March 13, 2011

SVP morass: Will psychologists "just say no"?

 Dr. Franklin,
          My understanding is that psychiatrists and the American Medical Association made a conscious, ethical decision to not get involved in the SVP [Sexually Violent Predator] morass. I am not sure why psychologists dove in. Smelling blood in the water, cash in bank accounts or trying to show up the "real doctors" has led to our participation in one of the largest, most expensive frauds put over on society, with the field of psychology becoming the laughingstock of real researchers. We are now participating in a system that systematically violates the Constitutional rights of individuals and uses the shoddiest of data to rationalize our position. Has there been any thought to a movement by psychologists or the APA to "just say no"?
-- Eugene Braaksma, Licensed Psychologist



What a timely question. Privately, many mainstream forensic psychologists agree with your assessment, and some have even gone public with their concerns. Most recently, two psychologists in the San Francisco Bay Area have gone so far as to echo your call for a professional boycott. But for several reasons, I think the major impetus for change will come not from within, but from larger systemic forces outside psychology.

Photo © Karen Franklin 2011
Calling for a boycott are forensic psychologists Paul Good and Jules Burstein. Writing in the American Journal of Forensic Psychology, they liken preemptive detention laws to a "modern-day witchhunt":
Psychologists testifying for the state in SVP civil commitment trials are using contrived mental disorders and the scientific veneer of actuarial formulae…. [The ‘predator’ paradigm] gives the public a false sense of security by concentrating vast sums of money on incarcerating a small group of sexually violent offenders, in place of a more useful public health approach to the problem of sexual violence. The consequences of this misguided effort include emphasizing incarceration over treatment, draining scarce resources from a multi-pronged approach to preventing sex crimes, demonizing sex offenders, and promoting the "slippery slope" of preventive detention…. Psychologists should put the public interest ahead of their guild interest and expose this mistake in social policy. One dramatic step would be to resign from state SVP panels.
"Full Employment for Psychologists Act"*

But, as this semi-facetious title by Charles Patrick Ewing suggests, two decades into these laws the sheer number of embedded psychologists makes a boycott impractical. These psychologists will not boycott a system that is making them "boatloads" of money, as one testified – up to a cool $1.5 million a year. As Ewing lays bare in Justice Perverted, the opportunity has proved irresistible for psychologists, many with little scientific sophistication or prior expertise in forensic psychology or sex offending:
In the short run the payoff, especially for some individual practitioners, has been great, but in the long run, the damage done to their professions and the people who would be served by them may prove to be much greater…. It is difficult to picture … psychologists who now earn their living developing checklists that purport to predict sex offender recidivism, doing evaluations and testifying in sex offender civil commitment trials, and/or training others who do so, encouraging state legislatures to put them out of work.

Photo © Karen Franklin 2011
Most of these psychologists are well intended. They believe they are doing righteous work to protect the public from dangerous predators. If they thought otherwise, cognitive dissonance would force them to quit the lucrative panels, as a minority of their colleagues have done. Their structural position of embeddedness creates blinders. When one is walking among the trees, one cannot see the forest. And there is an element of group-think. Surrounded by like-minded professionals, they mistake these colleagues' concordance for a consensus in the broader profession.

More alarmingly, as psychiatrists Michael First and Allen Frances point out in the current issue of the Journal of the American Academy of Psychiatry and Law, these practitioners are being systematically mistrained as to proper diagnostic and risk assessment practices. Just last week, I heard about a government evaluator (annual earnings from SVP evaluations: $500,000) who testified in support of civilly detaining a rapist based upon a previously unknown mental disorder called "paraphilia not otherwise specified – attracted to power and control."

You can't make this stuff up. 

Even if psychology had the unified will to step into this minefield, I doubt that our field has the political clout to impact the industry in any significant way. Embedded psychologists are mere functionaries, interchangeable cogs in a machine, scoring checklists and regurgitating memorized formulas. Unless and until legislatures and courts recognize that these laws are not doing much (if anything) to reduce sexual violence or keep the public safe, the growing chorus of critical scholars in the fields of psychology, criminology and law will remain as tiny voices crying out in the wilderness.

