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Sousa M, Andrade J, de Castro-Rodrigues A, Gonçalves RA. The Effectiveness of Psychological Treatment in Adult Male Convicted for Sexual Offenses Against Children: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:1867-1881. [PMID: 35411837 DOI: 10.1177/15248380221082080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Child sexual abuse is a public health problem of global magnitude with profound and negative consequences for the victims and society. Thus, psychological intervention with individuals who sexually offended against children is crucial for reducing recidivism. Numerous reviews and meta-analyses have shown the effectiveness of psychological interventions in individuals who sexually offended, but few reviews have been done on this subtype of offenders. This article reviews evaluation studies of intervention programs designed to treat individuals who sexually offended against children, providing a more detailed account of treatment procedures. Articles were identified from peer-reviewed databases, bibliographies, and experts. Following full-text review, 12 studies were selected for inclusion by meeting the following criteria: quantitative or qualitative research studies published in English from 2000 to 2020 with titles or abstracts that indicated a focus on treatment effectiveness, detailing the psychological treatment procedures on adult, male individuals convicted for child sexual abuse. Cognitive-behavioral therapy with a relapse prevention approach was the most frequent modality found in child sexual offending treatment. Besides, different criminogenic and non-criminogenic factors emerge as targets for intervention. Study design, study quality, and intervention procedures shortened the accumulation of evidence in treatment effectiveness.
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Affiliation(s)
- Marta Sousa
- Psychology Research Center, University of Minho, Braga, Portugal
| | - Joana Andrade
- Psychology Research Center, University of Minho, Braga, Portugal
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Páv M, Sebalo I, Brichcín S, Perkins D. Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231165416. [PMID: 37157822 DOI: 10.1177/0306624x231165416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.
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Affiliation(s)
- Marek Páv
- Psychiatric Hospital Bohnice, Prague, Czech Republic
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Lätth J, Landgren V, McMahan A, Sparre C, Eriksson J, Malki K, Söderquist E, Öberg KG, Rozental A, Andersson G, Kaldo V, Långström N, Rahm C. Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet. Internet Interv 2022; 30:100590. [PMID: 36573073 PMCID: PMC9789379 DOI: 10.1016/j.invent.2022.100590] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The use of child sexual abuse material (CSAM) is an international public health and child protection challenge. OBJECTIVE To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users. METHODS We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019-2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre- to post-treatment, according to the Sexual Child Molestation Risk Assessment+. RESULTS A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18-29 [49]; 30-39 [30]; 40-49 [15]; 50-59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre- to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate -0.25, 95 % CI, -0.46 to -0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events. CONCLUSION We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.
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Affiliation(s)
- Johanna Lätth
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Corresponding author at: Centre for Psychiatry Research, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden.
| | - Valdemar Landgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Allison McMahan
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte Sparre
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Julia Eriksson
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden
| | - Kinda Malki
- Department of Medicine, K2 Medicin, Solna, K2 KEP Askling Pasternak, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Elin Söderquist
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Katarina Görts Öberg
- Department of Medicine, H7 Medicin, Huddinge, H7 Endokrinologi och diabetes Rydén, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, 58 183 Linköping, Sweden,Department of Biomedical and Clinical Sciences, Linköping University, 58 183 Linköping, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, 35 252 Växjö, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christoffer Rahm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Reaching Men and Women at Risk of Committing Sexual Offences - Findings From the National Swedish Telephone Helpline PrevenTell. J Sex Med 2021; 18:1571-1581. [PMID: 37057437 DOI: 10.1016/j.jsxm.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2012 the Swedish Helpline project PrevenTell, targeting men and women with self-identified out-of-control and paraphilic sexual behavior, was launched by ANOVA, Karolinska University Hospital. The overall purpose was to reach the target group and via a telephone-contact encourage further on-site assessment and treatment. AIM To describe men and women contacting PrevenTell during the first 7 years by delineate sexuality-related risk-factors for sexual violence, gender differences, and age- and gender-preferences when reporting a pedophilic interest. METHOD A 52-item semi-structured telephone interview was conducted by experts in sexual medicine with individuals who contacted the helpline. The interview covered sociodemographic characteristics, problematic sexual behavior(s), and mental health and based on the information reported, interventions included recommending an