Clinical Psychology Of Sex Offenders Research Paper

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The clinical psychology of sex offenders involves assessment, treatment, and prevention. Clinical assessment involves the careful description of the problem and an estimation about the risk for recidivism, or re-offense. Clinical treatment involves interventions to reduce the risk of recidivism. Clinical prevention involves interventions before a person becomes a sex offender to reduce the risk of recidivism. There is much more research on assessment and treatment of sex offenders than there is on prevention of sex offending.

1. Who Are Sex Offenders?

A sex offender is anyone who has forced another person to engage in sexual contact against their will. Sex offending may or may not involve physical force. For example, a person can use psychological force to get another person to have sex, as in the case of a power differential between two persons (e.g., employer–employee). However, coercive sex that involves physical force is more likely to be regarded as sex offending than coercive sex that does not. Another issue is the ability of the victim to give consent. Minors and developmentally disabled persons are usually considered to lack the ability to give consent. A person’s ability to give consent may also become impaired, such as in the case of substance abuse. Thus, a person engaging in sex with a person who is unable to consent or whose ability to give consent is impaired might be considered a sex offender.

The term sex offender usually is associated with a person who has been apprehended in a legal context for their coercive sexual behavior. Nevertheless, not all persons who engage in sexually coercive behaviors are caught. Thus, two persons could engage in the same sexually coercive behavior, but the one who is caught would be considered a sex offender and the one who is not caught would not. Moreover, legal statutes vary from jurisdiction to jurisdiction. For example, sexual penetration may be required to be considered a sex offender in some jurisdictions, while other jurisdictions may have broader definitions that include nonpenetrative forms of sexual contact. Legal jargon may obscure the meaning and impact of sexually coercive behavior, as well. For example, terms such as ‘indecent liberties’ and ‘indecent assault’ may both refer to rape, as defined as forced sexual intercourse. However, indecent liberties or indecent assault charges carry very different legal meanings and punishments than does rape. Similarly, rape committed by a stranger is more likely to be prosecuted than rape committed by someone known to the victim. Nevertheless, the behavior in both instances is rape. Because of these inconsistencies and vagaries in legal definitions of sex offending, the current article will adopt a broad approach to sexual aggression, focusing on coercive sexual behavior whether or not the perpetrator has been apprehended.

There is often disagreement between perpetrators and victims on whether sexual aggression actually occurred, or the seriousness of it. A comprehensive discussion of the veracity of perpetrator and victim reports is beyond the scope of this research paper. However, current definitions of sexual aggression give more weight to victims’ perceptions of the occurrence of sexual aggression, given perpetrators’ tendencies to defend and minimize aggressive behavior and the inherent power differential between victims and offenders. It is usually disadvantageous to bring the negative attention to oneself that accompanies accusing someone of sexually victimizing them. In courtroom settings, victims’ personal and sexual histories are examined in cases of sexual abuse in a manner that is unparalleled for other types of offenses. Nevertheless, child custody disputes appear to be one context in which there may be some risk, albeit small, for false accusations of sexual abuse on the part of a parent seeking to disqualify the parenting fitness of the other parent.

The Diagnostic and Statistical Manual (DSM ) of the American Psychiatric Association includes several sexual disorders, or paraphilias, that sex offenders may have. These include fetishism (sexual arousal associated with nonliving objects), transvestic fetishism (sexual arousal associated with the act of cross-dressing), voyeurism (observing unsuspecting nude individuals in the process of disrobing or engaging in sexual activity), exhibitionism (public genital exposure), frotteurism (touching a nonconsenting person’s genitalia or breasts, or rubbing one’s genitals against a nonconsenting person’s thighs or buttocks), pedophilia (sexual attraction or contact involving children), sexual masochism (sexual arousal associated with suffering), and sexual sadism (sexual arousal associated with inflicting suffering). Although the fetish disorders do not involve contact with an actual person, these disorders can result in arrest when a fetishist steals the fetish items (e.g., undergarments). Rape often does not involve sexual arousal directly associated with suffering and is more commonly classified in DSM as a component of antisocial personality disorder than as a sexual disorder. Such a classification appears justified, in that many rapists engage in both sexual and nonsexual forms of aggression and other rule-violating behaviors. The focus of this research paper will be on rape and child molestation because there exists more research on these topics than on any of the other types of sexual offenses. The emphasis in the literature on these two sex offenses reflects the fact that these may create more harm to victims than the other disorders.

