Psychosexual Evaluation
by Steven E. Mussack & Mark S. Carich

This is a PDF version of “Chapter 1 - Psychosexual Evaluation” of the Safer Society Handbook of Sexual Abuser Assessment and Treatment.

Working with individuals involved in sexual offenses begins with a professional, detailed evaluation. For social workers and psychologists, developing an effective treatment plan rests entirely on a complete understanding of the client’s history, needs, and risk factors. This chapter provides essential guidelines for conducting the comprehensive psychosexual evaluation required before beginning treatment of adults who have committed sexual offenses.

The conclusions and recommendations drawn from this evaluation carry immense weight, affecting the client, their family, and the safety of the community. This chapter outlines a structured, evidence-based approach to this challenging process.

The Foundation of Treatment: RNR Principles

Grounded in the Risk-Need-Responsivity (RNR) framework, the evaluation process ensures that treatment intensity and interventions are appropriately matched to each client. The goal of the psychosexual evaluation is twofold: to objectively gather all necessary information and to establish a comprehensive differential diagnosis, forming the foundation for treatment planning and ongoing assessment of progress.

Key Components of the Evaluation Process

This resource details the main components of a psychosexual evaluation report, emphasizing objective data gathered from multiple sources. Professionals are guided through assessment of:

• Risk and Needs: Overview of dynamic risk factors and criminogenic needs that, when targeted by intervention, have the greatest effect on reducing the likelihood of repeat offenses.
• Detailed Sexual History: Procedures for collecting information about offense-relevant and non-offense-related behaviors, current and past sexual interests, and the role of developmental, psychological, and relational factors in the client’s thought patterns.
• Psychosocial History and Strengths: Guidelines for exploring the client's background, including family, academic, marital, and criminal history, while identifying client strengths that can be reinforced during treatment.
• Mental Health Assessment: Evaluation of the client’s current mental status and identification of enduring psychological or intellectual issues that affect their ability to benefit from specific types of treatment.
• Accountability and Denial: Guidance for assessing the client’s acceptance of responsibility, noting that denial is viewed as a normal coping response and no longer presumptively considered a barrier to treatment amenability.

Practical Guidance for Clinicians

Conducting these evaluations requires specialized skills and sensitivity. This chapter provides direction for professionals on key practical considerations:

• Effective Interviewing: Maintaining respect and objective neutrality consistently and consciously separating the individual from their offending behaviors to reduce defensiveness and help with disclosure.
• Collateral Data: Gathering collateral information (from interviews, documentation, and family) to create a full narrative picture of the client’s functioning and honestly.
• Specialized Testing Overview: Overview of specialized assessments, including polygraphic assessment (lie detection), penile plethysmography (measuring sexual arousal in males), and visual reaction time testing (VRT), which help gather objective data on sexual interests.

This chapter equips professionals to navigate the complexities of pre-treatment assessment with confidence and structure, enabling informed decision-making regarding treatment intensity, structure, and effectiveness, while promoting prosocial change and community safety.

The authors cover the following topics:

• • The Risk-Need-Responsivity (RNR) Framework

• • The Psychosexual Evaluation Process

• • Conducting a Psychosexual Evaluation
    • • Communicating with the Referral Source
    • • Meeting and Interviewing the Client
    • • Conducting Collateral Interviews

• • Components of a Psychosexual Evaluation Report
    • • Report Introduction
    • • Psychosocial History
    • • Assessment of Client Strengths
    • • Criminal History
    • • Substance Use or Abuse History
    • • Medical History
    • • Sexual History
    • • Mental Health/Psychological Assessment
    • • Specialized Assessments
    • • Risk Assessment
    • • Assessment of Amenability to Treatment
    • • Report Summary and Recommendations

• • Summary and Conclusions

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