A New Treatment Study Focusing on Intertwining Cognitive-Behavioral Therapy with Interpersonal Psychotherapy

• A PDF Version of the Report is here:
  < insecure_parental_attachment_in_pedophiles_.pdf 
• The References are given here as a Word file:
  < insecure_attachments_-_references.docx >

Abstract

This proposal focuses on demonstrating a correlation between attachment deficits and pedophilia that has been neglected in the research to date. Prior research shows that there is a link between insecure parental attachment and individuals diagnosed with pedophilia, which can be an indicator of inappropriate relationships in adulthood such as
romantic relations with a child. 
Fifty incarcerated males who have been convicted of any sexual act involving a minor will be randomly assigned to either the standard cognitive-behavioral treatment (CBT) or CBT and interpersonal psychotherapy. They will be assessed pre- and post-treatment and over a period of 10 years. 
It is hypothesized that the group who receives CBT and interpersonal psychotherapy will demonstrate lower levels of recidivism than the group with the standard CBT treatment. The implications of this research study would update and correct the flaws in the current sex offender treatment being used across the country, as well as state or federal policies regarding sexual offender treatment.

Insecure Parental Attachment in Pedophiles

A study of 453 pedophiles showed that these offenders had collectively molested over 67,000 children, about 148 children per pedophile (Abel & Osborn, 1992). Statistics like this demonstrate a need for research regarding how to treat these individuals and reduce their rate of offending. 
This literature review will focus on pedophilia and will explore the literature regarding the etiology of pedophilia, treatment strategies, and risk of reoffending within this population. The proposal will conclude by hypothesizing that pedophilia is largely influenced from attachment deficits during childhood and an effective strategy to treat pedophilic offenders is to use a treatment method that specifically addresses attachment deficits.

Child Sexual Offenders versus Pedophiles

There is a vast difference between child sex offenders and pedophiles. 

Child sexual offender is a legal term that refers to anyone who has committed a sexual act involving a child, which covers a broad range of behaviors (...). A child sexual offender may have no direct desire or love for children, but instead has a general lack of regard for others’ feelings and rights, or has other motivations for their sexual offending (...). [...]
In contrast, pedophilia is strictly a psychological term. The DSM-IV-TR defines  pedophilia as recurrent sexual fantasies, urges, and/or behaviors that involve sexual 
activity with a prepubescent child, as well as if the individual has acted on these fantasies or urges (...). [...] 
However, there is also the possibility that an individual diagnosed with pedophilia can also be legally classified as a child sexual offender after engaging in pedophilic illegal behavior and being convicted.

Theories on the Etiology of Pedophilia

Past childhood sexual trauma.

One of the most common etiological theories of pedophilia is that most pedophiles have had some sort of childhood or past sexual trauma that they experienced or witnessed that can be related to their diagnosis [...]

Researchers theorize that the trauma of being sexually abused or witnessing sexual abuse during childhood creates a sense of loss of control in the victim; thus, the victim begins sexually offending during adulthood as a way of taking back control [...] 

Finkelhor and Araji (1986) suggest that the pedophile may see himself [...] in the child, and by acting as the aggressor that once victimized him, he is overcoming the feelings of powerlessness or shame that he felt when he was a child [... ... ...].

Although [...] studies show that there are child sexual offenders who were victimized in their youth, they also show a large percentage of child sexual offenders who were not victimized. Additionally, the studies discussed do not focus specifically on pedophilia separate from sexual offending as a whole. This is a limitation to the studies because it is difficult to identify the extent to which these results apply specifically to pedophiles, since the study failed to separate the two populations of perpetrators. [...]

Freund et al. (1990) found that the self-reports showed that it is very likely that pedophiles, compared to the other groups, do not accurately report abuse in their own childhood and may possibly exaggerate it because they perceive that this justifies their behavior. 

Although some studies (... ... ...) indicate that a large number of offenders have been sexually victimized during childhood, research (Freund et al., 1990) also indicates that some offenders may be lying regarding prior victimization and that many offenders have never been victimized at all (James, 2006). 

This suggests that prior sexual victimization does not explain the sexual victimization of children for all offenders, and that other factors may be contributing to the  characteristics associated with those who offend against children.

Neurological, biological, and developmental theories.

The next theory to be discussed is that pedophilia is due to neurological (brain functioning), biological (physical functioning), or developmental (the standard benchmarks for growth throughout one’s life) factors. This theory is very popular because if pedophilia can be explained by a defect in the brain, then it stands to reason that its underlying cause could be treated by a medical intervention (Seto, 2008).

Researchers who support this theory argue that pedophilia is a physical ailment or symptom that the individual does not choose to participate in, but rather experiences due to neurological or developmental problems (...). 

[... ... ...] 
[Several studies suggest] that neurological damage sustained due to injury may increase the likelihood of developing pedophilia (Blanchard et al., 2003). A study by Bremner (2008) suggests that any type of abuse during childhood can result in neurological damage, causing damage such as lesions on the prefrontal cortex of the brain. The result of this damage may be the inability to properly regulate or interpret emotions making it hard to have relationships with functioning adults (Bremner, 2008). [...]
Developmental or neurological issues could also impact an individual’s brain 
development regarding sexual desires, impulsivity, and judgment creating pedophilic
urges or ideas (...). 

Researchers who argue these theories often use case studies, which only show a possible link to pedophilia rather than a direct cause (...). These studies also do not address the majority of individuals with brain injuries, developmental disabilities, or lower intelligence that never develop sexually deviant desires or behaviors. This is because these studies commonly use individual case studies or small samples, rather than a larger population, which means the results are unreliable because one cannot generalize information obtained from case studies to an entire population accurately.

Conditioning.

A third theory into the etiology of pedophilia is that pedophilia develops through the act of conditioning due to pornography, masturbation, early sexualization, or other methods of sexual conditioning (Finkelhor & Araji, 1986).

