Dr. Julie Goldenson, Clinical and Forensic Psychologist

1. O OFFENDERS…. Dr. Julie Goldenson, Clinical and Forensic Psychologist

2. LEARNING OBJECTIVES 1.QUIZ: SEX OFFENDERS FACTS AND FALLACIES 2. SEX OFFENDERS 101 • Common Types of Sexual Offences • Unusual preference vs. Paraphilic Disorder • Age preference • Researched variables associated with offending • Internet based offences 3. ASSESSMENT • FAQ about assessments and Core Components • Contextualizing your clients’ offences: ACES and Complex Trauma • Sexual Preference Testing • Risk Assessment (Static and Dynamic Factors) • Critical aspects of a good report 4. COLLABORATING • Help us help you 5. CONCLUSIONS

3. QUIZ: Login: kahoot.it

4. LEARNING OBJECTIVES 1. QUIZ: SEX OFFENDERS FACTS AND FALLACIES 2. SEX OFFENDERS 101 • Common Types of Sexual Offences • Unusual preference vs. Paraphilic Disorder • Age preference • Research variables associate with offending against children • Internet based offences 3. ASSESSMENT • FAQ about assessments and core components • Contextualizing your clients’ offences: ACES and Complex Trauma • Sexual Preference Testing • Risk assessment (Static and Dynamic Factors) • Aspects of a good report 4. COLLABORATING • Help us help you 5. CONCLUSIONS

5. SEX OFFENDERS 101 HOW MANY SEXUAL OFFENDING CASES HAVE YOU HAD IN YOUR PRACTICE? WHICH OFFENCE TYPE HAVE YOU HAD WITH MOST FREQUENCY?

6. SEX OFFENDERS 101: Variety of offences • Rape • Contact Offences Against Children • Non-Contact offences: • Exhibitionism • Voyeurism • Interacting with minors over the internet (or police posing as children) for Solicitation/Luring • Accessing/Possessing, distributing or creating child sexual exploitation material

7. SEX OFFENDERS 101: UNUSUAL PREFERENCES VERSUS A DISORDER Paraphilia is the experience of sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. Perhaps not as “atypical” as we thought though……….

8. SEX OFFENDERS 101:FETISHES ARE COMMON • Study done by Department of Psychology at Université du Québec àTrois-Rivières (Joyel & Capintier, 2017) • Overall, nearly half (45.6%) of the sample subjects were interested in at least one type of sexual behaviour that is considered anomalous, whereas one third (33%) had experienced the behaviour at least once. • voyeurism - 35%, fetishism - 26%, frotteurism - 26% and masochism - 19%) E.G., PARAPHILIC INFANTALISM

9. SEX OFFENDERS 101: PARAPHILIAS To meet criteria for Paraphilic DISORDER. Must occur over 6 months or longer, and be intense arousal, fantasies, urges or behaviours that cause distress or impairment 1) ANOMALOUS ACTIVITY PREFERENCES Anomalous courtship disorders (distorted component of normal courtship behaviour; e.g., exhibitionistic disorder, voyeuristic disorder, frotteuristic disorder) Algolagnic disorders, which involve sexual pleasure from pain and suffering of oneself or others (e.g., sexual masochism and sexual sadism) 2) ANOMALOUS TARGETS PREFERENCES (e.g., pedophilia/anomalous target age) or directed to non-humans (fetishistic disorder or transvestic disorder )

10. SEX OFFENDERS 101: PARAPHILIAS • Voyeuristic disorder • Exhibitionistic disorder • Frotteuristic Disorder • Pedophilic Disorder • Fetishistic Disorder (inanimate/non-genital parts) • Transvestic disorder • (“autogynephilia”) male sexual arousal to thoughts of himself as a female.as self as female

11. SEX OFFENDERS 101: WHEN A DISORDER BECOMES ILLEGAL as self as female Paraphilias becomes legally problematic when they involve a non-consenting person or a person who is not able to give consent (child or profound physical or intellectual disability). Of note: according to Supreme Court ruling, in 2016, bestiality is legal, “so long as no penetration is involved.”

