Remaking Relapse Prevention with Sex Offenders: A Sourcebook


Edited by: D. Richard Laws, Stephen M. Hudson & Tony Ward

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  • Front Matter
  • Back Matter
  • Subject Index
  • Part I: Relapse Prevention in Historical Perspective

    Part II: A Revisionist Critique

    Part III: Conceptual and Clinical Revisions

    Part IV: Clinical Innovations: Assessment and Treatment

    Part V: Sexual Preference Assessment

    Part VI: Programs: Major Interventions Using Relapse Prevention

    Part VII: Relapse Prevention Applied to Special Populations

    Part VIII: The Bottom Line

    Part IX: The Way Forward

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    This book contains a wealth of information about the current status of relapse prevention (RP) in the treatment of sex offenders. More than 10 years have passed since the publication of Richard Laws's first edited book on this topic in 1989. Almost 20 years have gone by since the RP model was initially formulated as a cognitive-behavioral treatment approach for individuals with alcohol or drug problems. It was not until the early 1980s that several of us met at Atascadero State Hospital in California to discuss the potential application of RP to the treatment of sex offenders. At that meeting, Bill George and Janice Marques, two former students (now colleagues) of mine, met with Richard Laws, Bill Pithers, and other professional staff at the hospital and began to develop the foundation of applying RP to the problem of sex offending. As the chapters in this volume clearly attest, we have come a long way from this early work in investigating the parallels and differences between addiction treatment and developing successful interventions for illicit and harmful sexual behavior. It is also clear that we have a long way to go. As stated by many authors, modifications are needed in both the theoretical understanding of the determinants of sexual offending and the development of more effective treatment modalities that are linked to this conceptual underpinning.

    The same process of reformulating and extending the original RP model in the treatment of addictive behaviors is currently under way. Reviews of RP outcome studies (including a recent comprehensive meta-analysis) in the alcohol, smoking, and other drug treatment literature have revealed a mixed picture. Most studies do not demonstrate that RP programs are associated with higher rates of abstinence as compared to other treatment approaches. For example, the results of “Project Match,” a large controlled trial comparing three approaches in the treatment of alcohol dependence (motivational enhancement therapy, Alcoholics Anonymous/12-step facilitation, or cognitive-behavioral treatment based largely on RP), revealed that the three treatment conditions did not differ significantly in terms of overall abstinence rates at the 1- or 2-year follow-up assessments. These results are similar to those obtained in other drug treatment studies (e.g., for smoking or cocaine addiction) that have evaluated RP. Although these studies show that abstinence rates are not usually significantly reduced by participation in RP treatment, results often show a significant reduction in relapse rates for those who engage in any substance use following completion of treatment (e.g., increased temporal delay prior to an initial lapse, reduced magnitude or extent of relapse episodes). As such, RP programs appear to be more effective in relapse management than in preventing any relapse from occurring. These findings support the hypothesis that RP may be more effective as a harm reduction approach than as an intervention designed to inculcate total abstinence in drug dependency treatment.

    The other finding noted by reviewers of the RP drug treatment literature is that these programs frequently show a “delayed emergent effect” for positive treatment outcomes. Studies comparing pharmacotherapy with RP in the treatment of cocaine dependency have shown that, although both treatment approaches appear to have equivalent effects early in the posttreatment period, more delayed follow-up assessments (1 year or longer) tend to show that RP is associated with greater consolidation of treatment gains compared to control conditions. The finding that RP treatment effects may emerge later in time is consistent with a learning-based model in which new coping skills and improved self-regulation are acquired and improve over time with practice, particularly if it is gradually reinforced by the benefits of abstinence or less harmful drug use.

    Since the publication of our RP book, much new work has evolved in the addiction treatment field. Two developments have had major impacts. The first is the “stages of change” model originally developed by Prochaska and DiClemente to describe the various stages that people go through in their attempts to quit smoking: precontemplation and contemplation for change, preparation and action in intiating change, and long-term maintenance or relapse. In the early movement from “precontemplation” to “contemplation,” the major focus is on motivation—considering the “pros and cons” of smoking or quitting, enhancing motivation for change, getting prepared to take action, and so on. The second influential development has been the emergence of “motivational interviewing” or what Miller and Rollnick have called motivational enhancement therapy (MET). Numerous studies have shown that MET can enhance commitment to treatment or self-initiated change in the “action” stage. Professional treatment matching or consumer choice among various treatment options is also promoted to enhance commitment to the action stage. The model postulates maintenance as a critical final stage in which individuals either successfully maintain treatment gains (such as long-term abstinence) or become involved in the relapse process. Most addiction clients are unsuccessful in maintaining total abstinence in any one quit attempt, although many are successful in the long run through participation in formal treatment or self-initiated trials over time.

