Attachment

1
Attachment Sexual Offending

• Liam Marshall
• Rockwood Psychological Services
• www.rockwoodpsyc.com

2

• 1) It is easy for me to become emotionally close
  to others. I am comfortable depending on them
  and having them depend on me. I dont worry
  about being alone or having others not accept me.
• 2) I am uncomfortable getting close to others. I
  want emotionally close relationships, but I find
  it difficult to trust others completely, or to
  depend on them. I worry that I will be hurt if I
  allow myself to become too close to others
• 3) I want to be completely emotionally intimate
  with others, but I often find that others are
  reluctant to get as close as I would like. I am
  uncomfortable being without close relationships,
  but I sometimes worry that others dont value me
  as much as I value them
• 4) I am comfortable without close emotional
  relationships. It is very important to me to feel
  independent and self-sufficient, and I prefer not
  to depend on others or have others depend on me

3
Topics

• Intimacy
• Attachment Treatment
• History of Attachment as a Psychological Concept
• Attachment in Childhood
• Attachment in Adulthood
• Attachment in Adult Sexual Offenders

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Intimacy
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Intimate Attachments provide...

• sense of security and emotional comfort
• companionship and a sense of shared experience
• a chance to be nurturing and to be nurtured
• reassurance and self-worth
• support during adversity
• a sense of meaning in ones life
• provides a sense of kinship, belongingness
• Marshall, 1989 1993 Marshall et al., 1993.

6
High Intimacy Individuals are characterized by...

• Greater
• ability to withstand stress
• resistance to depression and anxiety
• physical health
• psychological well-being

7
High Intimacy Individualsare perceived by others
to be...

• warm and sincere
• egalitarian
• cooperative
• confident
• interpersonally skilled
• nonaggressive
• empathic, caring

8
Low Intimacy Individuals are characterized by...

• aggression or hostility
• distrust of others
• low self-esteem
• poor interpersonal skills
• lack of depth in relationships
• low empathy
• feelings of emptiness/emotional loneliness

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Attachment Treatment

• Comfort Exploration

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CLIENTS PERSPECTIVE (Drapeau, 2005)

• 1. See therapist as crucial but also see value
  of procedures
• 2. Base judgments of quality of the program on
  the skills of the therapist
• 3. Good therapists are seen as honest,
  respectful, nonjudgmental, available, caring,
  confident, competent, and persuasive
• 4. Good therapists encourage discussion, listen,
  display leadership and strength, and maintain
  order
• 5. Do not respond to therapists who are
  critical, devaluing, or confrontational
• 6. Many clients who do well say they are able to
  re-enact aspects, with the therapist, of their
  past reactivation of attachment schemas with
  the therapist
• 7. Most prevalent interpersonal interactions
  involve therapist supportively challenging the
  clients in a caring manner
• 8. Clients desire to participate in decision
  making (work collaboratively) and they wish to
  attain mastery and feel competent

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Therapist features that were related to
significant treatment - induced changes

• Warmth
• Empathy
• Rewarding
• Directive

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History of Attachment as a Psychological Concept

• Freud - emphasis on childhood and the lasting
  effects of early social experience on later
  development
• Harlows (1950s 60s) - research on infant
  behaviour in rhesus monkeys - contact comfort
• Tinbergen (1950s) Imprinting some species show
  a biological process in which the young acquire
  an emotional attachment to another to enhance
  their chances of survival.
• Bowlby Father of Attachment
• Ainsworth Strange Situation Test

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Attachment Theory Origins

• Innate capacity Harlows
• Group of baby rhesus monkeys removed from mother
  at birth and raised in lab with 2 surrogate
  mothers
• Half had food in bottle from cloth mother, half
  from wire mother.
• Assessment of Attachment - amount of time with
  mother and extent of security seeking.
• Babies spent 17-18 hours a day with cloth mother
  but less than 1 hour with wire mother.
• Regardless of food source they sought out cloth
  mother.
• Contact comfort more important to infants than
  food.

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History of Attachment as a Psychological Concept

• Bowlby (1950s)
• Attachment behaviours all those behaviours that
  allow a child to achieve and retain proximity to
  someone else to whom he is attached
• Attachment figure the person who is sought out
  for comfort when distressed, anxious, or
  frightened.
• Primary attachment figure in childhood is usually
  a parent. In adulthood it is a romantic partner
  or a close friend.
• Attachment relations based on who the person
  would most like to be with when feeling
  distressed, not on the attachment figures
  ability to help.

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3 Functions of Attachment (Bowlby, 1976)

• 1) Enhance infant survival.
• 2) Promote an internal working model" of
  relationships - expectations and predictions.
• 3) Attachment figure provides a secure base from
  which the infant can explore and learn

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History of Attachment as a Psychological Concept

• Ainsworth
• Strange Situation Test
• Attachment Categories

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Episodes of SST
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Coding

• 1) active play and exploration in the caregivers
  presence
• 2) how enthusiastic the greetings are when the
  child is not distressed
• 3) the effectiveness of contact when the infant
  is distressed
• 4) the presence or absence of anger, petulance
  and physical contact when the infant is
  distressed.

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Childhood Attachment Classifications

• Secure - 60-65 of children
• Use caregiver as a secure base
• Communicates affect during play
• Actively seeks contact/interaction at reunion
• Shows no resistance to contact or interaction
• When distressed -- is soothed by contact with
  caregiver
• Avoidant - 20-25
• Little or no proximity seeking
• Little or no distress on separation
• Little affective sharing
• Often affiliates to stranger
• Often conspicuous avoidance of caregiver on
  reunion

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Attachment Classifications Cont.

