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The Wiley handbook of what works with sexual offenders: Contemporary perspectives in theory, assessment, treatment, and prevention 1st Edition Franca Cortoni (Editor)
The Wiley Handbook of What Works with Sexual Offenders
WILEY-BLACKWELL SERIES IN: WHAT WORKS in OFFENDER REHABILITATION
Edited by Leam A. Craig
Forensic Psychology Practice Ltd, The Willows Clinic, UK
Centre for Applied Psychology, University of Birmingham, UK School of Social Sciences, Birmingham City University, UK
Louise Dixon
School of Psychology, Victoria University of Wellington, New Zealand and
the late, J. Stephen Wormith
Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Canada
WHAT WORKS IN OFFENDER REHABILITATION: AN EVIDENCE-BASED APPROACH TO ASSESSMENT AND TREATMENT
Leam A. Craig, Louise Dixon, and Theresa A. Gannon
THE WILEY HANDBOOK OF WHAT WORKS IN CHILD MALTREATMENT: AN EVIDENCED-BASED APPROACH TO ASSESSMENT AND INTERVENTION IN CHILD PROTECTION
Louise Dixon, Daniel Perkins, Catherine Hamilton-Giachritsis and Leam A. Craig
THE WILEY HANDBOOK ON WHAT WORKS FOR OFFENDERS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES: AN EVIDENCE-BASED APPROACH TO THEORY, ASSESSMENT, AND TREATMENT
William R. Lindsay, Leam A. Craig and Dorrothy Griffiths
THE WILEY HANDBOOK OF WHAT WORKS IN VIOLENCE RISK MANAGEMENT: THEORY, RESEARCH AND PRACTICE
J. Stephen Wormith, Leam A. Craig and Todd Hogue
THE WILEY HANDBOOK OF WHAT WORKS WITH SEXUAL OFFENDERS: CONTEMPORARY PERSPECTIVES IN THEORY, ASSESSMENT, TREATMENT, AND PREVENTION
Jean Proulx, Franca Cortoni, Leam A. Craig and Elizabeth J. Letourneau
The Wiley Handbook of What Works with Sexual Offenders
Contemporary Perspectives in Theory, Assessment,
Treatment, and Prevention
Edited by Jean Proulx, Franca Cortoni, Leam A. Craig, and
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Library of Congress Cataloging‐in‐Publication Data
Names: Proulx, Jean, 1956– editor. | Cortoni, Franca, editor. | Craig, Leam A., editor. | Letourneau, Elizabeth J., editor.
Title: The Wiley handbook of what works with sexual offenders: Contemporary Perspectives in Theory, Assessment, Treatment, and Prevention / edited by Jean Proulx, Franca Cortoni, Leam A. Craig, Elizabeth J. Letourneau.
Description: First Edition. | Hoboken : Wiley, 2020. | Includes index.
Identifiers: LCCN 2019056776 (print) | LCCN 2019056777 (ebook) | ISBN 9781119439455 (cloth) | ISBN 9781119439370 (adobe pdf) | ISBN 9781119439424 (epub)
Subjects: LCSH: Sex offenders. | Sex offenders–Psychology. | Sex offenders–Rehabilitation. | Sex crimes–Prevention.
Set in 10/12.5pt Galliard by SPi Global, Pondicherry, India
Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY
9 Neurobiological Considerations on the Etiological Approach to Sexual Offender Assessment: CAse Formulation Incorporating Risk Assessment–Version 2 (CAFIRA–v2) 153
Leam A. Craig, Martin Rettenberger, and Anthony R. Beech Part III Management of Sexual Offenders
Franca Cortoni and Leam A. Craig, Section Coordinators
10 The Utility of Treatment for Sexual Offenders
Liam E. Marshall
11 Contemporary Programs Designed for the Tertiary Prevention of Recidivism by People Convicted of a Sexual Offense: A Review, and the U.K. Perspective 185
Laura Ramsay, Adam J. Carter, and Jamie S. Walton
12 Ensuring Responsive Treatment Options for Male Adults Who Have Sexually Offended 201
Robin J. Wilson, Yolanda Fernandez, and David S. Prescott
13 Pharmacological Treatment of Sexual Offenders
Rajan Darjee and Alex Quinn
14 Community Dynamic Risk Management of Persons Who Have Sexually Offended
Robin J. Wilson, Jeffrey C. Sandler, and Kieran McCartan
Jean
15 Evidence‐Based Assessment and Treatment Approaches for Adolescents Who Have Engaged in Sexually Abusive Behavior 267 Alex R. Dopp, Cameron M. Perrine, Kathryn E. Parisi, Morgan A. Hill, and Michael F. Caldwell
16
Franca Cortoni and Georgi Stefanov
17 Sexual Murderers
Jean Proulx, Jonathan James, and Tamsin Higgs
18 Online Sexual Offenders: Typologies, Assessment, Treatment, and Prevention 311
Sarah Paquette, Francis Fortin, and Derek Perkins
19 An Evidence‐Based Model of Treatment for People with Cognitive Disability Who Have Committed Sexually Abusive Behavior
Matthew C. Frize, Jessica Griffith, Robert Durham, and Catherine Ranson
20 The Role of Major Mental Illness in Problematic Sexual Behavior: Current Perspectives and Controversies 353
21
Heather M. Moulden, Jeffrey Abracen, Jan Looman, and Drew A. Kingston
Jennifer DeFeo
About the Editors
Jean Proulx is a professor in, and the director of, the School of Criminology at the University of Montreal, and Researcher at the International Centre for Comparative Criminology at that university. Since 1987, he has also been active, both as researcher and forensic psychologist, in treatment programs for sex offenders at the Philippe-Pinel Institute of Montreal, a maximumsecurity psychiatric institution. His main research interests are the pathways in the offending process, personality profiles, and sexual preferences and recidivism risk factors in sexual murderers, rapists, pedophiles, and incest offenders. Over the past 30 years, he has published 10 books, and more than 150 book chapters and peer-reviewed articles in French and in English.
