Sexual Offending and Mental Health

Multidisciplinary Management in the Community

Sarah Galloway, Julia Houston

• Publisher: Jessica Kingsley Publishers
• Year: 2008
• Print ISBN: 9781843105503
• eBook ISBN: 9781846427855
• Topic: Medicine
• Subtopic: Medical Law

Sexual Offending and Mental Health draws together theoretical, clinical and mental health issues for the range of professionals working in the community and in-patient settings with sex offenders and those who have behaved in sexually inappropriate ways.

The contributors describe current influential models of sexual offending and the developmental, psychological and social factors involved. They discuss the prevalence of personality and mental disorders in known sex offenders and the impact these disorders have on their treatment and management. They describe clinical work with individuals, their partners and families, and also consider the impact of this work on professionals. The book includes an outline of current approaches to risk assessment, an overview of the recent changes in legislation in England and Wales, and suggestions for multi-disciplinary management in the community.

This book will be essential reading for professionals working in health or criminal justice settings with people who have committed sexual offences or whose sexual behaviour has caused concern for others.

Part I:

Theoretical Perspectives

1

An Overview of Sexual Offending

Julia Houston

INTRODUCTION

This opening chapter provides an overview of contributing factors and theoretical models of sexual offending. In order to understand how mental health problems may affect sexually inappropriate behaviour, it is first necessary to be aware of the range of other factors involved. The chapter starts by considering what is known about the range of factors that are potentially contributory to sexual offending. This covers biological vulnerabilities and predispositions, childhood and developmental experiences, sexual development and learning, interpersonal functioning, and underlying beliefs. Current influential theories are then outlined, including aetiological theories of why men offend against children and adults, and theories to account for how this occurs.

CONTRIBUTORS TO SEXUAL OFFENDING

Individuals who sexually offend are a widely heterogeneous group and it would be presumptuous to assume that the factors outlined below are relevant for every individual. However, these are the key areas that have been studied in populations of men who have sexually offended, and which have been drawn together to develop aetiological models. It is important for clinicians working with offenders with mental health problems to be aware of these factors in order to consider which of them may also be relevant.

Predispositional and biological vulnerabilities

Early theories of sexual offending attempted to explain this by one predominant factor. One such theory was Goodman’s (1987) biological theory, which emphasised the role of genetic and hormonal factors. The limitations of such ‘single-factor’ theories led to the development of more complex multivariate theories, such as Marshall and Barbaree’s (1990) integrated theory of sexual offending. However, hormonal factors were still viewed as playing a key role. One aspect of this theory is that a critical developmental task for adolescent males involves learning to distinguish between aggressive and sexual impulses, as this has consequences for their ability to control aggressive tendencies during sexual experiences. The authors argue that both types of impulse originate from the same brain structures. Differences in hormonal functioning will make this task more difficult, particularly for vulnerable individuals who have had adverse early developmental experiences.

The role of biological factors was not predominantly considered throughout the 1990s, as other contributors to sexual offending gained more prominence. However, recently Smallbone (2006) has proposed an ‘attachment–theoretical revision’ of Marshall and Barbaree’s (1990) integrated theory, in which he argues that the focus on biological influences should be expanded, and it is becoming acknowledged that genetic and environmental factors which cause psychopathology need to be considered relevant in relation to sexual offending (Ward, Polaschek and Beech 2006a, pp. 331–340).

Childhood and developmental experiences

It is well-recognised that negative childhood and developmental experiences can have an important contributory role in the development of later sexual offending, in particular those experiences which affect the development of secure attachments. Many studies have found that the family backgrounds of sexual offenders are characterised by high levels of disruption, neglect and violence (Craissati, McClurg and Browne 2002) and by high rates of childhood disturbances (Craissati and McClurg 1996). Prentky et al. (1989) also found that caregiver inconsistency and sexual deviation and abuse in the family were both related to severity of sexual aggression in convicted rapists.

One specific area of focus has been offenders’ own experiences of sexual and physical victimisation. With regard to physical abuse, rapists have been found to have experienced more physical violence in their families than other types of sex offenders (Marshall et al. 1991) and non-sex offenders (Leonard 1993), although high rates (40%) have also been reported among convicted child abusers (Craisatti and McClurg 1996).

There is a wide variation in rates of reported sexual abuse across studies, although a consistent finding is that the rates are higher than for non-sex offenders and non-offenders. In studies of men who have offended against children, rates of victimisation have been reported between 44 per cent and 51 per cent (Craisatti and McClurg 1996; Craissati et al. 2002; Scoales and Houston 2006). Carter et al. (1987) found that 23 per cent of detained rapists had been victims of sexual abuse themselves. However, although it may be an important contributor for some individuals, clearly sexual victimisation is neither always necessary nor sufficient for future perpetration of sexual offending.

Sexual development and learning

Another important area of research with regard to sexual development and learning has been whether or not men who sexually offend are more aroused by sexually deviant images, than men who do not offend. A meta-analysis of studies using the penile plethysmograph (PPG) suggested that convicted rapists tend to show different sexual preferences to non-offenders, and responded more to rape cues than non-sex offenders (Lalumiere and Quinsey 1994). Differences have also been found between men who offend against children within a family setting and non-offenders (Marshall, Barbaree and Christopher 1986). Although about 18–19 per cent of both these groups showed some level of sexual arousal to pre-pubescent children, the former group showed lower levels of arousal to adult females. When considering arousal to images of children post-puberty, the rates increased. Thirty-two per cent of non-offending men were aroused by this age group compared to 52 per cent of the intra-familial offenders and 70 per cent of extra-familial offenders. Clearly, being sexually aroused by children is, in itself, not sufficient to explain sexual offending. Similarly, although in some individuals the presence of deviant sexual fantasies are a significant contributor to their offending, the presence of coercive sexual fantasies per se are not sufficient to define a rapist population and are commonly reported by non-offending males (Leitenberg and Henning 1995).

