Search

Background: Violence against people in need of care is a challenge for long-term care situations. Sexual violence in particular, is subject to strong taboos and has so far been little researched. Family physicians can play a role in preventing violence against people in need of care., Objective: The objective of this study was to examine family physicians' attitudes to their responsibilities in cases of sexual abuse of patients in need of care. At the same time, we also examined subjective confidence in relation to the procedure in cases of suspected abuse and family physicians' interests in further training on this topic., Material and Methods: A cross-sectional study addressed to 1700 family physicians in Germany with a written survey between September and November 2016. Questionnaires from 302 physicians could be evaluated for the study., Findings: Almost all respondents saw it as part of their responsibility as doctors to intervene in cases of sexual abuse of patients in need of care. There is great uncertainty about how to proceed in cases of suspected sexual abuse of patients in need of care. Respondents' main interest in further training related to the differential diagnosis of sexual abuse and the correct procedure in cases where abuse is suspected., Conclusion: Further training provision, particularly on the signs of sexual abuse of people in need of care, could contribute to increasing family physicians' confidence to act., (© 2021. The Author(s).)

ReSi: Evaluation of a Program for Competency Training and Prevention of Sexual Abuse in Kindergarten This paper describes the "ReSi-Kompetenzförderprogramm" and its evaluation. Based on the resilience approach, this programme aims to foster the social-emotional, body-related and linguistic competencies of kindergarteners and teach them age-appropriate preventive knowledge concerning sexual abuse. A randomized-controlled trial was conducted (n = 412). At three different points in time the Kindergarten teachers and the parents filled in questionnaires about the children's competency development. To assess the knowledge and action strategies of the children, standardisized children interviews were conducted. Effects of the programme were found for self-assertion, stress management, communicative and interactional competencies, body-related competencies, conflict resolution competence and the communicative behaviour. Besides, children in the intervention group show greater knowledge about body parts, emotions and action strategies in security-relevant situations.

Prevention of sexual violence against children and adolescents obtains high priority in educational contexts. This is due to the massive (possible) psychosocial impacts of sexual victimization as well as to the considerable prevalence rates that are reported in current studies. Preventive approaches are predominantly native to violence prevention and sex education where they are characterized by independent lines of tradition and positions. This contribution outlines their empirically largely unexplained relation with a focus on the history and development of the discourses of sex education. Diverging disciplinary attempts of positioning towards the prevention of sexual violence reveal an area of conflict between sex-positive and preventive educational objectives. A primacy of preventive contents is seen to be threatening a comprehensive sex education that emphasizes the positive aspects of sexuality. On the other hand, its standards are opposed to excluding and to tabooing sexual violence as a topic. Yet unfinished is therefore the search for a "third way" that might transfer the opposites of both approaches into integrative educational concepts. Unsettled questions about possible contributions of sex education to the prevention of sexual violence, and especially to which extent they are sensitive to difference are discussed based on international research and the theory of sex education.

In the following article similarities and differences concerning the treatment of sex offenders in the psychiatric forensic commitment (§ 63 German penal code) and of persons with a self-reported sexual interest in children, who were diagnosed and treated in the outpatient prevention of sexual abuse (PSM) in Göttingen are demonstrated. Diagnostic and therapeutic characteristics of outpatient prevention as well as the initial results of the evaluation of the Göttingen therapy manual are presented and differentiated from the normal treatment program in psychiatric forensic commitment.

Several studies point to various barriers in achieving sexual self-determination for people with disabilities as well as a high degree of thematic uncertainty among staff in residential homes. In addition, women with disabilities and people in institutions are especially at risk in a particular way, to be victims of sexual violence. The ReWiKs project develops, based on evaluated guidelines for sexual self-determination, materials in order to reflect the institutional handling of the subject. Training modules and recommendations are also developed. In addition, extracts of materials are created in simple language. All materials are evaluated before their publication in an intensive theory-practice dialogue.

Objective: Investigation of two questions: first, whether sexual/forensic therapists are able to make valid assessments for future criminal behavior and second, whether their treatment changes factors relevant for new offences., Methods: First, the predictive validity for recidivism of HCR-20 and SAPROF were tested. Second, the dynamic scales of both instruments were analyzed concerning changes during treatment process., Results: Both instruments showed good predictive validity. The dynamic scales scores of HCR-20 did not change, whereas the I- and M-scale scores of SAPROF increased statistically significant., Conclusion: The therapists were able to identify high-risk clients and seemed to mainly focus their interventions towards factors associated with new offences., (© Georg Thieme Verlag KG Stuttgart · New York.)

