The words “and beyond” in the title are vital to evaluating
this book. Although written specifically for those involved in sex
offender civil commitment proceedings, Doren has assembled a volume
of use to
any professional in the field. Dr. Doren is well known in both courtroom
and conference venues.
Dr. Doren quickly explains that he does not address the ethics or
appropriateness of civil commitment legislation and respects “the process of professionals
limiting their practice to areas that do not compromise their values
and ethics”. He recommends participating in the commitment process “to
ensure that only the most clear cases meeting criteria are committed
instead of the broader group that would likely be committed without your
helping”. He notes: “With this view in mind, participation
in the commitment process is felt ethical for people who otherwise do
not think these laws represent the proper balance between societal protection
and individuals’ rights”.
Dr. Doren leads the reader through numerous issues central to forensic
sex offender evaluation. In addition to chapters on the components of
civil commitment laws around the USA and key assessment procedures, Dr.
Doren provides extensive discussion of current risk assessment instrumentation.
Although his knowledge of scales such as the PCL-R, VRAG, RRASOR, Static
99, and MnSOST-R is well known, he further investigates these scales
both on their own and in combination. While the interpretation of multiple
scale results has been the topic of some controversy, Dr. Doren focuses
on the various dimensions that the scales assess, both individually and
in combination.
The chapter on diagnostic issues, including the refinement of relevent
paraphilias, will apply to anyone who has grappled with defining sexual
disorders. After addressing such concerns as “why diagnose at all?” and
the various shortcomings of the DSM-IV, Dr. Doren speaks to the issue
of “criteria versus guidelines”, emphasizing clarity and
consistency. An extensive discussion of key diagnostic components follows,
from “recurrent, intense sexually arousing” to “over
a period of at least six months”. In these sections, Dr. Doren
examines both the meaning and implications of every word in great detail.
Focusing both on pedophilia and the controversial existence of paraphilic
rape, Dr. Doren addresses issues ranging from “demonstrating its
existance” to “determining Paraphilia, NOS, from overt behavior
alone”. Dr. Doren further discusses the differentiation of paraphilic
rape from sexual sadism.
From the outset, Dr. Doren states his concern that much of the supportive
research will quickly become outdated as new data become available.
However, he does not mention that much of his discussion, particularly
that regarding
the assessment of psychopathy and sexual sadism, will be of fundamental
importance to those tasked with evaluating apparently high-risk sexual
abusers. Given recent evidence that the diagnosis of sexual sadism
can be more problematic than previously thought (e.g. Marshall, Kennedy, & Yates’ discussion
in the October, 2002 Sexual Abuse: A Journal of Research and Treatment),
Doren’s thoughtful discussion of these most difficult topics
appears all the more essential.
While numerous authors (from Monahan to Serin and Brown) have emphasized
the importance of understanding recidivism base rates, Dr. Doren provides
stepwise discussion of base rates for those evaluating sex offenders.
Topics include short- versus long-term assessments, selection of instruments,
evaluating cases beyond the framework of existing scales, and extrapolation
beyond the parameters of the various instruments. He concludes with chapters
on the problems involved with clinical adjustments (ranging from their
definition to their theoretical basis), report writing and testimony,
and ethical issues involved in civil commitment proceedings. He adds
practical appendices that include a relapse prevention interview (authored
by Ruth Mann, Richard Beckett, Dawn Fisher, and David Thornton), templates
to assist evaluators in writing precommitment forms and reports, and
a sample evaluation.
Dennis Doren is a veteran evaluator of men who have sexually abused.
Although he is most recently known for turning a careful eye to the proper
use of actuarial scales, this effort reflects a broad base of knowledge
and reflection on the most recent recidivism research. He provides readers
with valuable step-by-step thoughts on evaluation, and detailed consideration
of its inherent difficulties and controversies.
- References available upon request