Will the courts step up?

In a critical overview just published online in Psychiatry, Psychology and Law, a leading forensic scholar in Australia says the courts shoulder some of the responsibility for failing in their role as gatekeepers. If the courts were more rigorous, fatally flawed approaches to risk assessment would not predominate in sex offender cases, argues Ian Coyle of Bond University in Queensland.

At a minimum, Coyle suggests, the playing field should be leveled. In Australia, as elsewhere around the world, the government has vastly superior resources for expert witnesses than does the defense:
The theoretical equality of all before the law is thus subverted in practice by inequality of means.

Another barrier to justice is the complexity of the statistics and measurement theory invoked in these cases. Lacking advanced scientific training, it is hard for the average judge or attorney to make sense of the competing claims and accurately determine which are valid and which are not.

Making matters worse, even when individual judges educate themselves so that they can detect and reject pseudoscience, for example by rejecting the fictional diagnosis of "hebephilia" as a basis for civil commitment, higher courts often overturn their decisions. The disappointing truth is, judges are mere functionaries, too.

The coming crash

Photo © Karen Franklin 2011
In the end, I predict the system will ultimately crumble not due to principled opposition but by virtue of its own excesses. In the United States, as many states teeter on the edge of bankruptcy, it is hard to justify spending $1 billion per year or more to civilly detain a tiny handful of sex offenders at the expense of public schools, higher education, and even prisons.

It is a tricky business, because legislators and judges do not want to incur public wrath by appearing "soft" on sex offenders. Still, as citizens feel the effects of massive cutbacks in public services, I expect they will become less tolerant of government waste across the board.

The backlash is already starting. For example, last week in Minnesota a legislative auditor released a report slamming the sex offender civil commitment program as costly and ineffective:
Hundreds of sex offenders confined in state treatment facilities receive inadequate therapy from under-qualified staff at excessive cost, according to [the] report…. At the same time, many other offenders present such low risk to the public that they could safely be released to community group homes, saving taxpayers millions of dollars. And in what they describe as a public safety paradox, auditors found that some sex offenders are held indefinitely, even though they pose less risk than dangerous felons in state prisons who are being released back to the streets. Auditors called on state officials to replace this "all or nothing'' system and develop a plan for low-cost alternatives, while spending more on treatment of the most dangerous offenders.
California is following suit, with an audit of its SVP program due out in June. Psychologists may be especially interested in one particular task of the audit, to examine "the qualifications of staff or contractors who conduct the evaluations and determine if they are consistent with professional standards and laws and regulations."

Bottom line, the bough will come crashing down when the massive costs finally become too much for governments to bear, and when citizens figure out that SVP laws -- while symbolically appealing -- are a wasteful and ineffective approach to reducing sexual violence.

How will our misguided colleagues pay their mortgages and fund their children's college educations then? Hopefully they're putting some of those millions in the bank for a rainy day.

*from Justice Perverted 

March 11, 2011

New column: Ethics and captive populations

A recent photo in the Los Angeles Times pictured a psychologist administering therapy to a group of men locked in cages the size of phone booths. An expert advised that the cages should be called "therapeutic modules," lest the prisoners "feel like animals and respond accordingly." The arrangement is the prison's response to a judicial mandate to provide treatment to mentally ill prisoners. But as the photo illustrates, much prison therapy is far removed from traditional treatments that psychologists are trained to provide.

So begins my "Ethics Corner" column in the current issue of California Psychologist magazine, which evolved out of a blog post a few months ago, "Prison therapy: It's all in the name." The full column is HERE. I have also created a stand-alone web page of selected resources on correctional ethics (HERE).

Wearing body armor and sitting just out of urination range, psychologist Daniel Tennenbaum tries to engage Vacaville prisoners to sing along with "Sitting on the Dock of the Bay." Photo credit Los Angeles Times.
A plug for the CPA: For those of you in California, I hope you will think about joining the California Psychological Association if you are not already a member. The CPA gives psychologists a voice, has local associations that facilitate networking (and socializing), and provides a number of member benefits, including the Ethics Committee's free hotline.

