"One a Day Keeps the Prison Away": Understanding the Experiences of Individuals Convicted of Sexual Offences Receiving Anti-Androgens for the Treatment of Problematic Sexual Arousal.

Problematic sexual arousal (PSA) is an umbrella term to describe a range of clinical presentations related to excessive sexual thinking (e.g., sexual preoccupation) and sexual behavior (e.g., hypersexuality). Although such concepts are known to affect sexual recidivism among individuals convicted of sexual offences, PSA is not routinely or directly targeted in offending behavior programs in England and Wales. However, in recent years, there have been moves to incorporate pharmacological interventions for addressing this among people with sexual offence histories. Although some work to understand the experiences of those taking SSRI medication for this purpose has emerged, little is known about the experiences of service users taking anti-androgen medication. In this study, we interviewed all individuals in prison taking anti-androgens for the treatment of problematic sexual arousal following convictions for sexual offences in England at the time of data collection (N = 10). Using a phenomenologically oriented thematic analysis, we established themes pertaining to "Differing needs: Motivations for treatment," "Medication as a risk management strategy," and how the medication helped the men in their pursuit of "Discovering a 'new me'." This work contributes important knowledge to inform the development of ethical and effective prescribing of anti-androgen medication with this population and offer recommendations for both future research and the development of clinical practice.

A Multi-Perspective Qualitative Study About Working With Autistic Individuals in Prison-Based Interventions to Address Sexual Offending.

Research suggests that sexual offending is one of the more common forms of offending behaviour committed by autistic individuals. Despite this, very little research has investigated approaches to rehabilitation for autistic individuals who have sexually offended. The small body of literature that does exist suggests that interventions to address sexual offending may not be sufficiently adapted for this group. In this paper we present an exploratory qualitative study that (i) explores how prison-based interventions to address sexual offending are experienced by autistic individuals with sexual offense convictions and the staff who work with them, and (ii) identifies and explores the features of prison-based sexual offending interventions that may be challenging or beneficial for autistic individuals, from the perspective of those involved in treatment. Semi-structured interviews were conducted with 12 autistic men serving prison sentences for sexual convictions, and 13 members of prison staff. A multi-perspective phenomenologically-informed thematic (MPT) analysis identified three themes of 'Feeling overwhelmed', 'Out of the comfort zone', and '(Dis)connected to others'. These themes highlight some of the key issues relating to the format and delivery of interventions, as well as the impact of the broader prison context on rehabilitation.

Primary and secondary prevention of child sexual abuse.

The high prevalence rates and numerous consequences associated with child sexual abuse makes preventing these offences a societal priority. Prevention strategies have traditionally involved only tertiary interventions, implemented by the criminal justice system after an offence has occurred. More recently, some have argued for a public health approach to preventing child sexual abuse, which includes interventions at the primary and secondary levels. Secondary prevention aims to provide treatment and support to those at-risk of sexually offending before any involvement with the legal system. Increased demand for secondary prevention services and early results from current initiatives demonstrate that at-risk individuals are willing to seek treatment without external pressure from the legal system, and often report numerous treatment-related benefits. These findings support the need for widespread implementation of primary and secondary prevention initiatives. The safety of children requires that society stops merely reacting to sexual offences, and instead begins implementing proactive evidence-based strategies that can prevent even initial incidents of child sexual abuse. This article explores some of the many benefits and barriers associated with primary and secondary prevention, as well as strategies for overcoming these barriers. Recommendations for the development and implementation of prevention initiatives are also included.

Circles of support and accountability (CoSA): a review of the development of CoSA and its international implementation.

Circles of Support and Accountability (CoSA) was initially developed in Canada as a community-based programme designed to assist in the community reintegration of individuals who are deemed at high or very high risk of sexual recidivism. This article outlines the historical foundations and frameworks of the CoSA model, and examines the recruitment and training of CoSA volunteers. It reviews the impact that CoSA has on recidivism, as well as the psycho-social implications of the model on the former offenders participating in CoSA (the 'Core Members'), volunteers, and the community at large. International implementation of CoSA is addressed by a review of project initiatives undertaken around the world. This article concludes by addressing the future directions of CoSA, both within Canada and internationally.

