Friday, April 17, 2015

Discussing sexual abuse prevention: Jane Theriault talks to Keith Kaufman

As part of the prevention series, I spoke with Keith Kaufman, a professor of Clinical Psychology at Oregon State University and former ATSA president, about his newest prevention project, a self-assessment tool using the Situational Prevention Approach.

Keith started doing prevention work in the mid-1980s, motivated by his clinical training and his work supervising a treatment program for offenders at Ohio State University. He says that he spent a lot of time treating offenders, and there saw a lot of children who were victimized as well. He was encouraged by the potential to help – in his words, “Prevention works with other medical diseases, so why not here?”

His focus has changed over time to situational prevention. Situational prevention has existed for over 60 years as a tool to create safer housing worldwide, and for more than 20 years as a method of crime prevention, but its application to the prevention of sexual violence is relatively new. It began when Smallbone (2006) edited a book encouraging its use there, and it has moved to a more applied method, the Situational Prevention Approach, when two children’s hospitals found offenders in their midst. Since then, it’s been used at at least 2 other hospitals and also by the Boys and Girls Clubs of America.

The Situational Prevention Approach is based on the idea that many of the most vulnerable organizations and communities are the least able to pay for a consultant to come in and do prevention work, or even to purchase expensive tools or a curriculum. For the Boys and Girls Clubs, this led to a self-assessment tool that staff can use themselves to identify risks, learn about prevention and risk reduction solutions, and draw on the protective factors and strengths that they have to help with prevention. Data collection has begun, and the preliminary results look good – clubs were able to identify 7-10 times more risks in their environment after using the screening tool, and also prevent those risks. Additionally, they described it as easy and simple to use.

Keith believes that the program works well because of this simplicity, as well as how practical it is for the clubs that are using it. Because it’s process based, it tailors itself to the organization that is using it. They only see risks that are related to them, and the only solutions that they see are practical – they don’t see steps that won’t fit their organization.

You can read more about the Situational Prevention Approach and the partnership with the Boys and Girls Club of America in a 2012 issue of the ATSA Forum.  (Click here for more information).

Jane Harries Theriault, Ph.D., adjunct faculty in psychology at the University of Massachusetts – Lowell and Middlesex Community College.

Friday, April 10, 2015

In 500 words (or less): Talking Online Sexual Offenders with Michael Seto, Ph.D.

Online offending encompasses a range of crimes, including crimes involving child pornography or other forms of illegal pornography, sexual solicitations of minors, and the use of internet technologies to facilitate sexual assaults, sexual trafficking, or sex tourism (see Seto, 2013). The most commonly prosecuted and clinically identified online crimes, however, involves possession, distribution or production of child pornography (United States Sentencing Commission, 2014). Clinical and research interest in this form of offending has blossomed in the past decade, reflecting the increasing numbers of prosecutions for online sex crimes and clinical referrals.

There is an emerging consensus from research evidence that online offenders are a distinct population from offline offenders who commit contact or non-contact sexual crimes. Babchishin, Hanson and VanZuylen (2015) conducted a meta-analytic review of 30 comparison studies and found that online offenders were less antisocial (as indicated by criminal history, substance use, and personality traits) than contact sex offenders, but were more likely to be pedophilic and to have specific problems with sexual self-regulation. Online offenders also differed by having more psychological barriers to offending, endorsing fewer positive beliefs about sex with children, reporting less emotional identification with children, and greater empathy. Reflecting the role of opportunity in offending, online offenders had more access to the internet, whereas contact offenders had more access to children.

Though there are fewer studies, there is also evidence to support the idea that different types of online offenders are distinct populations as well (Seto et al., 2012). Compared to child pornography offenders, online solicitation offenders had less relationship stability and were less sexually preoccupied. Seto (2013) suggested that child pornography offenders are more likely to be pedophilic than online solicitation offenders, wherein identified child pornography offenders predominantly seek out content depicting prepubescent or pubescent children whereas solicitation offenders predominantly seek out young adolescents.

There is some overlap across different sex offender populations. Seto, Hanson and Babchishin (2011) found that one in eight online offenders (most being child pornography offenders) had an official record for contact sexual offending. In the six studies with self-reported offending information obtained through treatment disclosures and/or polygraph interviews, half of the online offenders admitted having committed contact sexual offenses. Some child pornography offenders have also committed online solicitation offenses, and vice versa, but cumulatively this evidence suggests there are distinct online and offline offender populations.

