Dr Peter Chamberlain Senior Clinical Psychologist Owenia House Specialist Rehabilitation Service for Sex Offending December 2012 Dr Peter Chamberlain Senior Clinical Psychologist

Owenia House: Effectively a behavioural clinic within the Forensic Mental health Service Our core objective is to prevent sexual abuse of children by intervening with offenders and potential offenders Provides: Community based assessment and treatment services for adults who have sexually offended against children, or fear they may do so. A treatment service for paraphilias e.g. exhibitionists, public masturbators

Owenia House (As at 12 December 2012) Staff: 6 Director, 4 Clinicians, Administrative Officer Clients: 72* (waiting list of 23) All Male, average age 43 with ages ranging from 19 - 74 * We have a capacity for approximately 120 Groups: (Closed/Open) Standard (2 phased) – normally functioning Skills Based Treatment – intellectually impaired Rural – rural clients, normal functioning, full day each month Individual Sessions: NOS (other paraphilias & child sex offenders as required)

Principle Theoretical Models Finklelhor’s (1984) Precondition Theory motivation*, internal and external barriers and victim resistance *3 components: emotional congruence: emotional need to relate to children sexual arousal: children are a potential source of sexual gratification blockage: adult sexual & emotional gratification unavailable Ward & Stewart’s (2003) ‘Good Lives’ Model constructive & holistic approach beyond a single focus on risk management enhancement drives rehabilitation realising an offending-free life that is beneficial and rewarding in ways that are socially acceptable & personally fulfilling Offending Trajectory Therapeutic Philosophy

Pathways Model of Child Sexual Abuse (Ward and Siegert 2002) Principle Theoretical Models Continued: Pathways Model of Child Sexual Abuse (Ward and Siegert 2002) Sexual Offending Intimacy Deficits Normal sexual scripts Offend at specific times; child is pseudo-adult Multiple Dysfunctional Mechanisms Deviant sexual scripts Deviant fantasies Generally comorbid psychopathologies Antisocial Cognitions No distorted scripts Offending reflects general pro-criminal beliefs/attitudes Emotional Dysregulation Dysfunctional emotional regulation Deviant Sexual Scripts Distorted (subtle) sexual scripts Interact with dysfunctional relationship schemas Theoretical morphing: Finklelhor's Precondition Theory Hall & Hirschman’s Quadripartite Theory (critical threshold) Marshall & Barbaree’s Integrated Theory (negative early – life experiences

Typologies of Child Sex Offenders Preferential (fixated) versus Situational (regressed) offenders. Fixated: Primary sexual orientation is to children - interest generally begins in adolescence, - pre-planned, premeditated persistence interest - males primary target Regressed: Primary sexual orientation to age mates - interest in children emerges in adulthood - pseudo adult substitute - females primary target

General Characteristics Clinical Profile Considerations (DSM-IV-TR): Axis 1 (Clinical Disorders) depression common (suicidal), psychosis 5-8%, Axis 2: (Personality & Intellectual Disorders) Personality disorder 5-7% Intellectual disability 15% Presentation variable Sexual abuse (estimates 40-50%); earlier and more severe abuse associated with earlier offending

Criminality > 60 % of child sexual offenders have at least one previous conviction almost twice as likely to have been for non-sexual offences than for sexual offences.

Sexual Preference 48% of non-familial offenders have arousal to children. 28% of father-daughter incest offenders have arousal to children. 15% of non-offender males have arousal to children.

Assessment Referral Information Current Legal status Detailed personal history (family of origin & current family situation, relationship history, education, occupation, medical & mental health history, medications, substance use/abuse) Sexual and non sexual offending history Detailed sexual history Psychometrics as indicated Recidivism risk Sexual attitudes and beliefs inventories Treatment Plan

Degrees of Denial WHY DID YOU SEXUALLY ASSAULT THE VICTIM? NOTHING HAPPENED ‘I never laid a finger on her’ ‘The boy’s lying’ ‘The cops are out to get me’ SOMETHING HAPPENED BUT AND IT WASN’T MY IDEA ‘The kid came on to me’ ‘She was all over me’ IT WAS MY IDEA BUT AND IT WASN’T SEXUAL ‘I was being affectionate’ ‘I was angry at my wife’ ‘I was teaching her to be careful’ IT WAS SEXUAL AND BUT IT WAS WRONG IT WASN’T WRONG ‘There’s nothing wrong with it’ ‘She liked it’ BUT BUT THERE WERE EXTENUATING SITUATIONAL CIRCUMSTANCES ‘I was having money problems’ ‘I was drinking too much’ ‘My wife wouldn’t sleep with me’ THERE WERE EXTENUATING PSYCHOLOGICAL FACTORS ‘I was sexually abused as a child’ ‘I don’t know what got into me’ ‘Women scare me’

Group Treatment Programmes Closed (set programme, 2 stage) Open/Continuous (own pace, enter & at leave different times) Intensive (Country, short time) Skills-based (IQ compromised) SOIG (Information, support, supervising adult) * NOS (Other paraphilias) – Individual Treatment

Group Content cognitive, behavioural, situational antecedents, values pattern/offence cycle high risk moods and thinking concept irrelevant decisions lapses and strategies developing support network changes in lives – focus/orientation to children individual relapse prevention plan

Offending Cycle 5 4 6 3 1 2 Self - Centred Internal Conflict Shame, self-pity, personality driven depression, self-defeating behaviour 5 Offending Behaviour Along continuum of sexual aggression Self - Directed Cognitive Distortion Denying, rationalising, minimising, sanitising, and avoiding detection 4 6 3 Offence - Directed Behaviour Victim targeting, grooming, setting up the offence scenario 1 2 Conscious Intentions to Offend Acting in a manner that enhances the fantasies, imagery, arousal and/or impulses Deviant Sexual Fantasies and Images Experiencing feelings/arousal that reinforces the deviant imagery

Treatment Goals Understanding patterns of abusive behaviour Understanding consequences of abusive behaviour Victim empathy Take responsibility for actions Changing associated emotional, behavioural and lifestyle patterns Recognition of lapses Individualised risk management programme

End of Treatment Expectations responsibility for abusive behaviour responsibility for future offence-free life disclosure of personal information recognition pro-offending attitudes avoidance of minimising/justifying effects insight into victim issues understanding impact lifestyle factors understanding and implementing relapse prevention strategies motivation to change as evidenced by value action plan

Treatment Success Heterosexual: treated 18% (7.5%) untreated 43% (18%) Homosexual: treated 13% (5.5%) untreated 43% (19%) Familial/Incest treated 8% (3%) untreated 22% (7%) NB Figures outside of brackets are unofficial police records and child protection services statistics. Those inside brackets are official police records.

Referral Criteria Two pathways: Mandated or Voluntary Criteria: Must have sufficient time if mandated Voluntary must self-refer and not be before the court Offences must have been against children (i.e. adult victim offences not accepted). NOS clients the exception Must accept some responsibility (deniers precluded) >17 years of age Male

Referral/Discharge considerations No child contact Likelihood for change Motivation for change Social supports