appointment at ANOVA, supporting other appropriate healthcare, or motivation of individuals still ambivalent to treatment. RESULTS Data collection took place between March 2012 and October 2019. A total of 1573 respondents in the main target group (1454 men and 119 women) gave informed consent for participation. Compulsive sexual behavior was reported by 69% of respondents and 56% described at least one paraphilic interest. The prevalence of concomitant compulsive sexual behavior and a paraphilic interest was high, varying between 65% and 83%. Significant gender differences were found in socioeconomic and mental health variables, in which women showed fewer positive and stable life factors compared to men. A sexual preference for minors was reported by 24% of respondents. In this group, 63% reported use of child sexual exploitation material and 15% committed child sexual abuse. Respondents were offered anonymity, however 55% disclosed their identity and were enrolled for further assessment and treatment at ANOVA. CLINICAL IMPLICATIONS The result of this study is of substantial relevance when developing secondary preventive initiatives targeting sexual violence in the community. STRENGTHS AND LIMITATIONS This is the first study to present data from a national helpline targeting both men and women with a wide range of self-identified problematic sexual behaviors. Limitations include the lack of diagnostic confirmation on-site, hence, presented data provides only an indication of clinical conditions. Furthermore, the main objective of the interview was to motivate participants to seek further treatment, sometimes necessary to prioritize this over adherence to the semi-structured questionnaire, explaining the relatively high absence rate in some variables. CONCLUSION Men and women at risk of committing sexual crimes can be reached through a national helpline service and motivated to undergo further assessment and treatment. Adebahr R, Söderström EZ, Arver S, et al. Reaching Men and Women at Risk of Committing Sexual Offences - Findings From the National Swedish Telephone Helpline PrevenTell. J Sex Med 2021;XX:XXX-XXX.
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Deming A, Jennings JL. The Absence of Evidence-Based Practices (EBPs) in the Treatment of Sexual Abusers: Recommendations for Moving Toward the Use of a True EBP Model. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2020; 32:679-705. [PMID: 31010394 DOI: 10.1177/1079063219843897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite a continued evolution of the field of sexual abuser treatment toward a distinct professional discipline with clinicians using an increasing variety of treatment approaches, there is no consensus regarding the strength of our various clinical interventions as evidence-based practices (EBPs). This article provides a brief history of the development and goals of EBPs in medicine and mental health, and a review of the earnest efforts of researchers within the field to establish treatment approaches with sexual abusers as evidence-based. An appraisal of the current status of EBP's with sexual abusers is provided. Although there have been improvements in the methodological quality of treatment outcome research with sexual abusers, divergent opinions about treatment effectiveness remain, and the field has not yet agreed on a system or set of criteria for what constitutes "evidence." We contend that clinical practice has been influenced as much, or more, by new paradigms that are intuitively meaningful and perceived as needed than it has by what has been determined to be scientifically efficacious. This trend and other processes in our field that seem to be slowing the development of EBPs with sexual abusers are discussed. Recommendations for conducting evidence-based reviews and moving the field of sexual abuser treatment toward the use of a true EBP model are provided.
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Affiliation(s)
- Adam Deming
- Indiana Sex Offender Management and Monitoring Program, Indianapolis, USA
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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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Ly T, Fedoroff JP, Briken P. A narrative review of research on clinical responses to the problem of sexual offenses in the last decade. BEHAVIORAL SCIENCES & THE LAW 2020; 38:117-134. [PMID: 32026512 DOI: 10.1002/bsl.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Research on the treatment and programs for people who have committed sexual offenses has greatly increased in the past decade. The aim of this review is to discuss research that has been published over that period (2010-2019) that is relevant for treatment providers. The articles included in this review were found through PsycINFO and PubMed (Medline) using the keywords "treatment or therapy" and "sex offen*". The inclusion criteria were publications that discuss treatment of persons who have committed sexual offenses (written in the English language only). Any articles that examined only special populations were excluded, such as those that examined persons who committed sexual offenses who were female, had intellectual disabilities, deafness, juveniles, etc., because these groups will likely have needs and responsivity factors that differ from the "average" natal-born male sex offender. Results showed that several meta-analyses indicate that treatment is effective in reducing sexual recidivism. The most frequently used treatment for sex offenders is cognitive behavioral therapy, which is often provided in conjunction with pharmacological treatment to reduce sexual impulsivity and/or sex drive. This review is limited to the specific key search terms. The findings of this review support the use of treatment and a community reintegration approach when treating persons who have committed sexual crimes to prevent sexual recidivism.
