Sunday, December 11, 2011

A Jerry Sandusky flight of fancy...

Caveat: In reading this post, I would ask that you allow me a “flight of fancy”, as it were. Under normal conditions, risk assessments are made of persons before the court and are conducted using validated tools and procedures in a standard fashion. Attention to detail and precision are important goals in risk assessment. The following pays attention to those prescriptions in spirit; however, I’m not suggesting that my process below would be acceptable if we were actually attempting to assess risk posed for true judicial or case management purposes.

So, here goes…

Best as I can figure, the score Jerry Sandusky would get on the Static-99R is -1. Based on what has been reported in the media (admittedly, this is not a formal risk assessment, but you’ll see where I’m going with this), that’s what you get. Negative one.

According to the reports: Mr. Sandusky has been married for a long time and has no other criminal history; the alleged victims are all persons he appears to have known for a while; and there is apparently no violence other than that directly associated with sexual offending. So, no points for “ever lived with a lover…”, “index non-sexual violence”, “prior non-sexual violence”, “prior sexual offenses”, “non-contact sexual offenses”, “prior sentencing dates”, or “any stranger victims”.

That leaves one point for “any unrelated victims” and one point for “any male victims”. Then, of course, you have to consider his age. Sandusky is in his sixties, which means that his score on the age item would be -3. Total it up and you get -1. If you follow the nominal risk category labels suggested by the Static-99R’s developers (Karl Hanson and David Thornton), this score would put Sandusky in the low risk group according to static (life history, or unchangeable) factors.

Then, there’s the issue of the appropriate normative sample against which to compare him. Since 2008, Hanson, Thornton, and others associated with Static-99R have suggested that it would be inappropriate to simply use a one-size-fits-all normative group against which to compare individual offenders. Options for comparative samples include “routine”, “non-routine”, “preselected for treatment need”, and “preselected for risk and need”. The intent is to ensure that we really do compare apples with apples and oranges with oranges. Meta-analytic data suggest that using a normative group that includes all offenders amounts to a veritable “fruit salad” in which the heterogeneity of the sample leads to possible over- or under-estimation of risk for some individual offenders.

In a short paper originally published in the CCOSO Newsletter (republished in The Forum of the Association for the Treatment of Sexual Abusers ATSA), Thornton, Hanson, and Helmus suggested that the we might be able to use scores on measures of dynamic risk to help us choose an appropriate normative group for better interpreting an offender’s risk as scored on Static-99R. Stable dynamic risk factors are those that assist us in measuring risk according to factors related to personality or other longstanding aspects of someone’s make-up—but which are theoretically amenable to change with treatment or other interventions. Using the Stable-2007, Thornton et al. suggested that, among persons with the same Static-99R score, higher scores on the Stable-2007 would indicate higher levels of criminogenic need and an attendant increase in overall risk to reoffend.

Lacking any clinical interview with Mr. Sandusky, it is difficult to speculate what his exact score might be on any risk measure but, again, if we simply infer from information presented in the media, we can get a rough idea of what stable dynamic risk factors might be pertinent.

Of course, we have to emphasize that the reported offenses are all still allegations. For this exercise, one must assume that what’s been reported in the media is correct. So, for sake of argument, it appears reasonable to assume at least some degree of marital strife. It also seems reasonable to strongly suspect deviant sexual preferences and to presume the presence of emotional identification with children. Last, it seems likely to me that sexual pre-occupation and some degree of poor cognitive problem-solving and impulsivity might also be reasonably assumed.

Putting all this together, Mr. Sandusky would very plausibly be assessed as being of at least moderate risk to reoffend based on Stable-2007. Thornton et al. would suggest that this is indicative of a need for participation in a formal treatment program aimed at addressing risk for sexual reoffending and other aspects of lifestyle instability and dysfunction. This is to be contrasted with psychoeducational or short-term counseling programs usually offered to lower risk offenders (in keeping with the tenets of the Risk-Need-Responsivity Model).

At this point, it is likely worthwhile to briefly revisit the punishment vs. treatment issue. I’ve expounded on this much more precisely in previous posts, but it bears reiterating that there is little if any research showing that punishment alone reduces recidivism. The meta-analytic data suggests that this relation actually may work in reverse to what many might assume, in that it appears that punishment without programming leads to increased reoffending. Whatever we might think of individual studies supporting (or not) the benefits of providing treatment and other human service interventions, some really large meta-analytic studies show a strong effect of lower risk as a consequence of cognitive-behavioral programs, including treatment for sexual offenders. Bottom line, however much we might want to punish the Sanduskys of the world, punishment will not get us nearly as much bang for our risk reduction buck as will treatment. It’s fine to want to sanction someone for their actions, but we shouldn’t kid ourselves that that will eliminate risk to reoffend.

Back to our flight of fancy risk assessment exercise…

Referring to the Static-99R Evaluators’ Workbook, persons in the “Preselected for Treatment Need” normative sample have a roughly 3.1% chance of sexually reoffending within five years, or a 5.4% chance of doing so within 10 years of release. Pretty low, eh? I bet that the majority of the public would be shocked to learn that Sandusky’s putative risk for reoffense is so low; especially, given the degree of media attention and public outcry this case has garnered to date.

However, this is an excellent example of how the process of risk assessment doesn’t always line up with public perception. We sometimes let our emotional impulses determine how we think about the risk posed by the offender. If he actually committed the offenses, it is very reasonable to assume that Mr. Sandusky did an awful lot of harm to a large number of boys and young men. Such offenses naturally evoke some degree of anger, disgust, and denunciation. However, none of those responses necessarily makes for good risk assessment or, ultimately, good risk management.

Should he be found guilty of the offenses, Mr. Sandusky will be subject to punishment for his actions. It is also possible that he will attend a treatment program for persons who have sexually offended. Depending on the length of the sentence, his health, and the release practices of the state in which he is incarcerated, it is also possible that he may someday be released back to the community. That brings us back to his Static-99R score and the consideration of Stable-2007 variables.

Should he be released at some point in the future, it would be scientifically defensible to consider the risk Sandusky poses for reoffense to be low. One of the salient risk factors to be considered here is age-related desistance. Of course, Sandusky is alleged to have been offending as recently as only a few years ago, when he was already of advanced age. Some might be inclined to say that this negates age-related desistance as a modifier of risk potential—I disagree. The data I’ve seen so far on the age-related desistance issue do not suggest that age is a dichotomous factor. Rather, it is incremental or continuous. What that indicates is that all persons are likely to “slow down” in most areas of life as they age, but not necessarily in the same exact fashion. All in all, advancing age WOULD BE a risk-reducing factor for Sandusky, just like it is for every sexual offender—it might just not be as much of a risk-reducing factor for him as it might be for his peers.

In closing, the intent of this blog post is not to garner sympathy for offenders nor somehow to excuse their actions. Rather, my intent was to highlight the apparent disconnect between our emotions about offending and our knowledge about scientifically defensible risk assessment processes. Concluding that Jerry Sandusky would be in the low risk range for sexual reoffending is not the same thing as concluding that his actions are acceptable or mitigating the harm done to the putative victims. Neither does that rating suggest that Mr. Sandusky should be exempted from criminal prosecution, criminal sanction, or eventual evidence-based risk management processes should he ever be released.

