Sexual Offending Behavior Research Articles

Mode deactivation therapy and cognitive behavioral therapy: A description of treatment results for adolescents with personality beliefs, sexual offending and aggressive behaviors.

This paper is a comparison of two groups of adolescent sexual offenders receiving different types of therapy; one group participated in Treatment As Usual (TAU), which is a Cognitive Behavioral Therapy (CBT) based approach, and the other group engaged in Mode Deactivation Therapy (MDT). The data presented is reflective of treatment comparisons not a research protocol. The results are descriptive and not necessarily comparison research. MDT is an empirically based therapy, based on CBT, Dialectical Behavioral Therapy (DBT; Linehan, 1993), and Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1993), recently implemented in the Behavioral Studies Program, existing in Portsmouth, Virginia. MDT is a methodology that systematically assesses and expands underlying compound core beliefs that are a product of their unconscious experience merging with their cognitive processing, acceptance, balance, and validation. By addressing these beliefs, MDT examines underlying perceptions that may be applicable to setting in motion the mode related charge of aberrant schemas, that enable the behavior integration of DBT principles (Beck, 1996; Nezu et a], 1998). The MDT system also implements the Case Conceptualization method based an adaptation of the Beck (1996) suggested methodology of mode deactivation. Results suggest that MDT may be more effective in this treatment research than TAU, evident by reduced internal distress, resulting from various psychological disorders, and reduced sex offending risk. ********** The focus of MDT is based on the work of Aaron Beck, M.D., particularly his recent theoretical work, the system of (Beck, 1996, Alford & Beck, 1997). Other aspects of MDT have been included in the Behavior Analytic literature, such as Kohlenberg and Tsai (1993), Functional Analytic Psychotherapy (FAP), as well as, Dialectic Behavior Therapy (DBT) (Linehan, 1993). The specific application of MDT is delineated by Apsche, Ward, and Evile (2002) in an article, which specified the applied methodological implications for MDT with specific typologies. The article also provided a theoretical study case study that illustrates the MDT methodology. Beck (1996) suggested that the model of individual schemas (linear schematic processing) does not adequately address a number of psychological problems, therefore the model must be modified to address such problems. Working with adolescents who present with complex typologies of aberrant behaviors, it was necessary to address this typology of youngsters from a more global methodology, to address their impulse control and aggression. Beck (1996) describes the notion as a network of cognitive, affective, motivational, and behavioral components. He further described as consisting of integrated sections or suborganizations of personality, that are designed to deal with specific demands. Beck continues to describe primal modes as including the derivatives of ancient organizations that evolved in prehistoric circumstances and are manifested in survival reactions and in psychiatric disorders. Beck (1996) also explains that the concept of charges (or cathexes) being related to the fluctuations in the intensity gradients of cognitive structures. Beck, Freeman and Associates (1990) suggested that cognitive, affective and motivational processes are determined by the idiosyncratic structures or schema that constitute the basic elements of personality. This is a more cognitive approach suggesting that the schema is the determinant to the mood, thought, and behavior. Alford and Beck (1997) explain that the schema typical of personality disorder is theorized to operate on a more continuous basis; the personality disorders are more sensitive to a variety of stimuli than other clinical syndromes. Mode Deactivation Therapy and Cognitive Behavioral Therapy Further study of cognitive therapy emphasizes the characteristic patterns of a person's development, differentiation, and adaptation to social and biological environments (Alford & Beck, 1997). …

Mode Deactivation Therapy (MDT): Case conceptualization.