    It is in the maintenance stage that RP appears to have its greatest impact. We originally described RP as a maintenance stage intervention rather than as a complete “stand-alone” program that would embrace both the contemplation and action stages of the behavior change process. As such, RP can be considered as one component of a broad-spectrum cognitive-behavioral approach that also includes relevant interventions for the other stages of change, including MET for clients who are not yet ready or willing to make a firm commitment to abstinence in the action stage. Detailed assessment of the client's problem may reveal important individual differences that may dictate differential treatment plans (treatment matching or informed consumer choice among treatment options).

    Motivation and skill acquisition are both essential ingredients of behavior change. As the old saying indicates, “Where there's a will, there's a way”—there needs to be both the “will” (motivated commitment to change) and a “way” (practicing more adaptive coping skills) to change. Whereas motivation addresses the issue of why to change in the initial commitment to action, RP can provide the means of how to change.

    RP is best described as a self-management approach to behavior change. Therapists who are presenting RP to clients sometimes describe it as similar to driver-training programs. Driving is a unique behavior in that it involves both personal freedom and responsibility: One is free to explore the open road, but one must do so in a responsible manner. No matter what happens on the trip, the driver is always ultimately responsible for his or her actions. This model of auto-regulation (one of the older terms used to describe self-management) fits well as an analogue to the stages-of-change model that posits various components of the “journey” of behavior change. Of course, students who sign up for “driver's ed” or other driving training programs are already motivated to learn how to drive. These programs have an additional goal of harm reduction in that they attempt to teach novice drivers to acquire and maintain safe driving skills designed to protect both the driver and others who may be affected by the driver's behavior. As such, RP teaches skills that assist the driver how to proceed safely on his or her journey, with a focus on how to proceed in the ever-changing travel environment by encouraging both enhanced awareness and the learning of appropriate driving skills.

    In terms of enhanced awareness, drivers are encouraged to keep their hands on the wheel and their eyes on the road ahead (as well as keeping an eye on the road behind in the rearview mirror)—to watch for warning signals, possible sudden detours or dead-ends, and other hazards of the road (especially the behavior of other drivers and pedestrians). In the terminology of RP, drivers need to be aware of “seemingly unimportant decisions” that may lead them into a “slippery slope” where they could end up in the ditch or stuck in “downtown Reno.” To facilitate appropriate and safe driving skills, enhanced awareness facilitates better coping strategies on the road, including both cognitive strategies (consulting road maps and planning ahead to avoid high-risk situations) and behavioral skills (e.g., knowing how to steer properly, when to put on the brakes, when and how to pass safely, and when it is time to pull over at a rest stop). What is the parallel motivation for engaging in safe and responsible behavior for sex offenders? For those who are incarcerated, it is the desire to be free, to drive again on the open road, and to pursue one's own destination goals with the dignity that comes from being “back on track” and with the intention of not harming oneself or others. Although driving is not allowed in prison, one can still learn to walk a new path of personal change. Walking is better than stalking.

    From a clinical perspective, RP is an individualized approach that varies from driver to driver. Although some “core” components of RP can be taught in groups based on standardized treatment manuals, an individualized approach can help tailor the core elements to meet the individual differences of participants. The heart of driver training is individualized training with the driver behind the wheel. Here the role of the therapist is like that of a “copilot,” as is the case with some driver training programs in which the car is equipped with two steering wheels, one for the driver and the other for the trainer. This is a good strategy to employ in RP programs for either addiction or sexual offending problems. Often, the best clinical results occur when there is an active mutual collaboration between the client (driver) and therapist (trainer): Both are mutually responsible for tailoring the treatment to the client's unique characteristics (e.g., different styles of offending). To the extent that the therapist and client can work together as partners in developing an individualized treatment plan, the client is likely to assume a greater stakeholder role in the treatment process. As noted by several authors, RP can also provide a common language for the client and therapist to discuss offending behavior. It also provides a flexible biopsychosocial model of the etiology of the problem, one that fosters both an attitude of acceptance (in which it is hoped that the client comes to accept responsibility for causing harm and to accept responsibility for change) and optimism for the potential of successful change. As one sex offender we talked to during the early Atascadero visit (after discussing possible parallels between recovery from addiction and recovery from offending behavior) said, “You mean I could be like an alcoholic? Alcoholics can recover from their addiction to alcohol, so why can't sex offenders?” Most of us believe that sex offenders are made, not born that way. Most developed their affliction by some combination of Freudian, Pavlovian, and Skinnerian conditioning. Despite the forces of conditioning, it is possible for offenders to “remake” their lives by changing their behavior.

