Internet child pornography : an examination of attachment and intimacy deficits

This study found that Internet child pornographers (ICP) reported significantly less optimal attachment than non-offenders, matched child and matched adult sexual offenders. ICP also reported a more negative view of self than non-offenders and the matched sexual offender groups. Finally, the ICP group reported more social avoidance and distress than non-offenders. The portfolio explores the influence of treatment readiness on the best practice principles when working with violent offenders in relation to their assessment, and subsequent treatment recommendations. The importance of treatment readiness and its utility in relation to these principles is highlighted in four case studies.

An empirical investigation of women's affective responses to filmed violence

This thesis examined the subjective emotional responses of women to depictions of violent and sexually violent film. Findings highlighted the significance of contextual factors, such as the gender of the perpetrator and victim upon viewers, and found that exposure to sexual violence in the media has important implications for women. The portfolio's four case studies demonstrate the complexities involved in making risk judgements and treatment planning given the diversity of offences and needs, as well as the implications these decisions can have when determining the amenability of offenders to specific sex offender treatment.

Assessing female sexual offenders' motivations and cognitions : an exploratory study

Semi-structured interviews eliciting cognitions and motivations were carried out with 15 incarcerated female child sexual abusers (nearly 50% of the current UK female sexual offender prison population). Qualitative analysis indicated that four of the five motivational schemas (implicit theories) suggested by Ward (Ward, 2000; Ward & Keenan, 1999) to underlie male sexual offenders' cognitions could be clearly identified in women, these were: Uncontrollability (UN, identified in 87% of participants), Dangerous world (DW, 53%), Children as sexual objects (CSO, 47%) and Nature of harm (NH, 20%). Entitlement, the final implicit theory (IT), commonly found in males, was not identified in any participants in the sample. Further analysis indicated that there were four main motivational types of offender based on combinations of these ITs. These were: (1) presence of DW/CSO, indicating sexual motivation and cognitions with fear of violence; (2) presence of DW/no CSO, indicating fear of violence with no sexual cognition or motivation; (3) presence of CSO/no DW, indicating sexual motivation and cognition; the NH IT also strongly featured in this group; and (4) presence of UN/no DW or CSO, indicating lack of control, sometimes with sense of protection for the victim. Suggestions are made on how the results can inform theoretical developments in the field as well as policy and practice.

The structural properties of sexual fantasies for sexual offenders : a preliminary model

While the phenomenon of sexual fantasy has been researched extensively, little contemporary inquiry has investigated the structural properties of sexual fantasy within the context of sexual offending. In this study, a qualitative analysis was used to develop a descriptive model of the phenomena of sexual fantasy during the offence process. Twenty-four adult males convicted of sexual offences provided detailed retrospective descriptions of their thoughts, emotions and behaviours—before, during and after their offences. A data-driven approach to model development, known as Grounded Theory, was undertaken to analyse the interview transcripts. A model was developed to elucidate the structural properties of sexual fantasy in the process of sexual offending, as well as the physiological and psychological variables associated with it. The Sexual Fantasy Structural Properties Model (SFSPM) comprises eight categories that describe various properties of sexual fantasy across the offence process. These categories are: origin, context, trigger, perceptual modality, clarity, motion, intensity and emotion. The strengths of the SFSPM are discussed and its clinical implications are reviewed. Finally, the limitations of the study are presented and future research directions discussed.

The ethics of care and treatment of sex offenders

The ethics of care acknowledges the importance of establishing and maintaining practices that help people to meet their needs, develop and protect basic capabilities for problem solving, emotional functioning, and social interaction, and avoid pain and suffering. In this article, we explore the contribution an ethics of care perspective can make to work with sex offenders. First, we briefly describe five classes of ethical problems evident in work with sex offenders. Second, the concept of care is defined and a justification for a version of care theory provided. Third, we apply the care ethical theory to ethical issues with sex offenders and demonstrate its value in responding to the five classes of problems outlined earlier.