Franca Cortoni is a registered clinical forensic psychologist and professor of criminological psychology. Since 1989, she has worked with and conducted research on female and male sexual offenders. She worked for many years with the Correctional Service of Canada where she provided assessment and treatment services to incarcerated male and female offenders, was director of an in-prison treatment program for high-risk sexual offenders, and director of correctional research. In 2007, she moved to a full-time academic position at the School of Criminology at the Université de Montréal. She is also a research fellow at the International Centre of Comparative Criminology. Her research focuses on the factors associated with the development of sexual offending behavior, risk assessment, and treatment of both male and female sexual offenders. She has published extensively and made numerous presentations at national and international conferences on both male and female sexual offender issues. She is currently past-president of the Association for the Treatment of Sexual Abusers (ATSA).
Leam A. Craig, Ph.D., C.Psychol, CSci, MAE, FBPsS, FAcSS, EuroPsy, is a consultant forensic and clinical psychologist and partner at Forensic Psychology Practice Ltd. He is a visiting professor of forensic clinical psychology at the School of Social Sciences, Birmingham City University, and hon. professor of forensic psychology at the Centre of Applied Psychology, University of Birmingham. He is a chartered and dual registered [forensic and clinical] psychologist, a chartered scientist, holder of the European Certificate in Psychology, and a full member of the Academy of Experts. He was awarded fellowship of the British Psychological Society and the Academy of Social Sciences for distinguished contributions to psychology
and the social sciences. He has previously worked in forensic psychiatric secure services, learning disability hospitals, and consultancy to prison and probation services throughout England, Wales, and Northern Ireland, specializing in high‐risk, complex cases. He was previously consultant lead to three community forensic psychiatric hospitals for people with personality disorders, learning disabilities, and challenging behavior. He is currently a consultant to the National Probation Service on working with offenders with personality disorders. He acts as an expert witness to civil and criminal courts in the assessment of sexual and violent offenders and in matters of child protection. He has previously been instructed by the Salvation Army, Catholic and Church of England Dioceses, South African Police Service, and currently receives instruction from the United States Air Force European Defence Counsel. He has over 100 publications including 12 books published/in press. In 2013 he received the Senior Academic Award by the Division of Forensic Psychology for distinguished contributions to academic knowledge in forensic psychology and in 2018 the Emerald Literati Award for a Highly Commended paper. In 2015 he co-authored a Ministry of Justice research-funded report into the use of expert witnesses in family law and in 2016 he was appointed as chair of the British Psychological Society, Expert Witness Advisory Group. His research interests include sexual and violent offenders, personality disorder, and forensic risk assessment, and the use of expert witnesses in civil and criminal courts.
Elizabeth J. Letourneau is professor, Department of Mental Health and director, Moore Center for the Prevention of Child Sexual Abuse, Johns Hopkins Bloomberg School of Public Health. Since 1988 she has engaged in research on child sexual abuse prevention, policy, and practice. Dr. Letourneau held previous academic and research positions at the Medical University of South Carolina and with the United States Navy. She currently serves on the U.S. National Academies of Science Forum on Global Violence Prevention and the Maryland State Council on Child Abuse and Neglect. She previously served on the World Health Organization Guidelines Development Group for Responding to Child and Adolescent Sexual Abuse. Dr. Letourneau’s research – published in 100 articles and chapters – has been cited in state and federal sex crime cases, by state legislatures, and by international bodies, including the Australian Royal Commission into Institutional Responses to Child Sexual Abuse. She is a long-time member of the Association for the Treatment of Sexual Abusers, where she served as president and co-authored guidelines on adolescent practice.
About the Contributors
Jeffrey Abracen Central District (Ontario) Parole Department of Psychology Correctional Service Canada Toronto, ON Canada
Christopher T. Allen Department of Psychology Kennesaw State University Kennesaw, GA U.S.A.
Anthony R. Beech Centre for Applied Psychology University of Birmingham Birmingham U.K.
Michael F. Caldwell Department of Psychology University of Wisconsin – Madison Madison, WI U.S.A.
Adam J. Carter
Her Majesty’s Prison and Probation Service, England and Wales London U.K.
Laura Chiang Division of Violence Prevention Centers for Disease Control and Prevention
Atlanta, GA U.S.A.
Franca Cortoni School of Criminology University of Montreal Montreal, QC Canada
Leam A. Craig Forensic Psychology Practice Ltd The Willows Clinic Sutton Coldfield U.K.