    One problem with an individualized RP treatment approach is that it creates problems for treatment outcome researchers who often prefer a standardized treatment protocol that can be manualized and followed in a systematic step-by-step fashion. Participants can then be randomly assigned to receive RP or some other comparison condition. There is merit to this argument, and it appears that RP means a lot of different things to different treatment providers. To many, RP has taken on the meaning of a treatment goal rather than a specific cognitive-behavioral treatment method. In the addiction treatment literature, many different programs have taken on the goal of RP, including pharmacotherapy, various forms of psychotherapy and behavior therapy, and even incarceration itself. From this broad perspective, anything that prevents relapse could be considered an effective intervention. Here, the use of RP as a goal rather than a treatment model reflects the growing awareness that interventions geared to the maintenance stage of behavior change are necessary. Even within the cognitive-behavioral model of RP, a wide variety of cognitive and behavioral assessment and treatment approaches are described, based on social learning theory and its application to the modification of addictive behaviors. As a result, there is no standard definition of RP, and treatment protocols often integrate several RP treatment approaches into a single package, making it difficult for researchers to tease out effective or ineffective components. Despite these methodological problems, many authors in this book have put forth testable hypotheses about what works and what does not in RP. Future revisions of the model will benefit from this important and needed research.

    The discussion of the potential overlap between RP and harm reduction (HR) approaches discussed in this book is both stimulating and controversial. Whereas RP is usually described as an individual treatment approach, HR programs are typically more comprehensive in scope, extending the treatment model by including both environmental changes and public policy approaches. To return to the example of driver training as an individualized approach, HR also focuses on a wider approach to reducing harm, including the provision of a safer environment (safer cars and highways) as well as establishing policies designed to protect both the driver and the larger community (e.g., speed limits, low blood-alcohol limits for driving, mandated use of seat belts, etc.). A similar comprehensive approach in working with sex offenders is recommended by several authors in this book. RP programs need to be integrated into the larger context associated with posttreatment supervision and a safe return to the community. Another advantage of the HR model is that it facilitates both primary and secondary prevention goals and may provide access to active offenders by increased outreach and intervention.

    Overall, this book is a rich source of information on the application of RP with sex offenders. It presents readers promising directions for change and areas that need revision based on new research findings and the integration of emerging theoretical models that show considerable promise in this field (especially harm reduction and behavioral economics, both of which are covered in different chapters). All of this is valuable “grist for the mill” as we enter the new millennium and strive to develop more effective treatment programs. I like to think of the original statement of the RP model in the 1985 book as a prototype, a vehicle (the 1985 RP model) that was designed to introduce a cognitive-behavioral approach to the addiction treatment field that was previously dominated by a biological disease model of etiology and a strict adherence to 12-step groups such as Alcoholics Anonymous as the only acceptable approach to treatment. Although there have been essentially no changes in the 12-step approach since its origins more than 50 years ago, RP continues to evolve and change based on research findings and clinical experience. This material in this book should help us construct a better, safer vehicle for the treatment of sex offenders in the new millennium.

    G. AlanMarlattUniversity of Washington
  • About the Editors

    D. Richard Laws was most recently a psychologist with Adult Forensic Psychiatric Community Services in Victoria, British Columbia and coordinator of the Victoria Adult Sex Offender Management Program. He is now retired and self-employed as South Island Consulting. He received his Ph.D. from Southern Illinois University in 1969. While completing his doctorate, he was employed as a medical research associate at the Behavior Research Laboratory, Anna, Illinois. After graduating, he moved to Atascadero State Hospital in California, where he was an experimental psychologist and director of the Sexual Behavior Laboratory from 1970 to 1985. On receipt of a grant from the National Institute of Mental Health, he moved to the University of South Florida, where he was a professor in the Florida Mental Health Institute and director of an outpatient treatment program for child molesters from 1985 to 1989. He is well known in the field of sexual deviation as an innovator in the development of assessment procedures and in program development and evaluation. He is the author of 50 articles and book chapters and an equal number of professional presentations. He currently serves on the editorial boards of the Journal of Interpersonal Violence, Sexual Abuse: A Journal of Research and Treatment, Trauma, Violence, and Abuse, and The Journal of Sexual Aggression. He is adjunct faculty in the Department of Psychology, University of Victoria, and Associate Member, Mental Health, Law, and Policy Institute, Simon Fraser University. He is a past president of the Association for the Treatment of Sexual Abusers (ATSA) and served on its executive board from 1991 to 1998. He is the editor of Relapse Prevention With Sex Offenders (1989), coeditor with W. L. Marshall and H. E. Barbaree of Handbook of Sexual Assault (1990), and coeditor with W. T. O'Donohue of Sexual Deviance: Theory, Assessment, and Treatment (1997).

