ATSA Forum

Vol. XXIX, No. 3
Summer 2017

Editor's Note

by Heather Moulden, Forum Editor

Welcome to the summer 2017 issue of the Forum. Here is your perfect summer reading for by the beach or at the cottage. As usual you will find columns from our students, committee updates, and the FAQ piece addressing the question, “Is pornography use safe for those convicted of a sexual offence?” Of course, this is all in addition to our featured articles on relevant research applications and practical clinical tools for those working with both adults and youth.

This issue features a follow-up to an article on prosocial reasoning you read in our Spring issue. In the previous piece Norbert Ralph made the argument that prosocial reasoning is an important consideration when working with adolescents who have sexually offended. In this article he delves into treatment to enhance prosocial reasoning as a stand-alone intervention or as a positive byproduct of other tried and true treatments.

In our next feature, Chantal Hermann considers how evaluation of sexual aggression has long been discussed as an important component of the decision to commit sexual violence. Despite various conceptualizations, the cognitive processes underlying sexual offending continue to present new questions. The author reviews her work on explicit and implicit evaluations of sexual aggression as a potential predictor of future sexual offending behaviour with some interesting results and more new questions.

Finally, we know that effective risk management is dependent upon sound risk assessment and comprehensive risk formulation. In his article, Sébastien Prat discusses his research in France that aimed to explore the trajectories of individuals convicted for child pornography offences. Specifically, he considers various typologies proposed, and his own interest in predicting outcomes for this group, given the challenges with anticipating specific risk outcomes, such as escalation in offending from hands-off or online offences to hands-on offences. In this article he makes the case for risk assessment within clinical risk formulation so as to improve the management of this group.

From his award winning research, Franklyn Graham, shares with us his doctoral thesis work on hypersexuality and psychopathy. His work points to some interesting neurobiological deficits that show promise as markers in the assessment and potential points of intervention for those at highest risk.

Our ATSA committees are busy as ever and included some updates for members in this issue. The Membership committee would like to remind you to nominate eligible colleagues for the ATSA Fellow designation. You will find the criteria and nomination process in this issue for the September 1, 2017 deadline. Also, the International committee provides an update on changes to the committee and its membership.

I hope you enjoy this issue of the Forum. As always, I look forward to reading your articles and I am happy to work with you on developing ideas for a Forum piece. 

Enjoy your summer.

Heather M. Moulden
ATSA Forum Editor


President's Message

by Michael Miner, ATSA President 2016-2017

Well, summer has come to the Upper Midwest, with temperatures here in Minneapolis forecast to approach 90 degrees Fahrenheit.  There is something ironic about that, given decisions made here in the United States over the last couple of days.  The last few months have been a busy time for ATSA and the Board.  We had our Spring Board meeting in early May in Kansas City, the site of October’s Annual Meeting.  I hope that all of you are able to attend.  Along with a great program taking shape, Kansas City is home to amazing barbeque and is known for its music scene. 

One of the major accomplishments since my last column is the release of the Practice Guidelines for Assessment, Treatment, and Intervention with Adolescents Who Have Engaged in Sexually Abusive Behavior.  They are currently available on the ATSA webpage and are a must read for anyone who works with adolescents.   I discussed some of the changes and controversies in these guidelines in my last column, where I also acknowledged members of the committee who drafted these guidelines.  It is exciting to finally have them available.  Promulgation of new guidelines and adoption of innovations and changes are complex processes that impact multiple systems, especially in our field with the inter-related and interactive involvement of courts, criminal justice agencies, corrections, and mental health professionals.  We have learned a lot about adolescent males who have engaged in sexually abusive behavior over the last 10 to 15 years.  We know less about females and special populations.  These guidelines are meant to provide treatment professionals with processes and procedures which are empirically informed and/or validated.  As our field advances, changes in such processes and procedures are inevitable, and we are challenged to change our practices to accommodate these changes.

Our collaboration with GIFR on the ATSA Master Classes continues, with a large array of classes currently available.  This collaboration is allowing us to meet our obligation to members by providing education and training besides our annual meeting.  It also provides ATSA with another funding stream, helping us to become less reliant on income from the annual meeting and membership dues.  Concerns have been expressed regarding the impact of these classes on Chapter meetings, as well as on our Annual Meeting.  This is something the Board has been aware of and concerned about from the start of this collaboration, and we will monitor it moving forward.  However, it is important that ATSA keep up with the evolving education and training environment, and have an on-line training presence.

The other major decision made by the Board in May was to accept the recommendation of our journal’s Editor-in-Chief, Michael Seto, and change the name of our journal from Sexual Abuse: A Journal of Research and Treatment to Sexual Abuse.  Dropping the tag line brings the journal title more in line with its broader mission, to expand content to include public policy, prevention, and victim advocacy.  This expanded content is obvious from reading the journal and is a tribute to Michael Seto and to the leadership of the previous Editor-in-Chief, James Cantor, as well as the Associate Editors and the Editorial Board.  You probably won’t see much evidence of the name change for a while.

I informed you in an earlier column of a grant that ATSA received from the United State Department of Justice, SMART Office.  You’ll recall that ATSA received funding to implement treatment guidelines and to evaluate the impact of such guidelines.  Unfortunately, we have decided to decline the funds from the SMART Office.  This decision was due to an impasse between ATSA and the Justice Department regarding limitations on consultant daily fees.     

Finally, for those members in the United States.  I was made aware this morning, that the US House of Representatives passed a bill that would change the Federal laws regarding production of child pornography to include behaviors that would capture children who engage in sexting behavior and would impose a minimum required sentence of 15 years in prison for such behavior.  Called the “Protecting Against Child Exploitation Act of 2017”, this bill is another overreach by the United States and fails to consider what is normal adolescent behavior and how a reasonable adult should respond to the risky, and sometimes harmful, behavior of children.  I would encourage all of my US colleagues to contact their Senators and implore them to oppose the “Protecting against Child Exploitation Act of 2017” because it protects no one and abuses the very children it claims to want to protect.

Thanks to you all for being members of ATSA.  I hope you have a great summer, and I look forward to seeing many of you in Kansas City this fall.

Michael Miner


Is pornography use safe for those convicted of a sexual offence?

Drew A. Kingston, Ph.D., C.Psych
Royal Ottawa Health Care Group and University of Ottawa

There continues to be ongoing debate about the effects of pornography on sexual aggression and evidence for or against such a link is important for the assessment and treatment of individuals who have committed a sexual offense.

Although methodological approaches  to studying pornography’s putative effects differ, a number of studies and meta-analytic reviews conducted with community participants and sexual offenders have shown a small yet consistent relationship between pornography consumption, particularly violent pornography, and inappropriate attitudes (Allen, Emmers, Gebhardt, & Giery, 1995) and aggressive behavior (Kingston, Fedoroff, Firestone, Curry, & Bradford, 2008). Such effects have been demonstrated both experimentally and in more naturalistic settings.     

Despite the observed association between pornography consumption and negative attitudes/beliefs and aggressive behavior, there are clearly many individuals who view pornography and do not exhibit particularly problematic beliefs or commit acts of violence. In fact, some research has shown positive outcomes after viewing pornography, such as an increased satisfaction with sexual interactions in addition to other self-perceived positive effects (see Hald & Malamuth, 2008).

As such, it has been suggested that the negative effects of pornography consumption are critically dependent upon a complex interaction with particular individual and cultural differences. These potentially relevant factors include cultural, home, and peer environments, as well as stable personality characteristics (e.g., impersonal sexual orientation, psychopathy) and transient emotional states (e.g., feelings of rejection). In other words, pornography use is more likely to exert a negative impact among those who already exhibit a constellation of problematic characteristics. In an earlier study, my colleagues and I (Kingston et al., 2008) tested this hypothesis and showed that frequent pornography use contributed to the prediction of violent (including sexual) recidivism in a mixed sample of participants who were convicted of sexual aggression; however, this relationship was particularly evident among individuals who were deemed to be a higher risk to re-offend, whereas there was little association between pornography and recidivism among lower risk individuals. Although beyond the scope of this FAQ, my colleagues and I (see Kingston, Malamuth, Fedoroff, & Marshall, 2009) presented a number of plausible theoretical explanations for these effects which were essentially formulated around information-processing models and the specific activation of cognitive constructs resulting from exposure to pornography.

The notion that pornography can have a negative effect at least for some individuals has important implications. For example, valid assessment of pornography use is important as is the conceptualization of whether or not pornography use is a relevant criminogenic need for that individual. Another important issue pertains to the availability of sexually explicit material to individuals while incarcerated.  Some have suggested that allowing individuals to obtain pornography while incarcerated contradicts core issues addressed in treatment and therefore should be completely banned within correctional settings. Contrary to this position, however, is that a total restriction on pornography within correctional settings facilitates an artificial and unrealistic environment. Indeed, most of our clients are released at some point and it follows that restricting access to legal pornography may be counterintuitive, such that individuals might experience an increased desire to obtain the previously restricted material.  A more appropriate solution would perhaps be to allow similar opportunities in the institution as exist in society and to embed educational information and relevant therapeutic interventions pertaining to pornography’s effects in a treatment program. The impact of such material, especially for individuals with a predisposition for subsequent sexual aggression, can then be fully addressed in a therapeutic environment. 

Allen, M., Emmers, T., Gebhardt, L., & Giery, M. A. (1995).  Exposure to pornography and acceptance of rape myths. Journal of Communications, 45, 5-26.

Hald, G. M., & Malamuth, N. M. (2008). Self-perceived effects of pornography consumption. Archives of Sexual Behavior, 37, 614-625

Kingston, D. A., Fedoroff, P., Firestone, P., Curry, S., & Bradford, J. M. (2008).  Pornography use and sexual aggression: The impact of frequency and type of pornography use on recidivism among sexual offenders. Aggressive Behavior, 34, 341-351.

Kingston, D. A., Malamuth, N. M., & Federoff, J. P., & Marshall, W. L. (2009).  The importance of individual differences in pornography use: Theoretical perspectives and implications for treating sexual offenders. The Journal of Sex Research, 46, 1-17.

