Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. Guay, J., Proulx, J., Cusson, M., & Ouimet, M. (2001). Paedophilia: Pathology, criminality, or both? These females exhibit dependency needs and often abuse substances. Groth, A.N. 257275). Researchers have found that child sexual abusers exhibited heightened sexuality in childhood. Journal of Family Violence, 24,183191. (For information on "Adult Sex Offender Recidivism,"see Chapter 5in the Adult section.) (1997). The containment approach to managing sex offenders. There are also a few hundred alcoholics and inadequates. Laws & W. O'Donohue (Eds. Recent advances: developmental risk factors and offense pathways. Women and Men Who Sexually Abuse Children: A Comparative Analysis. Female and male sex offenders: A comparison of recidivism patterns and risk factors. endstream
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With severe passive inadequates, the only way to prevent relapse is to keep them in hostel care indefinitely. If the age is unknown and later revealed, attention-focused offenders often continue with the relationship, even if it remains online only. Sexualpredators. A review of the factors that can influence the effectiveness of sex offender treatment: Risk, need, responsivity, and process issues. Cohen (Eds. Likewise, they have the ability to use more than one strategy to achieve their goal of sex, for which they spend an extensive time refining. Journal of Sexual Aggression: An International, Interdisciplinary Forum for Research, Theory and Practice, 16,4758. Sexual Abuse: A Journal of Research and Treatment, 16,285298. Female perpetrators of child sexual abuse: A review of the clinical and empirical literature. Female sex offenders: Clinical and demographic features. Men who molest their sexually immature daughters: Is a special explanation required? Sexual Abuse: A Journal of Research and Treatment, 18,269270. (1982). These findings are consistent with many traditional typologies of rapists and child sexual abusers; however, the results suggest that the generalist vs. specialist model is a better way to assess sexual offenders, regardless of victim type. Prior to testing, 74 percent (n = 115) of the internet offenders had no known sexual contact with children. This individual sexually assaults for retaliatory reasons and often degrades or humiliates the victim. In addition to childhood abuse, the majority of sexual offenders (93 percent) exhibited insecure attachment (Marsa et al., 2004). (A meta-analysis combines the results of many evaluations into one large study with many subjects.) An examination of the assumptions of specialization, mental disorder, and dangerousness in sex offenders. Journal of Sexual Aggression, 17,4660. According to theDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(American Psychiatric Association, 2013), a diagnosis of pedophilia requires an individual to have recurrent, intense and sexually arousing fantasies, urges or behaviors directed toward a prepubescent child (generally 13 years of age or younger) over a period of at least six months; to have acted on these urges or to be distressed by them; and to be at least 16 years old and at least five years older than the child victim. Learn more. Indeed, this heterogeneity challenges effective risk management and treatment of offenders (Martinez-Catena, Redondo, Frerich & Beech, 2016). Sexual violence against women: A psychological approach to the assessment and management of rapists in the community. With respect to sexual recidivism, the total sample consisted of 23,393 sexual offenders (including 1,839 rapists and 9,603 child sexual abusers whose recidivism rates were compared). Developmental and offense histories of female sexual offenders. endstream
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Summary of the Evidence on Behavioral Theories Paper presented at the 23d Annual Conference of the Association for the Treatment of Sexual Abusers, Albuquerque, NM. Lee, J.K.P., Jackson, H.J., Pattison, P., & Ward, T. (2002). 2 (pp. This acknowledges the fact that behavioural patterns amongst such offenders are not mutually exclusive and there can be multiple motivations for committing such crimes. (2005). (2007) found crossover offenders scored higher on risk assessment than offenders reporting one victim type; yet Kleban et al. Childhood risk factors associated with crossover offending. Vandiver, D.M. Reingle ( 2014, p. 911) uses a definition from Gottfredson ( 1981) that conveys the overlap as a "strong empirical and theoretical relationship occurring between victimization and the perpetration of crime and delinquency". Laws, & H.B. Child Abuse & Neglect, 32,529548. Symposium presented at the 27th Annual Conference of the Association for the Treatment of Sexual Abusers, Atlanta, GA. Simons, D., Heil, P., & English, K. (2004). inadequate meaning: 1. not