Reflecting both similarities and differences between online and offline offenders, efforts have been made to translate knowledge from contact offenders to online offenders. In the arena of risk assessment, early work suggested much of what we know about risk factors for sexual recidivism applies. For example, offender age, criminal history, and evidence of pedophilic sexual interests have been shown to predict sexual recidivism among child pornography offenders (Eke, Seto, & Williams, 2011; Faust, Renaud, & Bickart, 2009; Seto & Eke, in press; Wakeling, Howard, & Barnett, 2011). An important predictor is whether child pornography offenders have committed other offenses as well, particularly contact sexual offenses.

For intervention, many practitioners have attempted to adapt contact sex offender programs, for example, creating less intense versions (fewer treatment hours) that emphasize online behavior and sexual self-regulation and de-emphasize generally antisocial attitudes, beliefs and behavior (Beier et al., 2015; Middleton, Mandeville-Norden, & Hayes , 2009). Whether these online offender programs are effective needs to be determined.

Michael C. Seto, Ph.D.


Babchishin, K. M., Hanson, R. K., & Vanzuylen, H. (2015). Online child pornography offenders are different: A meta-analysis of the characteristics of online and offline sex offenders against children. Archives of Sexual Behavior, 44, 45-66.

Beier, K. M., Grundmann, D., Kuhle, L. F., Scherner, G., Konrad, A., & Amelung, T. (2015). The German Dunkelfeld Project: A Pilot Study to Prevent Child Sexual Abuse and the Use of Child Abusive Images. The Journal of Sexual Medicine.

Eke, A. W., Seto, M. C., & Williams, J. (2011). Examining the criminal history and future offending of child pornography offenders: An extended prospective follow-up study. Law and Human Behavior, 35, 466-478.

Faust, E., Renaud, C., & Bickart, W. (2009, October). Predictors of re-offence among a sample of federally convicted child pornography offenders. Paper presented at the 28th Annual Conference of the Association for the Treatment of Sexual Abusers, Dallas, TX.

Middleton, D., Mandeville-Norden, R., & Hayes, E. (2009). Does treatment work with internet sex offenders? Emerging findings from the Internet Sex Offender Treatment Programme (i-SOTP). Journal of Sexual Aggression, 15, 5-19.

Seto, M. C. (2013). Internet sex offenders. Washington, DC: American Psychological Association.

Seto, M. C., & Eke, A. W. (in press). Predicting recidivism among adult male child pornography offender: Development of the Child Pornography Offender Risk Tool (CPORT). Law and Human Behavior.

Seto, M. C., Hanson, R. K., & Babchishin, K. M. (2011). Contact sexual offending by men with online sexual offenses. Sexual Abuse: A Journal of Research and Treatment, 23, 124-145.

Seto, M. C., Wood, J. M., Babchishin, K. M., & Flynn, S. (2012). Online solicitation offenders are different from child pornography offenders and lower risk contact sexual offenders. Law and Human Behavior, 36, 320-330.

United States Sentencing Commission. (2012). Report to the Congress: Federal child pornography offenses. Retrieved April 10, 2015, from

Wakeling, H. C., Howard, P., & Barnett, G. (2011). Comparing the validity of the RM2000 scales and OGRS3 for predicting recidivism by Internet sexual offenders. Sexual abuse: a journal of research and treatment, 23, 146-168.

Thursday, April 2, 2015

Q&A with Franca Cortoni Guest Editor of a Sexual Abuse Special Edition on "Female Sexual Offenders".

Sexual Abuse: A journal of Research & Treatment
Special Edition (edited by Franca Cortoni, PhD)                on “Female Sexual Abusers”
To Be Published – June 2015

What Is So Special About Female Sexual Offenders? Introduction to the Special Issue on Female Sexual Offenders
Cortoni, F.

An Incident-Based Comparison of Female and Male Sexual Offenders
Williams, K. S., & Bierie, D. M.

Adverse Childhood Experiences in the Lives of Female Sex Offenders
Levenson, J. S., Willis, G. M., & Prescott, D. S.

Characteristics of Females Who Sexually Offend: A Comparison of Solo and Co-Offenders
Gillespie, S. M., Williams, R., Elliott, I. A., Eldridge, H. J.,  Ashfield, S., & Beech, A. R.

An Ecological Process Model of Female Sex Offending: The Role of Victimization, Psychological Distress, and Life Stressors
DeCou, C. R., Cole, T. T., Rowland, S. E., Kaplan, S. P., & Shannon M. Lynch, S. M.
Women Convicted of Promoting Prostitution of a Minor Are Different From Women Convicted of Traditional Sexual Offenses: A Brief Research Report
Cortoni, F., Sandler, J. C., &. Freeman, N. J.

