David S. Prescott, LICSW

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Books: 2003 in review

review by David Prescott, Forum Editor

Editors note: If there is a common frustration for myself, authors, and readers, it is that there is a limit to how many books can be reviewed in each issue. In many cases, it can be difficult for members to contribute reviews, and our best reviewers are often busy contributing to ATSA in other ways. As 2003 comes to a close, I am including a number of smaller reviews of recent books in the hopes that members may better choose among them.

In Their Shoes:
Examining the Issue of Empathy and Its Place in the Treatment of Offenders.

Edited by Yolanda Fernandez, Ph.D.
Published by Wood’N’Barnes, 2002
195 pages, $27.95;
available at www.woodnbarnes.com

Anyone who has ever argued with a loved knows that empathy is a dynamic aspect of humanity that can ebb and flow without apparent reason. Those entering the field of sexual abuse are quickly told that empathy is a key element in treating this population, and yet recent research demonstrates little correlation between empathy and recidivism (e.g. Hanson & Bussiere, 1998). Worse still, most of this research indicates that we have a long way to go in properly defining and measuring this elusive construct.

Fernandez and her colleagues have produced a volume depth and breadth that will interest practitioners, students, and researchers alike. It is likely the first and most extensive volume of its kind on the subject. Its scope ranges from Geris Serran’s exhaustive overview of attempts to measure empathy to Ruth Mann, Maxine Daniels, and William Marshall’s hands-on discussion of role play in empathy development. Perhaps most importantly, Fernandez and her colleagues place strong emphasis on the importance of empathy in treatment providers, and provide a “Criteria for Therapist Assessment” checklist as an appendix.

William Marshall provides an introductory chapter on the “historical foundations and current conceptualizations of empathy”, that addresses such controversial areas as trait/state views of empathy, and its distinction from sympathy. He further discusses his multi-stage model of empathy, along with its weaknesses. Liam Marshall provides a chapter describing the development of empathy in individuals from a human evolutionary perspective. It discusses affective interpersonal responses, gender differences, and attachment, with potential application to abusers of all ages.

Dana Anderson and Philip Dodgson provide a chapter on “empathy deficits, self-esteem, and cognitive distortions in sexual offenders” that considers many of the finer points of empathy development, such as their observation that changes in one’s emotional vocabulary do not always result in the important changes in thinking and behavior that reduces the risk of harmful behavior. They also refer to William Marshall’s observation that in some cases, the affective response to another’s situation can itself be so upsetting that the observer will respond by relieving their own distress, thereby appearing unempathic. Beyond mere academic discussion, the authors stress the importance of self-esteem in the development of empathy and the reduction of cognitive distortions that drive re-offense. Other chapters include Heather Moulden and William Marshall’s discussion of “empathy, social intelligence, and aggressive behavior” and Geris Serran’s “emotional expression and recognition”. The book’s broad scope ensures that readers will find some chapters of greater relevance to their work than others.

Given our field’s history of difficulty in defining empathy and understanding its relationship to sexual recidivism, this book is both timely and useful. As we come to better understand the active ingredients of treatment (e.g. thoughts, behaviors), In Their Shoes will no doubt contribute significantly to our attempts to help abusers better access their treatment. While empathy, self-esteem, and integrity may not yet show up in the research, Fernandez and her colleagues clearly demonstrate that our attention to empathy can result in better treatment outcomes and better hope for those effected by sexual abuse.

Challenging Experience:
An Experiential Approach to the Treatment of Serious Offenders

by John Bergman, MA, RDT, MT-BCT and Saul Hewish, Dip CC.
Published by Wood’N’Barnes, 2002
160 pages, $27.95
available at www.woodnbarnes.com

One need not look far to find controversial elements of experiential treatment with sexual offenders. Critics describe it as intrusive, traumatizing, and without empirical support. Others express concerns around training, its potential for misuse, and their own discomfort. Bergman and Hewish address many of these concerns from the start.

