Rebecca Lievesley

Evaluation of the use of pharmacological treatment with prisoners experiencing high levels of hypersexual disorder

Abstract This paper presents an evaluation of the impact of pharmacological treatment in reducing hypersexual disorder in adult males who have been incarcerated following conviction for a sexual offence. The evaluation compares two types of pharmacological treatment, one of which is part of the current NICE guidance for treatment of hypersexuality (Antiandrogens), whilst the other type (SSRIs) is off-label use in the UK for hypersexuality. The participant pool comprised 127 adult male prisoners serving sentences for sexual offences in a UK prison. Participants had been voluntarily referred for pharmacological treatment to manage hypersexual disorder. The results demonstrated a significant reduction of hypersexual disorder pre- and post-medication and contribute to the evidence base for the use of pharmacological treatment with individuals for whom hypersexual disorder may be a salient factor in their offending. Limitations of the current research are discussed.

Preliminary evaluation of the use of pharmacological treatment with convicted sexual offenders experiencing high levels of sexual preoccupation, hypersexuality and/or sexual compulsivity

The current study presents the preliminary evaluation of the impact of pharmacological treatment (Selective Serotonin Reuptake Inhibitors and anti-androgens) on hypersexuality, sexual preoccupation and sexual compulsivity. The participant pool comprised 64 convicted UK sexual offenders who had been voluntarily referred for pharmacological treatment to reduce their hypersexual arousal, 51 of whom agreed to take the medication (with a further five individuals on hold or under assessment at the time of data extraction). The preliminary findings were very encouraging; analysis on measures assessing sexual preoccupation, hypersexuality and sexual compulsivity indicated a significant reduction between pre- and post-medication, across both types of medication. Limitations of the current research are discussed.

Understanding service users’ and therapists’ experiences of pharmacological treatment for sexual preoccupation and/or hypersexuality in incarcerated sex offenders

This research comprises two qualitative studies understanding the experiences of (1) convicted sex offenders voluntarily receiving pharmacological treatment to reduce sexual preoccupation and (2) therapists working with these offenders. The studies form part of a research programme evaluating the use of pharmacological treatment with sexual offenders. In study one, semi-structured interviews were conducted with 13 sexual offenders receiving selective serotonin reuptake inhibitors. In study two, interviews were conducted with eight intervention staff with varying levels of experience of working with offenders taking anti-libidinals. Thematic analysis was used and in study one, two main themes emerged: (i) the impact of the pharmacological treatment on prisoners’ daily functioning; (ii) barriers to compliance/engagement. In study two, three main themes emerged: (i) offenders’ reluctance to engage with pharmacological treatment; (ii) challenges for therapists; (iii) pharmacology: ‘just another piece of the puzzle’. Findings are discussed in relation to practice and future research.

“I kind of find that out by accident”: Probation staff experiences of pharmacological treatment for sexual preoccupation and hypersexuality

This paper aimed to explore the views and experiences of probation staff working with individuals convicted of a sexual offence who have been prescribed medication to manage sexual arousal (MMSA). Semi-structured interviews were utilised with a sample of probation staff (Offender Supervisors and Managers, n=12), who supervise individuals convicted of a sexual offence, either in prison, or post-release in the community. Data were analysed using thematic analysis. Two main themes emerged: (1) Barriers for probation staff and (2) Suspicious but hopeful. Theme one encapsulates factors that prevent probation staff from engaging with MMSA; theme two highlighted the samples’ uncertainty and mistrust of the use of medication as a potential tool for risk management and scepticism about individuals’ motivations, particularly in the community. The main limitation of this study was the differing levels of knowledge the sample had about MMSA and their subsequent ability to discuss MMSA other than in a theoretical sense. Practical implications include the need for further training for probation staff, improved collaboration between departments and ongoing support for staff to support the success of the MMSA intervention. This study offers a novel perspective on MMSA - that of the probation staff supervising prisoners taking MMSA. This has not been explored before, and the findings and associated implications are of importance for the treatment and care of those convicted of sexual offences.

