Dr Sophie Reeves, Clinical Psychologist, Victorian Institute of ...

UNDERSTANDING SEXUALLY
ABUSIVE BEHAVIOUR:
Formulation and Intervention
Dr Sophie Reeves
BA(hons) PGradDipPsych DPsych MAPS
Forensicare
2010

Overview
Assessment
- Defining sexually abusive behaviour
- Formulating sexual problems
- Victim impact: the ripple effect
- Assessment of risk of sexual recidivism
Intervention
-Pharmacological treatment
-Psychological treatment
-Environmental management

Types of Sexually Abusive
Sexual Harassment
Behaviour
Any form of unwelcome attention that is offensive, humiliating or o
intimidating
making promises or threats in return for sexual favours;
uninvited kisses, embraces, touching or other physical contact;
repeated invitations to go out after prior refusal;
smutty or sexist jokes or comments, or sexually explicit conversation;
sexual gestures or sex based insults, taunts, teasing or name calling;
staring or leering at a person or parts of their body;
displays of sexually graphic material including posters, pictures, graffiti or
reading material;
persistent questions or insinuations about a person’s private life;
offensive phone calls, letters, e-mail messages or computer screen saver
messages;
innuendo, including sexually provocative remarks and suggestive or
derogatory
comments about a person's physical appearance.

Indecent exposure
Rape
sexual assault
Child molestation
Viewing and/or procuring child pornography
Obscene Communications
Sexually motivated stalking (predatory)

Understanding Sexually Abusive
Behaviour
In what context does sexually abusive
behaviour develop?
What motivates an individual to engage in
sexually abusive behaviour?

Assessment of Sexually Abusive
Behaviour: : Sources of Information
Clinical interview
Psychometric testing
Collateral information

Understanding the Context
Sexually Abusive Behaviour is
Occurring
Mental illness
Paraphilia
Substance abuse
Personality structure
Medical condition

Formulating Sexually Abusive
Behaviour
Individuals who engage in sexually
abusive behaviour are not an homogenous
group
Co-occurrence occurrence of sexually abusive
behaviours is not uncommon
Most individuals who engage in sexually
abusive behaviour are male

Female Sexually Abusive
Perpetrators
Research is limited because female perpetrated
sexual abuse is not commonly reported
Existing research has identified:
-typologies of females who sexually abuse
-higher rates of psychiatric conditions compared
to non-sexual offending female population
-rates of sexual recidivism are lower in females
than males
e.g.1% compared to 13-14% 14% over 5 years
Cortoni & Hanson (2005)

Central Features of Current
Theories of Sexual Offending
Draw upon cognitive, behavioural, biological and
social learning approaches
Describe multiple pathways to offending
Identify developmental, vulnerability, state and
contextual factors which interact to result in
sexual offending
Sexual offending fulfils certain needs of
individuals

Pathways Model (Ward & Siegert 2002)
Assumption that every human action involves emotions
or motives, an interpersonal context, cognitive
interpretation and planning, physiological arousal and
activation
There are a number of distinct aetiological pathways that
culminate in sexually abusive behaviour
Four sets of mechanisms hypothesised to cause clinical
phenomena in sexual offenders
Emotional dysregulation
Intimacy and social skills deficits
Cognitive distortions
Deviant sexual arousal

Sexual
crime
Sexual
crime
Sexual
crime
Common Clusters
Deviant sexual arousal
Intimacy deficits
Inappropriate emotions
Cognitive distortions
vulnerability
Sexual
crime
Family environment Biological factors
Learning history Cultural issues
Sexual
crime

Considering the Offence Process
Cycle of offending behaviour
Originally applied to individuals with
substance abuse problems
This model is based upon the premise that
behaviour does not just ‘suddenly happen’

Offence Cycle
Post
Offence
Trigger
Offence
Grooming
Deviant sexual fantasy
Risky thinking
Targeting
High
risk situations

Examples of Cognitive Distortions
“It’s s not really harming the victim or me by looking
at it”
“I I have got nothing better to do”
“This will be the last time”
“I’m m just going to look at adult porn”
“I I am educating the victim”
“The victim may enjoy it”
“If I masturbate I relieve the urge to contact others”
‘I’m m just providing support’
‘I’m m just being friendly’