    Stephen M. Hudson, Ph.D., Dip. Clin. Psyc., is an associate professor in Clinical Psychology and Director of Clinical Training at the University of Canterbury, Christchurch, New Zealand, and a consultant to both the Kia Marama Sex Offender Treatment Program at Rolleston Prison, Department of Corrections and the New Zealand Police. He has worked as a clinical psychologist in both mental health and forensic settings since 1974. His clinical and research interests include social competency deficits in offending and offense processes, as well as issues in health psychology. He currently serves on the editorial board of the journal Sexual Abuse: A Journal of Research and Treatment. He is also a member of both the International Sex Offender Treatment Programme Accreditation Panel for H. M. Prison Service, London, England, and the Accreditation Panel: Sex Offender Treatment, Correctional Services Canada. He has published more than 75 articles and book chapters. His coedited books are The Juvenile Sex Offender (1993; with Barbaree and Marshall) and Sourcebook of Treatment Programs for Sexual Offenders (1998; with Marshall, Ward, and Fernandez).

    Tony Ward, Ph.D., is currently Coordinator of the Forensic Psychology Doctoral Program at the University of Melbourne. His research interests include the area of attachment and intimacy deficits in sexual offenders, cognitive distortions, sexual offending theory, and relapse prevention treatment models. He has presented at many international conferences, run workshops, and has approximately 80 publications. He is a coeditor (with W. L. Marshall, Y. M. Fernandez, and S. M. Hudson) of Sourcebook of Treatment Programs for Sexual Offenders.

    About the Contributors

    Jan-Marie Alarcon is a clinical psychologist at Atascadero State Hospital. She received a master's degree in Marriage and Family Counseling in 1985 from Azusa Pacific University, a master's in psychology in 1988, and her Ph.D. in psychology in 1991 from the Rosemead School of Psychology, Biola University. She completed her clinical internship at Patton State Hospital, a forensic mental health hospital, and has worked as a clinical psychologist at Atascadero State Hospital since 1992. She was the treating psychologist for the Sex Offender Treatment and Evaluation Project (SOTEP) from 1992 to 1996. Since 1996 she has been a treating psychologist for the Sex Offender Commitment Program (SOCP), under the auspices of the California Welfare and Institutions Code 6600. She has provided court testimony, supervision, and training on the treatment of sex offenders.

    Dana Anderson is Clinical Director of the Sexual Offenders Treatment Program at Kingston Penitentiary, a maximum-security prison. She is currently completing her doctoral thesis at Queen's University, Department of Psychology, Canada. She is an active researcher, and among her publications, she is the coauthor of a book on the treatment of sexual offenders.

    Jacqueline Bedard is a therapist at the Native Clan Organization's Forensic Behavioral Management Clinic in Winnipeg, Manitoba, Canada. She is involved in the provision of institutional and community-based sexual offender treatment programs and has been particularly active in the development and delivery of culturally appropriate treatment/healing programs for Canadian Aboriginal offenders. She is also the co-editor of Paths to Wellness: A Gathering of Communities Addressing Sexual Offending Behaviour. In addition to her work with offenders, Jacqueline has worked with women and children survivors of sexual abuse for more than 10 years. She received her master's degree from the University of Manitoba in 1994.

    Anthony Beech is Senior Lecturer in Forensic Psychology at the University of Birmingham, United Kingdom, and Research Fellow for the U.K. government-funded STEP (Sex Offender Treatment Evaluation Project) Team. After his doctorate and postdoctoral investigations into the mechanisms underlying schizophrenic symptomatology at Oxford University, he moved into sex offender research. Over the past 8 years, he has been involved in treatment evaluation and the development of systems to look at treatment need and treatment change in sex offenders. He has written papers on these and other related projects.