12. SEX OFFENDERS 101: AGE PEDOPHELIA: Adult sexual interest in infants and very young children Epidemiological studies suggest roughly 1-5% of population HEBEPHILIA Adult sexual interest in pubescent children (roughly, ages 11 or 12-14) • Denotes a physical stageof development rather than chronological age EHEBOPHILIA Adult sexual interest in reproductively viable teenager. Not a deviant interest (Sexual interest is normative; e.g., “Barely Legal” pornography.)

14. SEX OFFENDERS 101: WHY DO PEOPLE OFFEND AGAINST CHILDREN Not one theory but many correlates: • PEDOPHILIA (Not all pedophiles are offenders and not all sexual offenders against children are pedophiles) • Biological Correlates: of Pedophilia: • Inch shorter on average than non-pedophiles and greater proportion of left handedness • Lower IQ by 10 points (discoveries that are consistent with developmental problems, whether in utero or in childhood). • Less white matter, the connective circuitry of the brain than non- pedophiles (Cantor 2008). • Scattered examples of men with brain tumors or neurological diseases affecting inhibition leading to changes in sexual preferences

15. SEX OFFENDERS 101: ETIOLOGY 9. • Psychiatric Comorbidities of pedophilia: • Among pedophiles in residential or outpatient treatment, two-thirds had a lifetime history of mood or anxiety disorders • 60% had lifetime substance abuse history • 60% qualified for a personality disorder diagnosis of which obsessive-compulsive (25%), antisocial (22.5%), narcissistic (20%), and avoidant (20%) (Fagan et al., 2002; Green, 2002)

16. Not everyone who engages in sexual acts with a child is a pedophile. Statistics re: sexual preference testing of those caught for contact offences with children suggest that only 30-50% showed pedophilic preference using phallometric testing (Seto, 2008).

17. 2. SOCIAL COMPETENCE: social skills deficits with adults • 3. COGNITIVE DISTORTIONS e.g., that children like it, can consent • 4. EMOTIONAL DYSREGULATION- problems regulating mood, mood issues, and using sex as coping/tension reduction behaviour • 5. DISINHIBITION (impulses over-ride fear of getting caught, victim empathy) • 6. POOR ATTACHMENT EXPERIENCES • 7. ATYPICAL SEXUAL DEVELOPMENT/EXPOSURE TO CHILDHOOD SEXUAL ABUSE : Earlier exposure to sex in childhood coupled with less success and having conventional sexual experiences SEX OFFENDERS 101: ETIOLOGY 9.

18. SEX OFFENDERS 101: INTERNET OFFENDERS • CP a lucrative criminal trade, and sparked new waves of arrests, charges and convictions • Internet offenders are not the same as contact offenders and within groups variability amongst internet offenders • Sometimes require different assessment and treatment • Assessing risk is 2 pronged: a) Is this offending comorbid with contact offences? ; b) will individuals recidivate online

19. SEX OFFENDERS 101: INTERNET OFFENCES Recent findings –online offending has not been shown to predict future contact sex offending (Hanson and Babchishin, 2009) METANALYSIS DATA (Babchishin, Hanson & Herrman, 2011) • CP offenders tend to be younger than contact offenders • Less likely a racial minority • Less antisocial • More lonely but identify less with children • More likely to have experienced physical abuse as a child • More victim empathy/fewer distortions • Higher sexual deviancy as measured by PPG

20. SEX OFFENDERS 101: INTERNET OFFENCES • SOME QUESTIONS TO UNDERSTAND THE BEHAVIOUR: • How is the internet being used? Is the CP the main focus of the person’s deviant online behaviours, or does it occur in combination with other behaviours; e.g., : • To engage contact with others who others who have sexual interest in children • To locate children as potential victim (grooming/solicitation) • To engage in online sexual communication with children • To promote sex trafficking

