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Acknowledgments
6
Dedication
6
Table of Contents
8
1 Description of the Problem
10
1.1 Definition
11
1.2 Epidemiology
12
1.3 Effects of Sexual Violence on Victims
13
1.4 Sexual Coercion in the Community
14
1.5 Course and Prognosis of Sexual Violence
17
1.5.1 Differences Between Sexually Violent Persons
17
2 Theoretical Models to Explain Sexual Violence
19
2.1 Hierarchical-Mediational Confluence Model (HMC)
19
2.2 A Comprehensive Model of Prediction
20
2.3 An Integrated Theory of Sexual Offending
20
2.4 A Theory of Interacting Proximal and Distal Predictive Factors
21
2.5 Facilitators of Sexual Violence
22
2.5.1 Pornography and Sexual Violence
23
2.5.2 Alcohol Use and Sexual Violence
25
2.6 The Influence of Early Childhood Abuse and/or Neglect
30
2.7 Prevention
30
3 Diagnosis
33
3.1 Differential Diagnosis
33
3.1.1 Unreliability of Paraphilia Diagnoses
33
3.1.2 Problems with DSM IV-TR Criteria of Paraphilia
34
3.1.3 Significant Problems with the Diagnosis of Sadism
35
3.2 Co-Morbidity and Co-Occurring Diagnoses
37
3.3 Sexual Coercion and Hypersexuality
39
3.3.1 Sexual Coercion and Sex Hormones
40
3.4 Assessment Strategies
40
3.4.1 Psychosocial Evaluation
40
3.4.2 Psychometric Testing
41
3.4.3 Risk Assessment
42
3.4.4 Assessment of Sexual Fantasies
43
3.4.5 Polygraph and Viewing Time Procedures
44
4 Treatment
46
4.1 Does Treatment Work?
46
4.2 Reformulated Relapse Prevention
50
4.3 Different Pathways and Different Treatments
51
4.4 A Treatment Program That Does Work
52
4.5 Important Therapist Skills
52
4.5.1 Empathy
53
4.5.2 Genuineness
55
4.5.3 Warmth
55
4.5.4 Acceptance
55
4.5.5 Confidence
56
4.5.6 Supportiveness
56
4.5.7 Emotional Expressivity
56
4.5.8 Self-Disclosure
56
4.5.9 Open-Ended Questions
57
4.5.10 Flexibility of Style
57
4.5.11 Positive Attitudes
57
4.5.12 Rewarding
58
4.5.13 Humor
58
4.6 Support Versus Confrontation Versus Collusion
58
4.7 Motivational Interviewing
60
4.8 Schema Therapy and Cognitive Distortions
63
4.9 Targets of Treatment
66
4.9.1 Self-Esteem
66
4.9.2 Acceptance of Responsibility
67
4.9.3 Pathways to Offending
68
4.9.4 Victim Empathy
69
4.9.5 Social Skills
70
4.9.6 Healthy Attachment
70
4.9.7 Emotional Regulation
71
4.9.8 Deviant Sexual Fantasies
72
4.9.9 Self-Management Plans
76
4.10 A Special Population—Individuals with Developmental Disabilities
78
4.11 Best Practices in Treatment of Sexually Violent Persons
80
4.12 Cultural Considerations in Sex Offender Treatment
81
4.13 Summary and Conclusions
83
5 Case Vignettes
85
Case #1 (Joe)
85
Case #2 (John)
86
Case #3 (MM)
86
Case #4 (JC)
87
6 Further Reading
89
7 References
90
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