    Kurt M. Bumby is Clinical Director for the Missouri Division of Youth Services in Jefferson City, Missouri, and serves as the Director of Sex Offender Services at Behavioral Health Concepts, Inc., in Columbia, Missouri. He is a clinical assistant professor of psychiatry, medical psychology, at the University of Missouri-Columbia School of Medicine. In addition, he is a consultant for the Center for Sex Offender Management as well as Liberty Behavioral Health Care Corporation and serves as the state public policy representative for the Association for the Treatment of Sexual Abusers (ATSA). He earned his doctorate in forensic clinical psychology at the University of Nebraska, Lincoln, specializing in the assessment and treatment of sexual offenders. He has presented at numerous conferences and has published several articles and book chapters on sex offenders and other forensic issues.

    Adam J. Carter, M.Sc, is currently the Treatment Manager of the Sexual Murderers unit at HMP Brixton. He has worked with sex offenders since 1992 and regularly trains sex offender treatment providers in both the United Kingdom and Scandinavia. He is engaged in doctoral study of risk assessment and prediction of sexual murderers and has developed considerable expertise in working with this client group.

    Shirl Chartrand is the Project Manager for Aboriginal Programs at Regional Headquarters, Prairie Region, for Correctional Service Canada. Prior to this she worked at Stony Mountain Institution, where she specialized in the provision of culturally appropriate healing for Canadian Aboriginal offenders. In this capacity, she worked alongside Native Spiritual Elders and was part of the Native Clan Organization's Forensic Behavioral Management Clinic's treatment team. Shirl received her bachelor of arts degree from the University of Manitoba in 1991. She is a woman of Ojibwe and French ancestry who has put to use her Traditional teachings and gifts along with her counseling skills to support the wellness of offenders.

    Joanna M., Clarke, MSc., is Head of the Psychology Professional Advisory Unit at HM Prison Service Headquarters. She has worked with sex offenders for most of her career and played a central role in establishing the Sexual Murderers Unit at HMP Brixton. This unit specializes in the assessment, treatment, and research of this complex client group, and Jo Clarke has presented both nationally and internationally on the work of the unit. She is currently researching burnout in sex offender treatment providers.

    Emily M. Coleman has been the Director of the Sex Offender Program at Clinical and Support Options, Inc., a community mental health center in western Massachusetts, since 1986. She also serves as a consultant to numerous agencies in New England. She has published in the field and lectures throughout North America, specializing in the assessment and treatment of intellectually disabled sexual offenders. She is on the board of the Association for the Treatment of Sexual Abusers and on the board of Stop It Now, a national organization that focuses on the primary prevention of sexual abuse. She has more than 20 years of clinical and research experience in the assessment and treatment of sexual offenders. She received her master's degree in behavior modification from Southern Illinois University in 1975.

    Georgia F. Cumming has been Program Coordinator for the Vermont Department of Corrections sex offender programs since 1986. Prior to holding this position, she was a probation and parole officer for 12 years. She has been instrumental in the development of the external supervisory dimension of the relapse prevention approach to the treatment and supervision of sexual offenders. She has presented workshops extensively throughout North America on the topic of relapse prevention and supervision of sexual offenders. She has coauthored numerous journal articles and two book chapters on adapting the relapse prevention model to the supervision of sex offenders on probation and parole. She is the coauthor of Supervision of the Sex Offender (1996).

    David M. Day has directed the evaluation component of the Sex Offender Treatment and Evaluation Project in California since the project began in 1984.

    Hilary Eldridge is Director of the Lucy Faithfull Foundation, Birmingham, England, which specializes in work with sex abuse, and runs the Wolvercote Residential Clinic for adult male sex offenders. She consults on probation and prison programs and is an international conference speaker. Her publications include the Therapist Guide for Maintaining Change and Maintaining Change: Relapse Prevention Manual for Adult Male Perpetrators of Child Sexual Abuse. Over the past 8 years, she has developed a specialism in assessing and treating female sex offenders and remaking relapse prevention techniques to suit their specific needs.

