Presentation in Sexpo's international seminar "Sex Offending: Preventive Interventions and Recidivism" 2013

1. Insights of the Preventive Project Dunkelfeld (PPD):
Setup, Approach, Treatment Change and
(Potential) CP Offenders as Special Target Group
Gerold Scherner & Laura Kuhle
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2. Overview
• Background and Aims
• Project Design and Procedure
• Treatment
• Preliminary Results
• (Potential) CP Offenders as special
target group
• Prevention Network “Kein Täter werden”
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3. BACKGROUND AND AIMS
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4. Background
Clinical experience suggests that there are / is
• Little psychotherapeutic treatment offers for
pedophilic / hebephilic persons
• Need for therapy for those who never committed
a respective offense
• Need for therapy for those who are not known to
legal system or not under supervision / probation
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5. Background
Relatively little is known about CP and/or CSA offenders who are not formally
involved with the criminal justice system.
Mandatory reporting laws create an environment in which at-risk individuals are
unlikely to ever be seen voluntarily and which makes prevention efforts and
research more difficult.
Risk factors associated with reoffending in forensic or correctional samples may
not be generalized to undetected offenders.
Clinicians would have incomplete and inaccurate information upon which to make
recommendations with regard to risk management and treatment targets.
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6. Pedophilia/Hebephilia ≠
Child SexualAbuse (CSA)
Sexual Preference Disorder Sexual behavioral disorder
(Pedophilia/Hebephilia) (CSA)
Dunkelfeld („dark field“)
Pedophilia/Hebephilia pedohebephilic Non-pedohebephilic
(potential offenders) offenders offenders
Hellfeld
(„brightfield“
= cases known legal system)
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7. Pedophilia/Hebephilia ≠
Consuming Child Abusive Images (child pornography offenses)
Sexual Preference Disorder Sexual behavioral disorder
(Pedophilia/Hebephilia) (consuming Child abusive images)
Dunkelfeld („dark field“)
pedohebephilic Non-
Pedophilia/Hebephilia
offenders pedohebephilic
(potential offenders)
offenders
Hellfeld
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8. Aims
• Closing gap of treatment offers
• Closing gap of knowledge(accompanying research )
• (Primary) Prevention of ChildSexualAbuse
(CSA)
• Prevention of ChildPornography (CP)
offenses
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9. PROJECT DESIGN AND
PROCEDURE
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10. Target Groups of PPD
Organic brain dysfunction, a
psychotic condition and/or a
problem with drug or alcohol
undetected abuse that is not stabilized
Non-
preferential
detected EXCLUDED
Excluded
Offenders Currently detected
Previously detected Target Group C
Pedophiles
Hebephiles Never detected Target Group B
No offenses Target Group A
Potential
offenders
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11. Media Campaign
How can target groups be reached?
How can public be sensitized for the problem
(society and responsibility)?
How can contribution to differentiated public consideration concerning
perception of pedophilia / hebephilia be achieved ?
Homepage
Pro-active Public Media Campaign „kein täter werden“
Relation Billboards, Spots „don´toffend“
(journalists, political decision (possible only by pro bono www.kein-taeter-werden.de
makers etc.) support of scholz&friends)
www.dont-offend.org
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12. Media Campaign
Communication Aims I:
Pedophilic / Hebephilic persons have to perceived as clients with special needs
flächendeckende Behandlungsangebote geschaffen werden
Pedophilie / Hebephilia is not equal to CSA / CP offenses - Destigmatization
Treatment is possible
Area-wide treatment offers have to be established
Preventive treatment is primary preventive child protection
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13. Media Campaign
Communication Aims II:
Message pedophilic / hebephilic persons:
„ You are not guilty for your sexual preference but you are
responsible for your sexual behavior“
Raise awareness and acknowledge personal strain
Offer low threshold contact options
Providing confidentiality
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14. Media Campaign
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15. Media Campaign
Outdoor Advertising: 2.000 sites in and around Berlin for a period of 4 – 8
weeks.