• Resistant 10
• Appear ambivalent toward caregiver
• Seek proximity and contact but also show open
  resistance to contact
• Super-anxious during separation
• Not easily soothed at reunion
• Seem angry or passive toward parent
• Disorganized-disoriented 10
• Disorganized sequences Approach then avoid
• Contradictory behavior
• Odd motor activity Inappropriate stereotyped,
  repetitive gestures
• Attachment behavior directed toward stranger when
  caregiver returns
• Depressed, dazed, disoriented, Flat affect

21
Attachment in Childhood

• Stages of development
• Stability of attachment
• Factors impacting attachment

22
Stages of Development

• 1. Pre-attachment (0 - 2 months)
• indiscriminate social responsiveness preference
  for faces
• 2. Attachment-in-the-making (2 - 7 months)
• preference for primary caregiver, but no distress
  when the caregiver is gone
• 3. Clearcut Attachment (8-24 months)
• Proximity seeking
• Stranger anxiety
• Separation anxiety
• Greeting reactions
• Secure-base behavior
• 4. Reciprocal relationships (18 months )
• Understand caregivers coming and going and
  predict their return, and care for attachment
  figures needs
• Internal Working Model
• A mental model that infants build as a result of
  their experience with their caregivers

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Stability of Attachment Category

• Classification stability is generally high,
  ranging from 50 to 96 for assessments 2 to 6
  mos. apart or longer (Solomon George, 1999).
• Highest stability levels are generally found in
  middle-class samples, and the lowest in
  disadvantaged samples.

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Stability of Attachment

• Fonargy, Steele, and Steele (1991)
• mothers prenatal attachment categorization
  (secure v insecure) predicts the infant-mother
  attachment categorization, when the infant was 12
  months old, 75 of the time.

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Stability of Attachment

• Benoit and Parker (2000)
• Found concordance between the attachment
  categorizations of grandmothers, mothers, and
  their infants
• Criticisms
• Small sample size
• Middle to Upper-middle class respondents who
  typically are stable over many variables
• Only found concordance using 3 categories of
  attachment. Effect disappears when using 4
  categories

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Stability of Attachment

• Waters (1978) 96 concordance rate in strange
  situation attachment classifications of infants
  tested at ages 12 and 18 months
• Similar findings by Frodi, Grolnick, Bridges,
  1985 Main Weston, 1981

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Stability of Attachment

• However
• Thompson, Lamb Estes (1982) 53 of infants were
  assigned the same attachment classification at 12
  and 18 months
• Belsky, Campbell, Cohn, Moore, 1996, and
  Easterbrooks, 1989, report similar results
• Easterbrooks (1989), and Main and Weston (1981)
  report a similar pattern of instability of
  attachment categorization for infant-father
  attachment in the Strange Situation Test

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Stability of Attachment

• Thompson, Lamb, Estes, 1982
• mothers returning to work and/or the infant
  experiencing a change in the primary caregiver
  was associated with change in attachment
  categorization.
• Yet the distributions at time 1 and 2 matched
  Ainsworth et als (1978) distribution
• And, changes were bi-directional. I.e., insecure
  infants just as likely to become securely
  attached, as secure infants were to become
  insecurely attached

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Effect of lack of an attachment bond

• Bowlby (1953)
• Strong attachment to single mother figure is
  essential for later mental health.
• 'Affectionless psychopathy may characterise
  those who are deprived of an early attachment
  bond.
• Effects of lack of attachment relationship or
  break in the relationship are called maternal
  deprivation.
• Bowlby considered that there was a critical
  period from about 6 months to 3 years when
  infants should have continuous, unbroken
  relationship with one person (monotropism).

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What are the causes of disruption?

• Factors which occur after birth which may
  interfere with the attachment bond
• Adoption
• Death of a parent
• Abuse
• Neglect
• Unresolved chronic pain (earache or colic)
• An emotionally cold mother
• Frequent changes of address
• Inadequate care.

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Causes of the development of different attachment
styles?

• Maternal Sensitivity
• Attachment group membership predicted by number
  of mother-child synchronous behaviours.
• Intrusive mother behaviour relates to avoidant
  behaviour.
• Unresponsive mother behaviour relates to
  resistant ambivalent behaviour.

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Attachment in High Risk Populations

• Abuse/neglect more likely to exhibit
• disorganized (Cole-Detke Kobak, 1998)
• avoidant (Lyons-Ruth, Connell, Zoll, Stahl,
  1987)
• Physically Handicapped Infants
• No difference in attachment style distribution
  from normals (Cappuzzi, 1989 Wasserman, Lennon,
  Allen, Shilansky, 1987)

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Attachment in High Risk Populations

• High Social Risk/Low SES
• More likely to be insecurely attached
  (Susman-Stillman, Kalkose, Egeland, Waldman,
  1996 Fish, 2001)
• Secure versus Insecure predicted my maternal
  sensitivity
• Infant temperament predicted type of insecure
  attachment
• Prenatal Substance Abuse
• Prenatal substance abuse throughout pregnancy and
  infant self-soothing behavior positively related
  with security of attachment (p lt .03).

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Does attachment to father matter?

• At 18 months of age 50 of infants have strong
  attachments to someone other than their mother.
• Main Weston (1981) Strength of attachment to
  father depended upon the amount of time father
  spends with child
• Fox et al., (1991) found children showed similar
  kinds of attachment to both parents.

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Attachment Style and Cognitive Development

• Cassidy (1988) Kindergarten childrens self
  esteem scores were related to secure attachment
  to caregiver
• Frankel Cates (1990) Securely attached infants
  become better problem solvers
• Crandell Hobson (1999)
• Compared 20 secure 16 insecure Mentally
  Challenged mothers and their 3-year-old children
• Children of secure mothers scored 19 points
  higher on the Stanford-Binet IQ test.
• Degree of parent-child synchrony was also related
  to child IQ.
• Fonagy et al., (1997) Secure pre-schoolers and
  young school aged children more competent in
  theory of mind task.

