Workshops
“Hera” Hall

Wednesday, October 6, 15.00-17.00

W 001
GROUP THERAPY WITH ADULT SEX OFFENDERS
Steven Sawyer, MSSW, CGP
Project Pathfinder, Inc., St. Paul, MN, USA
ssawyer@projectpathfinder.org

Wednesday, October 6, 18.00-20.00

W 002
THE ASSESSMENT OF MEN WHO SEXUALLY ABUSE IN FAMILY SITUATIONS
Roger Kennington
ex-Chair of NOTA, Probation officer, Newcastle upon Tyne, England
Roger5ken@aol.com

Thursday, October 7, 9.00-11.00

W 003
WORKING WITH RESISTANT CLIENTS IN SEXUAL OFFENDER THERAPY
Yolanda Fernandez, Ph.D. 1, Liam Marshall, M.A. 2
Correctional Services of Canada, Canada 1 Rockwood Psychological Services, Canada 2
fernandezym@csc-scc.gc.ca, liam@rockwoodpsyc.com

Thursday, October 7, 12.00-14.00

W 004
AXIS I COMORBIDITY AND SEX OFFENDING
Martin Kafka, MD, PhD
Dept of Psychiatry, Harvard Medical School, Boston, USA
Mpkafka@aol.com

Thursday, October 7, 15.00-17.00

W 005
THE USE OF ACTUARIAL INSTRUMENTS IN THE EVALUATION OF SEX
OFFENDERS: A BEST-PRACTICE EVIDENCE-BASED APPROACH
Howard E. Barbaree, Ph.D.
Law and Mental Health Program, Centre for Addiction and Mental Health and the University of Toronto, Canada
Howard_Barbaree@camh.net

Thursday, October 7, 18.00-20.00

W 006
THE USE OF VIEWING TIME TO ASSESS SEXUAL INTEREST IN CHILD MOLESTERS
Carmen L. Z. Gress,
University of Victoria, Victoria, BC, Canada
Robert Konopasky,
Saint Mary’s University, Halifax, NS, Canada
rkonopasky@hfx.andara.com

Friday, October 8, 9.00-11.00

W 007
THE POLYGRAPH AND SEX OFFENDING
Don Grubin, MD, MRCPsych.
Professor of Forensic Psychiatry, (Hon) Consultant Forensic Psychiatrist
University of Newcastle, Newcastle upon Tyne, England
don.grubin@ncl.ac.uk

Friday, October 8, 12.00-14.00

W 008
HOW TO USE STRUCTURED CLINICAL GUIDELINES WITH ACTUARIAL TOOLS IN A CONVERGENT APPROACH TO RISK ASSESSMENT
Douglas P. Boer, Ph.D.,
Correctional Service of Canada
boerinc@telus.net

Friday, October 8, 15.00-17.00

W 009
A COLLABORATIVE APPROACH FOR TREATMENT WITH SEXUALLY AGGRESSIVE YOUTH AND THEIR FAMILIES
Joann Schladale, M.S., L.M.F.T.
Resources for Resolving Violence, USA
schladale@aol.com

Friday, October 8, 18.00-20.00

W 010
RISKY BEHAVIORS IN SEXUALLY- REACTIVE CHILDREN AND ADOLESCENTS
Robert Alan Prentky, Ph.D.
Research Department, Justice Resource Institute, Bridgewater, USA
rprentky@jri.org

Saturday, October 9, 11.00-13.00 *

W 011
ALTERNATIVE APPROACHES FOR THE PREVENTION OF CHILD MALTREATMENT
ΕΝΑΛΛΑΚΤΙΚΕΣ ΠΡΟΣΕΓΓΙΣΕΙΣ ΓΙΑ ΤΗΝ ΠΡΟΛΗΨΗ ΤΗΣ ΚΑΚΟΠΟΙΗΣΗΣ ΚΑΙ ΠΑΡΑΜΕΛΗΣΗΣ ΤΩΝ ΠΑΙΔΙΩΝ
Helen Agathonos – Georgopoulou, M.A., B.Sc, Ph.D.
Ex-Chair of ISPCAN, Athens, Greece
agathonos@hotmail.com

Saturday, October 9, 16.30 – 18.30 *

ΑΝΤΙΜΕΤΩΠΙΣΗ ΚΑΙ ΠΡΟΛΗΨΗ ΤΗΣ ΕΠΙΘΕΤΙΚΗΣ ΣΥΜΠΕΡΙΦΟΡΑΣ

Βασίλης Αλεβίζος, Βασίλης Κονταξάκης, Γρηγόρης Βασλαματζής, Δημήτρης Αναγνωστόπουλος