2. History

The clinical study of sex offenders had its beginnings in research on sexuality. Some of the earliest scholarly writings on sexual deviance were detailed case studies by psychiatrist Krafft-Ebing (1965/1886). Krafft-Ebing postulated that all sexual deviations were the result of masturbation. The case study method focused exclusively on highly disturbed individuals without matched control cases, which precluded objective considerations of etiology (Rosen and Beck 1988).

Kinsey and colleagues (1948) conducted large-scale normative surveys of sexual behavior, resulting in major works on male and female sexuality. Because adult–child sexual contact was relatively common in his samples, Kinsey underplayed the negative effects of such behavior (Rosen and Beck 1988). Work on sexual deviance continued at the Kinsey Institute after Kinsey’s death (Gebhard et al. 1965).

A major advance in the assessment of sexual arousal was the development of the laboratory measures of penile response by Freund (1963). Freund’s measure, known as the penile plethysmograph, involved an inflatable tube constructed from a condom, by which penile volume change in response to erotic stimuli (e.g., nude photographs) was measured by air displacement (Rosen and Beck 1988). Less intrusive penile measures to assess circumference changes were later developed (Bancroft et al. 1966; Barlow et al. 1970). Among behaviorists, penile response to deviant stimuli (e.g., children, rape) became virtually a gold standard of measurement for sexual deviance (e.g., Abel et al. 1977).

The emphasis of behaviorists on the role of sexual arousal in sex offending came under criticism from feminist theories. Rape was conceptualized as a ‘pseudosexual’ act of anger and violence rather than as a sexual disorder. This approach was popularized by Groth (1979). More recent conceptualizations have incorporated sexual, affective, cognitive, and developmental motivational components of sex offending (Hall et al. 1991).

3. Risk Factors For Sex Offending

One major risk factor for being a sex offender is being male. Less than 1 percent of females perpetrate any form of sexual aggression, whereas the percentage of men who are rapists ranges from 7 to 10 percent, and the percentage of men who admit to sexual contact with children is 3 to 4 percent. Evolutionary psychologists suggest that mating with multiple partners provides males with a reproductive advantage. Thus, sexually aggressive behavior may be a by-product of evolutionary history. Nevertheless, most men are not sexually aggressive. Thus, being a male may be a risk factor for being sexually aggressive, but certain environmental conditions may be necessary for someone to become sexually aggressive. For example, aggressive behavior, including sexually aggressive behavior, is accepted and socialized among males more than females in most societies.

Another risk factor for males becoming sexually aggressive, particularly against children, is personal sexual victimization. Boys who have been sexually victimized are more likely to engage in sexualized behaviors (e.g., sexual touching) immediately following sexual victimization than boys who have not. Moreover, in recent studies, over half of adult sex offenders have reported being sexually abused during childhood. However, the sexual abuse of males is not invariably associated with becoming sexually abusive, as the majority of males who are sexually abused do not become abusers.

The single best predictor of sex offending is past sex offending. Persons who have sexually offended multiple times in the past are more likely to sexually offend in the future than those who have limited histories of sex offending. Recidivism rates for child molesters and rapists are similar at 25 to 32 percent. Persons who have committed multiple sex offenses have broken the barriers against offending and have lowered the threshold for re-offending by developing a pattern of behavior. Thus, sex offenders having multiple offenses are the group that poses the greatest risk to community safety. Moreover, the predictive utility of past sex offending suggests that interventions with first-time offenders and interventions to prevent sex offending from starting are critical to avoid the establishment of an ingrained pattern of behavior.