According to this theory, pedophiles develop their preference for children through
associating children with sexual desires and/or fulfillment. One way this happens is that
when individuals are sexually abused as children, they are watching an adult who is
stimulated sexually by children. This could lead to the victims associating sexual arousal
with children (.. idem ..) If a prepubescent individual has their first consensual and pleasurable sexual experience with a prepubescent peer, then it is possible that the individual will always associate sexual excitement with prepubescent children (.. idem ..) Perhaps, for some reason, they have become emotionally blocked from moving on in their fantasies as they age (.. idem ..).

The critique of this theory is that early sexualization might strengthen the already present attraction to children, but does not necessarily indicate how pedophilia was developed. 

Another aspect of conditioning involves masturbation. 
When an individual has pedophilic fantasies during masturbation, the association between pedophilic fantasies and sexual arousal/gratification is strengthened. After the association has been strengthened through this repetition of masturbation, the individual may want to act out his fantasies in order to gratify his desires (... ...) 
As with the aforementioned theory by Finkelhor and Araji (1986), this theory
does not explain why the individual originally used pedophilic fantasies during
masturbation, furthering support for the possibility that conditioning strengthens the
pedophilic fantasies rather than causes it.

Attachment Theory.

The final theory to be discussed regarding the possible etiological causes of pedophilia is the prevalence among pedophiles to have an insecure attachment with their parents.

Sawle and Kear-Colwell (2001) demonstrated that pedophiles displayed higher ercentages of insecure parental attachment as compared to both sexual abuse victims and those who were neither sexual abuse victims nor perpetrators. The pedophiles were usually classified as anxious-ambivalent or avoidant attachment styles. 

These styles mean that the pedophile have difficulty cultivating relationships with peers due to the type of attachment he had with his parents (... ... ...). 
Many pedophiles may be incapable of creating secure attachments with friends and are less likely to become intimate with other people compared to non-pedophiles who are capable of creating secure attachments (... ...).

Many studies have indicated that sexual offenders reported high levels of neglect,
rejection, and little to no warmth from their parents, as well as low levels of supervision,
discipline, and consistency (... ... ...). 

Additionally, these studies indicated that pedophiles have a much higher rate of insecure attachments in both childhood and adulthood when compared to non-pedophilic control groups (Bogaerts et al., 2005). 

Further support for attachment theory is found in a study conducted by Hudson and Ward (2000). This study found that child molesters reported high rates of self-reliance, rather than reciprocal sharing and dependence with their mothers, meaning they felt unable to intimately and emotionally share with their mother (Hudson & Ward, 2000). 
Other studies run parallel to these findings, many stating that child molesters are
more likely to be insecurely attached than other sexual offenders and non-offenders (e.g.
Craissati et al., 2002; Hudson & Ward, 2000).

These studies provide support for the theory that a pedophile’s lack of parental warmth or attachment can be an important factor in why they developed pedophilia and why they are unable to form age-appropriate relationships. These insecure attachments can lead the pedophile to have low self-esteem and struggle with relationships (Seto, 2008). [...]

McCormack et al. (2002) goes on to argue that a pedophile’s negative evaluations about himself are a likely cause for the common lack of age-appropriate relationships and friendships as an adult. Sometimes these negative evaluations of oneself also lead to a lack of ability to trust, be intimate, and engage in appropriate intimate and platonic relationships, causing a higher likelihood of interest in children (Bogaerts et al., 2005).

This experience with detachment can lead a child to grow up without knowing how to connect with people in appropriate and healthy relationships (.. idem ..) 
Hudson and Ward (2000) mention that this difficulty to create relationships can influence other relationships in an individual’s life, such as peer relationships. They reported pedophiles to have few, if any, friends growing up. 

Similarly, Furnham and Haraldsen (1998) showed that early childhood relationships with peers were a leading factor in the cause of pedophilia and that there was a clear link between pedophilia and issues regarding intimacy and attachment. They argued further that directly focusing on these causes in treatment might be the most effective means to
reduce recidivism and should be further studied (... ... ...). 

Baker, Beech, and Tyson (2006) state that attachment problems can cause the individual to create cognitive distortions that he is unable to distinguish from reality. These distortions make it difficult for them to create age-appropriate, intimate relationships and lead them to develop fantasies and create relationships with inappropriate persons (Baker et al., 2006). This asocial lifestyle is a very common trait in sexual offenders who are emotionally detached from others (...).

These results suggest that having insecure attachments make a child more vulnerable to being sexually assaulted or abused, which in turn leads the child to an earlier awareness of sexuality (...). 
This early sexualization leads to higher and earlier rates of masturbation, which, when paired with fantasies of younger children and violent acts, increases the likelihood that the child will age to become a pedophile (...). 
Although the research between attachment and pedophilia is correlational, it emphasizes the importance attachment may have in the etiology of this diagnosis.

Risk and Recidivism in Pedophilia

Risk is the probability that a pedophile is likely to reoffend, whereas recidivism is
the actual act of reoffending (...). Risk can be assessed by several different measures, depending on the researchers (Hall & Hall, 2007; Seto, 2008). [...] These instruments and assessments allow the researcher to estimate the likelihood of the pedophile reoffending.

Marshall, Jones, Ward, Johnston, and Barbaree (1991) state that clarifying the
type of sexual offender is extremely important when calculating risk. Similarly, a study
of 400 male participants by Greenberg, Bradford, Firestone, and Curry (2000) found that
a pedophile’s relationship to his victims was extremely important when assessing risk. 

[...] Examining the sexual offender’s history with the victim, or characteristics of the victim, is an important aspect to acknowledge when attempting to assess the pedophile’s risk of reoffense. [...]

There is some variation regarding how to correctly calculate rates of recidivism and risk
among researchers in the psychological field. Hall and Hall (2007) argue that this field
lacks longitudinal research, where a pedophile is followed for many years and the
researchers record whether he reoffends over that time period. Most studies only follow
the offender during treatment or sometimes for a short period of time afterwards (...). 