Διοργάνωση: Section of Preventive Psychiatry of the World Psychiatric Association & Institutional Program for Eastern Europe and the Balkans

* In Greek

W 001
GROUP THERAPY WITH ADULT SEX OFFENDERS
Steven Sawyer, MSSW, CGP
Project Pathfinder, Inc., St. Paul, MN, USA
ssawyer@projectpathfinder.org

Group therapy is a widely utilized modality for treating adult sex offenders. There is a growing body of literature supporting the efficacy of group therapy in resolving a variety of patient problems; and there are a variety of theoretical models, techniques and formats that could be utilized by a treating clinician. Optimizing the use of the group through effective group facilitation techniques promotes treatment progress which in turn improves outcome.
This workshop will review the more commonly utilized theories including Cognitive Behavioral and Interpersonal Theory. Techniques consistent with these models will be illustrated with case examples and experiential illustrations. Skills needed to conduct group observation, facilitation of interaction, blending structure and interaction processes, and methods to avoid overuse of an individual focus while still supporting the individual task oriented demands of structured treatment will be illustrated. Examples of group process measures for assessing activity in the group will be utilized and discussed.

W 002
THE ASSESSMENT OF MEN WHO SEXUALLY ABUSE IN FAMILY SITUATIONS
Roger Kennington
ex-Chair of NOTA, Probation officer, Newcastle upon Tyne, England
Roger5ken@aol.com

This workshop will examine the usefulness or otherwise of current static and dynamic risk assessment measures in cases known abusers may have no convictions. Legal issues relating to the Family Courts in England and Wales will also be discussed.

W 003
WORKING WITH RESISTANT CLIENTS IN SEXUAL OFFENDER THERAPY
Yolanda Fernandez, Ph.D.
Correctional Services of Canada
fernandezym@csc-scc.gc.ca
Liam Marshall, M.A.
Rockwood Psychological Services, Canada
liam@rockwoodpsyc.com

Working with clients who are resistant to the treatment process can be draining and frustrating for both the therapist and the client. Therapists working with difficult clients need to be aware that their own characteristics, behaviours and treatment style may significantly impact their ability to work with such clients. The existing literature on process variables and therapist characteristics suggests that therapist behaviours influence outcomes of therapy. Poor therapeutic process can lead to increased resistance and/or client drop-out. This seminar offers practical strategies and techniques for working with difficult clients. The presenters will begin by discussing reasons why clients may seem resistant to treatment and suggesting techniques for addressing these issues prior to clients beginning treatment. The presenters will then summarize the research on therapist characteristics associated with positive treatment outcome, both in general psychotherapy and specifically sexual offender treatment. A "collaborative approach" to working with clients will be outlined that may help reduce early resistance to therapy. In addition, topics such using Motivational Interviewing techniques, helping clients see the benefits of change, and integrating difficult clients into a treatment group will be covered. Skills and knowledge will be developed through a mixture of didactic presentation and participant exercises.

W 004
AXIS I COMORBIDITY AND SEX OFFENDING
Martin Kafka, MD, PhD
Dept of Psychiatry, Harvard Medical School, Boston, USA
Mpkafka@aol.com

Operational definitions for paraphilias (PAs) and paraphilia-related disorders (PRDs) will be presented. Data suggesting both similarities and differences between PAs and PRDs will be described including an exploration of clinically -defined hypersexuality as a feature associated with both sets of conditions. Studies of psychiatric Axis I comorbidity will be presented with a particular emphasis on mood disorders and impulsivity disorders diagnosed in 220 consecutively evaluated outpatient males with PAs and PRDs. The relationships between monoamine neurotransmitters, androgens, psychiatric comorbidity and hypersexuality will be integrated into a rationale for prescribing medications for PAs and PRDs.

W 005
THE USE OF ACTUARIAL INSTRUMENTS IN THE EVALUATION OF SEX
OFFENDERS: A BEST-PRACTICE EVIDENCE-BASED APPROACH
Howard E. Barbaree, Ph.D.
Law and Mental Health Program, Centre for Addiction and Mental Health and the University of Toronto, Canada
Howard_Barbaree@camh.net

