“You Have to Separate the Sinner From the Sin”: Clinician’s Approaches to Psychological Assessments With Men who Have Sexually Offended

Abstract

Men who have sexually offended are often referred for presentence psychological assessments to determine factors which contributed to offending, identify risk of recidivism, and develop treatment recommendations. The accuracy of assessments is largely reliant on the cooperation of the assessee. Despite the significant legal and emotional consequences, how clinicians approach these assessments, attempt to engage assessees, and overcome resistance have not been investigated. This research sought to develop an understanding of the clinicians’ experience of conducting the assessment. How clinicians approach interviews with men who have sexually offended and the techniques they use were explored. Six interviews were conducted with qualified psychologists, at a private practice, whose role included conducting psychological assessments across a range of forensic matters. The findings, reached using Interpretative Phenomenological Analysis, highlighted the relational/social nature of the interaction and the clinicians’ experience of a somewhat blurred line in practice between forensic assessments and therapeutic endeavours.

Keywords

Forensic Psychological Assessments Sex Offenders Interviews Interpretative Phenomenological Analysis

Introduction

Typically, persons charged with sexual offences undergo a risk assessment during their journey through the justice system, to formally ascertain his or her level of risk of reoffending (Craig & Beech, 2010). Forensic assessments, which in addition to identifying the individual’s risk of reoffending also outline risk factors specific and pertinent to the offence, have been found to increase the ability of predicting recidivism by approximately 20%–30% over chance (Murphy & McGrath, 2008). By outlining the personal and environmental factors of importance to concentrate on in supervision and rehabilitation (Harris & Hanson, 2010), these assessments are integral to effective treatment, reducing recidivism, and the protection of the community (Craig & Beech, 2010). Where assessments are carried out in the preliminary period to the individual’s appearance in court, the outcome of the assessment is employed as a consideration in sentencing (Zappala et al., 2018).

Empirically validated structured risk assessment tools are available for clinicians to employ in assessments. Clinicians can base their decision-making on these instruments, the predictive values of which exceeds clinical judgement alone (Dawes et al., 1989 cited in Shingler et al., 2018). These instruments consider static risk factors, such as the victim’s gender, and dynamic risk factors, such as deviant sexual interests (Beech et al., 2003). To score the individual on these instruments, the clinician must ask questions of an intimate nature in clinical interviews. The degree of openness and disclosure of personal detail required may be problematic as a result of the characteristics associated with this population.

Sex offenders typically evoke strong negative feelings in others (Kjelsberg & Loos, 2008) and experience a significant degree of social prejudice, exclusion, and vilification (Wakefield, 2006) as a result of the stigma attached to these crimes (Burchfield & Mingus, 2008). As a probable consequence, they have been found to be guarded, sensitive to judgement (Youssef, 2017), and more suspicious and cynical than other offenders (Phenix & Hoberman, 2015).

Accurate self-report by sexual offenders of their cognitions and problematic behaviours is essential for accurate risk assessments and for developing well-matched risk management plans (Gannon et al., 2008). Given that the accuracy of predictions for recidivism is dependent on the collection of sufficient information concerning predictors, the clinician must attempt to overcome any reluctance demonstrated by the assessee to discussing their offending behaviour and personal lives (Logan, 2013). The extent to which the objectives of the interviews in forensic psychological assessments (FPAs) are fulfilled may therefore be largely reliant on the clinician’s capacity to motivate assessees to cooperate and their ability to overcome any reluctance they have to disclosing information (Logan, 2013). Although research has not been conducted exploring how this may be accomplished in assessments, strategies have been identified in other areas of applied psychological practice.

Strategies suggested by Newman (1994) to be effective in reducing resistance in psychotherapy include empathising with the client and why they feel resistant. Empathy is proposed to help clients feel heard and safe and encourage them to share details of their offending behaviour (Miller & Rollnick, 2002). Development of an effective therapeutic relationship, reliant on fundamental elements of genuineness, empathy, and positive regard (Rogers & Truax, 1967), is considered vital to exploring the fundamental meaning of the resistance which is crucial for overcoming it (Manetta et al., 2011). In addition, clinicians in psychotherapy rely on a range of skills, including paraphrasing and summarising, which demonstrate to the client that they have been heard, help them feel understood, and encourage them to open up freely (Nelson-Jones, 2015).

