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IJOXXX10.1177/0306624X20919714International Journal of Offender Therapy and Comparative CriminologyChawke et al.

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Offender Therapy and
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DOI: 10.1177/0306624X20919714
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With Men who Have Sexually

Offended

Gemma Chawke1 , Patrick Randall2,

and Simon C. Duff1

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

Keywords
Forensic Psychological Assessments, Sex Offenders, Interviews, Interpretative
Phenomenological Analysis

1University of Nottingham, UK
2Forensic Psychological Service, Dublin, Ireland

Corresponding Author:
Gemma Chawke, University of Nottingham, Nottingham NG8 1BB, UK.
Email: gemma.chawke@nottingham.ac.uk
2 International Journal of Offender Therapy and Comparative Criminology 00(0)

Introduction
Typically, persons charged with sexual offences undergo a risk assessment during their
journey through the justice system, to formally ascertain his or her level of risk of reof-
fending (Craig & Beech, 2010). Forensic assessments, which in addition to identifying
the individual’s risk of reoffending also outline risk factors specific and pertinent to
the offence, have been found to increase the ability of predicting recidivism by approx-
imately 20%–30% over chance (Murphy & McGrath, 2008). By outlining the personal
and environmental factors of importance to concentrate on in supervision and rehabili-
tation (Harris & Hanson, 2010), these assessments are integral to effective treatment,
reducing recidivism, and the protection of the community (Craig & Beech, 2010).
Where assessments are carried out in the preliminary period to the individual’s appear-
ance in court, the outcome of the assessment is employed as a consideration in sen-
tencing (Zappala et al., 2018).
Empirically validated structured risk assessment tools are available for clinicians to
employ in assessments. Clinicians can base their decision-making on these instru-
ments, the predictive values of which exceeds clinical judgement alone (Dawes et al.,
1989 cited in Shingler et al., 2018). These instruments consider static risk factors, such
as the victim’s gender, and dynamic risk factors, such as deviant sexual interests
(Beech et al., 2003). To score the individual on these instruments, the clinician must
ask questions of an intimate nature in clinical interviews. The degree of openness and
disclosure of personal detail required may be problematic as a result of the character-
istics associated with this population.
Sex offenders typically evoke strong negative feelings in others (Kjelsberg & Loos,
2008) and experience a significant degree of social prejudice, exclusion, and vilifica-
tion (Wakefield, 2006) as a result of the stigma attached to these crimes (Burchfield &
Mingus, 2008). As a probable consequence, they have been found to be guarded, sen-
sitive to judgement (Youssef, 2017), and more suspicious and cynical than other
offenders (Phenix & Hoberman, 2015).
Accurate self-report by sexual offenders of their cognitions and problematic behav-
iours is essential for accurate risk assessments and for developing well-matched risk
management plans (Gannon et al., 2008). Given that the accuracy of predictions for
recidivism is dependent on the collection of sufficient information concerning predic-
tors, the clinician must attempt to overcome any reluctance demonstrated by the
assessee to discussing their offending behaviour and personal lives (Logan, 2013). The
extent to which the objectives of the interviews in forensic psychological assessments
(FPAs) are fulfilled may therefore be largely reliant on the clinician’s capacity to moti-
vate assessees to cooperate and their ability to overcome any reluctance they have to
disclosing information (Logan, 2013). Although research has not been conducted
exploring how this may be accomplished in assessments, strategies have been identi-
fied in other areas of applied psychological practice.
Strategies suggested by Newman (1994) to be effective in reducing resistance in
psychotherapy include empathising with the client and why they feel resistant.
Empathy is proposed to help clients feel heard and safe and encourage them to share
Chawke et al. 3

details of their offending behaviour (Miller & Rollnick, 2002). Development of an

effective therapeutic relationship, reliant on fundamental elements of genuineness,
empathy, and positive regard (Rogers & Truax, 1967), is considered vital to exploring
the fundamental meaning of the resistance which is crucial for overcoming it (Manetta
et al., 2011). In addition, clinicians in psychotherapy rely on a range of skills, includ-
ing paraphrasing and summarising, which demonstrate to the client that they have
been heard, help them feel understood, and encourage them to open up freely (Nelson-
Jones, 2015).
The aforementioned roles of empathy, therapeutic skills, and the therapeutic alli-
ance, in overcoming resistance have been similarly identified in the literature regard-
ing psychotherapy with sex offenders (Sandhu & Rose, 2012). Men who have sexually
offended have been identified as sensitive to a lack of empathy in clinicians (Beech &
Mann, 2002) and have been found to emphasise the importance of clinicians being
caring and understanding towards them (Youssef, 2017). It has been argued that the
therapeutic alliance is more pertinent with this population than with other types of
offenders (Beech & Mann, 2002; Youssef, 2017).
Although research from the general psychotherapy literature and literature on psy-
chotherapy with sex offenders highlights the importance of therapeutic skills to
improve engagement, reduce resistance, and develop an effective therapeutic relation-
ship, the appropriateness of application in FPAs has been doubted as a result of the
significant differences which exist between these clinical endeavours (Melton et al.,
2017). These differences underly the argument that the duties associated with the ther-
apist’s role and the clinician in a forensic assessment are inherently conflicting
(Greenberg & Shuman, 1997).
Clinicians in forensic assessments are distinguished from the supporting and
empathic therapist as objective, neutral professionals (Greenberg & Shuman, 1997).
Rather than serving a supportive, therapeutic role their task is described as the dispas-
sionate assessment of forensic issues (Greenberg & Shuman, 1997). As a result, the
approach of the clinician and the nature of the relationship are suggested to be in sharp
contrast to that normally found between psychologists and clients (Connell, 2015 cited
in Jackson & Roesch, 2015). Whereas psychologists in therapeutically oriented assess-
ments prioritise the maintenance of therapeutic relationships, it is argued that such
relationships do not exist in forensic assessments between the clinician and the indi-
vidual being assessed as he or she is not the clinician’s client, this position is occupied
by the referral agent (Monahan, 1980).
Despite the suggestion that people are most likely to take risks admitting to unde-
sirable acts if they are assured that support will continue (Marshall, 1994), and that
the therapeutic relationship has been suggested to be central to all work with offend-
ers (Ward & Stewart, 2003), the use of therapeutic relationship building skills and
techniques have been discouraged in forensic assessments (Shuman, 1993). Such
skills, which refer to manners of relating to another with the intention of providing
therapeutic support, may convey to the individual being assessed the existence of an
alliance which is argued to be beyond the reach of clinicians in this work (Shuman,
1993). Development of such an alliance is considered unethical in forensic
4 International Journal of Offender Therapy and Comparative Criminology 00(0)