Psychological and interpersonal dimensions of sexual function and dysfunction

Introduction. There are limited outcome data on the etiology and efficacy of psychological interventions for male and female sexual dysfunction as well as the role of innovative combined treatment paradigms.
Aim. This study aimed to highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction, to offer an etiological model for understanding the evolution and maintenance of sexual symptoms, and to offer recommendations for clinical management and research.
Methods. This study reviewed the current literature on the psychological and interpersonal issues contributing to male and female sexual dysfunction.
Main Outcome Measure. This study provides expert opinion based on a comprehensive review of the medical and psychological literature, widespread internal committee discussion, public presentation, and debate.
Results. Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides an integrated paradigm for understanding and treating sexual dysfunction.
Conclusions. There is need for collaboration between healthcare practitioners from different disciplines in the evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. The assessment of male, female, and couples’ sexual dysfunction should ideally include inquiry about predisposing, precipitating, maintaining, and contextual factors. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Treatment seeking for vulvodynia and vaginismus: a systematic review

This systematic review synthesises the current literature regarding treatment seeking decisions in women with vulvodynia and vaginismus. A database search was conducted to identify literature of interest, including both qualitative and quantitative research. Of the 555 related articles, nine were deemed eligible. Findings suggest that treatment seeking can be a protracted process that has significant implications for women with vulvodynia and vaginismus. The women’s attitudes, perceptions and distress levels impact treatment seeking, with relationship factors and selfconcept affecting motivation for treatment seeking. Knowing what motivates treatment seeking could improve the rates of diagnosis and successful treatment, thus improving the quality of life for women with vulvodynia and vaginismus.

The treatment of sex offenders : evidence, ethics, and human rights

Public policy is necessarily a political process with the law and order issue high on the political agenda. Consequently, working with sex offenders is fraught with legal and ethical minefields, including the mandate that community protection automatically outweighs offender rights. In addressing community protection, contemporary sex offender treatment is based on management rather than rehabilitation. We argue that treatment-as-management violates offender rights because it is ineffective and unethical. The suggested alternative is to deliver treatment-as-rehabilitation underpinned by international human rights law and universal professional ethics. An effective and ethical community–offender balance is more likely when sex offenders are treated with respect and dignity that, as human beings, they have a right to claim.

Dynamic risk and sexual offending: the conundrum of assessment

The potential to reduce sexual victimisation, promote community safety, and decrease incarceration costs has resulted in considerable progress in terms of how we understand and predict sexual recidivism. And yet, the past decade has seen a degree of fragmentation emerge as research attention has shifted away from relative risk prediction (with its focus on static risk factors) to the identification of factors capable of reducing risk through intervention (i.e. dynamic risk). Although static and dynamic risk are often treated as orthogonal constructs [Beech, A. R., & Craig, L. A. (2012). The current status of static and dynamic factors in sexual offender risk assessment. Journal of Aggression, Conflict and Peace Research, 4(4), 169–185. doi:10.1108/17596591211270671], there are arguments to support a claim that the two are in fact functionally related [see Ward, T. (2015). Dynamic risk factors: Scientific kinds or predictive constructs. Psychology, Crime & Law (in this issue); Ward, T., & Beech, A. R. (2015). Dynamic risk factors: A theoretical dead-end? Psychology, Crime & Law, 21(2), 100–113. doi:10.1080/1068316X.2014.917854]. This discussion clearly affects how we assess dynamic risk. This review considered several commonly used methods of assessment and the evidence offered for their predictive accuracy. Of note were differences in the predictive accuracy of single psychometric measures versus composite scores of dynamic risk domains and the conventions used for establishing effect sizes for risk assessment tools.

Self-regulation of sex offending, future pathways and the Good Lives Model : applications and problems

Two theoretical developments, the Self-Regulation Model of the Offence and Relapse Process and the Good Lives Model, have recently offered promise in the advancement of sex offender treatment. The present paper represents a preliminary attempt to operationalize these theoretical principles by developing a number of practical treatment procedures. We have employed the method of a life map, which traces personal development from birth and which incorporates long-term future projections. This includes all actions, events, incidents and skills (whether positive or negative), which have led to a sense of self-esteem and the development of personal values. These will include risk factors and criminogenic needs which lead to offending as well as positive experiences and self-resources which can be incorporated into a future Good Lives Pathway. Two case illustrations are presented, which demonstrate the way in which all experiences from the past can be incorporated into alternative future pathways. These pathways will include positive self-resources and protective variables which develop into a non-offending future and negative self-resources with risk variables which develop into an offending future. The cases illustrate the way in which GLM and self-regulation pathways can be combined in a robust practical treatment procedure. Practical difficulties inherent in the procedure are also discussed.