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Affiliation(s)
- Thanh Ly
- Forensic Research Unit at the Institute of Mental Health Research, Royal Ottawa Mental Health Care Group, Ottawa, Ontario, Canada
| | - J Paul Fedoroff
- Sexual Behaviours Clinic at the Royal Ottawa Mental Health Care Group, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical-Centre Hamburg-Eppendorf, Hamburg, Germany
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Fromberger P, Schröder S, Bauer L, Siegel B, Tozdan S, Briken P, Buntrock C, Etzler S, Rettenberger M, Leha A, Müller JL. @myTabu-A Placebo Controlled Randomized Trial of a Guided Web-Based Intervention for Individuals Who Sexually Abused Children and Individuals Who Consumed Child Sexual Exploitation Material: A Clinical Study Protocol. Front Psychiatry 2020; 11:575464. [PMID: 33488416 PMCID: PMC7820175 DOI: 10.3389/fpsyt.2020.575464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background: There is a high demand for evidence-based and cost-effective treatment concepts for convicted individuals who sexually abused children (ISAC) and individuals who consumed child sexual exploitation material (ICCSEM) under community supervision (CS). The @myTabu-consortium developed a guided web-based intervention for convicted ISAC and ICCSEM under CS consisting of six online modules targeting psychological meaningful risk factors. The study aims to evaluate the effectiveness of this guided web-based intervention in reducing dynamic risk factors and the risk to re-offend compared to a placebo condition. Furthermore, these dynamic risk factors are measured before and after every module to evaluate their individual effectiveness to reduce the respective risk factor as well as risk to re-offend. This clinical trial protocol describes the planned methods as well as the intervention concept. Methods: The methodological design is a placebo controlled randomized add-on trial (N = 582) with follow-ups at 8 points in time. The placebo condition controls for attention and expectation effects and comprises the same amount of modules with a comparable temporal effort as the experimental intervention. The trial is conducted as an add-on to community supervision as usually done. Primary outcomes are dynamic risk factors assessed by self-report risk assessment tools and officially recorded re-offenses. Discussion: To the best of our knowledge, the study is the first to compare the (cost-) effectiveness of a guided web-based intervention for convicted ISAC and ICCSEM under community supervision against a placebo condition. Methodological limitations (e.g., potential ceiling- or volunteers-effects) are discussed. Clinical Trial Registration: German Clinical Trial Register (DRKS 00021256). Prospectively registered: 24.04.2020.
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Affiliation(s)
- Peter Fromberger
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Sonja Schröder
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Louisa Bauer
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Bruno Siegel
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Safiye Tozdan
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Jürgen L Müller
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
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Klapilová K, Demidova LY, Elliott H, Flinton CA, Weiss P, Fedoroff JP. Psychological treatment of problematic sexual interests: cross-country comparison. Int Rev Psychiatry 2019; 31:169-180. [PMID: 31090478 DOI: 10.1080/09540261.2019.1591353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, the Czech Republic, Russia, the United Kingdom, and the United States, who participated in an International Consensus Meeting held in Prague (2017), summarize treatment programmes in their countries. The comparison revealed some general findings: each country has variability between its own programmes; most countries have different programmes for people who are in custody and who are in the community; the state-directed treatment programmes are primarily focused on criminal individuals, while non-criminal individuals are treated in preventive programmes and/or in special clinics or are untreated; the presence of PSI in patients is acknowledged in most programmes, although specific programmes exclusively for individuals with PSI rarely exist. Studies on effectiveness are difficult to compare due to methodologic, political, and cultural differences. Further communication between more countries to share knowledge about successful treatments and preventive approaches is needed, especially enhanced international collaboration between researchers and clinicians to verify the effectiveness of current clinical and experimental program, rs.
