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Dr. Jeremy Sharp Transcripts Leave a Comment

[00:00:00] Dr. Sharp: Hey, y’all. This is Dr. Jeremy Sharp, and this is The Testing Psychologist podcast, the show where we talk all about the business and practice of psychological and neuropsychological assessment.

Welcome back. I have a good episode for you today. This is a little bit of a unique one. My return guest, Dr. Brenna Tindall is back to dive into the assessment of intimate partner violence and sexual violence and talk through the overlap between those two and how we might separate one from the other if they can be separated. And if so, how to make appropriate recommendations for each of those populations.

If you didn’t catch Brenna back in episode 45, I would go check that out. She talked with me generally about assessment in the criminal justice system. We got into some detail, but not a lot. And so she is back today to go into a lot more detail in these areas.

Just a little bit about Brenna. Brenna is a licensed psychologist. She specializes in forensic evaluations. She has done a lot of work with general psychological evaluations, insanity evaluations, competency evaluations, sex offense specific evaluations, domestic violence evaluations, dual diagnosis substance use, cognitive testing, and child contact assessments.

She is certified in any number of instruments. She’s a Certified Trainer for the SOTIPS and VASOR-2 adult sex offender risk assessments. She’s a Certified Trainer of the J-SOAP-II for juvenile sex offense assessment. She’s a Certified Child Contact Assessment (CCA) Evaluator. She’s well prepared to talk about any number of issues in the criminal justice assessment world. She has presented across the country on a variety of topics.

On a personal note, I’ve known Brenna for a long time and she is always pushing the envelope with[00:02:00] doing more research, doing new research, and trying to figure out the best ways to assess and learn about these different profiles within the criminal justice system, and really just how to help folks as best she can. So I have a lot of personal and professional respect for Brenna and I’m happy to have her back. Please enjoy this in-depth conversation with Dr. Brenna Tindall.

Brenna, welcome back to the podcast. 

Dr. Brenna: Hi, thanks for having me.  

Dr. Sharp: I’m glad to have you again. We’ve talked a little bit over these last few months. Your first episode was a hit. I know you have a lot to say on a lot of topics. I’m glad to have you back.

Dr. Brenna: Thank you.

Dr. Sharp: Let me back up. For anyone who didn’t hear your first episode, you came on maybe a year and a half ago and talked generally about forensic assessment and what that looks like, competency, insanity, and all sorts of super interesting things.

Today, we’re going to zero in a lot closer on assessing intimate partner sexual violence, the relationship with domestic violence, how those are different, why is it important, and all those pieces. So this is one of those episodes I think the forensic folks are going to go a little nuts over. It seems to be an emerging area and there’s not a whole lot to read out there. So you are really on the forefront of this kind of work. I’m just fortunate and lucky that we’re here in the same town and you want to come to hang out with me for a while. 

Dr. Brenna: Thank you. I would say, probably shout out to the father of the domestic violence sex offense crossover, which is [00:04:00] Mervyn Davies. He’s a clinician that’s been practicing and is probably the only research study about that. He was a mentor and supervisor and still is. He’s great. He’s lectured with me at two conferences. So shout out to him because he’s the one that started the conversation. 

Dr. Sharp: Nice. I’ll put any info I can find on him in the show notes too so folks can check that out.

I like to lead off here in the most recent episodes, just asking why is this important to you.

Dr. Brenna: That’s a good question. As I mentioned, I think in the previous podcast, I’m a psychologist. I started working with offenders and doing a lot of sex offense-specific evaluations in terms of the criminal world, and then I got roped into doing domestic violence evaluations in terms of helping create a good protocol for that, and also the recognition that there’s a lot of crossover between some of the issues with these offenders.

It wasn’t until I started doing the domestic violence training and the supervision that I just had this moment. I remember talking to this one female client who I knew had been in a domestic violence relationship as a victim, and I said, I just have a question. And I was like, “Did you ever have consensual sex with your spouse?”

I thought she was going to punch me because the look on her face was like, “Are you kidding me? How would I say no to sex when I would get beat up for just washing the dishes wrong?” That was something that just blew my mind, especially as somebody that look tries to look at a lot of issues that it never even occurred to me to think about that, especially with my sex offense-specific background.

So that really opened my eyes to a different type of evaluation or thought process with regard to some of these cases because what I was finding was within the domestic violence evaluation assessment world, but it’s based on a [00:06:00] lot of domestic violence stuff and unless someone’s had really good training, they’re not touching on how there might be sexual violence in the relationship even if it’s not charged as an offense. Similarly, in the sex offense world, there are a lot of us who’re not looking into domestic violence-specific issues and asking about those even though there’s a big correlation between the two.

So really my passion came out of my own stupidity because it didn’t even cross my mind to think about that as part of a domestic violence case.

Dr. Sharp: Well, that’s how we learn, I think. We get blindsided with these client stories and it’s like, oh my gosh, I need to be thinking about these things a little more closely. 

Do you have any guess why there hasn’t been a whole lot of research into it so far, or why people were blind to it for this long?

Dr. Brenna: It goes back to how we’ve conceptualized consent a little bit with sex. And I think we’re obviously transitioning and have been, especially in Colorado with regard to what is needed for consent in a relationship. And so, I think there’s always been this age-old thought process that if somebody doesn’t say no, then it’s okay. So, if somebody’s not being like, no, get off me or someone’s not holding somebody down, that that’s not rape, or that’s not non-consensual sex.