The aforementioned roles of empathy, therapeutic skills, and the therapeutic alliance, in overcoming resistance have been similarly identified in the literature regarding psychotherapy with sex offenders (Sandhu & Rose, 2012). Men who have sexually offended have been identified as sensitive to a lack of empathy in clinicians (Beech & Mann, 2002) and have been found to emphasise the importance of clinicians being caring and understanding towards them (Youssef, 2017). It has been argued that the therapeutic alliance is more pertinent with this population than with other types of offenders (Beech & Mann, 2002; Youssef, 2017).

Although research from the general psychotherapy literature and literature on psychotherapy with sex offenders highlights the importance of therapeutic skills to improve engagement, reduce resistance, and develop an effective therapeutic relationship, the appropriateness of application in FPAs has been doubted as a result of the significant differences which exist between these clinical endeavours (Melton et al., 2017). These differences underly the argument that the duties associated with the therapist’s role and the clinician in a forensic assessment are inherently conflicting (Greenberg & Shuman, 1997).

Clinicians in forensic assessments are distinguished from the supporting and empathic therapist as objective, neutral professionals (Greenberg & Shuman, 1997). Rather than serving a supportive, therapeutic role their task is described as the dispassionate assessment of forensic issues (Greenberg & Shuman, 1997). As a result, the approach of the clinician and the nature of the relationship are suggested to be in sharp contrast to that normally found between psychologists and clients (Connell, 2015 cited in Jackson & Roesch, 2015). Whereas psychologists in therapeutically oriented assessments prioritise the maintenance of therapeutic relationships, it is argued that such relationships do not exist in forensic assessments between the clinician and the individual being assessed as he or she is not the clinician’s client, this position is occupied by the referral agent (Monahan, 1980).

Despite the suggestion that people are most likely to take risks admitting to undesirable acts if they are assured that support will continue (Marshall, 1994), and that the therapeutic relationship has been suggested to be central to all work with offenders (Ward & Stewart, 2003), the use of therapeutic relationship building skills and techniques have been discouraged in forensic assessments (Shuman, 1993). Such skills, which refer to manners of relating to another with the intention of providing therapeutic support, may convey to the individual being assessed the existence of an alliance which is argued to be beyond the reach of clinicians in this work (Shuman, 1993). Development of such an alliance is considered unethical in forensic assessments as confidentiality does not exist between the parties and a therapeutic approach may mislead the assessee into thinking that it does (Shuman, 1993). The therapeutic relationship results from the use of a well-developed empathic skill, the implementation of which supports the recipient of the empathy to feel that he or she is not alone (Keefe, 1980).

Therapeutic support, requiring the use of empathy, has been found highly beneficial in nonforensic contexts for promoting self-disclosures (Dawson et al., 1984). Although it has been suggested that the gathering of accurate information during forensic assessments in terms of quantity and quality may be assisted by empathic questioning (Melton et al., 2017), the appropriateness of its use is debated in forensic assessments (Vera et al., 2019). The use of empathy in this context has been cautioned by some authors as, in addition to impacting upon the clinician’s objectivity, empathy in forensic assessments has been suggested to be unethical (Shuman & Zervopoulos, 2010). Employing empathic techniques in clinical interviews is argued to lower the assessee’s defences and may promote the disclosure of crimes which are unprotected in the assessment and damage the assessee legally (American Psychiatric Association, 1984 cited in Greenberg & Shuman, 1997). Although initial and later refreshed warnings of confidentiality limits can be provided to protect the individual, Shuman (1993) insisted that “an embellished warning is not enough in that empathetic techniques are intended to break down resistance and to encourage self-disclosure without censorship” (pp. 293–294).

In addition, it is argued to be unequivocally inappropriate to demonstrate awareness of how the assessee feels or thinks as openly reflecting or restating the cognitive or affective experience of the assessee implies the existence of a therapeutic relation (Shuman, 1993). Other authors, however, have argued that such awareness is a desirable social skill which represents emotional intelligence and humanises the clinician to the individual being assessed (Brodsky & Wilson, 2013). Rather than empathic behaviours acting as potential tools for manipulation or seduction, Brodsky and Wilson (2013) outlined that an empathic clinician, who can take another’s perspective, may be a more ethical clinician. It has been argued elsewhere that where the clinician makes serious effort to correct erroneous preconceptions of the individual being assessed, he or she shouldn’t be precluded from utilising compassion and understanding in their approach in recognition of the potential for the use of empathy to be necessary for obtaining information required for the assessment (Melton et al., 2017). In such circumstances, empathy is considered not to be coercive, deceptive, or “unfair” as previously suggested (Melton et al., 2017). Although these issues have been discussed as matters of personal opinion, the perspectives of practicing clinicians’ have yet to be explored (Brodsky & Wilson, 2013).