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Attachment Style and Social Development

• Park Waters (1989) Securely attached children
  coordinate their activities with friends more
  harmoniously.
• Meins Russell (1997) Greater social
  responsiveness and flexibility in securely
  attached two and a half year-old children.
• Sroufe et al., (1993) Longitudinal study. At
  10-11 years children classified as securely
  attached in 1st year of life had many more
  favourable outcomes.
• Avoidant infants became isolated children.
• Ambivalent infants became deviant and more
  difficult (e.g. hyperactive, aggressive).

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Attachment Style Social Development (Cont.)

• Moss et al., (1996)
• Link between psychopathology and Disorganized
  attachment style
• This may be the result of the infants need to
  seek comfort from a caregiver who provokes fear.
• Majority of children with Disorganized
  classification showed problems during the 3-7
  year-old period
• It must be remembered that only 5 of children
  were classified as disorganized

38
Conclusions

• Childhood Attachment develops in stages
• Affected by SES, Abuse, Maternal Sensitivity,
  Prenatal care, Disruptions in primary caregiver
• Childhood attachment affects Cognitive Social
  Development

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Attachment in Adulthood

• What is attachment in adulthood
• Interpersonal relationships

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Adult Attachment

• Main
• Adult Attachment Interview (AAI)
• Four categories of attachment that are
  theoretically empirically related to childhood
  categories
• Hazan Shaver
• Attachment Questionnaire - 3 items
• Effect of attachment style on romantic
  relationships
• Feeny Noller
• Importance of parental responsiveness in early
  childhood
• Secure attachment style related to greater
  self-esteem, self-confidence, and less anxiety

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Adult Attachment

• Mental Models of Self and Others
• Secure
• Self - friendly, likeable
• Others - reliable, trustworthy
• Anxious/ambivalent
• Self - unconfident, underappreciated
• Others - unreliable, noncommittal
• Avoidant
• Self - suspicious, aloof
• Others - unreliable, overeager

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Adult Attachment

• Issues in adult attachment theory research
  related to close interpersonal relationships
• Stability of attachment style
• Relationship characteristics satisfaction
• Relationship dissolution

43
Related Research

• Gerontology

44
Elderly Attachment Continued
45
Simpson (1990)

• Impact of attachment style on
• Nature of relationship
• Interdependence
• Commitment
• Trust
• Relationship satisfaction
• Emotional experiences related to relationship
• During relationship
• Relationship dissolution

46
Simpson (1990)Method

• Participants
• University students
• 144 heterosexual dating couples
• M age men 19.4
• M age females 18.7
• M length of relationship 13.5 months
• 92 in relationship for more than 1 month

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Simpson (1990)Results

• Attachment Relationship Indexes
• Secure style greater
• interdependence, commitment, trust,
  satisfaction
• more frequent positive emotions
• less frequent negative emotions
• Insecure styles
• less frequent positive emotions
• more frequent negative emotions

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Simpson (1990)Results
49
Simpson (1990)Results
50
Simpson (1990)Results

• Relationship dissolution
• Avoidant men least emotional distress

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Simpson (1990)Summary

• Attachment style related to quality of romantic
  relationships.
• Attachment style related to emotional experience
  within romantic relationships.
• Attachment style related to response to
  relationship dissolution

52
Simpson (1990)Summary

• Perception of relationship related to own
  attachment style and not partners
• But, anxious women tended to date avoidant men,
  and anxious men were dating less secure women
• Stability of attachment style
• Attachment style not affected by length of
  relationship

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Attachment Sexual Offending

• Why attachment?
• Theories
• Research

54
Theories of Relationship of Attachment to Sexual
Offending

• Freund (1960s)
• Marshall Barbaree (1990)
• Marshall (1993)
• Ward (1994)
• Marshall Marshall (2000)
• Smallbone (2004)

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Freund

• Sexual Offending is a Disorder of Courtship
• Four stages of courtship (Problem)
• Finding a prospective partner (Voyeurism)
• Attracting Attention (Exhibitionism)
• Touching (Frotteurism)
• Sexual Interaction (Rape)
• Criticisms
• Little evidence of courtship behavior in sexual
  assault
• Why dont females have courtship disorder
  problems?

56
Marshall Barbaree, 1990

• First Integrated theory of sexual offending
• Biological Influences
• Childhood Experiences
• Sociocultural Context
• General Cultural Features
• Availability of Pornography
• Transitory Situational Factors

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Marshall reports that intimate attachments
provide...

• sense of security and emotional comfort
• companionship and a sense of shared experience
• a chance to be nurturing and to be nurtured
• reassurance and self-worth
• support during adversity
• a sense of meaning in ones life
• provides a sense of kinship, belongingness
• Marshall, 1989 1993 Marshall et al., 1993

58
High Intimacy Individuals are characterized by...

• Greater
• ability to withstand stress
• resistance to depression and anxiety
• physical health
• Psychological well-being

59
High Intimacy Individualsare perceived by others
to be...

• warm and sincere
• egalitarian
• cooperative
• confident
• interpersonally skilled
• nonaggressive
• empathic, caring

60
Low Intimacy Individuals are characterized by...

• aggression or hostility
• distrust of others
• low self-esteem
• poor interpersonal skills
• lack of depth in relationships
• low empathy
• feelings of emptiness/emotional loneliness

61
Bartholomews Model of Attachment

• Two Dimensions - Inner working models of Self
  Others
• Self as capable of inspiring love in others
• Others as capable of being loving (reliability)
• Four Categories
• Secure
• Preoccupied
• Fearful
• Dismissive

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Bartholomews Dimensional Model of Attachment
63
Bartholomew

• Secure Comfortable with closeness and autonomy
• Preoccupied desperate for acceptance, low
  self-esteem
• Fearful Fearful of closeness, low sense of
  self-worth
• Dismissive Avoidant of closeness,
  anti-interdependence

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Bartholomew Continued

• Measures
• RQ
• RSQ
• Criticisms
• Reliability of measures
• Over-endorsement of the Secure category
• Not measured under conditions likely to inspire
  attachment behavior