And so I think that that’s just something that’s been in our culture that we’re thinking about differently, especially with position of trust and the coercion that is there and having a relationship with a student, if you’re a teacher.

And so I think looking at more of implicit coercion has really gotten the conversation going about looking at the sexual violence. And I think victims have been asked about these questions and they’ve said that, yes, we absolutely were raped, but it just has not been something that’s addressed because when they’re charged with domestic violence, they can’t really [00:08:00] charge at this point in the legal system, a sexual assault within the framework of that even though everyone knows well it probably did happen.

We always say, don’t ask the question you don’t want to know the answer to in terms of this whole question, because it’s hard for people to talk about sex. And it’s hard to bring up for somebody; well, not only are you a domestic violence victim, but you’re likely a sex assault victim. But as I point out, one of the research studies says that between 40 and 45% of women in domestic violence, abusive relationships will also be sexually assaulted during the course of the relationship.

That’s pretty staggering, right? And I think there’s been a lot of people that haven’t addressed that within their own recovery and treatment because providers are not addressing it because why would’ve we without that framework?

Dr. Sharp: Right. Well, the thing that you said that’s shocking to me, I’m trying to sort through this here in the moment, is just that there’s not really a framework for charging sexual assaults within a domestic violence situation, if I’m phrasing that the right way.

Dr. Brenna: Yeah.

Dr. Sharp: That raises for me another question of, and this is a naive question, but is there a framework for sexual assault charges within a marriage or a committed relationship?

Dr. Brenna: Yeah, absolutely. But again, we see it come out in different ways where maybe one partner is maybe intoxicated or under the influence, and so they’re engaging in much more aggressive behavior, but you don’t often see a lot of domestic violence survivors in relationships, male or female, who come out and say I was also sexually assaulted because the view is like, you’re not saying no, so you must be okay with it.

I presented at the at Alliance conference in New York this past spring, and it [00:10:00] was interesting because my Uber driver that picked me up from my hotel to take me to the training, she was asking what I was presenting on.

I told her, and she was like, oh, actually, I’m the victim of domestic violence and started sharing her story. I asked her a very appropriate Uber conversation, but I said, do you feel like that was ever consensual in the relationship? She said, “Well, yeah, I was consensual. And she’s like, “But I said, no, what do you mean?” And she’s like, well, I don’t know. I guess I just felt like she said, there was one time that I said no, early on and she said, I ended up in the hospital because I was beaten so badly. So I never said no after that. And so it was interesting because I think even she didn’t think that it was an assault in that situation.

Again, that’s not to say that every domestic violence relationship or anyone that’s charged with domestic violence engages in sexually assaulted behavior. It’s more just that there are some that do, and that report engaging in sexually assaulted behavior while in domestic violence treatment. And that needs to be paid attention to because it means we’re not looking at that in the assessment process for these types of crossover offenses. 

Dr. Sharp: Yeah. I was going to ask, are you seeing this coming up in your interactions with survivors or with alleged perpetrators? What catches your attention most?

Dr. Brenna: Yeah, and I think it’s typically with the offenders because the way I do a sex offensive evaluation, if I see anything related to assaults or domestic violence in their history is so significantly different than it used to be before I started doing the domestic violence world. 

I will a lot of times refuse to finish a sex of offense evaluation on somebody if I don’t have a record about their domestic violence case. So referral sources have been really good about trying to track down information about that because a domestic [00:12:00] violence case can be charged SOTIPS now. There’s a broad spectrum. So I think knowing what did the domestic violence case involve and do we see any power and control dynamics that are similar to the sex offending behavior? And so there are now risk assessments out there that look at those differentiated risks.

So sometimes, like I said, it’ll be a sex offense-specific referral because someone’s being convicted or charged of a sex offense, and then we’ll see the domestic violence. And so now we’re trying to change how we do those evaluations and make sure that we are assessing the domestic violence risk and helping tease out which is more significant, the sexual. assault part of it or the domestic violence part of it.

And then the other way that it comes out is doing a domestic violence evaluation, and when you start asking questions about the sexual things, just looking to see if there is other stuff that’s showing up that they might not consider coercive or abusive and addressing if they have sexual risk factors that need to be addressed as part of treatment.

The domestic violence management board is working really hard. They have a great crew trying to help get this process really nailed down because the domestic violence system is very behind in terms of the way it prosecutes and the way it evaluates. I don’t know if there’s a similarity between that and the fact that it has one of the highest rates of re-offense are domestic violence offenders.

And that’s concerning to me because I’m like, we’re either doing an injustice to the offenders because we’re not actually identifying what they need in order to not do this because I’ll see people that have 4 or 5, 6 domestic violence charges, and I’m sitting here thinking, I got to do something different because what’s the phrase, if you always do which you always did, you always get, which you always got.

So, it’s two-part, which is, let’s make sure we’re getting the right intervention to address that risk, but two it’s why are we allowing these individuals to continue to re-offend and hurt people? We have to be doing something different from the criminal justice standpoint. And I don’t think [00:14:00] that here 24, we’ve had the right assessment tools to give really good information to help with the prosecution of cases- really good risk assessments and good testing that’s in the evaluations that help show some more pathology that help lead credence to the person’s risk level or not.

Dr. Sharp: There’s a lot to unpack there, I think.

Dr. Brenna: Yes.

Dr. Sharp: One piece that jumped out is just the fact that this negligence or unawareness or poor definition of these behaviors can go both ways. So just as a victim or survivor might not conceptualize non-consensual sex as a separate thing from domestic violence, the offender may not either. It just makes me think we got to be extra careful about really digging into both sides of those and defining each of those really well so that we can accurately assess it. 