Research on psychotherapy with offenders has identified that the clinician’s approach and nature of the relationship with the client are vital to the outcome (Marshall & Burton, 2010). Empathy and warmth were among the features of a clinician’s style highlighted as accounting for between 30% and 60% of the variance in treatment beneficial effects among sex offenders (Marshall, 2005; Marshall et al., 2002). Given the importance of the style, attitudes, and relational approach of clinicians towards their clients in psychotherapy (Ward & Maruna, 2007), research focusing on clinicians’ approaches in FPAs may provide useful information on engaging assessees in this process and ensuring accurate assessments of risk.

The Current Study

As a result of the reliance in court on psychological evidence, the findings of FPAs can influence the outcome of the case, the individual involved, and the society at large (Zappala et al., 2018). Accurately assessing the risk of reoffending in men who have sexually offended is central to their effective management (Westwood et al., 2011). The need to be precise in formulating offending, identifying risk, and developing treatment recommendations in assessments is therefore paramount for rehabilitation and public safety.

Despite the significant legal and emotional consequences of FPAs, there is a dearth of research on this topic. How clinicians approach these assessments and the extent to which they employ therapeutic skills, or are actively empathic, is not known at present. In recognition of the significant consequences of FPAs necessitating this topic to be empirically studied, the current study proposes to address the gap in the literature by exploring practicing clinicians’ experiences and perceptions.

Method

Research Design and Analysis

Semi-structured interviews with qualified psychologists employed by a forensic psychology service in the Republic of Ireland were used to gather data, later analysed using Interpretative Phenomenological Analysis (IPA) methods.

The clinicians’ role comprised of conducting FPAs across a range of offending behaviours. Within this, their remit was to administer psychological tests, collect collateral information where possible, gather information in clinical interviews with the referred individual to inform formulations, and allow them to score the individual on a selected risk measure. Ethical approval was sought, and received, from a U.K. Russell Group University Research Ethics Committee.

The primary focus of this study was to explore FPAs of men who have sexually offended from the perspectives of clinicians. The aim was to understand a specific phenomenon in the lives of the participants. Given that research questions should govern methodological approach (Corbin & Strauss, 2008), and that qualitative research allows for detailed exploration of the experiences of individuals (Hennink et al., 2010), a qualitative approach focusing on how individuals interpret and attribute meaning to their experiences was considered fitting. The emphasis of IPA on the importance of the individual’s account (Pringle et al., 2011) and focus on how a given person makes sense of the phenomenon in a given context (Flowers et al., 2009) rendered it an appropriate form of analysis for this study which aimed to seek in-depth information regarding clinicians’ perceptions.

The methodology was motivated by principles of social constructionism. This social constructionist epistemological stance understood that everyone brings their own experience and expertise to the research encounter and knowledge is not something which is possessed but something that is constructed (Losantos et al., 2016). The technique of “not knowing” was applied in data collection where the questions asked by the researcher were born from the participant’s answers (Losantos et al., 2016). It was envisaged that this kind of conversational questioning would balance the power dynamic between the researcher and the participants (Losantos et al., 2016) and render it a process of joint construction.

Participants

Consistent with IPA guidelines, sampling was purposive whereby selection criteria were based on relevance to the research question (Back et al., 2011). Sampling involved selecting a sample of individuals who could provide accounts of their perspectives and experiences of the topic of interest (Smith & Osborn, 2008). A homogeneous sample was sought of qualified psychologists employed at the service with a minimum of 6 months experience conducting FPAs with men who have sexually offended. Clinicians were invited to participate via email. For the purposes of this study, and consistent with the terms of the service, an FPA was defined as including a risk assessment thereby differentiating it from a psychological assessment.

Six female, Caucasian psychologists were interviewed between June and December 2018. See Table 1 for participants’ demographic data. All participants currently provide, or have in previous employment, provided therapy.

Table 1.

Participants’ Demographic Data.

