SEX SPECIFIC ASSESSMENTS
(formerly referred to as Sex Offender Evaluations):
PSYCHOSEXUAL EVALUATION:
Drs. Cushing conduct Sex Specific Evaluations which focus on the risks presented by the accused or convicted abuser as well as the clientˇ¦s treatment needs. Factors from the individual's psychosocial and psychosexual histories, which may contribute to sexual deviance, are gathered, measured and considered in the Risk Assessment.
It should be noted that there is NO known set of personality characteristics that can differentiate the sexual abuser from the non-abuser. Psychological profiles cannot be used to prove or disprove an individual's propensity to act in a sexually deviant manner. However, evaluations provide the basis for the development of comprehensive treatment plans and should provide recommendations regarding the intensity of intervention, specific treatment protocol needed, amenability to treatment, as well as the identified risk the abuser presents to the community.
When conducting evaluations of those charged with or convicted of sexual offenses, Drs. Cushing make every effort possible to be fair and impartial in order to provide objective and accurate data. We will respond only to referral questions that fall within our expertise and present level of knowledge. We strive to be respectful of the client's right to be informed of the reasons for the evaluation and the interpretation of data, as well as the basis for recommendations and conclusions. As a part of the evaluation, we ask that we be made fully aware of the client's legal status. This allows for appropriate substantiation for the resulting conclusions and recommendations.
Drs. Cushing are most mindful of the limitations of a client's self-report. We make all possible efforts to verify the information provided by the client through the gathering and thorough review of written documentation and collateral interviews. This includes gathering and reviewing information from all available and relevant sources, including:
. Criminal investigation records including police reports and witness statements
. Children and Family Services (DCFS) investigations
. Previous evaluations and treatment progress reports
. Mental health records and assessments
. Medical records
. Correctional system reports
. Probation/parole reports
. Offense statements from abuser
. Offense statements from victim
Whenever possible, interviews with the client's significant other and/or family of origin will be conducted. Any evaluation conducted without sufficient collateral information will need to be interpreted cautiously.
Victims will not be re-interviewed for the purpose of gathering information for the abuser's evaluation as it is necessary to keep the abuser and victim interview and evaluation processes separate.
The evaluation procedures will include:
. Clinical interview
. Paper/pencil psychosexual and personality testing
. Intellectual assessment as needed
. ABEL sexual interest assessments
Information gathered in the evaluation process includes, but is not limited to: (order does not indicate prioritization)
. Intellectual and cognitive functioning
. Mental status examination
. Medical history: head injuries, physical abnormalities, enuresis, encopresis, current use of medication, allergies, accidents, operations, major medical illnesses
. Self-destructive behaviors, self mutilation and suicide attempts
. Psychopathology and personality characteristics
. Family history
. History of victimization: physical, emotional, and sexual
. Educational and occupational history
. Criminal history: sexual and non-sexual
. History of violence and aggression including use of weapons
. Interpersonal relationships: past and current
Specific to the evaluation of those accused or convicted of sexual abuse is the comprehensive assessment of the client's sexually deviant sexual behavior. As such, the evaluation will assess the possible presence and extent of issues involving the client's:
. Cognitive distortions
. Social competence
. Impulse control
. Substance abuse
. Denial, minimization and inability to accept responsibility
. Sexual behavior: sexual development, adolescent sexuality and experimentation, dating history, intimate sexual contacts, gender identity issues, adult sexual practices, masturbatory practices, sexual dysfunction, fantasy content, and sexual functioning
. Sexually deviant behavior: description of offense behaviors, number of victims, gender and age of victims, frequency and duration of abusive sexual contact, victim selection, access and grooming behaviors, use of threats, coercion or bribes to maintain victim silence, degree of force used before, during and/or after offense, sexual arousal patterns
Glenwood Testing Center psychologists are sensitive to the individual's cognitive functioning, including reading and writing capabilities, and this will be considered and accommodated prior to arranging the battery of testing instruments. If a client cannot read at the level necessary to comprehend the test questions, arrangements for using a standardized approved auditory (taped or read) version of the test instrument should be made.
The clinical interview will incorporate sufficient discussion necessary to augment, clarify and explore the information obtained from the review of collateral materials (and interviews), as well as the other components of the evaluation (testing results, etc.).
The degree of similarity or disparity between the abuser and the victim's statements will be noted. The client's explanations for false allegations should be documented.