Dr. Brenna: Yeah. It’s very interesting like I said, because Colorado, as I’ve said before, they’re really pretty progressive when it comes to the management of both domestic violence offenders and sex offenders. And so when I’ve trained this presentation in various states over the past year, it’s just very interesting to see the aha moment of a lot of people that are really thinking we have to do this a little bit different, but it is complicated.

Even Merv and I work a lot on a lot of cases trying to figure out how do we best make recommendations for individuals that have both sex offense-specific risk factors and domestic violence risk factors and not pour on the wrong intervention.

I think there’s always an assumption if it’s a sex offense, they have to go automatically and do sex offense treatment, but maybe the preeminent issue is domestic violence and the sexual offending is just part and parcel of that cycle. So, it is very tricky and it’s something that I think we’re still really trying to perfect and train and get people to understand that they have to be [00:16:00] able to look at both issues separately, and then the crossover issues.

We’re lucky that we have a risk assessment now that does that mark over is a psychologist in Canada who’s just awesome. He has the Violence Risk Scale – Sexual Offense Version, and that allows us to tease out whether their criminality violence risk is higher than the sex offense risk, and provides some good information when making recommendations and evaluations. 

Dr. Sharp: Sure. One thing that I’m wondering about is how much these are separate from one another as far as we know. I assume that sexual violence can exist without domestic violence and vice versa, but do we have any idea how much they’re co-occurring or how much they’re separate?

Dr. Brenna: Yeah. There really is one really good study that Merv did along with somebody else. And the interesting statistics are that these are from individuals who had domestic violence cases and not sex offense cases. And through the course of treatment or wherever the numbers that report engaging that actually the offenders are reporting engaging in non-consensual sex is pretty staggering.

I think some of the numbers that we talk about, which is what is it, 89% as I’m just looking at the numbers, 89% of domestic violence offenders, 89 out of 100 in this sample size reported engaging in non-consensual sex with an intimate partner. 73/100 said they’d had sex with the partner while the partner was asleep or unconscious and 31 of those said they’d had sadistic rape fantasies.

And so, it’s just a really interesting thing to look at that they’re acknowledging that in treatment and we’re starting to ask the questions in the right way and get them to understand because if you ask somebody who has a domestic violence charge, have you ever sexually assaulted your partner? The answer is always no, right?

Dr. Sharp: Right.

Dr. Brenna: They don’t conceptualize that there is a fear [00:18:00] of their partner just because of the fear of other areas. And so that’s where the domestic violence board is really trying to work on how do we integrate the sexual component of power and control dynamics into the treatment process and the intervention process so that we’re not missing some of those individuals who do have both issues. 

Dr. Sharp: Right. So zooming out just a bit for others who are unfamiliar with this process, can you just walk us through some of the core assessment tools for:

1) Domestic violence,

2) Sexual offenders?

And then we’ll talk about how they cross over and how we might dig into that too.

Dr. Brenna: Yeah. It’s a little bit different in terms of how the legal system functions with domestic violence cases right now and sex offenses.

With regard to a sex offense, if you’re charged with a sex offense, you can either get an evaluation done before you’re accepting a plea. I talked about that with my last interview where an attorney might hire somebody to look at their estimated risk if they’re convicted and then that’s used to negotiate a plea deal or help them decide if they want to take it to trial. But in Colorado, it’s mandated by law that if someone has been convicted, or has pled guilty to a sex offense, they have to go through a sex offense-specific evaluation.

In the domestic violence world, they have to do an evaluation, but it’s always done post-sentence. So a lot of times the evaluation is not done pre-sentence so that people have access to that before making sentencing arguments and whatnot. And so, there’s in the state right now, trying to get some standards changed so that the people making decisions about these offenders have all the information before they’re making decisions about giving PR Bond or letting them have access to the victim again and lifting the protection order. That is something that’s in process. And like I [00:20:00] said, the state is doing a great job.

I think I mentioned to you that I’m on the domestic violence fatality review board that is headed up by the attorney general. And it’s been an amazing thing to be a part of to review cases and help see how policy change might help with the evaluations and how we can get that so that again, it helps not only get the right sentence and containment for people who are really violent, but also helps give information about maybe the offender doesn’t need to go to domestic violence treatment and they need mental health treatment so that we’re doing more thorough assessments and the judges have all that information before a sentence is handed down that may not be appropriate based upon no information.

Dr. Sharp: Sure. And what’s that assessment process actually look like in each of those cases? Just talk through the process and the instruments if those are relevant.

Dr. Brenna: The Domestic Violence Offender Management Board, the DVOMB, and then the Sex Offender Management Board is the SOMB.They have really amazing standards that they have and anyone can find them online. There are sections about what are required areas of the evaluation, and then what are maybe more suggestions, and recommendations. And they give providers options within there because not all providers are Ph.D., PsyDs who can do some of the more sophisticated testing. Not everybody has been trained on giving the Hare test for psychopathy. 

I like that from my own standpoint I have the advantage of being able to add some more sophisticated tests, but we also have to be able to do tests that people that have an LPC or social work license can also do because they can be certified to do these evaluations just fine. So they give a little bit of wiggle room with regard to what tests are used to assess certain domains.

And actually, like I said, they’re very similar in theirs. Just like any psychological evaluation, which is you’re doing a really [00:22:00] extensive biopsychosocial background, but it’s just always interesting because sometimes when I have people that are new and I’m training, they’re like, why do you care how many times the person’s moved? Or why do you care if they have four friends and not six, or why are you asking them how many times they moved in this amount of time?