Participant (N = 6)	M_age = 40.5 (years)	Years’ experience conducting FPAs of men who have sexually offended (M = 9.83)	Training route
Anne	49	6	Counselling
Bridget	32	2	Counselling
Clare	31	4	Counselling
Danielle	45	16	Counselling
Edel	49	20	Clinical
Fran	37	11	Forensic

Note. FPAs = forensic psychological assessments.

Data Collection

Semi-structured interviews were conducted with the aim of exploring the clinicians’ experience of conducting interviews in FPAs with men who have sexually offended.

An interview schedule was not developed as the technique of “not knowing” was applied in data collection. Instead, topics of interest were generated prior to data collection through discussions in supervision. There was a flexibility in the interviews and while the topics of interest were explored with each participant, the time spent exploring each area varied according to the participants’ individual contributions.

Interviews commenced with a deliberately broad and open-ended question. The participants’ response guided the direction of the interview and following questions were more focused and accompanied by prompts and clarifications where necessary.

The duration of interviews ranged from 30 to 45 min. Participants were previously known to the interviewer in a professional capacity which served to reduce the need to build rapport as the participants presented at ease on arrival. Interviews were recorded using a Dictaphone and during transcription, identifying information was removed and participants were given a unique code.

Process of Analysis

Data analysis followed IPA principles described by Flowers et al. (2009). The analytic process consisted of familiarisation with the data and noting observations, comments, and reflections in the left margin. Transcripts were re-read, and the recording listened to, to gather new insights, facilitate immersion in the data, and allow recall of the interview atmosphere (Pietkiewicz & Smith, 2014). During the note-making stage, personal reflexivity was considered and, in line with the approach outlined by Flowers et al. (2009), descriptive, linguistic, and conceptual comments were made. Transformation of notes into themes titles occurred in the right margin whereby concise phrases were developed from the initial notes to capture the essential quality of the information in the text. Connections were sought between themes and a list of superordinate themes and subordinate themes were compiled for each transcript.

Consistent with the idiographic commitment of IPA (Smith et al., 1995), each transcript was examined with an equally attentive exploration. Themes generated in the analysis, and demonstrated in a final table, were compared, contrasted, and exemplified with individual narratives. The themes identified in the final table (see Table 2 below) provided a persuasive account describing the perspectives of the participants. These themes were described, illustrated with extracts from the participants’ transcripts, and analysed in relation to existing theory. The findings therefore not only include interpretative commentary linking the themes to theory but also the participants’ own account of their experiences using their own words thereby retaining the voice of their personal experience and presenting the emic perspective.

Table 2.

Superordinate and Corresponding Subordinate Themes.

Superordinate themes	Subordinate themes
The interview is a social interaction	You need to “engage with them as you would any other person.” You must “connect with him in a way that makes it easy for him to tell us his life story.”
Therapeutic components blur the “clear line” between therapy and assessments	Reminding the “therapist in you” that this “is an assessment, so the aim is not to provide therapy here” but “the contact that I have with them might help.”
The power imbalance	Taking the lead.

Discussing observations made during the analytic process, themes, connections identified and the preliminary results with the co-authors and qualified psychologists in three group sessions served to ensure personal biases did not affect analysis, check decision-making, and refine findings.

Findings and Discussion

The aim of this research was to explore clinicians’ experiences of conducting interviews in FPAs with men who have sexually offended. Three superordinate themes were identified across all interviews (see Table 2).

The Interview is a Social Interaction

Throughout the interviews, participants referred to the relational nature of the interaction. They recognised the impact they have on the assessee and the influential nature of their approach on the assessment. Anne outlined that you need to “Give them a sense of that you that they are in safe hands” and explained “you have to make these people feel at ease to tell you this really personal stuff.” The nature of interactions between clinicians and subjects of assessments has previously been identified as exerting influence on the extent to which the objectives of the assessment interview are fulfilled (Shingler et al., 2018). Within this superordinate theme pertaining to the power of the interaction, and particularly the relationship, between the assessee and the clinician, two subordinate themes were identified.

You need to “engage with them as you would any other person”

This subordinate theme refers to the power of humanisation. Participants understood that because of the nature of offending this population is often vilified and seen in complete terms of their behaviour. They considered that it can be a powerful experience for the assessee to feel respect and humanisation. The participants did not suggest going above or beyond in this regard, rather they referred to treating the assessee as they would any other person and as Edel outlined engaging “as one human to another.” This approach is consistent with previous research which described how psychologists endeavoured to treat inmates being assessed as they would a fellow professional or acquaintance (Shingler et al., 2018). The clinicians recognised the importance of recognising assessees as human beings and that to do so, and treat them like any other person, it was imperative that they look beyond the individual’s behaviour. Danielle explained,

first and foremost maybe you need to be able to separate the behaviour from the person. I think if you can do that than the rest follows, if you can do that you are going to have empathy for them.