Hopefully, as this case goes forward, Sandusky will be properly assessed by a trained professional and a scientifically defensible plan of action will be developed that assists him in addressing whatever risk factors are actually present. All of this would be intended to reduce the level of risk he might pose to others in the community. Ultimately, that’s the dilemma of people who sexually abuse. We can reduce risk among the most reviled of our citizens, but only through compassionate rehabilitation and sensible community supervision.


Wednesday, October 12, 2011

Denial, Minimization, and Polygraphy

This blog comes to you jointly authored by David Prescott and your resident blogger.

There has been much talk of late about polygraphy and sexual offender risk management in a number of forums. Recent issues of The Forum of the Association for the Treatment of Sexual Abusers have included both articles and reviews of books about the polygraph. Similarly, the list-serve of the same organization has seen a number of recent threads on this topic, with heated debate from both sides. Further, at a couple of recent trainings conducted in New York State (by RJW), the topic also came up, with equally spirited discussion. From our observations (and, perhaps, participations in those discussions), it is pretty clear that this topic includes a significant degree of passion and has the potential to polarize (alienate?) persons who, by our estimation, are all similarly inclined towards public safety.

Overall, the debate seems to progress along a number of lines:

  1. How do denial and minimization affect recidivism?

  2. How much “truth” is necessary in order to provide effective treatment or risk management?

  3. Do we need to “honor” the victims of sexual abuse by making sure that offenders take full responsibility for their actions?

  4. What does the research tell us about the overall utility of the polygraph itself as a tool for use in sexual offender risk management?
First, many of us appreciate that the polygraph can produce disclosure/confession very quickly, but there is a very real question of whether short-term confession equates to someone who can be honest with others in the long term. How much is our thinking influenced by a moral judgment rather than opinions based on science? As the fathers of former and current teenagers, we are very aware that they lie to us every so often. All teenagers do. However, we are more concerned that they learn to live a balanced and self-determined life than we are in accounting for each time they’re not completely honest with us. Indeed, we are sometimes caused to consider whether there isn’t a certain degree of denial or minimization that adaptively functions as legitimate ego defense.

The meta-analytic data suggest that neither denial nor minimization are particularly fruitful as indicators of reoffense risk, but we are aware that other data seek to clarify that global perspective. As clinicians, we find it interesting that full disclosure is a prerequisite for treatment entry or continued participation for sexual offenders, and sexual offenders only. In no other aspect of mental health or impulse control do we compel clients to enunciate in painstaking detail the particulars of every instance in which they either did or might experience the negative symptoms or manifestations of their difficulties. Think what might happen if we held schizophrenics or drug addicts to the same standard? Would anyone ever get better?

Third, while many of us feel that the rapid accountability that polygraphy provides is part of a victim-centered approach, we are unfamiliar with any research showing that survivors of sexual abuse want compelled disclosure. If it were us, we would prefer that someone who hurt us had demonstrated meaningful change rather than confess merely because he/she was compelled to do so by representatives of the legal system. Admission does not equal understanding. Most of the survivors with whom we’ve worked have simply said they just wanted the behavior to stop. It is clear that sexual offender treatment can be of assistance to victims; however, we question by what authority we presume to speak for survivors.

Last, there seems to be no research showing that the polygraph is directly beneficial to clients’ treatment progress in the long term. The available data (from McGrath and crew in Vermont), scant as they are, would seem to suggest either the opposite or simply no effect. Nonetheless, many of us believe that the polygraph is an important part of the equation for various reasons, such as the fact that it produces more information. What is less clear is that more information is necessarily better information. How much of “the truth, the whole truth, and nothing but the truth” is required for offenders to appreciate the harm caused by their behavior and to make genuine and real efforts to stop? Similar to our questions above, if we were providing treatment for other kinds of crime, would it be necessary to account for every instance of criminal behavior? Or, is it that we feel compelled to account for every hurtful sexual behavior because of the high stakes?

As noted above, the current data underscoring the reliability and validity of polygraphy as used with sexual offenders are scant or questionable. That is not to say that polygraph assessment doesn’t assist some clients some of the time, and we get that. Rather, we believe that, as a field of inquiry and practice, we owe it to our clients, victims, and the community-at-large to employ methods supported by sound science. Perhaps, this is the reason why many courts have qualms about accepting polygraph results? For us, we’re all about the data. Show us the data and we’re good to go. Otherwise, we likely ought to be more circumspect.

We also wonder why a tool used so extensively in common practice has not been the subject of more research? Other technologies—actuarial risk assessment scales, PPG, and VRT measures—all routinely used in sexual offender risk management have been subject to extensive inquiry as to their relative utility in our cause. Why not polygraphy? As one ATSA list-serve poster noted, we don’t need extensive research to accept that parachutes are an important preventive measure when jumping out of a plane. However, is this degree of face validity appropriate regarding the polygraph? In this regard, we are very mindful of Marshall’s research on the deleterious effects of confrontation in treatment and means by which to offer effective treatment to “deniers”. Perhaps, the issue is more about how we use polygraph and for what purpose. This brings us back to our questions about how much “truth” is required and what methods of eliciting those truths are most likely to get us what we want—increased public safety?

Perhaps, we need to be more honest with ourselves: Our field uses the polygraph to meet our needs more than those of our clients. Whether that is good or bad depends on one’s orientation and definition of what sexual offender treatment actually is. However, it might also be time to address an irony in this discussion: An essential part of the polygraph examinations involves being certain of the technology and the results. When our field is as uncertain as it is, where does our own credibility start to come into question?

Wednesday, August 17, 2011

Fox News Psychiatrist Says You Can Catch Pedophilia by Viewing Child Pornography

In a recent blog, Fox News psychiatric consultant Dr. Keith Ablow states that “environment, not genetics, determines sexual orientation.”

Man, where do I start?

Dr. Ablow’s blog appears to have been stimulated by the recent furor over sexually suggestive pictures in the French edition of Vogue of 10-year-old fashion model Thylane Loubry Blondeau. Here’s a link to additional commentary in the Huffington Post.

Now, let’s be clear about something: Thylane is a very attractive little girl who will no doubt grow up to be a very attractive big girl (i.e., a woman). She truly is quite striking. However, the key issue here is that she is a “little girl” who is being dressed and presented as if she belongs with the “big girls”. In my mind, sexualized representations of minors is a big bad idea, for a whole host of reasons—and I’m typically a very liberally minded person. That doesn’t mean that it hasn’t been happening for a long time or that it will stop anytime soon, for that matter.

"I've turned from a little nice school girl, into this sexy, slutty seductress and I like it. I like it a lot."

Britney Spears (at least according to the internet)

As a father of daughters, I see this sort of thing as just plain wrong. It’s actually part of the reason why I have typically devoted a segment of many presentations on the nature of sexual deviance to the issue of sexualizing minors. I call this my “Blame it on Britney” segment, in which I lament the regenesis of the Catholic schoolgirl fantasy (blame it on Britney) and highlight such things as Hannah Montana (Miley Cyrus) being photographed in stages of undress for Vanity Fair and the existence of a truly dreadful Eastern European singing duo called Tatu. Interestingly, Tatu is a couple of cute twenty-somethings whose shtick is that they are Lesbian Catholic Schoolgirl Lovers—a male adolescent trifecta of sorts, I suppose. Problem is, they’re not being marketed to adolescents, their pictures (in various stages of undress) are presented in Maxim and other publications intended for adults (mostly, if not exclusively, men).

