Problem assimilation and offender rehabilitation

Whilst the overall effectiveness of offender rehabilitation programs in reducing recidivism is now well established, there has been less discussion of the reasons why rehabilitation programs may be unsuccessful for some offenders. In this paper we suggest that the Assimilation model of change (Stiles et al., 1991) may have utility in explaining how offender rehabilitation programs bring about change, and argue that those offenders who have particularly low levels of problem awareness may be at increased risk of treatment failure. Methods of measuring problem awareness and treatment readiness are discussed along with possible methods of intervention, including the Pennebaker method.

UnitingCare West Outreach Services and the Good Lives Model of offender rehabiliation

UnitingCare West is a not-for-profit community services organisation committed to achieving justice, hope and opportunity for all, and works to support and empower in particular those most in need in the WA community. Through its program Outreach Services, it delivers a specialist re-entry service for sex offenders and men serving life and indeterminate sentences. The program has recently been reviewed by Dr Andrew Day from the Centre for Offender Reintegration, Deakin University with input from Dr Tony Ward, University of Victoria, Wellington, New Zealand. In this paper we describe the aims of the review, the process and findings and our ongoing work in developing a rationale for the service that is underpinned by the Good Lives Model (GLM) of offender rehabilitation. More generally, the presentation will seek to understand the needs of offenders who re-enter the community following long-term imprisonment in relation to those areas of need identified in the GLM.

The application of the transtheoretical model to offender populations : some critical issues

Purpose : Over the past two decades, the transtheoretical model (TTM) of change has become perhaps the most widely used model of behaviour change in the treatment of addictive and/or problem behaviours. More recently, the stages of change component of the TTM has been adopted for use in forensic settings. This paper aims to review the application of the TTM model to offender populations.

Arguments : The application of the TTM to offenders raises a number of issues regarding the process of behaviour change for offenders attending treatment programmes. It is argued that while the TTM has been designed to account for high frequency behaviour (e.g. smoking, alcohol misuse), offending behaviour may be less frequent and the process of change less cyclical. Moreover, it is suggested that the most important issue in a treatment context is the proper integration of the TTM constructs. There have been few empirical tests of this aspect of the model.

Conclusion : While the TTM may have some value in explaining how rehabilitation programmes help offenders to change their behaviour, the stages of change construct is, by itself, unlikely to adequately explain the process by which offenders desist from offending.

Offender emotion and self-regulation : implications for offender rehabilitation programming

Despite a growing body of evidence pointing to the central role of negative emotional states in the offence process, there has been relatively little work, either theoretical or applied, investigating this area. This paper offers a review of the literature that has sought to investigate the association between negative emotion and offending. It is concluded that there are grounds to consider negative emotional states as important dynamic risk factors that should be addressed as part of any psychological intervention to reduce the risk of re-offending amongst forensic clients.

Promoting forgiveness in violent offenders: A more positive approach to offender rehabilitation?

In this paper we suggest that the effectiveness of many offender rehabilitation programs may be further enhanced by the inclusion of interventions that build on existing motivation to change. Taking the example of anger management interventions delivered within the context of violent offender rehabilitation, we propose that the emphasis on positive personal change implicit in therapies designed to promote forgiveness may hold some promise. Such therapies may be useful in so far as they facilitate the development of perspective-taking skills, and assist in the therapeutic management of shame and guilt in ways that are likely to be engaging for violent offenders.

Coerced offender rehabilitation : a defensible practice?

The use of the criminal justice system to force offenders to receive psychological treatment is one of the most controversial aspects of service provision for offenders. Coerced treatment needs to be distinguished from pressured treatment, both having objective and subjective dimensions. In this paper some arguments for and against coerced offender rehabilitation are discussed. We suggest that coercing offenders into attending rehabilitation programmes (or placing legal pressure on them to attend) is unlikely by itself to lead to poorer outcomes. Rather, the individual's perception of coercion will be more influential in determining how an offender approaches treatment. Even when offenders perceive they are being coerced, it is likely that pre-treatment anti-therapeutic attitudes can change over the course of a programme, such that therapeutic gains (risk reduction) can occur. Coercion and its effects on treatment engagement and rehabilitation outcomes require further empirical research and conceptual analysis.

The multifactor offender readiness model

There has been a resurgence of interest in the rehabilitation of offenders. Research has consistently shown that rehabilitation programs for offenders, when they adhere to general principles of program design and delivery, will achieve significant reductions in recidivism. In this paper, we suggest that even greater reductions in recidivism can be achieved when readiness is addressed at the level of the individual offender, the program, and the context. A comprehensive understanding of readiness allows for fuller engagement in treatment, thus increasing probability of good treatment outcomes. We describe person, program, and context factors in a model of offender treatment readiness and discuss implications of the model for both assessment of offenders and for modification of low readiness.

