Dr Peter Chamberlain

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Owenia House Specialist Rehabilitation Service
for Sex OffendingDecember 2012

• Dr Peter Chamberlain
• Senior Clinical Psychologist

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Owenia House Effectively a behavioural clinic
within the Forensic Mental health Service

• Our core objective is to prevent sexual abuse of
  children by intervening with offenders and
  potential offenders
• Provides
• Community based assessment and treatment services
  for adults who have sexually offended against
  children, or fear they may do so.
• A treatment service for paraphilias e.g.
  exhibitionists, public masturbators

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Owenia House(As at 12 December 2012)

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

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Principle Theoretical Models

• Finklelhors (1984) Precondition Theory
• motivation, internal and external barriers and
  victim resistance
• 3 components
• emotional congruence emotional need to relate
  to children
• sexual arousal children are a potential source
  of sexual
• gratification
• blockage adult sexual emotional gratification
  unavailable
• Ward Stewarts (2003) Good Lives Model
• constructive holistic approach beyond a single
  focus on risk management
• enhancement drives rehabilitation
• realising an offending-free life that is
  beneficial and rewarding in ways that are
  socially acceptable personally fulfilling

Offending Trajectory
Therapeutic Philosophy
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Pathways Model of Child Sexual Abuse (Ward
and Siegert 2002)
Principle Theoretical Models Continued
Theoretical morphing Finklelhor's Precondition
Theory Hall Hirschmans Quadripartite Theory
(critical threshold) Marshall Barbarees
Integrated Theory (negative early life
experiences
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Typologies of Child Sex Offenders

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

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General Characteristics

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

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Criminality

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

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Sexual Preference

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

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Assessment

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

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Degrees of Denial
WHY DID YOU SEXUALLY ASSAULT THE
VICTIM?
NOTHING HAPPENED I never laid a finger on
her The boys lying The cops are out to get
me
SOMETHING HAPPENED
BUT
AND
IT WASNT MY IDEA The kid came on to me She
was all over me
IT WAS MY IDEA
BUT
AND
IT WASNT SEXUAL I was being affectionate I
was angry at my wife I was teaching her to be
careful
IT WAS SEXUAL
AND
BUT
IT WAS WRONG
IT WASNT WRONG Theres nothing wrong with
it She liked it
BUT
BUT
THERE WERE EXTENUATING SITUATIONAL
CIRCUMSTANCES I was having money problems I
was drinking too much My wife wouldnt sleep
with me
THERE WERE EXTENUATING PSYCHOLOGICAL FACTORS I
was sexually abused as a child I dont know
what got into me Women scare me
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Group Treatment Programmes

• Closed (set programme, 2 stage)
• Open/Continuous (own pace, enter at leave
  different times)
• Intensive (Country, short time)
• Skills-based (IQ compromised)
• SOIG (Information, support, supervising adult)

• NOS (Other paraphilias) Individual Treatment

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Group Content

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

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

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

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End of Treatment Expectations

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

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Treatment Success

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

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Referral Criteria

• Two pathways Mandated or Voluntary
• Criteria
• Must have sufficient time if mandated
• Voluntary must self-refer and not be before the
  court
• Offences must have been against children (i.e.
  adult victim offences not accepted). NOS clients
  the exception
• Must accept some responsibility (deniers
  precluded)
• gt17 years of age
• Male

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Referral/Discharge considerations

• No child contact
• Likelihood for change
• Motivation for change
• Social supports

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