Actually, the age demographic most interested in Britney is “tweens” while the sexualized elements are clearly aimed at guys in my age demographic. I suppose this is part of the reason for Celia Rivenbark’s inflammatory book title “Stop Dressing Your Six-Year-Old Like a Skank”—think track pants on a young girl with the word “juicy” written across the fanny. How wrong is that?

But I digress…Back to Dr. Ablow…

In discussing Thylane Loubry Blondeau, Dr. Ablow says this:

“I objected (to the Thylane photos) for a number of reasons, including my belief that sexual images of children, marketed to the public, can actually "create" pedophiles.”

He then notes that he received many comments that supported his criticism of Vogue, but objected to his notion that sexual orientation can be shaped by environment or cultural forces. He then calls forward his many years of working as a psychiatrist to support his position (can anybody else smell “unstructured clinical judgment”?). Does this guy read?

As a case in point, he states that men deprived of access to women by circumstances such as incarceration exhibit greater homosexual behavior, which is absolutely true. But, Dr. Ablow misses the point of sexual orientation. He seems to think that it is about convenience or purely situational variables. He also seems to have missed a good many years of scientific inquiry into this very subject.

I think the mistake he is making is in equating sexual behavior with sexual orientation (or preference). I know of many gay males who married women and engaged in sexual activities, sometimes fathering children, solely because they were dreadfully terrified of being found out. I also know of many persons in the arts who seem to have ever-changing sexual interests. For example, it has been rumored for years that Mick Jagger and David Bowie were “sexually involved” at some point in the 1970s (at least that’s how the story goes, I do not assert its authenticity). My point is that both men have perpetually been seen in public with beautiful women on their arms. For his part, Jagger is an infamous womanizer. So, are they gay, are they bi, or are they simply exploring some artsy-fartsy fantasy? Who knows? Personally, I’m pretty content to declare each of them to be of heterosexual orientation.

So, what about Dr. Ablow? His premise would seem to suggest that we can simply choose what we want to be sexually oriented to by flooding ourselves with images of a particular stimulus, or that our environment can change what I would contend Mother Nature has had a good hand in establishing. Karl Hanson has always contended that he didn’t include sexual orientation in the items of the Static-99—even though possession of sexually deviant interests via phallometry has consistently been an effective predictor of future offending in persons who already have—because it is a “dynamic” variable. I’ve never agreed with him, mostly because I am one of those people who believes that, like a leopard, you can’t change your sexual preference spots. As research into sexual orientation gets more refined and technological, it would seem that the data supports my opinion. I actually believe Karl’s data on the Stable also supports this contention, but that’s an argument for a later time.

Here’s my first case in point: For how long have misguided persons tried to suggest that homosexuality is a disease to be cured? During the run-up to the 2012 election, this issue has again taken center-stage, with at least one Republican candidate being linked to treatment centers for homosexuals.

Newsflash: The professional community delisted this “condition” some 38 years ago. It’s time for everyone to catch up, including Dr. Ablow.

Here’s my second case in point: Many readers will know that I got my start in this business as a research assistant to phallometric pioneer Dr. Kurt Freund. For the better part of 10 years, my job was to create, refine, and administer phallometric test protocols that included sexually explicit pictures of children, teens, and adults. I was also tasked with identifying visual stimuli of a sexually aggressive nature. I spent literally thousands of hours watching this stuff, which included child pornography, violent sadistic pornography, and all manner of horrific and graphic media. Yet, here I am—older, more cynical, perhaps more darkly humored—but about as sexually boring as I have ever been. I don’t want to have sex with children and I believe that “no” means “no” (and that “Ow” means “Ow”). So, all that environment added up to one big bust. Further, my wife made me watch “Brokeback Mountain” and it didn’t make me gay.

Last case in point: I work in a field where we try to keep persons with sexual attraction to children from acting on those attractions. Sometimes we do that by having them fantasize about grown-ups. Other times we restrict their access to children (i.e., removing the stimulus from the environment). But, guess what, the larger majority of them who are sexually interested in children remain so. That is not, however, to say that their behavior does not change. In fact, many so-called Minor-Attracted-Persons never act on their interests because they understand the ramifications. Those who have acted on those interests can learn not to do so in the future.

Again, preference/orientation versus behavior.

In closing, there is a sinister aspect to all this. Clearly, child pornography is just bad. It shouldn’t exist. But, the research data is uncertain as to the characteristics of those who view it, especially regarding their propensity to engage in hands-on offenses with children. What we don’t need is a whole lot of fear-mongering and scare tactics to support a political or ill-conceived social agenda. Simply put, suggesting that viewing child pornography will turn you into a pedophile is as ludicrous as the suggestion that masturbation will grow hair on your palms or make you go blind.

Perhaps AUDIOphilia should perform “Turning Japanese” at this year’s ATSA conference in Toronto?

Thursday, July 28, 2011

New Developments in COSA-land

Hello All:

There are a number of interesting developments in the world of Circles of Support & Accountability.

In an earlier blog, I referred to an international collaboration of COSA-friendly nations during a conference in Riga, Latvia. That collaboration has continued, and there is now a European Union group of folks continuing the dialog—proving that COSA is garnering truly world-wide interest.

At this fall's ATSA conference in Toronto, Mechtild Hoing and Bas Vogelvang of the Netherlands will present COSA in Europe: Circles Together for Safety during a time slot that also includes a presentation by Fresno, California’s Clare Ann Ruth-Hefflbower entitled Into the Future: Expansion of Circles of Support and Accountability (COSA) in the U.S. For those who are interested, Andrew McWhinnie, Eileen Henderson, and I will also be delivering a half-day preconference workshop on the topic, entitled Circles of Support and Accountability Comes Home.

To date, COSA has been seen largely as a Canadian and British endeavor—with those two nations having projects of considerable tenure (17 and 10 years, respectively). However, it will be important for projects outside of those two nations to take center-stage to ensure the ongoing development of the Circles movement (if you can call it that).