Assessing offender readiness to change problems with anger

It is widely acknowledged that offender rehabilitation outcomes can be improved by attending to responsivity issues, including the readiness and motivation of offenders to undertake and engage in treatment. The measurement of responsivity, readiness and motivation in offenders, however, has received relatively little research attention. In this paper we focus on anger management programmes and evaluate the utility and psychometric properties of a measure of stages of change in relation to changing anger - the Anger Readiness to Change Questionnaire (ARCQ). Using data from a large sample of offenders undergoing anger management interventions, we investigated the construct validity, convergent validity and predictive validity of the ARCQ. We conclude the ARCQ may have utility as a measure for selecting offenders who are suitable for anger management interventions.

Conceptualizing women's sexual function : linear vs. circular models of sexual response

Introduction. The lack of an adequate empirical base for models of female sexual response is a critical issue within the female sexual dysfunction (FSD) literature.

Aim. The current research compared the extent to which a linear model of sexual response and Basson's circular model of female sexual response represent the sexual function of women with and without FSD.

Main Outcome Measures. Women's levels of sexual function/dysfunction were assessed with the Female Sexual Function Index and additional items measured women's endorsement of models of female sexual function as representing their own sexual experience.

Methods. An anonymous online survey assessing female sexual response and associated aetiological factors was completed by a random sample of 404 women.

Results. Although the linear model of sexual response was a good fit for women with and without sexual dysfunction, the relationship between sexual arousal and orgasm was mediated by sexual desire for women with FSD. The fit of the initial circular model of women's sexual response was poor for both groups. Following pathway modification, the modified circular model adequately represented the responses of both groups and revealed that a number of the relationships between sexual response variables were stronger for women with FSD.

Conclusions. The linear model was a more accurate representation of sexual response for women with normal sexual function than women with FSD and sexual arousal and orgasm was mediated by sexual desire for women with FSD. The modified circular model was a more accurate representation of the sexual response of women with FSD than women with normal sexual function.

Patterns of treatment of external genital warts in Australian sexual health clinics

Background: External genital warts are a common sexually transmitted viral disease. We describe the patterns of treatment for initial presentations of external genital warts (EGWs) in Australian sexual health centers.
Methods: This was a retrospective audit of 489 case notes from consecutive individuals who presented with a new diagnosis of EGWs to 1 of 5 major sexual health clinics in Australia. Eligibility criteria were consecutive patients aged 18 to 45 years inclusively, presenting with first ever episode of EGWs from January 1, 2004. Exclusion criteria were patients who were immunocompromised, including HIV infection, or enrollment in a treatment study for EGWs.
Results: The median age at presentation of women was 23.2 years and of men 26.8 years. One quarter (n = 127) of patients had another sexually transmitted infection diagnosed at presentation. Nearly half of the patients (n = 224) presented only once for treatment. Most often, patients were treated with a monotherapy (n = 382/489; 78%), usually cryotherapy (257; 53%). Staff applied treatment in 361 (74%) cases. There was wide variation across sites, possibly reflecting local policies and budgets. We found no difference in wart resolution (n = 292; 60%) by initial treatment chosen.
Conclusions: The diagnosis and treatment of genital warts constitute a sizable proportion of clinical visits to the audited sexual health services and require a large input of staff time to manage, including the application of topical treatments. Our results help complete the picture of the burden of EGWs on Australian sexual health centers before the introduction of the HPV vaccine.

Sexual content induced delay : a re-examination investigating relation to sexual desire

This article reports the utility of an information processing approach to examine whether there is a relationship between sexual content induced delay and levels of sexual desire as determined by self-report questionnaires. We tested this idea using a partial replication of the J. H. Geer and H. S. Bellard (1996) protocol demonstrating sexual content induced delay (SCID) in responding to sexual versus neutral words. In addition, the experiment examined whether SCID was different in people with varying levels of sexual desire. It was hypothesized that persons with low levels of sexual desire might respond more slowly to sexual word cues than others. Words with equal frequency of usage and similar word length were chosen from among those used in the Geer and Bellard study. The experiment was conducted with 171 volunteers who completed sexual desire questionnaires, lexical decision making tasks, and word ratings. The SCID effect was demonstrated by both men and women in the study with no significant variation between the sexes. In accordance with prediction, it was found that persons with lower levels of sexual desire responded more slowly to sexual stimuli than other participants, and rated sexual words as less familiar, less acceptable, and less positive emotionally to them. These findings have implications for understanding how emotional content contributes to SCID. They also suggest that further exploration of these ideas, perhaps using other stimulus modalities, may be helpful in advancing understanding of responses to sexual cues, and the potential implications that may have in better understanding sexual desire.