Beth Dangerfield South East Melbourne Primary Health Network Heatherton, VIC Australia
Rajan Darjee Centre for Forensic Behavioural Science Swinburne University of Technology Alphington, VIC Australia
Jennifer DeFeo Private practice Aliso Viejo, CA U.S.A.
Alex R. Dopp Department of Psychological Science University of Arkansas
xii About the Contributors
Fayetteville, AR
U.S.A.
Robert Durham
Disability Forensic Assessment & Treatment Service
Department of Health & Human Services
Melbourne, VIC
Australia
Yolanda Fernandez
Department of National Defence
Sexual Misconduct Response Centre Correctional Service of Canada
Ottawa, ON Canada
Rebecca Fix Department of Mental Health
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD U.S.A.
Francis Fortin School of Criminology
Université de Montréal
Montreal, QC Canada
Beverly Fortson
Division of Violence Prevention
Centers for Disease Control and Prevention
Atlanta, GA
U.S.A.
Matthew C. Frize
Disability Forensic Assessment & Treatment Service
Department of Health & Human Services
Melbourne, VIC
Australia
Christine A. Gidycz Department of Psychology
Ohio University
Athens, OH
U.S.A.
Alyssa Glace Department of Psychology
Portland State University
Portland, OR U.S.A.
Katherine Gotch
Integrated Clinical & Correctional Services
Portland, OR U.S.A.
Jessica Griffith
Disability Forensic Assessment & Treatment Service
Department of Health & Human Services
Melbourne, VIC
Australia
Jean‐Pierre Guay School of Criminology
University of Montreal
Montreal, QC Canada
Tamsin Higgs Department of Psychology University of Montréal
Montreal, QC Canada
Morgan A. Hill Department of Psychological Science
University of Arkansas
Fayetteville, AR
U.S.A.
Gaye Ildeniz Centre of Research and Education in Forensic Psychology School of Psychology
University of Kent
Canterbury U.K.
Maggie Ingram Department of Mental Health
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD
U.S.A.
Jonathan James School of Criminology University of Montreal Montreal, QC
Canada
Keith Kaufman Department of Psychology Portland State University Portland, OR U.S.A.
Drew A. Kingston HOPE program San Diego, CA U.S.A.
Raymond A. Knight Department of Psychology Brandeis University Waltham, MA
U.S.A.
Elizabeth J. Letourneau Moore Center for the Prevention of Child Sexual Abuse
Johns Hopkins Bloomberg School of Public Health Baltimore, MD
U.S.A.
Wayne A. Logan
Florida State University College of Law
Tallahassee, FL
U.S.A.
Nicholas Longpré Department of Psychology University of Roehampton London U.K.
Jan Looman Forensic Behaviour Services Kingston, ON Canada
Alex Lord Sexual Behaviour Service Broadmoor Hospital Crowthorne U.K.
Patrick Lussier School of Social Work and Criminology Université Laval Quebec, QC Canada
Liam E. Marshall Waypoint Centre for Mental Health Care Penetanguishine, ON Canada
Greta Massetti Division of Violence Prevention Centers for Disease Control and Prevention Atlanta, GA
U.S.A.
Kieran McCartan Health and Social Services University of the West of England Bristol U.K.
Erin McConnell Department of Psychology Portland State University Portland, OR U.S.A.
Evan McCuish School of Criminology
Simon Fraser University Burnaby, BC Canada
Heather M. Moulden St. Joseph’s Healthcare Hamilton Hamilton, ON Canada
Kevin L. Nunes Department of Psychology Carleton University
Ottawa, ON
Canada
Caoilte Ó Ciardha
Centre of Research and Education in Forensic Psychology
School of Psychology
University of Kent Canterbury U.K.
Sarah Paquette
Internet Child Exploitation Unit
Sûreté du Québec
Montreal, QC Canada
Kathryn E. Parisi
Department of Psychological Science University of Arkansas Fayetteville, AR
U.S.A.
Chloe I. Pedneault Department of Psychology
Carleton University Ottawa, ON Canada
Derek Perkins
Broadmoor Hospital West London Mental Health NHS Trust
London
U.K.
Cameron M. Perrine
Department of Psychological Science
University of Arkansas
Fayetteville, AR
U.S.A.
David S. Prescott
Becket Family of Services
Portland, ME
U.S.A.
Jean Proulx
School of Criminology
University of Montreal
Montreal, QC
Canada
Alex Quinn
The Orchard Clinic
Royal Edinburgh Hospital
Edinburgh
Scotland
U.K.
Laura Ramsay
Her Majesty’s Prison and Probation Service, England and Wales
London
U.K.
Catherine Ranson Office of the Senior Practitioner
Compulsory Treatment Team
Office of Professional Practice Department of Health & Human Services
Melbourne, VIC
Australia
Martin Rettenberger Centre for Criminology (Kriminologische Zentrastelle – KrimZ)
Ewa B. Stefanska Department of Psychology University of Roehampton
London
U.K.
Helen Wakeling Directorate of Rehabilitation and Assurance
Her Majesty’s Prison and Probation Service London U.K.
Jamie S. Walton
Her Majesty’s Prison and Probation Service, England and Wales London
U.K.
Robin J. Wilson
Department of Psychiatry and Behavioural Neurosciences
McMaster University Hamilton, ON Canada
Judith Zatkin Department of Psychology
Portland State University
Portland, OR U.S.A.