    Lawrence Ellerby is Clinical Director of the Native Clan Organization's Forensic Behavioral Management Clinic in Winnipeg, Manitoba, Canada. He is also the Canadian Provincial Coordinator on the Board of the Association for the Treatment of Sexual Abusers and has a private practice in which he primarily works with violent and homicide offenders. Along with Native Spiritual Elders, he has advocated for, and developed, a blended model integrating Traditional healing and contemporary treatment for Canadian Aboriginal offenders. He has published extensively in this area. His other clinical interests and publications include the importance of a therapeutic alliance in the treatment of sexual offenders, the impact of providing sexual offender treatment on clinicians, and the treatment of sadistic sexual offenders. He received his Ph.D. from the University of Manitoba in 1998.

    Yolanda M. Fernandez is currently a fourth-year doctoral student in clinical/forensic psychology at Queen's University under the supervision of Dr. Bill Marshall. She graduated with a B.A. (Hons.) in 1994 and an M.A. in 1996 from Queen's University in Kingston, Ontario. In addition to her studies, she is a therapist for the Sexual Offender Program at Bath Institution (a medium-security federal penitentiary). She is an active researcher who currently has made several presentations at international conferences and 17 publications. Her publications include one coauthored book and one coedited book.

    Lane Fischer, Ph.D. completed his doctoral studies at the University of Minnesota and practiced psychology in Minneapolis/St. Paul before joining the faculty of Brigham Young University in 1993. He worked at Wilder Child Guidance Clinic in its incest treatment project. He conducted psychological assessment of children and adolescents and led children's survivor groups in conjunction with multiple family treatment of incest. His research focuses on the assessment and treatment of children and adolescents and the psychometric qualitities of instruments such as the Abel Screen and the MMPI-A.

    Dawn Fisher is a Consultant Clinical Forensic Psychologist at Llanarth Court Secure Hospital in South Wales and Honorary Senior Research Fellow at the University of Birmingham, United Kingdom. She acts as a consultant on a number of treatment programs and has experience in working with a range of sex offenders, including adolescents, adults, and those who are developmentally delayed. She has written a number of papers and book chapters on sex offenders. She has recently been appointed to the U.K. government joint prison/probation panel for accrediting offender programs.

    William H. George is on the faculty at the University of Washington in Seattle where he is Associate Professor of Psychology and Director of the Institute for Ethnic Studies in the United States. He received his doctoral training in clinical psychology and his postdoctoral training in addictive behaviors from the University of Washington between 1976 and 1984. He served on the Psychology faculty at the State University of New York at Buffalo before returning to Seattle in 1992.

    Don Grubin is Professor of Forensic Psychiatry at the University of Newcastle and (Honorary) Consultant Forensic Psychiatrist at Newcastle City Health Trust. He received his psychiatric training at the Maudsley and Broadmoor hospitals and the Institute of Psychiatry. He has been based in Newcastle-upon-Tyne since 1994.

    James L. Haaven, M.A., is Director of the Social Rehabilitation Unit at Oregon State Hospital. He has more than 20 years of experience in working with sexual offending behavior of persons with developmental disabilities. He consults and trains internationally. He received degrees from the University of Washington and Pacific Lutheran University.

    R. Karl Hanson is Adjunct Research Professor in the Psychology Department at Carleton University. He conducted clinical work with sex offenders for the Ontario Ministry of Correctional Services and the Clarke Institute of Psychiatry before starting, in 1991, his current position as Senior Research Officer with the Department of the Solicitor General Canada. His contributions to the sexual offender field have included a meta-analysis of predictors of sex offense recidivism, actuarial risk scales for sex offenders (RRASOR, Static-99), and various empathy and attitude measures. He received his Ph.D. in clinical psychology from the University of Waterloo (Ontario) in 1986.

    Aaron W. B. Konopasky is currently a doctoral student in philosophy at Princeton University. His research interests include philosophy of psychology, philosophy of mind, and epistemology.

    Robert J. Konopasky received his M.A. from the University of Western Ontario in 1969 and his Ph.D. from the University of Windsor in 1972. Currently he is a professor at Saint Mary's University, Halifax, Nova Scotia, Canada. Working as a clinical psychologist in private practice since 1974, he is the Senior Consultant of the Center for Psychological Services Limited. Since 1989, and under contract from Correctional Service Canada, the center has assessed more than 900 sexual offenders and treated more than 300 sexual offenders in the community. Dr. Konopasky's sexual offender research interests include empathy, cognitive distortions, and PPG. He has presented at many international conferences and run workshops.

    Bernadette Lamoureux, B.Sc, is a clinical criminologist. She has been involved for more than 20 years in the sexual offenders treatment program of the Institute-Philippe-Pinel-de-Montréal, a maximum-security psychiatric institution.