One of the greatest difficulties in seeding Circles of Support & Accountability—beyond recruitment of volunteers—has been establishment of the credibility of the model. Until recently, only two peer-reviewed evaluations have existed, each with admittedly small samples and short-term follow-up:

Wilson, R.J., Picheca, J.E., & Prinzo, M. (2007). Evaluating the effectiveness of professionally-facilitated volunteerism in the community-based management of high risk sexual offenders: PART TWO—A comparison of recidivism rates. Howard Journal of Criminal Justice, 46, 327-337. link to abstract

Wilson, R.J., Cortoni, F., & McWhinnie, A.J. (2009). Circles of Support & Accountability: A Canadian national replication of outcome findings. Sexual Abuse: A Journal of Research & Treatment, 21, 412-430. link to abstract

I am pleased to announce that a third, peer-reviewed evaluation of the COSA model is now available:

Bates, A., Macrae, R., Williams, D., & Webb, C. (2011). Ever-increasing circles: A descriptive study of Hampshire and Thames Valley Circles of Support and Accountability. Journal of Sexual Aggression. Published online first February 22, 2011 as DOI: 10.1080/13552600.2010.544415. link to abstract

In this recent review, data are presented showing the effectiveness of COSA in international jurisdictions. In the United Kingdom, COSA is managed by a registered charity known as Circles UK, which is charged with promoting use of this model in England and Wales. The UK COSA model is slightly modified from the Canadian original, in that most core members are still “under license” (British terminology for continuing to be supervised by Probation Services). As such, COSAs in the UK are more formally situated within the statutory framework of criminal justice (i.e., MAPPA), whereas Canadian COSAs tend to focus on core members who are entirely post-sentence. Notwithstanding this difference, the bulk of the COSA work in the UK model remains with the voluntary sector, rendering the two models more similar than not.

In their study, Bates et al. followed 60 core members for an average period of 36.2 months; however, with no control or comparison sample. Eight core members experienced behavioral difficulties related to sexual offending, resulting in five core members being recalled to prison for probation violations and two others being placed on a Sex Offence Prevention Order (i.e., an order of recognizance). One core member (1.7%) engaged in behavior leading to a new sexual offense conviction.

Overall, the UK findings are very much in line with those reported previously in Canada in the papers noted above. Interestingly, and as a further corollary to the Canadian data, the UK project also observed a harm reduction effect, in that the core member who reoffended was convicted for downloading child pornography whereas his previous convictions were for hands-on offenses against children.

So, with the Bates et al. data in hand, we can say with some strength that the COSA model is neither regionally nor nationally specific—meaning that similar findings can be found in COSA projects whether they be located throughout a particular nation or from nation to nation. However, as many will attest (cf. pop music), breaking through in the all-important American market is key. To date, only anecdotal data exist regarding the effectiveness of the COSA model in US jurisdictions.

Currently, there are well-established COSA projects in California, Minnesota, and Vermont, with additional projects in the development or early stages in Colorado, Washington, and North Carolina, among others. Reports from the Fresno, CA coordinator (the aforementioned Clare Ann Ruth-Heffelbower) are that there have been no documented cases of sexual reoffending among the 25 COSAs formed to date; although, there have been parole violations for technical reasons, some of which were related to risk for sexual reoffense.

I recently had the pleasure of meeting with folks involved in the Minnesota Department of Corrections’ COSA project, known as MnCoSA. They have established nearly 30 COSAs and are gearing up to evaluate data that will speak to the effectiveness of the model in their state. Of particular interest is the fact that the MN-COSA project has used a random assignment design—by far the most statistically-elegant research project on COSA to date. In speaking with Joann Dillavou and Bill Donnay (collaborator Grant Duwe was unable to attend) of the MN DOC, it appears that preliminary data are showing markedly similar reductions to those observed in Canada and the UK.

One last thing to note: I recently had the great pleasure of meeting with folks involved in two US-based COSA projects—specifically, those located in Denver, CO and Brattleboro, VT. Both Colorado and Vermont have been working on developing COSA projects for nearly a decade. At present, both projects are in receipt of funding from grants associated with the Second Chance Act.

All of us in the COSA world are particularly excited about developments emanating from projects run by our American and international partners.

Thursday, July 21, 2011

Guest Blog from Jill Levenson

Hello All.

Here is a guest blog from Florida's Jill Levenson, a public policy researcher and expert. In this piece, Jill discusses a variety of issues associated with evidence-based risk management of sexual offenders--focusing specifically on the SORNA. Please note that the majority of Jill's references are in Sage Journals, which means that ATSA members can access them for free from the Members Only side of RJW

With the SORNA deadline approaching next week, only eight states are in substantial compliance with the law. The Sex Offender Registration and Notification Act (SORNA), which is Title 1 of the Adam Walsh Act (AWA), requires states to meet minimum standards in their sexual offender tracking and disclosure procedures.

Why is it that over 80% of states are not complying, especially when facing a 10% loss of federal crime funding each year? Since its inception, certain pieces of SORNA have been quite controversial and, in many cases, "deal-breakers" for states. Aside from the fiscal reality that SORNA will cost more for most states to implement than they would lose through penalties, parts of the law contradict evidence and best practices that some states have spent years refining.

Take, for example, the rigid offense-based tier system that classifies offenders by their statutes of conviction. There is a seemingly intuitive logic to the belief that statute titles, crime degrees, and descriptions accurately portray the offense in question. We all know, however, that in many cases statutory language does a poor job of characterizing the crime—and an even worse job of characterizing the criminal. In other words, SORNA tiers confuse the seriousness of the crime with the risk to reoffend. Although the SORNA guidelines cleverly avoid using the word risk, there is a clear implication, based on the associated longer registration durations and more frequent updates, that the Tier 3 offenders are more dangerous and therefore necessitate closer monitoring for longer periods. As well, "tier enhancements based on recidivism" can be made, allowing an offender with more than one conviction to be upgraded to a Tier 3 based on the repetitive nature of the criminal behavior—again suggesting to the public that higher tier assignments are associated with an increased likelihood of recidivism.

Unfortunately, in most instances, offense definitions are an inadequate means for evaluating risk or determining supervision needs. They overestimate risk for most offenders, and underestimate risk for those who plea-bargained to lesser offenses. Andrew Harris and colleagues (2010) found that applying SORNA criteria in Ohio and Oklahoma greatly skewed the distribution of risk into the highest tier compared to the states' prior classification schemes using risk assessment tools. Naomi Freeman and Jeffrey Sandler (2010) found that SORNA tiers were less effective in identifying sexual recidivists in New York than assessment tools utilizing risk factors statistically associated with recidivism. Many states have spent the past two decades developing and refining evidence-based risk management systems, and although SORNA does not technically require states to abandon the use of those tools, it does require registration and notification decisions to be based on the federal guidelines rather than the state's risk assessment.

And, speaking of longer registration durations (25 years to life), they contradict research indicating that sexual offenders become less likely to reoffend with increased time spent offense-free in the community. According to Static-99 guidelines, an offender's risk declines by half after 5 years, and by half again after 10 years. As well, reoffending declines with age. Right now, 20% of America's sexual offenders are over 56 years of age. Over time, with longer registration durations, we should anticipate an aging sexual offender population of which a greater proportion will pose a lower risk to public safety.

SMART Office staff have claimed that the purpose of SORNA was never to prevent recidivism, but to provide a monitoring tool for law enforcement and to increase public awareness. Indeed, the AWA legislative intent does not mention reduced reoffending as a goal. But, isn't that a little disingenuous? Why the need for enhanced law enforcement monitoring and increased public awareness if not for the hope of preventing future sex crimes and protecting potential victims from the trauma of sexual assault? Do Americans really want to spend tens of millions of dollars on sexual offender notification if it doesn't pay off in terms of protecting communities? Surveys of the American public have found that most citizens support SORN laws because, in fact, they believe them to be effective in reducing sexual recidivism. About a dozen empirical investigations (see summary in Levenson, 2009) have been conducted to date on the effectiveness of SORN laws to reduce recidivism. Most have not shown declines in sex crime rates generally or sexual recidivism specifically that can be attributed to SORN. Interestingly, the two studies that have noted significant effects on recidivism were conducted in Washington and Minnesota—both states with empirically derived risk assessment systems and concordant monitoring and management plans.

