Behavioral Approaches to Sexual Deviation

Assessment

Five methods involved in the comprehensive assessment of paraphilics will be described. These methods generate data that overlap in many ways, allowing comparisons across procedures. Hypotheses [Page 79]generated to account for any discrepancies can then be pursued by further interviews and testing.

• 1
  Clinical interview: The majority of reports describe relatively unstructured approaches to interviews with these men. The client's mental status must be evaluated, as additional psychopathology may suggest different approaches to treatment or a pretreatment intervention (e.g., medication for schizophrenia or severe depression). The major focus of the clinical interview, however, is on the client's life history (including particularly his history of childhood and adult relationships and his sexual history), his attitudes and beliefs, his emotional functioning and coping style, and a variety of aspects of his offense history.
• 2
  Self-monitoring: Clients are required to produce daily records of the frequency and intensity of sexual urges, activities, and fantasies. Evidence of pornography and cybersex use should also be collected.
• 3
  Sexual preference testing: This has traditionally been one of the central features of the behavioral approach. Phallometric testing (measurement of erectile response to various sexual stimuli) has the longest history and best-established research base. Other researchers have developed visual reaction time (VRT) measures to track the amount of time clients spend looking at and evaluating pictures of clothed adults and children. To date the limited evidence on the value of VRT suggests it may be helpful in identifying the sexual interests of child molesters.
• 4
  Biological and neuropsychological assessments: For a small percentage of sexual deviants, disturbances in their sexual steroid or hormonal systems are apparent and may be related to their problem behavior. When the client complains of preoccupation with sex or in other ways appears to be sexually driven, assays of his circulating testosterone are in order. Similarly, when the person's history or evaluation results suggest possible memory, learning, or other cognitive dysfunction, then a full neuropsychological assessment should be completed.
• 5
  Psychological testing: Except for evaluating psychopathy, personality testing has not revealed anything significant concerning sexual deviants. Screening for psychopathy is essential, as it contributes to an estimate of future risk to reoffend. Composite actuarial risk assessment instruments form part of a complete assessment of sexual offenders.

Other features that are typically evaluated by psychological tests include sexual interests, dysfunctions, and knowledge; attitudes toward women and children and toward sex; intimacy and loneliness; selfesteem; alcohol and drug use; empathy; assertiveness.

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