Group Sexual Offending by Juvenile Females
Wijkman, M., Weerman, F., Bijleveld, C., & Hendriks, J.

Could you talk us through where the idea of the special edition came from?

The idea that ‘there is no information on females so we must use male information’ is now out-of-date. While nowhere near the level of knowledge on male sexual offenders, there is now enough evidence that women and men sexual offenders do differ in significant ways in terms of gender-specific characteristics, offense patterns, and recidivism rates. However, it is unclear how well these issues are understood in the field since most researchers and clinicians will seldom deal with female sexual offending issues. As a special issue on female sexual offenders had already been published in 2011 by the Journal of Sexual Aggression, we (James Cantor, then Editor-in-Chief of SAJRT and I) felt the time had come for SAJRT to officially acknowledge, via this special issue, the fact that research on female sexual offending has its rightful place in the field of sexual aggression.

What kinds of challenges did you face throughout the process?

The biggest challenge was sorting through the large number of manuscripts submitted for the special issue and having to turn down quite a few of these submissions. The issue of female sexual offending appears to have become quite prominent in the field, with a large number of people attempting to conduct research on what are essentially very small samples of women. I find the increased recent research interest on women very exciting after too many decades of neglect. However, it is rarely acknowledged that this research area is fraught with difficulties that are not just due to small samples. Gender-specific research is much more than simply testing male-based theories on female samples; the knowledge building exercise must be built from the ground-up on women. Only then can it be compared to that of men to clearly establish differences and similarities. As a result, it will be some time before we gain a sound understanding of the factors that lead to sexual offending behavior among women.

What kinds of things did you learn as a result of pulling this edition together?

Based on my observations, the most recurrent problem with the research on female sexual is its reliance on male-based theories and data points (e.g., psychometric instruments validated for males; assessing factors present in males but not validated for women). This type of approach is classic in the area of forensic/correctional psychological/criminological research in that male-based knowledge is assumed to be gender-neutral (i.e., the crime matters – not the gender of the offender) and therefore applicable to women. The problem with this gender-neutral approach is that it fails to acknowledge that other –gender-specific – factors may be at play when women sexually offend. A simple example will help illustrate this problem: Williams and Bierie (2014) found that while 2% of men committed their sexual offense with a female co-offender, 32% of women commit their sexual offense in company of a male co-offender. Not surprisingly, there is nothing in the male literature that helps explain this gender-specific aspect of female sexual offending. Other examples of differences between men and women that require gender-specific explanations include the differential impact of childhood victimization, the important differences in sexual recidivism rates, and gender differences in offense-supportive cognitions or sexual arousal patterns. It is only by directly studying the women themselves that we will understand these issues.  

Now that you’ve pulled these articles together, what are some implications for practitioners?
The research presented in the special issue will help clinicians better understand prevalence issues, victimization and offense process issues, differences in solo versus co-offending among women, factors that differentiate subgroups of women all considered to be sexual offenders, and juvenile girls who are involved in group sexual offending. This new knowledge will provide practitioners with a stronger empirical basis for their differential clinical evaluation, treatment and management of women who sexually offend. Most importantly perhaps, I hope that this special issue will help clinicians understand that sexual offending is not “worse” or “less worse” when committed by a woman instead of a man but that the explanations for it that might differ - hence the importance of adopting a gender lens when working with female sexual offenders.

Franca Cortoni, PhD

Sunday, March 29, 2015

In 500 words (or less): Talking Desistance from Sexual Offending with Danielle Harris, PhD

“Desistance” refers to the slowing down, de-escalation, or stopping of offending. Although the term is relatively new to those who study sexual aggression, the phenomenon has been a staple of criminological research for two centuries (Laws & Ward, 2011). The observation of “natural desistance” or aging out (when one stops committing crime as they get older) is a key component of the criminal career paradigm. Some researchers, in fact, argue that no variable (e.g. race, gender, marital status, employability, educational achievement, parenthood, psychological treatment, or therapy) either combined or alone, accounts for the decline in crime better, or more completely than does age.

One reason why desistance is such a new concept for people who have committed sexual offenses is the enduring assumption of inevitable recidivism (Willis, Levenson & Ward, 2010). There is a persistent belief among many practitioners, policymakers, and members of the public that sex offenders seldom if ever stop and that when they are released from custody, recidivism (or “failure”) is the expected result.

The fact that many men convicted of sexual offenses share more similarities than differences with generic, nonsexual criminals has been the subject of much recent research (Harris, Smallbone, Dennison, & Knight, 2009; Lussier, 2005). Studies consistently find that rapists (more so than child molesters) tend to have persistent and versatile criminal histories and tend not to “specialize” in sexual offending. The empirical reality that sex offenders and non-sex offenders are inherently similar leads to the logical hypothesis that we can also expect them to desist in a similar fashion.