The theoretical constructs of Mode Deactivation Therapy (MDT) are based on the Mode Model (Beck, 1996), suggesting that people team from unconscious experiential components and cognitive structural processing components. Therefore, to change behavior of individuals there must be a restructuring of the experiential components and a corresponding cognitive reformation of the structural components. MDT is an empirically based methodology that systematically assesses and restructures dysfunctional compound core beliefs. By restructuring these beliefs, MDT addresses underlying perceptions that may be applicable to setting in motion the mode related charge of aberrant schemas, that enable the behavior integration of Dialectic Behavioral Therapy (DBT) principles (Linehan, 1993) of treating of sex offending or aggressive behavior (Kohlenberg & Tsai, 1993). The Mode Deactivation framework also utilizes the case conceptualization methodology and emphasizes a team approach in working with clients; particularly those with reactive emotional dysregulation, which includes parasuicidal acts and aggression. The case conceptualization is systematically designed to provide functionally based treatment to complex emotional, thought, and behavior disorders. The following article demonstrates this comprehensive process and delineates the procedures used to develop the case within the mode deactivation theoretical perspective. INTRODUCTION The concepts of mode deactivation therapy (MDT) are derived from Beck (1996) and Alford & Beck (1997) and their conceptualizations of the expansion of cognitive behavioral therapy into more global constructs known as modes. The application of MDT from theory to practice included the adaptation of Linehan's (1993) application of dialectical behavioral therapy (DBT). The similarities of MDT and DBT are obvious. MDT treats the personality beliefs and behaviors with Linehan's notion of finding the grain of truth and validating the client's beliefs rather than challenging the cognitive distortions. Underlying the MDT methodology is the Problem Solving Case Conceptualization. Problem solving case conceptualization is a combination of Beck's (1996) case conceptualization and Nezu, Nezu, Friedman, Haynes (1998) problem-solving model, with several new assessments and methodologies recently developed. The goal is to provide a blueprint to treatment within the case conceptualization. The Case Conceptualization helps the clinician examine underlying fears of the resident. These fears serve the function of developing avoidance behaviors in the youngster. These behaviors usually appear as a variety of problem behaviors in the milieu. Developing personality disorders often surrounds underlying posttraumatic stress disorder (PTSD) issues. The Case Conceptualization method has an assessment for the underlying compound core beliefs that are generated by the developing personality disorders. Thus far, preliminary results suggest that our typology of youngsters have a conglomerate of personality disorder compound core beliefs. This conglomerate of beliefs, is the crux of why youngsters fail in treatment. One cannot treat specific disorders, such as sex offending and aggression, without gathering these conglomerate beliefs. It is also apparent that these beliefs are not cluster specific. That is to say that the Conglomerate of Beliefs and Behaviors contains beliefs from each cluster that integrate with each other. Because of this complex integration of beliefs, it makes treatment for this typology of youngster more complicated. The conglomerate of compound core beliefs represents protection for the individual from their abuse issues, which may present as treatment interfering behaviors. The attempt to use the usual didactic approaches to treatment, without addressing these beliefs amounts to treatment interfering behavior on the part of the Psychologist, or treating professional, is not an empirically supported and counter-initiated. …

Mode Deactivation Therapy: A theoretical case analysis (Part I).