assessments as confidentiality does not exist between the parties and a therapeutic
approach may mislead the assessee into thinking that it does (Shuman, 1993). The
therapeutic relationship results from the use of a well-developed empathic skill, the
implementation of which supports the recipient of the empathy to feel that he or she
is not alone (Keefe, 1980).
Therapeutic support, requiring the use of empathy, has been found highly benefi-
cial in nonforensic contexts for promoting self-disclosures (Dawson et al., 1984).
Although it has been suggested that the gathering of accurate information during
forensic assessments in terms of quantity and quality may be assisted by empathic
questioning (Melton et al., 2017), the appropriateness of its use is debated in forensic
assessments (Vera et al., 2019). The use of empathy in this context has been cautioned
by some authors as, in addition to impacting upon the clinician’s objectivity, empathy
in forensic assessments has been suggested to be unethical (Shuman & Zervopoulos,
2010). Employing empathic techniques in clinical interviews is argued to lower the
assessee’s defences and may promote the disclosure of crimes which are unprotected
in the assessment and damage the assessee legally (American Psychiatric Association,
1984 cited in Greenberg & Shuman, 1997). Although initial and later refreshed warn-
ings of confidentiality limits can be provided to protect the individual, Shuman
(1993) insisted that “an embellished warning is not enough in that empathetic tech-
niques are intended to break down resistance and to encourage self-disclosure with-
out censorship” (pp. 293–294).
In addition, it is argued to be unequivocally inappropriate to demonstrate awareness
of how the assessee feels or thinks as openly reflecting or restating the cognitive or
affective experience of the assessee implies the existence of a therapeutic relation
(Shuman, 1993). Other authors, however, have argued that such awareness is a desir-
able social skill which represents emotional intelligence and humanises the clinician
to the individual being assessed (Brodsky & Wilson, 2013). Rather than empathic
behaviours acting as potential tools for manipulation or seduction, Brodsky and Wilson
(2013) outlined that an empathic clinician, who can take another’s perspective, may be
a more ethical clinician. It has been argued elsewhere that where the clinician makes
serious effort to correct erroneous preconceptions of the individual being assessed, he
or she shouldn’t be precluded from utilising compassion and understanding in their
approach in recognition of the potential for the use of empathy to be necessary for
obtaining information required for the assessment (Melton et al., 2017). In such cir-
cumstances, empathy is considered not to be coercive, deceptive, or “unfair” as previ-
ously suggested (Melton et al., 2017). Although these issues have been discussed as
matters of personal opinion, the perspectives of practicing clinicians’ have yet to be
explored (Brodsky & Wilson, 2013).
Research on psychotherapy with offenders has identified that the clinician’s
approach and nature of the relationship with the client are vital to the outcome
(Marshall & Burton, 2010). Empathy and warmth were among the features of a clini-
cian’s style highlighted as accounting for between 30% and 60% of the variance in
treatment beneficial effects among sex offenders (Marshall, 2005; Marshall et al.,
2002). Given the importance of the style, attitudes, and relational approach of
Chawke et al. 5

clinicians towards their clients in psychotherapy (Ward & Maruna, 2007), research
focusing on clinicians’ approaches in FPAs may provide useful information on engag-
ing assessees in this process and ensuring accurate assessments of risk.

The Current Study

As a result of the reliance in court on psychological evidence, the findings of FPAs can
influence the outcome of the case, the individual involved, and the society at large
(Zappala et al., 2018). Accurately assessing the risk of reoffending in men who have
sexually offended is central to their effective management (Westwood et al., 2011).
The need to be precise in formulating offending, identifying risk, and developing treat-
ment recommendations in assessments is therefore paramount for rehabilitation and
public safety.
Despite the significant legal and emotional consequences of FPAs, there is a dearth
of research on this topic. How clinicians approach these assessments and the extent to
which they employ therapeutic skills, or are actively empathic, is not known at pres-
ent. In recognition of the significant consequences of FPAs necessitating this topic to
be empirically studied, the current study proposes to address the gap in the literature
by exploring practicing clinicians’ experiences and perceptions.