This is an important aspect of the clinician’s approach due to several characteristics associated with this population. Research suggests that men who have sexually offended are sensitive to judgement and are unlikely to make disclosures unless they feel they will be accepted regardless of their offending behaviour (Youssef, 2017). As such this practice is likely beneficial in that the clinicians ensure that they do not judge the assessee rather they separate them from their behaviour and see the person as a human being. It is important, however, to consider how such treatment may impact upon the assessee given concerns voiced in the literature concerning the potential for assessees to be enticed in assessments. Where assessees have experienced stigmatisation, vilification, and potentially brusque encounters with criminal justice agency staff, such respectful treatment and humanisation may be disarming and may render assessees vulnerable to misperceptions of the role of the clinician. Exploring assessee’s experiences will shed light on how their disclosures and engagement are impacted by such humane and respectful treatment.

You must “connect with him in a way that makes it easy for him to tell us his life story”

This subordinate theme built on the clinicians’ awareness of how they interact influences the assessee and referred to their attempts to ensure the assessees feels safe to share.

Clinicians’ recognised the importance of an engaging interpersonal style and using interpersonal skills to engage the assessee in the interview. Edel referred to “very basic stuff um you know engaging in small talk um you know did you get here ok were you able to find the place, would you like a cup of tea you know checking very basic human things.” It will be important to explore these attempts to engage and the use of interpersonal skills with assesses as previous research suggests that warmth, sociability, and other attributes required for rapport building may not necessarily be viewed positively by recipients (Landy et al., 2016). In the absence of honesty and compassion, these efforts may be regarded as purely strategic (Shingler et al., 2018).

Clinicians emphasised the importance of their approach encompassing the Rogerian core conditions. Clare explained that “I’m trying to make them you know feel comfortable and like as part of that you do have to bring in those Rogerian qualities.” In addition to being empathic, congruent, and nonjudgemental (Rogers & Truax, 1967), participants posited therapeutic skills as necessary to facilitate engagement. Anne outlined the importance of “empathising about the fact that they are distressed or empathising with you know like that sounds like a very difficult childhood, um paraphrasing to help them move through that distress.” She explained the consequences of not using these skills “if we don’t there is a sense that they could shut up, they can close down.” Although it has been suggested elsewhere that the use of empathy may be misleading (Shuman, 1993), consistent with Melton et al.’s (2017) position Clare explained that this was not an attempt to be deceptive rather “that’s me being genuine” but also that it positively impacts on information gathering “that’s how you get the person to relax and to tell you more information and to open up and explore it a bit more.”

In addition to using interpersonal and therapeutic skills to support assessees to share openly, clinicians emphasised the need to develop a therapeutic relationship with the assessee describing this connection as the cornerstone of a thorough FPA. Edel explained that “the value of the relationship in the assessment is really important and I suppose it is the bedrock really for um the outcome of the assessment.” This emphasis on the human connection, which clinicians felt “can’t be underestimated,” has been discussed in the literature in terms of its importance in cultivating productive working relationships (Blagden et al., 2016). It is consistent with the Good Lives Model (GLM) which posits the therapeutic alliance and working in a respectful and empathic manner as crucial to assessment with offenders and important for motivating engagement (Ward & Stewart, 2003). Bridget explained the importance of the therapeutic relationship in terms of “creating that space where someone feels comfortable enough to talk about the most shameful aspects of their life but also the most abusive or victimisations that they have experienced.” Indeed, the clinicians’ considered that the assessment would be negatively influenced by the lack of a relationship. Danielle outlined that “if you don’t have that therapeutic alliance, I think you are just going to hit a barrier and I think you are just going to get factual detail.” Fran cautioned that without this relationship “they are probably not going to trust you as much and may not confide in you as much as they would otherwise.” The centrality of the relationship to the assessment was demonstrated in their assertion that a comprehensive assessment was not possible in its absence as they would only receive factual information from the assessee, the assessment would lack depth and their formulation would suffer. Indeed, the relationship has been recognised in existing psychological literature as imperative to change (Edwards & Loeb, 2011), vital in therapy (Knox, 2008), and important in assessment feedback (Finn & Tonsager, 1992). Although participants were aware of the potential dangers of this relationship, they considered that being open and transparent about limitations offered sufficient protection to the assessee.