Prosocial Treatment Methods for Juveniles Who Sexually Offended

Norbert Ralph
Private Practice
San Leandro, CA

The treatment of juveniles who have sexually offended (JwSO) is challenging in several respects. While the harm done to the victims and prevention of future harm is always a concern, other issues need to be addressed. This includes a possible personal history of child abuse of the JwSO, other trauma history, family dysfunctions, substance abuse, school and peer problems, and comorbid psychiatric conditions. A recent ATSA Forum article (Ralph, 2017) recommends evaluating and considering another area of functioning for JwSO as well, prosocial or moral reasoning. That article suggested prosocial reasoning as a developmentally related criminogenic risk factor for these youth. This hypothesis relates to Bonner's (2012) finding that early adolescence is a high risk, transitory developmental period for committing illegal sexual behaviors, and there is no evidence that most JwSO have a lifelong, incurable sexual disorder or paraphilia. For example, a 14-year-old male may have adult sexual abilities and drive, but still have immature social judgment. Those 14-year-olds who may have deficits, relative to the average 14-year-old, regarding prosocial reasoning, may be at greater risk for general and sexual delinquency. Notably Bonner provides evidence that 14-year-olds have the highest incidence regarding sexual crimes of any age group, presumably related to this mismatch of abilities and judgment. 

A relevant consideration is whether deficits in prosocial reasoning are treatable. Are there interventions that enhance prosocial reasoning, and have beneficial effects for youth on probation such as reducing recidivism or other positive outcomes? The current article will address this issue. There is a significant treatment literature regarding effective methods to promote prosocial reasoning in youth on probation, including Reasoning and Rehabilitation (R&R) and its adaptation for adolescents (R&R2;Ross & Hilborn, 2003), Moral Reconation Therapy (MRT;Little & Robinson, 1988), and Aggression Replacement Training (ART;Goldstein, Glick, & Gibbs, 1998). Also research by the author regarding prosocial treatments with JwSO is presented.

Reasoning & Rehabilitation (R&R) Program

The Reasoning & Rehabilitation (R&R) program is a cognitive-behavioral group based intervention developed in Canada, and is supported by positive outcome studies (Antonowicz, 2005). A youth version for those under the supervision of social services or juvenile justice agencies was developed, the R&R2 Short Version for Youth (Ross & Hilborn, 2003). It is listed by the Washington State Institute for Public Policy (2016) as a beneficial practice for juveniles. The treatment model for the R&R2 uses a handbook, takes 12 sessions, and requires 18 contact hours. The authors of the R&R2 note:

Neuroscience has established that adolescence is a period during which youths are experiencing extraordinarily rapid brain development. Based on the neurocriminology model, the youth are engaged in prosocial simulation training and prosocial role-taking throughout the program in order to stimulate their development of prosocial neuronal connections - the foundation of a prosocial identity. (Ross & Hilborn, 2003, para. 7)

Field testing was conducted in Estonia, and an evaluation study was subsequently done in Scotland which found that youth who completed the R&R2 program had reduced antisocial attitudes and risk of offending, and improved problem-solving ability and behavior (Curran, 2006). Further research is needed to show the generalizability and robustness of these findings, and no research has yet been done using with model with JwSO.

Moral Reconation Therapy (MRT)

MRT is another group-based intervention, which uses a workbook as part of treatment (Little & Robinson, 1988). Training at accredited sites is required for use of the workbook. For youth the treatment program can be completed in approximately 26 sessions. Ferguson and Wormith (2013) reviewed 33 studies of MRT and reduction in recidivism was used as an outcome measure. They calculated an overall effect size for MRT of d= .32, but the juvenile effect size was d=.14. Two articles (Burnette, et al., 2003; Burnette, et al., 2004) showed positive changes with youth on probation using MRT, including increases in the level of moral reasoning. It is also listed by the Substance Abuse and Mental Health Services Administration as an evidence-based practice, and is included under juvenile interventions by the Washington State Institute for Public Policy in their meta-analytic review as a beneficial practice (2016). Although no studies with either MRT program have been used with JwSO,both MRT and R&R2 reduce recidivism with the general probation population, of which JwSO are a subset. Therefore, it is reasonable to hypothesize that these programs would also be effective with JwSO.

Aggression Replacement Training (ART)

Another approach which addresses moral or prosocial reasoning skills is ART (Goldstein, Glick, & Gibbs, 1998). It was developed primarily for juveniles on probation, using developmental psychology theories and research regarding child cognitive development, social learning, moral reasoning, and anger and emotional control. A central feature of this model is the promotion of moral or prosocial reasoning. The effectiveness of ART in reducing recidivism with youth on probation is also documented in a number of studies (e.g. Goldstein, Nensén, Daleflod, & Kalt, 2005). Amendola and Oliver (2010) in summarizing the literature note that ART is a "Model Program" for the United States Office of Juvenile Justice and Delinquency Prevention, and the United Kingdom Home Office.

The effectiveness of ART appears to be established for the general probation population. A question is whether ART is also effective and promotes positive outcomes for the subset of youth on probation with sexual offenses. The effectiveness of ART with JwSO was addressed in three related studies completed by the author. The same residential setting for JwSO was used in these studies. The first study was conducted in 2009 using a matched time series design with randomization (N=19). Outcomes were assessed using a psychological symptom inventory. Beneficial outcomes were found for reduced levels of psychological distress. This was the first randomized design done with any population with ART or with JwSO. However, it's important to note that long-term indicators such as recidivism or sexual acting out were not used as outcome measures.

A subsequent study in 2012, attempted to replicate these findings, but did not include a control group (Ralph, 2015a). However, additional psychological assessment techniques were used. The findings supported the hypothesis that ART contributed to therapeutic changes on psychological outcomes for youth in residential JwSO treatment. On the Child Behavior Checklist (Achenbach & Rescorla, 2001) completed by caregivers, five scales showed improvement from pre- to post- treatment which were Social Problems, Attention Problems, Rule Breaking Behavior, Externalized Total, and Total. On the Symptom Checklist 90-R (Derogatis & Savitz, 2000) completed by the youth, the Anxiety scale showed significant changes. On the Youth Outcome Questionnaire (Burlingame, Wells, Cox, & Lambert, 2004) completed by caregivers, Critical Items also showed positive changes. Two measures of prosocial reasoning, the Washington University Sentence Completion Test (Hy & Loevinger, 1996), and the Prosocial Reasoning Outcomes (Ralph, 2016a) also showed positive changes. This 2012 study was the first to show changes in prosocial reasoning with ART. It is important to note that this study did not include a control group and had methodological limitations, including ruling out maturation, testing, or a placebo effect as rival hypotheses to explain changes in scores.

In both the 2009 and 2012 studies open-ended focus groups were conducted with ART participants where they reported positive outcomes consistent with the quantitative findings. Youth generally identified the following ART strategies as helpful in being able to inhibit impulsive or counterproductive responses to adverse situations, and to formulate more positive and prosocial action alternatives. Youth described that they could "check themselves before they wrecked themselves." Importantly they also described a "virtuous cycle" in contrast to their usual impulsive behavior. When youth began using prosocial coping strategies they began using them more because of the reinforcement from the positive results of these approaches.

A subsequent longitudinal study (Ralph, 2015b) was carried out which followed all youth admitted to the same residential program from 2006 to 2012 (n =129 male youth ages 12 – 17). Sexual acting out was one of several outcomes studied, and 126 cases had complete data regarding this variable. This variable was defined as any episode of significant sexual acting out, some of which may have been considered a violation of the law. A total of 20.6% of youth had at least one such episode. Also a total of 20.9% youth completed the ART program during that time period. The rate of sexual acting out for those who participated in ART was 7.4%, compared to 24.2% for those who did not. A one-tailed Fisher's Exact Test was used to compare the groups, which were significantly different, p=.042.

Although this series of research studies has various methodological issues, together they show promise that ART was related to general psychological outcomes and associated with reduction in sexual acting out. Further larger scale studies are needed to confirm these preliminary results.

Being a Pro

The author has developed a treatment workbook for promoting prosocial reasoning, titled Being a Pro (Ralph, 2016b). It was influenced by research regarding measures of prosocial reasoning (Ralph, 2017), and also research on ART noted above. The structure of the Being a Pro workbook was informed by current research regarding best practices for youth on probation, notably the studies reported above with JwSO youth with ART. These are summarized in a prior article (Ralph, 2012). Approaches which emphasize counseling and skill building are manualized, have fidelity checks, training and supervision of practitioners, are more effective for youth on probation. These factors are also emphasized by Lipsey (2009) in his review article of effective interventions for youth on probation. Goense, Assink, Stams, Boendermaker, and Hoeve (2016) conducted a meta-analysis of 17 studies of interventions for juveniles with antisocial behavior. They found a medium treatment effect when integrity was high (d = 0.633, p < 0.001), but no significant effect when integrity was low (d = 0.143, ns). Both fidelity and outcomes measures were incorporated into the Being a Pro model. An outcome study was conducted for Being a Pro with 39 male adolescents (average age 15.7 years) on probation, in either outpatient or residential treatment for sexual offending (Ralph, In press). Results were consistent with the hypothesis of positive changes in prosocial behavior and reasoning as a result of the prosocial intervention, theBeing a Pro workbook. However, the design of a simple pre-post test did not rule out all rival hypotheses, and further research is necessary to validate the effectiveness of this approach.


There is reasonable evidence from research on ART and MRT that approaches which promote prosocial reasoning in youth on probation generally are effective in reducing recidivism. MRT as noted above was also associated with improved psychological functioning in youth on probation. Also the ART studies with JwSO reported above indicate it is associated with positive psychological outcomes for these youth. The studies and methods reviewed had limitations, and additional research is warranted. Prosocial treatment methods and their theory are consistent with neurodevelopmental research regarding adolescence being a "critical period" in the development of prosocial behaviors. It is a period when these skills are developing, and also youth with deficits are at greater risk for delinquent outcomes. This seems consistent with the hypothesis that adolescence may be a critical period of brain plasticity to promote prosocial reasoning. In summary, the above research suggests that treatment of JwSO might include interventions to promote prosocial reasoning.


Amendola, M., & Oliver, R. (2010). Aggression replacement training stands the test of time. Reclaiming Children and Youth, 19, 47-50.

Antonowicz, E. (2005). The reasoning and rehabilitation program: Outcome evaluations with offenders. In M. McMurran & J. McGuire, Eds. Social problem-solving and offending: Evidence, evaluation and evolution (pp. 163-182). Hoboken, NJ: John Wiley & Sons, Ltd.

