ABSTRACT

Clinical work with offenders with histories of sexual violence is an important aspect of forensic practice. A key feature of this is the clinical interview, which allows individual and offence-related issues to be explored. Research suggests that some sexual offences contain sexual motivations and may therefore be related to deviant sexual fantasies. This case study reports on the assessment and formulation of a patient detained in a regional secure unit. Although he had no previous sexual convictions, he had a history of being sexually violent towards others. During clinical interviews the patient disclosed having deviant sexual fantasies for several years relating to the rape and strangulation of women. These fantasies fuelled his daily masturbatory behaviour and he reported several attempts to enact them before his detention in hospital. Once in hospital the object of his sexual desires became a female nurse, whom he wanted to rape and strangle, the idea of which again fuelled his daily masturbatory behaviour. These disclosures necessitated preventative measures being taken by his clinical team and re-enforced the importance of giving due consideration to violent sexual fantasies and the importance of evidence-based risk formulations that inform the care and management of forensic patients.

摘要

对有性暴力史的罪犯进行临床工作是法医实践的一个重要方面。其中一个关键特征是临床访谈，它允许探讨个人和与犯罪相关的问题。研究表明，一些性犯罪包含性动机，因此可能与越轨的性幻想有关。本案例研究报告了一名被拘留在区域安全单位的患者的评估和制定。虽然他之前没有性犯罪，但他有对他人实施性暴力的历史。在临床访谈中，患者透露多年来一直有与强奸和勒死妇女有关的异常性幻想。这些幻想助长了他的日常手淫行为，他报告说，在他被拘留在医院之前，他曾多次尝试实施这些幻想。入院后，他的性欲对象变成了一名女护士，他想强奸和勒死她，这种想法再次助长了他的日常手淫行为。这些披露要求他的临床团队采取预防措施，并再次强调适当考虑暴力性幻想的重要性以及为法医患者的护理和管理提供信息的循证风险公式的重要性。