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Affiliation(s)
- Kateřina Klapilová
- a Laboratory of Evolutionary Sexology and Psychopathology , National Institute of Mental Health , Klecany , Czech Republic.,b Faculty of Humanities , Charles University , Prague , Czech Republic
| | - Liubov Y Demidova
- c Laboratory of Forensic Sexology, Department for Forensic Psychiatric Assessment in Criminal Proceedings , V. Serbsky National Medical Research Centre for Psychiatry and Narcology , Moscow , Russia
| | | | | | - Petr Weiss
- a Laboratory of Evolutionary Sexology and Psychopathology , National Institute of Mental Health , Klecany , Czech Republic.,f Institute of Sexology, 1st Faculty of Medicine , Charles University , Prague , Czech Republic
| | - J Paul Fedoroff
- g Sexual Behaviours Clinic , The Royal and University of Ottawa , Ottawa , Canada
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Lampalzer U, Briken P. Gruppenpsychotherapie bei Menschen mit pädophilen Neigungen aus dem Dunkelfeld. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Völlm BA, Clarke M, Herrando VT, Seppänen AO, Gosek P, Heitzman J, Bulten E. European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders. Eur Psychiatry 2018; 51:58-73. [PMID: 29571072 DOI: 10.1016/j.eurpsy.2017.12.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 01/15/2023] Open
Abstract
Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.
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Affiliation(s)
- Birgit A Völlm
- Section of Forensic Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Martin Clarke
- Nottinghamshire Healthcare NHS Foundation Trust, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Vicenç Tort Herrando
- Unitat Polivalent de Psiquaitria Quatre Camins, Penitentiary Psychiatry, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
| | - Allan O Seppänen
- Helsinki University Hospital Psychoses and Forensic Psychiatry Vanha Valtatie 198, 04500 Kellokoski, Finland & Vanha Vaasa Hospital Vierinkiventie 1, 65380 Vaasa, Finland
| | - Paweł Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02-957 Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02-957 Warsaw, Poland
| | - Erik Bulten
- The Pompe Foundation, Forensic Psychiatric Centre Pompestichting, Nijmegen, Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
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Keßler A, Rettenberger M. Die Wirksamkeit psychotherapeutischer Behandlung von Sexualstraftätern nach Entlassung aus dem Strafvollzug. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Das zentrale Wirkkriterium forensischer Psychotherapie besteht in der Verringerung des Rückfallrisikos hinsichtlich neuerlicher Straftaten. In der vorliegenden Studie wurde die in Hessen dezentral organisierte psychotherapeutische Versorgung von Personen, die aufgrund sexuell motivierter Straftaten verurteilt wurden, evaluiert. Methoden: Hierfür wurden psychotherapeutisch behandelte Probanden (n = 134) mit psychotherapeutisch nicht behandelten Probanden (n = 134) hinsichtlich der Rückfälligkeit verglichen, wobei die Vergleichbarkeit beider Gruppen mittels eines Matching-Verfahrens bezüglich rückfallrisikorelevanter Merkmale sichergestellt wurde. Der Behandlungserfolg wurde mit Hilfe zweier Rückfalldatenquellen überprüft: Erneut eingegangene Anzeigen bei der Staatsanwaltschaft sowie Wiederverurteilung und erneute Eintragung im Bundeszentralregister (BZR). Ergebnisse: Behandelte Probanden wiesen hinsichtlich allgemein gewalttätiger und sexuell motivierter Rückfälle signifikant niedrigere Anzeigeraten auf (14.2 % bzw. 9.7 %) als die unbehandelten Vergleichsprobanden (26.9 % bzw. 19.4 %), wobei bei den übrigen Rückfallkriterien die Signifikanzgrenze nicht erreicht wurde. Diskussion: Die Ergebnisse der vorliegenden Studie verdeutlichen, dass auch eine dezentral organisierte Versorgungsstruktur grundsätzlich geeignet ist, zur Verhinderung von Rückfällen von entlassenen Sexualstraftätern beizutragen.