Bonner, B. (2012). Don’t shoot: We’re your children. What we know about children and adolescents with sexual behavior problems. Retrieved February 20, 2017, from Boy Scouts of America,

Burlingame, M., Wells, M. G., Lambert, M. J. (2004). Youth Outcome Questionnaire (Y-OQ). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp. 235-273). New York, NY: Routledge.

Burnette, K. D., Swan, E. S., Robinson, K. D., Woods-Robinson, M., & Little, G. L. (2003). Effects of MRT on male juvenile offenders participating in a therapeutic community program. Cognitive-Behavioral Treatment Review,12(2), 2-5.

Burnette, K. D., Swan, E. S., Robinson, K., Woods-Robinson, M., & Little, G. L. (2004). Treating youthful offenders with moral reconation therapy: A recidivism and pre-posttest analysis. Cognitive-Behavioral Treatment Review, 3(4), 14-15.

Derogatis, L. R., & Savitz, K. L. (2000). The SCL-90-R and the Brief Symptom Inventory (BSI) in primary care. In M. E. Maruish (Ed.), Handbook of psychological assessment in primary care settings (pp. 297-334). Mahwah, NJ: Lawrence Erlbaum Associates.

Ferguson, L. M., & Wormith, J. S. (2013). A meta-analysis of moral reconation therapy. International Journal of Offender Therapy and Comparative Criminology, 57:1076-106.

Goense, P. B., Assink, M., Stams, G. J., Boendermaker, L., & Hoeve, M. (2016). Making ‘what works’ work: A meta-analytic study of the effect of treatment integrity on outcomes of evidence-based interventions for juveniles with antisocial behavior. Aggression and Violent Behavior, 31, 106-115.

Goldstein, A. P., Nensén, R., Daleflod, B., & Kalt, M. (Eds.). (2005). New perspectives on aggression replacement training: Practice, research and application. John Wiley & Sons.

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The Relationship between Implicit and Explicit Evaluations of Sexual Aggression and Sexually Aggressive Behavior

Chantal A. Hermann, Ph.D.
Ontario Ministry of Community Safety and Correctional Services

Evaluations[1] are an individual’s evaluative thoughts about something such as a person, object, or behavior (e.g., Albarracín, Zanna, Johnson, & Kumkale, 2005; Ajzen, 2001; Gawronski & Bodenhausen, 2007). Social psychology theory and research support the idea that evaluations, in part, predict behavior (e.g., Ajzen 1991, 2001; Glasman & Albarracín, 2006; Kraus, 1995). Empirical evidence suggests this is true whether the evaluations are immediate (implicit evaluations) or deliberative (explicit evaluations), and that both the immediate and deliberative evaluations are important (e.g., Greenwald & Farnham, 2000; Nosek & Smyth, 2007). From this research, Kevin Nunes, our colleagues, and I hypothesized that how someone evaluates sexual aggression would predict, in part whether or not they would engage in sexually aggressive behavior.

To explore this research question, we conducted several cross-sectional studies examining the relationship between implicit and explicit evaluations of rape and sexually aggressive behavior. As I noted above, we hypothesized that evaluations would be associated with sexually aggressive behavior, but this had not previously been explored in research. Some of our studies have found more positive implicit evaluations of rape are associated with self-reported sexually aggressive behavior and self-reported likelihood to rape (Nunes, Hermann, & Ratcliffe, 2013), and all have found more positive explicit evaluations of rape are associated with self-reported sexually aggressive behavior and self-reported likelihood to rape (Hermann, Nunes, & Maimone, 2016; Nunes, Hermann, White, Pettersen, & Bumby, 2016; Nunes et al., 2013). For example, in our first study exploring this research question, Nunes et al. (2013)  found implicit and explicit evaluations were independently associated with past sexually aggressive behavior and self-reported likelihood to rape in a sample of students.

We also wanted to explore this research question using a sample of men recruited from the community. Sexual aggression encompasses behaviors that differ on dimensions of tactic (verbal coercion to physical aggression) and  activity (unwanted kissing or touching to penetrative acts). We know that many sexual assaults go undetected, and even if they are detected, may not result in official charges or convictions. This means that individuals with convictions for sexual aggression may not be fully representative of men who engage in sexually aggressive behavior against adults. In our past research we have used student samples, but these samples tend to be fairly homogeneous in their demographic characteristics, so they also may not be fully representative of men who engage in sexually aggressive behavior against adults. Community samples can offer diversity and complement samples of students and men with convictions for sexual aggression against adults.      

In Hermann, Nunes, and Maimone (2016) we explored whether implicit and explicit evaluations of sexual aggression were associated with sexually aggressive behavior in samples of students and community men. In both samples we found explicit evaluations of sexual aggression were moderately to strongly associated with sexually aggressive behavior, but this same pattern of results was not found for implicit evaluations of sexual aggression. These results suggested more research was needed to explore the role implicit and explicit evaluations play in sexual aggression.

Of particular interest is whether evaluations of sexual aggression predict future sexually aggressive behavior. If evaluations are a causal factor for this type of behavior, then we would expect that they would predict whether or not people engage in future sexually aggressive behavior. To the best of our knowledge, we are the first to explore this research question. In Hermann and Nunes (2016), we found implicit and explicit evaluations of sexual aggression independently predicted whether community men engaged in future sexually aggressive behavior. These results are noteworthy as they provide new evidence about the direction of potential influence between evaluations and sexually aggressive behavior. Furthermore, our results are consistent with the idea—but of course do not demonstrate—that implicit and explicit evaluations of sexual aggression play a causal role in sexually aggressive behavior.

In addition to bettering our understanding of the role evaluations may play in sexual aggression, we also learned that the pattern of relationships between evaluations and sexual aggression was consistent for samples of students and community men. A common critique of research on sexual aggression conducted with student samples is that the results may not generalize to other samples of men (i.e., community or incarcerated samples). The results reported above suggest that this may not be the case for research exploring the relationship between evaluations of sexual aggression and sexually aggressive behavior. Next we would like to try to replicate these findings with incarcerated samples of men with convictions for sexual aggression against adults to determine if research conducted with students and community men could also generalize to this population.

The results of these studies are just the first step in understanding the relationship between evaluations and sexual offending. These studies need to be replicated and expanded on in research using different samples (students, community men, men in the criminal justice system), validated measures of evaluations, and different research designs (e.g., experimental, longitudinal, etc.). If future research finds evaluations predict sexually aggressive behavior against adults, that evaluations of sexual aggression can change, and that change is associated with changes in sexually aggressive behavior, then evaluations of sexual aggression would be an important target in risk assessment and treatment. 


I would like to thank ATSA for the Pre-Doctoral Research Grant that funded my doctoral dissertation research. To date, this research is reported in Hermann, Nunes, and Maimone (2016) and Hermann and Nunes (2016). This research was also facilitated by funding from the Social Sciences and Humanities Research Council of Canada. The views expressed are those of the authors and not necessarily those of the Ontario Ministry of Community Safety and Correctional Services.


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Hermann, C. A. & Nunes, K. L. (2016). Implicit and explicit evaluations of sexual aggression predict subsequent sexually aggressive behavior in a sample of community men. Sexual Abuse: A Journal of Research and Treatment. Advance online publication. doi: 10.1177/1079063216682952

Hermann, C. A., Nunes, K. L., & Maimone, S. (2016). Examining implicit and explicit evaluations of sexual aggression and sexually aggressive behavior in men recruited online. Sexual Abuse: A Journal of Research and Treatment. Advance online publication. doi: 10.1177/1079063216681560

Kraus, S. J. (1995). Attitudes and the prediction of behavior: A meta-analysis of the empirical literature.Personality and Social Psychology Bulletin, 21, 58-75. doi: 10.1177/0146167295211007

Nosek, B. A., & Smyth, F. L. (2007). A multitrait-multimethod validation of the Implicit Association Test: Implicit and explicit attitudes are related but distinct constructs. Experimental Psychology, 54, 14-29. doi 10.1027/1618-3169.54.1.14

Nunes, K. L., Hermann, C. A., & Ratcliffe, K. (2013). Implicit and explicit attitudes towards rape are associated with sexual aggression. Journal of Interpersonal violence, 28, 2657- 2675. doi: 10.1177/0886260513487995

Nunes, K. L., Hermann, C. A., White, K., Pettersen, C., & Bumby, K. (2016). Attitude may be everything, but is everything an attitude? Cognitive distortions may not be evaluations towards rape. Sexual Abuse: A Journal of Research and Treatment. Advance online publication. doi: 10.1177/1079063215625489

[1] We use evaluationthroughout to refer to attitude as defined in the social psychological literature, in which the essential feature of attitudes is evaluation; this is intended to distinguish it from the use of attitude in the correctional/forensic/criminological literature, which usually seems to reflect a much broader lay definition (Nunes et al., 2013; Nunes, Hermann et al., 2016).

Child pornography offenders: Profiles of a complex group

Sébastien PRAT
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
Forensic Psychiatry Program, St. Joseph’s Healthcare Hamilton, Canada

1.       Introduction

It is known that child pornography has existed since ancient times. However, the first child pornographic images as we now know them can be traced to 1862 (Tyler, 1985).  As the reach of this particular type of offence has expanded globally, it highlights the challenges of tackling this problem as it requires an international collaboration of many national task forces (Krone, 2005). Easier said than done as the laws are quite different for each country and for a long time, child pornography has been described in many criminal codes under the section of obscene messages. Lately, according to the evolution of criminality, and specifically, criminality involving the new means of telecommunication, specific laws have been introduced. The legal evolution has not been linear if we compare one country to another. For example, specific laws pertaining to child pornography offenses were issued in 1977 in the US, in 1980 in Denmark, in 1984 in the Netherlands and only in 1994 in France (Tyler, 1985; Frederick, 1996; Prat et al., 2012).