And so this biopsychosocial interview becomes important in scoring risk assessments because items such as residential instability or employment instability elevate risk. And so, some of the questions you may never ask in a normal psychological valuation are asked in these evaluations. And so, they catch people off guard sometimes. But usually, that background information leads to information to help score the risk assessment items that have been identified as predictive of recidivism.

In addition to just a good background, we obviously want to see all police reports of anything that is related to the case. And then we try to get a good criminal history that we get from the referral source that shows if they have other cases. And then as I said, it’s just so important that we’re all now starting to make sure we’re getting those police reports, especially for domestic violence in history.

And then, people are probably familiar with the MCMI®-IV or the MMPI, which is tests of emotional functioning. So a lot of people will give those to find out what kind of pathology is there. And I think that’s an important test that I give a lot more credence to now with domestic violence cases.

Merv has taught me looking at some of those skills like turbulence. You might not think like, oh, okay, not a huge deal, whatever, somebody’s up and down, they have erratic response style to things, but you can imagine if you have elevations on turbulence with somebody who’s highly abusive and impulsive using strangulation that they have that personality profile that’s important.

And so, using some of the data [00:24:00] from those scales of narcissism or anti-social personality, those things become a little bit more important to really look at when we’re trying to tease out this risk and whether someone’s more criminogenic or sexual in terms of risk. And then we usually do a very thorough substance abuse assessment, because again, we know that that’s present in a lot of both these types of cases.

We do cognitive screening of mental status and then specific risk assessments for each type of case. And that’s where there’s been a bit of change for those of us who can do both the sex offense and the domestic violence cases is that you’ll see in a sex offense evaluation, people would be doing domestic violence, also risk assessment because there’s some domestic violence conviction in their history.

And then the same is true with the domestic violence cases is looking through risk factors for sexual offending and seeing if any of those apply to the client, not necessarily scoring them, but seeing like, oh, we know these are risk factors for sexual offending. Does this domestic violence client present with any of those that we need to earmark?

And so I think the biggest thing is once we have all that data is compiling it into what are the appropriate recommendations. And so I think I’m always harping on making sure they’re not generic recommendations and that they match up with what the results say. I mean, it doesn’t make sense, like I said, if somebody is schizophrenic and unstable on medication to send them into a domestic violence treatment group, because they can’t even stay in contact with reality.

So, it’s hard for providers, including myself to switch gears and be like, okay, wait, I know this is a domestic violence case, but let me slow down. Maybe we need to just stop that for a second and send them to mental health treatment. But there’s always fear there that you’re like, wait, but they need to be in domestic violence treatment.

I think really trying to make the argument of what is causing domestic violence behavior is our job as evaluators. And I think we’re getting so much better at that. And that’s why I think this is really important to me is to get people to really identify [00:26:00] what those risk factors are and apply the appropriate intervention. Otherwise, we’re just spinning our wheels doing the same thing.

I’ve had guys that have gone through domestic violence treatment three times and there’s nothing wrong with it. It’s just that it’s a great treatment, but that may not be the most salient need based upon their history or whatever they have. 

Dr. Sharp: Right. I want to dive into that; how you separate the two, and how you make appropriate recommendations for domestic violence versus sex offense, but before I do that, do you have a preference with the MMPI versus the MCMI? I get this question a lot.

Dr. Brenna: It’s difficult. It depends on the case. I tend to use the MCMI more just because it’s shorter. I think that helps, especially when we’re giving them in a correctional facility or whatnot. And I like the scales and the reflection of that as it relates to, for example, in the sex offense world, we have the sexually violent predator assessment and some of the items on that relate specifically to the MCMI-IV. So it actually loads on three of the scales. And so if they meet a certain level. They check in that area. So I think a lot of the risk assessments have been based on the scores on the MCMI more so than anything from the MMPI. 

Dr. Sharp: Got you. That answers my next question, which is if you know of any research that ties MCMI-IV profiles or scales to these concerns we’re talking about- domestic violence or sexual violence?

Dr. Brenna: It’s a really great question and that’s actually something that Merv and I are working on now that we have a pretty good… I’ve been doing a similar thing, and we’ll talk about this I think in a future episode maybe is the sex trafficking offender and looking at some of exactly what you’re saying and tracking data on that. And that’s really Merv’s and my goal.

I am presenting it ATSA in Atlanta in two weeks, and that’s one of the things we’re going to talk about is looking at a lot of the crossover [00:28:00] cases we’ve had and seeing what those MCMI skills are. Are there commonalities between? Do they all score high narcissism? That’s really the next step. And it’s so fascinating because I feel like between us, we have a lot of good data to look at and see what commonalities might exist that give us some information. 

Dr. Sharp: Nice. Let’s really dig into this. This seems to be the crux of this discussion is how do we accurately assess these two separate related issues and then make appropriate recommendations for these folks? This is pretty serious. It’s not like we’re talking about giving a kid preferential seating in the classroom. Recommendations, I would assume, have to be pretty on point. You don’t have a lot of time to waste with these offenders. So how do you start to separate these two issues that are obviously related to one another? What’s that process been like for you?

Dr. Brenna: It’s really interesting because I remember it was funny when I was studying for my comps, my master’s degree. I remember somebody said, if you don’t know the answer to a question, you always say I’m going consult. That’s always a good answer if you don’t know the answer.