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Affiliation(s)
- Achim Keßler
- Psychologisches Institut, Johannes Gutenberg-Universität Mainz (JGU), Mainz, Deutschland
| | - Martin Rettenberger
- Psychologisches Institut, Johannes Gutenberg-Universität Mainz (JGU), Mainz, Deutschland
- Kriminologische Zentralstelle (KrimZ), Wiesbaden, Deutschland
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Abstract
Sexual violence is common and can have profound effects on victims compared with other forms of violence. This violence includes unwelcome and forced sexual contact on adults or children. Assessment of individuals who perpetrate sexual violence starts with a comprehensive biopsychosocial evaluation after a finding of guilt. Clinicians should then evaluate risk. Based on this assessment, a risk management plan should be developed, directed at the specific risk of the offender. Management options include external control (eg, incarceration, probation), psychotherapeutic interventions, pharmacologic interventions, and treatment of comorbidity. This organized approach aids in reducing the risk of future sexual violence.
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Cooper ESN, Holgersen H. Treatment Experiences of Child Sexual Offenders in Norway: A Qualitative Study. JOURNAL OF CHILD SEXUAL ABUSE 2016; 25:699-718. [PMID: 27636233 DOI: 10.1080/10538712.2016.1212958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article is an attempt at gaining a better understanding of treatment of adults who have committed sexual offenses against children. In this study we aimed to explore what people who have committed sexual offenses against children find useful in therapy. The study was approached using qualitative methodology, and information was collected through semistructured interviews. Four male child sexual offenders were recruited from the Institute of Clinical Sexology and Therapy in Oslo, Norway. The informants were interviewed with a focus on what factors they found useful in therapy. Through an explorative, thematic analysis, five main themes were found. These themes include: "Why I started going to therapy," "Why did I do it?" "Therapy as life," "Previous and current relationships with others," and "I lived in a fantasy world where everything was okay." Based on this study and other earlier studies and theories it appears that the previously mentioned themes recur as important contributory factors in the treatment of child sexual offenders.
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Affiliation(s)
| | - Helge Holgersen
- a Faculty of Psychology , University of Bergen , Bergen , Norway
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Baur E, Forsman M, Santtila P, Johansson A, Sandnabba K, Långström N. Paraphilic Sexual Interests and Sexually Coercive Behavior: A Population-Based Twin Study. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1163-1172. [PMID: 26754158 DOI: 10.1007/s10508-015-0674-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/22/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Abstract
Prior research with selected clinical and forensic samples suggests associations between paraphilic sexual interests (e.g., exhibitionism and sexual sadism) and sexually coercive behavior. However, no study to date used a large, representative and genetically informative population sample to address the potential causal nature of this association. We used self-report data on paraphilic and sexually coercive behavior from 5990 18- to 32-year-old male and female twins from a contemporary Finnish population cohort. Logistic regression and co-twin control models were employed to examine if paraphilic behaviors were causally related to coercive behavior or if suggested links were confounded by familial (genetic or common family environment) risk factors. Results indicated that associations between four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behavior were moderate to strong. Transvestic fetishism was not independently associated with sexual coercion. Comparisons of twins reporting paraphilic behavior with their paraphilic behavior-discordant twin further suggested that associations were largely independent of shared genetic and environmental confounds, consistent with a causal association. In conclusion, similar to previously reported predictive effects of paraphilias on sexual crime recidivism, paraphilic behavior among young adults in the general population increases sexual offending risk. Further, early identification of paraphilic interest and preventive interventions with at-risk individuals might also reduce perpetration of first-time sexual violence.
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Affiliation(s)
- Elena Baur
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- LWL-Maßregelvollzugsklinik, Herne, Germany
| | - Mats Forsman
- Swedish Prison and Probation Service, R&D Unit, PO Box 12055, 102 22, Stockholm, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Pekka Santtila
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Ada Johansson
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Sandnabba
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Niklas Långström
- Swedish Prison and Probation Service, R&D Unit, PO Box 12055, 102 22, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Licht im Dunkelfeld - erste Ergebnisse eines neuen Präventionsansatzes. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2016. [DOI: 10.1007/s11757-016-0358-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mendelson T, Letourneau EJ. Parent-Focused Prevention of Child Sexual Abuse. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:844-52. [PMID: 25757528 DOI: 10.1007/s11121-015-0553-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Child sexual abuse (CSA) is a serious public health issue. Current after-the-fact approaches to treating victims and punishing offenders are not adequate to address a problem of this magnitude; development and rigorous evaluation of CSA prevention strategies are critical. We propose that CSA prevention efforts should target parents of young children. Parents have been neglected as a focus of CSA prevention; they merit attention given their potential to improve children's safety via effective communication and monitoring. This paper provides an overview of current strategies for reducing CSA prevalence and their limitations, presents a rationale for parent-focused CSA prevention, and discusses considerations pertinent to development of an effective parent-focused approach. Parent-focused CSA prevention offers potential as a public health approach to prevention of CSA, and it is time that we devote resources toward developing and studying this important area.