[...] Hanson (2002) conducted a study on recidivism and age in sexual offenders. [...] 
Recidivism rates can vary by the type of offender, therefore these factors need to be accounted for when assessing risk of reoffense.

Other problems with calculating risk and tracking recidivism are that not all studies use the same measurements. Therefore, when self-reports are used to show recidivism rates, there could be inaccuracies because the offender could provide inaccurate information (...). Criminal reports could also be inaccurate because the pedophile may have committed other crimes but has not been caught. Both of these possible ways of keeping track of recidivism could result in inaccurate recidivism estimates.

Instruments used for risk and recidivism.

Risk of reoffending can be measured different ways, but one of the most common measures is the Static-2002 (Hanson & Thornton, 2000). The Static-2002 assigns a raw score to the sexual offender to measure his risk of reoffending (.. idem ..). It is heavily supported in the psychological community as being one of the most specific assessment instruments to address sexual risk (...). [...]

The strength of this instrument is that it can be used on any type of male sexual offender, and that it shows the likely outcome of recidivism after release due to the offender’s criminal history.

However, there are some limitations to this instrument. 
For example, it relies on static factors, or factors that do not change over time, which does not address any possible changes in the offender’s life or habits. Also, assigning a number to an individual does not always accurately predict how they will behave because human beings are unpredictable and constantly changing (...). 
A coded form of static variables does not account for emotional variability and cognitive distortions in the sexual offender (...). 
However, research still presents this instrument to be one of the best and most accurate measures of recidivism (...).

The Abel Assessment of Sexual Interest (AASI) has been used with pedophiles and
has been shown to accurately differentiate between non-pedophiles and pedophiles (Abel, Jordan, Hand, Holland, & Phipps, 2001). [...]
The AASI is currently one of the most accurate detectors of faking in pedophiles (.... The results of the AASI have been accepted as reliable evidence in several court cases to date (...). 

There have been many risk instruments developed over the last few decades that
compete with the Static-2002 and the AASI (...), but this proposal specifically focuses on these two due to their consistency and strength. 
The Static-2002 has proven valid and constant, giving reliable risk data for many previous studies (...). The AASI is not only consistent, but it also is able to be more accurate than other tests while also being unobtrusive and simple to administer (...).

Treatment of Sexual Offending

Treatment methods tend to focus on reducing sexual recidivism rates, however, most methods focus dually on factors other than sexual offending, like treating the pedophile’s mental, emotional, interpersonal, psychological, or developmental problems. [...]
Some examples of treatment methods [...] will be reviewed in the following section [...].

Medication

Medications are used on sexual offenders for several different purposes. Some medications are used to treat depression or anxiety in offenders but have the side effect of diminished libido. Other medications are meant to solely inhibit the hormones that produce testosterone. A common medication used is Depo-Provera (Medroxyprogesterone). [...] 
Some other anti-androgen drugs include Leuprolide Acetate, Triptorelin, Cyproterone Acetate, Androcur, and Tamoxifen (...). 
Anti-androgens are specifically designed to block specific hormones in order to stop the production of testosterone, lower libido, block androgen receptors in the body, and/or over stimulate the hypothalamus which reduces testosterone levels significantly (...).

Beech and Mitchell (2005) discuss the use of selective serotonin reuptake inhibitors (SSRIs) to help sexual offenders with mood disorders as well as to help improve their interpersonal skills. 
SSRIs are commonly taken by individuals struggling with depression, anxiety, and other mood disorders; however, for a sexual offender, these drugs help to encourage appropriate social behavior by reducing the anxiety or other psychological problems that have blocked them from appropriate social attachments in the past (... ... ...).
As well as the benefit of the SSRI helping with mood disorders and anxiety, it has the
side effect of diminished libido which aids in sexual offender treatment by lessening the
offender’s physical drive to reoffend sexually (Seto, 2008).

Although some research has shown that medication can be an effective tool in sexual offender treatment, it does have its limitations. Medications can be controversial because many physicians won’t prescribe it because of the side effects as well as the ethics regarding forced medications (Seto, 2008). Also, there is a limited amount of research regarding SSRIs with sexual offenders because most of the studies done are case studies, making it impractical to assume that this treatment is applicable to the larger population of pedophiles (...).

Reconditioning methods.

Reconditioning methods decrease the association between arousal and children and increase the association between arousal and ageappropriate persons. Some methods for this are aversion therapy and discrimination therapy (...).

Aversion therapy takes a negative unconditioned reinforcer, like electric shock, and follows it with a conditioned stimulus, like an image of a child (...). The point of this treatment is to condition the pedophile to associate negative consequences with becoming sexually aroused in response to children. [...]
The point of discriminative conditioning is to associate positive rewards to an attraction to age-appropriate adults.

Another therapy that is used in reconditioning is orgasmic reconditioning which is meant to teach the pedophile to associate climax and ejaculations with age-appropriate 
sexual fantasies, hoping to reduce the sexual interest in children (...). This can be done in several ways, including using sexual imagery and fantasies of age-appropriate adults during climax. 

These therapies are meant to help the offender associate negative consequences with sexualized thoughts towards children. The flaw, however, is that reconditioning only addresses the behavior and not the cognitive distortions or causal reasons that spurred the behaviors initially. It also can be extremely invasive and sometimes ause unintended harm to the participant, like loss of libido or sexual confusion (...) [...]

Cognitive-behavioral therapy

One of the most common approaches to treating sexual offending and pedophilia is cognitive-behavioral therapy (CBT). CBT combines behavioral approaches, such as reconditioning, with cognitive restructuring to attempt to change the thought process of pedophilic urges. Therapists might ask the individual diagnosed with pedophilia to explain his sexual offending and then the therapist will help him to identify the distorted thoughts (... ...).

CBT then tries to get to the root of the behavior by examining his underlying thought processes and trying to change them, so that in turn, the behavior will change as well (...).