While not intended to be a complete volume on every facet of experiential treatment, the authors have compiled an excellent set of exercises that move from simple warm-ups, through low- to high-intensity. Strategies for designing sessions are provided. Those practitioners in settings where high intensity experiential treatment might not be warranted will still find many fresh ideas for moving closer to substantive issues in treatment.

Bergman and Hewish emphasize a number of critical elements at the outset. These include using the exercises only within a strong therapeutic relationship, and following some basic rules of role-play. Safety and simplicity are fundamental values that are emphasized throughout the text. The authors point to many underlying theories very succinctly, while outlining a number of areas where practitioners will wish to be knowledgeable before fully using this book. Far from complicated or convoluted, the exercises seem almost deceptively easy, and will be beneficial to those attempting to access the affective aspects of treatment, exit from power struggles, or get past old beliefs.

Challenging Experience plainly reflects the years of work the authors have invested in this treatment. Each aspect is honed down to its most basic elements. Overcoming doubt and resistance, for example, is expressed with confidence and simplicity: “The client only needs to see the conflict clearly. He needs to know that it is between him and his ‘this is stupid’. He will do the solving …We use these techniques to be ‘in the now’ where clients can solve problems just as we do, ‘in the now’” (p.6).

The reader will wish to keep in mind that the exercises contained in this book can be very powerful tools that require careful use. However, just as they can move clients who are stuck at one place in treatment, they can also move stuck therapists. Despite the book’s simplicity, it is never reductionist, and can stand on its own or as a springboard to more advanced study.

Child Maltreatment Risk Assessments: An Evaluation Guide

by Sue Righthand, Ph.D., Bruce Kerr, Ph.D., and Kerry Drach, Ph.D.
Published by Haworth Press, 2003
216 pages, $24.95, and
available at www.haworthpress.com

Those familiar with Dr. Righthand’s contributions to the JSOAP, JSOAP – II, and OJJDP bulletin “Juveniles Who Have Sexually Offended” will already be aware of her diligence and thorough understanding of the field. For this book, she has teamed up with two other experts in forensic evaluation to produce a document essential to those assessing and preventing child abuse. Its focus on the origins of child maltreatment and developing risk management strategies makes it invaluable to ATSA members working with families and their reunification.

Righthand, Kerr, and Drach describe risk assessment as a process of “identifying factors that research has found may increase or mitigate risk. One objective of risk assessment is to identify the risk of future child maltreatment that individuals or families present. Another objective is to design interventions for effectively managing risk” (p.83). After an introductory chapter outlining recent research into the effects of child abuse and neglect, the authors review the literature around numerous etiological factors, including discussion around recent investigation into the helpful effects of safety plan implementation. A chapter on “formulating risk management strategies” includes an overview of treatment outcome literature. As ATSA members might expect, cognitive-behavioral interventions appear to be more effective than psychodynamic ones, and attention is given to treatment dosage and intensity. There is further discussion of matching parenting training with appropriate supportive services, and various abuse-specific interventions for family and child. Throughout their discussion, the authors stress that child maltreatment and its effects are “interactive processes involving both person-specific factors, such as individual competence, and situational variables” (p.166).

The final chapter, entitled “putting it all together” is a comprehensive overview of the process, and will interest all who are asked to describe risk. An extensive review of risk factors, ranging from historical and developmental, through personal and dispositional, to current contextual factors, is provided, along with discussion of core questions for practitioners to ask. These include considerations of the persistence of risk factors across time and situation, factors that mitigate as well as increase risk, and the extent to which risk factors can be remedied or managed. The chapter concludes with a section on “conducting and writing quality evaluations”.

Although written specifically for child maltreatment situations, Righthand and her colleagues offer overviews and advice that will benefit virtually any ATSA member. It is comprehensive, emphasizes diverse considerations, and borrows from numerous areas of study. For evaluators interested in expanding or sharpening their skills, this book will provide many possible avenues for further investigation and inquiry.