This finding that practicing clinicians support the development of a therapeutic relationship in forensic assessments refutes the arguments in the literature that such a relationship is inappropriate in this context. It raises concerns, however, concerning how this practice impacts upon assessees. Exploring the potential for them to confuse the limits of confidentiality and make damaging self-disclosures, particularly those who have experienced a therapeutic relationship previously in interventions, will allow greater consideration of the impact on the individual being assessed. Furthermore, it will be important to consider the potential for assessees to feel vulnerable following their disclosure of sensitive information in a context where they cannot be supported due to the short-term nature of the relationship.

For the clinicians, this practice while beneficial in terms of supporting the development of trust with the assessee may prove challenging as they attempt to balance their professional responsibilities, duties, and boundaries while also connecting with the assessee in a manner which enables them to share their story and develop a working relationship with them. Shingler et al. (2018) spoke of the balance which must be struck by psychologists in forensic assessments whereby they attempt to adopt an interpersonal style which is not overly formal, as this has been previously noted as problematic resulting in offenders feeling suspicious and withdrawing, which is engaging yet does not compromise their professional integrity, judgement, or the assessee’s best interests. Although the clinician’s placed value on the relationship with the assessee, it raises questions concerning the impact on the assessee and likely poses challenges for the clinicians themselves as they attempt to maintain appropriate professional boundaries yet engage with the assessees as human beings, support them to feel safe to share yet not mislead into sharing information. Having identified the clinician’s perspectives, it will be important to explore this practice with assessees and determine whether they concur from their experience that the benefits of the relationship outweigh the potential risks.

The clinician’s recognition of the importance of empathy in the interview adds to a debate in the literature on the appropriateness of empathy in forensic assessments. Although empathising with individuals is intended to help them feel understood, use of empathy in forensic assessments has been argued to be harmful to individuals as it may lower their defences and lead to damaging self-disclosures (Shuman, 1993). It has been recognised that empathic techniques can be used to protect assesses from harm in assessment interviews, however, research suggests that clinicians may not be able to accurately distinguish between inappropriate use of empathy to gain information and empathy to protect the assessee (Shuman & Zervopoulos, 2010). However, given that research has found this population to appreciate clinicians being understanding, respectful, and caring towards them (Youssef, 2017) and to be sensitive to a lack of empathy in clinicians (Beech & Mann, 2002) an accurate assessment may arguably be reliant on an empathic approach. Indeed, empathy is suggested to provide the basis for individuals to be heard and understood which is anticipated to result in them being more likely to honestly share their experiences (Marshall et al., 2002). As such a problem arises, the use of empathy in FPAs may result in damaging self-disclosures by an assessee but the absence of it may result in a superficial and inaccurate assessment. It will be important to explore the emphasis placed by clinicians on the importance of using empathy in the interview with assessees.

The recognition within this theme of the need to approach the assessment with empathy, prepared to use therapeutic skills and with the intention of building a therapeutic relationship with the assessee contradicts the suggestions of previous authors (e.g., Shuman, 1993) that the differences between therapy and assessments necessitate a different approach. This may be best understood within the following superordinate theme which considers how the distinctions in the literature drawn between these tasks are not so clear in practice.

Therapeutic Components Blur the “Clear Line” Between Therapy and Assessments

The role and approach of the clinician in forensic assessments is differentiated in the literature from that of the clinician in therapy (Greenberg & Shuman, 1997). This superordinate theme and the underlying subordinate themes captured the overlap which exists in practice in differentiating between these tasks.

Reminding the “therapist in you” that this “is an assessment, so the aim is not to provide therapy here” but “the contact that I have with them might help”

It was clear from the clinicians’ report that they identified the inherent differences between assessment and intervention work. Participants referred to differences in purpose, for example, Fran outlined that “you are not really trying to achieve any change through the assessment,” role and time allowances, for example, Edel explained that

you do have less time and so um yeah that means that there obviously there are certain areas that while you the clinician or the therapist in you would like to explore you can’t um but yeah it is really it’s an issue of not being in that role and not having that that time.