Or, consider the requirement that minors adjudicated delinquent in juvenile courts must be registered as sexual offenders. Though the SORNA guidelines conceded to states that public notification was discretionary, even registering juveniles with law enforcement contradicts a century of juvenile justice philosophy in the United States. The labeling of minors, and the subsequent potential obstacles to educational, occupational, and social opportunities, seems counter-intuitive to both juvenile advocates and victim advocates. This component of SORNA has been a noted barrier to implementation for many states.

We've seen the harrowing story of Jaycee Dugard in recent weeks, and all of us wondered how a registered sexual offender could get away with holding someone captive for 18 years. We've heard the scathing reports of parole agent incompetence, and we've used our 20/20 hindsight to shrewdly point out the missed clues. There is no doubt in anyone's mind that Garrido was high risk; he'd had two previous arrests, one resulting in a conviction for the abduction and rape of a woman whom he held hostage until she escaped.

But, perhaps, the real answer to the unfathomable question—How could this happen?? —is simply that Philip Garrido was a needle in a haystack. Philip Garrido is an example of how overzealous SORN laws might actually be counterproductive. As the registered sexual offender population nears three quarters of a million, fiscal and personnel resources are spread thin, law enforcement agents' capacity to target their monitoring toward more dangerous individuals is compromised, and the public's ability to distinguish truly high-risk predators is diluted. As Robin Wilson astutely pointed out in his recent San Francisco public radio interview, cases like Jaycee (and Adam Walsh, Jessica Lunsford, and Megan Kanka) are exceedingly rare, which is why they command so much attention—they shock us. They are statistically improbable events not representative of the vast majority of sexual assault cases and, thus, not the best cases on which to base public policy designed to address a rampant social problem.

Oh, and what about those 100,000 missing sexual offenders discussed repeatedly in AWA legislative hearings and in news reports? The ones who supposedly take advantage of discrepancies in laws to shop around for lax states where they can more easily neglect to register and avoid detection while seeking new child victims? My colleagues and I (Levenson & Harris, 2011) analyzed data downloaded directly from the online registries, along with surveys of registry managers, and we discovered that approximately 4% of the nation's RSOs have addresses that cannot be verified. We estimate the number of noncompliant sexual offenders to be between 25,000 and 30,000—but less than half of them are officially designated by states to have truly absconded. And, incidentally, research conducted in Minnesota, South Carolina, New York, and New Jersey all conclude that failure to register does not typically contribute to the likelihood for sexual recidivism.

Perhaps the apparent lack of state enthusiasm for SORNA will provide an impetus to re-open the dialogue about sexual offender management. SORNA in its current form sacrifices precision for over-inclusion, quality for quantity, efficiency for symbolism. By going back to the drawing board, with input from victim advocates, law enforcement, psychologists, criminal justice practitioners, and academic researchers, Congress has an opportunity to create model legislation that is evidence-based and more likely to achieve the goal of preventing repeat sexual violence.

Jill S. Levenson, Ph.D., LCSW

Associate Professor, Department of Psychology

Lynn University

Boca Raton, FL


Freeman, N. J., & Sandler, J. C. (2010). The Adam Walsh Act: A False Sense of Security or an Effective Public Policy Initiative? Criminal Justice Policy Review, 21, 31-49.

Harris, A. J., Lobanov-Rostovsky, C., & Levenson, J. S. (2010). Widening the Net: The Effects of Transitioning to the Adam Walsh Act Classification System. Criminal Justice and Behavior, 37(5), 503-519.

Levenson, J. S. (2009). Sex offense recidivism, risk assessment, and the Adam Walsh Act. Sex Offender Law Report, 10(1).

Levenson, J. S., & Harris, A. J. (2011). 100,000 Sex Offenders Missing … Or Are They? Deconstruction of an Urban Legend. Criminal Justice Policy Review, doi: 10.1177/0887403411415398.

Monday, June 13, 2011

Troubling things are happening in Canada…

Over the past several years, the Correctional Service of Canada has been implementing significant changes to the way it does business (see CSC, 2007). Currently, the Conservative government is gearing up to push its Omnibus Crime Bill through the House of Commons, which will result in sweeping changes to how crime and justice are managed in Canada. I’ve written about this before (Wilson, 2008), but something happened recently that really upset me.

During a check-in with a former intern and colleague back in Canada, she informed me that on May 26, 2011 the last community-based sexual offender group session was held at the Keele Centre, a halfway house in Toronto. That brought to a close 18 years of uninterrupted post-release aftercare for sexual offenders on conditional release to Canada’s largest city. I’m told that this program was one of the last to be terminated as the Correctional Service of Canada moves to significantly alter the way in which it offers (or maybe doesn’t) treatment to offenders after they are released from prison. Most institutionally-based sexual offender treatment programs have already been terminated and staff—including some of international renown—have been reassigned to other duties.

On the surface, these may seem like simple bureaucratic decisions—the sorts of things that many governments might do as they attempt to retool their services. However, I think it is really important that we put this in some context.

Celia Ruygrok was a Carlton University student working alone on an overnight shift at an Ottawa halfway house when she was murdered in July 1985 by a resident of that same halfway house. Tema Conter was murdered in Toronto in January 1988 by a convicted murderer and sexual offender who had spent most of his adolescent and adult life in jail. He was living in a downtown Toronto halfway house that was subsequently closed and never reopened. In June 1988, 11 year old Christopher Stephenson was abducted from a Brampton shopping mall, sexually assaulted, and murdered, again, by a known sexual offender living in a halfway house that, to my knowledge, never again accepted sexual offenders as residents.

These tragedies resulted in changes to the operation of community residential facilities across Canada, including the development of detailed Operating Standards for the Correctional Service of Canada (CSC). Indeed, the deaths of Celia, Tema, and Christopher galvanized the people of Ontario (and, arguably, the people of the entire nation) against what they saw as haphazard policies in managing the risk posed by sexual offenders conditionally released to the community.

The deaths of these three persons were examined in the Ruygrok Coroner’s Inquest, the Pepino Inquiry, and the Stephenson Inquest. Those reviews ushered in dramatic changes in perspective regarding community-based sexual offender management in Canada. During the Stephenson Inquest of 1993, 108 recommendations were made, of which the following three were among the most pertinent to the Correctional Service of Canada (Solicitor General Canada — see Petrunik, 1994):

  1. the development of a "national strategy for the assessment, management, and treatment of sex offenders"

  2. the creation of a "National Coordinator for the treatment and management of Sexual offenders"

  3. the funding and expansion of "established community based sexual offender treatment programs for offender aftercare"

In anticipation of the third finding, the Correctional Service of Canada in the Ontario Region instituted three contracted pilot programs (Kingston [Dr. Bill Marshall], Hamilton [Dr. Rita Bradley], and Toronto [Dr. Ron Langevin]). In a sense, CSC was striking a deal with these communities—ostensibly by establishing programs and policies to ensure that no further tragedies would occur.