This is the first part of a case study presenting a single case analysis of an 18 year-old African -American male. It also presents a theoretical analysis of the case implementing Mode Deactivation Therapy (MDT) (Apsche, Ward, & Evile, 2002). MDT is a form of CBT that combines the balance of DBT with a methodology to address the adolescents' belief system. MDT has been shown to be effective in a descriptive study with CBT (Apsche & Ward, 2002). The analysis of MDT while reviewing this case presents an opportunity to understand the development of mdt, while reviewing it's effectiveness with this case. The individual in this case, John, was a troubled youngster. He had been the recipient of severe and pervasive physical abuse by his mother and father. He and his sister were neglected and abandoned as children at the age of 5 years old. John developed a complex system of personality disorder beliefs to cope with his world. These beliefs had led John to commit numerous violent acts as a sexual offense. This theoretical case study represents the beginning of mode deactivation therapy from theory to clinical practice. He was treatment savvy and was able to define basic cognitive therapy techniques but would engage in dialectical debates about distortions and would negatively engage his therapist who suggested that he distorted information. ********** INTRODUCTION The development of Mode Deactivation Therapy (MDT) as an applied CBT methodology has been a challenge. The difficulty begins in the attempt to treat adolescents with complicated history and multi-axial diagnoses. Many of the adolescents that we treat are victims of sexual, physical, and/ or emotional abuse. These individuals have developed survival coping strategies. Many of these survival mechanisms translate into personality traits and/or disorders. These personality traits and/or disorders are not cluster bound. Meaning that they are translated into beliefs and schemas that are inclusive of beliefs from all three clusters. Often it has been thought that individuals stay true to their cluster, this is not so, with the adolescent typology that we treat. The concepts of mode deactivation therapy (MDT) are derived from many aspects of functional analytic behavioral therapy (FAP), dialectical behavior therapy (DBT), and cognitive behavior therapy (CBT). The focus of MDT is largely based on Beck's recent area of research and application, the system of modes (Beck, 1996, Alford and Beck, 1997). Functional analytic psychotherapy (FAP) (Kohlenberg & Tsai, 1993) theory states people act based on reinforcement contingencies. Although FAP takes into consideration that cognitions are involved, the focus is on the deeper unconscious motivations that were formed as a result of past contingencies. Perception is based on past contingencies, therefore, reality and the concept of reality reflects what has been experienced in the past. Considering reinforcement history in the context of a person provides a more complete assessment of a person and specific behaviors. By restructuring beliefs, MDT addresses underlying perceptions that may be applicable to setting in motion the mode related charge of aberrant schemes, that enable the behavior integration of DBT principles, (Linehan, 1993) of treating of sex offending or aggressive behaviors. Many of Linehan's teachings describe radical acceptance and examining the "truth" in each client's perceptions. This methodology of finding the grain of truth in the perception of the adolescent is at the crux of MDT. We also "borrow" radical acceptance in the form of helping the youth accept who he is based on his beliefs. The other major similarity between DBT and MDT is the use of balancing the dichotomous or dialectical thinking of the client. Often CBT as viewed by "arguing" the concepts of cognitive distortions fails with these youngsters. They do not respond to being in a one-down position, no matter how aligned they are with their therapist. …

Mode deactivation: A functionally based treatment, theoretical constructs.

The theoretical constructs of Mode Deactivation Therapy (MDT) are based on the Mode Model (Beck, 1996), suggesting that people learn from unconscious experiential components and cognitive structural processing components. Therefore, to change behavior of individuals there must be a restructuring of the experiential components and a corresponding cognitive reformation of the structural components. MDT is an empirically based methodology that systematically assesses and restructures dysfunctional compound core beliefs. By restructuring these beliefs, MDT addresses underlying perceptions that may be applicable to setting in motion the mode related charge of aberrant schemas, that enable the behavior integration of Dialectic Behavioral Therapy (DBT) principles (Linehan, 1993) of treating of sex offending or aggressive behavior (Kohlenberg & Tsai, 1993). The Mode Deactivation framework also utilizes the case conceptualization methodology and emphasizes a team approach in working with clients; particularly those with reactive emotional dysregulation, which includes parasuicidal acts and aggression. The case conceptualization is systematically designed to provide functionally based treatment to complex emotional, thought, and behavior disorders. The following article demonstrates this comprehensive process and delineates the procedures used to develop the case within the mode deactivation theoretical perspective. *********** The development of Mode Deactivation Therapy (MDT) has been a challenge both theoretically and clinically. The difficulty begins in the attempt to treat adolescents with complicated history and multiaxial diagnoses. Many of the adolescents that we treat are victims of sexual, physical, and/or emotional abuse. These individuals have developed survival coping strategies. Many of these survival mechanisms translate into personality traits and/or disorders. These personality traits and/or disorders are not cluster bound, meaning that they are translated into beliefs and schemas that are inclusive of beliefs from all three clusters. Often it has been thought that individuals stay true to their cluster, this is not so, with the adolescent typology that we treat. The concepts of mode deactivation therapy (MDT) are derived from many aspects of functional analytic behavioral therapy (FAP), dialectical behavior therapy (DBT), and cognitive behavior therapy (CBT). The focus of MDT is largely based on Beck's recent area of research and application, the system of modes (Alford and Beck, 1997; Beck, 1996). Functional analytic psychotherapy (FAP) (Kohlenberg & Tsai, 1993) theory states that people act based on reinforcement contingencies. Although FAP takes into consideration that cognitions are involved, the focus is on the deeper unconscious motivations that were formed as a result of past contingencies. Perception is based on past contingencies, therefore, reality and the concept of reality reflects what has been experienced in the past. Considering reinforcement history in the context of a person provides a more complete assessment of a person and specific behaviors. By restructuring beliefs, MDT addresses underlying perceptions that may be applicable to setting in motion the mode related charge of aberrant schemas that enable the behavior integration of DBT principles (Linehan, 1993) of treating of sex offending or aggressive behaviors. Many of Linehan's teachings describe radical acceptance and examining the in each client's perceptions. This methodology of finding the grain of truth in the perception of the adolescent is at the crux of MDT. We also borrow radical acceptance in the form of helping the youth accept who he is based on his beliefs. The other major similarity between DBT and MDT is the use of balancing the dichotomous or dialectical thinking of the client. Often CBT as viewed by arguing the concepts of cognitive distortions fails with these youngsters. …