Clare differentiated between her approach which is “more information focused for assessment and more process focused I suppose for therapy.” Although clinicians differentiated between the tasks, the “clear line” originally identified became less distinct as the topic was explored further. Consistent with the social constructionist conceptualisation of knowledge, the clinicians appeared to construct an understanding of this topic as they reflected on their experiences and arguments. This process of trying to develop their understanding resulted in recognition across all interviews that the distinction between assessments and therapeutic interventions was not so clear in practice and that there is a therapeutic nature to the interaction in the interview. Danielle alluded to this by outlining that “yes it is about an assessment it’s about an end product but it’s about more than that as well.” The assessment was seen as having “quite a powerful and obviously a therapeutic component” wherein it provides assessees with an opportunity for “gaining insight” and “for catharsis as well so getting to express some emotions.” Rather than simply assessing risk, the clinicians recognised that the assessment can provide a space for an assessee to talk about “victimisations that they have experienced that they may never have spoken about in fact some people recall abuse during the um or say that they have never spoken about abuse they have experienced ever before.”

Participants recognised the therapeutic potential of assessments in that they can bring about change in assessees whereby they take responsibility for their offending behaviour and in doing so may even admit to further offences. Clare explained

I had an assessee who disclosed another offence to me but he was aware that I would have to report it but he kind of said like in going through this assessment and looking at my history and what I have done meant affecting that more and I just want to come clean about this thing.

The clinicians recognised that their interaction may influence the assessee’s future engagement with psychological services. Bridget explained

I think that’s really important for them going forward and even in terms of down the line if they want to engage in treatment or therapy or whatever that they’ve have had that initial first therapeutic experience in an assessment.

Anne agreed

I think it opens them up to seeing that the therapeutic process may not be so threatening so if you are making recommendations for ongoing therapy afterwards that they may have a sense that opening up hasn’t been so bad.

This is consistent with the assertion by Proulx et al. (2000) that risk assessment interviews are an opportunity to promote offender’s cooperation with risk management, and engagement in either current or future intervention.

Clinicians identified that whether the referral is for assessment or therapy, they use the same skills. Danielle reported “it’s definitely the same the same set of skills,” she elaborated

I am me and I think the skill set that I have is kind of one skill set maybe so no I haven’t I’d use the same skill, I think I really do because even when I am sitting with a therapy client I’d be formulating in the same way.

Although differences were acknowledged between therapy and the relationship “which wouldn’t be as deep because um yup it never gets to develop to that point,” how the clinicians thought they interacted was the same. Despite suggestions in the literature that clinicians should adopt a supportive approach when acting in care provision roles and a detached approach in forensic assessments (Greenberg & Shuman, 1997), Danielle disagreed suggesting that “how you are as a psychologist I hope isn’t any different in terms of how you would respond or react.”

Given the characteristics associated with men who have sexually offended and resultant suggestions for clinician approaches in treatment, it is arguably of importance that clinicians do maintain the same warm, engaging, and supportive approach in assessment. To change to a more formal, detached approach in assessments would likely result in assesses withdrawing or not feeling comfortable to share resulting in an assessment which lacks detail and depth. It is unclear how feasible adopting such an approach would be for clinicians as a result of their training and personal biases. Indeed, Greenberg and Shuman (1997) suggested that psychologists, by virtue of their work in the caring professions, may find it difficult to close off empathically to the assessee’s needs and vulnerabilities. This may impact upon their experience of overlaps and also on how disclosures made by the assessees are interpreted, for example, where an assessment is considered to have therapeutic value disclosures of further crimes by the assessee may not be recognised as a mistake but as development and taking responsibility.

This overlap highlighted between assessment and intervention raises important considerations for assessees. If clinicians experience overlaps between these types of referrals in practice, it is important to explore if assesses do also and if this impacts on their engagement and disclosures. Should assessees also recognise the therapeutic value of the assessment, this may have important implications for their rehabilitation as they may be more inclined following a positive experience to engage in future treatment than if they had experienced a distant and formal assessment with a clinician focused solely on scoring a risk assessment measure.

The Power Imbalance

The final theme pertains to the power imbalance between the clinician and the assessee. Clinicians described deciding what is discussed and when in the assessment interviews.

The clinician taking the lead

It was clear from the participants’ responses that they were in a position of power and exercised control in the assessment. Bridget explained “you are taking the lead so it’s much more directive in a sense you are guiding the way it goes.” This control is consistent with the need described by Logan (2013) for clinicians to have a clear purpose and direction, remaining imperceptibly in control of the interview. Clinicians recognised how their skills, approach, and power in the session could disarm the assessee and they appeared to engage in practice to try to rebalance this power. It appeared important to clinician that assesses made informed choices about their disclosures.