22. SEX OFFENDERS 101: LURING/SOLICITING • Again, a high degree of variability • Some cases seemingly more statutory (i.e., female adolescents chatting with older males). Still risk for exploitation, but less deviant • Police stings (e.g., Project Rafael) people getting caught (by police posing as minors) tend to have minimal criminal history / not antisocial;less sex deviance, more social skills/intimacy deficits (some people with intellectual deficits and other life challenges)

23. LEARNING OBJECTIVES 1. QUIZ: SEX OFFENDERS FACTS AND FALLACIES 2. SEX OFFENDERS 101 • Common Types of Sexual Offences • “Weird” versus a Paraphilic Disorder • Age Preferences • Research variables associate with offending • Internet offences 3. ASSESSMENT • FAQ about Assessments and Core Components • Contextualizing your clients’ offences: Understanding ACES and Complex Trauma • Sexual Preference Testing • Reporting risk (Static and Dynamic Factors) • Aspects of a good report 4. COLLABORATING • Help us help you 5. CONCLUSIONS

24. ASSESSMENT: FAQ AND COMMON COMPONENTS 1. HOW MUCH DOES THIS COST? • Variable. $250-300/hour – 12-30 hours. $3500-$10 000 • Can ask for a capped rate; some folks take legal aid 2. WHATS THE DIFFERENCE BETWEEN A CLINICAL PSYCHOLOGIST AND FORENSIC PSYCHOLOGIST? • Forensic psychologists have pre-and postdoctoral training in the interplay between psychology and the law and are competent in assessing credibility, risk, and other psycho-legal issues. • Attempt to be as neutral and non-partisan as opposed to empathic advocate; very different hats 3. WHAT’S THE DIFFERENCE BETWEEN FORENSIC PSYCHOLOGIST AND PSYCHIATRIST? • Ph.D., v. MD • Psychologists do psychological testing, psychiatrists do not; • IN CANADA, psychiatrists used more frequently to answer questions about NCRMD, Competence, etc. .

25. ASSESSMENT: FAQ and Common Components 3. WHAT’S INVOLVED IN THE PROCESS?? i. Extensive file Review (BIGGER is better) ii. Extensive interviewing of client (5-8 hours) and at least one interview with collateral source (assessing general history, personality and sexual development) iii. Psychological testing (2-6 hours) • Reading and intelligence • Personality (Personality disorder increases risk a • Psychological symptoms/Trauma • Overall assessment of credibility (What differentiates forensic and clinical) • Sexual Deviance Testing – PPG, Covert measure

26. ASSESSMENT: FAQ AND COMMON COMPONENTS 6. RISK ASSESSMENT (STATIC AND DYNAMIC FACTORS) 7. TREATMENT AND RISK MANAGEMENT SUGGESTINGS

28. ASSESSMENT: ACES AND COMPLEX TRAUMA VICTIMS AND OFFENDERS: SOMETIMES TWO SIDES OF THE SAME COIN STATS: While not always explanatory (or exonerating), sexual offenders (and offenders, generally) tend to have higher incidences of victimization IMPLICATIONS: Important to examine trauma history in the context of clients’ lives both for a formulation of behaviour, as well as to target rehabilitation

29. ASSESSMENT: ACES AND COMPLEX TRAUMA ADVERSE CHILDHOOD EXPERIENCES AND LIFELONG IMPACT • ACE Study (Felitti, et al., 1998) wide scale investigation examining associations between childhood maltreatment and later-life health and well-being. • In the late 1990s, a sizeable database of information was collected (that explored to the life histories of more than 17 000 patients and this longitudinal study demonstrated how specific adverse childhood experiences (ACEs) were strongly related to development and prevalence of risk factors for negative physical, psychological and social outcomes throughout the lifespan.

30. 10 ACE FACTORS Abuse [1]Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt. [2]Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured. [3] Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you. Household Challenges [4] Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend. [5] Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs. [6] Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide. [7] Parental separation or divorce: Your parents were ever separated or divorced. [8] Criminal household member: A household member went to prison. Neglect [9] Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.2 [10] Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it2, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.