CBT uses a variety of techniques and is done slightly differently by each therapist, but contains methods such as 

• social skills, 
• assertiveness, 
• coping skills training,
• victim empathy training, 
• externalization (learning how the offending individual’s actions look and feel to the child), 
• relapse prevention (continual therapy and use of techniques to avoid tempting situations throughout life), 
• identifying and restructuring cognitive distortions, and being aware of the cognitive influence on his behaviors (... ... ...).

Treatment methods, such as CBT, are thought to work best with pedophiles because it involves the rehabilitation of the offender as a whole, not just the cessation of the deviant behavior (... ...).

[...] CBT is one of the most popular approaches because it has been shown to help reduce recidivism rates thanks to the interventions it incorporates (... ... ...) [...]

CBT is specifically useful with patients dealing with attachment and interpersonal difficulties because it incorporates relationship building as well as confronting cognitive 
distortions - unrealistic thoughts (...). 
As mentioned in the previous section, insecure parental attachment is thought to be strongly associated with pedophilia and therefore, having a treatment method that can work to address these issues together is extremely important. [...]

Interpersonal psychotherapy

[...] Interpersonal psychotherapy is a treatment style that specifically focuses on attachment problems, current and past relationships, and interpersonal skills (...).
Weissman et al. (2000) state that “interpersonal psychotherapy is a focused, time-limited psychotherapy that emphasizes the link between mood and the current interpersonal relations of the [patient]…” (p. 4).

Earlier studies have shown that specific interpersonal problems are associated with different attachment styles (...). 
Horowitz et al. (1993) created a model called the Inventory of Interpersonal Problems that classified insecure attachment (also known as fearful-avoidant attachment) as being
characteristically highly introverted, subassertive, and exploitable. They continued to
describe individuals with this type of attachment classification to have low sense of self
worth and a lack of faith in others. 

Horowitz et al. (1993) believed that these qualities made individuals with insecure attachment less likely to actively pursue appropriate relationships with others due to fear of rejection. Interpersonal psychotherapy and interpersonal skills training specifically target these cognitive distortions, like lowered self-esteem and extreme introversion to the point of influencing one’s lifestyle, by teaching methods of building stronger relationships with age-appropriate partners and family as well as addressing the reasoning behind the attachment deficiencies. 

Crits-Christoph, Gibbons, Temes, Elkin, and Gallop (2010) studied interpersonal
psychotherapy versus cognitive behavioral therapy on 72 patients who were struggling
with major depressive disorder. 
Results showed that participants who were receiving interpersonal psychotherapy showed outcomes of establishing stronger relationships and the lessening of depressive symptoms compared to the CBT group (Crits-Christoph et al., 2010). 
Although this study did not focus on sexual offenders, but it does suggest that interpersonal therapy could address shared issues, such as social attachment.

Research Proposal

There is a neglected area in the research literature regarding insecure parental  attachment in relation to pedophilia. Attachment issues have been shown to have a significant effect on future relationships (...), so this proposal states that by addressing these deficiencies in pedophiles, it will help to create age-appropriate relationships instead of pedophilic behavior. 

CBT [Cognitive Behvioral Therapy] is a common sexual offender treatment but it lacks the aspects of interpersonal psychotherapy that directly address this deficit of attachment in pedophiles. By combining these two treatment methods and uniquely targeting attachment deficits in pedophiles, this proposal hopes to demonstrate that the use of interpersonal psychotherapy and CBT therapy will result in lower recidivism rates and enhanced interpersonal skills and age-appropriate relationships than CBT therapy alone.

Method

Participants

Participants will be 50 incarcerated male offenders who have been convicted of any sexual act involving a minor, soliciting a minor, possession of child pornography, and/or meet diagnostic criteria for pedophilia. Participants will only be selected to be part of this study if their victim(s) were under the age of 13 years old at the time of the crime to be consistent with the DSM-IV-TR diagnostic criteria for pedophilia (...). 
All of the participants will be male even though this study does acknowledge that pedophilia can be found in females as well. This study will not focus on juvenile sexual offenders; therefore, only offenders over the age of 18 years old will be allowed to participate.

Instruments

Static-2002. 
The Static-2002 is a common tool used with sexual offenders for measuring recidivism (Doren, 2002; Hanson & Thornton, 2000). It examines the following characteristics of the offender: 

• age at release from a criminal institution,  
• persistence of sexual offending 
  (prior sentencing occasions for sexual offences, juvenile sexual offence arrests, and rate of sexual offending), 
• deviant sexual interests 
  (non-contact sexual offences, gender of victim, age and relation to victim), 
• relationship to victims 
  (stranger, family, or other relation), and 
• general criminal records 
  (any record in criminal justice system, prior sentencing for anything, community supervision violations, years between re-offending, prior non-sexual violence sentences). 

Each of the items is coded with a specific score that can range from 0 - 3 and then tallied to create a total score that indicates the likelihood of re-offending. The total score is then interpreted as: 

• 0-2 is low risk, 
• 3-4 is low to moderate risk, 
• 5-6 is moderate risk, 
• 7-8 is moderate to high risk, and
• over 9 is high risk. 

Since this instrument classifies the participant’s risk based on each
participant's past record and interests, the Static-2002 will only be administered once at
the start of treatment (Hanson & Thornton, 2000).

Abel Assessment of Sexual Interest.

The second assessment tool that will be utilized is the Abel Assessment of Sexual Interest (AASI), created by Gene Abel (Abel et al., 2001). 
This is a recently developed measure in which sexual deviance and interest are assessed through visual reaction time (.. idem ..). Participants are first given a questionnaire to assess their sexual interests. The participants then see photographs of different people of all ages (including children) in different poses. The amount of time that they choose to view each photograph is recorded. 
It is thought that participants will look at photographs containing individuals to whom they are attracted for longer periods of time than at photographs that contain individuals to whom they are not attracted. This tool has been specifically used with pedophiles and has been proven to accurately differentiate between non-pedophiles and pedophiles (.. idem ..).

Inventory of Interpersonal Problems.

