Risk Assessment: guidance document for psychotherapists and counsellors

Prepared by Dr Andrew Smith in 2015

The following guidance document is written to help counsellors working with adult sexual offenders and non-abusing partners, or other adults who are in a position of having to protect children from the risk of sexual abuse. This guidance should not be used by counsellors to write special risk assessment reports, as this should only be undertaken by experienced risk assessors. However, the guidance can help counsellors to make on-going assessments with regard to:

• Whether the counsellor has the experience or skills to work with the level of risk a client seems to pose
• Formulating therapeutic interventions, targeted at particular areas of risk or dysfunction
• Whether background and/or generic risk factors in addition to acute risk factors emerging, or coming to light within the counselling process, necessitates reporting concerns to the relevant authorities

Background of client

3. The following background factors should be considered when assessing sexual risk and a non-abusing adult ability to protect from that risk. For instance, Beech and Ward’s theoretical risk framework (2003) incorporates the following developmental attachment theory. Building on the general attachment, child-developmental work of Bowlby (1969), Marshall (1989) found that family backgrounds of sexual offenders are typified by neglect, violence and disruption and erratic or rejecting parenting.  Smallbone and Dadds (1998) similarly found that poor attachment to parent figures, particularly mothers, was predictive of general antisocial behaviour and sexual offending. There is also a wealth of research data on how background impacts on risk and ability to protect in Safeguarding Children: Living with Trauma and Family Violence, Bentovim et al. (2009). With regard to offenders, their experience and response to parents, siblings, peers, school, work etc., can provide valuable information about the development and likely presence of risk and protective factors, if linked into research data, even if such research is not cited. Beech (1998), Hanson and Harris (2000) and Thornton (2000) have all identified the important risk factors which can change (therefore increasing or decreasing risk) over time – trait or so-called dynamic risk factors: deviant sexual interest; pro-offending attitudes; socio/affective problems and self-regulation difficulties. Ward and Seigert (2002) conceptualise these risks similarly in their pathway model as: dysfunctional sexual scripts, antisocial cognitions, intimacy and social skills deficits, and emotional dysregulation.  A person’s background can be mined for the presence or absence of such risk factors.
4. There is a significant cross-over between background factors providing information about an offender’s risk and a non-abusing partner’s ability to protect. Research-led, clinical judgement is needed to differentiate. However, below is a reminder of relevant questions and areas which can be explored:
5. Has the person been able to maintain good relationships with parents?
6. The presence and absence of abuse and neglect?
7. What role did the person take up in the family (submissive or dominant)?
8. Has the person been able to maintain positive relationship with siblings?
9. What is the culture of the family; is there dysfunction in the lives of parents and siblings?
10. What was the experience of primary and comprehensive school, relationships with fellow pupils?
11. Was the person bullied or did they bully?
12. What was their relationship like with teachers and authority?
13. Were there discipline problems?
14. Did they under- achieve, relative to their social circumstances?
15. How was distress managed (flight/avoidance; fight/aggression)?
16. How did they meet needs for power, status, safety?
17. What ‘goods’ in terms of ‘Good Lives’ seem particularly important to them?
18. Are there issues with drugs, alcohol, mental health, suicide and self-harm, general criminality, gambling, debt, risk-taking, related to impulse control?
19. Has the person been able to obtain social capital: education; occupation; maintaining constructive family and social relationships? (this presence or absence of social capital can provide information about resilience; ability to take on board new information; problem- solving; prioritising; objectivity; deferring gratification; empathising with others and managing relationships – all core skills related to ability to control deviant impulses and to protect children from such impulses).

Medical and psychosexual

4. Some people may use child abuse images or other stimulus, to try to deal with problems with sexual arousal.  The sexual arousal problem may be the underlying issue that is causing them to act out.  Thus, with escalating sexual acting out, it is recommended to check for an underlying sexual dysfunction or physical cause.  If you need support with this process, contact StopSO and ask for a supervisor who is trained to advise in this medical area.  If the behaviour is triggered by a general sexual dysfunction, then it is recommended that the following blood tests are completed, before therapy begins, to include: diabetes, cholesterol, testosterone, thyroid and pituitary function.
5. Has the person got erectile dysfunction, arousal problems or issues with low libido (with their partner)?
6. Has the illegal behaviour recently escalated?