The profiles of the offender are quite varied, describing different psychopathology and motivations for the offense (Burke et al., 2002). Many offender and offence characteristics have been described to explain this phenomenon. Child pornography is mainly known as pictures or videotape, but the narrative aspect, referring to specific literature, has to be considered as child pornography also and can be used to stimulate deviant fantasies. Artistic aspects have been emphasized as a tolerance of this kind of production in some countries (Krone, 2004; Kleinhans, 2004), and the border has sometimes blurred between real artistic depictions and indecent pornography. To give an example, in 1973 Tony Duvert received a literature prize in France for a book entitled “Paysage de Fantaisie” (Fantasies’ landscape), that clearly described pedophilic fantasies[1]. This publication was released during a time of cultural sexual liberation, which may explain how the obscene aspect was ignored while people focused on the “innovative and liberal style”. It is also interesting to note that David Hamilton, a famous photographer, is also known for his movie “Age of the innocence”, which depicted pubescent girls. To my knowledge, there are no indecent or obscene images in the movie, but the poses of the protagonists could be considered sexually suggestive. Although his work has not been considered child pornography, it is interesting to note that people charged and convicted for possession of child pornography, have also possessed material related to David Hamilton’s “artistic production”[2].

2.       Complexity of the child pornography offense

Child pornography as a concept is further complicated by the fact that some non-pornographic material can be used in pedophilic fantasy (Krone, 2004; Kleinhans, 2004). Casual images from clothing catalogues, newspaper images, or cartoons are often found in collections. It has been debated in many countries whether those kinds of images can be considered illegal, since they do not result from a sexual offense. Many countries consider those productions illegal, but some countries, such as France, allow a defense if the consumer can prove that the subject, although appearing as a minor in the image, is in reality older than 18 (Prat et al., 2012). From a clinical perspective, this consideration does not make any sense, because, the consumer is still interested in viewing minors in erotic or pornographic images. Based on those different considerations, scales have been developed to classify the images, or any kind of production, that can be related to child pornography. One example is the Combating Paedophile Information Networks scale (COPINE scale), developed at the University College of Cork in Ireland, which includes 10 levels from indicative to sadistic and bestiality. It is interesting to note that from step 6 “explicit erotic posing”, most countries agree that the images are considered illegal, but there is some variation between countries for lower levels. From the COPINE scale, the Court of Appeal, in the case Regina v. Oliver (2002), issued the Sentencing Advisory Panel scale (SAP scale), describing 5 steps from “nudity or erotic posing with no sexual activity” to “sadism and bestiality”; the purpose of designing the scale was to help the judges/jury to provide appropriate sentencing based on the gravity of the offenses depicted in the images. This SAP scale, issued from a trial, can be considered as a practical legal tool for use with those convicted, as opposed to the COPINE scale which was mainly designed for clinicians and researchers (Taylor & Quayle, 2003; Krone, 2004; Quayle et al., 2006). Indeed the SAP scale focuses on illegal material, as opposed to the COPINE scale which describes all possibilities as to how a minor can be depicted.

The use of child pornography goes beyond functioning as a tool to fulfill sexual fantasy. In addition, it is used as currency for exchanging material between collectors and within specific websites. The collection of child pornography is well described as a risk factor. Such materials are also used to normalize the activity in the process of grooming potential victims. Furthermore, consumption of any depiction of child sexual abuse supports rationalization of abusive behavior, and reinforces cognitive distortions related to sexual activity with minors. Finally, financial interest is also a motivation to deal in child pornography, because a significant market exists. However, generally, people interested in the money are not really motivated by pedophilic interest, and this speaks to the complex and varied motives for the production and distribution of child sexual abuse material (Tate, 1990; Marshall, 2000; Taylor et al., 2001; Quayle et al., 2001; Frei, 2005; Beech et al., 2008).

Apart from the features of the material itself, the characteristics of the collection have been highlighted as relevant to conceptualizing risk and risk management. We describe notably 1/ the importance of the collection for the collector; 2/ the constancy of the collection; 3/ the organization of the collection; 4/ the attempts to conceal the collection, and 5/ the degree to which the collection is shared with others, or part of a virtual community, such that the collector considers his material to be relevant or desirable to someone else (Taylor et al., 2001).

As mentioned above, the profiles of child pornography consumers are quite varied. Three different studies highlighted three different typologies to explain the motivations. Burgess and Hartmann (2005) defined three categories: 1/ “Traders”, people who send and collect child pornography on the Internet; 2/ “Travelers”, people who try to make contact with children using coercion or manipulation and; 3/ “Traffickers”, people who are actively involved in child trafficking for the purpose of sexual exploitation. Elliot and Beech (2009) described 4 groups, 1/ the “periodically prurient”, those who access images out of curiosity, who can have addictive behaviors, but who have no particular sexual interest in children; 2/ “fantasy only”, people who have sexual fantasies about children, who fuel this interest by sharing images and have no known history of physical aggression; 3/ “direct victimization”, people with a particular interest in contact with children, either real or virtual, and use images or stories to groom victims; and 4/ “commercial exploitation”, people trading images for money.

3.       Assessing the profiles to guide the clinician about risk

Because of the complexity of the offense and the specificities of the profiles, those assessing the risk of recidivism first need to ask what kind of risk is being assessed (Wakeling et al., 2011). There is specific sexual recidivism, violent recidivism and general recidivism. When we think about child pornography and sexual offenses in general, we are primarily interested in sexual recidivism. Regarding child pornography offenses, we also need to think about what kind of risk we are looking for. Generally, child pornography is described as carrying a low risk of recidivism, from 1.5 to 6 % (Babchishin et al., 2011; Babchishin et al., 2015; Faust et al., 2014). However, we have little information about the type of recidivism and the offender profiles. Because child pornography involves a wide range of profiles, we must be able to define precisely the type of recidivism according to the profile.

3.1.   From a virtual and hands-off offense

A significant hurdle in defining recidivism for this group is that we do not know what to expect after a child pornography downloading offense (Neutze et al., 2014). Generally, we are interested in assessing the risk for the subject to offend again in the same manner, but there are questions about how to classify potential offenses from virtual to real and from hands-off to hands-on offenses. On this “double scale”, we can define four stages, 1/ child pornography would be the most virtual and most hands-off offense against children; then 2/ sexual online grooming and the obscene phone calls or image sharing, are still a hands-off offense, but less virtual; 3/ exhibition becomes a real offense, because of the face-to-face relationship, but is still a hands-off offense, because there is no physical contact between the offender and the victim; and 4/ sexual molestation and rape are clearly hands-on offenses, regardless of differences in terms of coercion, violence and gravity. The idea of exploring the risk assessment in terms of child pornography consumption is to know if we want to predict the same behavior, or a potential escalation. The tool to assess the risk of re-offense must be designed regarding those aspects of virtuality/reality and hands-on/hands-off. The Child Pornography Offender Risk Tool (CPORT) was recently developed and shows promising data, as it will help focus on the relevant information for assessing  risk (Seto & Eke, 2015), but still does not signal the manner of re-offence. However, by using it in combination with typologies and motivation conceptualizations, we can enrich our risk evaluations and thus risk management.

An international perspective: Research on French child pornography offenders

Based on a sample of adult French males convicted of child pornography downloading, this author performed two studies: 1/ a comparison between non pedophilic and pedophilic child pornography consumers; and 2/ using only the pedophilic child pornography consumers, a comparison between those whose offending was limited to downloaded child pornography, and those who already had another closer contact with a child (from online grooming to rape).

As child pornography consumption and any related offenses are complex offenses, it appeared important to be able to discriminate between looking for the images on the Internet and engaging in any other type of sexual behaviour with children. Four variable domains were identified in each study: 1/ the social and emotional functioning of the offender, including educational background, employment, relationship status and sexuality; 2/ childhood history of the offender in terms of violence, parental relationships; 3/ the perception of the offense with specific attention to indications of remorse, rationalization; and 4/ psychological functioning inferred from introspection capacity, and cooperation during the assessment.

3.1.1. Pedophilic vs non-pedophilic child pornography consumers

In terms of the social and emotional variables, we found that non-pedophiles had better academic achievement, more stable employment, and felt better integrated in society. This group was typically heterosexual, and denied complaints of loneliness or sexual dissatisfaction. In terms of childhood history, the only significant result was the absence of a father or father substitute. We did not find any group differences in terms of violence experienced in childhood, or antisocial traits.

In terms of the perception of the offense, the non-pedophilic group endorsed positive attitudes towards minors, and described regret and culpability, contrary to the pedophilic group, which presented with more minimization or rationalization. The non-pedophilic group expressed a morbid curiosity towards the images, explaining the need to also access images of car accidents or war. The non-pedophilic group was more inclined to talk about their sexuality. They cooperated more and exhibited capability for introspection compared to the pedophilic group.

3.1.2. Hands-off vs hands-on child pornography offenders

In the study comparing hands-off and hands-on child pornography offenders, it was interesting that the groups did not differ greatly. This can be explained by the fact that both groups were composed of pedophilic subjects, who likely present with the same characteristics. In terms of emotional and relational aspects, no statistical differences were found. However, the offender’s attitude towards the offense was significantly different, such that the hands-off group presented with a more positive attitude, characterized by remorse or acknowledging  the status as victim for the depicted child.

In the same way, the hands-off group expressed more sense of virtuality, with the idea that they were alone behind their computer, with no contact, and at no risk of being caught for their fantasies. The hands-on group had more difficulty in talking about their sexuality. They showed no introspection, nor did they cooperate during the interview.

3.1.3. Criminal history of the hands-on child pornography consumers

As part of the second study, the criminal history of the hands-on child pornography consumers was explored further. The first idea was to test some kind of “escalation process” in the sexual behavior, from consuming child pornography to assaulting a minor. It was interesting to find that most of the subjects had been convicted many years before for a hands-on/“close physical proximity” offense, such as sexual assault or exhibition. However, after the 2000’s and  the Internet’s explosion, most of the convictions were related to child pornography downloading, with no convictions for another sexual assault or exhibition; some were convicted however for communicating with minors on the Internet.  It is important to be cautious with these results, because they were based solely on convictions. However, because there was such a large majority of subjects presenting in this way, (although controversial) what, if anything, might this mean about pornography as a protective factor for pedophiles?

4.       Conclusion

Although the research reviewed here did not specifically identify risk factors or link the variables to recidivism, it focused on specific patterns and behaviors, and in this way may provide guidance about what to explore during an interview, to be able to conceptualize and differentiate profiles, and then consider the potential acting out or re-offence most likely. Furthermore, the indirect elements presented above can be used to formulate the level of intensity of an individual’s interest and behavioural patterns in accessing child pornography materials. In this way, the present research can be incorporated into assessments designed to gather information both for the purpose of formal risk assessment, such as with the use of the CPORT, but also for the purpose of conceptualization and risk management formulation.