he study of recidivism in sex offenders is an area of both theoretical and clinical importance, contributing as it does to our understanding of sexual aggression and informing our attempts at prevention. During the past 10-12 years, considerable progress has been made in the field of risk prediction with sex offenders. Research on static or historical factors such as an offender’s developmental history have led to the promulgation of empirically validated actuarial risTS_IN_THE_EVALUATION_OF_SEX_OFFENDERS:_A_BEST-PRACTICE_ EVIDENCE-BASED_APPROACH" > W 005
THE USE OF ACTUARIAL INSTRUMENTS IN THE EVALUATION OF SEX
OFFENDERS: A BEST-PRACTICE EVIDENCE-BASED APPROACH
Howard E. Barbaree, Ph.D.
Law and Mental Health Program, Centre for Addiction and Mental Health and the University of Toronto, Canada
Howard_Barbaree@cadated and commonly used actuarial instruments, including the RRASOR, the Static-99, the SORAG, and the MnSOST-R. Data on prediction accuracy and inter-rater reliability will be reviewed, based on a review of the published literature together with data from a large scale (N=468) study of recidivism among a group of treated sex offenders followed for five years after release from custody. The appropriateness of various clinical “adjustments” to the actuarial outcome will be discussed and evaluated. Materials that will assist in the use of actuarial assessment will be provided.

W 006
THE USE OF VIEWING TIME TO ASSESS SEXUAL INTEREST IN CHILD MOLESTERS
Carmen L. Z. Gress,
University of Victoria, Victoria, BC, Canada
Robert Konopasky,
Saint Mary’s University, Halifax, NS, Canada
rkonopasky@hfx.andara.com

Classification by viewing time scores has received significant interest in the applied setting as a supplement or even stand-alone alternative to penile plethysmography. The client controls the duration he or she views images of both genders and different ages; the duration taken to view each image is unobtrusively recorded. Long viewing times are understood to indicate sexual interest; short times indicate no or less sexual interest. As this method does not require an obtrusive measure of change in penis size, practitioners have seized on viewing time without a thorough understanding of the underlying theory, assumptions, and the choices that must be made when constructing a particular viewing time test. The goal of the workshop is to provide participants with a framework of current literature, specific and unambiguous definitions of viewing time, the different methods for measuring viewing time, what kind of information it provides and the information it does not, the problems with particular measures of it, and, most important, when viewing time should and when viewing time should not be used to assess sexual interest. Participants will be given information helpful in making informed decisions about the use of different viewing time methods and a guide regarding when to based decisions on them and when to demur.

W 007
THE POLYGRAPH AND SEX OFFENDING
Don Grubin, MD MRCPsych.
Professor of Forensic Psychiatry, (Hon) Consultant Forensic Psychiatrist
University of Newcastle, Newcastle upon Tyne, England
don.grubin@ncl.ac.uk

This workshop will be an expansion of my key note presentation. The background to polygraphy will be discussed, how it works and how tests are run illustrated, and the impact on community sex offender treatment programmes described. Controversies surrounding polygraphy will also be examined, together with an account both of ways in which it can be abused, and of how abuse can be prevented.

W 008
HOW TO USE STRUCTURED CLINICAL GUIDELINES WITH ACTUARIAL TOOLS IN A CONVERGENT APPROACH TO RISK ASSESSMENT
Douglas P. Boer, Ph.D.,
Correctional Service of Canada
boerinc@telus.net

Quite apart from the academic discussions of what works best in terms of risk assessment, there is the need for clinicians to do risk assessments of offenders. There are academic proponents of actuarial approaches and there are opposing academic proponents of structured clinical approaches. To date, neither type of approach has convincingly proven superior to the other. Regardless, clinicians have to decide which risk instruments are best for the client sitting in front of them. Keeping abreast of the literature and the new risk assessment instruments (which, despite claims of new and innovative approaches, all seem to contain relatively similar violence predictors) is difficult for clinicians. Hence, the present workshop offers some simple guidelines for risk assessment measure selection to aid the clinician in the navigation of the troubled waters of the available risk measures. Following the selection of appropriate structured clinical guideline and actuarial measures, the benefits of a convergent approach to combine the findings in a useful manner are discussed and explained by using recent examples.

W 009
A COLLABORATIVE APPROACH FOR TREATMENT WITH SEXUALLY AGGRESSIVE YOUTH AND THEIR FAMILIES
Joann Schladale, M.S., L.M.F.T.
Resources For Resolving Violence, USA
schladale@aol.com

