Assessing and Managing Problematic Sexual Interests A

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First published 2021
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Contents

Contributorsxi
Series foreword by xvii
Richard Shuker and Geraldine Akerman
Foreword by xxi
Anthony Beech

PART I
Assessment1
1 How do sexual interests cluster and relate to
sexual offending behaviours against children? 3
Sarah Paquette and Sébastien Brouillette-Alarie
Introduction3
The current study 7
Conclusion18
References18

2 Exploring and assessing the current sexual

interest of men who have committed sexual
and non-sexual violent offences 23
Geraldine Akerman, Jennifer Hardy and Paul Hamilton
Introduction23
Background24
Method30
Procedure32
Results33
References37

3 The role of PPG in sexological assessment and

treatment of sexual offenders: a comparison of
British and Czech practice 41
Derek Perkins, Marek Páv and Petra Skřivánková
Introduction41
Materials and methods 42

v
viContents

Results42
Discussion: comparison of both practice systems 51
Conclusion52
References53

4 Using the Explicit and Implicit Sexual Interest

Profile in applied forensic or clinical contexts 57
Alexander F. Schmidt and Derek Perkins
Paraphilic interests in forensic contexts 57
Indirect latency-based measures of sexual interest in
children58
Testing single cases with the Explicit and Implicit
Sexual Interest Profile 66
Using the Explicit and Implicit Sexual Interest Profile
in court 73
Conclusion78
Notes78
References79

5 Using the Rapid Serial Visual Presentation to

detect sexual interest 83
Angelo Zappalà and Pekka Santtila
Why it is important to detect deviant sexual interest and
how to detect it 83
Attention-based measurement procedures 84
Rapid Serial Visual Presentation procedure 85
The attentional blink phenomenon 86
Dual-target Rapid Serial Visual Presentation (dtRSPV)
as an attention-based measurement procedure to
detect Deviant Sexual Interest (DSI) 87
Future directions 93
Notes96
References96

6 Using eye-related measures to assess

sexual interest 101
Charlotte Wesson and Todd E. Hogue
Previously used assessments for sexual preference 102
Measuring sexual preference with eye-tracking 104
Measuring sexual preference using pupil dilation 107
Contentsvii

Limitations to eye-tracking 109

Key conclusions and summary of recommendations
for best practice 110
References111

7 Sexual fantasy use as a proxy for assessing

deviant sexual interest 115
Ross M. Bartels
Introduction115
Sexual fantasy versus sexual fantasizing 116
The role of sexual fantasizing in sex offending 117
Assessing sexual fantasy use 118
Issues and recommendations 124
Conclusion126
Note126
References126

PART II
Management131

8 The treatment of sexual deviance within a

therapeutic setting 133
Jayson Ware, Meagan Donaldson and Danielle Matsuo
Introduction133
Treatment philosophy 134
Description of strategies and exercises 138
Summary145
References145

9 Compassion and acceptance as interventions

for paraphilic disorders and sexual offending
behaviour149
Jamie S. Walton and Kerensa Hocken
First wave 150
Second wave 152
The third wave: principles of relational frame theory
and an evolutionary functional perspective 153
ACT and CFT and their potential usefulness as
therapies for paraphilia and offending 158
ACT158
viiiContents

CFT162
A brief summary of ACT and CFT outcomes in
mental health 164
Compassion and acceptance integrated into
contemporary rehabilitation practice 164
Conclusion166
Note166
References166

10 A psychoanalytic approach to paraphilic

disorders, perversions and other problematic
sexual behaviours 171
Jessica Yakeley
Introduction171
Forensic psychotherapy 172
Paraphilias, paraphilic disorders and perversions –
diagnostic controversy and confusion 173
Psychoanalytic theories of perversion 176
Perversion and paraphilic disorders: a contemporary
clinical theory 181
Psychoanalytically informed treatment of paraphilic
disorders and perversions 183
Challenges of treatment 184
Conclusion190
Notes191
References191

11 Medication to manage problematic sexual arousal 193

Emma Marshall, Belinda Winder, Christine Norman
and Nicholas Blagden
Introduction193
Measurements of problematic sexual arousal 196
Clinical interviews 197
Self-report measures of symptoms 197
Self-report measures of consequences 198
Comorbidity and wellbeing 198
Psychological treatment of individuals convicted
of sexual offences 200
Medication to manage problematic sexual arousal 200
Types of medication 202
Hormonal therapy medications 202
Contentsix