Participants demonstrated attempts to ensure assessees were fully informed of the assessment process. Danielle reported that “the first meeting for me is about my information sharing, what the assessment is about, what they can expect, the information I am going to be asking them about” she elaborated “I set my store all out for them so they know when they are coming in here what to expect.” Their sharing of information may be considered to be demonstration of their awareness of the assessee’s needs as human beings for clarity (Shingler et al., 2018). Clinicians recognised the importance of reiterating the limits of confidentiality in the interview to ensure that assessees make informed decisions about their disclosures and that they were afforded choices to the greatest extent possible. Edel explained that “you need to let them know so they can then make that choice.” Their attempts to do so echoed the importance of engaging assessees collaboratively in the assessment, which has been identified by previous research as allowing assessees to have as much choice as possible in the circumstances (Shingler et al., 2018). This practice of reminding the assessees of the limits of confidentiality represents the clinicians’ recognition of the power they hold in the interview to elicit disclosures (Kvale, 2006) from the assessees which may not be of benefit to them. Navigating challenging power differences has been previously identified as of crucial importance in risk assessment interviews and an aspect which has been linked to the development of a human connection (Lewis, 2016).

Despite recent research emphasising the importance of collaborative risk assessment, the clinician’s demonstrated considerable power and control in the assessment. Given that assessees in forensic assessments are often coerced into engaging (Heilbrun et al., 2014), it will be important to consider how assessees experience this imbalance. Offenders in prison have reported feeling more free to participate in interviews where they are conducted on an equal footing (Shepherd, 1991) which may be something to consider further as there is the potential for assessments to feel like something done to assessees. A more collaborative assessment, however, may be challenging for clinicians to conduct where time restraints exist and there are particular topics necessary to cover to score the risk assessment measure necessitating a focus on information gathering.

Limitations and Future Research

The findings of this study are limited by the gender-biased sample. All the participants were female, as such it is not possible to comment on the extent to which the results are generalisable to male psychologists. Furthermore, psychologists who completed a counselling psychology training route were overrepresented in the sample. Counselling psychology aligns itself with humanistic theory (Mearns et al., 2013), in particular person-centred theory (Rogers, 1951), which may have influenced the findings. However, given the lack of a forensic psychology training route in Ireland, these findings are relevant and informative as many psychologists from clinical and counselling psychology training routes work in forensic settings. Finally, the findings may be limited as a result of the voluntary nature of participation (Shingler et al., 2018). It is possible that clinicians who volunteered to take part had positive experiences of conducting FPAs with men who had sexually offended. As such it is unclear whether their attitudes are representative of the wider population of clinicians engaging in this work.

Despite these limitations, the findings of this study nonetheless represent a starting point in understanding an area of clinical practice in forensic psychology which has been under researched. Further research is necessitated taking these limitations into consideration and exploring the extent to which the current findings can be applied to a wider population of clinicians both in community and secure settings with male and female psychologists.

Conclusion

This study researched the experience of six clinicians in conducting FPAs of men who have sexually offended. Themes identified in this study emphasise the importance of the therapeutic relationship with offenders, humanisation, and the therapeutic potential of assessment work. The findings, which were discussed in relation to similarities with previous research and ethical implications, highlight the relational/social nature of the interaction. The idea of FPAs being therapeutic and more than just an assessment of risk is a theme which arose in this study. Although discussion on this topic has referred to the differences between forensic assessments and therapy, this research highlighted that in the clinician’s experiences these theoretical differences become somewhat less clear in practice. The IPA methodology enabled a thorough exploration of how their understanding of the somewhat blurred line between assessments and therapy impacts upon the role and approach of the clinician in interviews. The potential implications for assessees of this finding were considered and how an alternative approach could impact on the accuracy of the assessment as a result of the characteristics associated with this population. In terms of implications for practice, this research has highlighted the complexities involved in conducting presentence FPAs, awareness of which may influence more conscientious and ethical practice. This study has addressed an area of forensic practice which has rarely been explored in research and this will be investigated further in an on-going study exploring these findings with, and the experiences of, individuals who have undergone psychological assessments following their engagement in sexual offending behaviour.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Gemma Chawke

Simon C. Duff

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