This presentation will illustrate a collaborative approach for engaging families in treatment with sexually aggressive youth in community-based and residential settings. This model explores family members strengths and resources to heal the pain of sexual abuse. While offender specific treatment challenges each perpetrator to stop destructive behavior, families receive support for healing related painful experiences. Youth and families learn to destroy powerful secrets of sexual abuse that may have influenced their lives for generations. Treatment addresses struggles with power, control, and connection that have often dominated the lives of these families.
Research indicates that multi-systemic family therapy with sexually aggressive youth influences successful treatment outcomes and is cost effective. Yet group therapy in residential treatment continues to be the primary approach to juvenile sexual offending. When these youth return home after residential treatment they are faced with the task of harm reduction in the environment that influenced initial decisions to commit offenses. It is imperative that interventions take this context into consideration.
Clinicians providing a comprehensive response to adolescent sexual offending can explore meaningful ways of involving families who may appear unwilling, or unable to participate. Families do have the ability to provide support and can be involved throughout treatment regardless of geographic location and limited resources.
Examples illustrating this approach will include: family systems interventions for harm reduction; facing up to abusive behavior; understanding life experiences that influence sexual harm; eliminating patterns of destructive behavior through creation of a new story based upon honor and integrity; and identifying therapeutic tasks required of each youth and their family members.

W 010
RISKY BEHAVIORS IN SEXUALLY- REACTIVE CHILDREN AND ADOLESCENTS
Robert Alan Prentky, Ph.D.
Research Department, Justice Resource Institute, Bridgewater, USA
rprentky@jri.org

Since February, 2001, we have been involved in an ongoing program of research on severely abuse reactive children, ranging in age from 5 to 20, that already begun to engage in sexually inappropriate and/or sexually coercive acts with other children. We have coded over 600 of these children using a 230 variable coding dictionary that was designed to help us develop a protocol for assessing risk with this young population. In addition to the question of the safe management of these youngsters are the broader, complex questions of the interface of development with adverse life experiences, the evolution of normative versus deviant sexual behaviors, the impact of gender, and short-term outcomes (different patterns of high risk and protective factors that lead to desistance (not re-offending) or persistence (re-offending).
Based on these data from 500 boys and 100 girls, I will present updated findings on the developmental course of (a) normative sexual behaviors, (b) atypical or deviant but not coercive sexual behaviors (paraphilias), and (c) sexually coercive & aggressive behaviors. In our cross-sectional approach, we created three age groups (6 - 10, 11 - 14, 15 - 20) based on the time that the child was first evaluated for sexually coercive behavior. I will discuss our findings on the course of normal and abnormal sexual behaviors from age 5 or 6 to late adolescence. In addition to discussing developmental differences, I will present our findings on gender differences, comparing the boys with the girls.

W 011
ALTERNATIVE APPROACHES FOR THE PREVENTION OF CHILD MALTREATMENT
Helen Agathonos – Georgopoulou, M.A., B.Sc, Ph.D.
Ex-Chair of ISPCAN, Athens, Greece
agathonos@hotmail.com

Although violence has always been present in the world throughout history, there have always been systems committed to prevent or limit it. Since the early 1980’s the field of public health has been taking over the burden of this insidious but preventable disease. Examples of success are known around the world, from small – scale efforts of individuals and communities to national policies and legislative initiatives. In 1996, the World Health Organization declared violence as a major and growing health problem across the world, committing itself to play a major role in its prevention worldwide.
The prevention of child abuse and neglect has been the target of many efforts by different disciplines. The majority of programs focus on victims or perpetrators while few focus on primary and secondary prevention approaches. The more common approaches are:

• Family support approaches such as training in parenting, home visitation and other family support programs and intensive family preservation services.
• Health service approaches such as screening by health care professionals and training for health care professionals.
• Therapeutic approaches such as service provision for victims themselves but also for children who witness violence, services for adults abused as children.
• Legal and related approaches such as mandatory and voluntary reporting, child protection services, child fatality - review teams, arrest and prosecution policies and mandatory treatment for offenders.
• Community – based efforts such as school based programs, prevention and educational campaigns, interventions to change community attitudes and behaviour.
• Societal approaches such as national policies and programs and international treaties.

The experience so far has identified several major domains for action that need to be addressed by all concerned in the prevention of child maltreatment: a) better assessment and monitoring, b) better response systems, c) policy development, d) better data, e) more research, f) documentation of effective responses and g) improved training and education for professionals. The endorsement of the UN Convention on the Rights of the Child by almost all countries of the world and its incorporation into national legal systems has contributed significantly to the development of a common language across cultures with the child as a subject of rights and a protagonist in its own life. Nevertheless, there is great need to mandate governments and their policies at all levels to implement these rights in everyday practice. For this, the concerted and coordinated initiatives of a whole range of sectors are required, in a synergistic collaboration with the public health approach.
The workshop will review the above efforts towards the prevention of child maltreatment and will present examples of promising practice of primary and secondary prevention within the Greek cultural milieu.