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Section 9
Working with Internet Pedophiles Part II: Assessment & Risk

Question 9 | Test | Table of Contents

Assessment and risk
Treatment of the offending behavior is rarely the responsibility of the non-specialist healthcare professional. It is important, therefore, to not become involved beyond the purpose of the assessment. Typically, this would include a general assessment of risk or an assessment of a mental health problem (such as depression) unrelated or minimally related to the offending behavior. If the client is under supervision on the sex offenders' register, criminal justice agencies may also be monitoring the offender, and co-ordination of information may be useful and clarification of responsibilities necessary, A summary of assessment for treatment - a more specialist realm - is covered in Sullivan and Beech (2003).

Risk and assessment are bound together. The most common historical method of assessment until recently was unstructured clinical judgment, which, though better at predicting recidivism than chance, has poor validity and reliability (Monaghan 1981), especially in view of inherent biases (Quinsey etal 1998).

The assessment process should include a short, structured professional judgment too! - a standardized checklist with both historical and dynamic factors. An example of this is the SVR-20 - if there is a risk of a contact offence – which is a validated scale that measures the risk of sexual violence in terms of psychosocial adjustment, sexual offences, future plans and other considerations. This measure has been validated to predict recidivism (De Vogei ef al 2004), A similar tool is the Child Abuse Potential Inventory (Milner 1986, 1989), White these and other similar actuarial instruments are based on predictive rather than explanatory factors in offending behavior, they are still seen as preferable to clinical interviews only. Clinical interviews will enable the clinician to understand the process of offending, and some sample questions on what to ask have been included in Quayle and Taylor (2002), Clinicians should also assess the client's motivation to change (Jones 2002).

The author is not aware of any validated scales for noncontact offences, although scales such as the Psychological Inventory of Criminal Thinking Styles (Walters 1995) may be of some use. This scale identifies eight styles of thinking that have been shown to be influential in criminal behavior. An example is 'power orientation', in which a client compensates for weak personal control by trying to exhibit control over his environment.

Once identified, the presence of these thinking styles in other areas can identify offence paralleling behaviors, which may highlight a continued risk. With all self-report questionnaires and clinical interview^/s it Is important to consider that socially desirable reporting - where clients distort their endorsements to how they would like to be seen - is common among offenders. Data should be verified where possible, which may be difficult if it is the client's first service contact. It is important for the practitioner to be aware that people with a high risk of offending may be detainable even if they have not committed an offence under the proposed Mental Health Act if they are deemed to have a Dangerous and Severe Personality Disorder (House of Commons Library 2002).

Relationship with contact offences
Prior to the advent of the internet, US customs believed that about 80 per cent of people possessing child images were involved in contact offending (Taylor 2001), More recent estimates suggest that about 36 per cent of image possession in the US are involved in contact offending (Wellard 2001); estimates of the rate in the UK vary from 20 to 33 per cent (Dobson 2003), The relationship between image possession and contact offences is complex, therefore.

Since the advent of the internet, there has been an emergence of image collectors who do not commit contact offences (Holmes er at. 2003), Interviews appear to suggest some image collectors use images as a substitute for contact offending, while others use them as a blueprint for contact offending. Very little has been written about this but, clearly, separating these categories of offenders will be crucial in the future for healthcare professionals.

The process of arousal may lead to offending if any single fantasy is maintained, developed and acted on (Blundell 2002), although Seto er a/ (2001) note that in addition to arousal, the internet may also develop other possible mediating factors, such as offence-supporting attitudes, aggressiveness and anti-social personality. Other internet processes that may influence contact offending include imitation (social learning), permission giving (social support) and social reinforcement of existing values.

Treatment of issues relating to internet offending against children
Specific treatment of offending behaviors is generally considered to be the domain of specialist and supervised forensic psychotherapy departments. However, this need not prevent the treatment of conditions such as depression and schizophrenia, although if the impact of successful treatment exacerbates offending behavior - with, for example, driving phobia or social phobia - specialist supervision should be sought.