Method
Research Design and Analysis
Semi-structured interviews with qualified psychologists employed by a forensic psy-
chology service in the Republic of Ireland were used to gather data, later analysed
using Interpretative Phenomenological Analysis (IPA) methods.
The clinicians’ role comprised of conducting FPAs across a range of offending
behaviours. Within this, their remit was to administer psychological tests, collect col-
lateral information where possible, gather information in clinical interviews with the
referred individual to inform formulations, and allow them to score the individual on
a selected risk measure. Ethical approval was sought, and received, from a U.K.
Russell Group University Research Ethics Committee.
The primary focus of this study was to explore FPAs of men who have sexually
offended from the perspectives of clinicians. The aim was to understand a specific
phenomenon in the lives of the participants. Given that research questions should gov-
ern methodological approach (Corbin & Strauss, 2008), and that qualitative research
allows for detailed exploration of the experiences of individuals (Hennink et al., 2010),
a qualitative approach focusing on how individuals interpret and attribute meaning to
their experiences was considered fitting. The emphasis of IPA on the importance of the
individual’s account (Pringle et al., 2011) and focus on how a given person makes
sense of the phenomenon in a given context (Flowers et al., 2009) rendered it an
appropriate form of analysis for this study which aimed to seek in-depth information
regarding clinicians’ perceptions.
6 International Journal of Offender Therapy and Comparative Criminology 00(0)

Table 1. Participants’ Demographic Data.

Years’ experience conducting

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

Note. FPAs = forensic psychological assessments.

The methodology was motivated by principles of social constructionism. This

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

Participants
Consistent with IPA guidelines, sampling was purposive whereby selection criteria
were based on relevance to the research question (Back et al., 2011). Sampling
involved selecting a sample of individuals who could provide accounts of their per-
spectives and experiences of the topic of interest (Smith & Osborn, 2008). A homoge-
neous sample was sought of qualified psychologists employed at the service with a
minimum of 6 months experience conducting FPAs with men who have sexually
offended. Clinicians were invited to participate via email. For the purposes of this
study, and consistent with the terms of the service, an FPA was defined as including a
risk assessment thereby differentiating it from a psychological assessment.
Six female, Caucasian psychologists were interviewed between June and December
2018. See Table 1 for participants’ demographic data. All participants currently pro-
vide, or have in previous employment, provided therapy.

Data Collection
Semi-structured interviews were conducted with the aim of exploring the clinicians’
experience of conducting interviews in FPAs with men who have sexually offended.
An interview schedule was not developed as the technique of “not knowing” was
applied in data collection. Instead, topics of interest were generated prior to data
Chawke et al. 7

collection through discussions in supervision. There was a flexibility in the interviews

and while the topics of interest were explored with each participant, the time spent
exploring each area varied according to the participants’ individual contributions.
Interviews commenced with a deliberately broad and open-ended question. The
participants’ response guided the direction of the interview and following questions
were more focused and accompanied by prompts and clarifications where necessary.
The duration of interviews ranged from 30 to 45 min. Participants were previously
known to the interviewer in a professional capacity which served to reduce the need to
build rapport as the participants presented at ease on arrival. Interviews were recorded
using a Dictaphone and during transcription, identifying information was removed and
participants were given a unique code.

Process of Analysis
Data analysis followed IPA principles described by Flowers et al. (2009). The analytic
process consisted of familiarisation with the data and noting observations, comments,
and reflections in the left margin. Transcripts were re-read, and the recording listened
to, to gather new insights, facilitate immersion in the data, and allow recall of the
interview atmosphere (Pietkiewicz & Smith, 2014). During the note-making stage,
personal reflexivity was considered and, in line with the approach outlined by Flowers
et al. (2009), descriptive, linguistic, and conceptual comments were made.
Transformation of notes into themes titles occurred in the right margin whereby con-
cise phrases were developed from the initial notes to capture the essential quality of
the information in the text. Connections were sought between themes and a list of
superordinate themes and subordinate themes were compiled for each transcript.
Consistent with the idiographic commitment of IPA (Smith et al., 1995), each tran-
script was examined with an equally attentive exploration. Themes generated in the
analysis, and demonstrated in a final table, were compared, contrasted, and exempli-
fied with individual narratives. The themes identified in the final table (see Table 2
below) provided a persuasive account describing the perspectives of the participants.
These themes were described, illustrated with extracts from the participants’ tran-
scripts, and analysed in relation to existing theory. The findings therefore not only
include interpretative commentary linking the themes to theory but also the partici-
pants’ own account of their experiences using their own words thereby retaining the
voice of their personal experience and presenting the emic perspective.
Discussing observations made during the analytic process, themes, connections
identified and the preliminary results with the co-authors and qualified psychologists
in three group sessions served to ensure personal biases did not affect analysis, check
decision-making, and refine findings.

Findings and Discussion

The aim of this research was to explore clinicians’ experiences of conducting inter-
views in FPAs with men who have sexually offended. Three superordinate themes
were identified across all interviews (see Table 2).
8 International Journal of Offender Therapy and Comparative Criminology 00(0)

Table 2. Superordinate and Corresponding Subordinate Themes.