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66
Marshall, W.L. (1993). The role of attachment,
intimacy, and loneliness in the etiology and
maintenance of sexual offending. Sexual and
Marital Therapy, 8, 109-121

• Attachment problems, Intimacy deficits,
  Loneliness contribute to a propensity to offend
  sexually

67
Marshall, 1993

• Vulnerability for sexual offending is key
• Vulnerability arises from poor quality
  parent-child attachment
• Poor childhood attachment leads to
• Low self-confidence
• Impoverished social skills
• Lack of empathy

68
Marshall, 1993

• Poor childhood attachment impair ability to form
  appropriate peer adolescent relationships
• Social messages
• Objectification of others
• Portray others as instruments of sexual pleasure
• Emphasize power and control over others
• Deny the need for social skills and compassion
  for others

69
Marshall, 1993

• Poor childhood and adolescent attachment
• Impair possibility for satisfactory adult
  relationships
• Provide basis for loneliness as an adult
• Diminish chance of intimacy in adult
  relationships
• Emotional loneliness
• A strong predictor of aggressive behavior (e.g.,
  Check, Perlman, Malamuth, 1985)
• Promotes a self-serving lifestyle

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Sexual Offenders

• W. L. Marshall et al
• Sexual offenders lack intimacy
• emotional loneliness increases aggression
• Sexual offenders show greater insecure attachment
  than non-sexual offenders and community controls

71
Sexual Offenders Continued

• Smallbone Dadds (1998)
• Prisoners
• 48 Sexual Offenders
• 16 Property Offenders
• 16 Non-Offenders
• Childhood maternal Paternal Attachment
• Adult Attachment

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Sexual Offenders Continued

• Smallbone Dadds (1998)
• SOs
• Less secure maternal, paternal, adult
  attachment than nonoffenders
• Less secure maternal attachment than property
  offenders
• Incest offenders more problems with mother
• Stranger rapists more problems with father

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Marshall, Marshall, Arujo-Salas (1999)

• Participants
• 30 Community Controls
• 30 Incarcerated Non-Sexual Offenders
• 32 Sexual Offenders (18 with adult victims, 14
  with child victims)

74
Marshall, Marshall, Arujo-Salas (1999)

• Measures
• Screening measure (for community and non-sexual
  offenders)
• Attachment
• Adult - Relationship Scales Questionnaire (RSQ)
  (Bartholomew Horowitz, 1991)
• Childhood - Attachment Questionnaire relating to
  father and mother (CAM, CAF) (Hazan Shaver,
  1986),
• Others
• Social Self-Esteem Inventory (Lawson, McGrath,
  Marshall, 1979)
• Interpersonal Trust Scale (ITS) (Rotter, 1971)

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Sexual Offenders Continued

• Marshall (1999)
• Sexual offending
• insecure maternal attachment
• Avoidant paternal attachment
• preoccupied attachment style in adulthood
• Secure maternal attachment
• secure adult attachment style
• neg r to fearful adult attachment style
• greater social self-esteem

76
Sexual Offenders Continued

• Smallbone Dadds (2000) -Male University
  Students
• Maternal anxious attachment general antisocial
  behavior
• Paternal avoidant attachment general antisocial
  behavior coercive sexual behavior

77
Etiological steps to sexual offending Marshall
Marshall, 2000
78
Marshall Marshall, 2000

• Sexual Offenders
• Childhoods marked by disruption, rejection, and
  poor parenting
• Often report being loners as children
• Earlier sexual involvement including
  masturbation
• Earlier and greater use of drugs and alcohol

79
Marshall Marshall (2000)

• Anxious/Ambivalent
• Low self-esteem, poor interpersonal skills,
  desperate need for attention increased risk for
  sexual abuse
• Research has shown sexual offenders to be more
  likely to report having been sexually abused as a
  child (Hanson Slater, 1998 Dhawan Marshall,
  1996 Marshall Mazzucco, 1995 Marshall, Serran
  Cortoni, 2000
• May view abuse in positive terms and attribute
  any negative consequences to flaws in their own
  character

80
Marshall Marshall (2000)

• Juvenile Sexual History
• Abel and Rouleau (1990) 40-50 of child
  molesters 30 of rapists report an interest in
  sexually deviant activities before age 18 years
• Cortoni Marshall (2000)
• No differences in onset of various sexual
  activities or number of peer-aged sexual
  partners.
• But, higher frequency of sadomasochistic
  fantasies and higher rates of masturbation during
  teens.
• Frequency of juvenile masturbation predicted
  adult use of sex as a coping strategy, which
  predicted adult sexual aggression.

81
Marshall Marshall (2000)

• Sex as a coping strategy
• Children deprived of love and affection use
  self-stimulation as a way to feel better
• Children learn quite early to masturbate and that
  this behaviour is pleasurable (Masters, Johnson
  Kolodny, 1985)
• Consequently, use masturbation as a
  self-regulatory strategy

82
Relationship of Coping to Sexual Offending

• Neidigh Tomiko (1991)
• Daily stressors - Self-denigrating strategies
• Urges to offend - Self-denigrating strategies
  Avoidance
• Looman, 1999 Proulx et al, 1998
• When in a negative mood sexual offenders use
  deviant fantasizing as a coping strategy

83
Marshall Marshall (2000)

• Sex as a coping strategy
• Cortoni Marshall (2000), and Marshall, Serran
  Cortoni (2000) Sexual offenders tend to use poor
  coping strategies (emotion-focussed,
  avoidance-focussed)
• Sexual offenders more likely than matched
  controls to use sex as a coping strategy

84
Relationship of Coping to Sexual Offending

• Marshall et al
• Child molesters use more emotion-focused
  strategies (e.g., blaming oneself,
  self-preoccupation, and fantasizing) compared to
  rapists, non-sex offenders, and non-offenders
• Sex as a coping strategy related to both
  emotion-focused and avoidance coping strategies
• Negative mood induction related to
• Lower self-esteem
• Greater anxiety