Selective serotonin reuptake inhibitors 203

Side effects of medication 203
Medication guidelines 204
Evidence of effectiveness 204
Conclusion207
References208

PART III
Approaches to assessment and management 215

12 Introducing the multi-component framework

of female sexual offending 217
Rachel Worthington
The extent of the problem – female perpetrators and
their victims 217
Females who offend using the Internet 219
Theories of female sexual offending 220
Gender equivalence 222
Gendered perspectives – what does it mean to be female? 224
Treatment227
Female sexual offending – where are we now? 229
Introducing the multi-component framework of female
sexual offending 231
Conclusion246
References247

13 Trauma, adverse experiences, and

offence-paralleling behaviour in the assessment
and management of sexual interest 251
Lawrence Jones
Developmental accounts of offending 252
Internal working models 256
Links between trauma and offending 257
Offence paralleling behaviour, trauma and the
self-regulation model 259
Trauma triggers 259
Trauma triggers and OPB linked to sexual interest
risk domains 264
Sexual preoccupation 264
Sexual preference for prepubescent or pubescent children 266
xContents

Sexualized violence 267

Paraphilic interest 268
Illustrative fictional case example – Chris 269
Conclusion271
References272

Index275
Contributors

Geraldine Akerman is a Chartered and Registered Forensic Psychologist and

Therapy Manager at HMP Grendon. She is a Visiting Lecturer at the Uni-
versity of Birmingham, UK and Honorary Professor of Cardiff Metropolitan
University, UK and Chair Elect of the Division of Forensic Psychology.

Ross M. Bartels is a Senior Lecturer in Forensic Psychology and leader of the

Forensic and Clinical Research Group at the University of Lincoln, UK.

Nicholas Blagden is an Associate Professor in Forensic Psychology, a

co-founder and trustee of the Safer Living Foundation, Chartered Psychol-
ogist, and Head of the Sexual Offences Crime and Misconduct Research
Unit (SOCAMRU). He has worked and researched within criminal justice
and prison settings for over 10 years. His work has been funded by the Her
­Majesty’s Prison and Probation Service (HMPPS) and he is currently engaged
in numerous collaborative forensic projects with NTU, HMPPS, Institute
for Mental Health, Canada and Correctional Services Australia. He sits on
NOTA’s policy and practice committee.

Sébastien Brouillette-Alarie (PhD) is the Scientific Coordinator of the Cana-

dian Practitioners Network for the Prevention of Radicalization and Extremist
Violence (CPN-PREV) and a lecturer in criminology at the Université de
Montréal. He has published peer-reviewed articles on the risk assessment of
criminal recidivism, the latent structure of risk scales for sexual offenders, the
aetiology of risk in sexual offenders, online radicalisation, sexual sadism, the
offending process of hebephiles, and psychopathy among women.

Meagan Donaldson is currently a Senior Psychologist in Sex and Violent

Offender Therapeutic Programs, Corrective Services New South Wales,
Australia. She has worked with sexual offenders for the past fifteen years, pri-
marily in the delivery of treatment for incarcerated sexual offenders within a
therapeutic environment.

Paul M. Hamilton, PhD earned his MA in Psychology from the University

of Houston in 1977 and his PhD in Clinical Psychology from the Fielding
Institute of Graduate Studies in 1996. Dr Hamilton is licensed in Texas as a

xi
xiiContributors

Licensed Psychologist, Licensed Specialist in School Psychology (LSSP) and

Licensed Sex Offender Treatment Provider (LSOTP). He is Certified as an
EEG Senior Fellow Emeritus in the Biofeedback Certification International
Alliance (BCIA) and is an Emeritus Registrant with the National Register of
Health Service Providers in Psychology. At the University of Houston, Victo-
ria, he served as a Clinical Assistant Professor and program director for the
schools Master’s Degree program in Forensic Psychology.

Jennifer Hardy is a Lecturer in Psychology at the University of Chester, where

she teaches on a number of forensic psychology modules. She gained her
Bachelor’s degree in Psychology at the University of Nottingham in 2012 and
her Master’s degree in Forensic Psychology at Nottingham Trent University in
2013. In 2013 she was awarded a PhD scholarship by Sheffield Hallam Univer-
sity. Jenny is currently lecturing at the University of Chester across a number
of undergraduate and postgraduate modules. Her main research interests are
in offender resettlement and treatment and women in the Criminal Justice
System.