Motivating offenders to change in therapy: an organizing framework

Objectives. Motivating offenders to change in therapy is an important aspect of effective offender treatment, yet despite this, offenders' motivation to change has received little close attention in the academic and professional literature. This situation is a result of an over-emphasis on the risk management model of rehabilitation, and a consequent failure to construe motivation within an overarching theory of offender rehabilitation.

Method. We present a social cognitive model of offender motivation — the Good Lives Model (GLM) — that provides a framework for incorporating factors that have been shown to be of importance in enhancing offender motivation. This is based upon the notion that all humans strive to achieve primary goods that are intrinsically rewarding and essential to well-being. Where offenders are concerned, criminogenic problems relate, not to the goods offenders seek, but to the way they seek them. Any treatment approach should take this into account and focus positively on equipping people with the skills required to achieve goals rather than simply look to manage risk. The motivational construct that we use here is that of goals. In the GLM, goals are the less abstract depictions of primary human goods and it is with these that people are typically engaged in their day-to-day activities and lives. Looking at therapeutic goal-setting, methods and styles of therapy, and therapist approaches, we derive theoretically-based key issues in motivating offenders to change in therapy.

Conclusion. In conclusion, we present a summary of 12 strategies and techniques that will not only help practitioners enhance their therapeutic effectiveness, but hopefully also act as a catalyst in the development of research on offenders' motivation to change.

Desistance from sex offending : motivating change, enriching practice

In this article we draw from desistance research and a strength-based rehabilitation theory, the Good Lives Model (GLM), to present a richer way of intervening with sex offenders. First, we define the concept of desistance and outline some of the major research findings concerning the factors that help offenders to cease offending. Second we briefly describe current best practice sex offender treatment and discuss its efficacy. Third, we explore the relationship between desistance research and the GLM, arguing that the GLM provides a useful conduit for desistance ideas into sex offender treatment programs. Fourth, we briefly consider the treatment implications of an integrated desistance-GLM approach.

Toward a clinically meaningful taxonomy of violent offenders: the role of anger and thinking styles

Violent offender rehabilitation programs aim to reduce the risk of re-offending in known offenders by addressing a range of different treatments needs, often with core intervention targets of improving anger regulation and altering antisocial beliefs and thinking styles. Such programs have proven efficacy in reducing recidivism for some, but not all, violent offenders, and little is known about the effects of these programs on different offender types. This study investigates whether subtypes of violent offenders can be meaningfully identified and considers how this influences short-term treatment outcomes. Cluster analysis identified three distinctive violent offender groups within a sample of 305 male offenders who had been assessed for participation in a violent offender rehabilitation program. An "unregulated" group had high levels of anger experience and expression and low levels of anger control, and held beliefs that were strongly supportive of a criminal lifestyle. A "regulated" group demonstrated levels of anger and beliefs supporting criminal activity that were not in a range that warranted treatment. Finally, an "overregulated" group was assessed as the group at highest risk of violent re-offending and had low levels of anger experience and expression and an absence of beliefs supporting criminal activity. The unregulated group appeared to gain the most benefit from treatment, although it had the highest levels of criminal thinking and problematic anger. These findings nonetheless offer support for the hypothesis that violent offender treatment programs may be optimally effective when targeted at particular types of offenders.

Integrating partners into erectile dysfunction treatment: improving the sexual experience for the couple

Introduction: Erectile dysfunction (ED) is a common condition estimated to affect more than 150 million men worldwide. ED should be regarded as a shared sexual problem which has significant detrimental effects both on the men who experience this condition and on their partners.
Evidence to support partner involvement in ED therapy: Evidence shows that the partner plays a key supportive role in the man's ED treatment and in successful long-term ED therapy. Including the partner in consultations may highlight discordant attitudes and communication problems between couple members which may indicate treatment acceptance or rejection, or realistic or unrealistic treatment expectations.
Options for partner involvement in ED therapy: Most patients with ED consult their physician in the absence of their partner. Therefore, involving the partner in therapy can be challenging. Two options which physicians should consider are: encouraging the patient to bring the partner into the office and, often more realistically, seeking information about, and providing information to, the partner, via the patient.
Objectives: The objective of these recommendations is to provide practical guidance on treating couples affected by ED, and suggest techniques that may be helpful in integrating the partner into the process of ED treatment.