The Relationship of Trauma Exposure to Sex Offending Behavior Among Male Juvenile Offenders

ABSTRACT The most common type of adult and juvenile sex offender treatment utilizes a Relapse Prevention (RP) model. In RP clients learn about their offense cycle with an emphasis on recognizing high-risk situations and negative emotional states that can be precursors or triggers to offending behavior. This study identifies ways that traumatic experiences and trauma-associated feelings can be offense triggers for juvenile sex offenders. Researchers interviewed the treating clinicians of 40 male juvenile sex offenders who received at least six months of RP sex offender treatment. Results showed that 95% of the youths had experienced a Post Traumatic Stress Disorder (PTSD) Criterion A traumatic event and that 65% met criteria for PTSD based on clinician judgments. Overall, clinicians identified prior trauma exposure as being related to the offense triggers in 85% of offenders. Specifically, the following trauma-related feelings were identified as offense triggers: intense fear in 37.5% of sex offenders, helplessness in 55%, and horror in 20%. Implications for sex offender treatment programs are discussed.

Some implications of prenatal alcohol exposure for the treatment of adolescents with sexual offending behaviors.

Prenatal alcohol exposure can seriously harm the fetus, resulting in a wide range of physical and central nervous system abnormalities. A follow-up study of persons prenatally exposed to alcohol found that 49% of adolescents and adults had repeatedly displayed inappropriate sexual behavior. While these persons are likely to present to sexual offender treatment programs, they are unlikely to be recognized as neurologically impaired because the sequelae of prenatal alcohol exposure are seldom accurately identified by clinicians. Persistent impairments in response inhibition, memory, and executive functions are common, requiring adaptations to standard sexual offender assessment and treatment.

A Dynamic Formulation of Sex Offender Behavior and Its Therapeutic Relevance

ABSTRACT Treatments for sex offenders in correctional/therapeutic facilities thus far have been primarily based on changing their deviant behavior, diminishing their anger and their desire to control their victims. The results of such treatments have been modest, and recidivism remains high. In this article, rapists and pedophiles are discussed within the framework of a unitary theory of the paraphilias. A new psychodynamic therapeutic approach is offered, centered around the offender's basic weak ego, ambivalent feelings toward the female figure, and their feelings of shame and rejection. It is postulated that such insightful therapy may prove more beneficial than previous treatments and that, together with already-present cognitive and behavioral therapeutic approaches, it may help the offenders to realize and to deal with the unconscious personal and collective conflicts at the basis of their behavior. Sex offenders are not only persons who break the law but also individuals with deeply buried conflicts, the resolution of which could expedite their reintegration into society and diminish recidivism.

Current concepts in preventing sexual abuse.

Most efforts to prevent sexual abuse have focused on teaching school children to resist abuse after it starts and to report it promptly to trusted adults. These programs increase children's knowledge and skills and the likelihood that children will disclose sexual victimization but have not been shown to reduce the incidence of abuse. A recent, unique approach to prevention is a Vermont social marketing campaign that encouraged sexual offenders to seek treatment. During the campaign, 50 persons voluntarily sought treatment for sexual offending or sexual behavior problems, and eight offenders presented themselves voluntarily to state attorney offices. Recent evidence indicates that many sexual offenders were themselves molested and that lack of family support about that molestation is an important risk factor for sexual offending. However, the number of treatment programs for "sexually reactive" children and adolescent sexual offenders in the United States declined from more than one thousand in 1994 to 337 in 2000. In nine states, no adolescent treatment program is currently available. There is an urgent need for methodologically sound research aimed at delineating the causes of sexual deviance and at measuring and improving the efficacy of treatment for sexual offenders.

