Sexual Offenders:
What you need to know, and why
RED RIVER
CHILDREN'S ADVOCACY CONFERENCE
FARGO, NORTH DAKOTA
MAY 10, 2012
STACEY BENSON, PSY.D., L.P.
An Overview of the Day
 1. Prevalence of Legal Sexual

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Compulsive Behavior
2. Types of Legal Sexual
Compulsive Behavior
3. Assessment of Legal
Compulsive Sexual Behavior
4. Treatment of Legal
Compulsive Sexual Behavior
5. Prevalence of Sexual Crimes
 6. Types of Sexual Crimes
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Hands On
Hands Off
 7. Types of Sexual Offenders

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Adolescent
Adult
 8. Assessment of Sexual
Offenders


Juveniles
Adults
 9. Treatment of Sexual
Offenders


Juveniles
Adults
Prevalence of Legal Sexual Compulsive Behavior
 According to the Internet Filter Review site, 40
million Americans visit Internet porn sites at least
once a month (Maltz, 2008).
 Currently, over 60 percent of all visits on the
Internet involve a sexual purpose (Schneider and
Weiss, 2010).
Prevalence of Legal Sexual Compulsive Behavior
 A record breaking 25% of employees in the United
States are accessing porn at work, according to a
2008 Nielsen Online survey (Maltz, 2008).
Prevalence of Legal Sexual Compulsive Behavior
 There are 100,000 Web sites dedicated to selling sex
in some way-not including chat rooms, emails, or
other forms of sexual contact on the web (Cybersex
Unhooked, 2007).
Prevalence of Legal Sexual Compulsive Behavior
 In the United States, twenty million “adult” magazines are
sold each month.
Prevalence of Legal Sexual Compulsive Behavior
 The numbers of paid subscribers for selected
pornography magazines are (The National Research
Bureau, 1992):
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Penthouse – 4,600,000
Playboy – 3,600,000
Hustler – 1,200,000
Gallery – 500,000
Oui – 395,000
Chic – 90,000
Prevalence of Legal Sexual Compulsive Behavior
 Nearly all college men and women have looked at an
explicit magazine, such as Playboy or Playgirl by the time
they leave high school and 85%-90% have done so in junior
high school.
 The average college male spends about six hours a month
looking at sexually explicit material and the average college
female about two hours.
Prevalence of Legal Sexual Compulsive Behavior
 December 2005: there were 63.5 million unique
visitors to adult websites.
 As of 2006: 87% of university students polled
engaged in virtual sex.
 Mobile porn revenue is over $1 billion.
 At the end of 2004, there were