Domestic violence and sexual violence are widespread and have serious health effects for those affected. If the problem is identified and confidence in responding exists, healthcare providers can make a significant contribution to support and intervention. In 2013 the WHO published evidence-based guidelines for responding to the issue in healthcare, training of healthcare providers and health policy. In principle, the guidelines confirm existing recommendations, best-practice guidelines and handbooks. They also encourage a review and further development-for example, regarding the issue of sexual violence. If and how the present recommendations are put into practice in healthcare and training of healthcare staff can currently be looked at only with the use of examples, given the lack of data in Germany. Examples from Berlin show that implementation is quite possible. However, there is a lack of clear mandate, of sustainability and of obligation. Existing good practice models are highly reliant on organisations' and employees' commitment. For Germany, the WHO guidelines indicate the need to develop national standards for healthcare in cases of domestic and sexual violence. A (legal) obligation for the healthcare system should be drawn up. A systematic embedding in training curricula of health care professions is needed. Quality assurance and a systematic evaluation of the practical implementation are required.

Background: The Forensic Therapeutic Outpatient Clinic (FTA) in Berlin targets the professional aftercare treatment of classified high-risk violent and sexual offenders released from prison or forensic psychiatric hospitals., Patients and Methods: A comparison sample (n = 32) matched to the patients of the FTA (complete survey n = 32) according to similar criminal histories and diagnoses (ICD-10) was collected from offenders released from prison and forensic psychiatry at a time before the FTA was established. The focus of the study was on recidivism measured by complaints received by police departments during the follow-up period., Results: Sexual recidivism occurred significantly later in the case of released offenders with aftercare treatment compared to those without. Moreover, for the duration of aftercare treatment the general risk of recidivism was approximately 85 % lower; however, after termination of treatment the recidivism rates of both samples converged to almost the same level., Conclusion: Individually adapted measures should be maintained after finishing aftercare treatment; however, because prisoners released from prison are frequently less prepared than patients from forensic psychiatric hospitals, the therapeutic work often reaches its limits in these cases. Therefore, social work should be taken into account right from the start.

Interpersonal violence represents a widespread phenomenon with a high prevalence. Consequences of these acts of violence are serious and extensive to the victims and from a socio-economic point of view. Physical examination of the victims is a key aspect in the medic-legal expertise. This article describes the basic principles and the standard procedures in conjunction with the examination of violent crime victims.

Unlabelled: A case report shows that a patient could make a progress in his therapy with the help of professional behavioural analysis after a 14-year period of stagnating forensic therapy. The method of behavioural analysis represents a criminalistic tool to reconstruct and to analyse an offence on the basis of objective data. Nowadays this method is also used successfully in individual cases in the field of forensic psychiatry. The article shows and discusses the methodology and the current use of behavioural analysis in forensic psychiatry., Conclusion: professional behavioural analysis of offences of certain forensic patients provides an additional benefit for their therapy and their risk assessment. This kind of approach should be intensified by increasing cooperation with behavioural analysis units and by further training for forensic therapists.

When children and adolescents show deviant sexual behavior, co-operation between institutions of the youth welfare service is necessary in order to prevent further assaults. As a part of the Hamburg model project for minors who are at risk for sexual offending we evaluated the existing case-unspecific co-operation between the city's institutions. Selection of the sample resulted in a diagram of co-operation between institutions that have or might have contact to sexual deviant children or juveniles. By analyzing 147 online-surveys, comprising quantitative as well as qualitative questions, revealed a comprehensive system rich in resources but only little case-unspecific cooperation. Highest average rating in co-operation was given to the non-governmental institutions and the police. The inquiry of reasons for the co-operation indicated a demand for specialized diagnostics and advice. Positively evaluated were an efficient and fast processing, an unbureaucratic handling of the case and constant availability. Pointed out negatively were "not-reacting", trivializing and a lack of capacities. In order to improve the level of information and the range of intervention programs, training of professionals in school and the youth welfare service is needed.