I guess I’m thinking about that because that’s something that I do almost always on a case where there is both a sex offense and domestic violence is consults with various people to also run it through them and talk through the problem because it’s interesting to see how difficult it is to:

1. Lay it out in a systematic fashion recommendation-wise,

2. Be able to articulate to a legal system why one is more important than the other.

Again, we have set up this system, which is very great, but sometimes rigid where we think, okay, if it’s a sex offense charge, they have to go to sex offense treatment right away. Or if it’s a domestic violence case that this is [00:30:00] where they go. And so I think what we’ve been trying to work on is saying, all right, wait a second. Let’s go again not on this fear base of what the crime is, stay from that for a minute and think about the issues that we’re seeing showing up and why those are contributing to the offending, and then address those through the particular type of treatment.

So long answer is that one, using the risk assessments helps that significantly. Like I said, I like Mark Olver’s VRS-SO. That helps. But I think once we get to the place of making recommendations, it’s looking at if somebody, let’s pretend we have a sex offense conviction that they’re being referred for and they have a prior domestic violence conviction, those are a little bit easier to some extent because we’re allowed to use both the domestic violence risk assessments and the sex offense ones because there’s conviction. So that helps tease out.

And when I’m seeing somebody that’s really high on the domestic violence risk need assessment is the DVRNA, the risk assessment for domestic violence. And some of the variables that increase risk on that are not anywhere on sex offense-specific risk assessments.

And so, it’s very fascinating when you start scoring them and looking and seeing like, wait on the sex risk assessment, they’re not presenting with a lot of these sexual risk factors that we typically see, but wait, on the domestic violence risk assessment, things like children being present while the offense is happening, using strangulation, suicide attempt in the past year.

So there are some really interesting questions on the DVRNA that I ask now, even on a sex offense evaluation because you don’t really think about those things as being important but they really are. And I think the police department does a really good job of putting those variables in the police report so that we’re able to score those.

So it’s helpful just to even ask those questions, even if you’re not looking at domestic violence because it gives some good information. And so, I think.. Sorry, go ahead.

Dr. Sharp: I was just going to jump in [00:32:00] and ask you, I may have misheard this, but you said, in each of these cases, you may not be allowed to assess the other side. Did I hear that right? 

Dr. Brenna: Yeah. And I say allowed, I would say we obviously want to go on what the risk assessment population has been normed on. And so, the sex offense-specific ones have been normed on adult male sex offenders only. So you don’t use those risk assessments on a juvenile offender. They’re also not appropriate to do if the client has an intellectual disability because those specific ones haven’t been normed on that population.

And the same is true with the domestic violence risk assessment. It’s supposed to be scored only if there’s a domestic violence conviction, but again, Merv who created the DVRNA along with the domestic violence management board, said if you’re going to use it in cases where there’s not a conviction, it’s just informational purposes and we’re not coming out with overall level, but we use it to say, oh, okay, well we have all of these. This should help inform what kind of intervention someone needs. So,  in a lot of cases, I’ll go ahead and look at the risk factors but just not score the assessment if they don’t have an actual conviction. 

Dr. Sharp: I see. You’ve got this information and then then you consult a lot to try to separate the two because I would imagine that there are a lot of folks who trigger a lot of items on both scales qualitatively or quantitatively.

Dr. Brenna: Yeah. I think about one case that I had, and it was the first. I actually asked the client if I could do a video interview of him after he finished the assessment because he was an interesting case where in Colorado, if you’ve ever been charged or if you ever been convicted of a sex offense at any point in your life, even if you’re like 10 years old, and then at a later point in your life, you get charged with a non-sexual crime that fits into a certain statute like domestic violence, [00:34:00] assault, menacing, then you actually have to go back and do another sex offense evaluation. So even if you were 10 and then you get an assault case when you’re 80 years old, you’d still have to go back and do a sex offense evaluation per Colorado statute.

We call those matrix cases. And so it’s interesting because this one client that I had, he had a sex offense from when he was 19. He’s now in his 50s, I believe and had a domestic violence case. It was pretty serious. And so he was referred for a sex offense evaluation interestingly because of the way the system is. He came in, but I’m like, all right, I can do both these. We can look at this.

In his case, there are no records about his sex offense because it was when he was 19. So we have no idea what his case actually involved. He self-reported one thing and maybe it’s true, who knows, but his domestic violence case involved in trying to, essentially almost killing somebody. But he’s in my office. And even during the interview, he’s actively hallucinating. He had just gotten released from a mental health hospital for having a suicide attempt. I remember asking, I don’t know how many times you’ve asked this question, but do you have any thoughts of hurting yourself or others?

And when I asked that, I said, do you have any thoughts of hurting others? He said, mm it’s still early. And I thought to myself, oh my gosh, what is happening right now? The risk assessment trainers sometimes say ice on the heart when you’re scoring risk assessments. That doesn’t sound very good to say, but sometimes you can get caught up in the emotion of the case and not really stick with actual data points. And so it’s really hard. You got to stay focused. And even if somebody has a really horrible offense on this side with risk assessment items, you have to stick with factual information which we can talk about that.

But with him, I showed the video at the conference and it was a very interesting response from the audience because there was so much disagreement with what to do with this client because here you have him [00:36:00] almost trying to like kill somebody and he had other domestic violence cases. He’s severely mentally ill. He was off his medication. And then he has this prior sex offense he didn’t do treatment for it. We have no records. For all we know, he could have tied somebody up and it was a child and raped him, or it could have just, not just, but it could be something like exposing his penis in public.

