Treatment providers and evaluators shall recognize that the
usage of psychophysiological tools may be utilized in the assessment of
offenders in relation to treatment progress, compliance with supervision, and
support effective risk management and risk reduction. The following will detail
each type of psychophysiological tool.
a) Phallometry
1) Phallometry is a specialized form of
assessment used in treatment with individuals who have committed sexual
offenses. Responsible use of phallometry results requires at least a
rudimentary understanding of how phallometry works and its advantages and
limitations. As with any instrument or procedure, treatment providers are
familiar with current literature and obtain appropriate training before using
or interpreting phallometric testing results. Examiners receive training in
phallometric testing in order to become knowledgeable about the technical
aspects of the equipment and the appropriate protocols for conducting
phallometric testing specific to the equipment being used. Examiners are also
familiar with the research evidence on the reliability and validity of
phallometric testing.
2)
Phallometric testing using penile plethysmography involves measuring changes in
penile circumference or volume in response to sexual and nonsexual stimuli.
Circumferential measures (measuring changes in penile circumference) are much
more common than volumetric measures (measuring changes in penile volume),
which are used in only a few laboratories worldwide. However, there is good
agreement between circumferential and volumetric measures once a minimal
circumference response threshold is reached. Therefore, circumferential
measures are the focus of this subsection (a).
3) Phallometric testing provides objective
information about male sexual arousal and is therefore useful for identifying
deviant sexual interests during an evaluation, increasing client disclosure,
and measuring changes in sexual arousal patterns over the course of
treatment.
4) Phallometric test
results are not used as the sole criterion for determining deviant sexual
interests, estimating risk for engaging in sexually abusive behavior,
recommending that clients be released to the community, or deciding that
clients have completed treatment programs. Phallometric test results are
interpreted in conjunction with other relevant information (for example, the
individual's offending behavior, use of fantasy and pattern of masturbation) to
determine risk and treatment needs. Phallometric test results are not to be
used to draw conclusions about whether an individual has committed a specific
sexual crime. As well, there are limited data available regarding the use of
plethysmography with clients who have developmental disabilities and clients
with an acute major mental illness. Therefore, treatment providers need to
exercise caution in using phallometry with these populations and in
interpreting and reporting phallometric results.
5) Prior to testing, examiners screen clients
for potentially confounding factors such as medical conditions, prescription
and illegal drug use, recent sexual activity, and sexual dysfunction. Clients
with active, communicable diseases, particularly sexually transmittable
diseases, are not to be tested until their symptoms are in remission.
6) Specific informed consent for the testing
procedure and release forms for reporting test results are obtained at the
beginning of the initial appointment. Laboratories have a standard protocol for
fitting gauges, presenting stimuli, recording data and scoring.
7) Examiners use the appropriate stimulus set
to assess sexual interests that are the subject of clinical concern. For
example, examiners use a stimulus set with depictions of children and adults to
test clients who have child victims or who are suspected of having a sexual
interest in children. At a minimum, examiners have at least two examples of
each stimulus category. Stimuli that are more explicit appear to produce better
discrimination between individuals who sexually offend and control subjects
than less explicit stimuli. It is important to ensure that the stimuli are good
quality and avoid any distracting elements.
8) Treatment providers are aware of the
applicable legislation in their jurisdiction regarding the possession of
sexually explicit materials. If permitted to use visual stimuli for testing of
sexual interest in children, examiners use a set of pictures depicting males
and females at different stages of physical development, ranging from very
young, prepubertal children to physically mature adults. The use of neutral
stimuli, such as pictures of landscapes without people present, may increase
the validity of the assessment. The inclusion of the neutral stimuli serves as
a validity check because responses to sexual stimuli that are lower than
responses to neutral stimuli might indicate faking attempts. Faking tactics
include looking away from or not listening to stimuli. Audiotaped stimuli may
also be used to assess sexual interest in children; if used, these stimuli
clearly specify the age and sex of the depicted individuals.
9) For testing of sexual arousal to
nonconsenting sex and violence, examiners using audiotapes include stimuli
describing consenting sex, rape and sadistic violence. Stimuli depicting
neutral, nonsexual interactions are also included. Stimuli can depict males or
females, children or adults.
10)
The phallometric testing report includes a description of the method used for
collecting data, the types of stimuli used, an account of the client's
cooperation and behavior during the testing, and a summary and description of
the client's profile of responses. Client efforts to fake or other potential
problems with the validity of the data or the interpretation of results are
also reported.