The last measure of assessment that this study will utilize is the Inventory of Interpersonal Problems (IIP), designed by Horowitz, Rosenberg, Baer, Ureno, and Villasenor (1988) to measure the emotional and psychological distress that is created from interpersonal relationships in an individual’s life. 
The therapist will be working from a questionnaire that contains lists of interpersonal problems for the therapist and participant to pick from and focus on, and then discussing whether or not the problem improved after treatment (.. idem ..). 
In another study using the IIP, it specifically relates the interpersonal struggles to attachment problems and shows the ability of the IIP to detect and define these issues (Horowitz, Rosenberg, & Bartholomew, 1993). 
The current study is looking at attachment deficits in pedophiles; therefore using this measurement will assess the attachment strengths and weaknesses of each participant.

Procedure

[... ... ... ...]
After all possible candidates for participation have signed the informed consent, they will be interviewed to determine whether they meet the diagnostic criteria for
pedophilia. [...]

The questions in the interview will be in respect to the DSM-IV-TR criteria regarding the definition of pedophilia (...). Questions will surround the following: 

• the occurrence, frequency, and intensity of sexually arousing fantasies of prepubescent children, 
• the occurrence, frequency, and type of behavior or urges involving sexual activity with a prepubescent child, 
• whether or not the participant has ever acted on his fantasies or urges, 
• whether or not the sexual urges, fantasies, or behaviors cause distress of interpersonal difficulty to the participant, 
• how old the subjects of his fantasies or actions are, and so on (...).

[...] After finalizing their agreement to participate in this study and their meeting the diagnostic criteria for a pedophile, the participants will be randomly placed into one of
two groups. 

• The first group will be treated with the standard sexual offender treatment, which is cognitive behavioral therapy (CBT). 
• The second group will be treated with the same CBT treatment as well as interpersonal psychotherapy.

Treatment will be done in a small group therapy setting with other offenders because research has shown that a less confrontational therapeutic style tends to have more positive outcomes than individual therapy, as well as the fact that relationships with others are highlighted in the group setting (...). Treatment will be the last 18 months of
incarceration [...]. 

Every participant will be assessed before they start treatment and an analysis will be done to determine how likely they would be to re-offend if released without treatment.
They will be administered three different tools of measurements. 

• First, they will be given the Static-2002 to test their constant risk of re-offending based on their age, gender, crimes, and past victims (...). 
• Second, the participants will receive the Abel Assessment for Sexual Interest (...). 
• Lastly, they will end with the Inventory of Interpersonal Problems (IIP) to examine the change in their level of attachment problems and interpersonal skills throughout treatment (...).

After the initial testing, the participants will begin to receive treatment, based on their respective groups, by a certified mental health practitioner. The AASI and IIP will be administered every 60 days during treatment, but will stop upon their release from
prison [...] 
Participants will be tracked for 10 years following release and their re-arrest records will be recorded at the 6-month, 1-year, 2-year, 4-year, 8-year, and 10-year mark. [...] 
The criminal arrest records of the offenders will be closely tracked to indicate if there are any reoffending patterns among participants, as well as show the recidivism rates at each interval. Marital records of all participants will also be tracked at these intervals to indicate any possible improvements in attachment capabilities.

Proposed Analyses

• Demographics. 
  Analyses will include the standard Statistical Package for the Social Sciences (SPSS) statistical analyses. [...]
• Risk. 
  ... Static-2002 and AASI ... 
  The raw scores of all participants on the Static-2002 will be analyzed to collect the average risk score for each group and for the participants as a whole. [...] 
  Both the answers to the questionnaire and the viewing time will be compared and
  contrasted between the two groups at each testing time to see if there are differences
  between the groups and to see if the results change throughout the experiment when
  assessing risk.

Two independent samples t-tests will be used to compare the CBT and the CBT with interpersonal psychotherapy group’s scores on the AASI. 

• The t-tests at the beginning of the study will be conducted to ensure that the groups do not show a significant difference regarding their initial level of risk. This will allow the researchers to conclude that any significant differences observed after treatment can be attributed to the impact of treatment, rather than due to pre-existing differences between the two groups. 
• A second independent sample t-test will be conducted at the completion of treatment to examine if the CBT combined with interpersonal psychotherapy group displays significantly lower AASI scores than the CBT alone group. 

It is hypothesized that the AASI scores will be significantly lower in the CBT with interpersonal psychotherapy group compared to the group that receives CBT alone.

Repeated measures ANOVAs will also be conducted for the AASI results, to see if the two groups showed significant differences in their AASI scores over the course of treatment. The ANOVA will take the AASI data and compare risk at the start of treatment, during treatment, and after treatment to see if there was any significant change over those three intervals. 

It is hypothesized that AASI scores will decrease over the course of treatment for both groups; however, the CBT with interpersonal psychotherapy group is expected to show a more dynamic decrease than the CBT alone group.

• Attachment.
  [...] IIP interview ... the results of these interviews will also be contrasted between the two groups throughout the experiment at each interval to see if any change occurs or if there is a significant difference when assessing attachment strengths between the groups.

Two independent samples t-tests will be used to compare the CBT alone and the
CBT with interpersonal psychotherapy group’s scores on the IIP. 

• The t-test at the beginning of the study will indicate whether there is a significant difference regarding the two group’s initial type of attachment. This will allow the researchers to conclude that any significant changes observed after treatment can be attributed to the impact of treatment, rather than due to pre-existing differences between the two groups. 
• A second independent samples t-test will be conducted at the completion of treatment to examine if the CBT combined with interpersonal psychotherapy group displays significantly higher IIP scores than the CBT alone group.

It is hypothesized that the IIP scores of the CBT with interpersonal psychotherapy group will show higher levels of secure attachment after treatment compared to the group that receives CBT alone.

• Repeated measures ANOVAs will also be conducted for the IIP results, to see if the two groups showed significant differences in their IIP results over the course of treatment. The ANOVA will take the IIP data and compare attachment types and deficits at the start of treatment, during treatment, and after treatment to see if there was any significant change over those three intervals. 