Sexual desire in women presenting for anti-androgen therapy

Women presenting with hirsuties/polycystic ovary syndrome have increased production of androgens. Clinical lore suggests that these women may have increased sexual desire. Treatment of hirsuties commonly involves antiandrogen therapy, a form of therapy with a potential for reducing sexual desire. The present study investigated sexual desire in 29 hirsute women aged 19 to 43 years presenting for therapy. We conducted a questionnaire appraisal of the women's sexual desire, body and self-esteem, and affect at baseline, 3 months, and 12 months and compared the data with a control group of 30 nonhirsute women of similar mean age. Those in the treatment group also had their Ferriman and Gallwey scores and body mass indices calculated at baseline and end of study for those in the treatment group. We determined hormone levels for those in the treatment group with baseline blood tests. Our hypotheses were that the hirsute women would experience different levels of sexual desire than the control group prior to therapy and that therapy would have a demonstrable effect on the self-reported sexual desire of these women. The study demonstrated that women with hirsuties had mean levels of sexual desire and body esteem that were significantly lower than the control group women. During the year-long course of therapy, the sexual desire levels of the hirsute women decreased progressively, while their self-esteem increased. The women's Ferriman and Gallwey scores fell, indicating diminishing hirsutism. These findings provide empirical data upon which clinicians can base advice to patients seeking therapy.

The assessment and management of common male sexual difficulties in family practice

Sexual problems are distressing for patients, and their doctors need to feel comfortable giving advice about and treating the more common conditions. Treatment of sexual problems can prevent much anxiety and the development of depression. This article outlines approaches useful in managing the more common male sexual difficulties encountered in family practice.

Pictorial cues and sexual desire : an experimental approach

The cognitive processing of sexual and non-sexual pictorial stimuli was examined to see whether picture rating and recognition tasks have potential utility as a means of assessing levels of sexual desire. Previous research has revealed slower responding to sexual compared to neutral semantic cues in persons with lower self-reported sexual desire. The present study investigated whether sexual pictorial cues evoked a similarly slower responding in people reporting low sexual desire compared to other individuals. A total of 136 participants completed two self-report measures of sexual desire (the Hurlbert Index of Sexual Desire and the Sexual Desire Inventory) before carrying out tasks involving affective ratings and recognition memory for pictorial stimuli. Participants were classified into relatively low, average, and higher groups on the basis of their scores on the desire measures. The stimuli were selected from the International Affective Picture System, and the tasks included (1) rating the valence, arousal, and sense of dominance or control for each picture, (2) recognition of previously seen images, and (3) a second rating of pictures viewed earlier. Level of sexual desire did not influence responding in the male participants. Female participants with lower sexual desire rated sexual images less pleasant and less arousing than the other participants, and completed picture recognition tasks more quickly. Sexual desire levels significantly influenced the interest ratings women gave to sexual pictures. We also found sexual content induced delays. These delays were not significantly different among desire groups. The variation in responding linked to levels of sexual desire in women suggests that more investigation of this methodology in a clinically diagnosed population might contribute to an understanding of low desire, and help design interventions addressing distress due to lack of sexual desire.

Effect of deer velvet on sexual function in men and their partners: a double-blind, placebo-controlled study

The use of alternative medicines and herbal remedies is an increasing trend in Western societies. For years, people have taken products made of deer velvet for their alleged beneficial effects on sexual function. There has been no scientific investigation of the effects of deer velvet powder on the sexual functioning of human males. This study investigated sexual function in men during a 12-week double-blind, placebo-controlled trial of deer velvet. Thirty-two volunteer male participants, aged 45–65 years, and their partners, were randomly assigned to either the deer velvet or placebo study group. The males took capsules containing ground deer velvet or placebo everyday for 12 weeks. Two sexual function questionnaires (the International Index of Erectile Function and the Brief Index of Sexual Function for Women) used at pre- and posttreatment assessed changes in sexual functioning in males and their partners. Blood tests at baseline, and end of study, determined levels of sex-related hormones in male participants. There were no significant differences in the sexual behavior of the men taking deer velvet compared with the men taking placebo capsules. There were no significant hormone changes from baseline to the end of the study in either group of men. We conclude that in normal males there was no advantage in taking deer velvet to enhance sexual function. All alternative health products or nutritional supplements should be subjected to randomized placebo-controlled trials to determine efficacy.