Most non-medical treatment of behaviors requires client co-operation, and any treatment needs to address motivation to change. There may be no implicit reward for the client changing his behavior due to high rewards for offending and high cognitive distortions in victim impact (Brown 1997). The clinician should ensure any treatment program addresses distortions in motivation and pro-offending thinking, victim impact and the cycle of offending behavior (Burke ef a/ 2002).

Processes and supervision issues
Working with internet pedophiles may raise strong emotions for most of us. In this section we will address issues of process that may require additional support and supervision if they occur. If the client has been previously involved in contact offending, their interpersonal style may be highly manipulative, risking leaving the clinician feeling afraid, ashamed, embarrassed, inadequate, hostile, weak or angry. Equally, the client may collude with the clinician's own needs and sabotage the clinical process or the professional relationship. Clinicians should receive supervision on complex clients such as these. Some processes that may occur in these instances are listed in Box 1.

Box1. Pitfalls in clinician-client relationships
- The client lacks self-control or has ideas of entitlement, and the clinician responds to this by being critical.
- The client tries to help and support the clinician, which parallels his grooming behavior. The clinician is emotionally deprived and fails to recognize this.
- The clinician's 'other-directedness' interferes with the client's need for confrontation.
- Clinician feels inadequate when client has repeated crisis behaviors or fails to make progress.
- Client is hypercritical of clinician, clinician becomes hostile.
- Client behaves histrionically, talking cathartically about abuse. Clinician withdraws psychologically
- Client abuses therapist's fascination for the subject and fails to address therapeutic issues.
- Client is mistrustful and fails to engage, clinician is uncomfortable with the subject and withdraws.
- Clinician engages in sexual transference issues.
- The clinician is emotionally deprived and colludes with the client's cognitive distortions

Summary and conclusions
The process of offending in internet pedophiles is multifactorial and complex. The relationship between image possession and contact offences has also become less clear since the advent of the internet. Clinicians should ensure their risk assessments are thorough but do not extend beyond the purpose of the original service contact and of establishing current level of risk to children. Clinicians may wish to visit Quayle and Taylor (2002), who provide a list of sample questions to ask, especially if the clinician has a limited understanding of the internet. Clinicians may, though, need to temper their own fascination with the subject and remember that It is unethical to collect information for this purpose.

Treating the offending behavior is not the domain of the non-specialist clinician, but an understanding of the research on what is effective with this client group may help the clinician in ensuring clients receive suitable treatment- It is essential to request and receive supervision with this client group, and some of the most important processes have been considered above.
- Wilcockson, Matthew; Working with internet pedophiles; Mental Health Practice; June 2006; Vol. 9; Issue 9.

Personal Reflection Exercise #2
The preceding section contained information about assessment and risk in working with internet pedophiles.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
The Predictive Validity
of the Revised Screening Scale
for Pedophilic Interests (SSPI-2)

- Faitakis, M., Stephens, S., & Seto, M. C. (2023). The Predictive Validity of the Revised Screening Scale for Pedophilic Interests (SSPI-2). Sexual abuse : a journal of research and treatment, 35(5), 649–663.

Peer-Reviewed Journal Article References:
Grady, M. D., & Levenson, J. S. (2021). Prevalence rates of adverse childhood experiences in a sample of minor-attracted persons: A comparison study. Traumatology, 27(2), 227–235.

Ischebeck, J., Kuhle, L. F., Rosenbach, C., & Stelzmann, D. (2021). Journalism and pedophilia: Background on the media coverage of a stigmatized minority. Stigma and Health. Advance online publication.

Stephens, S., McPhail, I. V., Heasman, A., & Moss, S. (2021). Mandatory reporting and clinician decision-making when a client discloses sexual interest in children. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 53(3), 263–273.

QUESTION 9
 According to Wilcockson, what is "power orientation"? To select and enter your answer go to Test.

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