In addition to evaluation procedure summaries, conclusions and recommendations, all collateral reports and interviews will be listed and acknowledged in the written evaluation report. The evaluation will determine and the report will address the following specifics regarding the client and his/her needs as well as the needs of the community:
.Dangerousness
.Treatment protocol
.Supervision/surveillance requirements
.Response to treatment
The final report will include a written assessment of client treatment needs and will identify strengths and weaknesses in the individual's psychosexual functioning for the purpose of directing treatment efforts to the appropriate areas.
Both community safety and the degree to which an abuser is capable/and willing to manage risk will be considered when generating recommendations. Such a thorough evaluation is highly recommended prior to an abuser being accepted into a community based treatment program. If a significant amount of time has lapsed between the completion of the evaluation and when the individual applies for acceptance into a treatment program, an evaluation update is required. However, the intent of the update will not be to duplicate the original evaluation, but to gather current data upon which the original treatment plan can either be confirmed or amended.
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SEX SPECIFIC (including Sex Offender) TREATMENT:
Sexual deviance is a complicated, multi-determined behavioral disorder. Treatment intervention is focused on assisting the individual to accept responsibility, increase recognition, institute change and manage sexually deviant thoughts, attitudes and behavior. The focus of Glenwood Psychologists’ treatment is on techniques designed to assist sexual abusers in maintaining control of their sexual deviance throughout their lifetime. Therefore, treatment should include simple, practical techniques that can be applied for the remainder of their lives. However, it must be noted that involvement in and successful completion of a treatment regimen does not cure sexual deviance. Every abuser is different. It is imperative that treatment interventions, including the individual's primary treatment plan meet the differing needs of each individual. While some clients may only require shorter term, solution focused, cognitive behavioral therapy, many sexual abusers require long term, comprehensive, offense-specific treatment.
Currently, cognitive-behavioral approaches appear to be the most effective method of treatment intervention. In addition, anti-androgen and other pharmacological therapies, substance abuse treatment, educational programming, including social competency building, and peer-facilitated self-help programs can be used as adjuncts to the cognitive behavioral model of treatment for sexual deviance. Individual counseling and a group approach can be used effectively to treat sexual issues.
Progress in treatment will be based on the measurement of specific objectives, including observational changes in cognitive proces, arousal patterns, as well as a consistent willingness and ability to apply newly learned behaviors. As the client continues to meet treatment expectations and accomplish the identified treatment goals, a gradual reduction of structured intervention may occur. Treatment is unlikely to be effective until a client acknowledges the abusive behavior and accepts responsibility for that behavior. It should be noted, however, that a client's initial denial may be impacted by the status of his legal proceedings or other external variables. Thus, the existence of some degree of denial should not preclude a client from entering treatment. Diminishing the degree of denial is a gradual process and that process will be incorporated into the client's individualized treatment plan.
Most treatment plans will include aspects of:
AROUSAL CONTROL to decrease/control deviant sexual arousal
COGNITIVE THERAPY to address dysfunctional core beliefs and replace distorted thoughts with accurate responsible messages
RELAPSE PREVENTION to teach the client how to successfully manage his or her behavior and recognize and cope with the factors that increase risk for reoffending. Self management is seen as a lifelong endeavor for a sexual abuser.
VICTIM AWARENESS AND EMPATHY to counter the cognitive distortions that supported the decision to abuse and to increase the abuser's awareness of the short and long term impacts of sexual victimization.
SOCIAL SKILLS TRAINING to improve communications skills, and teach assertiveness skills, anger management, stress management and relationship skills.
DEVELOPING HEALTHY RELATIONSHIP skill training to help overcome deficits in sex education, dating skills, relationship development and intimacy skills.
COUPLES AND PARENT THERAPY may be helpful and necessary for both short and long term change. Such treatment should focus on understanding the dynamics and treatment of sexually deviant cognitions and behavior. Other topics such as communication skills, problem solving, sex education, parenting, anger management and stress management may also need to be addressed.
REUNIFICATION: Contact between children and sexual abusers requires specialized treatment procedures and supervision. The priority of such treatment is to provide for the continued safety and protection of children, including those who have been previously victimized and those who are at risk for being victimized. Victims and/or other children will not be involved in family therapy with the sexual abuser until it is determined that involvement in the therapy is in THE BEST INTEREST OF THE CHILDREN!
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SEX ADDICTION including INTERNET ADDICTION:
Compulsive, repeated sexual behavior could take the form of a sexual addiction. Some researchers describe how sexually addicted individuals have become addicted to the neuro-chemical changes that take place in the body during sexual behavior, much as a drug addict becomes hooked on the effects of smoking "crack" cocaine or "shooting" heroin. Contrary to enjoying sex as a self-affirming source of physical pleasure, the sex addict has learned to rely on sex for comfort from pain, for nurturing, or relief from stress, comparable to the alcoholic's purposeful use of alcohol. Based on a recent 10-year research study of 1500 sexual addicts, it has been estimated that about 8% of the total population of men and about 3% of women in the US are sexually addicted. That translates into over 15 million women and men who suffer from this problem.