Objective: Evaluation of the relationship between antiandrogenic therapy of sexual offenders and home leave steps in a forensic psychiatric hospital., Methods: Retrospective evaluation of all sexual offenders (n = 79) who were treated in the forensic psychiatric hospital Berlin between the 1.1.1998 and the 1.1.2005., Results: There is an increase in the number of patients treated with antiandrogenic medication during the observed time period. Patients under this kind of pharmacotherapy receive higher grades of home leave steps., Conclusions: As possible reasons for the observed changes we discuss the contemporaneous implementation of a new pharmacotherapeutic treatment option (LHRH-agonists) and an aggravation of the German criminal law for sexual offenders.

Expert testimonies and judges of 224 lawsuits of the years 1991 to 2001, who lead to the order of Preventive Detention in the German federal states of Bavaria, Brandenburg, Northrhine Westfalia and Saxony were analysed. Offenders with the order of Preventive Detention have mostly committed violent and/or sexual offences. Nearly two third of the inmates show personality traits with relevance for psychiatry or even personality disorders. Thus the discrimination between forensic psychiatric measurements and preventive detention is difficult. The quality of forensic psychiatric reports does not reflect the complexity of this task. They show diagnostic and prognostic weaknesses.

Objective: In recent years, the offense preventive effect of forensic therapy has been the subject of controversial debate. In this review, the current state of therapy evaluation research in forensics is discussed, with special consideration of methodological aspects., Methods: Systematic research of literature on studies that analyse the risk-reducing effect of offender therapies., Results: The study designs are very heterogeneous and results are thus difficult to compare. Furthermore, there are only a few empirical studies on the relapse prevention efficiency of forensic therapies., Conclusions: Due to the methodological diversity of the studies, a concluding evaluation of the efficiency of forensic psychotherapies is not possible. The conclusions drawn from meta-analyses must thus be interpreted with great care.

Sexual offences are a heterogeneous group of offences that entail very different diagnostic categories relevant for key issues of expert assessment. Sexual offender trials usually deal with issues related to (diminished) responsibility and the necessity of a referral to a forensic psychiatric hospital ( section sign 63 StGB, German penal code). Furthermore, risk assessment is seen as a necessary precondition for relapse prevention and consequently, it forms part of any expert assessment in sex offender trials. In terms of treatment, manualized treatment programs prevail. Usually they lend themselves to psycho-educative, cognitive-behavioral and psychodynamic concepts. Notwithstanding the focus of any individual program, core elements of all programs pertain to offence related (e.g., victim empathy, attitudes and individual values, minimizations, etc.) and more general psychotherapy modules (anger management, substance abuse, social skills training, etc.). Advantages and disadvantages of these programs are named and discussed.

Sexual offenders are a heterogeneous group of offenders with different personality structures and different patterns of crime. As a consequence, difficulties arise with the definition of sexually deviant or offending behaviour, which depends on period of time and culture. After presenting the actual definition of sexual offences, their frequency is shown by means of German epidemiological data. The problem of the assumed relationship between paraphilia and sexual offending behaviour is called into question. After the description of the central neurobiological and endocrinological mechanisms, the established pharmacological treatment strategies (Selective Serotonine Reuptake Inhibitors, Antiadrogenes, LHRH (Luteotropic Hormone Releasing Hormone)-Agonists) are presented. Finally, the step-wise algorithm for the therapy of sexual according to Bradford is presented.

Internet pornography has been regarded as either stimulating sexual aggression and abuse or as serving as a safety valve. This controversy is an important issue in health, media and legal politics. According to empirical studies on pornography in general, soft-core pornography and nonviolent pornography can be regarded as harmless, whereas non-violent hard-core pornography and violent pornography may increase aggression. Individuals with a high risk for sexual aggression show more interest in violent pornography and are stimulated more strongly through such material. Two case histories illustrate the characteristics of internet pornography and "cybersex": easy access, anonymity, affordability, wide range and deviation of the material, unlimited market, blurring the borders between consumer and producer, interactive communication, space for experimenting between fantasy and in real-life behavior, virtual identities, easy contact between offender and victim or among offenders, and low risk of apprehension. The phenomenon of "sexual addiction" (or paraphilia- related disorder) is particularly relevant for the problematic use of internet pornography. Preventive measures to protect possible victims are presented as well as treatment strategies for offenders. Beside limiting access to the internet, these include therapy of comorbid psychiatric disorders and psychological problems (social isolation, bereavement, stress- and anger-management, guilt and shame, childhood traumata, cognitive distortion, victim empathy), psychopharmacotherapy and the enhancement of a more integrative and relationship-oriented sexuality.