It’s hard to go off of what you don’t know. And so it was interesting because I ended up teasing out the wrecks and I was like, all right, everybody, how many of you think that he needs sex offense treatment, how many domestic violence? And so it was split side by side, but I would say most people said sex offense treatment.

I guess people can think about that because it’s just that when you have the word sex and anything, it’s very fear-based for a lot of people, and everyone assumes that takes precedence over domestic violence, which is what’s concerning to those of us in the domestic violence world. That term has become a little bit washed out. So a lot of people refer to domestic violence as intimate partner violence or intimate partner sexual violence because I think that just people have become desensitized to the word domestic violence, like somehow going in and telling an employer, you have a felony domestic violence case causes less alarm than you saying you have a misdemeanor indecent exposure.

So that’s just an interesting component of this. Everyone’s afraid not to recommend sex offense treatment because it’s such a serious crime obviously.

There was a bit of fighting in the audience and then I said, well, does anybody want to know what actually recommended? I wonder if you can think of a third option I might have gone with first.

Dr. Sharp: Oh, no. Don’t put me on the spot.

Dr. Brenna: I know. It’s interesting, but do you think somebody who is actively hallucinating, who is homicidal, suicidal, is not on his medication, is a substance user, et cetera, he’s not going to be successful in either of those because they’re very intensive and you have to be able to be [00:38:00] with it enough to participate and acknowledge stuff.

And so what I ended up recommending with Merv’s supervision and input was mental health treatment, first and foremost. We don’t know actually which risk is higher at this point, but it’s not going to do any good to go one way or the other until his mental health is stabilized. Certainly, he needs some supervision and containment, but really the only way to help this person in my opinion if you look at the risk factors are his mental health because that’s what I was saying earlier is, all right, if we throw him into domestic violence treatment, maybe he needs it, but maybe what is causing the domestic violence behavior to keep repeating is unstable mood or lack of medication or trauma that’s been undiagnosed.

That’s where I’m proud of our state that we’re really getting to a place of saying we can address a domestic violence case through mental health treatment. Maybe it’s not always necessary to go that route of domestic violence at the outset.

That’s a case where after he gets stabilized, I would suggest having an updated assessment to then see what are the variables that are still here once the mental health is stabilized. And that will help better tease out whether it’s sex offense specific or domestic violence. Does that make sense?

Dr. Sharp: Yeah, it does. It makes me want to ask though, how many cases are there where that’s not true? It’s not true that there are major mental health or mood issues that are influencing these violent behaviors?

Dr. Brenna: That’s a great question. The problem is that there are a lot of people that come in a forensic evaluation where they’re not forthcoming. And so they will deny. It could be racial or cultural specific where it’s not something in their language that they talk about mental health problems where they say, yeah, of course, I’m depressed, or it’s just like, no, you just suck it up and you move on.

And so there’s a lot of people who don’t report a lot of those symptoms [00:40:00] sometimes because

1)They think it’s going to make them look bad.

2) They blow them off and don’t think they’re that important and have no insight that the fact that they have this history of trauma might be contributing to something they’re doing.

And so in those cases, it really is a little bit more difficult to say, ah, gosh, now I really have to just stick with domestic violence treatment or sex offenses treatment. When there’s cases of both, historically, we’ve sometimes put offenders in both domestic violence and sex offense treatment at the same time. I think anybody can understand why that might be a problem:

1) The cost of doing both.

2) The time commitment.

3) There may be a crossover of issues that they’re having to learn twice.

And so, it’s almost like a setup for failure to some extent, because it’s like who can participate in that much treatment. They’re both such intensive levels.

So a lot of times, especially if an offender is completely denying a case like a sex offense, what we have tended to do is to go with the domestic violence stuff first. It’s intensive, but I would say it’s not quite as intensive as sex offense treatment. And so going there and getting them used to the process is usually a good first line. And then the provider has a chance to assess stuff further and maybe make recommendations when they start transitioning into the sex offense world.

But I think the biggest thing is really clear communication between providers that once they’re shifting from domestic violence to sex offense, maybe really they found out that it is all domestic violence related risk factors and sex offense treatment is a much more minor issue because it’s part and parcel of the violence. Does that answer your question? 

Dr. Sharp: Yeah. And it just makes it clear how complicated this stuff is. I just want to ask more questions. I’m like, we need more research to know about the overlap in these behaviors and what drives what. 

Dr. Brenna: What’s hard though is there’s a little bit of [00:42:00] hands being tied because of the way the legal system is set up for the respective offenses. Because even if I say to somebody, I really think that even though this is a sex offense, we need to put that on hold and have them go do mental health treatment, work on their personality disorder or whatever, usually the probation department will be like, yeah, absolutely. I 100% agree. But their hands are tied because of the way the statute’s written or because of the standards that a client has to be still involved in that sex offense world per the law.  And so you have to get a little bit creative in that process of what does that look like and what are we allowed to do within the confines of following guidelines, but also addressing their needs.

It’s this thing where when you have both, especially if they have a conviction for both, it’s like, do you put them on sex offender supervision or do you put them on domestic violence supervision? And then, do they have to be compliant with the domestic violence world or the sex offense world? So those issues. That’s why it becomes very tricky to write out as recommendations because when somebody has a sex offense, they’re not allowed to be around their children in a lot of cases, but in the domestic violence world, that is not necessarily addressed.

One huge thing that comes up that sex offense providers typically don’t know, I didn’t, but you cannot do couples counseling with your victim until you’ve completed domestic violence treatment. So sometimes in a sex offense evaluation, l will be like so, and so needs to do couples counseling with this person because they have intimate partner deficits or whatever. But if they don’t know what the domestic violence world and what those rules say, that’s a huge no-no because you actually cannot participate in couples counseling until your domestic violence treatment is completely finished and the providers think it’s appropriate.