Interpersonal functioning

There is a clear link between childhood experiences and the development of adult attachment styles, and the ability of men who offend sexually to establish and maintain intimate relationships with adults has been studied extensively. Marshall (1989) first observed that there was a link between intimacy deficits and sexual offending and developed this further into one of the most influential earlier theories, the ‘integrated’ theory of sexual offending (Marshall and Barbaree 1990). Marshall (1989) suggested that men who offend sexually against children are likely to have high levels of ‘emotional loneliness’, difficulties in developing or maintaining close intimate relationships with adults and insecure attachment styles. This has been supported by subsequent research (Fisher, Beech and Browne 1999). Men who have offended against children tend to be characterised more by an anxious, pre-occupied and fearful style of attachment (Hudson and Ward 1997). Convicted rapists have also been found to have intimacy deficits and a limited capacity to form attachments (Seidman et al. 1994). They have a greater tendency than both non-offenders and those who have offended against children to have a ‘dismissive’ style of attachment towards women, in other words to be sceptical of the value of close relationships and blame others for their lack of intimacy.

Underlying beliefs and cognitive factors

Much research has examined the underlying beliefs held by sex offenders, and the ways in which these contribute to the development and maintenance of offending. Over the past 20 years the concept of ‘cognitive distortions’ has been extremely influential, defined by Abel et al. (1989, p. 137) as ‘justifications, perceptions and judgements used by the sex offender to justify his child molestation behaviour’. An example would be something like ‘just touching isn’t doing any harm’. Identifying and challenging cognitive distortions has been a key part of treatment with offenders against both children and adults. The most recent work in this area has moved on to examine deeper-held beliefs about children and adults. These are more akin to the notion of schemas in cognitive psychology (Young 1990), and have been described by Ward and Keenan (1999) and Polaschek and Ward (2002) as ‘implicit theories’.

Ward and Keenan (1999) analysed information from existing questionnaires about cognitive distortions. They proposed that men who offend against children hold implicit theories about the nature of the world which underlie the distorted beliefs used to justify their offending. These are:

•Children as sexual beings: children are inherently sexual and possess the capacity to make decisions about sexual activity.

•Nature of harm: there are degrees of harm and sexual activity is unlikely to be harmful unless there is physical injury.

•Entitlement: superior individuals (such as adults) have the right to assert their needs above others (such as children).

•Dangerous world: other people are likely to behave in an abusive and rejecting manner towards the offender. This can include either both children and adults (in which case children need to be dominated and controlled) or just adults, and children therefore represent a ‘safe haven’.

•Uncontrollable world: events just happen and individuals can do little to control emotions, events or sexual feelings.

Similar work was carried out for rapists (Polaschek and Ward 2002) and the implicit theories proposed are as follows.

•Women are unknowable: women are fundamentally different from men and therefore cannot be understood. Encounters with women will therefore be adversarial and women will be deceptive about what they really want.

•Women are sex objects: women are constantly sexually receptive to men’s needs but not always conscious of this. Their body language is more important than what they say and women cannot be hurt by sexual activity unless they are physically harmed.

•Male sex drive is uncontrollable: men’s sexual energy can build up to dangerous levels if women do not provide them with sexual opportunities, and once aroused it is difficult not to progress to orgasm.

•Entitlement: needs (which include sexual needs) should be met on demand and men should be able to have sex when they want to.

•Dangerous world: again, the world is a hostile and threatening place and people need to be on their guard, but there is no safe haven.

Preliminary studies have found supportive evidence for the presence of implicit theories in interview-based research with offenders (Beech and Ward 2004).

THEORIES OF SEXUAL OFFENDING

An extensive review of theories of sexual offending is beyond the scope of this chapter. This can be found in Ward et al. (2006a), where theories are comprehensively critically evaluated and their application to clinical practice discussed. Ward et al. (2006a, p. 15) note that ‘Theories are indispensible resources for clinical work with sexual offenders’. Theories should direct the clinician towards areas for assessment, assist with formulation and identify areas for treatment and risk management. Below are outlined the predominant theories which have been, or are currently, influential in this respect. It is perhaps a reflection of the complexity of sexual offending that most theories have been developed to account for one type of offender, or one aspect of the process.

Theories of sexual offending against children

Finkelhor’s four preconditions model

Finkelhor’s (1984) model of sexual offending against children (see also Ward et al. 2006a, pp. 19–31) was one of the first to take into account its complexity, and tried to account for both the factors that contributed to motivation for sexual offending as well as the process by which it occurred. It is now acknowledged that one of the major limitations of this model is that it is only applicable to certain types of offenders – those who are aware that their offending is wrong, and therefore for whom the process of offending involves overcoming inhibitions. It does not describe those men who have harmful goals, who deliberately set out to abuse a child. However, the model has been extremely influential in clinical practice in the UK, in particular in providing a framework for which many offenders can gain insight into the way their offending occurred. It is therefore described in some detail.

Finkelhor (1984) suggests that there are four factors which are complementary in accounting for the motivation to sexually offend against a child, and these make up the first of his preconditions.

MOTIVATION

•Emotional congruence: this describes the way in which children have a special meaning for many men who abuse children. For such individuals their emotional needs are met by children, who are viewed as safe and accepting, in contrast to adults.

•Sexual arousal: although the developmental ca...

Table of contents

• Cover Page
• Other Books
• Title Page
• Copyright
• Dedication
• Acknowledgements
• Contents
• Foreword
• Introduction
• Part I: Theoretical Perspectives
• Part II: Clinical Practice Issues
• List of Contributors
• Subject Index
• Author Index