The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence.

This paper provides an international perspective on the use of medications to treat problematic sexual interests, paraphilic disorders, and sexual preoccupation in men who have committed a sexual offence. Experts from Canada, the Czech Republic (CR), Russia, the United Kingdom, and the United States met in Prague, CR in May 2017 to review and compare their treatment approaches. This report is a summary of their discussions, including empirical data from CR and Russia which have not previously been published in the English language. All participants agreed that continuing international collaboration would be very useful for the development of ethical international prescribing guidelines, as well as pooling data from studies on the efficacy and utility of pharmacological and other biological treatments for people who have committed sexual offences.

"This Time It's Different" Preparing for Release Through a Prison-Model of CoSA: A Phenomenological and Repertory Grid Analysis.

Circles of support and accountability (CoSA) in the prison-model begin prior to the core members' release from prison and continue with them on release in to the community. The purpose of this study was to explore the expectations of release of those convicted of a sexual offense and how this develops during their participation in the prison sessions of CoSA. The research question was to consider how the prison-model of CoSA relates to the desistance of crime, in particular the phases of desistance developed by Gobbels, Ward, and Willis. Data were collected using both phenomenological interviews and repertory grids at two different time points; prior to starting the circle in prison (n = 9) and just before release (n = 5). The findings suggest the prison sessions provide a sense of support and "no longer being alone" often absent in those who sexually offend. The additional prison sessions enabled the participants to experience this during their approaching release date; a stressful period that was characterized by anxiety. Further research is now required to explore whether circles in the prison-model are able to encourage and reinforce the cognitive change required for desistance, enabling the core members to successfully manage their underlying anxieties surrounding societal stigmatization.

"It's Sort of Reaffirmed to Me That I'm Not a Monster, I'm Not a Terrible Person": Sex Offenders' Movements Toward Desistance via Peer-Support Roles in Prison.

Individuals incarcerated in prisons across the United Kingdom and abroad are able to volunteer for a variety of peer-support roles, which are characterized by prisoner-to-prisoner helping. Some research has found that such roles can represent turning points in the lives of those who have offended and encourage movements toward desistance. This proposed redemptive influence is argued to result from the prosocial behaviors that such roles appear to elicit in their holders. The present study aims to explore the mechanics of this claimed influence. While a limited amount of research has attempted this on a general offending population, no research has done so with a sample of sexual offenders. Given the intensive treatment programs involved in such contexts, and the requirements for sexual offenders to demonstrate reduced risk, the authors believe those serving time for sexual offenses represent an important sample on which to explore the potentially redemptive properties of peer-support roles. To this end, 13 peer supporters participated in semistructured interviews. Transcripts were analyzed using a phenomenologically oriented thematic analysis. Results suggest that sexual offenders who adopt peer-support roles are able to live up to desired selves by "doing good" in prison, "giving back," and consequently resisting negative labels. These benefits have been theoretically linked with better reintegration outcomes for sexual offenders, who are publicly denigrated in the extreme and find it especially difficult to (re)integrate. Suggestions regarding the future utility of such schemes are offered.

Stumbling into sexual crime: the passive perpetrator in accounts by male internet sex offenders.

Public reactions to internet child offending remain ambivalent in that, while there is vocal condemnation of contact child sex offending, there is less indignation about internet child abuse. This is potentially due to a lack of recognition of this type of offence as sexual offending per se. This ambiguity is reflected by internet sex offenders themselves in their verbalizations of their offending. This article presents a qualitative analysis of the accounts offered by seven individuals convicted of internet-based sexual offences involving the downloading and viewing of images of children. In particular, this article presents an analysis of the explanations of offenders for the commencement of internet activity and the progression to more illicit online materials. The data were collected through semi-structured interviews and analyzed using discursive methods, paying close attention to language use and function. The analysis documented the practices that internet child abusers employed in order to manage their identities, distance themselves from the label of sex offender, and/or reduce their personal agency and accountability. Implications of this analysis are discussed with reference to the current minimization of the downloading of sexually explicit images of children as a sexual crime per se by the public and offenders alike and the risk assessment and treatment of individuals convicted of these offences.