good enough or too low in quality: 2. too small in amount: 3. not confident enough to deal. In D.R. Masturbation to these fantasies may serve as a coping mechanism from stress, as a means to exert control, and ultimately, as a behavioral rehearsal to sexual offending. Lannings (1985, 2010) typology is a rationally-derived system that initially divided child sexual abusers into four situational types and three preferential types. English, K., Jones, L., Patrick, D., & Pasini-Hill, D. (2003). (1999). In D.R. Matthews, J.K., Mathews, R., & Speltz, K. (1991). In contrast, the approach-automatic pathway is characterized by the impulsive desire to sexually offend and assault (direct route). Often do not marry or marry as a cover for their preferred sexual activity, exhibiting low sex drive in marriage. Journal of Interpersonal Violence, 13,700725. This group of sex offenders tends tohave more professionals with higher incomes. collapsed child and adolescent categories and found only 9 percent of offenders had victims from both age categories. 459485). Miner, M.H., & Dwyer, S.M. Given the range of behavioural patterns at either end of the continuum, it is perhaps clear that further dimensions beyond the situational-preferential dimension are needed for a truly comprehensive typological system. Thesex-focusedtype of offender has the lowest level of crime expertise. Instead, sexual offenders may use deviant sexual fantasies as a means to achieve intimacy, power and control, absent of reality. Sexual Abuse: A Journal of Research and Treatment, 17,269292. |We@RaiGI3!J?r+SVNzTF5n X`J Likewise, of 983 online offenders, 4.2 percent recidivated with a violent offense. In W. Marshall, D. Laws, & H. Barbaree (Eds. Individuals on the approach-explicit pathway desire to sexually offend (direct), but they carefully plan their offenses (effective regulation, explicit). yp. Individuals on the approach pathways experience positive emotional states from offending; cognitive dissonance is absent. . These approach-oriented individuals vary with respect to self-regulation; some of them exhibit deficient self-regulation (i.e., impulsivity), whereas others display intact, effective self-regulation. Sexualized coping often serves as a means of meeting needs of intimacy and control (Grady, Levenson & Bolder, 2016). Any opinions in the examples do not represent the opinion of the Cambridge Dictionary editors or of Cambridge University Press or its licensors. The generalist theory of crime (Gottfredson & Hirshi, 1990) has also been examined in sexual offender research (e.g., Lussier, Proulx & LeBlanc, 2005). Such offenders are more likely to attend playgrounds or other areas where children gather. They know how to talk and listen to children and often target those who are neglected. Using polygraph testing to assess deviant sexual history of sex offenders Doctoral dissertation, University of Washington, 1998. Inadequate.. fq - The world's largest educational and scientific computing society that delivers resources that advance computing as a science and a profession; ya - The world's largest nonprofit, professional association dedicated to advancing technological innovation and excellence for the benefit of humanity; mk - A worldwide organization of . Pathways to sexual offending: Validity of Hudson and Ward's (1998) self-regulation model and relationship to static and dynamic risk among treated sex offenders. Overall, traditional typologies have demonstrated considerable problems, as indicated by inadequate definitions and inconsistent research findings. %%EOF
Pornography is seldom involved in these cases. Wright (Ed. According to self-regulation theory, the goal of engaging in sexually deviant behavior and the strategies employed to reach that goal become automatically integrated into the behavior of the offender because they have been consistently reinforced in the past (Ward & Hudson, 1998). Elliott, M., Browne, K. & Kilcoyne, J. Over time they gradually lower the child victims sexual inhibitions until they are willing to engage in sexual behaviour because of the benefits that they are receiving. Treatment of the sexual offender in a correctional institution. The first group consists of individuals who access pornographic images impulsively and/or out of curiosity. Tener, D., Wolak, J. The Psychology of Criminal Conduct,3d ed. These are the Massachusetts Treatment Center: Child Molester Typology (Version 3; MTC:CM3; Knight et al. Sexual Abuse: A Journal of Research and Treatment, 15,221236. ),Handbook of Sexual Assault: Issues, Theories, and Treatment of the Offender(pp. They access children through activities involving children orinwork or neighborhood. With respect to childhood violence, both indiscriminate offenders and rapists described childhood experiences consistent with physical and emotional abuse. This knowledge can be very useful in