The most well regarded theories of desistance (in addition to “aging out”) emphasize either the pursuit and achievement of informal social controls (i.e. fulfilling employment and a stable relationship) (Sampson & Laub, 1993) or cognitive transformation (Giordano, Cernkovich & Rudolph, 2002) where the individual consciously decides to change their behaviour, begins to see alternatives to a criminal lifestyle, and can rewrite their narrative in such a way that they can leave that life behind, ‘knife off,’ (Maruna, 2001) and become someone new.

Emerging research on sex offender samples (Farmer, Beech & Ward, 2011; Harris, 2014, In Press) so far concludes that, as a population, recidivism rates are fairly low and desistance is the modal outcome, but they appear to be desisting in spite of a range of obstacles that generic offenders do not experience. The realities for a sex offender living in the community post release (especially in the US) severely limit one’s ability to find stable, paid employment and pursue a fulfilling relationship, let alone find safe, affordable accommodation. Furthermore, the debilitating stigma that comes with the label of “sex offender” means that the achievement of a new identity and successful cognitive transformation is especially difficult.

Our mutual objective is the prevention of sexual abuse and the ultimate reintegration of those convicted of such offenses. Our emphasis should therefore be placed on repealing the especially stigmatizing legislation that does little to foster rehabilitation and instead promoting opportunities that encourage identity transformation, the pursuit of informal social controls, and the realisation of good lives.

Danielle Arlanda Harris, PhD


Farmer, M., Beech, A., & Ward, T. (2011). Assessing desistance in child molesters: A qualitative analysis. Journal of Interpersonal Violence, 1-21.

Giordano, P., Cernkovich, S., & Rudolph, J. (2002). Gender, Crime, and Desistance: Toward a theory of cognitive transformation, American Journal of Sociology, 107(4), 990-1064.

Harris, D. A. (2014). Desistance from sexual offending: Findings from 21 life history narratives. Journal of Interpersonal Violence. 29(9) 1554-1578. DOI: 10.1177/0886260513511532

Harris, D. A. (in press) Theories of desistance from sexual offending in Ward, T., Polaschek, D., & Beech, A. (Eds.), Theories of sexual offending, 2nd ed., Sussex: John Wiley & Sons.

Harris, D. A., Smallbone, S., Dennison, S., & Knight, R. A. (2009). Offense specialization and versatility in the criminal histories of adult male sexual offenders referred for civil commitment. Journal of Criminal Justice. 37, 37-44.

Laws, R. & Ward, T. (2011). Desistance from sex offending: Alternatives to throwing away the keys. New York: The Guildford Press

Lussier, P. (2005). The criminal activity of sexual offenders in adulthood: Revisiting the specialization debate. Sexual Abuse: A Journal of Research and Treatment 17(3), 269-292.

Maruna, S. (2001). Making good: How ex-convicts reform and rebuild their lives, Washington DC: American Psychological Association.

Sampson, R., & Laub, J. (1993). Crime in the making: Pathways and turning points through life. London: Harvard University Press.

Willis, G., Levenson, J. & Ward, T. (2010). Desistance and attitudes towards sex offenders: facilitation or hindrance? Journal of Family Violence, 25, 545-556.

Monday, March 23, 2015

Desistence from sexual offending

This week I attended a research symposium at Queens University, Belfast, on desistence from sexual offending organised by Shadd Maruna, Anne-Marie McAlinden as well as Mark Farmer. The event was designed to bring desistence researchers, as well as those interested in the topic, together from across the world (including, UK, Ireland, Canada, USA, New Zealand) to discuss present and future research in this area. The conference had interesting papers and informed debates from leading and emerging names in the Field (Shadd Maruna; Gwen Willis; Danielle Harris; Simon Hackett; Patrick Lussier; Anne-Marie McAlinden; Mark Farmer; Kim Kras; Stephanie Kewley; Joanne Hulley; Darren Woodward). The conference covered a lot of different issues including, but not limited to, conversations about research methodology and ethics relating to desistence, community re-entry, resilience, redemption, religion and treatment relating to youth as well as adults; this blog will cover some of the main themes that came out of the conference.

-          Narratives of desistence are similar internationally and cross culturally: Although there are international differences in terms of sex offender policy and practice, there was a great deal of similarity in sex offenders’ narratives of change, redemption and desistence.