    Calvin M. Langton is Research Associate with the Sexual Behaviours Clinic, Forensic Program, Clarke Division, Centre for Addiction and Mental Health. He is a doctoral candidate in medical science at the University of Toronto, Ontario. His research interests include cognition and affect in sexual offenders, community management strategies for forensic patients, and the development of cognitive-behavioral interventions for clients demonstrating oppositional behaviors in the treatment context.

    Patrick Lussier, M.Sc, is a criminologist. He is involved in both research and clinical activities at the Institut-Philippe-Pinel-de-Montréal, a maximum-security psychiatric institution. He is a Ph.D. student in the field of criminology.

    Ruth E. Mann, M.Sc, is head of the Prison Service Sex Offender Treatment Programme and is responsible for the development, implementation, monitoring, and management of all sex offender treatment within H. M. Prison Service (England and Wales). She is interested in ways of developing motivation for change and the application of motivational interviewing strategies within sex offender treatment.

    Janice K. Marques is Chief of Program Development and Evaluation for the California Department of Mental Health. She has worked for more than 20 years in the field of sexual abuse as a clinician, researcher, program developer, and consultant. She trained at the University of Washington with G. Alan Marlatt and was a pioneer in adapting his Relapse Prevention model for use with sex offenders. In California, she designed and directed the Sex Offender Treatment and Evaluation Project (SOTEP), a rigorous longitudinal study of the effectiveness of intensive cognitive-behavioral treatment in reducing reoffense among rapists and child molesters. She is past president of the Association for the Treatment of Sexual Abusers (ATSA) and a recipient of that organization's Significant Achievement Award

    W. L. Marshall is Professor of Psychology and Psychiatry at Queen's University and Director of the Bath Institution Sexual Offenders Program. He has been working with sexual offenders for 30 years and has published more than 230 articles, chapters, and books. He is presently president of the Association for the Treatment of Sexual Abusers and is the 1999 recipient of the Santiago Grisolia Prize for worldwide contributions to the reduction of violence.

    Robert J. McGrath is Clinical Director of the Vermont Treatment Program for Sexual Aggressors, the Vermont Department of Corrections' statewide network of 2 prison and 11 outpatient treatment programs. He has provided training to corrections, mental health, and judicial groups throughout North America and has authored more than 20 journal articles, book chapters, and monographs. He serves as a regular consultant to the National Institute of Corrections and the Center for Sex Offender Management. He is former chair of the Board of Directors of the Safer Society Foundation.

    Michael H. Miner is Assistant Professor and Psychologist in the Department of Family Practice and Community Health, Medical School, University of Minnesota. He received his Ph.D. in psychology from St. Louis University in 1984. He has been involved with sex offender treatment and research since 1986, first serving as the research psychologist for California's Sex Offender Treatment and Evaluation Project and then moving to the Program in Human Sexuality at the University of Minnesota in 1992. He currently directs sex offender treatment services at the University of Minnesota's Program in Human Sexuality. He has published numerous papers and book chapters on relapse prevention with sex offenders, sex offender treatment outcome, and forensic and sex offender assessment. His current research focuses on the evaluation of sex offender treatment and the empirical investigation of causal factors for child sexual abuse in adolescents and adults.

    William D. Murphy is Professor in the Department of Psychiatry at the University of Tennessee, Memphis. Since 1986, he has served as Director of the University of Tennessee Professional Psychology Internship Consortium and is Director of the Special Problems Unit, a sex offender treatment program operated through the University of Tennessee, Memphis. He has presented workshops and papers at regional and national meetings and has published chapters and journal articles in the sex offender field. He received his B.A. in psychology from Southern Illinois University in 1971 and his M.S. and Ph.D. in 1974 and 1976, respectively, in clinical psychology from Ohio University.

    Craig Nelson is Clinical Administrator at California's Atascadero State Hospital. He received his doctorate in clinical psychology from Kent State University in 1980. In addition to his current position, he has previously served as a staff psychologist, Coordinator of Research, Treatment Director of the Sex Offender Treatment and Evaluation Project, and Program Director at Atascadero State Hospital. He has numerous publications in the area of sex offender treatment and assessment. The 1996 recipient of the California Forensic Mental Health Association's William T. Rossiter Award for outstanding achievement in the field of forensics, he is currently a member of the Board of Directors of the Association for the Treatment of Sexual Abusers.