420 million pages of pornography.
 Adults admitting to internet compulsion=10%.
Prevalence of Legal Sexual Compulsive Behavior
 The vast majority of all the
respondents reported
exposure to hard-core, Xrated, sexually explicit
material .
 Furthermore, “a larger
proportion of high school
students had seen X-rated
films than any other age
group, including adults”:
84%, with the average age
of first exposure being 16
years, 11 months .
Prevalence of Legal Sexual Compulsive Behavior
 33% of the boys versus only
2% of the girls reported
watching pornography
once a month or more
often.
 As well, 29% of the boys
versus 1% of the girls
reported that pornography
was the source that had
provided them with the
most useful information
about sex (i.e., more than
parents, school, friends,
etc.).
Prevalence of Legal Sexual Compulsive Behavior
 In an anonymous survey of
247 Canadian junior high
school students whose
average age was 14 years,
James Check and Kristin
Maxwell (1992) report that
87% of the boys and 61% of
the girls said they had
viewed video-pornography.
 The average age at first
exposure was just under 12
years.
Prevalence of Legal Sexual Compulsive Behavior
 34% of kids reported exposure to unwanted sexual
material while surfing the internet.
 1 in 7 report unwanted solicitation as compared to 1
in 5 in 2000.
 92% of teens downloaded music online.
Prevalence of Legal Sexual Compulsive Behavior
 Pornography has become a substantial part of the
United States’ economy .
 No matter it’s means of access,
pornography produced annual
revenues in excess of $13 billion
dollars in the United States.
 Worldwide it produced $100 billion.
2006 World Wide Pornography Revenue
Pornography’s Effects
 Evidence shows that as many as one in three rapists
and child molesters use pornography to become
sexually aroused immediately proceeding and during
the commission of their crimes (Marshall, 1989).
 And other studies report that 56% of rapists and 42%
of child molesters reported that pornography was
somehow implicated in their offense (Able, 1985).
Pornography’s Effects
 Persons reporting exposure to pornography are 28% more
likely to engage in sexually deviant behavior (such as
exhibitionism or voyeurism) than the general population.
 Risk of engaging in sexual perpetration - that is, sexually
hostile or violent behavior - was found to increase by
between 21 and 30% for persons exposed to pornography.
Prevalence of Legal Sexual Compulsive Behavior
 It is estimated that about 15 % of people in the
United States using the internet for sexual
purposes DO have problems with their
cybersex activities (Cohn, 2010).
 Approximately 6% or about 9 million of these
users could be classified as “sexually
addicted”, and another 10% or about 15
million are using cybersex in ways that are
risky and showing signs of compulsivity.
So, does everyone become “addicted”?
 No
 Research shows that the majority of people who use
the internet for sexual purposes are recreational
users
 “Most people can use the internet (including for
sexual purposes) without being obsessed and
compulsive, managing their use with little difficulty
while continuing to maintain a reasonably balanced
life and without negative consequences” (Cohn,
2010).
 Think of these people like your “social drinkers”
The Progression
 When I talk to college students, I use the analogy of
drinking to help describe the problem.
 Some people can be social drinkers,
some people can not.
A word on calling it “Sexual Addiction”
Having Said That……
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Using pornography
Having affairs
Sexual texting
Posting on Craig's List
Etc
 These are Choices!!! Do not let clients or their partners excuse their
behavior by calling it an “addiction”.
 If they chose to conceptualize the behavior from an addiction model,
that can be helpful for many clients, but watch for “Its not my fault, I’m
addicted” statements.
 It is different from alcohol and drug addiction. It shares features, but it
is different
Assessment of Legal Compulsive
Sexual Behavior
The Power of Cybersex: The “Cyber-Hex”
 The internet has six
attributes- “the CyberHex”- that make it
unique among all other
media (Delmonico et al,
2007)
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These attributes make it
extremely alluring for
someone seeking sexual
arousal and fulfillment
 The 6 attributes:
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Intoxicating
Isolating
Integral
Inexpensive
Imposing
Interactive
(Delmonico et al, 2007)
Assessment of Legal Compulsive Sexual Behavior
 Extensive Questionnaire
 Detailed Clinical Interview
 Assessment instruments such as the ISST-R and
others
 Collateral information from the spouses
Questions To Ask Clients
 Questions that should be asked to help increase client’s awareness
in order for them to evaluate their involvement with porn
 Is porn increasing or decreasing your self esteem and integrity?
 Is it upsetting or alienating your intimate partner (or harming
your future chances of being in a healthy relationship)?
 Have you become preoccupied, out of control, dependent on, or
compulsively engaging with porn?
 How is porn shaping your sexual thoughts, desires, and
behaviors?
 What negative consequences could occur if you continue to use
porn?
(Maltz, 2008)
Questions To Ask Clients
 How many hours a week are you on the internet in sex
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related pursuits?
Have you accessed porn at work?
Have you made attempts to control it in the past? Were
they successful?
Do you belong to any pay sites? How much per month do
you spend?
Have you ever met someone in person you met on line?
Do you have a webcam?
Have you engaged in cyber sex?
Questions To Ask Clients
 Have other obligations (marital, financial, parenting,
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spiritual, community, job) taken a back seat to your porn
use?
Have you found yourself accessing more and more
“unusual” sites?
Do you get anxious or irritable if something interrupts
your ability to go on line?
Has it impacted your real life sexual life with your real
life partner?
What is the longest you have been on in one sitting?
What is the latest you have been up on line?
Questions To Ask Clients
 Do you use pornography as a reward after a good
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day? Or a pick me up after a bad day?
Have you engaged in riskier behavior now than in
the past?
Do you hide your Internet Porn use from others?
Do you think you have a problem?
Do you want to stop?
If your wife/partner did not find out and insist you
get into treatment, would you be here?
If she leaves you, will you terminate treatment?
Types of Online Users
 Recreational
Users
 Sexually
Compulsive
Users
 At-Risk
Users
10 Criteria for
Problematic Online Sexual Behavior
 1. Preoccupation with
sex on the internet
 2. Engaging in sex on
the internet more often
or for longer periods of
time than intended
 3. Repeated
unsuccessful efforts to
control, cut back on, or
stop engaging in sex on
the internet
 4. Restlessness or
irritability when
attempting to limit or
stop engaging in sex on
the Internet
 5. Using sex on the
Internet as a way of
escaping from problems
or relieving feelings
such as helplessness,
guilt, anxiety, or
depression
10 Criteria for
Problematic Online Sexual Behavior
 6. Returning to sex on the
Internet day after day in
search of a more intense
or higher-risk sexual
experience
 7. Lying to family
members, therapists, or
others to conceal
involvement with sex on
the Internet
 8. Committing illegal
sexual acts online (for
example, sending or
downloading child
pornography or soliciting
illegal sex acts online)
 9. Jeopardizing or losing a
significant relationship,
job or educational or
career opportunity
because of online sexual
behavior
 10. Incurring significant
financial consequences
 (Delmonico et al, 2007)
General Recommendations
 You should ask questions about sexual compulsive
behavior of all new clients, regardless of their presenting
problem. Its not unusual for clients to present with
issues of “anger” or “relationship issues” only to tell you
45 minutes in that they have a problem with internet
pornography.
 Try to avoid reacting with shock or disgust as they relay
to you the extent of their sexual experiences. They have
entrusted you with their secret shame, treat it with the
respect it deserves.
 Do a thorough assessment of their compulsive sexual
behavior.
 Refer when needed.
Treatment of
Legal Sexually Compulsive
Behavior
Treatment of
Legal Sexually Compulsive Behavior
 Stage 1: Precontemplation
 Stage 2: Contemplation
 Stage 3: Preparation
 Stage 4: Taking Action
 Stage 5: Maintenance
 Stage 6: Relapse
(Delmonico et al, 2007)
Stages of Preparing for Change
Initial Suggestions for Clients:
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Find a professional with experience in this area.
Calculate how much your Compulsive Sexual Behavior has cost you.
Change passwords to something that will be motivating.
Net Nanny.
Reestablish contact with positive support people.
Involve family and friends in your recovery.
Reestablish contact with your faith community.
Find a 12 step support group.
Encourage marital therapy or supportive therapy for the partner
Make a commitment to change-once an “addict” you can not go
back to being a “social drinker.” The person must stop all
compulsive sexual behavior.
The Next Step
 Clients are encouraged to keep an
Internet Log, and note the
antecedents to their behavior.
What were they doing?
What were they feeling?
What were they thinking?
What time of day is it?
Antecedents
 Does any kind of predictable pattern emerge?
 Are there any environmental manipulations we can
do based on these patterns?
 Can we identify risky:
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Feelings
Thoughts
Behaviors
Times of day
HHALT
 Hungry
 Horny
 Angry
 Lonely
 Tired
Recovery Strategies
Recognize what you’re missing.
1.
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2.
3.
4.
5.
6.
7.
8.
9.
Make a full assessment of the things you’ve cut down on, or cut out of
your life because of your addiction to the Internet.
Assess your online time.
Use time management techniques.
Find support in the real world.
Recognize your addictive triggers.
Carry positive reminder cards.
Take concrete steps to address problems.
Listen to the voices of denial.
Confront your loneliness.
(Young, 1998)
Treatment for Legal Sexual Compulsive Behavior
 Talk about self control
 High Risk Situations
 Self control
 Seemingly Unimportant Decisions
 Problem of Immediate Gratification
 Abstinence Violation Effect (might as well keep
doing it)
 Thinking Errors/Cognitive Distortions
Treatment for Legal Sexual Compulsive Behavior
 Cognitive and Behavioral Interventions (CI’s and
BI’s)
 Identify the true costs
 Understand the Cycle
 Make a commitment
Prevalence of Sexual Crimes
Prevalence of Sexual Offending
 NCMAC reports a significant and steady increase in
child pornography for the 7th year in a row as of 2005
 It is estimated that there are 20,000 new child porn
images online each week
 Child pornography has become a $3 billion annual
industry

They are getting younger, the abuse is more serious in nature
and many of the venues appear to be domestic in nature
Prevalence of Sexual Offending
 There were an estimated 88,097 forcible rapes reported to law
enforcement in 2009 (AARDVARC)

