CENTER FOR SEX OFFENDER MANAGEMENT
The Effective Management of Juvenile Sex Offenders in the Community
A Training Curriculum

 A Project of the Office of Justice Programs, U.S. Department of Justice

 

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Section 3: Assessment
2 Hours

TOPIC: ASSESSMENT

Psychological Evaluations and Psychosexual Evaluations: Similarities and Differences

Now that we have covered some of the broader issues involved in conducting this kind of an evaluation, let’s consider the specific elements that should be addressed in the psychosexual evaluation. Remember, the psychosexual evaluation is more than a psychological evaluation—although there are some similarities.

• Of course, clinical interviews with the juvenile and the parent or caregiver are common to both types of evaluations. Particularly for the psychosexual evaluation, they provide an opportunity to begin to gather a full psychosocial history, assess amenability to intervention, gauge the level of candidness and disclosure, identify the degree to which personal responsibility is assumed, and explore the current level of remorse and/or empathy.
• And as you can see, both psychological and psychosexual evaluations rely on a thorough review of records. With a psychosexual evaluation, however, there are oftentimes additional types of records that must be considered, such as police reports and victim statements.
• In addition, both a psychological and a psychosexual evaluation include general psychological testing to assess intellectual functioning, personality, and mental health needs. To name just a few, the Wechsler Scales may be used to assess intellectual functioning, the Minnesota Multiphasic Personality Inventory–Adolescent version (MMPI–A) can be used to assess various aspects of emotional, personality, and social adjustment, and the Massachusetts Youth Screening Inventory–2 (MAYSI–2) has become increasingly popular as a means of screening for mental health difficulties.³⁹
• And in the event that significant psychiatric concerns are identified, it may be helpful to refer the youth to a child and adolescent psychiatrist for further evaluation and recommendations.

It is at this point that the psychosexual evaluation takes a different and unique turn. So, let’s take a look at the key elements that are specific to the psychosexual evaluation that likely would not be included in a general psychological evaluation.

• With the psychosexual evaluation, there is considerable focus on the assessment of sexual attitudes, interests, and behaviors, through a detailed sexual history and the use of sex offense–specific measures.
• And oftentimes, a risk assessment tool is used that is specifically designed to estimate recidivism potential for juvenile sex offenders.
• In addition, when conducting a psychosexual evaluation, the use of physiological measures—such as the penile plethysmograph, viewing time measures, and/or the polygraph may be warranted. These are certainly not tools that would be used during a general psychological assessment, are they?
• Because of the important focus of the psychosexual evaluation, I’d like to spend a few minutes highlighting the sexual history aspect of the assessment.

Remember that starting with more neutral, less threatening types of issues can be a good strategy with assessments. So, when conducting the sexual history, the evaluator may wish to begin by simply listing the different ways in which individuals learn about sex—such as from sex education classes at school, from a parent or older sibling, from peers, or from television programs, movies, books, magazines, or the Internet—and then asking the youth to discuss the way or ways in which he or she learned about sex.

Another relatively neutral topic may be to ask about physical and sexual development—including if and when the youth first began to notice physical changes in his or her body, when puberty began, etc.

A potential next line of inquiry could focus on the kinds of issues, ideas, behaviors, or persons that the youth finds to be sexually appealing or interesting or even arousing (i.e., “turn–ons”), as well as the kinds of things that are “turn offs” for the youth. This may also be a relevant time to ask them about their exposure to or use of sexually explicit materials such as magazines, movies, or Internet sites.

All of these discussions can provide an easy lead–in to asking about the content of sexual fantasies, as well as masturbation practices, such as the onset, frequency, and driving forces behind masturbation (i.e., “Under what circumstances are you most likely to feel like masturbating?” and “What are you most likely to think about when you masturbate?”).

It will also be important to ask about any sexual experiences that the youth has had thus far, first by inquiring about consensual, age–appropriate behaviors, and then following with a discussion about any times that they experienced sexual contact with another person in which they may have felt pressured, forced, confused, or otherwise uncomfortable.

As you can see, these lines of questioning have gradually progressed from broader, normative, and more benign types of questions to those that may feel more intrusive. Ultimately this culminates in some very specific questions that focus on the details surrounding the sex offense(s) for which the juvenile was adjudicated.

In addition, it is vital that the evaluator inquires about the full range of potential sexual interests, fantasies, urges, or behaviors of the youth, beyond the adjudicated offense. This is because there may be problematic sexual behaviors or sexual deviance issues that may have gone unreported or undetected, such as exhibitionism, voyeurism, fetishes, or sexual contact with animals. And these issues may impact the level of risk and needs of the youth and that may require additional intervention.

Offense–Specific Assessment Tools

Beyond the clinical interview and the detailed exploration of the youth’s sexual history, the use of sex offense–specific, paper–and–pencil assessment instruments can provide additional and very important data that can enhance a psychosexual evaluation.⁴⁰ Let’s talk about a few of them.

On the Adolescent Sexual Interest Cardsort,⁴¹ for example, youth self–rate their degree of arousal to a series of statements or vignettes that include consensual and age–appropriate sexual behaviors, sexual contact with male and female children, forcible sexual encounters, and non–contact deviant sexual behaviors such as exhibitionism and voyeurism. Responses on this measure can provide insights into the youth’s normal and deviant sexual interests.

The Adolescent Cognitions Scale has a slightly different area of focus. It is comprised of several statements that support, minimize, justify, or excuse sex offending behaviors—also referred to as cognitive distortions or thinking errors.⁴² A youth’s endorsements of these items suggest the presence of cognitive distortions related to sex offending in general and/or a tendency to minimize or justify the youth’s own sex offending behaviors.

A more comprehensive juvenile sex offense–specific assessment tool, because it covers a broad range of issues, is the Multiphasic Sex Inventory–Juvenile version (MSI–J).⁴³ This instrument includes validity scales that are designed to assess the youth’s frankness and candor, versus tendencies to overexaggerate or minimize sexual issues. It also includes scales that explore sexual knowledge; cognitive distortions; attitudes toward treatment; a range of paraphilic interests, fantasies, and behaviors; and apprehension or confidence related to sexual matters. In addition, the MSI-J includes items that provide a brief assessment of the youth’s social–sexual history.

Lastly, a needs assessment tool that we highlighted during our discussion of the pre–disposition: the Child and Adolescent Strengths and Needs—Sexual Development (CANS–SD).⁴⁴ Again, the CANS–SD allows for a comprehensive review of several critical domains, including the assessment of individual factors, parent/caregiver issues, family variables, general risk factors, and several characteristics pertaining to the youth’s sexual behavior problems.

Please keep in mind that these instruments are not the only available tools for use with juvenile sex offenders. I simply highlighted these to give a sense for some of the specific types of issues that are covered in these offense–specific tools that would not be addressed by general psychological assessment measures. It is also important to remember that these tools are self–report measures and, as such, the amount of information that can be gleaned from these tools is directly influenced by the level of honesty and openness that the youth is willing to offer. Again, this highlights the importance of establishing a trusting professional relationship and engaging the youth in the assessment process. And the inherent fallibility of self–report measures is also one of the reasons that some evaluators use physiological measures to augment the psychosexual evaluation process.