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16. Media Campaign – Poster and Spot
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17. Intake Assessment
Self-reported Domains
 Sexual Age and Gender Preference
 Criminal History
 Sociodemographics & mental
disorders
 Dynamic Risk Factors (DRF)
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18. Intake Assessment
Sexual age preference
Sexual (body) age preference according to DMS-IV-TR (APA,
2000) was coded in the presence of recurrent, intense
sexually arousing fantasies involving sexual activity with…
… a prepubescent child: 302.2 Pedophilia
… a pubescent child: 302.9 NOS (Hebephilia)
A history of sexual contacts with prepubescent and/or
pubescent children was not considered to be sufficient for
the diagnosis of paraphilia.
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19. Intake Assessment
Criminal history
Detection status • Clinical Interview
CSA • Clinical interview
• Sexual behavior involving minors scale
(SBIMS; Neutze et al., 2011)
• Questionnaire of Sexual Experience & Behavior
(Q-SEB, Ahlers et al., 2008)
CP • Clinical Interview
• Questionnaire of Sexually Explicit and Non-
explicit Images of Children and Adults
(Q-SENICA; Neutze et al., 2011)
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20. Intake Assessment
Measures of DRF
Problematic • Offense-supportive attitudes (BMS; Bumby, 1996)
(offense-supportive) • Emotional & cognitive victim empathy deficits (ECS; Feelgood
cognitions & Schaefer, 2005)
Emotional deficits • Self-esteem deficits (RSE; Rosenberg, 1965)
• Loneliness (UCLA LS-R; Russell et al., 1980)
• Hostility towards women (HTW; Check et al., 1984)
• Emotion-oriented coping (CISS; Endler & Parker, 1999)
• Child identification (CIS-R; Wilson, 1999)
Sexual self- • Coping self-efficacy deficits (SESM-C; Neutze et al., 2011)
regulation deficits • Sexualized coping (CUSI; Cortoni & Marshall, 2001)
• Sexual preoccupation (SBIMS; Neutze et al., 2011)
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21. Sample Description
Sample Size “Prevention Project Dunkelfeld” (PPD) between 2005 and 2012
Respondends of Media Campaign
2000
1740 Baseline Assessments
1800
Individuals fullfilling inclusion criteria
1600
1400
1200
1000
800 719
600
373
400 Treatment
200 eligibility
0
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22. Sample Description
Clinical diagnosis
14,5
Sexuelle Ansprechbarkeit für
Pedophilia
präpubertäre Kinder (Pädophilie)
Hebephilia
Sexuelle Ansprechbarkeit für
52,1 peripubertäre Kinder (Hebephilie)
33,4
Sexuelle Ansprechbarkeit für
Teleiophilia
Erwachsene (Teleiophilie)
n = 683
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23. Sample Description
• First problem awareness: age: 22 yrs.
• Mean age: 39 yrs. (range: 17-67)
• Already seeking therapy: 54,7%
• Formal education: 38,8 % > 10 Jahre
62,2 % <=10 Jahre
• Living alone: 64,3 %
Source: Telephone-Screening
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24. Sample Description
82,5
Criminal history
%
50
44,8
45
no offenses
40 37,7
35
30 CP only
25
20
13,5 Mixed offender
15
10
5 3,9
CSA only
0
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25. TREATMENT
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26. Treatment
Setting 2005-2011
• Guided group therapy (6-10 participants), closed groups.
 45 sessions à 3 h, two therapists per group
 cognitive behavioral approach, good lives model
• Individual therapy
 45 sessions à 50 min.