Denial and Discovery: Behind the Scenes of Psychosexual Assessments

by Keith E. Anderson, LCSW, and Philip M. Smith, BA
Trafford Publishing, 2002
305 pages, $24.50, and
available at www.trafford.com

Anderson and Smith have created a unique book. It is a collection of ten case histories taken from their practice in Saco, Maine. The authors made significant alterations to identifying data to protect confidentiality, often fusing multiple features from several cases. It is not written as a “how-to” textbook nearly so much as reflections on the assessment process and the lives of those with whom they work. From the first pages it is clear that the authors view the entirety of their work, from evaluating adults and juveniles, to building a practice, to writing the book itself as an ongoing journey uncovering not just fact, but a broader sense of the truth.

To those of us who take note of the work of others as a means of improving our own skills, this book will be a welcome addition. It is informal, inquisitive, and easy to read. The authors stance appears quite humanitarian, and a respect for each client, from the initial denial to the ongoing “discovery” (hence the title) is evident throughout. The authors work together on each evaluation using their individual attributes to complement each other as well as connect with a wider range of clients. It is written for a general audience as well as professionals.

Each chapter is a narrative exploring the background, information gathering, and clinical interview of an individual, and each ends with a section on the “concepts and principles illustrated by the case”. Although the authors use diverse test batteries based on individual case situation, they are not described to any great extent. The clinical interview is the primary focus.

Clearly, the assessment process is dependent on numerous factors, including each area’s applicable legal framework, purpose for evaluation, referral sources, questions, and concerns, etc. Readers will likely find aspects with which they both resonate and disagree. In the end, the efforts of the authors to shed light on the most personal elements of interviewing and assessment, make this book both courageous and worthwhile.

How to Work with Sex Offenders:
A Handbook for Criminal Justice, Human Service, and Mental Health Professionals

by Rudy Flora, LCSW, ACSW
252 pages
Haworth Press

An inherent danger in crafting an introductory handbook is that attempts to cover every aspect of our work can do considerable disservice to its more sensitive elements. Examples include family reunification, therapeutic engagement, or diagnostic thresholds for sexual disorders. A number of recent efforts (e.g. Carich and Mussack) have been quite impressive. Mr. Flora’s book will benefit some who enter the field. However, it also omits a number of crucial developments in the field.

Flora, a practitioner and former probation officer, appears well aware of the need for a handbook that can assist law enforcement officials develop an introductory understanding of this population. As its title suggests, though, he covers a broad range of areas without noting the high level of training that each require. For example, the chapter on family addresses only the generic work of Salvador Minuchin, and, more specifically, the work of Chloe Madanes.

Those working in reunification situations are familiar with the complexity of the task. Myriad abusive elements of family interactions can remain hidden unless practitioners specifically take them into account. The contributions of such authors as Jan Hindman, Anna Salter, Jill Levenson and John Morin, and Jerry Thomas all go without acknowledgement or discussion. Flora endorses through its inclusion such steps as having the abuser apologize on his knees, without taking into account the many conditions under which this would be completely inappropriate. His emphasis on apology appears to preclude an emphasis on taking responsibility. As many have observed, apologies can create an expectation that they be accepted. The chapter neither addresses the impact of abuse on child victims, nor advocates further training.

Other areas where further discussion would have been helpful include the brief section on risk assessment (pp 222-3), which mentions the VASOR and RRASOR, but not the Static 99, SONAR, MnSOST – R, VRAG/SORAG, or other scales and methods. A section on recidivism notes the 13.4% rate found in the Hanson and Bussiere (1998) meta-analysis, but does not discuss other elements such as rapist/child molester breakdowns or recidivism across time at risk.

Although antisocial personality disorder is referenced (pp 197-8), psychopathy is not. The research and writings of Vernon Quinsey, Robert Hare, Marnie Rice, Steven Hart, Grant Harris, Chris Webster and others is not mentioned. Similarly, the section on “standards in treatment” (pp 50-54) borrows heavily from the work of Eli Coleman and his colleagues, but never mentions ATSA’s standards. While no author is obligated to mention ATSA or the work of its members, these omissions seem curious.

Flora’s work is not without considerable reference to the sex offender literature, and is not without merit. The introductory chapters can provide information to those looking to flesh out their interview schedules. However, sections such as “profiling sex offenders” (pp 20-22) risk leaving the uninitiated with a false sense of confidence.

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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