4. Motivational Factors For Sexual Offending

What causes men to become sex offenders? One common explanation has been the sexual preference hypothesis that sex offenders are more sexually aroused by coercive than by consenting sexual activity. Learning theories posit that sexual arousal to coercive sexual activity is conditioned. For example, a pedophile may have had sexually arousing experiences during childhood with peers and may never have outgrown these experiences. The fusion of violent and sexual images in the media may influence some men to associate sexual arousal with aggressive activity. The sexual preference hypothesis appears to be most appropriate for some sex offenders against children, particularly those who offend against boys. For many men who molest children, their sexual arousal to children exceeds their sexual arousal to adults, as assessed by genital measures. However, some child molesters, particularly incestuous offenders, may be more sexually aroused by adults than by children. The sexual preference hypothesis is less applicable to men who rape adults. Most rapists’ sexual arousal is greatest in response to adult consenting sexual activity and less in response to sexual activity that involves physical force. However, a minority of rapists do exhibit a sexual preference for rape over consenting adult sexual activity. These rapists would be considered sexual sadists.

Another common explanation of sex offending has been anger and power. Some feminist scholars have gone as far as to say that sex offending is a ‘pseudosexual’ act and that it is not about sex. However, recent feminist scholarship recognizes the sexual and aggressive aspects of sex offending. If sex offending is a violent, rather than a sexual, act, why does the perpetrator not simply assault the victim rather than sexually assaulting the victim? Anger and power are most relevant in explaining the rape of women by males. Adversarial relationships with women may cause some men to attempt to enforce their sense of superiority over women via rape. Some child molesters may also have anger and power motives for their offending. However, depression is a more common precursor to child molesting than anger. One source of depression may be perceived or actual social incompetence in peer relationships. Sexual contact with children may represent a maladaptive method of coping with this depression.

Excuses to justify sexually aggressive behavior may be the motivation for some forms of sex offending. Such excuses deny or minimize the impact of sexual aggression and are known as cognitive distortions. Cognitive distortions are common in acquaintance rape situations and in incest. An acquaintance rapist may contend that rape cannot occur in the context of a relationship or that the existence of a relationship justifies any type of sexual contact that the rapist desires. Common cognitive distortions among incest offenders are that sexual contact with their child is a form of affection, or sexual education, or that it merely amounts to horseplay. Thus, the motivation for a person employing cognitive distortions is that the sexual contact is ‘normal’ and is not aggressive.

It is likely that these different types of motivation for sex offending may interact for many sex offenders. Sexual arousal to coercive sexual behavior, emotional problems, and cognitive distortions may coexist for some sex offenders, and a singular explanation of the basis of the problem may be inadequate. Nevertheless, complex explanations of sex offending are less likely to result in treatment interventions than are explanations that identify the major motivational issues.

5. Treatment Interventions For Sex Offenders

The most common forms of treatment for sex offenders have been behavioral, cognitive-behavioral, and psychohormonal interventions. Behavioral methods have typically involved interventions to reduce sexual arousal to inappropriate stimuli (e.g., children, rape). Aversive conditioning, which pairs sexual arousal to the inappropriate stimulus with an aversive stimulus (e.g., foul odor, thoughts about punishment for sex offending) is perhaps the most widely used behavioral treatment with sex offenders. Cognitive-behavioral methods focus on the influence of cognitive factors, including individual beliefs, standards, and values, on sex-offending behavior. Common cognitive-behavioral treatments often involve cognitive restructuring, empathy enhancement, social skills training, and self-control techniques. Relapse prevention, which has been adapted from the treatment of addictive behaviors, has gained relatively wide acceptance in the treatment of sex offenders. This cognitive-behavior method involves self-control via anticipating and coping with situations following treatment that create high risk for relapse (e.g., social contact with potential victims). Psychohormonal treatments involve the use of antiandrogen drugs to reduce the production of testosterone and other androgens. Such androgen reduction suppresses sexual arousal. The antiandrogen that has been most commonly used is medroxyprogesterone (Depo Provera).