Sexual addiction can take many different forms. The addict may be addicted primarily to one behavior, such as sex with a prostitute, but generally uses a variety of sexual behaviors. For example, consider the salesman who might watch the dancers at a topless bar over a business lunch, have sex with a prostitute from an escort service in his hotel room one night while on a business trip, return home and have sex with his wife while fantasizing about the sexual massage he got last month, and masturbate while viewing pornographic images on the Internet at one a.m. two days later.
A complete list of sexually addictive behavior would be exhaustive and would increase with addicts' need to find new ways of finding sexual thrills. However, the more usual forms of sexual addiction are as follows:
***Compulsive masturbation--accompanied by mental images or thoughts about sex, or while viewing sexual images on the TV or computer screen or while looking at pornographic publications (or even while looking at non-sexual material, such as underwear or swim wear ads).
***Compulsive sex with prostitutes--this can be with female or male prostitutes or transvestites (transvestites are usually men dressed as sexy women) at their place of business or dispatched to your location or picked up on the street.
***Anonymous sex with multiple partners, "one night stands" picked up at bars or sex with strangers in parks or restrooms, or sex in any number of anonymous situations, where sex is the object and no relationship is established with the person.
***Multiple affairs outside a committed relationship, or serial relationships (one after the other).
***Frequent patronizing of topless bars, modeling studios, sexually oriented tanning salons, adult bookstores or sexual massage establishments.
***Habitual exhibitionism--exposing one's private body parts to unsuspecting onlookers, either directly (by removing or opening clothing) or indirectly through skimpy or revealing clothing. An example is the man who sits in his car with his fly unzipped and begins masturbating when someone appealing to him walks by.
***Habitual voyeurism--the so-called "peeping Tom," who finds sexual excitement in forbidden secret looks into other people's privacy. Examples are: looking into a neighbor's bathroom or bedroom window in hopes of seeing someone disrobed, peering up shorts or skirts on the sly, or looking through "glory holes" in restroom walls (strategically located holes in walls separating urinal or toilet stalls).
***Inappropriate sexual touching--touching someone for sexual excitement in a manner that attempts to appear accidental, such as "accidentally" brushing up against another person's breast or genitals in a crowd.
***Repeated sexual abuse of children--an adult who engages children in sexual activity, or an older child who engages much younger children sexually.
***Episodes of rape--forcing another person to be sexual against his or her will, like the obvious assaultive rape by strangers one hears about in the media, or the more subtle form perpetrated by someone known to the victim (often called "date rape").
INTERNET SEX ADDICTION:
The Internet has become the newest, most rapidly growing form of sexual acting out for many sex addicts today. A lot of sex addicts have added computer sex to their repertoire, as it fills a need for "more, easier and better." For the cybersex addict, increasing amounts of time are spent "surfing," downloading, creating files, masturbating, reading information posted on sexual bulletin boards, exchanging sexual information live with others in sexual chat rooms or via computer cameras, or directing their own live sex shows on interactive sites--in short, looking for what's new, what's better than last time. The Internet just happens to provide many of the things sex addict's seek, all in one place: isolation, secrecy, fantasy material, endless variety, around-the-clock availability, instant accessibility and a rapid means of returning, low or no cost. (The cost factor can change, however, if the sex addict keeps charging view-for-pay services on the internet, such as live interaction with performers who follow the customer's instructions for engaging in all kinds of prescribed sex acts that the customer can watch and masturbate to.)
Since one of the characteristics of sexual addiction is that it is progressive--that is, the habitual behaviors progressively become more frequent, varied and extreme, with more frequent and extreme consequences--sex addicts on the Internet often experience a rapid progression of their addiction. The new sexual thrills lead to spending huge amounts of time, moving more quickly into more extreme behaviors, taking greater risks, and getting caught more frequently. Thus, Internet sex has been referred to as the "crack cocaine" of sex addiction. Actually, the sped-up progression of the sex addict's problem via the internet can turn into a blessing, since it can move the addict into the consequences more quickly that can cause him or her to get help.