It is hypothesized that IIP results will show higher levels of secure attachment in the CBT with interpersonal psychotherapy group after treatment compared to the CBT alone group.

• Marital records will also be analyzed during follow up of all participants to see if one group had statistically significant higher levels of marriage than the other group.

It is hypothesized that having higher levels of secure attachment will be evident through higher levels of marriage. While these records may not fully capture whether the 
participant’s attachment capabilities have improved, it will provide an initial idea as to 
one of the ways that the participants could be establishing intimate relationships with
age-appropriate peers.

• Recidivism. Criminal records will also be analyzed to see if one group had statistically significant higher criminal re-arrest and conviction records compared to the other group. Percentages will be calculated for each group and compared.

Expected results are that the CBT alone group will have a higher percentage of re-arrest instances than the CBT and interpersonal psychotherapy group.

\b\f1\fs24 References\par
\b0 Abel, G., Jordan, A., Hand, C., Holland, L., & Phipps, A. (2001). Classification models\par
of child molesters utilizing the abel assessment for sexual interest. \i Child Abuse &\par
Neglect\i0 , \i 25\i0 , 703-718. doi: 10.1016/S0145-2134(01)00227-7\par
Abel, G., & Osborn, C. (1992). Stopping sexual violence. \i Psychiatric Annals, 22\i0 ,\par
301-306. doi: 1992-44629-001\par
Abel, G., Rouleau, J., & Cunningham-Rathner, J. (1986). Sexually aggressive\par
behavior. In W. Curran, A. McGarry, & S. Shah (Eds.). \i Forensic psychiatry and\par
psychology: Perspectives and standards for interdisciplinary practice \i0 (pp. 289-\par
313). Philadelphia, PA: F A Davis.\par
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental\par
disorders (Revised 4th ed.). Washington, DC: Author.\par
Baker, E., Beech, A., & Tyson, M. (2006). Attachment disorganization and its relevance\par
to sexual offending. \i Journal of Family Violence\i0 , \i 21\i0 , 221-231. doi:\par
10.1007/s10896-006-9017-3\par
Bogaerts, S., Declercq, F., Vanheule, S., & Palmans, V. (2005). Interpersonal factors\par
and personality disorders as discriminators between intra-familial and extrafamilial\par
child molesters. \i International Journal of Offender Therapy and\par
Comparative Criminology, 49\i0 , 48-62. doi: 10.1177/0306624X04271233\par
Bogaerts, S., Vanheule, S., & Declercq, F. (2005). Recalled parental bonding, adult\par
attachment style, and personality disorders in child molesters: A comparative\par
study. \i Journal of Forensic Psychiatry & Psychology\i0 , \i 16\i0 , 445-458. doi:\par
\cf2 10.1080/14789940500094524\par
\cf1\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 33\par
\f1\fs24 Bogaerts, S., Vanheule, S., & Desmet, M. (2006). Personality disorders and romantic\par
adult attachment: A comparison of secure and insecure attached child\par
molesters. \i International Journal of Offender Therapy and Comparative\par
Criminology\i0 , \i 50\i0 , 139-147. doi: 10.1177/0306624X05278515\par
Bremner, J. (2008). The neurobiology of trauma and memory in children. In M. Howe,\par
G. Goodman, & D. Cicchetti (Eds.), \i Stress, trauma, an\f2 d children\rquote s memory\par
\f1 development: Neurobiological, cognitivie, clinical, and legal perspectives \i0 (pp.\par
11-49). New York, NY: Oxford University Press.\par
Briken, P., Hill, A., & Berner, W. (2007). Abnormal attraction. \i Scientific American\par
Mind: Psychology and Behavioral Sciences Collection\i0 , \i 18\i0 , 58-63.\par
Caldwell, M. (2010). Study characteristics and recidivism base rates in juvenile sex\par
offender recidivism. \i International Journal of Offender Therapy and Comparative\par
Criminology, 54\i0 , 197-212. doi: 10.1177/0306624X08330016\par
Camilleri, J. & Quinsey, V. (2008). Pedophilia: Assessment and treatment. In R. Laws &\par
\f2 W. O\rquote Donohue (Eds.), \i\f1 Sexual Deviance: Theory, Assessment, and Treatment, 2\fs16 nd\par
\fs24 ed. \i0 (pp. 183-212). New York, NY: Guilford Press.\par
Canter, D., Hughes, D., & Kirby, S. (1998). Paedophilia: Pathology, criminality, or\par
both? The development of a multivariate model of offence behaviour in child\par
sexual abuse. \i Journal of Forensic Psychiatry, 9\i0 , 532-555. doi:\par
10.1080/09585189808405372\par
Cohen, L. & Galynker, I. (2002). Clinical features of pedophilia and implications for\par
treatments. \i Journal of Psychiatric Practice, 8\i0 , 276-289. doi:\par
10.1097/00131746-200209000-00004\par
\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 34\par
\f1\fs24 Coxe, R. & Holmes, W. (2009). A comparative study of two groups of sex offenders\par
identified as high and low risk on the Static-99. \i Journal of Child Sexual Abuse:\par
Research, Treatment, & Program Innovations for Victims, Survivors, &\par
Offenders, 18\i0 , 137-153. doi: 10.1080/10538710902743925\par
Craissati, J., McClurg, G., & Browne, K. (2002). The parental bonding experiences of\par
sex offenders: a comparison between child molesters and rapists. \i Child Abuse &\par