preparing interview strategies, conducting risk assessments, and formulating treatment and management plans. Male adolescents: Sexual victimization and subsequent sexual abuse. Ward and Hudson (1998, 2000) developed a nine-stage model of the sex offense process, which takes into account the heterogeneity of sexual offending. Offender definition, someone who has violated a criminal, religious, or moral law:The program aids individuals already in the criminal justice system and is. Garlick, Y., Marshall, W.L., & Thorton, D. (1996). Laws, & H.E. Without being cognisant of this, clinicians can significantly add to the subsequent shame, guilt and embarrassment that victims of these offences can experience later in their lives. Research Report 2005 No. Sexual Abuse: A Journal of Research and Treatment, 15,121134. International Journal of Offender Therapy and Comparative Criminology, 41,3644. Abel, G.G., Becker, J.V., Cunningham-Rathner, J., Mittelman, M.S., & Rouleau, J.L. The third type of rapist is the anger-retaliation or aggressive-aim rapist, who is motivated by power and aggression. 0000005870 00000 n
Recent models of sexual deviance suggest that poor parental bonding enhances the effects of child maltreatment and may subsequently initiate the processes that lead to sexual offending by creating vulnerability in the child (Marshall & Marshall, 2000), a lack of empathy for others (Craissati, McClurg & Browne, 2002b), or intimacy deficits (Ward et al., 1995). This section reviews the most frequently used and empirically tested sex offender typologies for child sexual abusers, rapists, female offenders and internet sexual offenders. Levenson, J. S., Willis, G. M. & Prescott, D. S. (2015). Journal of Counseling & Development, 71,2732. Yet, not all sexual offenders report being sexually victimized during childhood. One of the major distinctions in the majority of these typologies has been between fixated or preferential paedophiles who have a genuine sexual interest in children and those who offend for other reasons (Dietz, 1983). Ward, T., & Hudson, S.M. 2136). Similar to crossover findings, studies have shown that few sexual offenders "specialize" in sexual offending (Harris, Mazerolle & Knight, 2009; Lussier, Proulx & LeBlanc, 2005). Frequently, the sex-focused type inadvertently meets a minor online posing as an adult; they continue the sexual encounter after the victim's age is revealed. Female sexual offenders report different offense-supportive cognitions than males. Indeed, some offenders can be envisaged in the middle of this continuum with a preferential sexual interest in children as well as an awareness of situational opportunities to offend. ),Child Sexual Abuse and the Internet: Tackling the New Frontier(pp. Idioms with the word back, Cambridge University Press & Assessment 2023. This can flow into appropriate recommendations for treatment and management, and thus provide the most appropriate interventions in the individual case. Annals of the New York Academy of Sciences, 989,411427. The power-assertive or antisocial rapist is impulsive, uses aggressive methods of control and abuses substances. Retribution is consistent with: social contract theory. Of a subsample of 42 female sexual offenders, Simons and colleagues (2008) reported that the majority (81 percent) had been sexually abused by multiple perpetrators at a young age with high frequency. Several typologies have been created to categorize internet offenders. There is considerable overlap between these three typologies. Predicting new offenses committed by child pornography offenders. Marshall, D.R. 'pa pdd chac-sb tc-bd bw hbr-20 hbss lpt-25' : 'hdn'">, Example from the Hansard archive. Secure .gov websites use HTTPS Barbaree (Eds. & Morin, J. W. (2008). Although this typology has been validated in several studies, it has not demonstrated clinical utility with respect to recidivism or treatment (Camilleri & Quinsey, 2008). Add inadequate to one of your lists below, or create a new one. Hudson, S.M., & Ward, T. (1997). Differences were found with respect to criminal onset, length of criminal career, age of peak offending and time of entry into treatment. Adverse childhood experiences in the lives of female sex offenders. Journal of Quantitative Criminology, 6,231267. User Report 2004-02. The widespread availability of pornography on the internet has facilitated the development and maintenance of sexual deviance (Delmonico & Griffin, 2008; Quayle, 2008). New York: Free Press. Some enumerate certain offenses as crimes of violence. Attachment styles and psychological profiles of child sex offenders in Ireland. (2000). Classifying sexual offenders: The development and corroboration of taxonomic models. They are more likely than other female offenders to display symptoms of post-traumatic stress disorder (a serious psychological condition that occurs as