-          That the use of the label of sex offender is problematic to desistence: One of the strongest themes that emerged from the conference, touted by Gwenda Willis in her presentation, was the impact that the label of “sexual offenders” has upon desistence (recalling Kelly Babchishin’s recent blog and Harris & Socci, 2015). As Willis pointed out, reinforced by other delegates, the use of the label “sex offender” is not only problematic for the individuals in question but also for professionals as well as policy makers in the field as it creates self-fulfilling prophecies. In the conversation which followed there was recognition in the room that we needed to make a conscious decision to stop calling these individuals by the very thing that we don’t want them to be. However, what language can be used instead, when the term sex offender is embedded in public and political discourses?


-          Harm Vs offending:  On the second day of the symposium Simon Hackett expanded upon what Gwenda had said about labelling, suggesting that we focus on harm rather than offending. The use of harm is potentially beneficial on a number of levels for working with victims, offenders and across society.


-          Youth desistence from sexual offending: Simon Hackett discussed youths who commit sexually harmful behaviour, his findings reminded me of Nicole Pittman’s Raised on the Registry, stating support (formal and informal) was central in allowing this population to desist; consequentially, appropriate interventions are essential.  This led to a debate over the role of social and clinical interventions with individuals who cause harm to others through their sexual behaviour and where the field should be moving for youths as well as adults.


-          Researching desistence: When Shadd Maruna opened the research symposium he discussed the issues involved in researching desistence from sexual offending, highlighting that we are dealing with two challenging issues “desistence” and “sex offending”. Among the issues that Shadd highlighted are (1) that desistence is a fluid concept and that all researchers do not necessarily define it in the same way; (2) that sexual offending can be difficult to uncover because of its nature, therefore these two populations are difficult to identify and access; as well as (3) that there are very real ethical and moral issues related to this type of research. The experience of the researchers who talked across the two days reflected these comments; however, interestingly, the researchers commented that once they had secured their participants that all were in the main pleased to talk. The speakers all recalled experience of participants stating that they were happy to be able to discuss their experiences.


-          Methodology: The symposium highlighted the range of methodologies being used internationally to research desistence from sexual offending, including qualitative interviews (Harris, Hulley, Kewley, Farmer, Hackett), case studies (Hackett), quantitative methods (Lussier, Hackett) longitudinal research (Lussier, Hackett) and quasi experiments (Lussier). This really highlights the methodological innovations in the field. Although, recognising the sentiment that desistence research in the sexual abuse field is in its early its research is steeped in a rich methodological tradition from across the social sciences.


-          Linking together multi-faceted research on this issue: One clear message that came out of the symposium is that desistence is a multidisciplinary issue with speakers and delegates coming from a range of disciplines (Criminology, Law, Forensic Psychology, Clinical Psychology, Sociology). This reinforces the need for research in the social sciences to be grounded is a shared among the social sciences; desistence as well as sexual abuse are multi-faceted social issues and should be researched as such.

This research symposium really reinforced the importance of research into understand why people choose to stop sexually offending; if we can better understand why people choose to stop sexually offending it can better inform interventions, policies and reintegration strategies with this population.

Kieran McCartan, PhD.


Harris, A. J., & Socia, K. (2015) What’s in a Name? Evaluating the Effects of the “Sex Offender” Label on Public Opinions and Beliefs. Sexual Abuse: A Journal of Research and Treatment. ifirst

Tuesday, March 10, 2015

The Emerging Use of Feedback-Informed Treatment with People Who Have Sexually Abused


This blog post explores the use of ongoing structured client feedback in adherence to the responsivity principle of effective correctional treatment. After an introduction to the concept of Feedback-Informed Treatment (FIT), it describes the work of two ATSA members who are using FIT in very different settings.

Background Information

In an important study of what works in group treatment of people who have sexually abused, Beech and Fordham (1997) stressed the importance of attending to therapeutic processes and cohesion in group treatment and found that therapists typically rated themselves as being more helpful and concerned than their clients did. Indeed, client perceptions are more influential in treatment progress than therapists’ beliefs about their own skills (Orlinsky, Grawe, & Park, 1994). Despite what professionals want to believe, we are not the best judges of the therapeutic alliances.

At a time when our field argues whether treatment for people who have sexually abused works, many (e.g., Prescott & Levenson, 2009) have wondered whether our field is actually asking the right questions. Perhaps the most important question is what professionals can do to create programs for clients who may be at risk for refusing treatment or dropping out to “get it” and make meaningful change (Marques,  Wiederanders, Day,  Nelson, & van Ommeren, 2005).