Concurrently, the Clarke Institute of Psychiatry (now the Centre for Addiction and Mental Health) in Toronto was running a relapse prevention group program for outpatient sexual offenders. Dr. Christopher Webster (of HCR-20 fame) was the head of the department responsible. I was involved as the Senior Therapist in the Clarke Institute program and the lead therapist for the Toronto pilot program. When the Toronto pilot program folded, leaving CSC without community-based treatment resources in Canada’s largest city, CSC recruited me as its first ever community-based sexual offender specialist and the Relapse Prevention (RP) Maintenance Program was established.

The RP Maintenance Program had two streams: 1) the ‘Traditional Maintenance’ program for offenders who presented at the lower risk levels; and 2) the ‘Structured Maintenance’ program for higher risk offenders. The Traditional program was offered by CSC staff, while the Structured program was offered by the Clarke Institute of Psychiatry under contract to CSC. Essentially, I brought the Toronto pilot program in-house to CSC, while the Clarke Institute, under the new direction of Dr. Howard Barbaree (former SAJRT Editor and titan of Canadian sexual offender research and practice), morphed their program into the “structured” program option noted above.

The “national strategy” and “national coordinator” elements called for during the Stephenson Inquest were addressed in three phases. First, in 1994, a Corporate Advisor, Sex Offender Programs was designated and Canadian sexual offender treatment pioneer Dr. Sharon Williams was appointed to the position. Second, in 1995, a national consultation was subsequently held in Toronto, during which all sexual offender service providers affiliated with CSC from across the country met to discuss policy and procedure. Last, in 1996, CSC instituted standards for sexual offender assessment, treatment, and supervision (CSC, 1996). Eventually, these policy and practice standards became the foundation of CSC’s current National Sex Offender Treatment (NaSOT) programs. The RP Maintenance Program I developed in the Central Ontario Parole District (Toronto) served as the model program for the Maintenance component of NaSOT.

In the early days of community-based sexual offender treatment at the Keele Centre, where the groups were held, the back portion of the main floor was actually assigned to the Ministry of Natural Resources. It was very odd to carve out a space in the back corner of a warehouse storing canoes, outboard motors, tents, and the like. Nonetheless, we cobbled together a dozen old and stained office chairs and some funky 1970s dividers from the basement storage room and set up our “group area”. That’s where we held those initial sessions.

Over the ensuing 18 years, many staff and clinical interns came and went, but the RP Maintenance Program endured. We published our first review in 2000 (Wilson, Stewart, Stirpe, Barrett, & Cripps, 2000), with results showing incrementally lower rates of recidivism when combining community follow-up treatment with RNR-informed parole supervision. We updated this review in 2007 (Wilson, Cortoni, Picheca, Stirpe, & Nunes, 2007a), with results that were equally favorable. Actually, delivering the Wilson et al. (2007a) research report and another on Circles of Support & Accountability was the last thing I did in Canada before heading off to Florida to take on the Clinical Directorship of the Florida Civil Commitment Center. The COSA research report (Wilson, Cortoni, & Vermani, 2007b) was ultimately published on the CSC website as R-185 in 2009 but, more than four years later, there is still no sign of R-188.

How can that be?

Here is a research report detailing a coordinated effort by dedicated treatment and parole supervisory staff showing great results in terms of reduced recidivism and reduced harm to the community, and CSC won’t post the report. Seems a bit sinister, eh? Especially so, when you consider some of the other interesting things that have happened in Canada.

For instance, go to and try to find Smith, Goggin, and Gendreau (2002). Interestingly, “2002” has no reports under its tab.


As a public service, I’ll be happy to provide a pdf of this report to anyone who emails me ( In a meta-analysis of 117 studies involving 442,471 (!) subjects from international jurisdictions, Smith et al. (2002) investigated correlations between recidivism and (a) length of time incarcerated, (b) institutional sentence vs. a community-based sanctions, and (c) receiving an intermediate sanction (e.g., electronic monitoring, boot camps, drug testing). This represents, perhaps, one of the largest studies ever completed examining the effects of incarceration on reoffending. The following quote is important in understanding this study’s findings regarding the lesser effectiveness of “sanction alone” as a deterrent against reoffending:

We are confident that, no matter how many studies are subsequently found, sanction studies will not produce results indicative of even modest suppression effects or results remotely approximating outcomes reported for certain types of treatment programs. (p.19)

Simply put, this gargantuan study shows conclusively that sanction alone does not reduce crime, and that it is only by offering evidence-based human service interventions (following RNR principles outlined below) that we see reductions in reoffending on release to the community.

So, here we have two research reports funded and supported—in one way or another—by the Canadian federal government, that that same government (in its present incarnation) now seems inclined to disavow or pretend never happened. Not surprisingly, this is the same government (in its present incarnation) that now espouses a “get tough on crime” agenda that is, at times, at odds with the findings of these two reports (and others, I’m sure).

It is of some relevance to note that neither of these two reports are islands in the research literature. Regarding the Smith et al. meta-analysis, interested readers can check out a markedly similar meta-analysis by Aos and crew at the Washington State Institute for Public Policy (Aos, Miller, & Drake, 2006; see also Lipsey & Cullen, 2007). Treatment for sexual offenders now enjoys support from a number of large-scale publications, not the least of which is Hanson et al.’s meta-analysis of RNR principles as they apply to SO treatment (Hanson, Bourgon, Helmus, & Hodgson, 2009).

Many legislators and correctional professionals in the USA are currently agonizing over how to bring down skyrocketing criminal justice costs. Some say that a number of States on the verge of bankruptcy because of these costs. In these times of fiscal uncertainty, many jurisdictions are regretting some of the costly measures they initiated without first doing the research as to whether or not those measures would actually accomplish their appointed tasks (see Levenson & D’Amora, 2007). Nonetheless, the federal government in Canada appears hell-bent on going down the same road, in spite of what tales of woe their American colleagues might share. This is particularly disheartening when we consider that a good deal of the best practice research and literature regarding effective assessment, treatment, and risk management of offenders is of Canadian origin.

The following is an excerpt from a paper I wrote in 2008. It seems silly to try to rewrite it, so I’m simply reprinting the pertinent section here, with apologies to the Journal of Community Corrections:

Many might point to the turn of the millennium as the “heyday” of Canadian corrections. At that time, many of the major advances in criminal justice understanding and practice were coming out of Canada. Andrews’ and Bonta’s seminal work The Psychology of Criminal Conduct (1994; reissued 2007) addressed Martinson’s (1974) “Nothing Works” findings through meta-analysis and, in the process, helped define modern approaches to correctional programming in what has become known as the risk, needs, responsivity (RNR) model. In many ways, this model became the lynchpin of the Canadian arm of the “What Works?” movement that has revolutionized corrections … Simply put, the RNR model decrees that correctional programs must match level of intensity of treatment to assessed level of risk, while specifically targeting criminogenic needs in a manner that is attendant to participant idiosyncrasies and that maximizes motivation to change.