a result of experiencing a traumatic event) (Foa, Keane & Friedman, 2000) and depression. This behavior of this type of molesteris most similar to a sex addiction. Prentky, R.A., Knight, R.A., Rosenberg, R., & Lee, A.F.S. (1993). A self-regulation model of relapse prevention. Results indicated 35 percent of offenders had multiple victims at index offense and 26 percent of offenders were convicted of a previous sex crime. Four rules should guide any analysis of criminal conviction enhancements: 1. Journal of Interpersonal Violence,17,10461062. Likewise, rapists are more likely to reoffend violently rather than sexually. Research findings indicate that there may not be only one type of abuse that serves as a developmental risk factor for later sexual offending. ),Sexual Deviance: Theory, Assessment, and Treatment,vol. (2000). The majority of fixated child sexual abusers are individuals who sexually assault male children who are not related; regressed child sexual abusers often consist of incest offenders or offenders who sexually assault female adolescents (Priest & Smith, 1992). revised. Specifically, studies (e.g., Abel et al., 1988; English et al., 2000; Heil, Ahlmeyer & Simons, 2003; O'Connell, 1998) have shown that rapists often sexually assault children and incest offenders often sexually assault children both within and outside their family. The fourth group consists of individuals who download pornographic images for nonsexual reasons (e.g., financial gain). Early onset and deviant sexuality in child molesters. Researchers reported substance abuse and criminal history predicted future contact sexual offenses; self-reported sexual interest in children, criminal history and substance use problems predicted future violent offending among child pornography offenders. Long-term sexual problems. Advances in developmental risk factors and offense pathways can assist with risk and need evaluation, but additional research is needed to develop models of sexual deviance. In D.R. Paper presented at the 27th Annual Conference of the Association for the Treatment of Sexual Abusers, Atlanta, GA. Seto, M.C., Hanson, K.R., & Babchishin, K.M. Initially, the sex-focused type is not seeking sex with minors; instead, they are looking for immediate sexual interaction with adults. 2 (pp. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.). Levenson, J. S., Becker, J. Interpersonal skills are lacking, and they target the least resistant child, the youngest and most vulnerable. Findings indicated rapists were rated as exhibiting more expressive anger than child sexual abusers. Finkelhor, D. (1984). Recidivism and age: Follow-up data from 4,673 sexual offenders. New York: Guilford Press. 0000000972 00000 n
Ward, T., Hudson, S.M., Marshall, W.L., & Siegert, R. (1995). Consistent with Marshall and Barbaree's (1990) integrated theory of sexual offending, bestiality and masturbation to abuse experiences contribute to the development of deviant sexual interest and frequent masturbation suggests problems with emotional self-regulation. Rapists have been shown to exhibit avoidant parental attachments, whereas child sexual abusers display anxious or ambivalent attachment (Simons & Tyler, 2010; Simons, Wurtele & Durham, 2008; Ward et al., 1995). Similar findings were reported among 47 female sexual offenders assessed on a childhood experiences measure by Levenson, Willis and Prescott (2015). The self-regulation and good lives models: Analysis of primary goods and offender type. Socially inept with few adultfriendships. Some of the words that defined the week ending May 22, 2020. This study indicates that female sexual offense patterns may be less extensive than those of male sexual offenders. Sexual and Relationship Therapy, 8,109121. (2005). Perhaps unsurprisingly, they are more likely than other preferential offenders to abduct and murder their victims. Ht_o0WK'%M`]St6i^3I~$tsKuwRgQ|d? Comparisons between sexual and nonsexual rapist subtypes. Cann et al. 'Hiemal,' 'brumation,' & other rare wintry words. One typology, the teacher lover/heterosexual nurturer, describes female offenders who sexually abuse adolescent boys within the context of an acquaintance or position-of-trust relationship (Matthews, Mathews & Speltz, 1991; Vandiver & Kercher, 2004). English, K. (2007). The fixated offender prefers interaction and identifies with children socially and sexually (Simon et al., 1992). (1983). Recently, more extensive typologies of female sexual offending have been developed to summarize these female offense characteristics (Matthews, Mathews & Speltz, 1991; Nathan & Ward, 2002; Vandiver & Kercher, 2004). hs@qV One of the first typologies was formulated from the delineation of pedophilic and nonpedophilic child sexual abuse. Criminal propensity, deviant sexual interests and criminal activity of sexual aggressors against women: A comparison of models. Likewise, Levenson, Becker and Morin (2008) emphasize the importance of understanding crossover offending patterns to enhance safety planning for the offenders and the community. Such offenders usually do not have a genuine sexual interest in children, but may molest them for a number of often complex reasons. West Sussex, England: John Wiley & Sons. Aggression and Violent Behavior, 12,615627. . Health & Justice, 3, 1. Share sensitive information only on official, secure websites. Incapacitation refers to the restriction of an individual's freedoms and liberties that they would normally have in society. 