Introduction
Jean Proulx
In a provocative paper entitled “What Works? Questions and Answers about Prison Reforms,” Martinson (1974) favored a skeptical attitude to the possibility of rehabilitation of delinquents and criminals. As a consequence of this attitude, there was a shift in the criminal justice system of several countries toward strategies such as long‐term incarceration of offenders to increase public safety (Petrunic, 1994). After more than four decades of research in the field of forensic psychology, it is now well established that Martinson’s pessimism was misplaced. In fact, there is now a wide body of evidence that a variety of treatment and prevention programs are effective in reducing recidivism and favoring rehabilitation, in both delinquents and criminals (Weisburd, Farrington, & Gill, 2017). More particularly, this conclusion is true in the specialized case of sexual aggressors (Hanson, Bourgon, Helmus, & Hodgson, 2009; Marshall & Marshall, 2012; Schmucker & Lösel, 2008).
In the 1970s and the early 1980s, a major theme of empirical research in the field of sexual aggression was the study of the sexual preferences and interests of these offenders (Proulx, 1989). At that time, the main causative factors of the crimes of sexual aggressors were considered to be their sexual preferences for children as a sexual partner, and for coercive sexual behaviors with nonconsenting adult partners. Consequently, treatments were developed to reduce these deviant sexual preferences, and to increase sexual interest in consensual adult partners. In the 1980s and the 1990s, models of sexual aggression and treatment evolved, and began to take into consideration other factors such as social skill deficits, cognitive distortions, and the use of sex to cope with negative emotions (Marshall, Laws, & Barbaree, 1990). Another major contribution to the field of sexual aggression was the development of the self‐regulation model of relapse prevention (Ward, Hudson, & Keenan, 1998). This model integrates a diversity of factors, identified in previous empirical studies, into a model that takes into account the heterogeneity in sexual offenders, as well as the temporal sequence that culminates in an assault (Proulx, Beauregard, Lussier, & Leclerc, 2014). As a consequence, the field has moved on from a “one size fits all” approach to multifactorial conceptualization, assessment, and treatment of sexual aggressors. With that in mind, we elaborate a handbook that provides an overview of the state of the art in the field of research into sexual aggression.
This handbook comprises five sections. The first one presents the major theories that have been developed to explain sexual aggression against women and sexual aggression again
children. In addition, it includes a chapter on public health perspectives to understanding sexual aggression. In the second section, assessment issues are addressed. Instruments designed to evaluate the risk of recidivism, deviant sexual interests, and sexual sadism are presented, and good practice in case formulation for treatment purposes is described. The third section of this handbook is devoted to the treatment of sexual offenders. It includes chapters on components of contemporary treatment programs, including one on pharmacological treatment and one on responsivity to treatment. In line with the heterogeneity found in sexual offenders, the fourth section of this handbook addresses the specificity of populations involved in sexual offending, such as: female sexual offenders, sexual murderers, online sexual offenders, and sexual offenders with intellectual development disorder or major mental disorders. These chapters include details on the specific characteristics of these offenders and on their treatment needs. Finally, in the fifth section, cutting‐edge prevention strategies designed to reduce the incidence of sexual aggression against children and against women are presented.
This handbook on what works with sexual offenders is designed to provide an introduction to a diversity of theories of sexual aggression, and to approaches to the assessment, treatment, and prevention of sexual aggression. With the rapid advances in research and treatment during the past four decades, it can be difficult for professionals new to the field to know where to start. Who are the major researchers and clinicians in the field? Which assessment methods or treatment programs have been demonstrated to be effective? Which prevention strategies reduce the prevalence of sexual offending in specific contexts? We believe that this handbook provides easily accessible answers to these questions; in addition, it suggests specialized references for those interested in particular domains, be it the factors that favor sexual homicide or best practices in sexual‐crime prevention on university campuses.
References
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. Marshall, W. L., Laws, D. R., & Barbaree, H. E. (1990). Handbook of sexual assault. Issues, theories and treatment of the offenders. New York, NY: Plenum Press.
Marshall, W. L., & Marshall, L. E. (2012). Treatment of sexual offenders: Effective elements and appropriate outcome evaluations. In E. Bowen & S. Brown (Eds.), Perspectives on evaluating criminal justice and corrections (pp. 71–94). London, England: Emerald Publishing.
Martinson, R. M. (1974). What works? Questions and answers about prison reform. The Public Interest, 35, 22–54.
Petrunic, M. (1994). Modèles de dangerosité: Les contrevenants sexuels et la loi [Models of dangerousness: Sexual offenders and the law]. Criminologie, 27, 87–125.
Proulx, J. (1989). Sexual preference assessment of sexual aggressors. International Journal of Law and Psychiatry, 12, 275–280.
Proulx, J., Beauregard, E., Lussier, P., & Leclerc, B. (2014). Pathways to sexual aggression. Abingdon, England: Routledge.
Schmucker, M., & Lösel, F. (2008). Does sexual offender treatment work: A systematic review of outcome evaluation. Psychotheme, 20, 10–19.
Ward, T., Hudson, S. M., & Keenan, T. (1998). A self‐regulation model of the sexual offense process. Sexual Abuse: A Journal of Research and Treatment, 10, 141–157.
