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
In Their Shoes:
Examining the Issue of Empathy and Its Place in the Treatment of Offenders.
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
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
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
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
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.
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
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
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
avenues for further investigation and inquiry.
Denial and Discovery:
Behind the Scenes of Psychosexual Assessments
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
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.
first pages it is clear that the authors view the entirety of their
work, from evaluating adults and juveniles, to building a practice,
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
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
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
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
Rudy Flora, LCSW, ACSW
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,
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
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.