The rate of forcible rapes in 2009 was estimated at 56.6 per
100,000 female inhabitants, a 3.4 percent decrease when compared
with the 2008 estimated rate of 58.6. (AARDVARC)
 Rapes by force comprised 93.0 percent of reported rape offenses in
2009, and attempts or assaults to commit rape accounted for 7.0
percent of reported rapes. (AARDVARC)

In 2006 ND had 193 forcible rape cases, ranking us 48th in the
Nation (Bureau of Justice Statistics).
 In 2002 ND had 222 forcible rape cases. (Attorney General Crime
Report)
Prevalence of Sexual Offending
 1 in 4 girls is sexually abused before the age of 14.
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Source: Hopper, J. (1998). Child Sexual Abuse: Statistics, Research, Resources. Boston, MA Boston University School of Medicine.
 1 in 6 boys is sexually abused before the age of 16.
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Source: Hopper, J. (1998). Child Sexual Abuse: Statistics, Research, Resources. Boston, MA Boston University School of Medicine.
 More than 90% of all sexual abuse victims know
their perpetrator. Almost 50% of the offenders are
household members and 38% are already
acquaintances of the victims.

Source: US Department of Justice. (1997) and Finkelhor and Ormond. (2001).
Prevalence of Sexual Offending
 21.6% of women who reported being raped during
their lifetime were under age 12 at the time of their
first rape. 32.4% of these women were 12-17 years of
age. Therefore, over half of all female rape
victim/survivors surveyed in this study were under
the age of 18 at the time of their first rape.

Source: Full Report of the Prevalence, Incidence, and Consequences of Violence Against
Women: Findings from the National Violence Against Women Survey, (NCJRS) 2000
(www.ncjrs.org/pdffiles1/nij/183781.pdf)
Prevalence of Sexual Offending
 Persons under 18 years of age account for 67% of
all sexual assault victimizations reported to law
enforcement agencies. Children under 12 years old
account for 34% of those cases and children under
six years account for 14% of those cases

Source: Snyder, Howard. “Sexual Assault of Young Children as Reported to Law
Enforcement: Victim, Incident, and Offender Characteristics.” Bureau of Justice
Statistics, U.S. Department of Justice, 2000.
Prevalence of Sexual Offending
 According to the U.S. Department of Justice,
victims of rape and sexual assault report that in
nearly 3 out of 4 incidents, the offender was not a
stranger. Based on police-recorded incident data,
in 90% of the rapes of children younger than 12,
the child knew the offender.

Source: Greenfield, et al, 1997. Sex Offenses and Offenders: An Analysis of Data Rape and
Sexual Assault. United States Department of Justice.
Prevalence of Sexual Offending
 2/3rds of babies born to teenage mothers
were fathered by adult men, not same age
male peers.

Source: The Alan Guttmacher Institute, 1996 Based on a California Study
Prevalence of Sexual Offending
 Women reported that offenses against them were committed by:
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Strangers: 28%
Intimates/Partners: 10%
Relatives: 2%
Friends/acquaintences: 57%
Unknown: 3%
Men reported that offenses against them were committed by:
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Strangers: 48%
Friends/acquaintences: 52%
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Source: AARDVARC
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Prevalence of Sexual Offending
 The statistical victim of sexual assault is white, female, and
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under 18 years of age.
The typical offender is white, male, and over 18 years of
age.
1.8 rapes or sexual assaults are REPORTED by women for
each 1,000 over age 12. (That's about 248,000 per year.)
.3 rapes or sexual assaults are REPORTED by men for each
1,000 over age 12. (That's about 32,000 per year.)
Women reported that offenses against them were
committed by:
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Source AARDVARC
Types of Sexual Crimes
Types of Sexual Crimes
Hands On
Hands Off
 Sexual assault
 Exhibitionism
 Rape
 Possessing illicit
 Molestation
pornography
 Obscene telephone
calls
 Voyeurism
 Sexual harassment
 Forcible sodomy
 Sexual touching
Sexual Paraphilias
1.
2.
3.
4.
5.
6.
7.
Exhibitionism
Obscene Phone Calls
Voyeurism
Frotteurism
Fetishism
Transvestism
Sexual Masochism
8.
9.
10.
11.
12.
13.
14.
Hypoxyphilia
Sexual Sadism
Necrophilia
Zoophilia
Coprophilia and
Urophilia
Pedophilia
Mysophilia
Online Solicitation Offenders
 According to a 2011 study by Seto, Babchishin, Wood,
and Flynn, men convicted of internet solicitation offenses
had some significant differences from child pornography
offenders .
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Lower capacity for relationship stability
Lower sex drive/preoccupation
Less deviant sexual preferences
 They were also different from lower risk contact sexual
offenders.
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Lower capacity for relationship stability
Higher sex drive/preoccupation
Greater self-reported use of child pornography
Who are
sex
offenders?
What comes
to mind when
you think
about sex
offenders?
In Fact. . . .
Juveniles
comprise
25.8% of all
sexual
offenses
Also. . . .
Of all sex offenses
committed
against juvenile
victims, 35.6%
are committed by
juveniles.
Age and Sex of Juveniles Who Offend
 The rate of sexual offense
behavior rises sharply at
the age of 12, and plateaus
after age 14.
 The vast majority of
juveniles who sexually
offend are male (93%).

Females who offend tend to
be younger, have more
victims, offend alongside
peers more, have more male
victims, and have more
victims that are family
members.
But!
According to the U.S. Department of Justice, National Report Series from December
2011
 “Contrary to the popular perception that juvenile crime is on the rise, the data reported
in this bulletin tell a different story. As detailed in these pages, juvenile arrests for violent
offenses declined 10% between 2008 and 2009, and overall juvenile arrests fell 9%
during that same period. Between 1994—when the Violent Crime Index arrest rates for
juveniles hit a historic high—and 2009, the rate fell nearly 50% to its lowest level since at
least 1980. Arrest rates for nearly every offense category for both male and female and
white and minority youth were down in 2009.”