Superordinate themes Subordinate themes

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

The Interview is a Social Interaction

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

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

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

This is an important aspect of the clinician’s approach due to several characteris-

tics associated with this population. Research suggests that men who have sexually
Chawke et al. 9

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

You must “connect with him in a way that makes it easy for him to tell us his life story.” This
subordinate theme built on the clinicians’ awareness of how they interact influences
the assessee and referred to their attempts to ensure the assessees feels safe to share.
Clinicians’ recognised the importance of an engaging interpersonal style and
using interpersonal skills to engage the assessee in the interview. Edel referred to
“very basic stuff um you know engaging in small talk um you know did you get here
ok were you able to find the place, would you like a cup of tea you know checking
very basic human things.” It will be important to explore these attempts to engage
and the use of interpersonal skills with assesses as previous research suggests that
warmth, sociability, and other attributes required for rapport building may not neces-
sarily be viewed positively by recipients (Landy et al., 2016). In the absence of
honesty and compassion, these efforts may be regarded as purely strategic (Shingler
et al., 2018).
Clinicians emphasised the importance of their approach encompassing the Rogerian
core conditions. Clare explained that “I’m trying to make them you know feel com-
fortable and like as part of that you do have to bring in those Rogerian qualities.” In
addition to being empathic, congruent, and nonjudgemental (Rogers & Truax, 1967),
participants posited therapeutic skills as necessary to facilitate engagement. Anne
outlined the importance of “empathising about the fact that they are distressed or
empathising with you know like that sounds like a very difficult childhood, um para-
phrasing to help them move through that distress.” She explained the consequences
of not using these skills “if we don’t there is a sense that they could shut up, they can
close down.” Although it has been suggested elsewhere that the use of empathy may
be misleading (Shuman, 1993), consistent with Melton et al.’s (2017) position Clare
explained that this was not an attempt to be deceptive rather “that’s me being genu-
ine” but also that it positively impacts on information gathering “that’s how you get
the person to relax and to tell you more information and to open up and explore it a
bit more.”
In addition to using interpersonal and therapeutic skills to support assessees to
share openly, clinicians emphasised the need to develop a therapeutic relationship with
the assessee describing this connection as the cornerstone of a thorough FPA. Edel
10 International Journal of Offender Therapy and Comparative Criminology 00(0)

explained that “the value of the relationship in the assessment is really important and
I suppose it is the bedrock really for um the outcome of the assessment.” This
emphasis on the human connection, which clinicians felt “can’t be underestimated,”
has been discussed in the literature in terms of its importance in cultivating produc-
tive working relationships (Blagden et al., 2016). It is consistent with the Good
Lives Model (GLM) which posits the therapeutic alliance and working in a respect-
ful and empathic manner as crucial to assessment with offenders and important for
motivating engagement (Ward & Stewart, 2003). Bridget explained the importance
of the therapeutic relationship in terms of “creating that space where someone feels
comfortable enough to talk about the most shameful aspects of their life but also the
most abusive or victimisations that they have experienced.” Indeed, the clinicians’
considered that the assessment would be negatively influenced by the lack of a rela-
tionship. Danielle outlined that “if you don’t have that therapeutic alliance, I think
you are just going to hit a barrier and I think you are just going to get factual detail.”
Fran cautioned that without this relationship “they are probably not going to trust
you as much and may not confide in you as much as they would otherwise.” The
centrality of the relationship to the assessment was demonstrated in their assertion
that a comprehensive assessment was not possible in its absence as they would only
receive factual information from the assessee, the assessment would lack depth and
their formulation would suffer. Indeed, the relationship has been recognised in exist-
ing psychological literature as imperative to change (Edwards & Loeb, 2011), vital
in therapy (Knox, 2008), and important in assessment feedback (Finn & Tonsager,
1992). Although participants were aware of the potential dangers of this relation-
ship, they considered that being open and transparent about limitations offered suf-
ficient protection to the assessee.
This finding that practicing clinicians support the development of a therapeutic
relationship in forensic assessments refutes the arguments in the literature that such a
relationship is inappropriate in this context. It raises concerns, however, concerning
how this practice impacts upon assessees. Exploring the potential for them to confuse
the limits of confidentiality and make damaging self-disclosures, particularly those
who have experienced a therapeutic relationship previously in interventions, will
allow greater consideration of the impact on the individual being assessed. Furthermore,
it will be important to consider the potential for assessees to feel vulnerable following
their disclosure of sensitive information in a context where they cannot be supported
due to the short-term nature of the relationship.
For the clinicians, this practice while beneficial in terms of supporting the develop-
ment of trust with the assessee may prove challenging as they attempt to balance their
professional responsibilities, duties, and boundaries while also connecting with the
assessee in a manner which enables them to share their story and develop a working
relationship with them. Shingler et al. (2018) spoke of the balance which must be
struck by psychologists in forensic assessments whereby they attempt to adopt an
interpersonal style which is not overly formal, as this has been previously noted as
problematic resulting in offenders feeling suspicious and withdrawing, which is
Chawke et al. 11