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Affiliation(s)
- Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
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Långström N, Babchishin KM, Fazel S, Lichtenstein P, Frisell T. Sexual offending runs in families: A 37-year nationwide study. Int J Epidemiol 2016; 44:713-20. [PMID: 25855722 PMCID: PMC4469797 DOI: 10.1093/ije/dyv029] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexual crime is an important public health concern. The possible causes of sexual aggression, however, remain uncertain. METHODS We examined familial aggregation and the contribution of genetic and environmental factors to sexual crime by linking longitudinal, nationwide Swedish crime and multigenerational family registers. We included all men convicted of any sexual offence (N = 21,566), specifically rape of an adult (N = 6131) and child molestation (N = 4465), from 1973 to 2009. Sexual crime rates among fathers and brothers of sexual offenders were compared with corresponding rates in fathers and brothers of age-matched population control men without sexual crime convictions. We also modelled the relative influence of genetic and environmental factors to the liability of sexual offending. RESULTS We found strong familial aggregation of sexual crime [odds ratio (OR) = 5.1, 95% confidence interval (CI) = 4.5-5.9] among full brothers of convicted sexual offenders. Familial aggregation was lower in father-son dyads (OR = 3.7, 95% CI = 3.2-4.4) among paternal half-brothers (OR = 2.1, 95% CI = 1.5-2.9) and maternal half-brothers (OR = 1.7, 95% CI = 1.2-2.4). Statistical modelling of the strength and patterns of familial aggregation suggested that genetic factors (40%) and non-shared environmental factors (58%) explained the liability to offend sexually more than shared environmental influences (2%). Further, genetic effects tended to be weaker for rape of an adult (19%) than for child molestation (46%). CONCLUSIONS We report strong evidence of familial clustering of sexual offending, primarily accounted for by genes rather than shared environmental influences. Future research should possibly test the effectiveness of selective prevention efforts for male first-degree relatives of sexually aggressive individuals, and consider familial risk in sexual violence risk assessment.
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Affiliation(s)
- Niklas Långström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Swedish Prison and Probation Administration, Norrköping, Sweden, University of Ottawa, Institute of Mental Health, Ottawa, Canada, University of Oxford, Department of Psychiatry, Oxford, UK and Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- *Corresponding author. Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, 171 77 Stockholm, Sweden. E-mail:
| | - Kelly M Babchishin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Swedish Prison and Probation Administration, Norrköping, Sweden, University of Ottawa, Institute of Mental Health, Ottawa, Canada, University of Oxford, Department of Psychiatry, Oxford, UK and Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Swedish Prison and Probation Administration, Norrköping, Sweden, University of Ottawa, Institute of Mental Health, Ottawa, Canada, University of Oxford, Department of Psychiatry, Oxford, UK and Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Swedish Prison and Probation Administration, Norrköping, Sweden, University of Ottawa, Institute of Mental Health, Ottawa, Canada, University of Oxford, Department of Psychiatry, Oxford, UK and Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Swedish Prison and Probation Administration, Norrköping, Sweden, University of Ottawa, Institute of Mental Health, Ottawa, Canada, University of Oxford, Department of Psychiatry, Oxford, UK and Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Katsuta S, Hazama K. Cognitive Distortions of Child Molesters on Probation or Parole in Japan. JAPANESE PSYCHOLOGICAL RESEARCH 2016. [DOI: 10.1111/jpr.12107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martínez-Catena A, Redondo S. Etiología, prevención y tratamiento de la delincuencia sexual. ANUARIO DE PSICOLOGÍA JURÍDICA 2016. [DOI: 10.1016/j.apj.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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