A Life Sentence in Installments: A Qualitative Analysis of Repeat Offending Among Short-Sentenced Offenders

ABSTRACT Short-sentenced (less than 12 months) offenders in the United Kingdom consistently account for the greatest number of discharges from prison and demonstrate the highest risk and rate of reoffending. Moreover, until recent changes in UK legislation in 2015, individuals serving short sentences were released into the community with little support postrelease. The present study presents an exploration of (re)offending in individuals who have already served multiple short sentences in custody and aims to understand their experiences, perceptions, and insight into their offending. Is there anything apropos short sentences specifically, or those who continually serve them, that can explain the high rates of reoffending in this population? Semistructured interviews were conducted with eight prisoners currently serving short custodial sentences. Interpretative phenomenological analysis was implemented deriving three superordinate themes from the rich dataset: (a) living short sentences, (b) “You’d do the same if you were me,” and (c) negotiating an identity.

Circles of Support and Accountability, Assisted Desistance and Community Transition

This chapter will focus on what we know about sexual offending and desistence from sexual crime. It will contain a summary of sexual offending from a psychologist’s point of view. Both historical psychological studies and more recent developments of thinking in this area will be explored including seminal theories of sexual offending and desistance. These are explored in relation to Circles, and how Circles of Support can assist in desistance from crime where prison rehabilitation falls short. Recent research findings will be incorporated and implications for treatment and promoting desistance from crime will be explored.

'Because you’ve got faith it doesn’t mean that you’ve got wings on your back’: a qualitative analysis of the accounts of Christian prisoners serving time for a sexual offence

ABSTRACT Religious beliefs have been variously promulgated as both protective and risk factors for sexual reoffending. Moreover, therapists working with religious prisoners struggle with unravelling cognitive distortions embedded within religious views, with concerns about accusations of prejudice salient in their mindset. This paper presents a novel contribution to research by combining the qualitative analysis of the accounts offered by individuals (n = 12) convicted of sexual offences who describe themselves as Christians. Data were collected through semi-structured interviews and analysed using Interpretative Phenomenological Analysis. This paper focuses on two superordinate themes: (i) The God Effect and (ii) The Shadow Side of Religion. Implications of this research are discussed with reference to the assessment of dynamic risk and protective factors with religious individuals who have been convicted of a sexual offence.

Understanding the needs of individuals at risk of perpetrating child sexual abuse: a practitioner perspective

ABSTRACT Research estimates that as many as 1 in 20 children in the United Kingdom (UK) have been victims of child sexual abuse. The scale of this problem motivates prevention efforts; however, there is an apparent absence of preventative intervention for those individuals who are concerned about their sexual preference for children, including those who have not committed an offense. Due to the sensitive nature of child sexual abuse and stigma surrounding pedophilia, individuals who are concerned about their sexual interests in children are unlikely to willingly participate in research. By investigating the experiences of staff that are employed by an organization offering an anonymous helpline for people who experience sexual thoughts and behaviors toward children, this research aims to develop understanding of the needs of those individuals, in order to establish how child sexual abuse might be prevented. Semistructured interviews were conducted with five practitioners from a sexual abuse prevention organization, and thematic analysis revealed three main themes: (a) moving service users forward, (b) barriers to intervention, and (c) prevention: missing pieces. The first theme identifies ways in which practitioners may help service users to identify their problem, associated risk factors, and how they might begin to move forward. The second theme addresses certain factors that prevent service users from accessing or engaging with primary interventions. Finally, the third theme discusses the ways in which primary prevention could be built upon, by considering participants’ experiences that are shaped by their work in the field of primary intervention, and their experience of service users. This is the first time the needs of those who may benefit from primary prevention in the UK have been explored in this way; therefore, each theme is discussed in relation to primary prevention of child sexual abuse.