engaging yet does not compromise their professional integrity, judgement, or the
assessee’s best interests. Although the clinician’s placed value on the relationship with
the assessee, it raises questions concerning the impact on the assessee and likely poses
challenges for the clinicians themselves as they attempt to maintain appropriate pro-
fessional boundaries yet engage with the assessees as human beings, support them to
feel safe to share yet not mislead into sharing information. Having identified the clini-
cian’s perspectives, it will be important to explore this practice with assessees and
determine whether they concur from their experience that the benefits of the relation-
ship outweigh the potential risks.
The clinician’s recognition of the importance of empathy in the interview adds to a
debate in the literature on the appropriateness of empathy in forensic assessments.
Although empathising with individuals is intended to help them feel understood, use
of empathy in forensic assessments has been argued to be harmful to individuals as it
may lower their defences and lead to damaging self-disclosures (Shuman, 1993). It has
been recognised that empathic techniques can be used to protect assesses from harm in
assessment interviews, however, research suggests that clinicians may not be able to
accurately distinguish between inappropriate use of empathy to gain information and
empathy to protect the assessee (Shuman & Zervopoulos, 2010). However, given that
research has found this population to appreciate clinicians being understanding,
respectful, and caring towards them (Youssef, 2017) and to be sensitive to a lack of
empathy in clinicians (Beech & Mann, 2002) an accurate assessment may arguably be
reliant on an empathic approach. Indeed, empathy is suggested to provide the basis for
individuals to be heard and understood which is anticipated to result in them being
more likely to honestly share their experiences (Marshall et al., 2002). As such a prob-
lem arises, the use of empathy in FPAs may result in damaging self-disclosures by an
assessee but the absence of it may result in a superficial and inaccurate assessment. It
will be important to explore the emphasis placed by clinicians on the importance of
using empathy in the interview with assessees.
The recognition within this theme of the need to approach the assessment with
empathy, prepared to use therapeutic skills and with the intention of building a thera-
peutic relationship with the assessee contradicts the suggestions of previous authors
(e.g., Shuman, 1993) that the differences between therapy and assessments necessitate
a different approach. This may be best understood within the following superordinate
theme which considers how the distinctions in the literature drawn between these tasks
are not so clear in practice.

Therapeutic Components Blur the “Clear Line” Between Therapy and

Assessments
The role and approach of the clinician in forensic assessments is differentiated in the
literature from that of the clinician in therapy (Greenberg & Shuman, 1997). This
superordinate theme and the underlying subordinate themes captured the overlap
which exists in practice in differentiating between these tasks.
12 International Journal of Offender Therapy and Comparative Criminology 00(0)

Reminding the “therapist in you” that this “is an assessment, so the aim is not to provide
therapy here” but “the contact that I have with them might help.” It was clear from the
clinicians’ report that they identified the inherent differences between assessment and
intervention work. Participants referred to differences in purpose, for example, Fran
outlined that “you are not really trying to achieve any change through the assessment,”
role and time allowances, for example, Edel explained that

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

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

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

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

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

Anne agreed
Chawke et al. 13

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

This is consistent with the assertion by Proulx et al. (2000) that risk assessment inter-
views are an opportunity to promote offender’s cooperation with risk management,
and engagement in either current or future intervention.
Clinicians identified that whether the referral is for assessment or therapy, they use
the same skills. Danielle reported “it’s definitely the same the same set of skills,” she
elaborated

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

Although differences were acknowledged between therapy and the relationship “which
wouldn’t be as deep because um yup it never gets to develop to that point,” how the
clinicians thought they interacted was the same. Despite suggestions in the literature
that clinicians should adopt a supportive approach when acting in care provision roles
and a detached approach in forensic assessments (Greenberg & Shuman, 1997),
Danielle disagreed suggesting that “how you are as a psychologist I hope isn’t any
different in terms of how you would respond or react.”
Given the characteristics associated with men who have sexually offended and
resultant suggestions for clinician approaches in treatment, it is arguably of impor-
tance that clinicians do maintain the same warm, engaging, and supportive approach
in assessment. To change to a more formal, detached approach in assessments would
likely result in assesses withdrawing or not feeling comfortable to share resulting in an
assessment which lacks detail and depth. It is unclear how feasible adopting such an
approach would be for clinicians as a result of their training and personal biases.
Indeed, Greenberg and Shuman (1997) suggested that psychologists, by virtue of their
work in the caring professions, may find it difficult to close off empathically to the
assessee’s needs and vulnerabilities. This may impact upon their experience of over-
laps and also on how disclosures made by the assessees are interpreted, for example,
where an assessment is considered to have therapeutic value disclosures of further
crimes by the assessee may not be recognised as a mistake but as development and
taking responsibility.
This overlap highlighted between assessment and intervention raises important
considerations for assessees. If clinicians experience overlaps between these types of
referrals in practice, it is important to explore if assesses do also and if this impacts on
their engagement and disclosures. Should assessees also recognise the therapeutic
value of the assessment, this may have important implications for their rehabilitation
as they may be more inclined following a positive experience to engage in future treat-
ment than if they had experienced a distant and formal assessment with a clinician
focused solely on scoring a risk assessment measure.
14 International Journal of Offender Therapy and Comparative Criminology 00(0)