TREATMENT FOR SEXUAL ADDICTIONS:
Outpatient treatment usually consists of counseling sessions in a psychotherapy or counseling office scheduled one session or more each week. The outpatient treatment may be mainly individual sessions or marital sessions with a particular counselor, or may be more in the form of a treatment program consisting of individual, marital, group and educational sessions. Either way, the treatment is most effective when combined with specialized, free 12-step support group attendance in a group such as Sex Addicts Anonymous or Sexaholics Anonymous. Glenwood Testing Center mental health professionals are trained and experienced in treating sexual addictions and the partners of those addicts.
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CREDENTIALS: DR. FRANK CUSHING & DR. KYLE CUSHING &
DIANE CUSHING, RN, LCPC:
Both Dr. Cushings are Licensed Clinical Psychologists with significant additional training in evaluating and treating sex offenders, sex addicts, and sex abuse victims. They also both, along with Diane Cushing, R.N., L.C.P.C., offer psychotherapeutic treatment for sexual dysfunctions and intimacy issues in a committed relationship.
Dr. Frank Cushing has had considerable training in Human Sexuality. He completed a post doctoral, one- year Fellowship training program with the Wisconsin Sex Offender Treatment Network (WSOTN) with an emphasis on evaluating and treating Sex Offenders with the purpose of helping treat offenders to prevent future victims. He was elected Fellow with WSOTN in 1999. Dr. Frank Cushing was also a long-time member of The Association for The Treatment of Sexual Abusers and adheres to their Ethical Standards and Principles for the Management of Sexual Abusers. He has been treating and evaluating sexual problems for over 30 years.
Dr. Kyle Cushing also completed the extensive WSOTN training program and was elected Fellow in 1999. He also has considerable experience in working with the incarcerated population which he gained while working for the Federal Bureau of Prisons and the State of Michigan Forensic Psychiatry Unit. He has done considerable clinical work with both abusers and the abused.
Diane Cushing is a Registered Nurse and Licensed Clinical Professional Counselor who has been treating victims of sexual abuse and people with sexual dysfunctions for nearly 20 years. She completed specialized Rape Trauma training and has worked with scores of rape, incest, sexually molested and abused persons as well as sexual perpetrators.
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OTHER SEX-RELATED SERVICES:
Glenwood Testing Center mental health professionals offer a wide variety of services including Sex Therapy and Treatment of Sexually Abused Children, Adolescents and Adults. In addition, people with symptoms of trauma from rape, incest or sex molestation can receive supportive psychotherapy. Diane Cushing, R.N. and Dr. Frank Cushing have extensive experience in treating the following:
Impotence
Erection Difficulties
Premature Ejaculation
Difficulties with Female Orgasm
Painful Intercourse
Low Sex Drive or Libido problems
Sexual Orientation Issues
Embarrassment & Anxiety about Sex
Sexual Aversion
Sexual Boredom
Negative Body Image
Relationship & Marital Problems
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PARAPHILIAS:
What are they?
Paraphilias are problems with controlling impulses that are characterized by recurrent and intense sexual fantasies, urges, and behaviors involving unusual objects, activities, or situations not considered sexually arousing to others. In addition, these objects, activities or situations often are necessary for the person's sexual functioning. With a paraphilia, the individual's urges and behaviors cause significant distress and/or personal, social or occupational dysfunction. Someone with a paraphilia may be referred to as "kinky" or "perverted," and these behaviors may have serious social and legal consequences.
What Behaviors Are Considered Paraphilias?
Exhibitionism ("Flashing")
Exhibitionism is characterized by intense, sexually arousing fantasies, urges or behaviors involving exposure of the individual's genitals to an unsuspecting stranger. The individual with this problem, sometimes called a "flasher," feels a need to surprise, shock, or impress his victims. The condition usually is limited to the exposure, with no other harmful advances made, although "indecent exposure" is illegal. Actual sexual contact with the victim is rare. However, the person may masturbate while exposing himself or while fantasizing about exposing himself.
Fetishism
People with this problem have sexual urges associated with non-living objects. The person becomes sexually aroused by wearing or touching the object. For example, the object of a fetish could be an article of clothing, such as underwear, rubber clothing, women's shoes, or women's underwear or lingerie. The fetish may replace sexual activity with a partner or may be integrated into sexual activity with a willing partner. When the fetish becomes the sole object of sexual desire, sexual relationships often are avoided. A related disorder, called partialism, involves becoming sexually aroused by a body part, such as the feet, breasts or buttocks.
Frotteurism
With this problem, the focus of the person's sexual urges is related to touching or rubbing his genitals against the body of a non-consenting, unfamiliar person. In most cases of frotteurism, a male rubs his genital area against a female, often in a crowded public location. This disorder also is a problem because the contact made with the other person is illegal.