28 U.S.C. In M.Q. The assessment of developmental risk factors is important to determine the criminogenic needs of the individual offender; the assessment also contributes to static predicting (Craissati & Beech, 2006). Although these female typologies are useful to describe offense characteristics, they (like the male typologies) do not provide a theoretical framework for the etiology of sexual offending (Logan, 2008). Heil, P., & Simons, D. (2008). Child Abuse & Neglect, 32,549560. Child-molesters: An examination of cognitive factors. Assessing crossover in a sample of sexual offenders with multiple victims. ),Law and Mental Health: International Perspectives,vol. He may be mentally ill and prefers non-threatening sexual partners. inadequate definition: 1. not good enough or too low in quality: 2. too small in amount: 3. not confident enough to deal. Linking adverse childhood effects and attachment: A theory of etiology for sexual offending. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. The majority of theories regarding sexual deviance postulate that sexual offenders specialize in types of victims and/or offenses (Simon, 1997). In addition, female offenders were more likely to co-offend than male offenders. However, formal DSM-5 and ICD-10 criteria are not particularly useful for this task. In addition, their victim selection is based solely upon personal preference. Future research in this area is needed to further identify factors that characterize specialist offenders from generalist offenders. A link to reset your password will be emailed to you. Studies have reported prevalence rates from 32 to as high as 64 percent; the majority of studies found rates in the range of 50 to 60 percent (Abel & Osborn, 1992; English et al., 2000; Heil, Ahlmeyer & Simons, 2003; O'Connell, 1998; Wilcox et al., 2005). theory of disablement preventing offenders from commission of more crime through isolation, death, banishment, or motivation selective incapacitation Predicting relapse: A meta-analysis of sexual offender recidivism studies. Traditional typologies have been developed to provide a comprehensive understanding of deviant sexual behaviors required for treatment intervention and effective supervision. This section reviews the current research findings that compare the developmental risk factors of various offender characteristics. American Psychiatric Association. (2006). 0000000016 00000 n
Conte, J.R. (1991). Journal of Consulting and Clinical Psychology, 63,348362. Watch your back! As the name suggests, the seduction pattern of behaviour characterises individuals who essentially engage with children by seducing and grooming them with affection, attention and presents. Future research should differentiate between those who view pornography and later commit sexual abuse from those who use pornography as a supplement to or a substitute for sexual contact. An empirical assessment of the overlap between sexual victimization and sex offending. Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sex offenders. Journal of Interpersonal Violence, 7,211225. 3Note these recidivism measures exceed 100 percent as 27 of the 61 studies included in the meta-analysis included multiple indexes of recidivism. The impact of viewing on offending behavior. 79101). He is characterized as a social misfit, an isolate, who appears unusual or eccentric. Overall, small sample sizes and reliance on official records have limited the extensive investigation of this group. Sexual Abuse: Journal of Research and Treatment, 23,243259. An offender profile describes the likely social and mental characteristics of the offender . 0