Kerensa Hocken is a registered Forensic Psychologist. In 2016 she was

the winner of the prestigious Butler Trust award for excellence in cor-
rectional services, presented by Princess Anne. Kerensa is a trustee and
co-founder of the Safer Living Foundation (SLF), a member of the Com-
passionate Mind Foundation, and cofounder of the CFT forensic special
interest group.

Todd E. Hogue is a registered Forensic and Clinical Psychologist. His PhD

research focused on the development of a self-report measure of denial in
sexual offenders. During the early SOTP training he became interested staff
attitudes and developed the Attitudes Towards Sexual Offenders (ATS) scale
which is still actively being used. In 2006 he moved to an academic role at the
University of Lincoln and is currently Professor of Forensic Psychology and
Director of Research for the College of Social Science.

Lawrence Jones is a Forensic and Clinical Psychologist whose career has

included working in the community, at HMP Wormwood Scrubs and at Ramp-
ton High Secure Hospital, UK. He is a former Chair of the Division of Forensic
Psychology and teaches on the Sheffield and Leicester Clinical Psychology
doctorate courses and the Nottingham Forensic Psychology Doctorate.

Emma Marshall is a PhD student and Hourly Paid Lecturer at Nottingham

Trent University. She is part of the Sexual Offences, Crime and Misconduct
Research Unit (SOCAMRU). Emma is currently undertaking a mixed meth-
ods PhD research project evaluating the effectiveness of medication to manage
Contributorsxiii

problematic sexual arousal (MMPSA) and improve well-being in a commu-

nity setting. The research project has been designed to assess the impact and
effectiveness of MMPSA in reducing problematic levels of sexual compulsiv-
ity and improving well-being for individuals who have recently been released
from a custodial sentence.

Danielle Matsuo is the Director State-wide Programs, Corrective Services

NSW. She has over 15 years’ experience as a psychologist in a correctional
environment, after completing her Master’s degree in Forensic Psychology at
the University of New South Wales. Danielle is responsible for the develop-
ment, co-ordination and ongoing integrity of offender programs addressing
the criminogenic needs of sexual, violent and general offenders in NSW.

Christine Norman is a Senior Lecturer in psychology at Nottingham Trent

University. Her teaching and research are in biological psychology, psycho-
pharmacology, forensic psychology and mental health. Current research
interests are in overcontrolled personality type in relation to offending, the
use of medication to manage problematic sexual arousal, sexual addiction and
the implications of polyvagal theory in mental health.

Sarah Paquette (PhD) works as a Specialist Sexual Offending in the Internet

Child Exploitation (ICE) unit of the provincial police of Quebec, Canada. She
completed her PhD in psychology and is currently a lecturer in criminology
at the University of Montreal. Her research focuses on the factors associated
with online and contact sexual offending against children. She currently coor-
dinates and leads the PRESEL research project that aims to help develop best
police practices in order prevent child exploitation and to elaborate efficient
intervention strategies and systematic case prioritisation tools.

Marek Páv, PhD is a psychiatrist and sexologist working in Bohnice Psychiat-

ric Hospital as a Consultant and Medical Director and as Assistant Professor
at the 1st Medical Faculty of Charles University. He is currently involved in the
reform of the forensic care system in the Czech Republic. His research projects
include psychiatric rehabilitation, assessment of cost of care, somatic care in
SMI, risk assessment systems and sexology.

Derek Perkins is a Registered and Chartered Clinical and Forensic Psycholo-

gist, Professor of Forensic Psychology at Royal Holloway University of London,
and Co-Director of the onlineProtect research group on internet-related sexual
offending. He has published on forensic assessment, sexual offending, sexual
homicide, and child sexual exploitation, and regularly serves as an expert witness
in Criminal and Family Court proceedings.
xivContributors

Pekka Santtila is Professor of Applied Psychology at the Åbo Akademi Uni-

versity in Turku, Finland. He has published widely in the area of legal and
forensic psychology with a focus on different aspects of child sexual abuse
and its investigation. He has also led an Academy of Finland funded research
project on implicit measurement of sexual interest in children.