Over recent years, there has been an increase in adolescent delinquency in Germany and Switzerland. In this context, the episodic character of the majority of adolescent delinquency is usually pointed out; however, numerous studies show high re-offending rates for released adolescents. The goal of this study is to examine the legal probation of juvenile delinquents after release from penal reformative training. In this study, the legal probation of adolescents committed to the AEA Uitikon, in the Canton of Zurich, between 1974 and 1986 was scrutinized by examining extracts from their criminal record as of 2003. The period of catamnesis was thus between 17 and 29 years. Overall, 71% of offenders reoffended, 29% with a violent or sexual offence. Bivariate logistic regression showed that the kind of offence committed had no influence on the probability of recidivism. If commitment to the AEA was due to a single offence (as opposed to serial offences), the risk of recidivism was reduced by 71% (OR=0.29). The results of the study show that young delinquents sentenced and committed to penal reformative training have a high recidivism risk. Furthermore, the results point out the importance of the evaluation of the offense-preventive efficacy of penal measures.

In order to evaluate risk assessment instruments for sex offenders in Germany, we compared the predictive validity of the Static-99, HCR-20, SVR-20, and PCL-R scales for 134 sex offenders. The mean follow-up time was 9 years (range 1-340 months), using the first entry into the National Register of Criminal Convictions as endpoint variable. For the estimate of predictive power, the area under the curve (AUC) of receiver operating characteristic (ROC) analysis was calculated. The AUC plots accurately identified violent or sexual recidivists and "false positives" at all scale levels. Comparing the predictive validity of these four instruments, the results favored Static-99. As for the limited sample size, differences between the assessment instruments were, however, not statistically significant. The ROC analysis for Static-99 showed that including treatment dropouts does not improve predictive accuracy (including dropouts: AUC 0.710; excluding dropouts: AUC 0.721). Kaplan-Meier survival analyses yielded highly a significant correlation to recidivism time point for two Static-99 and SVR-20 risk categories. Higher-risk categories were related to earlier recidivism. However, relying on the Static-99 and SVR-20 alone showed false positive results: for up to two out of three sex offenders, they predicted recidivism which did not occur.

Objectives: This interdisciplinary paper reports on the literature on sexual abuse in psychotherapy and on a case of unwanted sexual advances by a therapist toward his patient. Measures to help prevent such cases are discussed from a lawyer's (first author) and a medical psychotherapist's (second author) point of view. OVERVIEW OF THE LITERATURE: In psychotherapeutic practice, the borders of the therapeutic relationship are frequently not clear and sexual abuse of patients by psychotherapists also occurs in Germany., Case Report: The reported case illustrates that under current German Criminal Code ( section sign section sign 174 c Abs.2, 181 f. Nr. 2 StGB) patients are protected by law against unwanted sexual advances by a therapist. However, physical examination by the therapist while the patient is undergoing psychotherapy may provide unscrupulous therapists with the opportunity to dismiss accusations of unwanted sexual advances as legitimate physical examinations. Thus they could further victimize patients in legal suits since due to the principle of innocent until proven guilty, it is difficult for prosecutors to prove a case., Discussion: To improve patients' rights and the standards of practice, the first author suggests legal prohibition of simultaneous psychotherapeutic treatment and physical examinations/treatment by the same doctor. He suggests that a referral to a consulting physician for any physical examination deemed necessary should become the standard practice, thus also providing added protection to any doctor involved against false accusations of misconduct. The second author discusses critically whether such a prohibition would truly protect the patients. She concludes that simultaneous medical and psychotherapeutic treatment of a patient by the same physician should be thoroughly thought through by the physician, but comes to the conclusion that in some cases a combined medical and psychotherapeutic treatment seems appropriate. Instead of a general prohibition she suggests improved information and education for patients and psychotherapists as well as better use of the already existing legal possibilities.