Exploring the complex relationship between adolescent sexual offending and sex chromosome abnormality.

The nature and importance of the relationship between sex chromosome abnormalities (SCAs) and sexual maladaptive behaviour is uncertain. When considering the aetiology of sexual offending behaviour, the importance of sex chromosome disorder lies in its biopsychological manifestations and in its complex interactions with external influences. At the Adolescent Forensic Service, in keeping with previous research in institutional settings, we found a higher pick-up rate of SCAs among sexual offenders (5/121) than would be expected in an unbiased community sample (1.2/1000 male livebirths; Jacobs et al. (1992)). We present descriptive data on five patients with SCAs out of a total of 121 sexual offenders who presented to the Adolescent Forensic Service over a 6-year period. We discuss the biopsychosocial features of these five patients and compare them with the remainder of the sexual offenders in the series. We discuss the advantages of early diagnosis and the need for professional vigilance by adolescent forensic psychiatrists, child and adolescent psychiatrists, paediatricians and clinical geneticists.

The impact of polygraphy on admissions of victims and offenses in adult sexual offenders.

Sexual offenders are extremely reluctant to disclose their offending histories for a variety of psychosocial and legal reasons. The polygraph has shown promise as a intervention for eliciting admissions of past sexual offending behaviors. For 60 adult male sexual offender (35 inmates and 25 parolees), the number of victims and offenses were recorded from the Presentence Investigative Report, Sexual History Disclosure form, and 2 consecutive polygraph examination reports. Dramatic increases in the number of admitted victims and offenses were found for inmates, but not for parolees, across each source. However, there was a substantial decline in the number of victim and offense admissions by the second polygraph examination for both groups, even though 80% of the examination results reveled deception about sexual offending behaviors. Standardized use of sanctions and privileges for deceptive and nondeceptive polygraph results, respectively, are proposed as a way of eliciting full disclosure of offending histories for these offenders.

Attachment and coercive sexual behavior.

This study examined the relationships between childhood attachment and coercive sexual behavior. One hundred sixty-two male undergraduate students completed self-report measures of childhood maternal attachment, childhood paternal attachment, adult attachment, antisociality, aggression, and coercive sexual behavior. As predicted, insecure childhood attachment, especially insecure paternal attachment, was associated with antisociality, aggression, and coercive sexual behavior. Moreover, childhood attachment independently predicted coercive sexual behavior after antisociality and aggression were statistically controlled. The hypothesis that paternal avoidant attachment would predict coercive sexual behavior independently of its relationship with aggression and antisociality was also supported. Posthoc analysis indicated that maternal anxious attachment was associated with antisociality and that paternal avoidant attachment was associated with both antisociality and coercive sexual behavior. These results are consistent with criminological and psychological research linking adverse early family experiences with offending and lend support to an attachment-theoretical framework for understanding offending behavior in general and sexual offending behavior in particular.

Sexual offending and antisocial sexual behaviour among patients with schizophrenia

Sexual offending and antisocial sexual behaviour among patients with schizophrenia

Traumatic brain injury in individuals convicted of sexual offenses with and without bipolar disorder

The authors examined the occurrence of traumatic brain injury (TBI) in individuals convicted of sexual offenses with and without bipolar disorder and a comparison group of patients with bipolar disorder without a history of sexual offending behaviors. Individuals convicted of sexual offenses and diagnosed with bipolar disorder had greater rates of brain injury resulting from head trauma than individuals convicted of sexual offenses without bipolar disorder and comparison patients with bipolar disorder. TBI predated the first sexual offense and/or the onset of bipolar disorder in most subjects.

SEXUAL PREDATORS

Social responses to sex-offending behaviors have included criminal sanctions and clinical interventions that have evolved over time. These developments have created various challenges for mental health professionals charged with providing care to offenders, particularly when legislative expectations have exceeded available treatments. A summary is provided of recent clinical developments in assessments, therapies, and pharmacology. The usefulness of SRIs, in particular, may prompt the involvement of more psychiatrists in this treatment. Other implications for future practice of these clinical and legal developments are also discussed.