85
Conditioning Processes

• Conditioning processes play a part in the
  development of eccentric and deviant sexual
  behaviours (Abel Blanchard, 1974 McGuire,
  Carlisle Young, 1965)
• Sexual preference hypothesis
• Negative and positive reinforcement
• Sex may be used to achieve feelings of intimacy,
  obtain affection, alleviate boredom or
  frustration, obtain self-affirmation, achieve a
  sense of conquest, escape from problems, fulfill
  a need to exercise power and control over another
  person, exploration of sexual taboos (e.g., anal
  intercourse), and releasing pent up anger

86
Marshall Marshall (2000)

• Child molesters have been found to be afraid of
  potential adult partners and threatened by sex
  with an adult but feel emotionally congruent with
  children (Howells, 1979)
• Rapists may have felt anger toward parents for
  maltreatment, blame women for their lack of
  interpersonal skills and incorporate aggression
  toward women into masturbatory fantasies.
• Rapists hold negative and hostile views of women
  (Burt, 1980 Marshall Hambley, 1996),

87
Marshall Marshall (2000)

• Disinhibiting factors
• Alcohol has been shown to disinhibit social
  constraints (Firestone, Keyes Korneluk, 1999),
  encourage the expression of aggression (Bushman
  Cooper, 1990), and facilitate sexual arousal
  (Wilson, 1981)
• Abel et al (Abel, Becker Cunningham-Rathner,
  1984 Abel, Gore, Holland, Camp, Becker
  Rathner, 1989) cognitive distortions disinhibit
  sexual offenders belief that children are
  sexually disposed, behave sexually provocatively
  toward adult males, initiate sexual activity with
  adults, enjoy such activity, and are not harmed
  by sex with an adult.

88
Marshall Marshall (2000)

• Disinhibiting factors
• Rapists have been shown to express views of women
  and their sexuality that can be expected to
  facilitate rape (Bumby, 1990 Burt, 1984
  Marshall Hambly, 1996).
• Hostility toward women, support for rape myths,
  condoning violence toward women, and distorted
  perceptions toward women
• Mood states have all been shown to
  trigger/disinhibit deviant sexual fantasies in
  sexual offenders loneliness, anger, humiliation,
  depression, feelings of inadequacy and conflict
  in a relationship, (Looman, 1999 McKibben,
  Proulx Lusignan, 1994 Proulx, McKibben
  Lusignan, 1996).

89
Marshall Marshall (2000)

• Opportunity
• Planning
• Grooming
• Cognitive deconstruction
• Opportunistic
• Further conditioning processes
• Fantasizing about offence during masturbation

90
Etiological steps to sexual offending Marshall
Marshall, 2000
91
Burk Burkhart (2003)

• Disorganized attachment as a diathesis for sexual
  offending
• Children develop organized means of controlling
  attachment relationships around age 6
• Punitive or Caring
• Self-control through the control of others
• DA children externalize attempts to self-regulate
• Control of others, though, precludes formation of
  secure attachments (reciprocity key to secure
  attachment)
• May use sex with others as a way to self-regulate

92
Ward, T., Hudson, S.M., Marshall, W.L.,
Siegert, R. (1995). Attachment style and intimacy
deficits in sex offenders A theoretical
framework. Sexual Abuse A Journal of Research
and Treatment, 7, 317-335.

• Insecure attachment style will be related to
  style of sexual offending
• Preoccupied
• Fearful
• Dismissive

93
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94
Sexual Offenders Continued

• Marshall et al (2002 2004)
• Preoccupied attachment style related to
• Grooming behaviour
• low levels of violence
• Child molesters not rapists

95
Grooming Behaviour among Differentially Attached
Child Molesters
From Marshall Marshall, 2002
96
Smallbone - 2004

• Meshing of Biological systems
• Nurturing (Parenting)
• Attachment
• Sexual

97
Siegal (2000)

• Neural adaptation to insecure attachment style
• Bypass of normal behavioural inhibition processes

98
Marshall Moulden, 2004

• Hypotheses based on Smallbone
• Attachment styles with a positive view of others
  will be related to sexual offending
• Lower levels of violence
• Grooming behaviour
• Child molesters
• Results
• Hypotheses not supported

99
Conclusions

• Little research on Attachment in sexual offenders
  
• 43 articles dissertations compared to more than
  20,000 for attachment in general
• Sexual offending and attachment theory relatively
  new and needs further exploration
• Attachment theory has potential utility for
  understanding sexual offending

100

• SECURE It is easy for me to become emotionally
  close to others. I am comfortable depending on
  them and having them depend on me. I dont worry
  about being alone or having others not accept me.
• FEARFUL I am uncomfortable getting close to
  others. I want emotionally close relationships,
  but I find it difficult to trust others
  completely, or to depend on them. I worry that I
  will be hurt if I allow myself to become too
  close to others
• PREOCCUPIED I want to be completely emotionally
  intimate with others, but I often find that
  others are reluctant to get as close as I would
  like. I am uncomfortable being without close
  relationships, but I sometimes worry that others
  dont value me as much as I value them
• DISMISSIVE I am comfortable without close
  emotional relationships. It is very important to
  me to feel independent and self-sufficient, and I
  prefer not to depend on others or have others
  depend on me

101
Outcome for Our Program
102
Therapists in therapy

• What does the research show?

103
Positive therapist features

• An ability to create an appropriate alliance with
  the client
• Ability to generate a belief in the possibility
  of change
• Providing opportunities for learning
• Instilling the expectation in the client that
  therapy will be beneficial
• Emotionally engaging clients

104
Therapist Interpersonal Characteristics

• Empathy - the ability of the therapist to attempt
  to understand and relate to, the feelings of the
  client.
• Genuineness - described as non-defensive,
  comfortable with themselves, involved in
  treatment sessions, honest and interested.
• Warmth - refers to accepting, caring and
  supportive behaviour of the therapist.