Neglect, 26, \i0 909-921. doi: 10.1016/S0145-2134(02)00361-7\par
Craske, M. (2010). \i Cognitive-behavioral therapy\i0 . Washington, DC: American\par
Psychological Association.\par
Crits-Christoph, P., Gibbons, M., Temes, C., Elkin, I., & Gallop, R. (2010). Interpersonal\par
accuracy of interventions and the outcome of cognitive and interpersonal\par
therapies for depression. \i Journal of Consulting and Clinical Psychology, 78,\par
\i0 420-428. doi: 10.1037/a0019549\par
Doren, D. (2002). \i Evaluating sex offenders: A manual for civil commitments and\par
beyond\i0 . Thousand Oaks, CA: Sage Publications.\par
Enright, S. (1989). Paedophilia: A cognitive/behavioural treatment approach in a single\par
case. \i British Journal of Psychiatry, 155\i0 , 399-401. doi: 1990-08053-001\par
Finkelhor, D. & Araji, S. (1986). Explanations of pedophilia: a four factor model. \i The\par
Journal of Sex Research\i0 , \i 22\i0 , 145-161. doi: 10.1080/00224498609551297\par
Freund, K., Watson, R., & Dickey, R. (1990). Does sexual abuse in childhood cause\par
pedophilia: An exploratory study. \i Archives of Sexual Behavior, 19\i0 , 557-568.\par
doi: 10.1007/BF01542465\par
\f2 Furnham, A. & Haraldsen, E. (1998). Lay theories of etiology and \ldblquote cure\rdblquote  for four types\par
\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 35\par
\f1\fs24 of paraphilia: Fetishism, pedophilia, sexual sadism, and voyeurism. \i Journal of\par
Clinical Psychology\i0 , \i 54\i0 , 689-700. doi: 10.1002/(SICI)1097-\par
4679(199808)54:5<689::AID-JCLP15>3.0.CO;2-9\par
Glasser, M., Kolvin, I., Campbell, D., Glasser, A., Leitch, I., & Farrelly, S. (2001) Cycle\par
of child sexual abuse: links between being a victim and becoming a perpetrator.\par
\i The British Journal of Psychiatry, 179\i0 , 482-494. doi: 10.1192/bjp.179.6.482\par
Greenberg, D., Bradford, J., Firestone, P., & Curry, S. (2000). Recidivism of child\par
molesters: A study of victim relationship with the perpetrator. \i Child Abuse &\par
Neglect\i0 , \i 24\i0 , 1485-1494. doi: 10.1016/S0145-2134(00)00197-6\par
Grubin, D. (2008). The case for polygraph testing of sex offenders. \i Legal and\par
Criminological Psychology\i0 , \i 13\i0 , 177-189. doi: 10.1348/135532508X295165\par
Hall, R. & Hall, R. (2007). A profile of pedophilia: definition, characteristics of\par
offenders, recidivism, treatment outcomes, and forensic issues. \i Mayo Clinic\par
Proceedings, 82\i0 , 457-471.\par
Hanson, K. & Thornton, D. (2000). Improving risk assessments for sex offenders: A\par
comparison of three actuarial scales. \i Law and Human Behavior, 24\i0 , 119-136.\par
doi: 10.1023/A:1005482921333\par
Hanson, R. (2002). Recidivism and age: Follow-up data from 4,673 sexual offenders.\par
\i Journal of Interpersonal Violence\i0 , \i 17\i0 , 1046-1062. doi:\par
10.1177/088626002236659\par
Harkins, L. & Beech, A. (2008). Examining the impact of mixing child molesters and\par
rapists in group-based cognitive-behavioral treatment for sexual offenders.\par
\i International Journal of Offender Therapy and Comparative Criminology, 52\i0 ,\par
\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 36\par
\f1\fs24 31-45. doi: 10.1177/0306624X07300267\par
Horowitz, L., Rosenberg, S., Baer, B., Ureno, G., & Villasenor, V. (1988). Inventory of\par
interpersonal problems: psychometric properties and clinical applications.\par
\i Journal of Consulting and Clinical Psychology\i0 , \i 56\i0 , 885-892. doi: 10.1037/0022-\par
006X.56.6.885\par
Horowitz, L., Rosenberg, S., & Bartholomew, K. (1993). Interpersonal problems,\par
attachment styles, and outcome in brief dynamic psychotherapy. \i Journal of\par
Consulting and Clinical Psychology\i0 , \i 61\i0 , 549-560. doi: 10.1037/0022-\par
006X.61.4.549\par
Hudson, S. & Ward, T. (2000). Interpersonal competency in sex offenders. \i Behavior\par
Modification\i0 , \i 24\i0 , 494-527. doi: 10.1177/0145445500244002\par
James, W. (2006). Two hypotheses on the causes of male homosexuality and\par
paedophilia. \i Journal of Biosocial Science, 38\i0 , 745-761. doi:\par
10.1017/S0021932005027173\par
Kalmus, E. & Beech, A. (2005). Forensic assessment of sexual interest: a review.\par
\i Aggression and Violent Behavior\i0 , \i 10\i0 , 193-217. doi: 10.1016/j.avb.2003.12.002\par
Kear-Colwell, J. & Boer, D. (2000). The treatment of pedophiles: Clinical experience\par
and the implications of recent research. \i International Journal of Offender\par
Therapy and Comparative Criminology\i0 , \i 44\i0 , 593-605. doi:\par
10.1177/0306624X00445006\par
Knight, R. & Sims-Knight, J. (2004). Testing an etiological model for male\par
juvenile sexual offending against females. \i Journal of Child Sexual Abuse:\par
Research, Treatment, & Program Innovations for Victims, Survivors, &\par
\i0\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 37\par
\i\f1\fs24 Offenders\i0 , \i 13\i0 (3/4), 33-55. doi: 10.1300/J070v13n03_03\par
Letourneau, E. (2002). A comparison of objective measures of sexual arousal and\par
interest: Visual reaction time and penile plethysmography. \i Sexual Abuse: A\par
Journal of Research and Treatment\i0 , \i 14\i0 , 307-334. doi:\par
