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Wednesday, September 14, 2011

Refusal of Treatment in Correction Settings


The rights of human beings have been a core issue that many have debated over the years.  When an individual is arrested the rights of this individual is significantly reduced and can be eliminated in certain circumstances.  There are some crimes that people feel do not put society in harm’s way and then there are the crimes that interfere with everyday life and can have devastating side effects for both society and the individual involved.  Sexual offenses can shake society in ways that can have lasting effects.  When individuals are arrested for sexual offenses there are usually little to no debates about the ethical treatment that takes place during treatment.  When the offender is developmentally disabled there is a sense of victim/offender when handling this situation.  You want to ensure that they understand that what they have done is unacceptable and show/teach them the socially acceptable way to deal with their sexual urges.  The rights that they have are consistent with those of mentally able individuals with special circumstances for disabled individuals.   For sex offenders presumed to lack the capacity to provide informed consent for the anticipated forensic service, the forensic practitioner nevertheless provides an appropriate explanation to the offender, seeks the examinee's assent, and obtains appropriate permission from a legally authorized person, as permitted or required by law (Otto, 2008).        
The ethical implications for treating sex offenders who refuse treatment are similar to any other mandated treatment situation.  You first want to ensure that they understand that treatment is mandatory and they will have to meet with you regardless of their refusal of treatment.  If treatment is taking place in a hospital setting this is the notion upon arrival and will not have to be discussed in length. If the examinee is ordered by the court to participate, the forensic practitioner can conduct the examination over the objection, and without the consent, of the examinee. If the offender declines to proceed after being notified of the nature and purpose of treatment, the forensic professional may proceed with treatment, but must ensure that the entire process is well documented for proof of no unethical treatment practices.
Treatment focus for sex offenders is broken down into four domains.  These treatment approaches are used in both correctional and community treatment settings.  Deviant sexual interest, arousal and preferences assume that the individual is being sexually excited by the wrong stimuli and the job of the forensic professional is to train them to react sexually to the correct stimuli (Hanser, Mire, 2011).  The offender is given homework that consists of acceptable arousal material that the offender is to masturbate to.  The premise is that through the reward of ejaculation the offender re-learns the correct stimuli and their body will in turn have positive reactions to the good sexual stimuli and negative reactions to the stimuli that previously aroused them.  Distorted attitudes deals with the ways that sex offenders use distorted thought patterns as a defense mechanism to avoid shame and guilt (Hanser, 2011).  The forensic professional helps them to recognize these distorted thought processes and helps them correct them.  Cognitive restructuring is intended to make offenders aware of the victims’ issues and uses this realization to help the offender connect with their mistake (Hanser, 2011).  Victim awareness/empathy training teaches offenders to understand the pervasive negative effects of sexual assault on the victim and the community (Hanser, 2011).       


References
Hanser R. D., Mire S. M., (2011) Correctional Counseling. Pearson Education, Upper Saddle River, New York
Otto R. (2008) Specialty guidelines for forensic psychologists. Retrieved on August 15, 2011 from http://www.ap-ls.org/aboutpsychlaw/22808sgfp.pdf

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