Grooming Techniques
Physical/verbal coercion
Emotional manipulation
Games
Alcohol and drugs
Spiritual manipulation
Grooming of parents

Targeting
Vulnerable victims
e.g. Single mother
Individuals with an Intellectual
Disability
Teenagers
Children

Victim Impact
Physical and emotional trauma
Post traumatic stress
Self harming behaviours
Stress associated with disclosure and the
court process
Ripple effect of sexual abuse
Sexualised behaviours (children)

Specific Issues for Victims in the
Church Community
Spiritual trauma
Religious beliefs questioned
Confusion over sexuality
Ostracised by church community

Risk Assessment: Questions to ask
Is this individual likely to repeat sexually
abusive behaviour in the future?
Under what circumstances?
Is their behaviour going to escalate?

Two meta-analyses analyses were conducted
examining research evidence concerning
recidivism risk factors for sexual offenders:
(Hanson, Harris, Scott & Helmus, , 1998)
(Hanson & Morton-Bourgon
Bourgon, , 2004)
Data
95 studies involving 31,000 sexual offenders
USA, Canada, UK, Austria, Sweden, Aus
84 studies mixed offence types
79 studies were predominantly adults
Predominantly Caucasian, all male except one study

Strongest Predictors of Sexual
Recidivism
Risk factors that research has found to be
the strongest predictors of sexual
recidivism include:
* Deviant sexual interests
* Antisocial orientation/(lifestyle instability,
history of rule violation)
Emotional identification with children
Conflicts with intimate partners

Risk factors that had no relationship with
sexual re-offending include:
Sexual abuse victimisation
Internalising disorders (anxiety,
depression)
Low self esteem
Degree of force in sexual offences
Lack of victim empathy
Denial or minimisation of offences

Sex offenders are more likely to re-offend
with a non-sexual offence than a sexual
offence
Base rate for sexual re-offending is
approximately 14-17% 17% over 5 years

Intervention
Pharmacological Intervention
Consideration of antiandrogens, SSRI’s
Psychological Intervention
Environmental Management
-preventative
-reducing re-occurrence of behaviour

Psychological Interventions
Treatment targets
Acceptance and responsibility for offending behaviour
Identification and challenging of cognitive distortions that
support sexual offending
Cognitive restructuring of general antisocial orientations
Development of a positive sexual identity

Reducing deviant sexual arousal and developing
non-abusive sexual fantasies
Understanding the consequences of offending
behaviour for the self, the victim and their
families
Development of healthy coping mechanisms
Development of prosocial relationship skills

The development of adaptive strategies in
regulating emotions (e.g. distress, anger)
Development of Relapse Prevention strategies
Management of addictive, compulsive features
contributing to the reinforcement of delinquency
Resolution of victimization in the history of the
adult

Offence Cycle
Post
Offence
Trigger
Offence
Grooming
Deviant sexual fantasy
Risky thinking
Targeting
High
risk situations

Environmental Management
Preventative Measures
Development of policies addressing the
following issues:
- How to respond if there are
concerns/suspicions of abuse
- A named contact in the church to co-ordinate
ordinate
concerns and take action
-Safe recruitment procedures for both paid
workers and volunteers
-Guidelines for running church activities with
children and young people

Preventative measures cont.
Seeking appropriate background checks
on employees/volunteers in the church
community
(police check, working with children
check, referees)
Ongoing training of employees
Adequate supervision/mentoring

Establishing clear boundaries for
employees/volunteers with regard to
their interactions with individuals
within the church community
Education of families and young
people regarding safety and how to
say no

Decision Making Regarding Risk
Management Should Consider the Following
Elements:
Level of supervision/monitoring within the
church
Balancing privacy/rights of the individual with
risk management needs
Support for the individual (within the church
and/or externally)
Documenting a management plan/contract
detailing what the individual can and can’t t do

Consideration of external assessment/consultation by
appropriately qualified practitioner with regard to
decision making
Regular review process required
An awareness that for many individuals, management
will be life long even if the individual has undergone
treatment or received prayer ministry
Appropriate support/privacy for the victim and their
family
Support for other members within the church
community, managing anxiety/hysteria/dispelling myths