11) The three most
common means of scoring plethysmograph data are standardized scores, percentage
of full erection, and millimeter of circumference change. Those using
phallometric assessment are aware of the advantages and disadvantages of each
scoring method. Research has found that standardized scores (e.g., z scores)
increase discrimination between groups. Transforming raw scores to standardized
scores for subjects who show little discrimination between stimuli can,
however, magnify the size of small differences between stimuli. Raw scores,
millimeter of circumference change, or scores converted to percentage of full
erection may be clinically useful in the interpretation of results.
12) Deviance indices can be calculated by
subtracting the mean peak response to nondeviant stimuli from the mean peak
response to deviant stimuli. For example, a pedophilic index could be
calculated by subtracting the mean peak response to stimuli depicting adults
from the mean peak response to stimuli depicting prepubescent children. Thus,
greater scores indicate greater sexual arousal to child stimuli.
13) Because the sensitivity of phallometric
testing is lower than its specificity, the presence of deviant sexual arousal
is more informative than its absence. Results indicating no deviant sexual
arousal may be a correct assessment or may indicate that a client's deviant
sexual interests were not detected during testing.
14) Research indicates that initial
phallometric assessment results are linked with recidivism. Repeated
assessments can be helpful to monitor treatment progress and to provide
information for risk management purposes.
b) Viewing Time
1) Viewing time is a specialized form of
assessment used in the treatment of individuals who have committed sexual
offenses. Responsibly using the results of viewing-time measures requires
treatment providers to have at least a rudimentary understanding of how viewing
time measures work, as well as their advantages and limitations. As with any
instrument or procedure, treatment providers should be familiar with current
literature and obtain appropriate training before using or interpreting viewing
time testing results.
2)
Unobtrusively measured viewing time is used as a measure of sexual interest.
The relative amount of time clients spend looking at pictures of children (who
can be clothed, semiclothed or nude) is compared to the time that the same
adult spends looking at pictures of adults. Research suggests that, as a group,
individuals who have offended against children look relatively longer at
stimuli depicting children than adults. Unobtrusively measured viewing time
correlates significantly with self-reported sexual interests and congruent
patterns of phallometric responding among nonoffending subjects. Little is
known, however, about the value of retesting using viewing time as a measure of
treatment progress.
3) As with any
test, specific informed consent for the test procedure and release forms for
reporting results are obtained prior to beginning testing. Examiners have a
standardized protocol for presenting the stimuli, recording and scoring.
Examiners are familiar with the reliability and validity of the test. In
particular, it is important that examiners know the degree to which the viewing
time measure being used has been validated for the client population being
assessed. This technology has primarily been used to identify sexual interest
in gender and age. As well, there is limited information specific to the use of
viewing time with clients with developmental disabilities.
4) For testing sexual interest in children,
examiners have a set of pictures depicting males and females at different
stages of development, ranging from very young children to physically mature
adults. It is important that stimuli are of good quality and avoid any
distracting elements. Treatment providers who use sexually explicit stimuli are
aware of applicable legislation in their jurisdiction about possession of these
materials.
5) The test report
includes a description of the method used for collecting data, the types of
stimuli used, an account of the client's cooperation and behavior during
testing, and a summary and description of the client's responses. Client
efforts to fake or other potential problems with the validity of the data or
the interpretation of results are also included.
6) As noted in this subsection (b), viewing
time is not to be used as the sole criterion for determining deviant sexual
interests, estimating a client's risk for engaging in sexually abusive
behavior, recommending whether a client be released to the community, or
deciding whether a client has completed a treatment program. Viewing time test
results are interpreted in conjunction with other relevant information (for
example, the individual's offending behavior, use of fantasy, the pattern of
masturbation) and are never to be used to make inferences about whether an
individual has committed a specific sexual crime.
AGENCY NOTE: Viewing time is a more accepted practice with
juveniles and less intrusive than phallometry or polygraphy.
c) Polygraphy
1) Polygraph testing involves a structured
interview during which a trained examiner records several of an examinee's
physiological processes. Following this interview, the examiner reviews the
charted record and forms opinions about whether the examinee was nondeceptive
or attempting deception when answering each of the relevant
questions.
2) Post conviction Sex
Offender Polygraph Testing is a specialized form of general polygraph testing
that has come into widespread use in the United States. Although all principles
applicable to general polygraph testing also apply to post conviction sex
offender testing, its unique circumstances generate additional challenges.