31. ASSESSMENT: ACES AND COMPLEX TRAUMA • Graded positive relationship between the number of ACEs in childhood and a wide number of risk factors for: • 1. morbidity (e.g., smoking, obesity, depression, substance abuse and sexually transmitted infections). • 2. Physical illnesses (e.g. heart disease and cancer) • 3. Negative Mental Health Outcomes (e.g., depression, suicidality, hallucinations) • **ACE “dosage“ mattered – those who experienced 4+ categories of ACEs (compared with subjects who scored zero on the questionnaire) were: • 2.5 times more likely to have contracted a sexually transmitted disease, • 2 times as likely to smoke cigarettes • 12 times as likely to have attempted suicide, • 7 times as likely to consider themselves an ‘alcoholic’…etcetc etc.

32. ASSESSMENT: ACES AND COMPLEX TRAUMA ADVERSE CHILDHOOD EXPERIENCES AND CRIMINALITY/SEX OFFENDING • Burgeoning studies suggest that ACEs also increase risk for criminality; e.g., for every additional type of adverse event reported, the risk of violence perpetration increased 35% to 144% in a wide-scale study of adolescents (Duke, Pettingell, McMorris & Borowsky, 2010). • Studies are coming out expressly on ACEs in male sexual offenders • Compared to non-offending males, sexual offenders were 3x more likely to experience sexual abuse; 2X more likely to have endured physical abuse; 13x more likely to experience verbal abuse (Levenson. Willis& Prescott, 2016)

33. ASSESSMENT: ACES AND COMPLEX TRAUMA

34. COMPLEX TRAUMA AND EMOTIONS AND RELATIONSHIPS DIFFICULTY WITH EMOTIONAL/AFFECTIVE REGULATION • Problems identifying and labeling emotions • Difficulty communicating wishes and needs • Difficulty controlling and modulating emotional reactions • Fear driven responses • Self harming behaviors/ Other maladaptive coping/addiction INTERPERSONAL DEFICITS/ATTACHMENT RELATED ISSUES • Problems with boundaries • Distrust /suspiciousness • Social isolation • Difficulty attuning to others’ emotions/perspectives ASSESSMENT: ACES AND COMPLEX TRAUMA

36. ALTERED BELIEFS AND BEHAVIOURS ALTERATIONS IN COGNITIONS • Problems with sustained attention, focus, task completion • Impaired executive functions (e.g., planning, anticipating) • Learning difficulties BIOLOGICAL IMPAIRMENT/IMPAIRED BEHAVIOURAL CONTROLS • Neurobiological issues • Aggression or oppositional behaviors • Self-destructive behavior • Substance abuse • Pathological self-soothing behaviors (e.g., cutting, using sex to self sooth) ASSESSMENT: ACES AND COMPLEX TRAUMA

37. COMPLEX TRAUMA, COGNITIONS AND CONSCIOUSNESS FRAGMENTED SENSE OF IDENTITY • Guilt, shame, low self-esteem, and no stable “sense of self” • Identification with perpetrator or feeling that he/she is ever-present • Dissociation or different states of self (fragmented) “…the victim of a single acute trauma may say she/he is "not her/himself" since the event, the victim of chronic trauma may lose the sense that she/he has a self.” (Herman, 1992 p.76) ACES AND COMPLEX TRAUMA

38. SO WHAT DOES THIS MEAN FOR YOU?

39. IMPORTANCE OF ASSESSING FOR TRAUMA • Many offenders (sexual and otherwise) have complex trauma. Some crimes are a reflection of poor emotional regulation, maladaptive attempts to cope, poor and inappropriate interpersonal attachments and these are often rooted in significant abuse history • A thorough assessment (interview, trauma symptom inventory)can both contextual the offence and assist in making appropriate treatment recommendations/remediation plans with standardized, treatment to address associated risk factors