March 10, 2011

Psychiatrists ramp up opposition to forensic misuse of DSM

"Pedohebephilia" would make bad situation worse, they warn  

As you will recall, at a recent debate members of the American Academy of Psychiatry and the Law (AAPL) were virtually unanimous in giving the thumbs-down to three controversial sexual disorders being proposed for the fifth edition of psychiatry’s diagnostic manual.

Piggy-backing on that sentiment, the Academy's official journal has just published two additional calls for caution. 

DSM's forensic influence cannot be ignored

Ralph Slovenko, an eminent professor of law and psychiatry at Wayne State University Law School, leads off with an editorial that counters a key claim of the proponents of diagnostic expansion. The oft-repeated claim is that the legal implications of a diagnosis are irrelevant, and should not be considered.

Rebutting this head-in-the-sand mentality, Slovenko gives a comprehensive overview of the DSM's impact in myriad areas of the law, from parental termination to disability determinations. As evidence of the DSM's vast influence, he cites language written into the statutes in 16 states mandating its use for various purposes.

As his overview makes clear, courts and legislatures across the United States have ignored the fine print in the introduction to the Diagnostic and Statistical Manual, stating that use of the manual for forensic purposes risks misunderstanding and misuse.

A case in point: Use of a made-up category, "Paraphilia Not Otherwise – Hebephilia," as justification for preventive detention of men who have served prisont time for sexual relations with adolescent.

No basis for fictional "hebephilia" disorder

Next, two psychiatrists who were influential in developing the current edition of the DSM launch a full-on assault on the use of the bogus diagnosis "hebephilia" in sexual predator civil commitment proceedings.

Michael First, editor and co-chair of the DSM-IV-TR, and Allen Frances, chair of the DSM-IV Task Force, clarify the intention of diagnosing paraphilias, or sexual deviances, and why diagnosing offenders against adolescents with "hebephilia" (a diagnosis that does not exist in any formal diagnostic system) is a flagrant abuse of psychiatric nomenclature. This is not the first time these authors have tried to set the record straight, but their current analysis is especially detailed and unequivocal.
The alleged diagnosis paraphilia not otherwise specified, hebephilia, arose, not out of psychiatry, but rather to meet a perceived need in the correctional system. This solution represents a misuse of the diagnostic system and of psychiatry. That a large number of forensic mental health workers have been mistrained to regard paraphilia NOS as a valid diagnostic category in SVP proceedings should not be construed as proper representation of the views of the entire mental health field. Similarly, the very preliminary studies conducted by a few research groups should not be construed to indicate that hebephilia has any solid scientific support. Hebephilia is not an accepted mental disorder that can be reliably diagnosed and should not be treated as such in SVP proceedings.
First and Frances issue a strong call against adding the pretextual diagnosis of "pedohebephilia" to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders:
Among several radical proposals made by the DSM-5 Sexual Disorders Workgroup is the backdoor introduction of the hebephilia diagnosis into the DSM-5 by expanding the existing well-accepted pedophilia category to include sexual arousal to pubescent individuals and renaming the broadened construct pedohebephilic disorder. There is no apparent need or compelling rationale to include hebephilia in DSM-5 beyond the research interests of a few scientists and the questionable use of hebephilia in SVP proceedings.
Despite opposition from forensic psychiatry, no doubt the wheels will grind on. After all, as legal scholar Charles Patrick Ewing describes in Justice Perverted, preventive detention has taken on a life of its own, becoming a lucrative and self-perpetuating industry. More on psychology's role in that very soon….

Related resources:

On my website, I have created a page of resources on the hebephilia controversy. But if you really want to immerse yourself in these diagnostic controversies, the place to visit is the "DSM-5 Paraphilias Controversy." On one page, blogger Andrew Hinderliter has amassed an impressive array of literature on the disputed paraphilias, including not only hebephilia, hypersexuality, and sexual sadism but also related hot-button topics such as transvestic fetishism.

