5 115 PERSONALIZED MONITORING AND FEEDBACK Text box 5.2: Bart’s background and ESM monitoring Background information: Bart had trouble making friends and keeping up at school. During puberty, Bart noticed sexual attraction to both pre-pubescent boys (from approximately 10 to12 years of age) and girls (of his own age). While he gets along with younger boys, he experiences difficulties in contact with girls. Especially girls he has a crush on. At his early twenties, Bart gets in touch via Internet with other persons sexual attracted towards children. They convinced him that sexual contact with children is harmless if their boundaries are respected. Bart manipulates boys to sexual acts and to share sexually explicit images on sites like Omegle, and Bullchat. After his apprehension he self-refers for treatment in a forensic outpatient clinic. CONSTRUCTING THE PERSONALIZED ESM QUESTIONNAIRE Asked after the causal and sustaining factors of his sexual offending behavior, Bart indicates he feels emotionally behind. He describes the adult world as big and scary. This makes him anxious. This fear and lack of self-confidence cause him to avoid (intimate sexual) relationships with women. Bart is more confident with children. He feels a need to care for them. When Bart feels lonely or angry, the need for contact with children increases. He then seeks contact with pre-pubescent boys through Internet. This might lead to sexual arousal. The combination of sexual arousal, and his belief that sexual contact with children is harmless results in online sexual offending. These interacting risk-relevant behavioral and psychological features reflect in the risk assessment conducted with the STABLE-2007 as: (lack of) Capacity for Relationship, Emotional Identification with Children, General Social Rejection and/or Loneliness, and Deviant Sexual Interests. Sexual Preoccupation does also emerge as a dynamic risk factor of Bart in de STABLE-2007 assessment. However, Bart does not recognize his frequent sexual activity to be a risk factor and is convinced that his offenses do not stem from a sexual motive. Bart and his therapist agree to focus the ESM items of the yet-to-be-score diary on feelings of: loneliness, anger, sadness, insecurity, and joy, also the need for: contact with children and sex, furthermore on the belief of being rejected by adults, and the frequency of sexual activity. INTERPRETATION RESULTS FEEDBACK REPORT Bart and his therapist go through the feedback report started with the bar graphs. Feeling sad, lonely, and insecure score relatively high. Bart confirmed these were the dominant feelings during the two weeks scoring. From the time-series plots they conclude that Bart masturbates between every third or fourth ESM measurement (which is at least once a day). In about half of these cases, he masturbates more than once. Bart clarifies that almost all sexual fantasies during masturbation concern pre-pubescent boys. From the network graph, Bart and his therapist notice two distinct clusters of connected risk-related features. One cluster contains momentary affective states, while the other cluster indicates interacting sexual desire (current and prior) and the need for contact with children. Bart recognizes that feelings of rejection are related to both anger and sadness. He also considers it interesting and understandable that feelings of insecurity are related to sadness. The connection between sexual desire and the need for contact with children is remarkable to Bart. He wants to explore in therapy whether there is a sexual component in contact with children for him after all. In addition, the therapist addresses the rate of recurrence of masturbation by providing statistics on the frequency of masturbation by age group. Given these statistics, Bart realizes he masturbates relatively much. Both Bart and his therapist discuss whether this might increase his risk of sexual reoffending. Note. Bart is the fictitious name of participant 3.
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