Weisburd, D., Farrington, D. P., & Gill, C. (2017). What works in crime prevention and rehabilitation: An assessment of systematic review. Criminology and Public Policy, 16, 415–449.
Part I
Theories of Sexual Offenders
Jean Proulx, Section Coordinator
Theories That Explain Sexual Aggression Against Women
Jonathan James and Jean Proulx
School of Criminology, University of Montreal, Montreal, Canada
Introduction
What leads some men to sexually assault a woman? Unfortunately, there is no consensus on the developmental processes that underlie this behavior (Lussier, 2018a). This may be due in part to the dominant approach to the analysis of sexual offending, that is, correctional psychology, which focuses on the management of convicted sexual offenders’ risk of sexual recidivism. Consequently, while effective tools do exist for the assessment of this risk, identification of the features of a sexual offender’s life course that increased his likelihood of committing a sexual crime remains elusive.
Many studies of sexual offending have focused on the identification of characteristics that are specific to sexual offenders, and have attempted to answer questions such as: Are these individuals different from those who have never committed a crime? Are all perpetrators of sexual crimes—particularly sexual aggressors against women—identical? And (the perennial) are sexual offenders the same as other criminals?
This chapter presents the most noteworthy explanatory theories and models, and empirical results, related to sexual aggression against women. For these purposes, “sexual aggression against women” is defined as an extrafamilial sexual assault by an adult male against an adult female (at least 16 years old) (for a discussion of theories related to marital rapists, see Proulx & Beauregard, 2014a). In addition, while sexual offending against women is polymorphic, and comprises sexual violence, sexual misconduct, and sexual exploitation, this chapter discusses only rape and contact sexual aggression (see Figure 1.1). For a discussion of child sexual abuse, sexual homicide, and noncontact sexual offenses, see Chapters 2, 17, and 21 of this book.
The Neuropsychology of Sexual Aggressors Against Women
In recent years, there has been a surge of interest in the identification of neuroanatomical and neurophysiological deficits in antisocial individuals, and in the relationship of these deficits to the psychological functioning of these individuals. Antisocial offenders, especially sexual offenders, have received particular attention (e.g., Beech, Carter, Mann, & Rotshtein, 2018; Raine, 2013).
Joyal, Beaulieu‐Plante, and de Chantérac (2014) conducted a meta‐analysis of studies of the neuropsychological characteristics of sexual offenders, in order to determine the specificity of the relationship between neuropsychological deficits and sexual offending. Their meta‐analysis compared sexual offenders against women (N = 533) to sexual offenders against children (N = 530), and compared all sexual offenders (N = 1,063) to nonsexual offenders (N = 378) and to noncriminals (N = 378). In tests of cognitive functioning, such as visual attention, speed processing, task switching, cognitive flexibility, and verbal fluency, both sexual offenders as a whole, and sexual offenders against women, exhibited a wider variety of cognitive problems than noncriminals. In addition, while sexual offenders against women scored higher than sexual offenders against children on tests of cognitive flexibility, perseveration, and reasoning, they scored lower on tests of verbal fluency and cognitive inhibition. Finally, sexual offenders against women and nonsexual offenders had similar neuropsychological profiles (e.g., low scores on tests of verbal fluency and inhibition).
This meta‐analysis revealed some important points. First, it is possible that poor cognitive performance is associated with sexual offending. Second, because the neuropsychological profile of sexual offenders against women differs from that of sexual offenders against children, these two groups should be investigated separately in both quantitative analyses and
Figure 1.1 Sex offending: a multidimensional viewpoint. Lussier and Mathesius (2018).
theoretical models. Finally, the many similarities between the neuropsychological profiles of sexual offenders against women and nonsexual offenders suggest that there is no causal relationship between neuropsychological deficits and sexual offending against women (Joyal et al., 2014). However, it is important to note that these results do not mean that all sexual offenders against women have neuropsychological characteristics similar to those nonsexual offenders. In fact, drawing that conclusion requires analysis of the heterogeneity of sexual offenders against women, and, especially, of the differences between sexual offenders with deviant and nondeviant sexual preferences (see Knight, 2010; Proulx & Beauregard, 2014b).
The Psychology of Sexual Aggressors Against Women
Deviant sexual preferences
Hanson and Morton‐Bourgon (2005) conducted a meta‐analysis of studies involving postsentencing follow‐up of 29,450 sexual aggressors (considered a homogeneous group), and concluded that deviant sexual preferences were the strongest predictor of sexual recidivism. Results such as this may reinforce the popular belief that sexual deviance is a causal factor of sexual aggression and the hypothesis that all sexual aggressors against women prefer nonconsensual sexual contact with women over consensual sexual contact (Barbaree, 1990). However, these results must be balanced against the results of Lalumière and Quinsey’s (1994) meta‐analysis of phallometry results from sexual aggressors against women (N = 415) and a control group (N = 192; nonsexual offenders against women and noncriminals). Those authors found that sexual aggressors responded more than nonrapists to rape cues and more to rape cues than to consensual sex cues. This being said, it is important to note that not all sexual aggressors against women are characterized by a sexual preference for rape (see also Michaud & Proulx, 2009), which means that a deviant sexual preference is at best a partial explanatory factor for sexual aggression.