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Processes Accounting for the Covariation Between Hypersexual and Psychopathic Traits

Franklyn Graham
Brandeis University

Last year I was awarded an ATSA Pre-Doctoral Research Grant to help fund my dissertation, a project that would not have been possible without the generosity of the ATSA organization. I am excited to have the opportunity to share an overview of what my research project entails.

My research interests center on the intersection between psychopathy and hypersexuality, two predictors of both the development of sexually aggressive behavior and later sexual recidivism (Knight & Sims-Knight, 2003, 2004; Hanson & Morton-Bourgon, 2005). Although Cleckley (1951) described the psychopath as disinhibited sexually and prone to seeking sexual gratification indiscriminately, he did not hypothesize that those high on psychopathic traits were oversexualized. In contrast, more recent empirical findings have suggested that psychopathic traits are correlated with a range of sexual behaviors that can broadly be defined as hypersexual (e.g., sexual drive, sexual compulsivity, sexual preoccupation, precocious sexuality, socio-sexuality; Graham, 2014; Harris et al., 2007; Kastner & Sellbom, 2012). In one study that examined the etiological pathways of sexual aggression, the correlation between psychopathic and hypersexual latent traits was so high that modification indices suggested combing the two constructs into a single latent trait (Knight, 2013; Knight & Sims-Knight, 2013).

Such consistent and high covariation between two hypothetical constructs suggests the possibility that common underlying processes may account for their co-occurrence. Unfortunately, few attempts have been made to explore such potential common etiological mechanisms. Identification of common mechanisms would be important for focusing the search for etiological models of sexual aggression and could generate more specific targets for treatment and assessment. The aim of this project is to identify and test potential common mechanisms.

Previous research has found that the covariation between hypersexual and psychopathic traits is largely due to manipulative and impulsive psychopathic traits (Harris et al., 2007; Knight & Sims-Knight, 2003). Unpublished data from our laboratory has found that only the Interpersonal and Lifestyle facets of the Psychopathy Checklist-Revised (PCL-R; Hare, 2003) were correlated with measures of hypersexuality as assessed by the Multidimensional Inventory of Development, Sex, and Aggression (MIDSA; see MIDSA, 2011) in a sample of 529 male sexual offenders. In a previous study using the three MIDSA scales that assess hypersexuality and MIDSA analog scales of the Interpersonal and Lifestyle facets of the PCL-R, we found that 47% of the variance in hypersexuality could be accounted for by the two psychopathy facets (Graham, 2014).

In the PCL-R the Interpersonal and Lifestyle facets load on two correlated, but distinct overarching factors. Interpersonal manipulativeness is a component of the Affective-Interpersonal Factor 1, associated with low anxiety/fear and the affective and interpersonal traits that are considered to be the “primary” features of psychopathy. In contrast, Lifestyle impulsivity is a part of a second overarching PCL-R factor, Lifestyle-Antisocial, which has been associated with negative emotionality and more generalized externalizing psychopathology (Hare, 2003; Verona, Edelyn, Patrick, & Joiner, 2001). These two factors show opposing correlates and are hypothesized to arise from different etiological pathways (Fowles & Dindo, 2006). Moreover, Newman and his colleagues have hypothesized distinct cognitive processing deficits that characterize those high on primary psychopathic traits versus externalizing traits (Baskin-Sommers & Newman, 2013; Newman & Baskin-Sommers, 2012). They have found evidence that the low anxiety, primary psychopathic traits are associated with an attentional bottleneck arising in early selective attention. This bottleneck is hypothesized to inhibit the processing of information peripheral to goal-directed behavior, resulting in a failure to modulate behavior in the face of new information (Newman & Baskin-Sommers, 2012). In contrast, disinhibited and externalizing traits have been shown to arise from deficits in executive functioning and a hyper-awareness of emotionally-valent stimuli, resulting in difficulties maintaining top-down cognitive control.

Although hypersexuality has traditionally been conceptualized as a univocal construct, more recent data have suggested that it, like psychopathy, might have important critical subcomponents. The issue of what phenotypic traits and developmental antecedes are core components of hypersexuality and hypersexual related constructs (e.g., sexual addiction, sexual impulsivity, sexual compulsivity) has sparked considerable controversy. One common conceptualization of hypersexuality has focused on the use of sexual behavior as a way of regulating negative affect (Kingston & Firestone, 2008). Self-report data have corroborated that this conceptualization covaries with alexithymia, neuroticism, anxiety, anger, and vulnerability to stress (Reid, Carpenter, Spackman, & Willes, 2008). The importance of negative affectivity in this conceptualization suggests that hypersexual traits and their covariation with psychopathy may be best understood as resulting from a common deficit in executive functioning.

Hypersexuality appears, however, to be a multifaceted phenomenon. Carvalho, Štulhofer, Vieira, and Jurin (2015) calculated a cluster analysis on a large sample of community members (n = 4,597) and found two clusters of hypersexual traits. The first cluster comprised 3% of the sample and was defined by items capturing sexual dyscontrol, such as failures to control sexual behavior and behavioral consequences. The second cluster included 22.4% of the sample and was defined by items measuring increased sexual drive and behavior. Assignment to the sexual dyscontrol cluster was associated with greater depression scores compared to members of the sexual drive/behavior cluster, suggesting greater negative affectivity. The two clusters suggest the presence of two distinguishable forms of hypersexuality--one associated with high sexual drive and engagement in sexual behavior and a second form more associated with disordered sexuality that includes a lack of control over sexual behavior and negative sexual consequences.

The differentiation between sexual dyscontrol, which encompasses the conceptualization of hypersexuality as the overuse of sexual behavior to cope with negative emotion, from high sexual drive and activity provides the possibility that the impulsive and manipulative psychopathic traits and their associated attentional deficits may be more strongly related to specific forms of hypersexuality. It is reasonable to speculate that both the impulsive, externalizing traits of psychopathy and sexual dyscontrol may share similar deficits in executive functioning and a hyper-reactivity to emotion stimuli.  

In contrast, manipulative psychopathic traits can be hypothesized to align more with the high sexual drive/behavioral components of hypersexuality, suggesting a common early attentional bottleneck resulting in an over-focus on reward and an inability to alter one’s focus on a goal, once such goal-directed behavior has been enacted. Both the high-drive conceptualization of hypersexuality and manipulative psychopathic traits also share potential neurological correlates. There is evidence that this high drive component may be related to a hyper-reactive dopaminergic response to potential reward.

The motivational aspect of sexual behavior, including the orienting to sexual stimuli and urges to express sexual behaviors are associated with activation of the mesolimbic dopaminergic pathway and is instrumental in the assignment of incentive salience to stimuli (Berridge & Robinson, 1998; Redoute et al., 2000; Stoléru, Fonteille, Cornélis, Joyal, & Moulier, 2002). Buckholtz et al. (2010) reported that the Impulsive-Antisocial (AI) factor of the Psychopathic Personality Inventory (PPI), also called the Self-Centered Impulsive factor, is associated with deficits in the mesolimbic DA system, with the presentation of rewarding stimuli resulting in increased DA release within the NAcc and Ventral Striatum. Meta-analysis of the PPI suggests that although the AI factor is closely aligned with externalizing traits and the second-factor psychopathic traits, it is also strongly related to total psychopathy scores and moderately correlated with the first-factor psychopathic traits (Miller & Lynam, 2012). Similarly, measures of the Behavioral Activation System are correlated with both psychopathy factors of self-report measures (Ross et al., 2007). This hyper-responsivity to reward can explain an exaggerated approach motivation and perceptual narrowing on rewarding stimuli that could account for the covariation between psychopathy in general and the sexual drive component of hypersexuality (e.g., excessive responsivity to sexual stimuli).

Taken together, these data suggest the possibility that there are two potentially interacting pathways that can account for the covariation among constructs. The first can be described as an attentional bottleneck that results in a common failure to attend to peripheral information and leads to an over-focus on rewarding stimuli and covaries with both the low anxiety, primary traits of psychopathy and the sexual drive components of hypersexuality. The second pathway involves a common failure in executive functioning and negative emotionality, that may account for the externalizing psychopathic traits and the sexual dyscontrol components of hypersexuality, resulting in an inability to maintain top-down cognitive control when faced with emotionally relevant (e.g. sexual) stimuli. Both paths can lead to an equifinal outcome of general hyper-responsivity to reward in both psychopathic and hypersexual individuals, resulting in an increased motivational salience and approach response towards potentially rewarding stimuli.

The present study is employing three behavioral tasks to measure both the two interacting pathways and the equifinal reward-focused outcome to explore the potential mechanisms accounting for the covariation between hypersexuality and psychopathy. I am using two tasks derived from the work of Sadeh and Verona (2008) and Lavie et al., (2004) to assess the relation between attentional deficits and the constructs of interest. The first task is a 2 x 3 flanker task that manipulates the congruence of distractors (congruent, incongruent) and the perceptual load of the task (low, medium, and high) to determine the impact of perceptual load on early attentional bottlenecks. Both psychopathic and hypersexual traits will be included as covariates in the model. It is expected that both high sexual drive and the manipulative traits of psychopathy will be associated with the presence of an earlier attentional bottleneck, as measured by faster responding to incongruent distractors at lower perceptual loads. The interference effect for each construct can then be used to determine whether an early attentional bottleneck mediates the relation between hypersexual and psychopathic traits.    

The second task uses a 2 x 2 flanker task in which cognitive load (low, high) and flanker congruence (congruent, incongruent) are manipulated to determine the impact of cognitive load on attentional control, as measured by the reaction time to incongruent versus congruent distractors. As in the first task, both psychopathic and hypersexual traits will be entered into the model as covariates predicting cognitive performance. It is expected that both sexual dyscontrol and the Impulsive/Antisocial externalizing traits of psychopathy will be more associated with greater interference effects from distractors under high load.