My comprehensive historical review of hebephilia is now available online. Or, for a shorter version, there's always my oldie but goodie blog post, from Halloween of 2007: "Invasion of the hebephile hunters: Or, the story of how an archaic word got a new lease on life."

March 9, 2011

Justice Perverted: Critical primer on sex offender policy

At a time when many U.S. states are teetering on the verge of bankruptcy and essential public services are being slashed and burned, does it make sense to spend billions and billions of dollars on largely symbolic laws that do little or nothing to prevent or deter sex offending?

Not according to Charles Patrick Ewing, a forensic psychologist and law professor at the University at Buffalo Law School.

I plan to say more about this book's implications for forensic psychologists in an upcoming post. For now, suffice it to say that I highly recommend this timely book to my readers; my review at Amazon is HERE.

March 8, 2011

Juvenile justice: Online resource

I stumbled across this fantastic resource for anyone interested in issues and trends in juvenile justice. The authors include Laurence Steinberg, Elizabeth Cauffman, Thomas Grisso, and other distinguished leaders in the field. Each article presents solid evidence on an aspect of juvenile justice, much of it in contradiction to what policymakers and the general public believe:

For example, contrary to widespread belief, as Elizabeth Cauffman notes, the causes of crime among male and female offenders are far more similar than different; as Peter Greenwood points out, there is no truth to the notion that, when it comes to delinquency prevention, "nothing works"; and, as explained by Alex Piquero, the causes of disproportionate minority contact are far more complicated than is often claimed both by those who insist that disparities in contact with the system are entirely due to racial bias on the part of the system and by others who contend that the disparities simply reflect racial differences in criminal involvement.

Making these resources available for free to the public is The Future of Children, a joint project of the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution. The mission of The Future of Children is to translate the best social science research about children and youth into information that is useful to policymakers, professionals, and members of the general public.

Click on the below links to go to the full articles, which are available in html and pdf versions for viewing, downloading, or printing. 

March 2, 2011

Steffan's Alerts #2: Informants, sex offenders and prisoner reentry

Click on a title to read the article abstract; click on a highlighted author's name to request the full article.


In a meta-analysis of data drawn from nine studies, Kelly Babchishin, Karl Hanson, and Chantal Hermann report on demographic and psychological characteristics of online and offline sexual offenders in a new issue of Sexual Abuse: A Journal of Research and Treatment. The authors suggest that online offenders, although exhibiting more sexual deviancy, may also have more self-control and psychological barriers to contact sexual offending than offline offenders.


In the same issue, Michael Seto, Karl Hanson, and Kelly Babchishin detail their findings about online sexual offenders’ past contact sexual offenses and future sexual recidivism from two meta-analyses. Approximately half of online sexual offenders self-reported a prior contact sexual offense, whereas 1 in 8 had an official record of a past contact sexual offense. A small number of online sexual offenders committed some type of sexual recidivism in follow-up periods of up to 6 years.


Ever wonder about the lives of confidential informants? In this issue of Justice Quarterly, Mitchell Miller provides insights from interviews of 84 informants from five southern states. A typology for better understanding the motivations of confidential informants is offered.
Prisoner reentry

Mark Berg and Beth Huebner, in another Justice Quarterly article, examine family ties and employment—two of the many areas related to recidivism—among offenders who are transitioning from prison to the community. They suggest that familial ties may play an important role in assisting offenders to lead a prosocial lifestyle.

Measuring sexual recidivism following prison-based treatment

Based on a sample of low-risk sexual offenders in New Zealand, Sarah Beggs and Randolph Grace demonstrate that reductions in sexual recidivism following prison-based treatment can be measured successfully through self-report psychometric tests and structured clinical rating scales. Average time at risk for recidivism was 12 years for this cohort. In their article, just published online in the Journal of Consulting and Clinical Psychology, the authors conclude, in part, that amelioration of dynamic risk factors for sexual offending leads to reduced sexual recidivism.

Steffan's alerts are brought to you by Jarrod Steffan, Ph.D., a forensic and clinical psychologist based in Wichita, Kansas. For more information about Dr. Steffan, please visit his website.