Alexander Schmidt is a clinical psychologist and Professor of Forensic Psy-

chology at Hamburg School of Medicine. With his colleague Prof Rainer Banse
he developed and validated the EISIP in a number of settings.

Petra Skřivánková is a psychologist at Psychiatric Hospital Bohnice in Prague

in the Czech Republic. She received her doctorate in Clinical Psychology from
the Charles University. Her current research interests include high-risk assess-
ment of offenders. She is currently completing a standardisation of a high-risk
assessment tool for adolescents SAVRY in the Czech Republic.

Jamie Walton is a National Specialist Lead in HM Prison and Probation Ser-

vice. He is a Registered Practitioner Psychologist (Forensic) with the Health
and Care Professions Council (HCPC), a Chartered Psychologist and an
Associate Fellow of the British Psychological Society (AFBPsS). Since 2006,
Jamie has worked in prison and healthcare settings predominantly supporting
individuals with convictions for sexual offending to lead crime-free lives. His
research interests are primarily in the causes of paraphilia and the design and
evaluation of therapeutic interventions designed to support safer living with
paraphilia.

Jayson Ware is currently the Group Director, Offender Services and Pro-
grams, Corrective Services New South Wales, Australia. He has researched or
worked with sexual offenders for the past twenty years and has authored 35
journal articles or book chapters primarily relating to the treatment of sexual
offenders. He has particular research interests in offender denial, group work,
enhancing treatment effectiveness, and therapeutic communities.

Charlotte Wesson is currently a PhD student at the University of Lincoln. Her

PhD research centres on measurement of sexual preference using a variety of
established and emerging measures. Though this research is mainly developed
with ‘typical’ samples, there is scope to extrapolate this to forensic populations.

Belinda Winder is a Professor in Forensic Psychology and Research Director

of the Centre for Crime, Offending, Prevention and Engagement at Not-
tingham Trent University. She is also part of the Sexual Offences, Crime and
Misconduct Research Unit (SOCAMRU) in the Department of Psychology
Contributorsxv

at Nottingham Trent University. Belinda is a co-founder, trustee, Vice Chair

and Head of Research and Evaluation for the Safer Living Foundation. She
received a Butler Trust Certificate for her work in prisoner rehabilitation in
2016, the Robin Corbett Award for Prisoner Rehabilitation in 2015, and the
Guardian University Award for Social and Community Impact in 2016.

Rachel Worthington is a Consultant Psychologist, a Chartered Psycholo-

gist, and a full member of the Division of Forensic Psychology, including
holding Associate Fellow status. She is also a Chartered Scientist and is fully
registered with the HCPC. She is a Senior Lecturer at the University of Cen-
tral Lancashire teaching on the Masters in Forensic Psychology and is also
an accredited therapist in eye movement desensitisation and reprocessing
(EMDR) for the treatment of trauma.

Jessica Yakeley is a Consultant Psychiatrist in Forensic Psychotherapy and

Director of the Portman Clinic, and Director of Medical Education, Tavistock
and Portman NHS Foundation Trust. She is also a Fellow of the British Psy-
choanalytic Society and Editor of the journal Psychoanalytic Psychotherapy.
She is Research Lead for the Royal College of Psychiatrists Psychotherapy Fac-
ulty and for the British Psychoanalytic Council. She is currently leading the
national development and implementation of new services for a multi-site
randomised-controlled trial of mentalisation-based treatment for antisocial
personality disorder as part of the UK Government’s National Personality Dis-
order Offender Pathways Strategy.

Angelo Zappalà is a psychologist, clinical criminologist and cognitive

behaviour therapist. He was awarded his PhD in Psychology at Åbo
Akademi University. He teaches Psychology of Deviance at IUSTO
(Pontifical Salesian University of Turin, Italy). In the same University
he is the director of the CRIMELAB. He is also the director of Cognitive
Behavioral Therapy School, the CBT.ACADEMY (approved by the Ital-
ian Ministry of the University and scientific research) and the director
of the Italian Festival of Criminology of Turin.
This volume is dedicated to Dr Ruth Mann.
Ruth’s kind, gentle and inspiring presence, both as a valued colleague
and much loved friend, over many years will never be forgotten. It was
always a pleasure to be in her company, to learn from her modestly of-
fered wisdom and to have so many happy memories of times spent with
her.
Series foreword