The Iowa Gambling Task (IGT; Bechara et al., 1994) will be used as a measure of reward responsivity. The IGT is often used as a measure of real world decision making, requiring participants to attempt to win as much fake money as possible by drawing from a series of decks of cards. Participants choose from among four decks. The first two decks are considered “disadvantageous” and are characterized by immediate high rewards and even higher later punishments. The second two decks are “advantageous” and include smaller immediate rewards, but also smaller punishments. To perform well on the task participants must learn which decks are more advantageous and focus on long-term gains over immediate rewards. It is hypothesized that poorer performance on this task will by correlated with both sets of psychopathic and hypersexual traits that are suggestive of increased sensitivity to reward.

Evidence supporting these hypotheses would provide information helpful to the understanding, assessment, and treatment of sexually aggressive behavior. Evidence of a covariation of high sex drive, early bottleneck cognitive deficit, and over-focus on rewarding stimuli would suggest that clients who exhibit manipulative, risk-taking psychopathic and sexual traits are experiencing an over-recruitment of dopaminergic activation in response to motivationally salient cues, implying high reward salience. At a fundamental level this would indicate a strong motivational draw toward rewards that are sexual in nature. Within the clinical realm this would imply the need for assessments that can assess reward motivation and reward responsivity. Therapeutic interventions for such offenders should, in turn, be tailored to the treatment of a high behavioral pursuit of reward. Evidence of an early attentional deficit in such offenders would increase our understanding of the arousal aspects of hypersexuality and would implicate neural areas tied to perceptual capacity (e.g., the septohippocampal system). This would encourage the development of assessment strategies that measure deficits in early selective attention.  It would suggest the creation of treatment modalities that enhance cognitive skills that foster attention to peripheral information (e.g., Baskin-Sommers & Newman, 2013).

Evidence of a covariation of high sexual dysfunction, an executive function deficit, over-distraction for rewarding stimuli, and externalizing symptoms would suggest that the offender suffers from problems of emotional and behavior control that would potentially be more responsive to interventions that specifically target this problem. Moreover, identification of a late attentional deficit in such offenders would imply impairments in executive functioning and working memory. Assessments that can determine the level of impairment in these systems would provide important information and direct the course of intervention toward treatment techniques that enhance concentration and working memory, enhance cognitive and inhibitory control, and improve emotional and behavior regulation.

I’m grateful to ATSA for helping to fund this project and look forward to sharing the results with the ATSA community.


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Harris, G. T., Rice, M. E., Hilton, N. Z., Lalumiere, M. L., & Quinsey, V. L. (2007). Coercive and precocious sexuality as a fundamental aspect of psychopathy. Journal of Personality Disorders21, 1-27.

Kastner, R. M., & Sellbom, M. (2012). Hypersexuality in college students: The role of psychopathy. Personality and Individual Differences53, 644-649.

Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction & Compulsivity15, 284-310.

Knight, R. A. (2013, September). New developments in the structural models of paraphilic coercion and rape. Paper presented at the 27th Annual Conference of the Society for Research in Psychopathology, Oakland, CA.

Knight, R. A., & Sims-Knight, J. E. (2003). Developmental antecedents of sexual coercion against women: Testing of alternative hypotheses with structural equation modeling. In R. A. Prentky, E. Janus, & M. Seto (Eds.), Sexual coercion: Understanding and management (pp. 72-85). New York: New York Academy of Sciences.

Knight, R. A., & Sims-Knight, J. E. (2004). Testing an etiological model for male juvenile sexual offending against females. Journal of Child Sexual Abuse, 13, 33-55.

Knight, R. A., & Sims-Knight, J. E. (2013, November). Tracking the antecedents and predictors of rape: Abuse, hypersexuality, callousness, antisociality, and PCD. Symposium presented at the 32rd Annual Conference of the Association for the Treatment of Sexual Abusers, Chicago, IL.

Lavie, N., Hirst, A., De Fockert, J. W., & Viding, E. (2004). Load theory of selective attention and cognitive control. Journal of Experimental Psychology: General133, 339-354.

Miller, J. D., & Lynam, D. R. (2012). An examination of the Psychopathic Personality Inventory's nomological network: a meta-analytic review. Personality Disorders: Theory, Research, and Treatment3, 305.

Multidimensional Inventory of Development, Sex, and Aggression (MIDSA). (2011). MIDSA clinical manual, 3rd ed. Bend, OR: Augur Enterprises. Available at

Newman, J. P., & Baskin-Sommers, A. R. (2012). Early selective attention abnormalities in psychopathy. Cognitive Neuroscience of Attention, 421-440.

Redouté, J., Stoléru, S., Grégoire, M. C., Costes, N., Cinotti, L., Lavenne, F., ... & Pujol, J. F. (2000). Brain processing of visual sexual stimuli in human males. Human Brain Mapping11, 162-177.

Reid, R. C., Carpenter, B. N., Spackman, M., & Willes, D. L. (2008). Alexithymia, emotional instability, and vulnerability to stress proneness in patients seeking help for hypersexual behavior. Journal of Sex & Marital Therapy34, 133-149.

Ross, S. R., Moltó, J., Poy, R., Segarra, P., Pastor, M. C., & Montañés, S. (2007). Gray’s model and psychopathy: BIS but not BAS differentiates primary from secondary psychopathy in noninstitutionalized young adults. Personality and Individual Differences43, 1644-1655.

Sadeh, N., & Verona, E. (2008). Psychopathic personality traits associated with abnormal selective attention and impaired cognitive control. Neuropsychology22, 669.

Stoléru, S., Fonteille, V., Cornélis, C., Joyal, C., & Moulier, V. (2012). Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: a review and meta-analysis. Neuroscience & Biobehavioral Reviews36, 1481-1509.

Sutherland, E. H. (1950). The diffusion of sexual psychopath laws. American Journal of Sociology56, 142-148.

Verona, E., Patrick, C. J., & Joiner, T. E. (2001). Psychopathy, antisocial personality, and suicide risk. Journal of Abnormal Psychology110, 462-470.


Treatment of High-Risk Sexual Offenders: An Integrated Approach

Review Submitted by David S. Prescott, LICSW


Treatment of High-Risk Sexual Offenders: An Integrated Approach
Jeffrey Abracen and Jan Looman
Wiley-Blackwell, 264 Pages

The amusing twist in this book comes at the outset. The authors make it clear, right up front, they would have preferred that someone else write this book. After all, there is very little available to professionals who work with this select group of clients. On the one hand, it calls to mind a quote attributed to Jerry Garcia: “Somebody had to do something, and it’s incredibly lame that it had to be us.” On the other hand, it is difficult to imagine a pair of authors better suited for this project.

David S. Prescott, LICSW
Forum Book Review Editor

Abracen and Looman are true scientist-practitioners involved in the treatment of some of Canada’s most high-risk clients for many years. Employed by the Correctional Service of Canada the authors have collaborated for many years, not only developing and implementing programming, but studying it as well. ATSA members are likely familiar with their work in some capacity, whether it’s their published research, Forum articles, or contributions to ATSA’s listserv (Jan Looman once produced new data analyses in response to a Listserv discussion, quipping that he did it because he was “bored at lunch”. It is this kind of interchange that makes ATSA the helpful resource that it is).  

Of course, Abracen and Looman have not operated in a vacuum. They have been fortunate enough to practice in Ontario during an era of explosive growth and expanding knowledge. As this book illustrates, they have developed many of their best ideas as a result of dialog with others, from Bill and Liam Marshall and their associates, to the late Marnie Rice, Grant Harris, and others from around the province. The end result is a document of work by innovative individuals, made better by the community of professionals around them.

These last points are not mere flattery. Beyond its elegant and informative writing style, the book describes many lessons learned and has numerous tips for clinicians based on the authors’ experience. When combined with incisive reviews of the literature, the chapters combine to form a whole that will deepen professionals’ knowledge base, both practically and empirically. Of course, the authors are not without strong opinions and biases; these certainly add to the interest of the book and point the way towards further research possibilities and professional self-development opportunities for the reader.

As one example of the authors’ leanings, they take the Good Lives Model (GLM) to task in ways that this admittedly biased writer believes did not consider the full body of this model’s literature. Indeed, the authors describe how they started to adopt elements of the GLM and abandoned it in short order. On the one hand, it seems they did not necessarily give it that much of a chance. On the other hand, it’s impressive that they tried it at all when they had already spent years developing their own programming – this speaks to their efforts at refinement. The literature on what works in psychotherapy suggests that if you aren’t convinced that a model will work for you, it’s probably better not to use it. Conversely, and by way of analogy, if your diet works for you, it’s probably best to maintain your eating habits.

Going beyond the bounds of many other book projects, the authors dig deep into the interactions between complex post-traumatic stress, attachment, and sexual offending. This is a welcome addition to the literature, as very little has been written in this area (Levenson, Willis, & Prescott, 2015; 2016; Reavis, Looman, Franco, & Rojas, 2013). They also provide a very helpful description of their work with comorbid substance abuse disorders.

The layout of the book is as straightforward as its writing style. After an introduction, the table of contents include:

  1. Background and definitions
  2. A description of the RTCSOTP group characteristics and program
  3. Treatment outcomes of high-risk violent and sexual offenders
  4. Therapist and setting characteristics
  5. The integrated Risk-Need-Responsivity (RNR-I) Model
  6. Etiological factors: Attachment theory and complex post-traumatic stress
  7. Combining attachment theory and complex post-traumatic stress disorder and theories of sexual offending: The RNR-I Model
  8. Good Lives Model and sexual offending
  9. Therapeutic orientation and relevance to assessment
  10. Self-management component
  11. Social skills and individual therapy
  12. Alcohol abuse, drug abuse, and sexual offending
  13. Deviant sexual arousal
  14. Practical applications of the RNR-I model in the assessment and treatment of sexual offenders with substance or alcohol abuse disorders
  15. A model for community management
  16. Summary and conclusions

The authors may have shied away from the project initially, but in all it is a concise and helpful history of a solid program for some of the most challenging clients in the world.


Levenson, J. S., Willis, G. M., & Prescott, D. (2015). Adverse Childhood Experiences in the Lives of Female Sex O enders. Sexual Abuse: A Journal of Research & Treatment, 27, 235-257.

Levenson, J. S., Willis, G. M., & Prescott, D. (2016). Adverse Childhood Experiences in the Lives of Male Sex Offenders and Implications for Trauma-Informed Care. Sexual Abuse: A Journal of Research & Treatment, 28 340-359. doi:10.1177/1079063214535819.