What is clear, however, is that findings of the past decade have cast confrontational approaches into a much less favorable light (Marshall, 2005; Parhar, Wormith, Derkzen, & Beauregard, 2008). In fact, in an influential article regarding addictive behavior, William White and William Miller (2007) stated:

There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate.

An emerging body of research in the behavioral health field indicates that incorporating formal feedback regarding progress and engagement into treatment services builds responsivity while simultaneously improving outcome and retention (Prescott & Miller, 2014, 2015). Feedback-Informed Treatment (FIT) has been successfully integrated into both mental health and substance abuse services, serving both voluntary and mandated clients, in agencies and systems of care around the world (Bertolino & Miller, 2012).  Multiple randomized clinical trials document that adding FIT to existing treatment services as much as double the effectiveness of the care provided, and reduces attrition and deterioration rates by 50% and 33%, respectively (Miller, Hubble, Chow & Seidel (2013). 

FIT involves administering two scales over the course of treatment; one measuring the quality of the therapeutic relationship (the Session Rating Scale [SRS]), and the other assessing progress or outcome (the Outcome Rating Scale [ORS]).   Over 1,100 studies have made clear the importance of the therapeutic relationship to treatment outcome (Duncan, Miller, Wampold, & Hubble, 2010). Indeed, in an era that emphasizes evidence-based practice, the therapeutic relationship is the most evidence-based concept in psychotherapy research (Bargmann & Miller, 2011). Understanding changes in the relationship can help ensure that clients are meaningfully engaged in change efforts, assist treatment providers in adjusting their strategies to meet each client’s needs (thereby adhering to the responsivity principle), and act as an early warning system for treatment deterioration and failure. At the same time, research has demonstrated that changes in a person’s individual, relational, and social functioning are strong predictors of successful therapeutic work (Bargmann & Miller, 2011; Miller, Duncan, & Hubble, 2004).

As research to date shows, access to real time feedback regarding progress and engagement provides clinicians with an opportunity to adjust services in a way that enhances individual client responsivity and achievement of treatment goals  (e.g., decreased reoffending). The same body of evidence documents that FIT promotes professional development, resulting in measureable improvements in individual provider responsivity and effectiveness (Miller, Hubble, Chow, & Seidel, 2013).  In 2013, FIT was deemed an evidence-based practice by the Substance Abuse and Mental Health Service Administration (SAMHSA) and listed on the National Registry of Evidence Based Practices and Programs.

Of course, evidence-based practices in the field of treating sexual aggression involves adherence to the principles of risk, need, and responsivity. FIT is best thought of as improving adherence to the responsivity principle. As the two vignettes below illustrate, programs adhering to the risk and need principles can further build responsivity by using FIT. The big question is whether the treatment provider and his or her agency is ready for the challenge of listening to their clients’ feedback and open to the professional self-development that follows. Changing one’s practice to meet the needs of clients is not easy. Indeed, maintaining a stance of eager anticipation about what one can learn from their client is vital to collecting the most helpful feedback.

FIT in a Sexual Offender Civil Commitment Setting (Valerie Gonsalves)

At the beginning of each session, I have the patient complete the ORS. If there’s a particular area that rates low, we can direct attention to that area. If there are inconsistencies between unit report and patient report, it can open up the discussion about those areas. For example, if someone received three or four sanctions in a week, but reports that they are doing well overall, raising this discrepancy can provide a nonjudgmental manner of addressing the sanctions. Similarly with the SRS, I administer this instrument at the end of each setting. For patients who may be hesitant to provide feedback or may experience distrust about the nature of the relationship, the SRS can serve as a launching point for conversations about alliance. I typically expand my discussion of alliance to include variables that have been found to be specifically relevant to mandated therapeutic relationships, such as trust, caring and fairness, and toughness (Skeem Louden, Polaschek, & Camp 2007).

Notably, in a civil commitment the mandated nature of the therapeutic relationship can serve as a barrier to accurate reporting. Patients may be frightened of experiencing negative consequences, either legally or within the institution, if they provide the clinician with an honest assessment of their current functioning or suggest an area for therapist improvement. As such, these patients typically demonstrate consistently high ratings on the ORS and the SRS. When this occurs, it can serve as a launching point for a discussing about meaningful treatment engagement or that the therapist may have to engage the patient in a discussion about methods of collecting this information in way that allows the patient to feel safe about being transparent. More often than not, my experience in a civil commitment setting demonstrates that patients will utilize these instruments in a manner that mimics that of community use.