40. ASSESSMENT: MEASURING SEXUAL DEVIANCE • Giving deviant sexual preference increases risk for re-offence, this is an important component of sexual offender evaluations • 1. Take a Thorough Sexual History • 2. Standardized measures • Often contain “embedded” items that are not transparent to test-taker; e.g. Multiphasic Sexual Inventory (Mollinder) • 3. Phallometric Assessment/PPG • Most accurate • Most invasive • 4. Computerized Viewing Time (Abel, Affinity) • People spend more time looking at images of people who are attractive to them • Images can be suggestive but not explicit or nude

41. ASSESSMENT: TYPES OF RISK ASSESSMENT CLINICAL JUDGEMENT ACTUARIAL ASSESSMENT e.g., Static 99 STRUCTURED PROFESSIONAL GUIDELINES e.g., Stable 2007

42. ASSESSMENT: ACTUARIAL RISK ASSESSMENTS ACTUARIAL ASSESSMENT: Decisions based on risk factors that are selected and combined based on empirical or statistical evidence. Provides a probabilistic estimate based on other offenders with similar characteristics – (i.e., Predicts likelihood that an offence will occur based on offence rate of people with similar risk factors who are released into the community and monitored for a period of time for reoffending) Most actuarial risk instruments include only static risk factors (Static as in not changing, historical)

46. ASSESSMENT: ACTUARIAL LIMITES STRUCTURED PROFESSIONAL JUDGEMENT: Certainly better than chance or clinical judgment alone, in predicting risk in the long term, but fails to consider dynamic, changing idiosyncratic factors or ways to mitigate shorter terms risk

47. ASSESSMENT: DYNAMIC MEASURES STRUCTURED PROFESSIONAL JUDGEMENT: Examines Dynamic Variables: Variables that have the potential to change over time • Acute-change in the short term; e.g. mood, circumstances, opportunity to re-offend • Stable-change over the long term; e.g., maturation, learning Structured clinical guidelines orient the assessor to problem areas relevant to the risk in the shorter term and can help evaluator look more systematically at idiosyncratic variables and make risk management recommendations.

48. ASSESSMENT: DYNAMIC MEASURES e.g., STABLE 2007

49. SAMPLE RISK FORMULATION: In taking together results of the MSI II, the Affinity 2.5 the Static-99R and the Stable 2007, as well as clinical data from other psychological measures, and interviewing, the following formulation of Mr XX risk for sexual offending is put forward: There is no evidence to suggest that Mr. XX has sexual preference for minors or any other paraphilias.A non-invasive measure of sexual testing suggested that he has a relative sexual preference for adult females. Mr. XX does, however, have a long standing history of having impersonal and paid sex, which he used in an attempt to get his social, emotional and sexual needs met, and also to cope with stress and a negative mood. His behaviours have likely been reinforced and maintained by his feelings of inadequacy, fears of rejection, and his emotional needs for connection. An assessment of static risk factors associated with recidivism, suggests that Mr. XX is in the Average risk range, compared to other offenders with similar characteristics. Looking at more dynamic or changeable factors that are relevant to Mr. XX he does have some areas of vulnerability, including impulsivity, negative mood, feelings of social isolation, sexual preoccupation and using sex for coping. The sum of these more dynamic factors places him in the Moderate risk category. It is the opinion of the undersigned, however, that while Mr. XX may be at risk to have impersonal and potentially paid sex (either at a massage parlor or strip club), he would be at low risk to intentionally procure the services of a minor. He is expressing acute distress about his charges (while not abnegating personal responsibility) and the implication of these charges on his future. Mr. XX also has a number of potential strengths and assets. He is actively engaged in targeted treatment to develop appropriate and healthier strategies to get his social emotional and sexual needs met. He has been, and continues to be motivated to work on bettering his own mental health. Finally, he also enrolled in a College program that gives him new possible directions for the future.

50. ASSESSMENT: ASPECTS OF A CREDIBLE REPORT