A cognitive behavioral model of assessment and treatment for intellectually disabled sexual offenders

Sex-offending behavior continues to exist as a major public health concern. In recent years, studies of risk prediction and identification of both static and dynamic factors associated with the behavior of sexual perpetrators have added to a collective understanding of the problem. However, a limited amount of available information exists concerning how to translate relevant factors into effective clinical treatments or risk management strategies for this population. This is particularly true with regard to intellectually disabled offenders. This paper presents a model of sex offending that focuses on cognitive behavioral variables proposed as functional causal pathways to guide assessment and treatment of such individuals. Clinical case examples are provided to illustrate the linkage between assessment and treatment.

A developmental approach to the treatment of adolescent sexual offenders

A developmental integrated framework for planning assessment, treatment, evaluation and research with sexually aggressive children and adolescent sexual offenders is presented in this paper. The model takes account of the fact that atypical sexual behaviour is usefully conceptualized as occurring not in isolation, but within the context ofthe youngster’s physical, cognitive. moral, social and emotional development and also within the context of the child's overall social network including the family, the peer group and the school. For case management, programme evaluation and research, assessment procedures are therefore developmentally referenced and span a range of domains including peer relationships, coping strategies, social skills, family relationships, taking responsibility for sexual aggression, adherence to treatment, understanding sexual offending behaviour, development of empathy and caring, and relapse prevention. Treatment procedures based on this model, unlike those based’on downward extensions of adult offending behaviour programmes, are matched to the youngster’s developmental level. They are also comprehensive, integrated, flexible and address general behaviour patterns of which sexual offending is but one.

Up the slippery slope: Groupwork with sex offenders with a learning disability

Techniques developed for work with sex offenders are not always applicable to or appropriate for sex offenders with a learning disability due to the cognitive and social difficulties which such individuals may have. This paper describes an attempt to adapt and combine a number of psychological and art therapy techniques in group work with sex offenders with a learning disability. The aim was to identify areas relevant in sexual offending behaviour and to adapt treatment approaches for the above client group.

Exploring the Relationship Between Childhood Sexual Abuse and Adult Sexual Perpetration

Empirical findings indicate that many adult sexual offenders experienced sexual abuse during childhood. It has been suggested that characteristics of offenders' sexual perpetrating behaviors may resemble their own victimization experiences, although there has been minimal empirical investigation in this area. The purpose of the present study was to provide preliminary data on the relationship between childhood sexual abuse and characteristics of sexual offending behavior. A sample of adult male sexual offenders with histories of sexual abuse completed the Sexual Victimization Survey as well as a measure on their sexual offenses. Such characteristics as the nature of sexual activities, duration and frequency of experiences, and age and relationship of participants were examined. Results showed trends in the hypothesized direction and revealed a variety of similarities between childhood sexual abuse and adult sexual perpetration. Findings of this exploratory study suggest the importance of addressing the nature of victimization in the treatment of sexually abused boys and offenders with histories of sexual abuse.

Adolescent Sex Offenders: Investigating Adult Commitment-Rates Four Years Later

the purpose of this study was to investigate the long term community re-adjustment of adolescent sex offenders released from a state residential group treatment program between 1988-1990. The results suggest: (1) the post-release behavior of adolescent sex offenders may not present the degree of personal risk assumed by the public; (2) the majority of adolescent sex offenders who eventually enter the adult correctional system will be committed on property related charges; and (3) serving adolescent sex offenders within an agency's main campus peer group treatment program may produce long term recidivism rates comparable with those reported among specialized treatment models. The findings are discussed in relation to the current demand for specialized sex offender programs and the need for correctional practitioners to develop strategies for this population of youth offenders.

Comparison of female and male children with sexual behavior problems

This article compares the characteristics of two groups of children, 34 females and 237 males, who exhibit sexual behavior problems and are clients of the Washington State Department of Social and Health Services, Division of Children and Family Services. In addition to the children's demographic variables, descriptions of their families, their sexual-offending behaviors, their victims, other presenting problems, legal actions, and risk of reoffending factors are presented.