The Power Imbalance

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

The clinician taking the lead. It was clear from the participants’ responses that they were
in a position of power and exercised control in the assessment. Bridget explained “you
are taking the lead so it’s much more directive in a sense you are guiding the way it
goes.” This control is consistent with the need described by Logan (2013) for clini-
cians to have a clear purpose and direction, remaining imperceptibly in control of the
interview. Clinicians recognised how their skills, approach, and power in the session
could disarm the assessee and they appeared to engage in practice to try to rebalance
this power. It appeared important to clinician that assesses made informed choices
about their disclosures.
Participants demonstrated attempts to ensure assessees were fully informed of the
assessment process. Danielle reported that “the first meeting for me is about my infor-
mation sharing, what the assessment is about, what they can expect, the information I
am going to be asking them about” she elaborated “I set my store all out for them so
they know when they are coming in here what to expect.” Their sharing of information
may be considered to be demonstration of their awareness of the assessee’s needs as
human beings for clarity (Shingler et al., 2018). Clinicians recognised the importance
of reiterating the limits of confidentiality in the interview to ensure that assessees
make informed decisions about their disclosures and that they were afforded choices
to the greatest extent possible. Edel explained that “you need to let them know so they
can then make that choice.” Their attempts to do so echoed the importance of engaging
assessees collaboratively in the assessment, which has been identified by previous
research as allowing assessees to have as much choice as possible in the circumstances
(Shingler et al., 2018). This practice of reminding the assessees of the limits of confi-
dentiality represents the clinicians’ recognition of the power they hold in the interview
to elicit disclosures (Kvale, 2006) from the assessees which may not be of benefit to
them. Navigating challenging power differences has been previously identified as of
crucial importance in risk assessment interviews and an aspect which has been linked
to the development of a human connection (Lewis, 2016).
Despite recent research emphasising the importance of collaborative risk assess-
ment, the clinician’s demonstrated considerable power and control in the assessment.
Given that assessees in forensic assessments are often coerced into engaging (Heilbrun
et al., 2014), it will be important to consider how assessees experience this imbalance.
Offenders in prison have reported feeling more free to participate in interviews where
they are conducted on an equal footing (Shepherd, 1991) which may be something to
consider further as there is the potential for assessments to feel like something done to
assessees. A more collaborative assessment, however, may be challenging for clini-
cians to conduct where time restraints exist and there are particular topics necessary to
Chawke et al. 15

cover to score the risk assessment measure necessitating a focus on information

gathering.

Limitations and Future Research

The findings of this study are limited by the gender-biased sample. All the participants
were female, as such it is not possible to comment on the extent to which the results
are generalisable to male psychologists. Furthermore, psychologists who completed a
counselling psychology training route were overrepresented in the sample. Counselling
psychology aligns itself with humanistic theory (Mearns et al., 2013), in particular
person-centred theory (Rogers, 1951), which may have influenced the findings.
However, given the lack of a forensic psychology training route in Ireland, these find-
ings are relevant and informative as many psychologists from clinical and counselling
psychology training routes work in forensic settings. Finally, the findings may be lim-
ited as a result of the voluntary nature of participation (Shingler et al., 2018). It is
possible that clinicians who volunteered to take part had positive experiences of con-
ducting FPAs with men who had sexually offended. As such it is unclear whether their
attitudes are representative of the wider population of clinicians engaging in this work.
Despite these limitations, the findings of this study nonetheless represent a starting
point in understanding an area of clinical practice in forensic psychology which has
been under researched. Further research is necessitated taking these limitations into
consideration and exploring the extent to which the current findings can be applied to
a wider population of clinicians both in community and secure settings with male and
female psychologists.

Conclusion
This study researched the experience of six clinicians in conducting FPAs of men who
have sexually offended. Themes identified in this study emphasise the importance of
the therapeutic relationship with offenders, humanisation, and the therapeutic poten-
tial of assessment work. The findings, which were discussed in relation to similarities
with previous research and ethical implications, highlight the relational/social nature
of the interaction. The idea of FPAs being therapeutic and more than just an assess-
ment of risk is a theme which arose in this study. Although discussion on this topic has
referred to the differences between forensic assessments and therapy, this research
highlighted that in the clinician’s experiences these theoretical differences become
somewhat less clear in practice. The IPA methodology enabled a thorough exploration
of how their understanding of the somewhat blurred line between assessments and
therapy impacts upon the role and approach of the clinician in interviews. The poten-
tial implications for assessees of this finding were considered and how an alternative
approach could impact on the accuracy of the assessment as a result of the character-
istics associated with this population. In terms of implications for practice, this
research has highlighted the complexities involved in conducting presentence FPAs,
awareness of which may influence more conscientious and ethical practice. This study
16 International Journal of Offender Therapy and Comparative Criminology 00(0)

has addressed an area of forensic practice which has rarely been explored in research
and this will be investigated further in an on-going study exploring these findings
with, and the experiences of, individuals who have undergone psychological assess-
ments following their engagement in sexual offending behaviour.