• Sexual and couple therapy; medical treatment on demand; After
care groups
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27. Treatment
Changes in PPD-treatment in 2012
 From closed groups to semi-open groups
 Implementing psychoeducational / motivational sessions
 additional interview with one of the future therapists of reference
 Revision of „guided Treatment Manual“
 Implementing prevention network for area-wide treatment offer
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28. Treatment
Revision of guided treatment (in progress)
• Implementing a preparatory /psychoeducational and motivational
module
• Change of Treatment Manual to a more flexible and „guided
Treatment Manual“, emphasizing discursivity and interrelatedness of
addressing treatment targets in sessions
Psychoeducation / Emotions Perceptions
Motivation
Motivation Empathy & Perspective Biography & Schemata
Taking
Sexual Fantasies & Social Relationships Intimacy & Trust
Behaviors
Coping & Problem Solving Planning the Future Protective Measures
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29. PPD: Treatment
Treatment targets I
DRF Intervention
Problematic cognitions Identification and decrease of deficits in…
Perception and interpretation
Offense-supportive attitudes
Cognitive and emotional victim empathy
deficits
Emotional deficits Identification und decrease of problematic
attitudes regarding emotions
Skills: communication of emotions / needs
Skills: regulation of stress and other
emotions
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30. PPD: Treatment
Treatment targets II
DRF Intervention
Emotional deficits Intimacy towards adults
Sexual satisfaction in relationships
Establishing social support
Developing future plan
Sexual self-regulation Skills: Perception of Self- and others
Skills: Awareness of moods, emotions and
needs
Decrease of sexual preoccupation:
medical treatment
acceptance of sexual fantasies
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31. Protective/Relapse Motivation
Prevention
Plans Medication
no
Attachment penalizing
Future-Me Emotional Skills
Plan
Sexual
(Relapse) Acceptance
Prevention Experience
in Fantasy /
Intimacy
Self-Control & Behavior
Emotional
Empathy Good life Skills Child
Pornography
Social
Relation-
cognitive
ships Self-efficacy
distortions
Problem
Solving Victim Empathy
Learning History
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32. Sexual
interest in
High sexual children Low self-
desire esteem
General Poor social
antisocial relationship
cognitions quality
Narrow
Dissexual
possibilities behaviors CSA
to create supportive
positive Pedo-hebephilic cognition
mood states
preoccupation
Poor Fear of dissexual
problem behaviors Social
solving isolation
abilities
Emotion-
Opportunity regulation
deficits
Negative Sexual self-
social regulation
influences deficits
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33. Session Opening
Continuous evaluation of level of functioning
Repetition and consolidation of contents
Modul
e2
Modul Modul
e 12 e3
Modul Modul
e 11 e4
Problematic
behaviors
Modul Risk situations Modul
e 10 Risk factors e5
Modul Modul
e9 e6
Modul Modul
e8 e7
Session Ending
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34. PRELIMINARY RESULTS
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35. PPD: Evaluation
Treatment Eligibility (n = 373)
Treatment Completers
80
In Treatment
Waiting list
29
Drop-out
203 12
Treatment denier
49
*August 2012
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36. PPD: Evaulation
Statistical analyses: Within groups
T0 TRetest Tint T1 T2
Baseline Pre- In-treatment Post- Follow-up
Treatment Treatment
TG
WG
Group comparisons of on DRF within treatment / waitingtime
to evaluate changes dependent conditions: Wilcoxon signed-rank test,
set at .05 level of significance; One-way repeated measure analyses
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37. PPD first results: Comparability on descriptive data
Criminal history by group: LT offenses
Treatment group (TG; n = 53) Waitinglist Group (WG; n = 22)
100
90 n = 26 non-CSA offenders n = 27 CSA offenders
80
% 70
60
50 45,5
40 31,8 34
30 22, 6 18,2 26,4
20
9
10 4,5
0
no offenses CP only offenses Mixed offenses CSA only offenses
(n = 12; n = 4) (n = 14; n = 7) (n = 18; n = 10) (n = 9; n = 1)
TG and WG comparable on LT offense history
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38. PPD first results: Improvement on measures of DRF
DRF-Improvement within TG
**Z = -2.72
+
Problematic
• Emotional victim • Offense-supportive
cognitions
empathy* attitudes**
• Cognitive victim empathy
(Perspective taking) Self-esteem**
Emotional • Hostility towards women
deficits
• Emotional loneliness**
• Emotion oriented coping*
• Sexual coping self- • Masturbation frequency
efficacy* Sexual related to CSA*
self-regulation
- up
Changes on DRF within TG are stable at one-year follow
*Z = -2.16; *Z = -2.49; No changes on DRF within WG = -2.62; *Z = -2.27; *Z = -2.44
**Z = -4.47; **Z
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39. PPD first results: Improvement on measures of DRF
DRF-Improvement within TG offender groups
• No changes in non-offenders
• CP only offenders showed less offense-supportive
attitudes
• CSA only offenders showed less offense-supportive
attitudes, but more emotional victim empathy deficits
• Mixed offenders improved most: less…
– loneliness & hostility towards women
– emotional victim empathy deficits & offense supportive attitudes
– coping self-efficacy deficits & sexual preoccupation
*Z = -2.55 *Z = -2.38; *Z = -1.96 *Z = -2.16; *Z = -2.37; **Z = -3.68; *Z = -2.12; *Z = -2.51; *Z = -2.11
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40. See other presentation
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