FIT in a Private Practice Setting (Jim Reynolds)

The importance of a positive therapeutic alliance has been consistently described in the literature and is well known by treatment providers.  However, no agency or organization where I have worked has actively measured the therapeutic alliance, much less incorporated aspects of the therapeutic alliance in the treatment planning/delivery processes. Consultation with colleagues suggests that this remains the general state of affairs within our field.

Implementing FIT into a solo, community-based practice is probably much easier than in agencies or large criminal-justice systems.  I did not need to ask anyone's permission.  I simply received training and implemented it without any difficulties.  I was able to easily adjust the policies and procedures which guide the treatment I provide clients, incorporating important principles from FIT into the therapy I provide. For example, my clients are provided complete and unfettered access to their treatment records - within the boundaries of relevant ethical principles and practices. There is no paper work for them to complete. No board or committee needs to be consulted.  A client only has to ask and they can see their case file.

FIT helps me to individualize treatment based on building client capacities and managing risks.  I can structure treatment according to the priorities, goals, preferences, and progress of the individual client as those elements relate to the reason(s) for being in treatment. These goals are not imposed on the client, either by me or by a supervising entity such as probation or parole. Client feedback on the ORS and SRS is taken seriously, and used to monitor/modify the course and length of treatment in real time.

Collaborating with clients and being transparent in my interactions with them helps to create a positive “culture of feedback” in which client input and feedback are integrated into the therapeutic process. The ORS and SRS are valid, reliable, and “user friendly” outcome measures of alliance that I use to guide services throughout the therapy process.  Using the ORS and SRS allows me to objectively monitor and chart each individual client's progress, to determine which clients are making progress and which are at risk for a negative or no change outcome. 

Information from the ORS and SRS helps me identify problems/concerns in the therapeutic relationship that may compromise the effectiveness of treatment. Identifying and repairing problematic alliances can improve clients' motivation for treatment as well as their level of active engagement in therapy.  I am able to use the information from the scales to adjust the level and type of care that I provide each client, in both individual and group therapies, in order to be responsive to each client's perceived needs and treatment goals. 

Overall, integrating FIT into a private practice can be easily accomplished.  Doing so has allowed me to easily collect client outcome data in real time that I can then use to help guide the treatment process. I use that information to guide the focus of therapy, as well as the frequency with which I meet clients. I am able to objectively identify clients who have achieved an optimum level of functioning and appropriately titrate treatment. I can also identify clients who are not benefiting from treatment and, if adjustments to treatment are unsuccessful, make appropriate referrals to another provider.


At first, implementing FIT can be challenging for people working in criminal-justice settings. It involves creating a culture of feedback and being willing to listen to unflattering feedback in order to strengthen the alliance and improve outcomes.  However, those who monitor their alliances and outcomes commonly report improved treatment progress, earlier detection of treatment problems and dropout, reduced client-driven complaints and grievances, and a seemingly endless resource for deep professional development and knowledge.

David S. Prescott, 
Valerie Gonsalves, 
Jim Reynolds,
Scott D. Miller


Bertolino, B. & Miller, S.D. (Eds) (2013). The ICCE Feedback Informed Treatment Manuals (6 Volumes). ICCE: Chicago, Illinois.

Duncan, B., Miller, S.D., Wampold, B., & Hubble, M. (2010). The heart and soul of change, second edition: Delivering what works in therapy. Washington, DC: American Psychological Association.

Marques, J.K., Wiederanders, M., Day, D.M., Nelson, C., & van Ommeren, A. (2005). Effects of a relapse prevention program on sexual recidivism: Final results from California’s Sex Offender Treatment and Evaluation Project (SOTEP). Sexual Abuse: A Journal of Research & Treatment, 17, 79-107.

Miller, S.D. & Bargmann, S. (2011). Feedback Informed Treatment (FIT): Improving outcome with male clients on man at a time. In J.A. Ashfield & M. Groth (Eds.), Doing psychotherapy with men. CreateSpace Independent Publishing Platform.

Miller, S.D., & Duncan, B. (2000). The Outcome Rating Scale. Chicago, Illinois: International Center for Clinical Excellence.