10.1177/107906320201400302\par
Marshall, W., Jones, R., Ward, T., Johnston, P., & Barbaree, H. (1991). Treatment\par
outcome with sex offenders. \i Clinical Psychology Review, 11\i0 , 465-485. doi:\par
10.1016/0272-7358(91)90119-F\par
Marshall, W. & Marshall, L. (2000). The origins of sexual offending. \i Trauma,\par
Violence, and Abuse\i0 , \i 1\i0 , 250-263. doi: 10.1177/1524838000001003003\par
Marshall, W., Serran, G., & Cortoni, F. (2000). Childhood attachments, sexual abuse,\par
and their relationship to adult coping in child molesters. \i Sexual Abuse: Journal\par
of Research and Treatment\i0 , \i 12\i0 , 17-26. doi: 10.1177/107906320001200103\par
\f2 McCormack, J., Hudson, S., & Ward, T. (2002). Sexual offenders\rquote  perceptions of their\par
\f1 early interpersonal relationships: an attachment perspective. \i Journal of Sex\par
Research\i0 , \i 39\i0 , 85-94. doi: 10.1080/00224490209552127\par
Miner, M. & Dwyer, M. (1995). Analysis of dropouts from outpatient sex offender\par
treatment\i . Journal of Psychology & Human Sexuality, 7\i0 (3), 77-93. doi:\par
10.1300/J056v07n03_06\par
Mitchell, I. & Beech, A. (2005). A neurological perspective on attachment problems in\par
sexual offenders and the role of selective serotonin re-uptake inhibitors in the\par
treatment of such problems. \i Clinical Psychology Review, 25\i0 , 153-182. doi:\par
10.1016/j.cpr.2004.10.002Pedophilia. (2004). \i Harvard Mental Health Letter\i0 ,\par
\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 38\par
\i\f1\fs24 20\i0 (7), 1-4.\par
Office for Human Research Protections Guide [OHRP]. (2003). Retrieved from\par
http://www.hhs.gov/ohrp/policy/prisoner.html\par
Pithers, W., Marques, J., Gibat, C., & Marlatt, G. (1983). Relapse prevention with\par
sexual aggressives: A self-control model of treatment and maintenance of\par
change. In J.Greer & I. Stuart (Eds.), \i The sexual aggressor\i0 . New York: Van\par
Nostrand Reinhold.\par
Quayle, E. & Taylor, M. (2003). Model of problematic internet use in people with a\par
sexual interest in children. \i CyberPsychology & Behavior\i0 , \i 6\i0 , 93-106. doi:\par
10.1089/109493103321168009\par
Ricci, R. & Clayton, C. (2008). Trauma resolution treatment as an adjunct to\par
standard treatment for child molesters: A qualitative study. \i Journal of EMDR\par
Practice and Research, 2\i0 , 41-50. doi:10.1891/1933-3196.2.1.41\par
\f2 Salter, D., McMillan, D., Richards, M., Talbot, T., Hodges, J., Bentovim, A., \'85 & Skuse,\par
\f1 D. (2003). Development of sexually abusive behaviour in sexually victimized\par
males: a longitudinal study. \i Lancet, 361\i0 , 471-476. doi: 10.1016/S0140-\par
6736(03)12466-X\par
Sawle, G. & Kear-Colwell, J. (2001). Adult attachment style and pedophilia: a\par
developmental perspective. \i International Journal of Offender Therapy and\par
Comparative Criminology\i0 , \i 45\i0 , 32-50. doi: 10.1177/0306624X01451003\par
Scalora, M. & Garbin, C. (2003). A multivariate analysis of sex offender recidivism.\par
\i International Journal of Offender Therapy and Comparative Criminology\i0 , \i 47\i0 ,\par
309-323. doi: 10.1177/0306624X03252396\par
\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 39\par
\f1\fs24 Sentencing Guidelines Council. (2003). Sexual Offences Act 2003. \i Sentencing\par
Guidelines Council Report\i0 , 1-142.\par
Seto, M.C. (2004). Pedophilia and Sexual Offenses Against Children. \i Annual Review\par
of Sex Research\i0 , \i 15\i0 , 321-361.\par
Seto, M., Harris, G., Rice, M., & Barbaree, H. (2004). The Screening scale for\par
pedophilic interests predicts recidivism among adult sex offenders with child\par
victims. \i Archives of Sexual Behavior\i0 , \i 33\i0 , 455-466. doi:\par
10.1023/B:ASEB0000037426.55935.9c\par
Seto, M. (2008). P\f2 edophilia: Psychopathology and theory. In R. Laws & W. O\rquote Donohue\par
\f1 (Eds.), \i Sexual deviance: Theory, assessment, and treatment, 2\fs16 nd \fs24 ed \i0 (pp. 164-182).\par
New York, NY: Guilford Press.\par
Stermac, L. & Hucker, S. (1988). Combining cognitive-behavioral therapy and\par
pharmacotherapy in the treatment of pedophilic incest offenders. \i Behavioral\par
Sciences & the Law\i0 , \i 6\i0 , 257-266. doi: 10.1002/bsl.2370060208\par
Texas Code of Criminal Procedure. (2006). Article 62.035.\par
VanDeventer, A. & Laws, D. (1978). Orgasmic reconditioning to redirect sexual arousal\par
in pedophiles. \i Behavior Therapy, 9\i0 , 748-765. doi: 10.1016/S0005-\par
7894(78)80006-9\par
Vrieze, S. & Grove, W. (2010). Multidimensional assessment of criminal recidivism:\par
Problems, pitfalls, and proposed solutions. \i Psychological Assessment\i0 , \i 22\i0 , 382-\par
395. doi: 10.1037/a0019228\par
Washington State Sentencing Guidelines Commission. (2004). Sex Offender Sentencing.\par
\i Sentencing Guidelines Commission\i0 , 1-16.\par
\f0\fs22 PARENTAL ATTACHMENT IN PEDOPHILES 40\par
\f1\fs24 Weissman, M., Markowitz, J., & Klerman, G. (2000). \i Comprehensive guide to\par
interpersonal psychotherapy\i0 . New York: Basic Books.\cf0\f3\fs20\par
}
 

Download: 

insecure_parental_attachment_in_pedophiles_.pdf

insecure_attachments_-_references.docx