Relationship and sexual history

• Beech and Ward’s theoretical risk framework identifies that in a meta-analysis (a review of research studies on sexual offenders), Hanson and Bussiere (1998) found that attachment problems, particularly with mothers, were consistent with difficulties in forming stable, adult relationships with age-appropriate adults, and also of sexual offending. Marshall et al. (1993) found that poor attachments can also lead to a lack of empathy, and a tendency to sexually objectify others. Ward and Keenan (1999) suggest that individuals brought up in such dysfunctional circumstances can develop faulty ‘implicit theories’ or ‘schema’ about the world, relationships and sex. Ward and Keenan posit four main antisocial implicit theories observed amongst sex offenders.
  1. Viewing children as sexual objects, deriving from a belief that people are primarily motivated by a desire for pleasure.
  2.  An exaggerated sense of entitlement, stemming from the belief that some people (i.e. men) are more important than others (i.e. women and children).
  3. The core belief that we live in a dangerous world, necessitating the goal of dominance or retribution, or otherwise the forming of relationships with children because adults seem too threatening.
  4. The belief that life is uncontrollable, including one’s own emotions, desires and circumstances. It is theorized by Ward and Keenan that these core faulty beliefs about the world can go on to generate specific distorted thinking, which both facilitates and minimises sexual offending.
• With regard to non-abusing partners, clinical experience indicates that an individual’s relationship history often impacts upon ability to protect. Below is a reminder of questions and areas which can be explored. Some questions are obviously more relevant to offenders than Non Offending Paedophiles (NOP).

Sexual Orientation

4. Any formative early sexual experiences (abusive or otherwise)
5. Early fantasies, and have they endured in any way?
6. At the time of sexual awareness and adolescence, how did the person relate to the opposite sex (prospective girl/boyfriend), and view themselves as sexual beings?
7. Number of casual sexual encounters
8. Number of adult relationships, and length of relationships
9. Any signs of sexual deviancy or preoccupations: internet use, sado-masochistic tendencies; swapping or group sex
10. Any pattern of how person functions in relationships (submissive, avoidant, aggressive, domineering, violence)
11. Convictions, allegations of domestic abuse, police call-outs, medical records
12. Beliefs about the role of men, women
13. How important is the role of being a parent to the person’s self-concept, and to fulfilling status needs?
14. Has the person had any relationships which seem constructive?
15. Has the person been able to flee abusive relationships?
16. Has the person ever been able to live on their own?
17. What are the dynamics of the current relationship?
18. Any dependency or intimidation in the current relationship?
19. Who calls the shots and holds the power in terms of age; physical size; intelligence; education; occupation; finance; physical attractiveness; verbal persuasion?

Offences, allegations and concerns section

• Risk Matrix 2000 (see Thornton, 2007 edition) score so-called static risk factors, risk factors repeatedly identified by research as strong predictors of sexual crime: number of previous sex offences, particularly against unrelated victims; violent offences; lack of intimate relationships; general criminality. In addition to dynamic risk factors, Hanson and Harris (2001) have identified acute dynamic risk factors, which can gradually and/or suddenly emerge to interact with existing static risk factors and dynamic risk factors, triggering a sexual crime. Typically these might be:
• the presence of a potential vulnerable victim;
• substance misuse;
• increased association with criminal peers;
• relationship problems or a
• life crisis.

6. The above research on risk can be used to guide the collection and analysis of data with regard to this section.  In terms of the offences or allegations section, it is helpful to the reader to firstly provide an account of the offence or allegation made by the victim, alleged victim or professionals, so the reader can compare the interviewee’s subsequent account with the accounts on file. When describing the abuse/alleged abuse it is best to be specific, reiterating ages of victims and perpetrators at the time, and detailing who exactly did what to whom, according to the varying accounts on file. The same applies with regards to reports of emotional or physical abuse. Below is a reminder of questions and areas which can be explored:
7. The extent to which the person denies, minimises or accepts responsibility for the abuse
8. What the person says about circumstances, thinking, feelings, prior, during and after the abuse (whether this is consistent with Finkelhor/Wolf/Cycles)
9. What empathy does the person have concerning how the victim/s felt before, during, after (immediate and long term) the abuse?
10. Why does the person think the allegations are false?
11. How does the person view risk?
12. How does s/he think that significant others and professionals view risk (scaling questions can be used for this, providing information about how realistic the person is being, and their ability to be objective)?
13. How has the person dealt with consequences of abuse being reported (including relationship with professionals, and dealing with child protection restrictions)?

Specific questions related to non-abusing partners

• Is there any discrepancy between the NOP’s intellectual capacity to appreciate risk and their emotional capacity to respond to risk?
• Is the NOP’s inability to protect temporary, due to the grooming of the offender?
• Is the NOP’s inability to protect due to grooming, compounded by historical deficits which are difficult to change, which mere educational/risk awareness raising is unlikely to shift?

Related questions about sexual abuse and sexual awareness

• What is the person’s understanding of the consequences of abuse generally?
• Can they describe different forms of abuse?
• Do they know the legal age of consent?
• If given scenarios to comment on, can they differentiate between illegal sex and abusive sex?
• Can they grasp the concept of sexual abuse as an abuse of power?