Declaration of Conflicting Interests

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

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

ORCID iDs
Gemma Chawke https://orcid.org/0000-0003-4012-3948
Simon C. Duff https://orcid.org/0000-0003-4844-5992

References
Back, C., Gustafsson, P. A., Larsson, I., & Berterö, C. (2011). Managing the legal proceedings:
An interpretative phenomenological analysis of sexually abused children’s experience with
the legal process. Child Abuse & Neglect, 35(1), 50–57.
Beech, A. R., Fisher, D. D., & Thornton, D. (2003). Risk assessment of sex offenders.
Professional Psychology: Research and Practice, 34(4), 339–352.
Beech, A. R., & Mann, R. (2002). Recent developments in the assessment and treatment of sex-
ual offenders. In: J. McGuire (Ed.), Offender rehabilitation and treatment (pp. 259–288).
Hoboken, NJ: John Wiley & Sons.
Blagden, N., Winder, B., & Hames, C. (2016). “They treat us like human beings”—Experiencing
a therapeutic sex offenders prison: Impact on prisoners and staff and implications for treat-
ment. International Journal of Offender Therapy and Comparative Criminology, 60(4),
371–396.
Brodsky, S. L., & Wilson, J. K. (2013). Empathy in forensic evaluations: A systematic recon-
sideration. Behavioral Sciences & the Law, 31(2), 192–202.
Burchfield, K. B., & Mingus, W. (2008). Not in my neighborhood: Assessing registered sex
offenders’ experiences with local social capital and social control. Criminal Justice and
Behavior, 35(3), 356–374.
Corbin, J., & Strauss, A. (2008). Strategies for qualitative data analysis. In J. Corbin & A.
Strauss (Eds.), Basics of qualitative research: Techniques and procedures for developing
grounded theory (3rd ed., pp. 67–85). Sage.
Craig, L. A., & Beech, A. R. (2010). Towards a guide to best practice in conducting actu-
arial risk assessments with sex offenders. Aggression and Violent Behavior, 15(4),
278–293.
Dawson, C., Schirmer, M., & Beck, L. (1984). A patient self-disclosure instrument. Research in
Nursing & Health, 7(2), 135–147.
Chawke et al. 17

Edwards, J., & Loeb, S. (2011). What difference does counselling make? The perceptions
of drug-using clients on low incomes. Counselling and Psychotherapy Research, 11(2),
105–111.
Finn, S. E., & Tonsager, M. E. (1992). Therapeutic effects of providing MMPI-2 test feedback
to college students awaiting therapy. Psychological Assessment, 4(3), 278–287.
Flowers, P., Larkin, M., & Smith, J. A. (2009). Interpretative phenomenological analysis:
Theory, method and research. Sage.
Gannon, T. A., Beech, A. R., & Ward, T. (2008). Does the polygraph lead to better risk predic-
tion for sexual offenders? Aggression and Violent Behavior, 13(1), 29–44.
Greenberg, S. A., & Shuman, D. W. (1997). Irreconcilable conflict between therapeutic and
forensic roles. Professional Psychology: Research and Practice, 28(1), 50–57.
Harris, A. J. R., & Hanson, R. K. (2010). Clinical, actuarial and dynamic risk assessment of sex-
ual offenders: Why do things keep changing? Journal of Sexual Aggression, 16(3), 296–310.
Heilbrun, K., DeMatteo, D., Holliday, S. B., & LaDuke, C. (Eds.). (2014). Forensic mental
health assessment: A casebook. Oxford University Press.
Hennink, M., Hutter, I., & Bailey, A. (2010). Qualitative research methods. Sage.
Jackson, R., & Roesch, R. (Eds.). (2015). Learning forensic assessment: Research and practice.
Routledge.
Keefe, T. (1980). Empathy skill and critical consciousness. Social Casework, 61(7), 387–393.
Kjelsberg, E., & Loos, L. H. (2008). Conciliation or condemnation? Prison employees’ and
young peoples’ attitudes towards sexual offenders. International Journal of Forensic
Mental Health, 7(1), 95–103.
Knox, R. (2008). Clients’ experiences of relational depth in person-centred counselling.
Counselling and Psychotherapy Research, 8(3), 118–124.
Kvale, S. (2006). Dominance through interviews and dialogues. Qualitative Inquiry, 12(3),
480–500.
Landy, J. F., Piazza, J., & Goodwin, G. P. (2016). When it’s bad to be friendly and smart: The
desirability of sociability and competence depends on morality. Personality and Social
Psychology Bulletin, 42(9), 1272–1290.
Lewis, S. (2016). Therapeutic correctional relationships: Theory, research and practice.
Routledge.
Logan, C. (2013). Risk assessment: Specialist interviewing skills for forensic practitioners. In
C. Logan & L. Johnstone (Eds.), Managing clinical risk: A guide to effective practice (pp.
259–292). Routledge.
Losantos, M., Montoya, T., Exeni, S., Santa Cruz, M., & Loots, G. (2016). Applying social con-
structionist epistemology to research in psychology. International Journal of Collaborative
Practice, 6(1), 29–42.
Manetta, C. T., Gentile, J. P., & Gillig, P. M. (2011). Examining the therapeutic relationship and
confronting resistances in psychodynamic psychotherapy: A certified public accountant
case. Innovations in Clinical Neuroscience, 8(5), 35–40.
Marshall, W. L. (1994). Treatment effects on denial and minimization in incarcerated sex
offenders. Behaviour Research and Therapy, 32, 559–564.
Marshall, W. L. (2005). Therapist style in sexual offender treatment: Influence on indices of
change. Sexual Abuse: A Journal of Research and Treatment, 17(2), 109–116.
Marshall, W. L., & Burton, D. L. (2010). The importance of group processes in offender treat-
ment. Aggression and Violent Behavior, 15(2), 141–149.
Marshall, W. L., Serran, G., Moulden, H., Mulloy, R., Fernandez, Y. M., Mann, R., & Thornton,
D. (2002). Therapist features in sexual offender treatment: Their reliable identification and
18 International Journal of Offender Therapy and Comparative Criminology 00(0)

influence on behaviour change. Clinical Psychology & Psychotherapy: An International