Proportions of Crimes Committed By Youth
(Most Serious Offense)
Additional Data
 The juvenile arrest rate for forcible rape in 2009 was
half its 1991 peak.
 The 2009 rape arrest rate was at its lowest level in
three decades.
 Juveniles accounted for 15% of all forcible rape
arrests reported in 2009.
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More than two-thirds (68%) of these juvenile arrests involved
youth ages 15–17.
Not surprisingly, males accounted for the overwhelming
majority (98%) of juvenile arrests for forcible rape.
Additional Data
 Also in 2009, there were 13,400 juvenile arrests for
sex offenses other than those related to prostitution.
 48% were under age 15.
 This is down 28% from 2000, and 10% below 2008.
 Not all children or adolescents who sexually harm
have been sexually abused. Many acted out after
viewing sexual content on the Internet.

Especially the younger children. They may act out the
confusing images they have seen on the computer as a way to
discharge their anxiety.
Below 12-more of an adrenaline rush
 Beyond 12-more of a hormonal rush

Normal Sexual Behavior in younger children
 Sexual play with children they know (playing doctor)
 Interested in sexual content in movies, tv, internet
 Interested in touching own genitalia
 Curious about sex
 Wants privacy when dressing
 Easily redirected if told “no”
 Intermittent sexual play that includes consent, and
with youth of similar age and size, whom they know
well
Less Common sexual behavior
 Sexual contact beyond touching or looking (penetration,
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oral)
Talks openly about sexual matters
Asks for sexual contact
Engages in sexual contact with someone they do not
know well
Chosen over other activities
Is aggressive, forced or coerced
Occurs with children smaller, younger or otherwise more
vulnerable
Does not respond to being told no
Kids Are Different!
 It is critical to understand that juveniles are VERY different from
adults with regard to sexual offense behavior!
 The research shows that juveniles tend to offend at MUCH
LOWER RATES compared to their adult counterparts, especially if
treated.

After treatment, children with sexual behavior problems have been found to be at
no greater risk for future sex offenses as other clinic children (2% to 3%).
 This is a case for avoiding referring to a minor as a “sex offender.”
Other Differences
 Juveniles are more likely to offend in groups than
adults (24% as opposed to 14%).
 They are more likely to have a male victim (25%
versus 13%).
 They are less likely to offend at home (69% versus
80%) and more likely to offend at school (12% versus
2%).
Type of Sex Offense by Age Category
Additional Demographics
 Juvenile’s who sexually harm are typically between the
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ages of 13 and 17.
They are generally male.
30-60% exhibit learning disabilities and academic
dysfunction.
Up to 80% have a diagnosable psychiatric disorder.
Many have difficulties with impulse control and judgment.
20-50% have histories of physical abuse.
40-80% have histories of sexual abuse.
80-90% will NOT sexually reoffend in adulthood.
Technology’s Recent Role
 Most of today’s youth
have access to the
Internet at home, school,
friends’ homes, or their
cell phones. Many use
text and picture
messaging services via
cell phones.
 These services have
made everything more
convenient. . . .
. . . .Including Risky Behavior
 Regarding COMPUTERS:
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Between 40% and 60% of teens
report they do not tell their parents
what they do online.
Between 15% and 20% of teens
admit to meeting someone offline
they did not previously know.
60% of adolescents report giving
personal information to an
acquaintance online.
The average age of first online
pornography exposure is eleven.
Computers, Continued
 One of every five
children report
being sexually
solicited on the
internet.
Risky Behavior, Continued
 Regarding PHONES:
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Sexting is prevalent, with
40% of youth saying they
have friends who carry out
such a practice.
Among teens aged 12 to
17, 4% have sent sexually
provocative images of
themselves to someone
else via text message, and
15% have received such a
message. Rates are higher
for older adolescents than
this general statistic.
Phones, Continued
Over half (56%) of
teenagers are aware of
instances where images
and videos were
distributed further than
the intended recipient.
 30% of youth know
people who were
adversely affected by
sexting.
 Only 24% of teens
would turn to a teacher
if they were affected by
issues related to sexting.

Technology and Juvenile Sexual Offenses
 Why do all those statistics about
teen computer and phone use
matter to our discussion of
juveniles who sexually offend?
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Redistribution of a sexually explicit
picture message is a sexual offense.
Adolescents with sexual offense behaviors
have often engaged in the exchange of
emails, text messages, and picture
messages with sexual content.
Youth are especially prone to become
victims of crimes based on technological
resources.
Often, teen behavior online and via cell
phone is less restricted than forms of “real
life” behavior.
Alternative Views
 Not all research has yielded similar results.
 Two studies from the University of New Hampshire
Crimes against Children Research Center suggest that
concerns about teen sexting may be overblown.

One study found the percentage of youth who send nude pictures of
themselves that would qualify as child pornography is very low.

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2.5 percent of youth surveyed have participated in sexting in the past
year, but only 1 percent involved images that potentially violate child
pornography laws (naked breasts, genitals or bottoms).
The other found that when teen sexting images do come to police
attention, few youth are being arrested or treated like sex offenders.

Researchers discovered that in most police-investigated sexting cases,
no juvenile arrest occurred.
 Standard cases: 18% arrested.
 With aggravating factors: 36% arrested.
Recent Legislation
North Dakota:
 As of April 24, 2009, it is a Class A
misdemeanor for a person to
knowingly surreptitiously create or
possess a surreptitiously created
nude/nearly nude image without
written consent from everybody in the
image.
 It is a Class A misdemeanor to
distribute such an image to harm or
humiliate the image subject.
 It is a Class B misdemeanor to acquire
and distribute any sexually expressive
image without the consent of the image
subject.
 Minnesota:
 No new legislation pertinent to
juvenile sexting is known at this time.
 Note: Many more state laws apply to
adults engaging in sexting practices.

Assessment of Sexual Offenders
Assessment of Sexual Offenders
Adults
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MnSOST-R
MnSOST-III
Static 99R
SVR-20
PCL-R
Risk Matrix 2000
Stable 2007
SRA-FV
PPG
AASI-II
Juveniles
 ERASOR
 JSOAP
 SAVRY
 MEGA
What is a Risk Assessment?
 A Risk Assessment is a comprehensive evaluation to
determination a particular sex offender’s likelihood
to commit a subsequent sex crime, and a
determination of their likelihood to benefit from
treatment
Predicting Who Will Reoffend
- before 1996
Clinical judgment