Reavis, J., Looman, J., Franco, K., & Rojas, B. (2013). Adverse Childhood Experiences and Adult Criminality: How long must we live before we possess our own lives? e Permanente Journal, 17(2), 44-48.


Changing The Journal Name

Michael Seto, Ph.D.
Editor-in-Chief, Sexual Abuse

You have noticed that the journal name has changed to Sexual Abuse, dropping the secondary title. This change was something that I have been thinking about since taking over as Editor-in-Chief in January 2015, and indeed it was something that I proposed to the Board of Directors of the Association for the Treatment of Sexual Abusers early in my tenure. Because I did not sufficiently or convincingly explain my thinking, the proposal was rejected in a close vote in May 2015.  I’m pleased to announce that the ATSA Board of Directors recently voted unanimously to support my updated proposal to change the title, in order to better reflect the evolving mission of the journal.

In particular, the change reflects that the journal’s aims involve high-quality scientific research and a scope that focuses on, but is broader than, treatment. The journal is intended to be an outlet for scholarly work on the characteristics of perpetrators or those at risk of perpetration, and with the etiology, life course, assessment and prevention of sexual exploitation and abuse. Treatment providers have been and will remain a core part of the journal’s intended audience, but we also want to include policy-makers, judges and lawyers, correctional staff, and other professionals who all have something to contribute to our understanding and our response to the problems of sexual exploitation and abuse.

As I noted in my inaugural editorial as Editor-in-Chief (Seto, 2015), the journal has a rich and impressive history supporting scholarship in our field. I believe Sexual Abuse is widely recognized and respected in the field, and my goal as Editor-in-Chief is to help the journal become even stronger and more effective in contributing to evidence-based theory, policy and practice. I think these goals can be achieved in part through making it clear we are multi-disciplinary and broadening the journal’s reach.



Apply for the ATSA Fellow for 2017

Bradley R Johnson, M.D., ATSA Membership Committee Chair

As Chair of the ATSA Membership Committee, I am pleased to announce the ATSA Fellow application for 2017.  Like other professional organizations, the ATSA Membership Committee and Board of Directors began two years ago to offer the ATSA Fellow, a special honorary designation to recognize ATSA members who have demonstrated allegiance to their profession and a strong commitment to the ongoing work of the Association.  A Fellow of ATSA goes “above and beyond” in regard to their dedication and contribution to ATSA.  The ATSA Fellow designation is an enhancement to their professional credentials and is recognized by their colleagues in ATSA as a member of a select group. 

Fellow applications require review and approval by the ATSA Membership Committee and Executive Board.  All newly appointed Fellows will be publicly recognized in the ATSA Forum and at the ATSA Membership Meeting and Luncheon on October 27th, which will be held this year at the ATSA Annual Research and Treatment Conference in Kansas City, MO (October 25-29, 2017).  Fellows receive a Fellow certificate that they can display with pride in their office.  Additionally, ATSA Fellows can use the initials ATSAF after their professional names to signify that they have reached this honor within the ATSA organization.

Submission Deadlines (application available at

Self-submissions or nominations from other ATSA members should be submitted to the ATSA office by September 1st.

What are the requirements to become an ATSA Fellow?

  1. Not less than seven consecutive years as a Member or Associate Member of ATSA (Years spent as Affiliate and Student Members do not count toward the ATSA Fellow.)
  2. Two letters supporting your submission or nomination must be received from current members of ATSA describing your dedication and strong commitment to ATSA, and why you should become a member of this select group.  Letters should explain how the applicant rises to the level of Fellow, distinguishing them from a routine member of ATSA.
  3. The ATSA member should be outstanding in their field and have made significant contributions to ATSA as demonstrated by completing  at least four (4) requirements from the following list while a member of ATSA:
    • Involvement in ATSA by serving on an ATSA organization committee or board
    • Involvement in ATSA by serving in a local chapter leadership role or committee
    • Organization of or major participation in an organized activity of ATSA or your local chapter
    • Give a professional presentation (paper presentation , poster session, workshop or symposium) at an ATSA Annual Conference
    • Give a professional presentation at a local chapter conference
    • Publish a scientific or scholarly article in the ATSA journal (Sexual Abuse)
    • Publish a scientific or scholarly article in the ATSA Forum
    • Serve as an editor, associate editor or on the editorial board of the ATSA journal (Sexual Abuse) or have reviewed at least ten (10) submissions to the journal
    • Publish an article on sexual offense assessment, treatment or prevention in a peer reviewed professional journal other than the ATSA journal (Sexual Abuse)
    • Participate in furthering ATSA’s contribution to public policy for the prevention of sexual abuse by aiding with the creation of a legislative or court response or press release
    • Participate as a mentor to a less experienced ATSA member as part of the ATSA Mentoring Program for at least one year
    • Other major contribution to ATSA or local chapter that is approved by the membership committee
  4. Completion of an application that is available on line at or through the ATSA office at (503) 643-1023.

Don’t be left out and submit your application today, or nominate someone who you believe should have the ATSA Fellow designation.  If you have any questions, contact the ATSA office, or you may contact Brad Johnson at 520-297-9878 or at

2017 Election

We are proud to announce the 2017 nominees for At-Large Representative and Prevention Representative positions. You should have received an emailed ballot by May 25, 2017. If you have not received a ballot, please email to request a ballot resend.

Please note that the deadline to vote is June 30, 2017.


2017 ATSA Executive Board Nominees

At-Large Representative Candidates

Below is the list of candidates for the elected At-Large Representative position on the ATSA Board of Directors.

Tyffani Dent

Download Dr. Dent's PDF questionnaire.

Victor Kersey

Download Mr. Kersey's PDF questionnaire.

Michael Thompson

Download Mr. Thompson's PDF questionnaire.

Michele Yep Martin

Download Ms. Yep Martin's PDF questionnaire.


Prevention Practice Representative Candidate

Below is the list of candidates for the Prevention Representative position on the ATSA Board of Directors.

Alison Hall

Download Ms. Hall's PDF questionnaire.



ATSA International Committee: An introduction

Kieran McCartan, Committee Chair

Welcome to the first piece by the newly formed international committee!


Sexual harm is a global issue that impacts individuals, communities and all societies. This means that we need a global solution that reflects a shared understanding of sexual harm that can be adapted to different countries and regions globally as appropriate. Internationally there are many organisations that prevent and respond to sexual harm, including but not limited to our sibling organisations NOTA, IATSO & AZASTA. While some may consider ATSA to be an American organisation it is truly international with approximately 300 members from 19 (non-USA) countries. The majority of ATSA’s international members are from Canada, UK, Australia, New Zealand and Europe (i.e., Italy, Sweden, Germany, etc); but we also have members from Japan, Hong Kong, Puerto Rico, Singapore, Israel and South Africa to name a few other countries.

The international component of ATSA’s membership is important because transnationally we face a lot of similar issues relating to sexual harm and use a lot of the same, or similar, tools and research; therefore it’s important that we talk, share and reflect on practice, research and policies.  

Aims, Objectives & Membership

The newly formed international committee came into being in January 2017 with the development of some coherent aims and objectives that were presented to the board. The newly formed international committee has three roles;

  1. To support the development of ATSA internationally and increase recruitment;
  2. To make sure the voices, opinions and knowledge of these ATSA members are heard in the organisation more clearly; &
  3. To increase the visibility of ATSA and its mission outside of the USA in existing and new member countries.

The role of the international committee is to stimulate debate, to reflect upon current practice (positive and challenging) and to consider ways that we can work together. The international committee aims to meet these roles in the following ways:

  1. The recruitment of international members onto all standing committees, including the recruitment of an additional international (non-Canadian) member. The idea would be that the international member would be there to give an alternative view, share good practice and feed material back to the international committee (which they would be a member of).
  2. Develop a new international committee comprised of international members who are the international representatives of other ATSA committees. The role of this committee would be to develop a coherent international voice within ATSA, act as a sounding board for ATSA/International issues and feed into boarder debates.
  3. The international committee would have a knowledge exchange session at the ATSA conference to share good practice and debate international issues. The idea is that we get a range of international views on contemporary and emerging issues/topics. This may be a pre-conference workshop, concurrent session, or roundtable debate. This could be written up for the Forum or broken down into a number of blogs for dissemination to the wider ATSA membership.
  4. To encourage international members to share their affiliation to ATSA in events that they speak at where appropriate.
  5. To bring international issues, development needs, training needs and opportunities to ATSA’s attention when appropriate.

Once the ATSA executive board agreed to the International committee’s remit I reached out to all the international members of ATSA to see who was interested in being involved. I had lots of positive responses from international members, not all of whom could be as involved as they wanted to be, and consequentially we formed the first iteration of the international committee.




Other ATSA roles

Danielle Harris



Research committee & ATSA executive board

Kasia Uzieblo



NL ATSA  executive board

Liam Ennis



Research committee

Heather Moulden

Professional (clinical) and Academic


ATSA Forum & ATSA executive board

Carla Xella

Professional (clinical)


Adult Clinical committee

Laura Kuhle



Student committee

Chi Meng Chu

Professional (Clinical & research)

Hong Kong

Wineke Smid



Research committee, NL ATSA executive board

Gwen Willis


New Zealand

Prevention committee & AZATSA executive board

Margret Ann Laws

Professional (police)

New Zealand

Anette Birgersson

Professional (clinical)


Juvenile Clinical committee

Kieran McCartan



Prevention committee, Membership committee,

SAJRT Blog & ATSA executive board

Maia Christopher



ATSA CEO & ATSA executive board

Moving Forward

Currently we are navigating how we can chat, debate and work together because up until now it has been through email and conference call (but conference calls across numerous time zones can be challenging); this will come through time and experience. We have plans for updates and outreach on international issues through the various blogs (SAJRT Blog, NOTA prevention blog), publications (ATSA Forum, NOTA news) and conferences (ATSA; NOTA; IATSO; AZATSA) that we are involved in. This year at the ATSA conference in Kansas City we have two events planned;

  • 1st Meeting of the international membership.

Date, time and location: TBC (see conference brochure for more details).

This will be an open meeting for all international members to come together at conference to chat, network and meet.