105
Therapist Interpersonal Characteristics

• Support - reflected by positive valuation,
  encouragement and comforting statements.
• Clients appear less aggressive and resistant
  toward therapists who are rated as highly
  supportive.
• Confidence - confident presentation by the
  therapists is crucial to effective treatment.
• Emotional responsivity - encouragement of
  emotional expressiveness by clients and emotional
  experiences during treatment.

106
Therapist Interpersonal Characteristics

• Open-ended questioning - helps the client develop
  insight into his/her difficulties and assists in
  cognitive restructuring.
• Problematic reactions by clients reduced in
  frequency when open-ended questions used.
• Directiveness - encourage clients to exhibit and
  practice particular behaviours in and out of
  therapy - optimal level - can increase negativity
• Provides structure for clients and enhances
  likelihood of cooperation.

107
Therapist Interpersonal Characteristics

• Flexibility - different clients and the same
  clients at different times can respond
  differently to the same counselor skills.
• E.g. directive approach may work with submissive
  clients but increases aggression in defensive
  clients.

108
Therapist Interpersonal Characteristics

• Encouraging active participation - clients who
  actively participate are more likely to
  successfully complete therapy and experience
  positive outcomes.
• Increases clients levels of commitment to, and
  compliance with the therapeutic process,
  reactance is reduced.
• Clients more likely to participate when new and
  positive behavior is targeted rather than a
  negative behaviour is to be reduced.

109
Therapist Interpersonal Characteristics

• Rewarding - reinforcement or encouragement
  typically given initially for small steps in
  right direction and then gradually moved to
  chains of small steps.
• Respect - behaving toward clients in a respectful
  manner conveys they are valued and models the
  type of behaviour therapists expect in return.
• Disrespectful responses to clients defenses have
  been related to poor outcome.
• In a series of studies treatment dropouts
  reported feeling disrespected by the therapist.
• (Marshall et al., 2001 Strupp, 1980 Salzman,
  Luetgert, Roth, Creaser, Howard, 1976
  Rabavilas et al., 1979)

110
Therapist Interpersonal Characteristics

• Use of humour
• may increase social interest.
• May reduce feelings of inferiority, help clients
  recognize the value of humour in their lives.
• Suggested it helps create a therapeutic
  atmosphere of freedom and openness.
• Releases tension, decreases anxiety, increases
  therapist-client cohesion.
• But must be in context of empathic relationship.
• Little research to date.
• (Rutherford, 1994 Greenwald, 1987 Falk Hill,
  1992 Marshall et al., 2001.)

111
Features That Impede Change

• Poor outcome is also associated with the quality
  of the therapeutic relationship.
• Negative therapist behaviours include
• Confrontational behaviour
• Rejection of the client
• Low levels of interpersonal skills
• Lack of interest in the client
• Manipulation of client for therapist needs
• (Marshall et al., 2001.)

112
Features That Impede Change

• Anger and hostility
• Negatively affects therapist-client relationship
  and treatment outcome.
• Major characteristic of poor outcome cases is
  therapist hostility in response to client
  negativism.
• Therapist expressing anger toward client
  associated with disrupted relationship and
  diminished progress.
• (Marshall et al., 2001 Strupp, 1980 Cullari,
  1996 Fremont Anderson, 1986)

113
Confrontation

• Particularly damaging to clients with low
  self-esteem.
• Associated with noncompliance in treatment.
• Clients react by
• discrediting or challenging therapist
• devaluing the issue
• agreeing on surface but dismissing the relevance
  of the issue
• (Annis Chan, 1983 Patterson Forgatch, 1985
  Cormier Cormier, 1991)

114
Clients perception of the therapist

• Positive correlation between clients perception
  of the quality of the therapeutic relationship
  and perception of positive outcome.
• (Walborn, 1996)
• These perceptions significantly influence client
  compliance and predict treatment outcome.
• (Saunders, 1999)
• Consequently it is not enough for therapists to
  believe they are displaying appropriate
  characteristics
• (Schindler et al., 1983 Ryan Gizynski, 1971
  Ford, 1978 Marshall et al., 2001.)

115
Clients perceptions of the therapist

• Greater treatment benefits generated by
  therapists who are perceived as
• Confident
• Involved
• Focused
• Emotionally engaged
• Have positive feelings toward the client
• Directive
• Persuasive
• Sincere

116
Clients perceptions of the therapist

• Therapists are relatively poor at evaluating
  their own therapeutic characteristics and style.
• In 34 of 47 studies clients estimates of
  therapist features correlated with beneficial
  treatment effects.
• Therapist ratings were related to outcome in only
  4 of 15 studies.
• (Free, Green, Grace, Chernus, Whitman, 1985
  Orlinsky et al., 1994)

117
Therapeutic Alliance/Atmosphere

• The therapists interpersonal characteristics and
  techniques in combination with the clients
  perceptions of the therapist play important roles
  in establishing the therapeutic alliance.
• Valued as the context of therapeutic change.
• Key component is collaboration between client and
  therapist.
• (Luborsky, Barber, Chris-Christoph, 1990
  Marshall et al., 2001 Safran Murran, 1996
  Matt Navarro, 1997)
• Strict adherence to treatment manuals without
  establishing a good therapeutic alliance is not
  effective. (Fernandez Serran, in press)

118
Therapeutic Alliance

• Poor outcomes show greater evidence of negative
  interpersonal process in the therapeutic
  relationship.
• particularly hostile and complex interactions
  between therapist and patient.
• Ratings of the therapeutic alliance have been
  shown to predict dropouts from treatment.
• (Marshall et al., 2001.)