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Wednesday, March 4, 2015

Q&A with Kristen M. Zgoba, co-author of “The Adam Walsh Act: An Examination of Sex Offender Risk Classification Systems”

Zgoba, K. M., Miner, M., Levenson, J.  Knight, R., Letourneau, E., & Thornton, D. (2015). The Adam Walsh Act: An Examination of Sex Offender Risk Classification Systems. Sexual Abuse: A Journal of Research and Treatment. Ifirst


This study was designed to compare the Adam Walsh Act (AWA) classification tiers with actuarial risk assessment instruments and existing state classification schemes in their respective abilities to identify sex offenders at high risk to re-offend. Data from 1,789 adult sex offenders released from prison in four states were collected (Minnesota, New Jersey, Florida, and South Carolina). On average, the sexual recidivism rate was approximately 5% at 5 years and 10% at 10 years. AWA Tier 2 offenders had higher Static-99R scores and higher recidivism rates than Tier 3 offenders, and in Florida, these inverse correlations were statistically significant. Actuarial measures and existing state tier systems, in contrast, did a better job of identifying high-risk offenders and recidivists. As well, we examined the distribution of risk assessment scores within and across tier categories, finding that a majority of sex offenders fall into AWA Tier 3, but more than half score low or moderately low on the Static-99R. The results indicate that the AWA sex offender classification scheme is a poor indicator of relative risk and is likely to result in a system that is less effective in protecting the public than those currently implemented in the states studied.

Could you talk us through where the idea for the research came from?

I’d like to say that we had a great story for coming up with the research idea but it was truthfully born out of necessity.  I was in the process of finalizing a National Institute of Justice grant on Megan’s Law and my co-authors and I believed it was necessary and responsible to evaluate the new federal law that became known as the Adam Walsh Act.  The bill was signed into law without an empirical foundation and sought to strengthen many of the stipulations of Megan’s Law.  My co-authors and I were thankful that the National Institute of Justice approved the funding and allowed the empirical research process and findings to speak for themselves. The idea of who would take the lead unfolded in a more comical way with everyone stepping back and claiming they were too busy to be lead!  Having pulled the shortest straw and having the shortest academic career resulted in me becoming the PI.

What kinds of challenges did you face throughout the process?

I think my co-authors would agree that much of the process was a challenge! Our project included five busy researchers, from five different states, with five different IRB approvals and state agency regulations.  I would say the process of data coding and collection probably posed the greatest challenges to my co-authors and I. First, we recognized that in order to code the Static risk assessments, the researchers and the assistants needed to be trained by David Thornton. Since we hailed from five different states (New Jersey, Massachusetts, Minnesota, Florida and South Carolina) we quickly determined that video conferencing was the most fiscally responsible (although a few of us did make our way to warmer climates for group coding!).  This three day training increased the validity of our data coding and our understanding of the instrument.  A second challenge that was particularly burdensome was the unavailability of consistent data collection across the states. Some of the data points were more readily available in some of the states and my co-authors and I had to be creative with our requests for additional data and/or the statistical methods that would take the missing data into consideration.  The states involved with the study were sometimes hindered by an inability to provide information that was beyond their control.  You learn through the process that items that might be intuitive for research purposes, do not necessarily have an operational purpose for state correctional agencies.

What kinds of things did you learn about co-authorship as a result of producing this article?

I quickly learned that I was co-authoring a grant and paper with very busy people!  I think everybody on this grant had experience as a co-author, so we became skilled at establishing schedules and responsibilities upfront.  We used an internet tool to schedule mutually agreeable conference call times and our responsibilities functioned in chronological order.  We then passed each manuscript version on to the next person in line. There were definitely points when we hit periods of natural slowdowns- exams, holidays, summer break, etc. I can’t say we didn’t experience some ‘topic fatigue’, but we understood this would be the case, given the length of our project and our very busy schedules.  I think we also learned that our writing styles varied, as is sometimes the case with larger groups, and our final products needed some verbal ‘smoothing’ and refining.  One difficulty when working with larger groups is having a final product that does not appear as though five people joined together five different papers.

What do you believe to be to be the main things that you have learnt about the impact of sex offenders registration, as well as the related legislation?

The results of our analysis were in line with findings from other studies seeking to determine best practices in the field of sexual offending legislation.  We confirmed that sexual recidivism rates were low, as most of us had reported in our previous research. The sexual recidivism rate was approximately 5% at 5 years and 10% at 10 years.  This of course should lead many to question the ‘one size fits all’ basis of the Adam Walsh Act and many other types of sex offender policies.  Furthermore, we discovered that actuarial measures and existing state tier systems did a better job of identifying high-risk offenders and recidivists than did the AWA. After multiple analyses, the results indicated that the AWA sex offender classification scheme was a poor indicator of relative risk and was likely to result in a system that was less effective in protecting the public than those currently implemented in the states studied.

Now that you’ve published the article, what are some implications for practitioners?

I think the main implication for practice is really that the manner by which states were handling sex offender registration, classification and subsequent notification was working. At least, relative to the current implementation of the AWA, it was working.  Unfortunately, the hands of many practitioners now may be tied to a system that is less reliable than what they were previously using.  This presents a disservice to all involved.