Objective: An international network study involving parallel, complementary interventions in three EU countries and an associate country (Germany, United Kingdom, The Netherlands and Norway) is reported. The aim is to develop a unified approach to the assessment of social risk and related behaviours in offender groups., Method: The Behavioural Status Index (BEST-Index) and a set of cross-validating instruments (PCL-R, HCR-20; SCL-90-R; BDHI-D) were applied to a sample of n = 231 mentally ill offenders., Results: Selected results using a sub-sample of n = 89 German offenders are reported and discussed., Conclusions: The BEST-Index shows convergent validity with respect to a social risk criterion and it helps to determine an objective data base for the improvement of carer assessments, related care planning, and delivery.

The management of recent sexual and physical assault in women has two aims: to provide medical and psychological care for the victim and to prevent possible health consequences of the trauma on one hand, and to facilitate the forensic assessment with regard to the perpetrator's prosecution on the other. The victim should always be encouraged to report an offence to the police and forensic medicine should be called in to assist in the victim's examination, whenever possible. In addition, emergency contraception and prophylactic measures against sexually transmitted infections (STI), especially HIV, must be offered. The profound emotional impact of sexual and physical assault requires knowledgeable and sensitive crisis intervention on the part of the counsellor and referral for ongoing counselling and support must be made available. A well trained and competent sexual assault care team with a sympathetic and non-judgemental attitude can contribute profoundly to the assaulted woman's regaining control over her life and being able to overcome the experienced trauma.

Domestic violence differs from the nonrecurring trauma e.g. in the context of rape by a stranger in different aspects, emphasising the complexity of the victim's reaction and the enmeshment of the perpetrator The violence takes place in an established system of an intimate relationship which the woman was contracting voluntarily. Violence happens repeatedly and often several individuals (partner, children are directly and indirectly involved, which abide a relationship with the perpetrator Therefore the treatment of the posttraumatic stress disorder outstands in several aspects. The victims initially shows difficulties in talking about the experienced violence and are afraid to become unloyal; a therapeutic approach is often possible only after a fairly long time. Most authors agree that trauma therap the three phases (1 security and protection, psychoeducation and stabilisation, (2 trauma confrontation and (3 reintegration. Establishing a secure environment and intrapsychic stabilisation are a requirement for the therapeutic confrontation with the traumata in order to avoid re-traumatisation. Working with domestic violence victims is complex and demanding, experience in the work with trauma victims and regular supervision are fundamental.

Epidemiological studies show a prevalence of sexual abuse experience among girls from 14-33%. Although indicators of abuse are unspecific, the combination of several findings may be indicative: Somatic signs may be sexually transmitted diseases, vulvovaginal complaints. Psychosocial nonsexual indicators are abrupt behavioural changes, running away from home, eating disorders. Psychosexual signs are hypersexualisation of the language and behaviour, disturbed body image and gender identity. Indirect evidence of abuse is given not only in cases of old vaginal and anal lesions but also in situations, where deep tears of the hymen in the typical localization at the posterior part can be found. The workup and care for children in whom there is suspicion of abuse but no clear evidence asks for highly competent professionals in a multidisciplinary cooperation including pediatric gynecologists, child psychiatrists, children-protection groups and other specialists to avoid on one hand unjustified destabilisation or even destruction of familial structures but to assure on the other hand, that the child victims are treated and followed after in a short and long term comprehensive medical and psychosocial care.

Shortly after the fall of the National Socialist regime efforts were made in the Federal Republic of Germany to legislate anew on sterilisation and castration. For some experts, in particular sexologists and forensic psychiatrists in Hamburg, the question of the "treatment" of sexual offenders soon played a major role. In another research context an endocrinological substance showing anti-androgenic effects was synthesised in 1961 at the Schering AG in Berlin. In 1966 this substance, cyproterone acetate, was used for the first time to subdue the sexual drive. During parliamentary debates on a reintroduction of castration as a method of treatment for sexual deviations the advocates of cyproterone acetate succeeded in "inserting" their expertise into the "law on voluntary castration and other methods of treatment", which was adopted by the German Bundestag in January 1969. This paper discusses the interface between applied pharmacology, forensic psychiatry and sexology, and the politics leading to this law.