119
Therapeutic Process in the Treatment of Sexual
Offenders
120
CLIENTS PERSPECTIVES(Drapeau, in press)

• 1. See therapist as crucial but also see value
  of procedures
• 2. Base judgments of quality of the program on
  the skills of the therapist
• 3. Good therapists are seen as honest,
  respectful, nonjudgmental, available, caring,
  confident, competent, and persuasive
• 4. Good therapists encourage discussion, listen,
  display leadership and strength, and maintain
  order
• 5. Do not respond to therapists who are
  critical, devaluing, or confrontational
• 6. Many clients who do well say they are able to
  re-enact aspects, with the therapist, of their
  past reactivation of attachment schemas with
  the therapist
• 7. Most prevalent interpersonal interactions
  involve therapist supportively challenging the
  clients in a caring manner
• 8. Clients desire to participate in decision
  making (work collaboratively) and they wish to
  attain mastery and feel competent

121
GROUP CLIMATE(Beech Fordham, 1997 Beech
Hamilton-Giachritis, in press)

• Used Moos (1986) Group Environment Scale 10
  subscales
• Pre to post-treatment changes produced a
  composite score to identify magnitude of
  treatment-induced gains
• Two of Moos subscales (Cohesion and
  Expressiveness) were significantly related to the
  composite measure of treatment gains
• - Cohesion includes involvement, participation,
  commitment to the group, and concern and
  friendship for each other
• - Expressiveness measures the encouragement of
  freedom of action and the expression of feelings

122
EMOTIONAL EXPRESSION AND MASTERY(Pfäfflin et
al., in press)

• Expressions of understanding (mastery) of the
  relevant issues appear first in treatment
• Emotional expression emerges later in treatment
• When emotional expressions first appear, mastery
  statements are reduced
• When emotional expression and mastery statements
  appear together, changes begin to occur quite
  rapidly

123
Marshall, Serran et al., 2001

• Examined therapist features and their
  relationship to client changes in sexual offender
  treatment.
• Videotaped sessions rated and then related to
  pre-post treatment changes.

124
Therapist features that were related to
significant treatment - induced changes

• Warmth
• Empathy
• Rewarding
• Directive

125
Results of regression analyses
126
Treatment strategies
127
Treatment Strategies

• Three approaches have typically been used
• a) Confrontational approach
• b) Unchallenging approach
• c) Motivational approach

128
Self-esteem
129
Enhancing client self-esteem as a therapeutic
technique

• Why is it important for some group members to
  improve their self-esteem?
• What techniques can you use?

130
Low self-esteem individuals

• Engage in self-handicapping behaviours such as
  practicing tasks less often.
• are less inclined to make commitments to change.
• perceive greater costs to involving themselves in
  situations which might threaten their self-image.
• do not expect change will lead to benefits.
• more readily give up efforts.
• more likely drop preventive strategies.
• (Baumeister, 1993)

131
Low self-esteem individuals cont.

• Engage in more frequent cognitive distortions.
• have poorly defined self-concepts.
• are reactive to self-relevant feedback and feel
  more threatened by negative feedback.
• experience more mood fluctuations (greater
  frequency and intensity of emotional distress).
• Brustad, 1988 Campbell, Chew Scratchley, 1991
  Harter, 1993 Janis Mann, 1977 Silberstein,
  Stiegel-Moore Rodin, 1988 Spencer et al.,
  1993 Wills, 1981.

132
Negative Emotions linked to low self-esteem

• Depression
• Trait anxiety
• Hopelessness
• Suicidal ideation
• Baumeister, 1990 Beck, 1976Harter, 1993 Tarlow
  Haaga, 1996.

133
Increased Self-esteem

• Increases belief in ability to perform novel
  tasks.
• Increases efforts at change.
• Increases belief that change will be a benefit to
  the individual.
• Spencer et al., 1993.

134
Importance of Self-esteem to Sexual Offending

• Self-esteem linked to aggressive behaviour.
• Association between self-esteem and sexual
  offending
• empathy deficits, social competence, intimacy,
  loneliness

135
Importance of Self-esteem to Sexual Offending
cont.

• Low self-esteem may cause the individual to
  channel violent tendencies toward targets
  perceived to be weak such as women and children.
• Baumeister, Smart Boden, 1996.

136
Ways in which sexual offenders may try to protect
their self-esteem

• Establish social and romantic relationships with
  other low self-esteem individuals
• denigrate their victims
• focus on portraying themselves in a favourable
  light
• comparing their offenses with others

137
Ways in which sexual offenders may try to protect
their self-esteem

• engaging in stereotypic or prejudiced behaviours
• avoiding risky situations (like group
  treatment) where they may receive negative
  feedback
• conceiving of their behaviour as a sickness
• seeing himself as a victim

138
Relationship Between Social Self-esteem and Other
Variables
139
Relationship Between Social Self-esteem and Other
Variables

• Sexual offenders low in SSE tend to be
• More anxious
• More susceptible to negative moods
• Acute risk factor!

140
Enhancement of Self-esteem

• Contextual Factors
• support from non-therapy staff
• acceptance by other inmates/residents
• Therapist/Client Factors
• therapist characteristics
• therapist style
• therapist/client relationship

141
Enhancement of Self-esteem cont.

• Range/frequency of social and pleasurable
  activities
• Educational/occupational skills
• Positive self-statements

142
Therapist strategies for improving self-esteem

• Distinguish between the offender as a person and
  his behaviour
• Emphasize strengths/positive characteristics
• Reinforce effort

143
Therapist strategies for improving self-esteem

• Remind them of their positive progress
• Recognize when denial/minimization is related to
  self-esteem problems and address it appropriately
• Provide face-saving ways out of excuses and
  rationalizations

144
What can we do as therapists?

• Primarily focus on positives
• Use supportive challenges
• Give positive feedback before and after negative
  feedback

145
What can we do as therapists?

• Make sure therapy goals are in line with
  abilities
• For low SE clients a series of small achievable
  goals may enhance performance
• For high SE clients more challenging assignments
  may enhance performance

146
Group exercises for improving self-esteem

• Complete the following exercise
• Write a list of 6 to 8 positive things about
  yourself in at least 4 categories.