Gender Differences in Theory of Mind, Empathic Understanding, and Moral Reasoning in an Offending and a Matched Non-Offending Population.

Previous research suggests that a lack of pro-social skills is characteristic of an offending personality. Two hundred male and female offenders and matched controls completed measures to assess: Theory of Mind, empathic understanding, and moral reasoning. Significant differences between the offenders and the control group, as well as between the male and female participants, were detected in theory of mind, empathic understanding and moral reasoning with offenders scoring lower than the control group, and with males scoring lower than females on most tests. The ability to assess Theory of Mind, empathic understanding, and moral reasoning, and subsequently to identify reduced ability, is not only useful for researchers but will also allow practitioners to tailor existing (or develop new) interventions specific to the needs of individuals. This could be particularly useful in terms of recidivism when applied to those involved in anti-social or offending behavior.

"I've Got the Energy to Change, But I Haven't Got the Energy for This Kinda Therapy": A Qualitative Analysis of the Motivations Behind Democratic Therapeutic Community Drop-Out for Men With Sexual Convictions.

Prison-based democratic therapeutic communities (TCs) provide an alternative to mainstream prison, where prisoners can work on psychological difficulties and address offending behavior. Research demonstrates TCs are effective at reducing reoffending rates for residents who stay in therapy 18+ months, and those who drop out of TCs offend at a significantly higher rate than those who complete therapy. Thus, it is important to reduce attrition in TCs. No research has yet explored the explanations for TC drop out offered by those with sexual convictions. The present study uses Interpretive Phenomenological Analysis to qualitatively explore the accounts of men with sexual convictions (n = 7) who dropped out of a TC in a UK prison. Results highlight that issues surrounding external responsivity, therapeutic relationships, and treatment readiness were salient in the participants' accounts of drop out. This research has implications for TCs seeking to better understand and address attrition of people with sexual convictions.

"You Want to Catch the Biggest Thing Going in the Ocean": A Qualitative Analysis of Intimate Partner Stalking.

This study employs a qualitative phenomenological exploration of the "lived" experiences of male intimate partner stalking (IPS) perpetrators serving a custodial sentence in the United Kingdom for an offense related to intimate partner violence (IPV). The purpose of this study is to capture the nature and complexity of the experiences of the pathway to IPS from the perspective of the perpetrator. The study seeks to provide a unique understanding of how IPS perpetrators attribute meaning to their behavior, illuminating the underpinning cognitive characteristics and emotions that play a role in their behavior. Semi-structured interviews were conducted with seven men with a history of IPS behavior. The resultant transcripts were analyzed using interpretative phenomenological analysis (IPA). Five superordinate themes reflecting participants' experiences were identified: (a) "The quest for attention and affection creating connection,"(b) "Conflicted identity and extremes of self," (c) "My life, a film set," (d) "Gameplaying: One step ahead," and (e) "Severed connections, changing the Gameplay." The findings are presented in relation to the existing literature and theoretical frameworks which seek to explain stalking perpetration. The analysis provides a greater understanding of men who have engaged in IPS behavior, demonstrating how hearing the perspective of the perpetrator has value in informing theory and intervention. The study has provided valuable insight into the cognitive characteristics of this population and a rich understanding of the profiles of men who have engaged in IPS behavior. Implications for forensic practice, policy, and research are outlined, and recommendations for future research and overall limitations are discussed.

A Qualitative Exploration of the Experiences of Veterans Who Are Serving Sentences in Custody.