Journal of Theory & Practice, 9(6), 395–405.
Mearns, D., Thorne, B., & McLeod, J. (2013). Person-centred counselling in action. Sage.
Melton, G. B., Petrila, J., Poythress, N. G., Slobogin, C., Otto, R. K., Mossman, D., & Condie,
L. O. (2017). Psychological evaluations for the courts: A handbook for mental health pro-
fessionals and lawyers. Guilford.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing (2nd ed.). Guildford.
Monahan, J. E. (1980). Who is the client? The ethics of psychological intervention in the crimi-
nal justice system. American Psychological Association.
Murphy, W. D., & McGrath, R. (2008). Best practices in sex offender treatment. Prison Service
Journal, 178, 3–9.
Nelson-Jones, R. (2015). Basic counselling skills: A Helper’s manual. Sage.
Newman, C. F. (1994). Understanding client resistance: Methods for enhancing motivation to
change. Cognitive and Behavioral Practice, 1, 47–69.
Phenix, A., & Hoberman, H. M. (Eds.). (2015). Sexual offending: Predisposing antecedents,
assessments and management. Springer.
Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative phenomenologi-
cal analysis in qualitative research psychology. Psychological Journal, 20(1), 7–14.
Pringle, J., Drummond, J., McLafferty, E., & Hendry, C. (2011). Interpretative phenomenologi-
cal analysis: A discussion and critique. Nurse Researcher, 18(3), 20–24.
Proulx, J., Tardif, M., Lamoureux, B., & Lussier, P. (2000). How does recidivism risk assess-
ment predict survival? In D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking relapse
prevention with sex offenders: A sourcebook (pp. 466–484). Sage.
Rogers, C. R. (1951). Client-centered therapy: Its current practice. Houghton Mifflin.
Rogers, C. R., & Truax, C. B. (1967). The therapeutic conditions antecedent to change: A
theoretical view. In C. R. Rogers (Ed.), The therapeutic relationship and its impact:
A study of psychotherapy with schizophrenics (pp. 97–108). University of Wisconsin
Press.
Sandhu, D. K., & Rose, J. (2012). How do therapists contribute to therapeutic change in sex
offender treatment: An integration of the literature. Journal of Sexual Aggression, 18(3),
269–283.
Shepherd, E. (1991). Ethical Interviewing. Policing, 7(1), 42–60.
Shingler, J., Sonnenberg, S. J., & Needs, A. (2018). Risk assessment interviews: Exploring
the perspectives of psychologists and indeterminate sentenced prisoners in the United
Kingdom. International Journal of Offender Therapy and Comparative Criminology,
62(10), 3201–3224.
Shuman, D. W. (1993). The use of empathy in forensic examinations. Ethics & Behavior,
3(3–4), 289–302.
Shuman, D. W., & Zervopoulos, J. A. (2010). Empathy or objectivity: The forensic examiner’s
dilemma? Behavioral Sciences & the Law, 28(5), 585–602.
Smith, J. A., Harré, R., & Van Langenhove, L. (1995). Idiography and the case study. Rethinking
Psychology, 1, 57–69.
Smith, J. A., & Osborn, M. (2008). Interpretative phenomenological analysis. In J. A. Smith
(Ed.), Qualitative psychology: A practical guide to research methods (pp. 53–80). Sage.
Vera, L. M., Boccaccini, M. T., Laxton, K., Bryson, C., Pennington, C., Ridge, B., & Murrie,
D. C. (2019). How does evaluator empathy impact a forensic interview? Law and Human
Behavior, 43(1), 56–69.
Chawke et al. 19

Wakefield, H. (2006). The vilification of sex offenders: Do laws targeting sex offenders increase
recidivism and sexual violence. Journal of Sexual Offender Civil Commitment: Science and
the Law, 1(1), 141–149.
Ward, T., & Maruna, S. (2007). Rehabilitation. Routledge.
Ward, T., & Stewart, C. A. (2003). The treatment of sex offenders: Risk management and good
lives. Professional Psychology: Research and Practice, 34(4), 353–360.
Westwood, S., Wood, J., & Kemshall, H. (2011). Good practice in eliciting disclosures from sex
offenders. Journal of Sexual Aggression, 17(2), 215–227.
Youssef, C. (2017). The importance of the therapeutic alliance when working with men who
have committed a sexual offence. Journal of Criminal Psychology, 7(3), 206–220.
Zappala, M., Reed, A. L., Beltrani, A., Zapf, P. A., & Otto, R. K. (2018). Anything you can
do, I can do better: Bias awareness in forensic evaluators. Journal of Forensic Psychology
Research and Practice, 18(1), 45–56.