147
Therapist Strategies for Improving Intimacy

• Outline the benefits of achieving intimacy.
• Outline the costs of remaining lonely.
• Look at the origins of intimacy
• childhood attachments
• adult attachment style
• emphasize the breadth of intimacy (partners,
  close friends, acquaintances).

148
Group Exercises for Improving Intimacy

• Have the group discuss the following questions
• What is intimacy?
• Why is intimacy important to you personally?
• What has poor intimacy kept you from achieving in
  the past?
• How will improved intimacy benefit you personally?

149
Finding a partner

• Ask clients to
• consider what sort of features to look for in a
  partner.
• create list of important features (encourage
  compatible features rather than physical).
• practice skills while dating (not every
  relationship must become long-term).

150
Relationship Skills Building

• May need to address issues of
• social skills, empathy, self-confidence.
• seeking a compatible partner.
• progressing slowly (challenge relationship myths
  such as love at first sight).
• learning from relationships - dont blame.
• expanding breadth of intimacy - more support if
  partner is lost.

151
Relationship Skills cont.

• developing ability to effectively initiate and
  maintain conversations
• developing listening skills
• overcoming social anxiety and shyness

152
Maintaining a relationship

• Have clients identify skills for maintaining a
  relationship, such as
• Good communication skills - both verbal and
  nonverbal
• capacity for trust
• self-confidence

153
Maintaining a relationship cont.

• appropriate self-disclosure
• conflict resolution
• challenging dysfunctional expectations (e.g.,
  partner can never change)
• engaging in enjoyable activities together while
  maintaining some independence

154
Loneliness

• Social Loneliness
• 1. Removed from prior social circle (i.e., job
  transfer).
• 2. Isolated from others - prison or hospital or
  by choice.
• 3. Restricted social range - few friends, few
  activities.

• Emotional Loneliness
• 1. Removed from intimates.
• 2. Feelings of alienation.
• 3. Poor quality (e.g., little depth)
  relationships.

155
Therapist Strategies for Addressing Loneliness

• Have the group discuss the following questions
• What is loneliness?
• What is the difference between emotional
  loneliness and social loneliness?
• Is being alone (i.e., not a in a relationship)
  the same as being lonely?

156
Loneliness Treatment cont.

• Identify and discuss fears of either being in a
  relationship or not being in a relationship.
• Challenge bases for feeling lonely
• being alone does not mean you are worthless
• positive things about being without a partner
• Enhance self-confidence.

157
Group Exercises for Treating Loneliness

• Have each group member create a list of the basic
  skills for building a relationship.
• Have each group member write out a list of what
  they would seek in a compatible partner.

158
Group Exercises for Treating Loneliness

• Have each group member create a list of mutually
  enjoyable activities which partners may pursue
  together.
• Have each group member create a list of things
  they can do when they are not in a relationship
  that they might not do otherwise?

159
Jealousy
160
Why Jealousy is Important to Sexual Offending

• Jealousy reflects a desire to control the
  relationship, betraying selfish desires rather
  than love.
• Many people interpret unfaithfulness (believed or
  real) by their partner to indicate they are
  worthless and perceive their partner in absolute
  terms (i.e., all bad).
• Independent partners may generate jealousy in men
  who lack self-esteem.

161
Suspicious Jealousy vs. Reactive Jealousy

• Suspicious Jealousy
• based on partners past behaviour
• but becomes exaggerated and persistent despite
  obvious changes by partner
• Reactive Jealousy
• response to clear evidence of infidelity
• but degree needs to be proportional to the
  betrayal

162
Jealousy

• Even if clear evidence, what do you do?
• Exam attributions (e.g., I am worthless, she is
  evil).
• Persist in working through feelings.
• Examine degree of perceived betrayal and analyze
  if reaction is in proportion.
• Recognize that the rational response is still
  painful.
• Self-reliance is more effective than distraction.

163
Factors That Influence Jealousy

• Greater frequency of unfaithfulness by partner.
• Degree to which partner is involved with other
  person.
• Who the person is (more attractive people are
  seen as a greater threat).
• Degree of unfaithfulness of the jealous person.
• Independence of partner (particularly for those
  with low self-esteem).

164
Therapist Strategies for Addressing Jealousy

• Have the group discuss the following questions
• What is the difference between suspicious
  jealousy and reactive jealousy? Which one is
  most damaging?
• What factors increase the chances you will feel
  jealous of your partner?
• Does jealousy reflect true love?

165
Group Exercises for Addressing Jealousy

• Have each group member create a list of
  attributions people often make when they believe
  their partner has been unfaithful.
• Have the group discuss how you could challenge
  each attribution.
• Have each group member create a list of possible
  strategies for dealing with unfaithfulness or a
  dissolved relationship.

166
Loneliness Jealousy
167
Sexuality

• Having sex isnt the problem

168
Why Sexuality is Important to Sexual Offending

• Sexual satisfaction is related to levels of
  satisfaction in the rest of the relationship.
• Many sexual offenders have very poor knowledge of
  sexuality in general.
• Myths about sex reduce the chances of obtaining a
  satisfying sexual relationship.
• Becoming comfortable talking about sex in general
  may make discussion of offenses easier.

169
Sexual Relations

• Differences between males and females
• Males are body-oriented, females are
  person-oriented.
• For males physical gratification is primary, for
  females emotions and commitment are primary.
• Females count love as more important in their
  lives than do males.

170
Sexual Relations cont.

• When females are dissatisfied they ask for more
  love and affection whereas males ask for higher
  frequency.
• All these differences are apparent in younger
  males but disappear by age 40 years.

171
Sexual Relations cont.

• Equitable relations lead to greater sexual
  satisfaction - satisfaction with sex is related
  to more general satisfaction with relationship.
• Dysfun