Concurrent with efforts to maximize treatment benefit, other Canadians were working hard to refine methods of assessing risk, particularly to address concerns raised by Monahan (1981) that unstructured clinical judgment regarding risk to reoffend led to accuracy levels below chance (i.e., we would have been better off flipping a coin than asking a risk assessment professional for an opinion).

Canadians were at the vanguard of the development of actuarial risk assessment tools, and many of these tools are now widely used internationally. For instance, the Level of Service Inventory–Revised (LSIR; Andrews & Bonta, 2000) is an industry standard for the prediction of general criminality, while the Violence Risk Appraisal Guide (VRAG; Quinsey et al., 2005) is the equivalent for violent recidivism. Regarding risk for sexual recidivism, Karl Hanson’s work began with the Rapid Risk Assessment for Sex Offender Recidivism (RRASOR; Hanson, 1997) and culminated in the STATIC-99 (Hanson & Thornton, 1999), which is currently the most widely used tool of its kind in the world.

Alongside advancements in program provision and risk assessment, Canada also led the way in effecting sensible policies regarding conditional release and community-based programming. On the strength of works by Andrews, Bonta, Gendreau, and others (e.g., Andrews & Bonta, 2007; Gendreau et al., 1996), Canadian corrections focused on offering evidence-based interventions in institutional settings, with aftercare and coordinated supervision upon release.

In closing, it pains and embarrasses me to say that the rest of the world has started to notice Canada’s dramatic change in approach. I am frequently approached at conferences and asked, “Hey, what’s going on in Canada?” Whether or not Canada leads the world in correctional research and practice is probably not such a big deal. More important is the bond of trust between the government and the community. After the deaths of Celia, Tema, and Christopher, deals were cut and accommodations were made—whether explicitly or implicitly—between those two entities.

They say that those who cannot remember the past are condemned to repeat it…


Andrews, D.A., & Bonta, J. (2007). The Psychology of Criminal Conduct. 4th Ed. Cincinnati, OH: Anderson.

Andrews, D.A., & Bonta, J. (2010). The psychology of criminal conduct. 5th Ed. Cincinnati, OH: Anderson.

Aos, S., Miller, M., & Drake, E. (2006). Evidence-based adult corrections programs: What works and what does not. Olympia: Washington State Institute for Public Policy.

Correctional Service of Canada (1996). Standards and guidelines on the provision of services to sex offenders. Ottawa, ON: Author.

Correctional Service of Canada (CSC, 2007). A Roadmap to Strengthening Public Safety: Report of the Correctional Service of Canada Review Panel. Ottawa, ON: Minister of Public Works and Government Services Canada.

Gendreau, P., Little, T., & Goggin, C. (1996). A metaanalysis of adult offender recidivism: What works! Criminology, 34, 575–607.

Hanson, R.K. (1997). The development of a brief actuarial scale for sexual offense recidivism. [User Report 1997-04] Ottawa, ON: Department of the Solicitor General of Canada.

Hanson, R.K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36, 865-891.

Hanson, R.K. & Thornton, D. (1999). Static-99: Improving actuarial risk assessments for sexual offenders. [User Report 1999-02] Ottawa, ON: Department of the Solicitor General of Canada.

Levenson, J.S., & D’Amora, D.A. (2007). Social policies designed to prevent sexual violence: The emperor's new clothes? Criminal Justice Policy Review, 18, 168-199.

Lipsey, M.W., & Cullen, F.T. (2007). The effectiveness of correctional rehabilitation: A review of systematic reviews. Annual Review of Law and Social Science, 3, 297-320.

Martinson, R. (1974). Nothing works: Questions and answers about prison reform. The Public Interest, 35, 22–54.

Monahan, J. (1981). The clinical prediction of violent behavior. Washington, DC: U.S. Government Printing Office. DHSS Publication No. (ADM) 81-921. Reprinted 1981 as Predicting violent behavior: An assessment of clinical techniques. Beverly Hills, CA: Sage.

Petrunik, M.J. (1994). Models of dangerousness: A cross jurisdictional review of dangerousness legislation and practice. [User Report 1994-02] Ottawa, ON: Department of the Solicitor General of Canada.

Smith, P., Goggin, C., & Gendreau, P. (2002). The effects of prison sentences and intermediate sanctions on recidivism: General effects and individual differences. Research Report 2002-01. Ottawa, ON: Solicitor General Canada.

Wilson, R.J. (2008). The end of corrections as we know it: A review. Journal of Community Corrections, 17, 9-10/24-26.

Wilson, R.J., Cortoni, F., Picheca, J.E., Stirpe, T.S., & Nunes, K. (2007a). Community-based sexual offender maintenance treatment programming: An evaluation. [Research Report R-188] Ottawa, ON: Correctional Service of Canada.

Wilson, R.J., Cortoni, F., & Vermani, M. (2007b). Circles of Support & Accountability: A national replication of outcome findings. [Research Report R-185] Ottawa, ON: Correctional Service of Canada.

Wilson, R.J., Stewart, L., Stirpe, T., Barrett, M., & Cripps, J.E. (2000). Community-based sex offender management: Combining parole supervision and treatment to reduce recidivism. Canadian Journal of Criminology, 42, 177-188.

Thursday, May 12, 2011

Here I go again...

The DSM-5 controversy continues...

Last week, I reported late-breaking news that the DSM-5 folks had decided to consider Paraphilic Coercive Disorder for possible inclusion in the Appendix of the book rather than in the main body of the text. They made the same decision regarding Hypersexual Disorder. In addition, they decided that Hypersexual Disorder should be grouped with the sexual dysfunctions rather than with the paraphilias.

These decisions have subsequently drawn attention by Karen Franklin in her blog and have generated quite a discussion on various list serves, especially the ATSA-list. I have excerpted some of those ATSA-list posts below, with permission from the various posters.

Dr. Franklin and her associates have been very critical of the proposed changes to the Paraphilias diagnoses, taking particular aim at Pedohebephilic Disorder (PHD) and Paraphilic Coercive Disorder (PCD), with seemingly lesser complaints about Hypersexual Disorder. Various parties have written letters to the Editor of the Archives of Sexual Behavior (ASB—where much of the discourse has taken place) and Dr. Franklin has frequently blogged on the topic.

In her recent blog, Dr. Franklin quotes DSM-IV Task Force Chair Dr. Allen Frances as having stated the following:

The evaluators, prosecutors, public defenders, judges, and juries must all recognize that the act of being a rapist almost always is an indication of criminality, not of mental disorder. This now makes four DSM's (DSM III, DSM IIIR, DSM IV, DSM 5) that have unanimously rejected the concept that rape is a mental illness. Rapists need to receive longer prison sentences, not psychiatric hospitalizations that are constitutionally quite questionable.

So, Dr. Frances is suggesting that we should not diagnose rapists because it will lead to hospitalization and not correctional incarceration. If this logic were true, then wouldn't we find more pedophiles, exhibitionists, and frotteurs in hospitals than in correctional facilities? I have worked in both correctional and hospital settings and I can tell you that, without a doubt, virtually all of the paraphilic clients I saw were either in correctional settings or were in hospital settings being evaluated to determine which correctional setting would be most appropriate. Paraphiliacs go to jail, not hospitals.