Pedophilia
People with this problem have fantasies, urges or behaviors that involve illegal sexual activity with a prepubescent child or children (generally age 13 years or younger). Pedophilic behavior includes undressing the child, encouraging the child to watch the abuser masturbate, touching or fondling the child's genitals and forcefully performing sexual acts on the child. Some pedophiles are sexually attracted to children only (exclusive pedophiles) and are not attracted to adults at all. Some pedophiles limit their activity to their own children or close relatives (incest), while others victimize other children. Predatory pedophiles may use force or threaten their victims if they disclose the abuse. Health care providers are legally bound to report such abuse of minors.
This activity constitutes rape and is a felony offense punishable by imprisonment.
Sexual Masochism
Individuals with this disorder use sexual fantasies, urges or behaviors involving the act (real, not simulated) of being humiliated, beaten or otherwise made to suffer in order to achieve sexual excitement and climax. These acts may be limited to verbal humiliation, or may involve being beaten, bound or otherwise abused. Masochists may act out their fantasies on themselves -- such as cutting or piercing their skin, or burning themselves -- or may seek out a partner who enjoys inflicting pain or humiliation on others (sadist). Activities with a partner include bondage, spanking, and simulated rape.
Sadomasochistic fantasies and activities are not uncommon among consenting adults. In most of these cases, however, the humiliation and abuse are acted out in fantasy. The participants are aware that the behavior is a "game," and actual pain and injury is avoided.
A potentially dangerous, sometimes fatal, masochistic activity is autoerotic partial asphyxiation, in which a person uses ropes, nooses or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.
Sexual Sadism
Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. This disorder is different from minor acts of aggression in normal sexual activity; for example, rough sex. In some cases, sexual sadists are able to find willing partners to participate in the sadistic activities.
At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement. It should be noted that while rape may be an expression of sexual sadism, the infliction of suffering is not the motive for most rapists, and the victim's pain generally does not increase the rapist's sexual excitement. Rather, rape involves a combination of sex and gaining power over the victim. These individuals need intensive psychiatric treatment and may be jailed for these activities.
Transvestitism
Transvestitism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the female partner, as well. Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. Cross-dressing itself is not a problem, unless it is necessary for the individual to become sexually aroused or experience sexual climax.
Voyeurism ("Peeping Tom")
This disorder involves achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed, and/or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person he is observing. Other names for this behavior are "peeping" or "peeping Tom."
How Common Are Paraphilias?
Most paraphilias are rare, and are more common among males than among females (about 20 to 1 of males to females). However, the reason for this disparity is not clearly understood. While several of these disorders are associated with aggressive behavior, others are not aggressive or harmful. Some paraphilias -- such as pedophilia, exhibitionism, voyeurism, sadism, and frotteurism -- are criminal offenses.
Having paraphilic fantasies or behavior, however, does not always mean the person has the mental illness. The fantasies and behaviors can exist in less severe forms that are not dysfunctional in any way, do not impede the development of healthy relationships, do not harm the individual or others, and do not entail criminal offenses. They may be limited to fantasy during masturbation or intercourse with a partner.
What Causes Paraphilia?
It is not know for certain what causes paraphilia. Some experts believe it is caused by a childhood trauma, such as sexual abuse. Others suggest that objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. In most cases, the individual with a paraphilia has difficulty developing personal and sexual relationships with others.
Many paraphilias begin during adolescence and continue into adulthood. The intensity and occurrence of the fantasies associated with paraphilia vary with the individual, but usually decrease as the person ages.
How Is Paraphilia Treated?
Most cases of paraphilia are treated with counseling and therapy to help these people modify their behavior. Medications may help to decrease the compulsiveness associated with paraphilia, and reduce the number of deviant sexual fantasies and behaviors. In some cases, hormones are prescribed for individuals who experience frequent occurrences of abnormal or dangerous sexual behavior. Many of these medications work by reducing the individual's sex drive.
How Successful Is Treatment for Paraphilia?
To be most effective, treatment must be provided on a long-term basis. Unwillingness to comply with treatment can hinder its success. It is imperative that people with paraphilias of an illegal nature receive professional help before they harm others or create legal problems for themselves. While paraphillias might not be curable, they are very much manageable with treatment. This treatment could include individual therapy aimed at controlling impulses, altering dysfunctional and distorted thinking that leads to the behavior and helping the person explore alternative, more socially acceptable behaviors when possible. In addition, often the spouse, partner or parents of the patient could be helped considerably by counseling to help them understand and cope with their family member's sexual deviance.
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