The two concepts that the text cites as being a response to deviant behavior are: treatment and punishment. These offenders do not experience an internal conflict after the offense because they achieved their goal to sexually offend. Useful clinically-derived child molester classification systems have been published since the 1960s (see Knight & Prentky, 1990; Prentky & Burgess, 2000). According to Gannon, Beech and Ward (2008), when offense crossover is disclosed, assigned risk level increases because child sexual abuse of males (i.e., gender crossover), impulsivity and regulation deficits (as suggested by age crossover), and stranger victims (i.e., relationship crossover) are shown to be significantly associated with sexual recidivism (Hanson & Morton-Bourgon, 2004; Stephens et al., 2016). Stewart (Ed. Click on the arrows to change the translation direction. Laws & W. O'Donohue (Eds. Please enter your User ID (APS Membership Number) and last name. Nonetheless, this research indicates that female offenders report poor sexual boundaries regarding illegal behaviors and they also disclose legal, but sexually problematic, behaviors. Sexual offenders (the majority of rapists and a subset of child sexual abusers) have demonstrated substance abuse and relationship problems, antisocial behavior in adolescence, employment instability and evidence of psychopathy (Harris, Mazerolle & Knight, 2009; Lussier, Proulx & LeBlanc, 2005). In T.A. Such an individual may perceive that the victim has shown a sexual interest in him, or that by the use of force the victim will grow to like him (Craissati, 2005). The good lives model and the risk need responsivity model: A critical response to Andrews, Bonta, and Wormith. Introduction. (2002). The inadequate molester is the sex offender who least resembles social and behavioral norms. Offender and victim characteristics of registered female sex offenders in Texas: A proposed typology of female sexual offenders. New York: Guilford Press. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. Post-conviction sex offender polygraph examination: Client-reported perceptions of utility and accuracy. 2636). The self-regulation model of sexual offending: The relationship between offence pathways and static and dynamic sexual offence risk. not confident enough to deal with a situation: The latter two were initially developed for use in criminal investigations and thus focus on offence behaviour. Sexual trauma in the life histories of rapists and child molesters. How to use inadequate in a sentence. A descriptive study of rapists and child molesters: Developmental, clinical, and criminal characteristics. Sexual offenders who victimized both adult and child victims and crossed over in the relationship domain had more victims than those who did not crossover. Robertiello, G., & Terry, K.J. Harris, D. A. Knight. Rapists typically assault as a result of anger, hostility and vindictiveness (Polaschek, Ward & Hudson, 1997). Hanson, R.K., & Morton-Bourgon, K. (2004). ) or https:// means youve safely connected to the .gov website. (2009). This is the least common type ofchild molester, and they have the fewestnumber of victims. Download the app today and discover APS while you're on the move. (2011). Adult female sexual offending: A comparison between co-offenders and solo offenders in a Dutch sample. "inadequate or ineffective" to test the legality of his detention. In this study, 48 percent of sexual offenders reported adult and child victims, 22 percent sexually offended against both genders and 26 percent crossed over into the relationship domain. 0 && stateHdr.searchDesk ? Females who abuse alone are more likely to abuse unrelated males and to be diagnosed with a mood disorder (Muskens, Bogaerts, van Casteren & Labrijn, 2011; Vandiver, 2006). Regardless, the online relationship usually progresses into physical meetings. Self-regulation model of sexual offending: Treatment compliance, motivation, and progress. inadecuado, inepto, insuficiente [masculine-feminine], insuffisante/-ante, dficient/-ente, insuffisant, nieodpowiedni, nieadekwatny, niewystarczajcy, , , , Test your vocabulary with our fun image quizzes, Clear explanations of natural written and spoken English. (2009). (1993). Sexual history disclosure using the polygraph in a sample of British sex offenders in treatment. One useful distinction is to determine whether the offending behaviour primarily reflects a deviant sexual interest in children or other motivations. Sexual Abuse: A Journal of Research and Treatment, 25,427443. The fourth group was classified as late onset accelerators (8 percent). Rape: Psychopathology and theory. Sexually oriented offenders. These female offenders report extensive physical and sexual abuse by caregivers. With respect to affect, child sexual abusers assault to alleviate anxiety, loneliness and depression. In addition, it is not known if these offenders are pedophiles and whether they view pornographic images more than the general population (Quayle, 2004). Cincinnati, OH: Anderson. Sexual sadism is defined as the repeated practice of cruel sexual behavior that is combined with fantasy and characterized by a desire to control the victim (MacCullock et al., 1983). RA, Smallbone, S. & Dennison, S.(2011). In the case of the persistent offender and other inadequates it may well be that they should earn their living under adequate supervision. Ainsworth, M.D.S., & Bowlby, J. 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