The focus on veterans in research is not a novel topic; however, the majority of studies are related to trauma, employment, mental health, suicide, and substance misuse. The criminal justice system involvement with veterans is a topic that has yet to be examined to a great extent. This study, conducted with adult male prisoners, elicited information from six veterans regarding their experiences of being in the armed forces, leaving the armed forces, and becoming involved in the criminal justice system. Responses were evaluated using interpretative phenomenological analysis (IPA) and three main themes were identified: "you're baptized into the army," "them and us," and "operational mind-set"; each of which comprised a number of superordinate themes. The research highlights that although it is important to acknowledge the heterogenic nature of this group, it is equally important to note that much of their thinking and behavior may be similar to those that have not had these experiences. As such, there is a need to reduce the notion that they are separate and different to other prisoners, requiring different treatment. The study highlights that many of the offending behavior programs and interventions already available to prisoners would be appropriate for this group. The current research supports the merit in creating a service in prisons that will allow ex-servicemen to meet together and access the support that is available to them. The implications of the research are discussed further.

"They Treat Us Like Human Beings"--Experiencing a Therapeutic Sex Offenders Prison: Impact on Prisoners and Staff and Implications for Treatment.

Research evidence demonstrates that sex offender treatment programmes (SOTPs) can reduce the number of sex offenders who are reconvicted. However, there has been much less empirical research exploring the experiences and perspectives of the prison environment within which treatment takes place. This is important, particularly for sexual offenders, as they often face multiple stigmas in prison. This study used a mixed-methods approach to explore the experiences of prisoners and staff at a therapeutically orientated sexual offenders' prison to understand whether the prison environment was conducive to rehabilitation. The quantitative strand of the research sampled prisoners (n = 112) and staff (n = 48) from a therapeutically orientated sex offenders prison. This strand highlighted that both prisoners and staff had positive attitudes toward offenders and high beliefs that offenders could change. Importantly, the climate was rated positively and, in particular, participants had very high ratings of "experienced safety." The qualitative strand of the research consisted of semistructured interviews with prisoners (n = 15) and a range of prison staff (n = 16). The qualitative analysis revealed positive prisoner views toward staff relationships, with most participants articulating that the prison and its staff had contributed to positive change in prisoners. Crucially, the environment was perceived as safe and allowed prisoners "headspace" to work through problems and contemplate change. This research offers some support to the notion that context is important for sex offender rehabilitation.

Food and drink packaging: who is complaining and who should be complaining.

This paper reports a questionnaire survey of shoppers at four supermarket stores in the UK. Regression analyses were used to determine factors in consumer complaints with the packaging of food and drink products. Neuroticism and treatment in hospital for an accident involving packaging in the last 3 years were significant associates. Analyses on who was most likely to suffer accidents or injuries while opening food and drink packaging indicated that handedness (that is, being left handed made accidents more likely) and scoring low on a measure of personal control during decision-making were significant associates. Analyses on who suffered the most serious accidents and injuries whilst opening food and drink packaging revealed that the decision-making style of social resistance (that is, the extent to which you resist asking for help from others) was related to susceptibility to the most severe accidents. These findings imply that individual factors (including both personal characteristics and personality traits) should be taken into account when considering the openability of packaging. The results of this study indicate that manufacturers should ensure that novel packaging closures have been tested on left handers in order to discover any unique difficulties for this sub-group, that packaging opening tools specifically for left-handed people should be made available and that manufacturers of packaging should always look at a 'worst case scenario' for their packaging closures as it is evident that some people will continue to struggle with difficult packaging until either they open it or they have injured themselves.

Making sense of denial in sexual offenders: a qualitative phenomenological and repertory grid analysis.

Denial in sexual offenders represents the first barrier to successful treatment a clinician is likely to face. Most sex offender treatment programs devote significant time to overcoming denial, with most programs having a focus on disclosure and "accepting responsibility." This is the first study that has aimed to make sense of sexual offenders' denial through a rigorous qualitative analysis. The main objective was to explore the experiences and lived worlds of sexual offenders in denial. A qualitative phenomenological methodology combining interpretative phenomenological analysis and repertory grids was implemented. Ten incarcerated sexual offenders in categorical denial participated in the research. The analysis revealed the narrative, relational, and self-reconstructive properties of denial and discusses the role and function denial may be playing for sexual offenders. The results highlight that denial can be viewed as a form of "sense making" and that clinically relevant treatment targets can be elicited without disclosure. It is concluded that viewing denial as a barrier to treatment impedes constructive work with offenders, and implications for treatment are discussed.