Lack of empathy, antisociality, and psychopathy
Hanson and Morton‐Bourgon (2005) found antisocial orientation (antisocial personality, antisocial traits, history of rule violation) to be the second‐strongest predictor of sexual recidivism. This finding is consistent with theories of sexual offending that posit that sexual aggressors’ infliction of pain, fear, or suffering on their victims denotes a characteristic lack of empathy (e.g., Marshall & Barbaree, 1990). Paradoxically, however, committing a sexual assault is not synonymous with a lack of empathy for the victim—some aggressors are convinced that their victim obtained pleasure from their sexual contact. In addition, even with sexual aggressors who admit to a lack of empathy for their victim (e.g., were indifferent to, or attracted by, their victim’s suffering), there is no basis for concluding that this lack of empathy is structural and generalized, rather than specific and situational (e.g., due to negative emotions or intoxication at the time of the offense) (Hanson & Scott, 1995). Keeping these nuances in mind, it is noteworthy that the results of studies that found no difference between the empathy of sexual aggressors, nonsexual offenders, and noncriminals constitute a challenge to theories that posit a generalized lack of empathy in sexual aggressors (see Polaschek, 2003).
Jonathan James and Jean Proulx
Marshall and colleagues (Fernandez & Marshall, 2003; Marshall & Moulden, 2001) conducted several comparative studies to evaluate empathy deficits among sexual aggressors against women. They reported that:
1. Sexual aggressors against women felt more empathy for women in general than nonsexual offenders.
2. Sexual aggressors against women felt similar (Fernandez & Marshall, 2003) or less (Marshall & Moulden, 2001) empathy for women who had suffered a sexual assault by another man as did nonsexual offenders, and less empathy than noncriminals (Marshall & Moulden, 2001).
3. Sexual aggressors against women felt less empathy for their victim than for other women.
4. Sexual aggressors against women felt less empathy for their victim than did nonsexual offenders.
5. Sexual aggressors against women felt more hostility toward women than did nonsexual offenders and noncriminals.
These results suggest that: (a) hostility toward women may be associated with sexual aggression (hostility toward women is also a risk factor for sexual recidivism; see Hanson, Harris, Scott, & Helmus, 2007), and (b) the empathy deficit of sexual aggressors against women is contextual and specific (e.g., triggered by anger against a woman), not structural and generalized. However, empathy deficits may be structural, and generalized, in sexual aggressors against women who scored high for psychopathy (Knight & Guay, 2018; Yang, Raine, Narr, Colletti, & Toga, 2009).
A consensus exists regarding the role of psychopathy in the sexual coercion of women (Knight & Guay, 2018). For example, a meta‐analysis of the relationship between Psychopathy Checklist—Revised (PCL‐R) scores and sexual recidivism revealed that a chronically unstable, antisocial, and deviant lifestyle (PCL‐R Factor 2; Hare, 2003) is a good predictor of this type of recidivism (Hawes, Boccaccini, & Murrie, 2013). While only a minority of sexual aggressors against women are psychopaths (12.1–40.0%; e.g., Porter, Campbell, Woodworth, & Birt, 2001; Serin, Mailloux, & Malcolm, 2001), the prevalence in this group is higher than in the general population (approximately 1.0%; Forth, Brown, Hart, & Hare, 1996; Hare, 1998) and in sexual aggressors against children (5.4–6.3%; Brown & Forth, 1997; Porter et al., 2001; Serin, Malcolm, Khanna, & Barbaree, 1994). It is also worth noting that the variation of psychopathy among sexual aggressors against women may reflect differences in the security level of the correctional institutions in which studies have been conducted or the predominance of certain types of aggressors in samples. For example, with regard to the latter point, there is a consensus that psychopaths are overrepresented in samples of opportunistic sexual aggressors against women (Brown & Forth, 1997; Knight, 2010; Proulx & Beauregard, 2014b). Finally, similar prevalences of psychopathy have been reported among sexual aggressors against women and nonsexual offenders (35.9 and 34.0%, respectively; Porter et al., 2001), suggesting that the sexual assault of women is an antisocial behavior reflecting a broader antisocial tendency (Lussier, LeBlanc, & Proulx, 2005).
Although lack of empathy may favor sexual offending against women, it is not systematically found in all sexual aggressors against women. Some sexual aggressors against women fail to recognize the gravity of their behaviors and the negative consequences of these behaviors on their victim’s psychological functioning, which raises the possibility that they have deficits related to the processing of information about their social environment (Hanson & Scott, 1995; Marshall, Hudson, Jones, & Fernandez, 1995).
Cognitive distortions and implicit theories
Cognitive distortions are the third‐strongest predictor of sexual recidivism, according to Hanson and Morton‐Bourgon (2005), and occupy a central place in theories of sexual offending (e.g., Ward & Siegert, 2002). Moreover, they are one of the main therapeutic targets in the treatment of sexual aggressors (Ward, Polaschek, & Beech, 2006)—despite the absence of supporting empirical evidence regarding their role in sexual aggression (Maruna & Mann, 2006; Ward, Gannon, & Keown, 2006).
