David S. Prescott, LICSW


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Book Review: Evaluating Sex Offenders: A Manual for Civil Commitments and Beyond

By Dennis M. Doren, Ph.D.

Sage Publications, 2002

Review by David Prescott

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

 


David S. Prescott, LICSW – PMB 210 - 190 US Route 1 – Falmouth, ME 04105
Email: DSP@DavidPrescott.net

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