Continuum of Criminal Behaviors
Responsible Irresponsible- nonarrestable arrestible Extreme- criminal 1.Has a pattern of accepting responsibility at home, at work, and in society. 2.Has a lifestyle based on hard work and the fulfillment of obligations. 3.Has consideration of others. 4.Derives self-respect and the respect of others through achievement. 5.Desires to violate occur, but disappear without having to make a conscious choice. 6.Does not infringe on the rights of others. 7.Makes choices that are in the best interest of both self and others. 8.Trusts in the judgment of others. Koerner & Fawcett Continuum of Criminal Behaviors 1.Accepts responsibility only to a degree and with excuses. 2.Frequently lies, manipulates, and intimidates. 3.Generally unreliable and chronically late (performs poorly at work). 4.Fails to fulfill promises and obligations at home. 5.Shows irresponsibility in some ways yet is conscientious in others. 6.Expects to fail and makes only half-hearted attempts. 7.Lacks goal direction. 1.Accepts responsibility only after being nailed down, and then fights all the way. Has all the thinking patterns of the extreme criminal, but with less extensive crime patterns. 2.Is a minor violator who rarely gets caught. 3."I'm a loner." "I'm unique." Is secretive. 4.Feels successful since a great deal of personal involvement in criminal activity has gone undetected. 5.Has strong returning desires to violate, but is discouraged from doing so much of the time. 6.Has always seem responsible and surprises everyone. 7.Without great restraints, will implement violations previously only thought about. 8.Moves away from family or from rural to urban areas for reasons of greater freedom and being unknown (incognito) 1.Accepts no responsibility 2.Has a continuous flow of criminal thoughts from the time s/he wakes up. 3.Has only self-concern. 4.Does not view self as criminal, but as a good person. 5.Seeks to promote self at the expense of others. 6.Criticizes others, claims injustice and blames others when things don't go as planned. 7.Commits hundreds of crimes and is never found out. 8.Sees being nice as a weakness. 9.Is over-confident and grandiose. Won't stop trying to beat the system.

Session 1: April 17 Introduction & assessment

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Session 1: April 17 Introduction & assessment

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