The scientific community’s interest in the cognitions of sexual aggressors is based on the hypothesis that cognitive distortions trigger or maintain coercive sexual behaviors. This hypothesis was proposed in light of the statements of some sexual aggressors that suggested that they interpreted their offense in an erroneous manner (e.g., they believed that the victim experienced pleasure during the sexual assault). To explain these cognitions, McFall (1990) suggested that sexual aggressors against women suffer from deficits in the interpretation of cues from women, and commit inappropriate sexual behaviors because they interpret negative cues as positive. This hypothesis followed from the results of comparative studies indicating that sexual aggressors against women decode cues from women less reliably than do nonsexual offenders, and more strongly endorse beliefs supporting rape—for example, women are responsible for their own rape, and men accused of rape are probably innocent (Lipton, McDonel, & McFall, 1987; Marolla & Scully, 1986). These results should however be interpreted with caution, since other studies have failed to find any differences in the attitudes and beliefs concerning women held by sexual aggressors against women, nonsexual offenders, and noncriminals (Overholser & Beck, 1986; Segal & Stermac, 1984).
There is a consensus that sexual aggressors against women and sexual aggressors against children have different cognitive distortions (Arkowitz & Vess, 2003; Bumby, 1996; Hayashino, Wurtele, & Klebe, 1995). Ward and colleagues developed a schema‐based theory of sexual offender cognition which posits that sexual aggressors’ cognitive distortions are the product of underlying implicit theories—causal theories that help explain and predict our own and others’ behavior (Ward, 2000). Further, they proposed that sexual aggressors against women (Polaschek & Ward, 2002) and sexual aggressors against children (Ward & Keenan, 1999) hold different implicit theories. Subsequently, Polaschek and Gannon (2004) confirmed the existence of Polaschek and Ward’s (2002) implicit theories in a group of sexual aggressors against women:
• Women as sex object (70% of the sample interviewed): Women are constantly sexually receptive to men’s needs but are not always consciously aware that they are.
• Entitlement (68%): Men must satisfy their sexual needs and have the right to punish women who refuse sexual contact.
• Women are unknowable (65%): Women are fundamentally different from men, with minds so inherently alien that men cannot easily grasp how they work.
• Dangerous world (19%): The world is a hostile and threatening place.
• Male sex drive is uncontrollable (16%): Male libido is inherently uncontrollable, and women must provide men with reasonable sexual access.
These results, together with those obtained from studies of sexual murderers (see Beech, Fisher, & Ward, 2005; James, Beauregard, & Proulx, 2019), suggest that: (a) almost all sexual aggressors against women hold at least one of Ward and colleague’s implicit theories described above, and (b) some implicit theories are overrepresented among some types of sexual
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aggressors against women (e.g., dangerous world and male sex drive is uncontrollable appear to predominate among sadistic sexual aggressors).
To date, there have been few empirical studies of the cognitive distortions of sexual aggressors against women. Nevertheless, the results suggest that the sexual assault of women is the consequence of deficits in the perception or processing of information in social contexts. The discrepancy between the cues generated in a social environment and the response of the sexual aggressor are thought to be associated with difficulties establishing and maintaining healthy and stable interpersonal relationships.
Intimacy deficits and attachment styles
Intimacy deficits (poor social skills, negative social influences, conflicts in intimate relationships, loneliness) are the fourth‐strongest predictor of sexual recidivism, according to Hanson and Morton‐Bourgon (2005), and occupy an important place in models and theories of sexual aggression (e.g., Marshall, 1989; Ward & Siegert, 2002). In these theories, sexual aggression is considered an inappropriate behavior resulting from the inability to establish and maintain intimate and mutually gratifying interpersonal relationships (Christie, Marshall, & Lanthier, 1979; Clark & Lewis, 1977).
Marshall (1989) has suggested that sexual aggressors fail to establish and maintain intimate relationships with others in adulthood because their childhood experiences precluded the development of a secure attachment style. As a result, they suffer from loneliness and low self‐esteem, which hinders the developments of intimate relationships and favors social isolation. It is thought that sexual aggressors’ emotional distress drives them to take refuge in fantasy worlds dominated by hostility toward women, and to exhibit sexually aggressive behaviors (Proulx, McKibben, & Lusignan, 1996).
Marshall’s hypothesis has been partially validated by empirical studies that demonstrated that loneliness is associated with hostility toward women and the tendency to resort to violence (Marshall & Hambley, 1996). However, this association is not specific to sexual aggressors against women; in fact, similar results have been obtained with noncriminals (Check, Perlman, & Malamuth, 1985). Moreover, it has been demonstrated that sexual aggressors against women and noncriminals have similar social‐skill deficits (Segal & Marshall, 1985a, 1985b, 1986). On the other hand, sexual aggressors against women and noncriminals do differ in some respects. Sexual aggressors against women are characterized by deficits in assertiveness (Stermac & Quinsey, 1986) and by an insecure attachment style—for example, Ward, Gannon, and Keown (2006) observed an insecure attachment style in 69% of sexual aggressors against women but only 55–65% of noncriminals.