Working with denial in convicted sexual offenders: a qualitative analysis of treatment professionals' views and experiences and their implications for practice.

Denial in sexual offenders represents the first barrier to successful treatment a clinician is likely to face. However, there is currently no research focusing on the experiences of treatment professionals who treat and manage deniers. This study aimed to bridge this research gap and to gain an insight into the perspectives and experiences of professionals who treat and manage sex offenders in denial. The purpose was to ascertain their views on whether deniers are amenable to treatment, whether they should be offered treatment (as presently they are excluded from sex offender programmes), and what they believe may work with this population. A qualitative methodology was used, and treatment professionals were interviewed using semistructured interviews at a HM Prison in England. The main findings indicated that participants viewed denial as a barrier to treatment and that categorical deniers should be excluded from treatment. Implications for treatment are discussed, and it is concluded that viewing denial as a barrier to treatment impedes constructive work with offenders. It is argued that denial as an organising principle for treatment needs rethinking and that admittance may not be required for personal reform.

The relationship between pre-registration house officers and their consultants.

CONTEXT: Previous studies have drawn attention to the importance of the trainee/trainer relationship in determining job satisfaction and motivation to learn. OBJECTIVES: To study the relationship between pre-registration house officers and their consultants through exploring an interpersonal exchange and the emotional context in which the exchange took place. To consider any association between the type of relationship implied and the trainee's attitude to their career. DESIGN: Postal questionnaire covering a wide range of issues. This study focused on an open question about a significant or interesting exchange, followed by supplementary questions exploring the emotional context of the exchange. SETTING: 336 hospitals throughout the United Kingdom. SUBJECTS: A cohort of doctors were followed from the time of their application to medical school, and studied towards the end of their pre-registration year (n=2456). RESULTS: The response rate to the questionnaire was 58.4%. Responses were categorised as Support and supervision; Unreasonable behaviour; Consultant fallibility; Fair criticism and No exchange. Over half the responses described an interaction that made them feel positive. Trainees particularly appreciated positive feedback, clinical support, teaching, career advice, patronage, or social interaction. The importance of formal appraisal or review sessions in providing the setting for a positive exchange was confirmed. Positive interactions were associated with a positive view of medicine as a career. A minority described an interaction that was negative, involving unreasonable demands, criticism (whether perceived as fair or unfair), humiliation, or sexism. These were associated with a more negative view of medicine as a career, and of themselves as doctors.

Stressful incidents, stress and coping strategies in the pre-registration house officer year.

CONTEXT: Previous studies have drawn attention to the stresses experienced by doctors in their first year. OBJECTIVES: To gain a deeper understanding of the causes of stress in newly qualified doctors, how they cope, and what interventions might make the year less traumatic. DESIGN: Postal questionnaire. This study focused on an open question asking about a stressful incident, the coping strategy used to deal with it, stressors in general and current levels of stress using the General Health Questionnaire. SETTING: 336 hospitals throughout the United Kingdom. SUBJECTS: A cohort of doctors followed from the time of their application to medical school, studied towards the end of their pre-registration year (n=2456). RESULTS: The response rate to the questionnaire was 58.4%. The incidents were categorised into the major groups Responsibility (33.6%), Interpersonal (29.7%), Overwork (17.0%), Death and disease (13.0%), and Self (6.7%). GHQ revealed psychological morbidity in 31% of respondents. Stress levels were highest in those reporting an incident about Responsibility or Self, lowest in those describing Death or disease. Stressors in general and preferred coping strategies differed between the groups. CONCLUSION: The incidents suggested the following interventions to reduce stress: better supervision in the first few weeks in post, at night, and for medical problems on surgical wards; more attention to avoiding sleep deprivation; more time for discussion with colleagues at work; more personal time with friends and family. The choice of incident described was influenced by the personal characteristics of the respondent.