    Michael A. O'Connell has a practice in Everett/Mill Creek, Washington, specializing in the evaluation and treatment of sexual deviancy. He earned both his Ph.D. in counseling psychology (1997) and his M.S.W. (1977) from the University of Washington. He began his work in the social service field when, as a navy officer, he was director of a naval correctional center. He has been working with sex offenders since 1981. He coauthored Working With Sex Offenders (1990), a guide for judges, prosecuting attorneys, probation officers, and others about whether sex offenders should remain in the community and under what conditions.

    William O'Donohue is the Nicholas Cummings Professor of Organized Behavioral Health Care Delivery at the University of Nevada, Reno. He is the director of the Sexual Assault Prevention and Counseling Program and the Victims of Crime Treatment Center. He has published over 150 journal articles, book chapters, and edited books in the areas of sexual offending and victimization, sexual harassment, child memory and forensic interviewing, child custody, sexual dysfunction, behavior therapy, and the philosophy of psychology. Growing interests include managed health care initiatives and the development of a new cognitive behavior therapy. He received his B.S. from the University of Illinois in 1979, an M.A. from SUNY at Stony Brook in 1982, a Ph.D. in clinical psychology from SUNY at Stony Brook in 1986, and an M.A. in philosophy from Indiana University in 1988.

    Erin Oksol is a doctoral student in clinical psychology at the University of Nevada, Reno. She is program coordinator and therapist for the Victims of Crime Treatment Center. She is interested in the use of the polygraph with sex offenders and the relationship of behavioral economics to a theory of sexual offending. She is additionally engaged in projects related to children's memory and sexual harassment in children. She received her B.A. from Concordia College in 1996 and an M.A. from Mankato State University in 1998.

    I. Jacqueline Page is Assistant Professor in the Department of Psychiatry at the University of Tennessee, Memphis. She serves as a psychologist of the Special Problems Unit, a sex offender treatment program operated through the University of Tennessee, Memphis. She has presented workshops and papers at regional or national meetings and has published book chapters and journal articles in the sex offender field. She received her B.S. in psychology in 1979 and her M.Ed. in educational psychology in 1980 from the University of Georgia. She received her M.A. in 1981 from Middle Tennessee State University and her Psy.D. in 1988 in clinical psychology from the Florida Institute of Technology.

    Tamara Penix is a doctoral student in clinical psychology at the University of Nevada, Reno. She is a program coordinator for the Victims of Crime Treatment Center and is working as an expert therapist on a federally funded grant. She is in the process of publishing several articles and book chapters in ther areas of sexual offending and victimization, reconceptualizing attachment, functional analysis, and expert witnessing. Her interests include the development of a theory of sexual offending, sexual self-control, and the development, evaluation, and dissemination of sex offender treatment. She received a B.A. from Kent State University in 1991 and an M.A. from New York University in 1994. She will complete her Ph.D. in 2001 following an internship with Atascadero State Hospital.

    Jean Proulx, Ph.D, is Associate Professor at the School of Criminology, University of Montreal. During the last 15 years he has published, in French and in English, two books and more than 50 articles or book chapters, mainly in the field of sexual aggression. As a researcher and as clinical psychologist he has been involved since 1987 in the sexual offenders treatment program of the Institut-Philippe-Pinel-de-Montréal, a maximum-security psychiatric institution.

    Jacqui Saradjian is a Consultant Clinical Psychologist employed by Leeds Community Mental Health Trust within the Forensic Service. She works in association with the Lucy Faithfull Foundation. She specializes in working therapeutically with victims and perpetrators of child abuse: sexual, physical, and emotional. For the past 10 years, she has carried out extensive research into female perpetrators of child sexual abuse and into the specific effects on victims of being sexually abused by females. To date, she has interviewed more than 70 such women and is a well-known conference speaker. She is the author of Women Who Sexually Abuse Children: From Research to Clinical Practice.

    Susan A. Stoner is a doctoral candidate in clinical psychology at the University of Washington in Seattle.

    Monique Tardif, Ph.D., is a clinical psychologist. She has been involved for more than 15 years in the sexual offenders treatment program of the Institut-Philippe-Pinel-de-Montréal, a maximum-security psychiatric institution.

    David Thornton, Ph.D., is head of the Offending Behaviour Progammes Unit within H. M. Prison Service (England and Wales). He is responsible for the development and implementation of all rehabilitation programs for imprisoned offenders. His research interests include risk prediction in sexual offenders and the evaluation of evidence-based treatment.

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