“The Jerk” factor
Correlated 0.10 with
sexual recidivism
Testing

60% of all child molesters
have no comorbid
pathology
1996 brought changes…
 Civil Commitment
 Meghan’s Law
 Psychologists started looking for some research to
back up our claims
Problematic Issues When Assessing Base Rates for
Sexual Reoffense
 Sexual assaults are underreported.
 Problems in defining recidivism.
 How do you find out if the offender actually
reoffended?
 How long should they be followed?
 Recidivism rates are different for different types of
offenders.
Base Rates for Different Types of Offenders
 Intra familial offenders
10-20%
(Barbaree & Marshall, 1998, Gibbens, Soothil & Way, 1995, Gorden & Bergen, 1988,
Dondis, 1965, Hanson, Steffy & Gauthieir, 1993)
 Extra familial child offenders
over 50%
(Prentky et all in press)
 Rapists
39%
(Prentky, Lee, Knight & Cerece in press)
Predicting Who Will Reoffend
- After 1996
 Predictions are now based on characteristics of
sexual offenders that have been shown to predict the
likelihood of a future sex crime-using actuarial
instruments
The Process
 Pre-interview regarding
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confidentiality and the
limits there of, purpose
of testing, who will see it,
procedure for the
evaluation etc.
MnSOST-R
MnSOST-III
Static 99R
Stable 2007
SRA: FV
 Background
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questionnaire
MMPI-2
MCMI-III (?)
Shipley
SAI
MSI
ABEL screen (?)
The Process
 Review every document you can find-there is no such thing
as a record that is “too old”, often old records can contain
very important information that brings new light to the
case, and how long such behavior has been going on.
 Dictate background information, questionnaire
information, police records and testing results and do a
preliminary score of the actuarial instruments
The Process
 Start out by explaining the process, exactly what you have

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been asked to do and what the limits of confidentiality are.
Have the offender tell you, in his/her own words what they
think they are being evaluated for, and put that quote in the
report.
Make sure they know the final report is going to the judge,
not just their attorney, and that it will be reviewed by both
attorneys.
No such thing as “off the record”
Get consent, written and verbal, to continue
What to look for in the testing/interview:
 Presence of a major

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
mental illness
Presence of cognitive
impairments
Presence of cognitive
distortions
High Denial
Blaming the victim
Argumentative
Multiple paraphillias
 Psychopathy
 Axis II
 Alfred Pleas
 Number of victims
and offended across
victim types (age,
gender etc)
 No treatment
 No support system
 Probation failures
The Process
 Dictate everything
 Refine the actuarials
 Contact Parole and Probation
 Work on diagnostics,
 summary
 and recommendations
The Content
 A risk assessment should be comprehensive, and
include at least some information on all of the
following areas:
The Content
 Reason for Referral
 Treatment History
 Administrative
 Sexual History
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Procedures and Referral
Time Line
Family History
Educational History
Vocational History
Military History
Legal History
Drug and Alcohol Use
History
 Previous Psychological
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Evaluations
Previous Sexual Crimes
Previous Risk
Assessments
Current Sexual Crime
Diagnoses
Summary
Recommendations
Assessment
 Ask open ended questions
 Use presumptive
questioning
 Build rapport
 Start with more neutral
questions
 Ask questions in unique
ways, and at different
times, helps get away from
“rehearsed” answers
 Don’t help them be a
better liar by pointing
out inconsistencies
 Ask good follow up, don’t
just note they have or
have not done
something; ask how
often, height of usage,
age it started etc.
 Remain non judgmental
neutral (dog story…)
Trouble Shooting
 What do you do if the score low risk on one, medium risk


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
on another, and high risk on a third??????
What do you do if they refuse to meet with you?
What do you do with female offenders?
Juvenile offenders?
Offenders from other countries?
First time incest offenders?
Typical Recommendations:
 Sex Offender Treatment following legal consequences
 Polygraph / Plythysmograph / Abel screen
 No contact with children
 Pay for victim’s counseling (donation to rape and abuse)
 No pornography usage
 Unannounced home and work visits after incarceration
period
J-SOAP-II
 Prentky and Righthand
 28 items, 4 subscales
 Empirically Guided
 Subscales are:
 Sexual Drive/Preoccupation
 Impulsive, antisocial behavior
 Intervention
 Community Stability/adjustment
J-SOAP-II
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Prior Legally charged sex offenses
Number of sexual abuse victims
Degree of planning in sexual offenses
Caregiver consistency
Pervasive Anger
School Behavior Problems
Juvenile Antisocial Behavior
Accepting responsibility for the offense
Empathy
Cognitive distortions
Quality of peer relationships
Management of sexual urges and desire
Stability of current living situation
Stability in school
Evidence of support system
ERASOR
 Worling and Curwen
 Empirically Guided
 5 domains
 Sexual Interests, attitudes and behavior
 Historical sexual assaults
 Psychosocial functioning
 Family environment functioning
 treatment
ERASOR
 1. Deviant Sexual Interest (children
 7. Prior Adult Sanctions for Sexual
 2. Obsessive Sexual
 8. Threats of, or use of, Excessive
 3. Attitude Supporting of Sexual
 9. Ever Sexually Assaulted a Child:
/ violence or both):
Interests/Preoccupation with
Sexual Thoughts.
Offending:
 4. Unwillingness to Alter Deviant
Sexual Interests/Attitudes:
 5. Ever Sexually Assaulted 2 or
More Victims:
Assault:
Violence/Weapons During Sexual
Offense:
 10. Ever Sexually Assaulted a
Stranger:
 11. Indiscriminate Choice of
Victims:
 12. Ever Sexually Assaulted a Male
Victim:
 6. Ever Sexually Assaulted Same
Victim 2 or More Times:
 13. Diverse Sexual Assault
Behaviors:

ERASOR
 14. Antisocial Interpersonal
Orientation:
 15. Lack of Intimate Peer
Relationships/Social Isolation:
 16. Negative Peer Associations and
Influences:
 17. Interpersonal Aggression:
 18. Recent Escalation in Anger or
Negative Affect:
 19. Poor Self Regulation of Affect
and Behavior (Impulsivity):
 20. High Stress Family
Environment:
 21. Problematic Parent/Offender
Relationship/Parental Rejection:

 22. Parents Not Supporting Sex
Offense Specific
Assessment/Treatment:
 23. Environment Supporting
Opportunities to Sexually
Reoffend:
 24. No Development or Practice of
Realistic Prevention
Plans/Strategies:
 25. Incomplete Sex Offense
Specific Treatment:
OBrian and Bera
 Naïve Experimenters
 Under Socialized Child Exploiters
 Sexual Aggressive
 Sexual Compulsive
 Disturbed Impulsive
 Peer Group Influenced
Worling
 Antisocial/Impulsive
 Over Controlled Reserved
 Unusual/Isolated
 Confident/ Aggressive
Toni Cavanaugh Johnson
 Group I: Natural and Healthy Sexual Play
 Group II: Sexually Reactive Behaviors
 Group III: Extensive Mutual Sexual Behaviors
 Group IV: Children who Molest
Amenability to Treatment
Will Treatment help anyway?
Early Conclusions
“There is no evidence that
treatment effectively
reduces sex offense
recidivism.”
(Furby 1989)
1. Lack of control groups
2. Small N
3. Unreliable reporting
methods
4. Other
Will treatment help anyway?
 Later conclusions:
 Sex offenders who
completed treatment, are
less likely to reoffend
(Nagayama Hall 1995)
 When current treatments
are evaluated with
credible designs, there is
a reduction in both
sexual recidivism &
general recidivism (Hansen
etal: 2000)
So, Lets send all offenders to treatment, right?
 Wrong:
 “If the offender starts treatment subsequently quits,
is kicked out, drops out, etc., he is statistically at a
higher risk to reoffend than if he never entered
treatment at all.”
(Hanson and Bussierses 1996)
Treatment of Sexual Offenders
Adults
Juveniles
Treatment of Sexual Offenders

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
Identify risk factors
associated with lifestyle
High Risk Situations
Triggers
Thoughts/Feelings and
Behaviors that lead to
reoffending
SUDS
Grooming behavior
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Cognitive and Behavioral
interventions
Counter conditioning
methods
Amends
Denial
Taking Responsibility
Treatment of Sexual Offenders
 Accepting Responsibility
 Making a Commitment to Treatment
 Denial
Denial of the facts
 Denial of intent
 Denial of impact
 Denial of responsibility
 Denial of the need for treatment

Treatment of Sexual Offenders
 Managing your behavior

Coping with Deviant arousal
The Sex Offense Cycle
 Seemingly Unimportant Decisions
 Abstinence Violation Effect (Giving )
 Behavioral alternatives at each level of the cycle
 Avoidance/Escape

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Minimal Arousal Conditioning
Ammonia Control
Covert Conditioning
Coping with Anger
Anger log
 Anger autobiography
 Taking responsibility for your anger
 Changing how you express anger

Treatment of Sexual Offenders
 Understanding Yourself

Childhood


What we learned about ourselves
Family Dynamics
What we learned about
 Rules
 Roles
 boundaries


Sexual autobiography
Treatment of Sexual Offenders
 Victim Impact

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How sexual abuse affects
victims
Victim Empathy
Thinking errors about
victims
Empathy role plays
Clarification letter
Treatment of Sexual Offenders
 Relationship and Communication Skills
 Understanding relationships
 Understanding your role in relationship failures
 Basic beliefs that interfere in relationships
 Self defeating styles of relating to others
Assertive
 Aggressive
 Passive Aggressive

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Effective communication
techniques
The Characteristics of bad
communication
Treatment of Sexual Offenders
 Thinking, Feeling, Behaving
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Automatic thoughts/feelings
Self statements
Thinking feeling link
Distorted thinking
Styles of distorted thinking
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All or Nothing
Rationalization
Minimization
Catastrophizing
Personalization
Overemphasizing one detail
Etc., etc., etc.
Restructuring distorted thinking
Treatment of Sexual Offenders
 Thinking, Feeling, Behaving
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Emotions
Expressing emotions
Situation and Setting
Symptoms
Behavior chains
Building offense chains
The imaginary relapse scenario
Treatment of Sexual Offenders
 Thinking, Feeling,
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Behaving
Positive/Negative Consequences
Changing Poor choices
Problem Solving
Behavior chains
Building offense chains
The imaginary relapse scenario
Treatment of Sexual Offenders
 Sexually Compulsive Behavior related to child
pornography requires different treatment


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
Minimal Arousal Conditioning
Ammonia Aversion
Masturbatory Reconditioning
Traditional Sex Offender Treatment
Treatment: Juveniles
 Very few studies have evaluated the efficacy of sex
offender treatment for juveniles.
 Currently, there are no evidence-based treatment
guidelines for this population.
Treatment: Juveniles
 The guidelines that exist are based on expert opinion
and accepted practice.


National Task Force on Juvenile Sexual Abuser Treatment
Association for the Treatment of Sexual Abusers (in process)
 So what can be done for the treatment of this youth?
Treatment
 Psychoeducation

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Healthy sexuality
Appropriate boundaries
Self-regulation
 Autobiography
 Fantasy work
 Medication (sometimes)

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SSRIs: setraline, fluoxetine, paroxetine
Antiandrogens/hormonal agents: medroxyprogesterone acetate
Luteinizing hormone-releasing hormone agonists: leuprolide acetate,
goserelin acetate
Treatment: Juveniles
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What is consent and who can give it
Legal vs. illegal sexual behavior
Understanding anger
Identifying problems
Disclosing

Denial
Thinking Errors
Who I hurt
What I did
How I did it
How I planned it
Victim’s Reactions
Victims Feelings
Who is Responsible

Pathways: A guided workbook for youth beginning treatment by Tim Kahn

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

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
Treatment: Juveniles
 Myths of Sexual Abuse
 Who is a victim
 Direct
 Indirect

Pathways: A guided workbook for youth beginning treatment by Tim Kahn
Treatment: Juveniles
 Why did I do it?
 Motivation (urges)
Emotional Needs
 Sexual Arousal
 Blockage

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Internal Barriers
External Barriers
Victim Resistance
My Sensitivity to Victim
Resistance
Pathways: A guided workbook for youth
beginning treatment by Tim Kahn
Treatment Goals
 1. Accept full responsibility for any sexually inappropriate and or criminal or

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harmful behaviors
2. Develop a clear understanding of and sensitivity to the impact of my behavior on
the people I have hurt
3. Develop an understanding of the thoughts and feelings that led to my
inappropriate behaviors and identity the factors that contributed to my poor choices
4. Learn to develop healthy and legal relationships that don’t hurt other people
5. Learn to have healthy sexual thoughts, feelings, actions and behaviors and learn
to control and eliminate unhealthy sexual thoughts, feelings actions and behaviors.
6. Identify high risk situations that could lead to committing sexually inappropriate
behavior.
7. Develop a strong network of people who will support me in making healthy
choices
8. Develop a healthy living plan that other people in my support system will read
and sign
9. Learn and demonstrate the four key treatment challenges, responsibility, honesty,
sensitivity and integrity.
 From: Pathways: A guided workbook for youth beginning treatment by Tim Kahn
Treatment: Juveniles
 Identifying Grooming and Maintenance Behaviors
 Understanding the chain of events that lead to offending
 Creating and Following a Relapse Prevention Plan