Using post conviction sex offender testing responsibly requires treatment
providers to have at least a rudimentary understanding of how polygraphy works,
its advantages and limitations, and special considerations related to its
integration into sex offender work. This subsection (c)(2) serves as a brief
introduction to these issues. As with any instrument or procedure, treatment
providers should be familiar with current literature and obtain appropriate
training before using or interpreting polygraph results.
3) Post-conviction sex offender testing is
intended to serve two objectives:
A) To
generate information beyond what can be obtained from other self-reported
measures; and
B) To explore and
support compliance and gauge progress with respect to supervision expectations
and treatment expectations and goals.
4) Some research indicates that the polygraph
exam can lead to clients providing increased information regarding their
offending; however, test validity and reliability often vary widely across
studies. Therefore, it is important for providers to become informed about
types of tests that produce the most accurate findings. As well, it is possible
that some of the information obtained through post conviction sex offender
testing might be fictitious, representing an accommodation to pressure for
disclosures. The second objective of post conviction sex offender testing
(enhanced supervision and treatment compliance) has received only limited
empirical attention.
5) The
American Polygraph Association, the National Association of Polygraph
Examiners, and other polygraph associations have developed standards for
certifying polygraph examiners who work in sex offender management and
treatment, as well as standards for administering sex offender tests. Some
states also regulate post conviction sex offender testing standards and
procedures. Treatment providers are familiar with laws, state regulations, and
association guidelines governing post conviction sex offender testing where
they practice. Treatment providers work with examiners who meet certificate
requirements and adhere to procedures recommended by a relevant polygraphists'
organization.
6) Four types of post
conviction polygraph exams are commonly performed with sex offenders:
A) Instant/Index Offense Tests are designed
to explore and clarify discrepancies between the offender's and the victim's
descriptions of the conviction offenses.
B) Sexual History Disclosure Tests are
designed to facilitate a client's disclosure to their treatment providers of
sexual history information, which may include sexually abusive or
offense-related behaviors.
C)
Maintenance/Monitoring Tests are designed to explore potential charges,
progress and/or compliance relative to treatment, supervision and other case
management goals, objects and expectations.
D) Specific Issue Tests are generally
designed to explore a client's potential involvement in a specific prohibited
behavior, such as unauthorized contact with a victim at a particular
time.
7) Polygraph test
accuracy is believed to be greatest when examiners focus on highly specified
(i.e., single issue, narrow and concrete) questions. Treatment providers
cooperate with examiners in structuring tests that are responsive to program
needs without unnecessarily compromising accuracy considerations.
8) Limits of confidentiality are fully
disclosed to clients prior to polygraph testing. Clients are informed in
writing about how the results of polygraph exams will be used and who will
receive the results. Clients are informed about the possible consequences to
them as a result of the polygraph exam.
9) There is very limited empirical research
on the use of polygraph with clients who have developmental disabilities and
clients with low/borderline IQs. Therefore, additional caution is advised if
treatment providers use polygraph in the management and treatment of these
clients.
10) Polygraph charts are
not the only means of monitoring offenders' behavior and are not to be the sole
basis for significant case decisions. Examiner and examinee characteristics,
treatment milieu, instrumentation, procedures, examination type, base rates of
attempted deception in the populations being tested, and other idiosyncratic
factors can affect accuracy and usefulness. Likewise, when questions are not
highly specific, there is reason for concern regarding the results of polygraph
testing for monitoring purposes.
11) Treatment providers' primary purpose for
collecting sexual history information is the increased ability to design
clinical interventions and other management strategies. The usefulness of post
conviction sex offender polygraph testing as a clinical tool derives from its
ability to elicit historical information, allowing psychosexual behavioral
patterns to be more fully revealed, better understood and, therefore, more
effectively managed and changed. Client disclosures of potentially
incriminating information to mandated reporters can, however, lead to future
prosecution. Treatment providers inform clients, in writing, of this potential
dilemma and how it is addressed in their jurisdiction and program.
12) Polygraphy is not used as the sole
criterion for determining deviant sexual interests, estimating a client's risk
for engaging in sexually abusive behavior, recommending whether a client be
released to the community, or deciding whether a client has completed a
treatment program. Polygraph results are interpreted in conjunction with other
relevant information to make these decisions. Polygraph results should be one
of the many variables for treatment providers to utilize when changing a
client's status in treatment.