Maybe Dr. Frances is referring to Civil Commitment Centers (CCC) when he speaks of hospitals? I work in one of those places, so I have a pretty good idea what they’re all about. I want to be very clear that SVP facilities are not prisons, they are civil facilities for persons not serving a criminal sentence. It is also important to note that the vast, vast majority of persons in CCCs go there after having satisfied a criminal incarcerative sanction (an exceptionally small number of SVPs come into the CCC via a state mental hospital, but that is truly quite rare). In the United States, where CCCs exist almost exclusively, correctional sentences for sexually abusive behaviors are often rather lengthy—certainly more lengthy than in most other G20 nations.

Equating a CCC with a hospital would be a grave mistake. Actually, CCCs are an interesting hybrid—they are secure, so as to further the aspect of preventive detention (and, thus, have many of the trappings of prisons); but the focus is treatment, which means they have a much higher number of clinical staff than you would find in a prison (and, thus, they are a bit more hospital-like). However, these are not “hospitals” like the ones where other psychiatrically diagnosed individuals may find themselves. All in all, I find Dr. Frances’ contention that PCD (or the other two) will result in more rapists or adolescent molesters going to hospital than jail to be a complete and total non-issue. Paraphilic persons are not going to hospitals now, and that is unlikely to change.

As to the oft-heard contention that sexual psychodiagnostics in the SVP world are less than optimal, on this I am likely to agree. Virtually all CCC residents have a paraphilia diagnosis of one sort or another. And, yes, it is true that you are more likely to find a Paraphilia NOS diagnosis (either “nonconsent” or “adolescent victims”) amongst this group than any other group of persons diagnosed with a paraphilia. Either there truly are more NOS persons in the cohort of offenders considered for CCC placement or there is something amiss in the way SVP candidates are being assessed, pre-commitment. In a piece on PCD written for ASB, Washington State prosecutor Paul Stern wrote:

Paraphilic Coercive Disorder would give the judicial system the best opportunity to most accurately identify the small group of men who have previously committed, and are likely in the future to commit, this type of predatory sexual violence.

Mr. Stern’s position is that adding PCD to the diagnostic nomenclature will not lead to greater pathologizing of criminal behavior. Rather, his belief is that having a more clearly defined diagnostic framework will decrease its use in comparison to the mess that is currently Paraphilia NOS nonconsent.

Truth be told, lots of esteemed scientists disagree as to whether or not there is sufficient evidence to establish distinct or different diagnoses, but that is ultimately a question for research. In her blog, Dr. Franklin seems to argue that we as field should issue a pre-emptive strike on these proposed diagnoses, so as to forever consign them to the dustbin of sexology.

If you agree that this pseudoscientific condition needs to be placed in the wastebasket once and for all, now is the time to speak up. The current public comment period ends June 15. While you’re at it, you might want to state your opposition to a couple of the other controversial proposals with potential for profound negative consequences in the forensic realm – pedohebephilia and hypersexuality.

As a further door-slam, Dr. Franklin points to research and commentary by Brandeis professor Dr. Ray Knight (a well-known rape typologist) as being supportive of doing away with PCD.

(PCD) had met with strong opposition from scientists, including premier rape researcher Raymond Knight of Brandeis University.

In truth, my read of Dr. Knight's criticism is that he believes that paraphilic coercion cannot be reliably distinguished from Sexual Sadism—that paraphilic coercion is not taxonomic on its own. My colleague Jan Looman posted this on the ATSA-list:

I don't think the issue is whether or not men become aroused to rape, but whether a group of men who become aroused to rape can be reliably distinguished from sadists (at least that's what I got from reading Ray Knight's stuff about this). I think that his position is that there are gradations of sadism and that the men who become aroused to rape can be captured in this category.

In his own ATSA-list response to Dr. Looman, Dr. Knight writes:

Your characterization about one of the objections to PCD is correct. There appears to be reasonably strong support for a continuum of "sadistic" fantasies/behaviors, maybe better labeled an "agonistic" scale or some other more inclusive name, and PCD is on that continuum and does not differ in kind from sadism. At the very least the two constructs cannot currently be reliably discriminated.

So, Dr. Knight doesn’t exclude the existence of paraphilic coercion. Rather, he says that it cannot be reliably distinguished from an already existing paraphilia—Sexual Sadism.

Interestingly, one of Dr. Frances’ frequent writing partners, Michael First (see First & Halon, 2008, p. 452), also does not exclude the likely existence of paraphilic coercion:

Conceptually, given the wide variety of stimuli known to be the focus of paraphilias, there is no reason to doubt the existence of a paraphilia in which the aberrant focus of sexual arousal is precisely the nonconsensual aspect of the interaction.

Another colleague, Jon Brandt, recently posted this on the ATSA-list:

Beyond criteria for diagnosis, the DSM has many uses including the benefits of nomenclature, and yielding effective treatment plans rooted in well-established diagnoses. But PCD and Pedohebephilia are not settled science.

There it is…Seemingly always at the heart of the criticism of the proposed diagnoses is that they have not been established in science. But, what does establishment in science look like? What are the critics (I’m not necessarily including Dr. Brandt here) actually calling on the field to do?

Are they suggesting that nobody ever did any research on paraphilic coercion (or paraphilic rape, or rape proneness, or whatever is the nom du jour)? Or, that nobody ever did a study looking at pedohebephilia? Or, are they suggesting that paraphilic diagnoses cannot be considered until they have been subjected to field trials and had their inter-rater reliabilities checked?

Again, I ask you: What does establishment in science look like?

It won't take anybody very long to find out that paraphilic coercion has been the topic of quite a large body of research. The same is true of pedohebephilia—SAJRT Editor James Cantor did a lit search and found a mountain of research and scholarly discourse referring to hebephilia. So, that can't be it. Let's turn then to the question of field trial research.

Without reading last week's blog or Paraphilias Subworkgroup Chair Ray Blanchard's letter to the Editor of ASB (because that would be cheating), how many field trials do you think have previously been conducted on the paraphilias?

I love this part.

That number is 3. Not three studies, not three groups, perhaps not even three paraphilias. Three subjects. That's it...3 (three) subjects studied during preparation for DSM-III. I may not be the sharpest statistician around but, to me, this seems pretty simple. None of the paraphilias we use have been subjected to adequate field trial research.

I repeat, none.

So, if you use the field trial standard, all the rhetoric about the proposed paraphilias not being "settled science" must now also apply to all the others. Differentially picking on PHD or PCD, while letting the others off the proverbial hook, seems to imply that just because some prior iteration of the DSM chose to include Exhibitionism, Pedophilia, Masochism, etc. in the mix, we should accept these diagnoses as somehow more "real" or bona fide. Does anyone else get the logical non sequitur in this?

In closing, my recommendation is this:

Ditch the bluster and let the science do the talking for a while. Research as to the inter-rater reliabilities of the PCD and PHD frameworks is underway. Hopefully, we may get some empirical direction regarding Hypersexual Disorder as well, but this is less likely. If we truly believe that “settled science” is the way forward, then all the pre-emptive conjecture is “pseudoscientific,” to use one of Dr. Franklin’s terms.


PS... The just released issue of the Sex Offender Law Report has three articles on PCD by Knight and Thornton, Stern, and myself.