Related questions about parenting

• Can they give a profile about what is a good and bad parent?
• What are their views on disciplining children?
• What are their views about intimate and physical contact and seeing the children naked, at different ages?
• Can they describe a household/home life, in which children would feel safe and protected?

Useful references, related to the above

• Beech, A.R. (1998) ‘A psychometric typology of child abusers’, in International Journal of Offender Therapy and Comparative Criminology, 42, 319-339
• Beech, A.R., Fisher, D.D. and Thornton, D. (2003) ‘Risk assessment of sex offenders’, Professional Psychology, Research and Practice
• Beech, A. R. and Ward, T. (2003) ‘The integration of etiology and risk in sexual offenders: a theoretical framework,’ Journal of Aggression and Violent Behaviour, 1 (1), 31-63
• Bentovim, A., Cox, A., Bingley Miller, L., and Pizzey, S. (2009) Safeguarding Children Living with Trauma and Family Violence, London and Philadelphia, Jessica Kingsley Publishers
• Bowlby, J. (1969) Attachment and Loss, Vol. 1. Attachment, New York: Basic Books
• Finkelhor, D. (1984) Child Sexual Abuse: New Theory and Research. New York: Free Press
• Hall, G.C.N. and Hirschman, R. (1982) ‘Sexual aggression against children: a conceptual perspective of etiology’ in Criminal Justice and Behaviour, 19, pp. 8-23
• Hanson, R.K. and Bussiere, M.T. (1998) ‘Predicting relapse: a meta-analysis of sexual offender recidivism studies’ in Journal of Consulting and Clinical Psychology, 66, pp.348-362
• Hanson, R.K. and Harris, A. (2000) ‘Where should we intervene? Dynamic predictors of sexual offence recidivism’ in Criminal Justice and Behaviour, 27, 6-35
• Hanson, R.K and Harris, A. (2001) The sex offender need assessment rating (SONAR): a method for measuring change in risk levels, [email protected]
• Hanson, R.K. and Thornton, D (2000) ‘Improving risk assessments for sex offenders: a comparison of the three actuarial scales’ in Law and Human Behaviour, 24, pp. 119-136
• Hart, S. Laws, D.R., and Kropp, P.R. (2003) ‘The risk-need model of offender rehabilitation’, in Ward, T., Laws, D.R. and Hudson, S.M. (2003) Theoretical Issues and Controversies in Sexual Deviance, Sage, London, pp. 338-354
• Marshall, W.L. (1989) ‘Intimacy, loneliness and sexual offenders’ in Behaviour Research and Therapy, 27, 491-503
• Marshall, W.L. and Barbaree, H.E. (1990) ‘An integrated theory of the etiology of sexual offending’ in Marshall, W.L.  and Barbaree, H.E., Handbook of Sexual Assault: Issues, Theories and Treatment of the Offender, Plenium, New York, pp. 257-275
• Marshall, W.L., Hudson, S.M. and Hodkinson, S. (1993) ‘The importance of attachment bonds in the development of juvenile sex offenders’ in Barbaree, H.E., Marshall, W.L. and Hudson, S.M. (1993). The juvenile sex offenders, Guildford Press, New York. pp. 164-181
• Quinsey, V.L. Harris, G.T. Rice, M.E and Cormier, C. (1998) Violent Offenders: Appraising and Managing Risk, American Psychological Association, Washington, DC
• Smallbone, S.W and Dadds, M.R. (1998) ‘Childhood attachment and adult attachment in incarcerated adult male sex offenders’ in Journal of Interpersonal Violence, 13, 555-573
• Thornton, D. (2000) ‘Constructing and testing a framework for dynamic risk assessment’ in Sexual Abuse: A Journal of Research and Treatment, 14, 139-154
• Ward, T., Bickley, J., Webster, S.D., Fisher, D., Beech, A. and Eldridge, H. (2006) The Self Regulation Model of the Offence & Relapse Process. 1: Assessment. Pacific Psychological Assessment Corporation:Trafford Publishing
• Ward, T. and Keenan, T. (1999) ‘Child molesters’ implicit theories’ in Journal of Interpersonal Violence, 14, pp. 821-838
• Ward, T. and Seigert, R.J. (2002) ‘Towards a comprehensive theory of child sexual abuse: A theory knitting perspective’ in  Psychology, Crime and Law, 8, pp. 319-351
• Ward, T. and Stewart, C.A.  (2003) The treatment of sex offenders: risk management and good lives, in Professional Psychology: Research and Practice ,34, pp. 353-360
• Wolf, S.C. (1988) ‘A model of sexual aggression/addiction’ in Journal of Social Work and Human Sexuality, 7, pp. 131-148