Evidence across recent studies of rapists, child molesters, and exhibitionists suggests that cognitive-behavioral and psychohormonal interventions may be more effective than no treatment or behavioral treatments. Recidivism rates among sex offenders, as measured by arrests for sex offenses, are 25–32 percent. Sex offender recidivism rates in studies of behavioral treatments have been approximately 40 percent. Both cognitive-behavioral and psychohormonal treatments have yielded recidivism rates of 13 percent. Why is there such a high rate of recidivism in studies of behavioral treatments? It could be contended that behavioral treatments are too narrowly focused on sexual arousal and ignore other motivational issues (e.g., emotional, cognitive). However, psychohormonal treatments also primarily focus on sexual arousal reduction and result in relatively low recidivism rates. Thus, it is possible that any positive effects of behavioral treatments may ‘wear off’ over time. It is also possible that the sex offenders in the behavioral treatment studies were at higher risk for recidivism, although the recidivism rates for all forms of treatment are based on both inpatient and outpatient samples. Thus, there is support for cognitive-behavioral and psychohormonal treatments being the most effective treatments with sex offenders. Nevertheless, the evidence of this treatment effectiveness is somewhat limited.

A major limitation of psychohormonal treatments is compliance. These treatments usually involve intramuscular injections and are effective only as long as they are complied with. Sex offender refusal and dropout rates with psychohormonal treatments range from 50 to 66 percent. Moreover, a study directly comparing the relative effectiveness of cognitive-behavioral vs. antiandrogen treatments within the same population of sex offenders is needed. Such a study could clarify whether the effective suppression of sexual arousal achieved by antiandrogen treatments is sufficient to reduce recidivism or whether the more comprehensive aspects of cognitive-behavioral treatments offer necessary adjuncts. Also unknown is whether a combined cognitive behavioral plus antiandrogen approach would be superior to either approach alone.

An encouraging development is evidence of effectiveness of cognitive-behavioral methods in reducing recidivism among adolescent sex offenders. Interventions with adolescents may prevent the development of a history of sex offending that is associated with reoffending. However, there are extremely few outcome studies of adolescent sex offender treatment.

Most of the available treatment research on sex offenders has been conducted with European American populations. It is unknown whether these treatments are equally effective with other groups. For example, cognitive-behavioral methods are individually based. However, individually-based interventions may not be as effective in cultures in which there is a strong group orientation. Thus, individual change might be offset by group norms. For example, in some patriarchal groups, misogynous attitudes may be normative and sexual aggression permissible. Conversely, there may be protective cultural factors that could be mobilized to prevent sex offending. Thus, the context in which interventions are used needs to be examined in future research.

6. Prevention

There have been virtually no prevention studies that have examined perpetration of sex offending as an outcome measure. Yet the costs to society of sex offending, in terms of damage to and rehabilitation of victims and of incarceration and rehabilitation of offenders, implore us to seek ways to prevent the problem before it occurs. The recidivism rates of the most effective treatments are at 13 percent, which is significantly better than other forms of treatment or no treatment. Yet, it could be contended that a 13 percent recidivism rate is unacceptably high. Perhaps the effective components of cognitive-behavioral interventions could be adapted for proactive use in prevention programs.

Most sexual abuse prevention programs have focused on potential victims for interventions. However, perpetrators, not victims, are responsible for sex offenses. A completely effective sex offense prevention program would eliminate the need for victim programs. Prevention programs for potential victims are critically important in terms of empowerment. However, there has been a disproportionate amount of attention in sexual abuse prevention to victims. Relatively simple modifications of existing victim prevention programs could potentially go a long way toward preventing perpetration of sex offenses. For example, most children’s sexual abuse prevention programs present the concept of ‘bad touch,’ which usually is instigated by someone else. Missing from most of these programs, however, is the idea that not only should someone else not ‘bad touch’ you, but you also should not ‘bad touch’ someone else. Such an intervention could reach many potential perpetrators who would not otherwise receive this information. The impact of efforts to prevent sex offense perpetration is unknown. Thus, there is a great need for the development and evaluation of interventions to prevent sex offending.


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