Ward, Hudson, and Marshall (1996) reported that the insecure attachment style of sexual aggressors against women differed from that of sexual aggressors of children: the former have a dismissing style, the latter a preoccupied one. Individuals with a dismissing attachment style are skeptical of the value of intimate relationships and place great importance on their independence. They are more likely to exhibit hostility, and are consequently inclined to violently assault women. They score lower for loneliness than individuals with a preoccupied attachment style but higher for fear of intimacy, anger expression, and anger suppression, and tend to accept rape myths more than aggressors with other attachment styles (Hudson & Ward, 1997). On the other hand, sexual aggressors with a preoccupied attachment style tend to seek approval from others and sexualize intimate relationships, leading them to engage in sexual contact with children. Not surprisingly, sexual aggressors against women tend to score
lower for loneliness, intimacy deficits, anxiety, and stress (Garlick, Marshall, & Thornton, 1996; Segal & Marshall, 1985a, 1985b, 1986), have a greater number of negative schemata toward others, and have higher self‐esteem (Ward, McCormack, & Hudson, 1997), than sexual aggressors against children.
The patterns described in the preceding sections suggest that sexual aggressors against women, and nonsexual offenders, are more similar than different with regard to intimacy deficits and attachment styles. There appear to be no differences in their social skills, their perception and evaluation of their intimate relationships, and their investment in their intimate relationships (Segal & Marshall, 1985a, 1985b, 1986; Ward et al., 1996, 1997). Moreover, the prevalence of a dismissing attachment style is similar in the two groups, which suggests that this insecure attachment style should be considered a risk factor for offending in general rather than for a specific propensity for sexual aggression (Ward et al., 1996, 1997). It should be noted that sexual aggressors against women tend to be lonelier than nonsexual offenders (Garlick et al., 1996), which supports Marshall’s (1989) initial hypothesis.
In light of the preceding observations, future studies should attempt to clarify the role of intimacy deficits in the process leading to the sexual assault of women, while taking into consideration the heterogeneity of this category of sexual aggressors. The preceding sections have demonstrated that the sexual assault of women is the product of multiple psychological deficits located at the surface level of symptomology (Ward & Beech, 2006). The deficits of intimacy, neuropsychology, empathy, or cognition described above are all incapable of explaining on their own what leads some men to sexually assault a woman. Accordingly, to better understand the phenomenon of sexual aggression, models that integrate all these factors, rather than analyze them in isolation, have been developed. The rest of this chapter will provide an overview of the best‐known explanatory models and multifactorial theories of sexual aggression, and typologies of sexual aggressors against women.
Models of Sexual Offending
Ward and Beech’s integrated theory of sexual offending (ITSO)
Ward and Beech’s (2006) ITSO is a theoretical framework that attempts to integrate every aspect of sexual aggression and explain the onset, development, and maintenance of sexual aggression (without however distinguishing between sexual aggression against women and sexual aggression against children). The theory draws upon Pennington’s (2002) suggestion that a neuroscientific account of human psychopathology requires consideration of four levels of analysis: etiology, brain mechanisms, neuropsychology, and symptom levels Etiology is concerned with the elements responsible for psychopathology, that is, the interactions between genetic and environmental factors. These interactions influence the structure and function of the brain, and so influence brain mechanisms. Since the structure and function of the brain in turn shape emotional, cognitive, and motor processes, they ultimately influence neuropsychological responses, which, in a social context, generate a clinical symptom (Figure 1.2).
In the initial version of the ITSO, Ward and Beech (2006) suggested that a sexual assault occurs as a result of a continuous flow of interactions between three distal and proximal causal factors: biological factors (influenced by genetic inheritance and brain development), ecological niche factors (i.e., acquired social, cultural, and personal factors), and neuropsychological factors. The revised version of the ITSO (Ward & Beech, 2016) includes a fourth causal factor,
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personal agency (i.e., intentional mental states), in order to take into account the fact that the symptoms that can lead to sexual aggression (deviant sexual preferences, emotional problems, cognitive distortions, social difficulties) are interrelated and play a functional role in a person’s psychological life.
The ITSO has several strengths. First, it integrates several theories that have been validated empirically. Second, by taking into consideration the diversity of potential interactions between causal factors at different levels of functioning, it allows identification of multiple pathways to sexual aggression. Third, it reintroduces a biological perspective—frequently neglected in attempts to explain criminal behavior—that situates sexual aggressors in cultural, social, psychological, and biological terms. Fourth, it provides a systematic and multifaceted framework for the evaluation and treatment of sexual aggressors. And finally, it offers a new and promising perspective, by suggesting that sometimes problems have single causes, localized in specific functional systems: “for example, an offender may articulate offense‐supportive statements which appear to stem from offense‐supportive implicit theories (the perception and motivation system), but which are actually the function of impression management strategies instead (motivation/emotional and action selection and control systems)” (Ward & Beech, 2006, p. 61). Consequently, “it may make more sense to allocate individuals to groups based of the type of functional systems compromised rather than upon the basis of their surface symptoms” (Pennington, 2002, in Ward & Beech, 2006, p. 340). Although the ITSO provides a coherent framework for the understanding of the diversity of pathways leading to sexual aggression, it has not been empirically validated.
Interlocking
Clinical symptoms: State factors
• Emotional problems
• Social difficulties
• Cognitive distorsion
• Deviant arousal
• Genetics
• Evolution
Ecological niche: proximal and distal
• Social and cultural environment
• Personal circumstances
• Physical environment
Figure 1.2 Schematic illustration of the Integrated Theory of Sexual Offending (ITSO). Ward and Beech, (2016).