This report is based upon a model project financially assisted by a grant from the German Federal Ministry for Families, Senior Citizens, Women and Youth, starting in 1999 and ending at the end of 2003. In cooperation with two disability care residential institutions, a conceptual approach and method to the questions of sexual self-determination and sexualized violence is being developed. Through qualitative methods of research e.g. focus groups, professional helpers of all hierarchies of the institution, including management, and the residents themselves, all had the chance to contribute their own opinions and experiences to the research topic. Specifically, to ensure their voice was heard, the people with mental retardation had an important impact on the questionnaire themselves. All aspects of sexuality were discussed--with notable difficulty arising in particular over the subject of sexual violence. It turned out that nonverbal communication and the interaction between the group members in the residents group were most indicative of their concerns. The staff at the nursing and living areas discussed the following topics: distance and closeness in the interaction between staff and residents, standards, reflections of their own professional attitudes, questions of legality as well as the tense topic of individual needs and tasks of the group. How those questioned described their solutions and ways of coping, and the impressions of the researchers forms the starting point for the compiled work. The initial ideas for the topics and the design of the concept are now laid out.

The present article gives inside in research work in progress. Habermas (1973) pointed out the interdependency of economical motivational and other personal interests and the scientific results in research. Starting research on (sexual) self determination in institutions for mentally retarded people we were confronted with quite a number of conflicts of interests. The present article tries to clarify these conflicts from different perspectives e.g. the perspective of the management of the institutions, the perspective of the concerned inhabitants and the perspective of the caregivers. Describing the areas and hindrances we try to find out what sort of fascilitators are needed to improve the participation of mentally handicapped persons in this research process. From a methodological point of view we chose a qualitative approach to generate prototypes and controlled this approach by an expert committee. One of the main results is that a policy against sexual abuse in these institutions has to be part of the general quality discussion.

Two research projects "Because Everything Concerning Violence Hurts--Sexual Exploitation of Girls and Women with Disabilities (Zemp and Pircher 1996) and "Sexualized Violence in the Daily Life of People with Disabilities" (Zemp et al. 1997) will be introduced. The following study examined women and men with disabilities who live in a residential institution due to their physical, mental and/or psychological disability. Sexual exploitation starts where a person is used by another in order to satisfy certain needs without being informed or giving consent. Sexual exploitation is an expression of a power relationship. People with disabilities are underprivileged concerning resources, articulation and information, position in society and degree of organisation. We worked with questionnaires and semi-structured interviews. It was important to us not to exclude anybody from the study due to the severity of the disability. In cases where participants were incapable of verbal communication, we used "yes/no-conversation" and "anatomical dolls". 130 men and 130 women between aged between 18 and 78 participated in this study. All women received prophylactic contraception in order to avoid the product of rape. Both male and female participants showed diminished knowledge of sexual education. Approximately 64% of female and 50% of male participants indicate that they have been exploited sexually. Disabled room mates were the predominant group of perpetrators for the male and the third important for the female participants. Sexualized violence in residential institutions is directly linked to structural violence. This can only be fought effectively by a change in paradigms from controlled to self-determined life.

This contribution introduces a battered women shelter in London, Great Britain which exclusively provides refuge to women with learning disabilities who experienced sexualized violence. In the case of sexual abuse in early childhood psychotherapy is provided. Beverly Lewis House is the only institution of its kind and is lead by the author of this article. The contribution gives an insight into the significance and the structures of such an institution. Six components will be described that are important for implementing a battered women shelter specified on serving women with a learning disability: the architecture and the structures of the institution, the funding, the team, the variety of offers, the establishment of a therapeutic climate and the further progress of the women after leaving the Beverly Lewis House. Furthermore, the staff are being instructed how to deal with behaviours resulting from abuse experiences such as eating disorders, self-harming behaviour and depressions. The contribution is predominantly written in "simple language" in order to make it accessible to people with learning disabilities.

Members of the family of origin and spouses have been invited to take part in a cognitive-behavioral treatment programme for incarcerated sexual offenders to support the offender. Offenders arranged appointments with their spouses, mother, fathers and the therapist. A one-year follow-up reveals considerable change in denying and minimisation of responsibility, forcefullness and degree of sexual intrusiveness of both the offenders and the spouses. Both groups showed a better understanding for and a more positive attitude to the offenders' sexuality. Furthermore, both groups showed a significant increase in applying concepts of relapse prevention.