From its origins as a British Psychological Society journal, the Issues in Foren-
sic Psychology series has had two central aspirations. The first has been to
promote novel, innovative and relevant ideas within forensic psychology into
a wider academic and professional domain, beyond that inhibited by Forensic
Psychologists themselves. The series has always intended to make the forensic
psychology open, accessible and available to practitioners in associated fields
in other professional backgrounds. The second aspiration of the series has
been to identify areas where gaps in research and practice were becoming
apparent and for editions within the series to identify and respond to areas of
emerging need and interest. Issues in Forensic Psychology has also wanted to
approach traditional themes in the field from fresh perspectives as develop-
ments in the field take new directions. This was evident from the first edition
of the book series which took a critical view of some of the well-established
and perhaps well-worn ideas in the risk assessment literature, revising and
developing concepts within the field of risk management and clinical for-
mulation. Later editions such as the edition on secure recovery came to be
influential in establishing new directions in forensic service development. This
examined the accepted concepts of patient ‘illness’ arguing how therapeutic
arrangements enabling a patient’s involvement and engagement were key in
personal recovery. Some of these ideas became expanded and developed in the
more recent edition on transformative environments and rehabilitation which
made a powerful argument for an empowering social climate as the portal
for personal and therapeutic change. Developing applied practice has been
emphasised throughout the series. The edition on forensic research opened
up a broad range of research methodologies to a wider audience, making a
compelling case for their utility and value. A later volume on supervision skills
and practice brought supervision to life, making a strong argument for its util-
ity and value for all those working in the forensic field. A volume on forensic
practice in the community was commissioned in response to literature being
disproportionately weighted towards those working in closed conditions
despite the reality that the vast majority of forensic service users are likely to
be under supervision, risk management or treatment within the community.
Other editions have provided in-depth focus on areas where understanding

xvii
xviii Series foreword

of offending needs to be improved, made evident in an edition on multi-­

perpetrator rape which expanded knowledge in a neglected area.
This current volume, Assessing and Managing Problematic Sexual Interests,
edited by Akerman, Perkins and Bartels, provides a long-overdue, much-­
anticipated and timely addition to the book series. As noted by Tony Beech and
by many of the contributors, recent developments in the field make it apparent
there is a clear need for a contribution to the field which provides an informed,
comprehensive and in-depth analysis of the area of deviant sexual interest.
The contributors certainly fulfil this objective. Part I provides a focussed,
nuanced, concise and in-depth analysis of developments, challenges, innova-
tions and limitations of what is known about the assessment of sexual interest.
These chapters explore what is known about the measurement of interests
with specific populations such as those who have offended against children
and men who have committed sexual and non-sexual violent offences. The
developments in contrasting assessment technologies, including self-report
and physiological, are considered through the sharing of research and prac-
tice across different cultures and countries. Exciting and innovative research
is also covered in this section, drawing on the most recent developments in
implicit measures of attitude and sexual interest, providing an important con-
tribution to an area which has significant potential. Other novel and valuable
developments in assessment practice are also considered. A chapter on Rapid
Serial Visual Presentation makes a strong case for the utility of this method
whilst reflecting on directions required for expanding its use. This theme is
expanded upon in a chapter reviewing eye related measures providing new
perspectives and contributions to the literature. Part I concludes by examin-
ing the relationship between sexual fantasy and deviant interest and provides
a novel angle and perspective of relevance to practitioners.
Part II explores the area of management and treatment from novel, varied
and contrasting approaches. The importance of contextual or process issues
in building an optimal therapeutic for the treatment of sexual deviancy is
emphasised; the role and utility of compassion and acceptance and how this
can provide an evidence-based and effective intervention enhancing the ther-
apeutic relationship is also strongly made. The contribution of psychoanalytic
approaches is then made in an accessible and thought-provoking way. The
role and contribution of medication, is also considered and its relevance and
its relevance clearly highlighted.
In Part III the book concludes with two chapters that provide an overview
of two current therapeutic approaches. One is an exploration of assessment
and treatment approaches with females who have committed sexual offences,
the other exploring the mechanisms linking trauma and risk describing how
Series forewordxix

offence paralleling behaviour can be used to monitor ongoing offence-related

sexual interest.
Together, this collection of chapters comprises an important and valuable
contribution to the series which will be welcomed by all practitioners and
academics with an interest in forensic practice.
Richard Shuker and Geraldine Akerman
Series Editors