So, it’s just important to know both sides of it because the domestic violence world has very specific things with protection orders and then the sex offense world does. So I think we’re getting there and like you said, more research is needed. [00:44:00] I’m looking forward to presenting in Atlanta and getting hopefully some more data to help us make it easier.

Dr. Sharp: Right. Do you have any sense of the… This is maybe the wrong way to look at it, but the best way I can think to ask of the risk of not getting the recommendations right. So maybe that’s the recidivism rate for either domestic violence or sex offense or is one “worse than the other” if you miss it?

Dr. Brenna: It depends on who you ask. For me, I feel so passionate about making sure, if I get somebody who’s coming in my office and they have 3 or 4 domestic violence cases previously, and I sit there and I’m like, you know what? This is not just the offender’s problem. This is us as a system letting them down because we’re obviously not addressing whatever it is that’s causing this.

That’s where I think we have now starting to get the system progressed where especially domestic violence evaluations are becoming more extensive and thorough and able to help identify some of those, and through a lot more educating of judges and prosecutors about what those domestic violence risk factors are because a lot of people don’t know that if somebody’s child is somewhere present in the house when this offense is going on, that raises their risk level for domestic violence. Strangulation, like I said, is an absolute, that’s the highest level of treatment automatically.

I think knowing those risk factors and educating people is super important. And I just feel an obligation where if we’re continuing to put that person just like, all right, they’re in domestic violence treatment because it’s a domestic violence case, they’re going to keep coming back because even if domestic violence treatment is amazing and the providers are amazing, it’s not addressing the things that are putting in there.

I think people are changing the way they’re conceptualizing it and that will help [00:46:00] prevent people from re-offending with domestic violence because I don’t think there’s any mis in domestic violence, like I said, the highest rate of recidivism, and yet I think we’re now just making the evaluation process more thorough and that’s going to help hopefully with the recidivism, would be my hope.

Dr. Sharp: That makes sense. It seems like there’s a lot of work to do in this area to move us forward.

Dr. Brenna: Yeah.

Dr. Sharp: Are you aware of any work on particular assessment measures that are more specifically targeting the overlap here?

Dr. Brenna: Yeah. It actually started when I was working with the committee. There’s a few of us that were working on creating a new protocol for a sex trafficking case. I bring that up because I think the conversation about sex traffickers is always, are they a sex offender or are they a domestic violence kind of more criminogenic? And it really started a conversation in the state about that.

And so myself, along with some other people started creating a different evaluation protocol for sex traffickers. And so within that, that’s when I started thinking, okay, wait a second, why aren’t we doing this with other evaluations? Why are we adding these other components in? Because sex trafficking is such a horrendous crime that we’re like, okay, we’ve got to be able to add in a Hare Psychopathy test, and we have to add in more violence risk assessments.

And so now there was an, it’s called a white paper, that the SMB put out that now has these new suggestions for what types of evaluations and assessments to use that actually gets at both criminogenic risk factors and sexual risk factors. I use that same matrix for domestic violence- sex offense, crossover cases, because I think we really have missed the boat on getting at the pathology behind even sex offending and what that looks like and [00:48:00] making sure that we’re not missing the vote because treating criminogenic risk factors is a lot different than treating sexual risk factors.

So like I said, we are recommending, with those traffickers, to use things more like the Hare Test of Psychopathy, to use the MCMI, maybe you need to use a Personality Assessment Inventory. Make sure you’re using good substance abuse measures to see what that is and add in trauma assessments so that we’re seeing where this comes from.

And that’s giving us good data now to be able to look and see about commonalities. The same is true now for some of those domestic violence sex offense cases is to use that same set of testing measures to get a better picture. I think the pathology is really important, like I said, behind these cases. 

Dr. Sharp: Of course. Is there anywhere that you know of where that assessment battery is spelled out that people can access? 

Dr. Brenna: Yeah. I can send it to you. It’s on the SMBs website, but I’m happy to send it to you. Maybe you can post it on your website or something. We offer some options for what people can do.

I’ve seen the system starting to shift a little bit. And I think people on all sides of the defense, whether it’s a defense attorney or it’s a prosecutor or it’s a victim advocate that I have, on the attorney General’s committee, we have access to these amazing people in all those areas that I think everybody’s on board, even the defense attorney rep of like, okay, yeah, this is a problem from both sides- not only to be able to prosecute and get them the right supervision.

From a defense attorney standpoint, it’s like, all right, well, my client keeps reoffending because nobody’s evaluating them correctly. So what do we need to do? And that’s a pretty cool thing to see that people are even working together to help fix this system. It doesn’t happen that often. So I think that’s pretty cool. 

Dr. Sharp: That is really cool. It also just reminds me how important our role is in these cases. [00:50:00] Psychologists are really like a linchpin of this whole process to be able to pull all these components together.

Dr. Brenna: Well, it’s such a privilege. I think obviously it’s always intriguing to go in and ask somebody why they did what they did. It’s important. It just shows the absolute value of making sure that you’re putting a 110% effort in when you’re doing these types of cases, because if you miss something, and you’re not paying attention to those variables, you’re not looking to see if they have domestic violence in their history. And you’re saying, yeah, go ahead and go have contact with this person again. Or you’re not making a report to child protective services, even though the kids are witnessing domestic violence every single day in the house.