Seemingly Unimportant Decisions (SUD’s)
High Risk Situations (HRS’s)
 Controlling and expressing my sexual feelings in a
positive way

Covert Sensitization
Vicarious Sensitization

Pathways: A guided workbook for youth beginning treatment by Tim Kahn

Treatment: Juveniles
 Accountability Plans
 Making things clear and apologizing for my behavior
 Clarification letters

Pathways: A guided workbook for youth beginning treatment by Tim Kahn
Treatment: Juveniles
 S.T.O.P. plans
 Support Through On Going Prevention

Pathways: A guided workbook for youth beginning treatment by Tim Kahn
Group Rules
 The worth of every member is universal, intrinsic





and unquestioned.
Start and end of time
Be respectful of all members
No electronics
Confidentiality
Excused Absences only
Who might NOT be a good group candidate
 Low iq, learning disabled, FASD
 Major mental illness
 Active CD issues
 Psychopathic
 Autistic
 Very low risk
 When the offense is such that group may reject them
 When the offense is such that they may reject the
group
Safety Plans
 Who is an informed supervisor?
 A sober, awake, adult, who knows what the child did, provides
line of sight supervision and is willing to call treatment team if
safety plan is violated
 Access to pornography?
 Parental controls, computer in central location, password
protected
 In positions of authority over younger children?
 No babysitting-ever
 Alarms on bedroom doors?
 Offenders door alarms, siblings door chimes
Safety Plans
 What about school and community activities?
 Who needs to know?
 Balance community safety and social stigma
 Contact with potential victims in the community?
Over the Phone? Via Social Media?



No babysitting
Need to check other things individually such as church, camp,
sporting events, public pools
Sleepovers?
Factors to Consider
 Individual factors in the youth
 Families overall health and functioning
 Do they minimize what their child did?
 Do they think this was all blown out of proportion?
 Do they blame the victim?
 Do they keep secrets
 Degree of potential harm
 Youths risk level of reoffense
 Treatment behavior/progress
Some reasons why they fail
 Child is hypersexual
 Child is impulsive
 Families not willing to follow the plan as written
 Do not monitor adequately
 Do not see the need for the plan
 Are afraid to report violations
Treatment for Sexually Abusive & Sexually
Inappropriate Behavior in Children & Adolescent
The stages of Accomplishment Model
The model is designed as a means of youths to demonstrate
and to recognized for their accomplishments in learning, not
as a measure of “success” or treatment “progress,” or as a
“level and privilege” system. With accomplishment of each
stage, the youths with whom we work are thus able to show
themselves, their families, and others that they are learning
important ideas about treatment, and are able to use these
ideas in their everyday life (Rich, 2009).
STAGE 1 & 2
 Stage 1, An Introduction to Treatment

Learn about treatment, and about oneself and why one is in
treatment
Understanding sexually abusive and sexually inappropriate
behavior is addressed
 Goals of treatment are identified

 Stage 2, Understanding Yourself

Learn more about oneself—including feelings, attitudes, & ideas

Examine how these responses sometimes can come together to
contribute to sexually abusive or sexually inappropriate behavior
Consent is Not Simply Saying Yes!
The definition of a sexual offence often revolves around consent. In
simple terms, it's all about permission (or agreement).
Kahn (2011) outlines that “True Consent” is Only
established when the following 5 criteria are met…
1. True consent requires that both people are
emotionally and intellectually equal
2. True consent requires honesty
3. True consent requires understanding
4. True consent requires permission to disagree or to
refuse without penalty or harm
5. True consent requires that both people really
understand what is going to happen
STAGE 3
 Stage 3, Understanding Dysfunctional Behavior

Learn to understand problematic behaviors, and the impact
one’s behaviors have on others
Dysfunction behavioral cycle and phases of the dysfunctional
behavior cycle
 High-risk situations and behaviors
 Behavior management, staying safe, & preventing relapse

STAGE 4
 Stage 4, Hitting the Target: Making Change Permanent

Learn how to better understand and connect with others, make
amends for one’s sexually abusive or inappropriate behavior, relate
& give back to the community, & build stronger relationships with
others



Examine how these responses sometimes can come together to
contribute to sexually abusive or sexually inappropriate behavior
Empathy ,caring, and victim awareness
Learning to communicate
• active listening & non-verbal communication
• assertiveness vs. aggression

Healthy and unhealthy relationships
• power & control in relationships
• recognizing boundaries
• Recognizing healthy & unhealthy sexual relationships
Lowering Reoffense Risk
 Increase non-delinquent
social involvement

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

Sports
Clubs
Church activities
Non-delinquent friends
 Stabilize living situation
and school involvement
 Monitor for alcohol and
drug use
 Manage anger
Lowering Reoffense Risk, Continued
 Restrict contact with
negative influences


Parental controls for
television
Examine movie and video
game ratings
 Eliminate access to offense
opportunities


Password-protect computer,
phone
Do not allow unsupervised
contact with prior victims or
similar individuals
Lowering Reoffense Risk, Continued
 Parental Involvement!!


Our program relies heavily on parental
involvement and we have a separate
group that meets for the parents.
It is based on Tim Kahn’s “Pathways
Guide for Parents” and covers things
such as
Where to turn, understanding the legal
issues, evaluation and treatment,
overcoming your own denial
 Direct vs. indirect victims
 Understanding the sexual offense cycles,
grooming and maintenance behaviors
and relapse prevention


From: “Pathways Guide for Parents” by Tim Kahn
Parents Group
 Discuss the importance of parents showing interest
in the their child’s treatment, becoming comfortable
discussing sexual issues, showing respect for
boundaries at all times, demonstrating responsible
thinking and emphasizing positive reinforcement.

From: “Pathways Guide for Parents” by Tim Kahn
Answering common questions such as:
 How to tell the difference between normal sexual behavior during

childhood and what is cause for concern?
How do I know my child is making progress?
How long will treatment last?
How do I talk with my child about their sexual behavior problem?
Who do I have to tell? Principal? Pastor?
When will I be able to trust my child around children again?
Does this mean they will become an adult sex offender?
Can our child go to parks or playgrounds alone?
Can our child go to Boy Scout meetings?
Can our child sleep overnight at another child’s house?