  • International roundtable: International Approaches to Understanding and Managing Risk of sexual recidivism

F-32: Friday 27th October, 3.30 – 5pm, ROOM TBC

The roundtable will discuss international similarities and differences in approaches to managing sexual recidivism risk posed by individuals convicted of sexual offences. The speakers will focus on what the risk management of sexual recidivism looks like in their country, focusing on good practice and challenges followed by a panel debate. The session will allow us to reflect upon and consider the realities of our current approaches to managing risk of sexual recidivism across jurisdictions. The roundtable will include speakers from the UK, Canada, Germany, Netherlands, Belgium, Italy, Sweden, New Zealand and the USA.

We are here to speak for and represent all international ATSA members, please do reach out to us by email or in person through conference.


2017 ATSA Conference: Exhibit and Support Opportunities

We are pleased to announce advertising and other opportunities for supporting ATSA available for the 36th Annual Research and Treatment Conference, scheduled for October 25 – 28, 2017 at The Sheraton Kansas City Hotel at Crown Center. ATSA is offering several new and exciting ways in which you can promote your services, agency or company to the approximately 1,300 – 1,500 professionals who will be attending the conference.

In addition to exhibit booths and table-tops, we are exploring creative space and advertisement options. For those interested in highlighting your organization or business, this year we will be featuring exhibit spaces using promotional signage located throughout the hotel, window or floor stickers, placement in the conference app and in the printed conference program.

Information about various opportunities for supporting the ATSA conference can be found here: 2017 ATSA Exhibitor Packet. If you are interested in participating, please read the Terms and Conditions document, complete the required forms and submit to the ATSA office with the necessary fee.

I hope you will choose to support the ATSA Conference. Please do not hesitate to contact me at (503) 643-1023 if you need additional information or have any questions or concerns. We look forward to your participation in the ATSA 36th Annual Research and Treatment Conference.

Best Regards,

Maia Christopher
Executive Director


Win a Free Conference Registration

Visit the ATSA Website to learn more.

New ATSA Conference Event

This year’s ATSA conference in Kansas City, Missouri, will be offering a new event the day before the conference starts. As part of ATSA’s commitment to corporate responsibility and as a thank you to our host community, we are holding a half-day public service event the afternoon of October 24 for a regional nonprofit –  Sunflower House – which assists children who have been physically and sexually abused. We will be providing a range of services from helping clean and organize the interior of the building, to doing some exterior landscaping, to stuffing envelopes, to organizing bags of toys for the children. There’s a project for everyone’s interest and abilities. We hope you will take advantage of this opportunity to enjoy a day of exercise and camaraderie as you help make a positive difference for children. You can visit for more information.

Keeping up with the news

Ann Snyder

ATSA now tracks and publishes links to news articles from around the world on issues related to sexual abuse. These news stories are available to ATSA members by logging in to the ATSA site and going to the Members’ Page. Look for the link to “In the News” to see the latest articles. The curated stories will keep you up to date on trends in public opinion, policies, and issues related to individuals who have committed sexual offenses. Articles are updated regularly, so be sure to check in every week or two to see the latest news.

Legislative update

Ann Snyder

ATSA continues to track legislation in U.S. states related to such topics as sex offender registry restrictions, criminal penalties and fees, changes in classifications of crimes, and other laws that impact persons who have committed sexual offenses. Currently, more than 300 bills are being monitored. You can find a state-by-state list showing the status of these bills on the Members’ Page by clicking on the link “Legislation.” If you have questions about any of the bills, please email

New ATSA Members

The following ATSA members were approved for Membership from March to May 2017.

Deborah Barron, MA
Moose Lake, MN

Ashley Kellogg, LICSW
Pittsfield, MA
Bonnie Bjorke, Psy.D.
St Peter, MN

Matt Kenney, LLPC
Grand Rapids, MI
Tara Blumeyer, PsyD
Mesa, AZ

Nicole Kinneer, LPC
Connellsville, PA
Kimberly Bomar, MS, BSW
Jackson, MI

Sarah Koop,
Knoxville, TN, United States
Andrea Brannen, M.A., LPC
Graterford, PA

Nicole Kries-Wyszynski, LCSW
Trenton, NJ
Ryan Breen, LCPC
Chicago, IL

Sonja Krstic, M.A., M.Ed.
Waltham, MA
Sarah C. Brown, M.S.W.
East Saint Louis, IL

Tonna L. Lawrenson, M.S.
Woodward, IA
Kristy Burton, LAC
North Little Rock, AR

Jillene Lemke, BA
Phoenix, AZ
Kim Bushey, LADC
Waterbury, VT

Whitney Lewis, LCSW
Las Vegas, NV
Amy Butler Bleeker, BA
Crystal Bay, MN

Sara Lynch, LMHC
Des Moines, IA
Ann Cacace, M.S.W. Candidate 2018
Mauston, WI

Kayla Malloy, LMHC
Albany, NY
Beverly Cavadini, BN, RN
Calgary, AB, Canada

John E. Mancini, LPC, CSAT, CAC
West Hartford, CT
Hayley Chambers
Henderson, NV

Tiffany Martin, LCSW
Sedalia, MO
Cecilia Chiles-Parker, LSW
Piscataway, NJ

David Medved, MA
Steilacoom, WA
William Citino, M.S.W., L.C.S.W.
Doylestown, PA

Jeffrey Melvin, Ph.D.
Lincoln, NE
Amy Clay, J.D.
St. Louis, MO

Heidi Menard, MSW, LCSW
Mauston, WI
Rachel Cook, LMHC
Orlando, FL

Carrie A. Mitchell, LCSW
Lillington, NC
Nicole Cossu
Chicago, IL

Lisa Mitchell, LCSW-R, BCBA
Patchogue, NY
Janelle Crisp, LPC
Pittsburgh, PA

Sarah R. Modec, MSEd
Duluth, MN
Veronica Cruz, MSW, LCSW-C
Rockville, MD

Linda Sutton Meade, Ph.D.
Farmington, MO
Ian Curtis, LCSW
Mishawaka, IN

Sandra J. Murnane, MS
La Crosse, WI
Jennifer Daer Shields, M.S.
Stillwater, OK

Angela Myhre, LMFT
Brookfield, WI
Mary Deitch, JD PsyD
Woodlyn, PA

Charles Nash
Muskegon, MI, United States
Sarah DeMarco, Psy.D.
Albany, NY

Amanda Nusbaum, M.A.
Brooklyn, NY
LeAnn Dickinson, PHD, LPC
Little Rock, AR

Michele O'melia, LPC
Ocean, NJ
Brenda DiMuro, M.S.
Frisco, TX

Sheryl Overby, MS
Omaha, NE, United States
Nicole Dolhi, MSW, LSW
Greensburg, PA

Shawna Pfaff, M.S.
Bismarck, ND
Nicole Dorio, DO
Stewarstville, NJ

Tracie Pletcher, BA
Greensburg, PA
Lisa Dube, MSW
Lawrence, MA

Jami Presswood, LCSW
Molly Fara, LCSW
Crest Hill, IL

Gina Ranfone, MA
Arlington, VA
Glenn Ferguson, PhD
Manasquan, NJ

Erica Reische, MA
Rushville, IL
Kelsey Fleet, LMLP
Wichita, KS

Kelli Reynolds, MS
Lakewood, CO
Ann Freeman, LCSW
Colorado Springs, CO

Larissa Rico, LCSW
Aurora, IL
Kim German, LMSW
Wichita, KS

Kristen Robertori
Avenel, NJ
Katherine Gorman, LGPC
Rockville, MD

Ellen Robinson, LMFT
Lancaster, CA
Erin Graffam, M.Ed.
Meriden, CT

Ardelia Rodgers, MA, LAC
Little Rock, AR
Laura Green, MSW/LCSW
Indianapolis, IN

Emily Salema, Psy.D.
Clarksboro, NJ
Haley Gummelt, Ph.D.
Tacoma, WA

Charles Sanderfur, M.Ed.
Knoxville, TN
Perryn Gutkowski, LCSW-C
Severn, MD

Sarah K. Schnatter, M.A., LPC
Graterford, PA
Melissa Ann Hammer, MSW
Benton Harbor, MI

Eleanor A. Schupick, MA
Rushville, IL
Ned Hanover, MSW, LCSW
Mount Laurel, NJ

Nimrod Shanee, Ph.D.
Ramat-Gan, Israel
Stalina Harris, MA
Rushville, IL

Sheri Sherrill, LMLP
Wichita, KS
Zayda Harsha, M.S.W., LGSW
Minneapolis, MN

Nicole Siha, M.A.
Elizabeth, NJ
Tim Haug
Walker, MN

Megan Smith, LMHC
Daytona Beach, FL
Jeffery Haynes, Ph.D, LMHC
Daytona  Beach, FL

Amy B. Tahran, M.Ed.
Jamestown, ND
Nancy Hein-Kolo
Fargo, ND

Michelle Tanur, M.A.
Long Island City, NY
Amy R. Hofmeister, MSEd
Rushville, IL

Chad Taylor, MA
Good Hope, IL
Cheryl Hopkins, MSW
Little Rock, AR

Jacques Thigpen, Ed.D.
Greenville, NC
Jeri Howell, MA
Rushville, IL

Patti D. Thomas, M.S.W.
Marysville, WA
Angela Hoyt, MS
Rushville, IL

John Vella, LPC
Florence, AZ
Eileen Huggins, BSW
Bemidji, MN

Joseph Voglewede, Ph.D.
Marcy, NY
Amie Hvizdak, Psy.D.
Keizer, OR

Lindsey Wagner, MS
Rushville, IL
Katie Ingram,
Royal Palm Beach, FL

Jessica Wilson, LPC
Wichita, KS
Michael Ito, Psy.D.
Baltimore, MD

Donna Wise, CSOTS
Concord, NC
Sarah Johnson, MSW
Shiloh, IL

Megan Wright, Psy.D.
Hopewell Junction, NY
Tobin Johnson, BA
Coeur d' Alene, ID

Reginald Rene Wright, MA, MFT
Apple Valley, CA
Tara Jones, MSW
Paisley, OR

Lisa Young, LCSW
Bridgeport, PA
Heather Kane, MSW (pending)
Muskegon, MI

Nicolette Zeller, LPC
Lenexa, KS
Gale Kelley, Ed.D., LMHC
Bradenton, FL


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