So there’s just these areas that I think we just are continuing to educate. I feel like we’re right at the cusp now with having good leadership at the domestic violence management board and with the attorney General’s office being behind it making some changes that are helpful for everybody.

Dr. Sharp: Yeah, of course. Well, I asked you this question last time and I’ll ask it again just to check in for any folks who might not have heard, and maybe your process has changed too, but you bring the idea that you have to come 110% with these evals to make sure you’re doing a good job. How do you keep yourself sane and taken care of in light of all the things that you hear and folks you interact with and things that your mind might conjure up from these cases. How do you set that boundary or compartmentalize or whatever you might call it? 

Dr. Brenna: I think that for me focusing on, there’s something about seeing behind… I just don’t believe people are born bad. I think that everybody has a story and I think it’s important to me. I feel like it’s a purpose to figure out what are those dynamics, good or bad, that might be able to help [00:52:00] this person. There’s a Turkish proverb that says something like, no matter how far you’ve gone down a wrong road, you can always turn back or something.

I believe that about people. I feel like it gives me purpose to figure out what those recommendations may be by finding out information, and asking better questions so that we can make that difference. And so I think making that I feel like it’s a purposeful thing for me. And so that’s helpful.

And the other thing is also doing training and talks like this and going around and trying to make a difference. I find that that helps me because I’m like, all right, I’m making this matter. I’m doing something with this. I’m trying to help educate people and bring them in and helping the offender and the victim. This whole process benefits everybody. And so I think for me it just feels very purposeful to let somebody share their story and it get them help that they obviously need. 

Dr. Sharp: Right. I’m going to ask you another maybe hard question. They’re ramping up as we go on here. How do you maintain this belief in human goodness in this field?

Dr. Brenna: Like I said, I feel like everybody has a story. It’s just so sad and so cliche that it just comes- there’s always just this cycle of violence that continues to happen where, like I said, it’s so cliche that it’s like, oh, well, yeah, this person had this happen to them, then this happened to them.

It’s a pretty awesome thing to be able to help identify what those issues are that have gotten that person to a place. It doesn’t mean like, oh, they’re going to get off of a crime or they’re going to be this, but it helps sort of say like, okay, wow, this person is on the autism spectrum. Let’s get them tested. I don’t know how many people have had to send for autism-specific testing in evaluation that nobody knew they were and that it was contributing to some sort of behavior that was happening.

And so I think from that standpoint, [00:54:00] it’s a really a cool place to be and to be able to identify those things and bring them out into the open. I had one case where I referenced Of Mice and Men and it’s just really interesting.

Like I said, this person just reminded me of Lennie’s Of Mice and Men. They were very intellectually disabled and it was very obvious this person was not capable of even having the wherewithal to commit this particular crime and this being set up. And so I just think it’s a really cool privilege that I have and you have to be able to look at some of these variables and help people understand them.

Dr. Sharp: Well, I think we’re really lucky to have you and folks like you doing the work. We talked last time. It’s a special personality I think that can hang for any amount of time in this niche in our field. I think we’re just lucky to have you and others who can do it.

Dr. Brenna: Well, thank you.

Dr. Sharp: Our time went by really quickly. I really appreciated all of this. Do you have resources for folks who want to learn more about this topic? I know you listed a bunch of measures and resources here from Colorado. I’ll list all those in the show notes, but any books, websites, or any professional groups that really can help people learn about this stuff?

Dr. Brenna: Yeah. I think going to the domestic violence management board website. It’s just DVOMB and the same with the SOMB website. They are very good about citing the research and it’s very evidence-based. And like I said, Colorado, they’re pioneers and all of it. And so we’re people that are actually,… It’s amazing to see that we’re here and we have that privilege.

I can send you a list of very specific references to this topic. You can put them in show notes or whatnot. A link to that as well is the [00:56:00] copy of what we call the white paper for the trafficking, because it lays out really nicely the testing instruments that we’re suggesting might be useful in looking at those. And I think you and I, in the future, are going to be having a conversation a little bit more about sex trafficking. Look forward to that. 

Dr. Sharp: Yes, absolutely. Yes, there will be a part three. And that would mean that would make you the only three-time podcast guest. 

Dr. Brenna: That’s very special. Now that’s definitely on the block. Well, one of these days we’re going to do one together. That’s what I think we’ll do. I’ll host one

Dr. Sharp: That sounds good. Well, thanks again. I really appreciate it. I’ll get your contact info from the other episode and make sure people can reach out if they’d like to. But this was great. It’s always good to talk to you.

Dr. Brenna: All right, bye. Thank you. 

Dr. Sharp: All right y’all. Thank you so much for listening to my interview with Dr. Brenna Tindall. I hope that you learned a lot as I did. Brenna is clearly on the forefront of research and practice in this relatively unique niche area. She’s definitely one of the folks to reach out to if you have any questions about this topic. I will have a lot of resources in the show notes, so definitely check those, and don’t hesitate to reach out to Brenna if you have questions or would like her to do any kind of training or speaking on these topics.

If you have not subscribed to the podcast, I’d love for you to do that. It’s really easy in whatever podcast app you might listen to. It should be a big subscribe button right there. Just hit that button and you will make sure not to miss any episodes going forward. If you’re feeling extra generous, I would love to get a rating and a review for the podcast. And if you have any constructive thoughts or comments, drop me a line at jeremy@thetestingpsychologist.com. Always like to hear ideas for future episodes and thoughts on how to improve the [00:58:00] podcasts.

Thank you all for listening. I will catch you next time.

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