From: “Pathways Guide for Parents” by Tim Kahn
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Parents Group
 Parents are taught the same “treatment lingo” as
their child, and are kept up to date on what their
child is learning in treatment so that they can ask
specific questions, instead of general “how is it
going” or “what are you learning?”
 We work on getting through denial and
minimization, and thinking errors.
 We spend a lot of time on parental responsibility.

From: “Pathways Guide for Parents” by Tim Kahn
Parents Group
 Such as limiting TV, video games and
computer times.
 Encourage sports, reading, family games.
 Monitor what your child is watching on TV
and computer.

Watch for sexual and violent themes, use the
parental controls available to you
 Encourage physical activity.
 Supervision and monitoring, especially if
younger children are present-no
unsupervised contact with children.
Supervisors should be adults.
 No unsupervised access to community
spaces.

From: “Pathways Guide for Parents” by Tim Kahn
Parents Group
 Parental discretion when it comes to sexual behavior.
 Try keep a regular routine (bedtimes, mealtimes etc.).
 Pay attention to hygiene.
 Pay attention to appropriate dress.
 No TVs in the bedroom


too hard to monitor content
encourages isolation
 Watch sexual language, jokes, TV shows in the house.

From: “Pathways Guide for Parents” by Tim Kahn
Parents Group
 We also spend time on the siblings
of adolescents with sexual behavior
problems-these children, if neither
victim or perpetrator, often get
overlooked.
 It is important to avoid secrets as a
family and to let them know as
much as it is developmentally
reasonable for them to know.
 Try to keep life for the sibling as
normal as possible and not allow
what has happened to keep them
from engaging in normal activities
(such as sleepovers, etc.).
 Try spend time one on one with
them, and consider some
counseling as well if this seems like
it is needed.

From: “Pathways Guide for Parents” by Tim Kahn
Parents Group
 Situations where a chaperone is needed, and not
needed.
If the victim is a family member
 Each should have their own separate counselor
 Review the clarification and restitution letters your
abusing child will write in treatment
 Often parents feel torn, conflicting loyalties come
into play.
 Encourage construction communication and
appropriate affection.

From: “Pathways Guide for Parents” by Tim Kahn
If the victim is a family member
 Lastly, family reunification, if this is feasible.
 This comes only after a through assessment of both the victim
and the perpetrator, and successful completion of treatment.
Ideally the child’s PO has done a home visit, and all members
of the family have agreed to the rules.
 The child is slowly integrated back into the home, starting with
brief visits, moving towards overnight visits, then weekend
visits etc.
 Meetings are held periodically during this process to assess
how it seems to be going.

From: “Pathways Guide for Parents” by Tim Kahn
If the victim is a family member
 Several house rules may be in place such as
 Where the bedrooms are and whether the doors will have
alarms on them.
 Video monitoring, intercoms, etc.
What Does NOT Appear to be Helpful
Placing children on public sex offender registries.
2. Segregating children with sexual behavior problems
from other children.
1.
•
•
Such as when foster homes, agencies, and facilities form
policies excluding children with a history of sexual offenses.
An exception is if the child’s behavior is out of control or poses
an acute and substantial risk for serious harm to other children.
 These policies offer little to no actual community protection.
 These practices make youth vulnerable to stigma and social
disadvantage (which could indirectly increase risk of reoffense).
A Shameless Plug
Benson Psychological Services
 Benson Psychological Services, PC offers the following
services
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

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Individual and Group therapy for Legal Sexually Compulsive
Behavior
Group Therapy for adult sex offenders
Group Therapy for adolescents who have sexually harmed others
Partners to offenders group
Parents group
Partners of those who have problems with legal sexually compulsive
behavior
 You can refer clients by having them call 701-297-7540
and speaking with our intake person, Alyssa, ext 153
Thoughts…Comments
References
Association for the Treatment of Sexual Abusers, Task Force on Children with Sexual Behavior Problems. (2006).
Report of the Task Force on Children with Sexual Behavior Problems. Retrieved from
http://www.atsa.com/sites/default/files/
Report-TFCSBP.pdf
Barbaree, H. E., & Marshall, W. L. (Eds.). (2006). The juvenile sex offender, second edition. New York, NY: The
Guilford Press.
Concerns about teen sexting overblown, according to new UNH research. (2011, December). University of New
Hampshire Media Relations. Retrieved from http://www.unh.edu/news/cj_nr/2011/dec/lw05sexting.cfm
Kahn, Tim. (year). Pathways: A guided workbook for youth beginning treatment. Brandon, Vermont: Safer
Society Press.
Phippen, A. (2009). Sharing personal images and videos among young people. Retrieved from SW Grid for
Learning Website: http://www.swgfl.org.uk/Staying-Safe/Files/Documents/sexting-detail
Sacco, D. T., Argudin, R., Maguire, J., & Tallon, K. (2010). Sexting: Youth practices and legal implications.
Retrieved from the Berkman Center for Internet and Society at Harvard University Website:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1661343
Seto, M.C., Babchishin, K. M., Wood, J. M., & Flynn, S. (2011). Online solicitation offenders are different from
child pornography offenders and lower risk contact sexual offenders. Law and Human Behavior, no journal
number specified, 1-11.
Wollert, R. (2012). The implications of recidivism research and clinical experience for assessing and treating
federal child pornography offenders: Written testimony presented to the U.S. Sentencing Commission. Child
Pornography Offenders, no journal number specified, 1-27.
Zimring, F. E. (2004). An American travesty: Legal responses to adolescent sexual offending. Chicago, IL:
University of Chicago Press.
Sources
 sex addiction workbook: proven strategies to help you regain
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control of your life - Tamara Penix Sbraga, William T. O'Donohue
Stages of Accomplishment - Phil Rich, EdD, MSW
Pathways - Timothy Kahn
Road to Freedom - John Morin, PhD & Jill Levenson, MSW
Adult Relapse Prevention workbook - Charlene Steen, PhD, JD
Treating Nono ffending Parents in Child Sexual Abuse Cases:
Connections for Family Safety - Jill Levenson & John Morin
A L.I.F.E. Guide - LIFE Ministries - Mark Laaser, PhD
Manual for Structured Group Treatment with Adolescent Sex
Offenders - Jacqueline Page, PsyD and William Murphy, PhD