Sexual and Relationship Therapy

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Forensic sexology versus clinical sexology: Some

cautionary comments

Daniel N. Watter Ed. D., Clinical and Forensic Psychologist

To cite this article: Daniel N. Watter Ed. D., Clinical and Forensic Psychologist (2006) Forensic
sexology versus clinical sexology: Some cautionary comments, Sexual and Relationship Therapy,
21:02, 143-148, DOI: 10.1080/14681990600637671

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Sexual and Relationship Therapy
Vol 21, No. 2, May 2006

LEADING COMMENT
Forensic sexology versus clinical
sexology: Some cautionary
comments
DANIEL N. WATTER
Private Practice, Morris Psychological Group, P.A., 50 Cherry Hill Road, Parsippany,
NJ 07054, USA

ABSTRACT Recent years have seen an increased need and interest in the field of forensic sexology. As
a result, many clinicians may have been asked to serve as forensic evaluators even though they may
have little or no training in this area. This editorial focuses on some of the significant differences
between the practice of clinical sexology versus that of forensic sexology. Clinicians wishing to add a
forensic component to their practice are advised to seek out specialty training and consultation before
entering this area of practice.

KEYWORDS: female gender issues; sexual physiology

Introduction
Recent years have resulted in an increased need and interest in the field of
forensic psychology in general (Schlesinger, 1996; Shapiro, 1999), and forensic
sexology in particular. Forensic sexology refers to the application of sexual science
to assist in the resolution of questions arising from crime or litigation. As a result,
many sexology clinicians have been asked to function as forensic evaluators, even
though they may have little training/experience in this area of practice (Melton
et al., 1987). While forensic sexology can be both fascinating and rewarding,
the inexperienced sexology clinician would be well advised to heed some
cautionary advice and seek out some specialty training and/or supervision prior
to venturing into this area of practice. Many experienced clinicians find themselves
in some very serious difficulty, simply because they do not realize that there are

Correspondence to: Daniel N. Watter, Private Practice, Morris Psychological Group, P.A., 50 Cherry
Hill Road, Parsippany, NJ 07054, USA. E-mail: [email protected]
Received 14 February 2006; Accepted 15 February 2006.

ISSN 1468-1994 print/ISSN 1468-1749 online/06/020143-06

ª British Association for Sexual and Relationship Therapy
DOI: 10.1080/14681990600637671
144 D. N. Watter

important differences between the practices of forensic sexology and clinical

sexology.
The purpose of this paper is to identify and comment on several of the differences
between the practices of forensic sexology and clinical sexology, and to examine the
question of ‘‘what exactly is being asked of us as forensic evaluators?’’ While at first
glance this may seem to be a simple question to answer, the reality is that it is loaded
with moral, ethical, and political overtones. The forensic arena is quite different than
the clinical arena. It has its own rules, values, and practices. An examination of these
differences will assist the sexology clinician who wishes to pursue forensic practice to
do so in an informed manner.

Difference #1
‘‘In clinical work, we assume those we are working with are telling us the truth; in
forensic work we often must assume they are lying.’’

While most sexuality clinicians have certainly encountered clinical patients who
were not fully open and honest, we usually assume that most of the people who
consult us are being as honest with us as they can be at the moment. Clearly, it takes
patients time to feel comfortable with their clinician, and they often reveal more
details over the course of treatment. Nevertheless, the assumption by both patient and
clinician is that it is in the patient’s best interest to be open and candid.
The understanding in forensic work, however, is that it is often not in the patient’s
best interest to be frank. Many are facing the prospect of conviction for a sex crime
and a possible incarceration, and are therefore, motivated to ‘‘put their best foot
forward.’’ Much of forensic evaluation consists of being certain to have enough
collateral information so that the examiner will be able check the veracity of the
patient’s version of events (Wincze, 2000). It is also necessary to be sure to include
testing that includes scales to detect lying and malingering.

Difference #2
‘‘In clinical work, we promise confidentiality; in forensic work, we make no such
promises.’’

Confidentiality is the bedrock on which effective psychotherapy rests. Many clinicians

have argued that it is the promise of confidentiality that allows our patients the
freedom to disclose their innermost thoughts, feelings, and desires. Without the
promise of such privacy, it is likely that psychotherapy would be rendered relatively
ineffective.
However, the forensic evaluation is not a confidential process. Those being
evaluated are clearly informed that anything they say can be included in the clinician’s
report. Therefore, we again see why the person being evaluated may have good reason
to be less than forthcoming with data. Indeed, one could argue that the forensic
interview may have limited utility due to this one factor alone.
 Forensic sexology versus clinical sexology 145

Difference #3
‘‘In clinical work, we expect to work slowly, and evaluation is seen a dynamic process.
In forensic work, we are expected to work ‘quickly’ and evaluation is seen as an
essentially static process.’’

As sexuality clinicians, we understand that the process of coming to know and

understand our patients is often a slow and gradual process. We expect that it will
take some time to know our patients, and that it will take some time for our patients to
get to know and feel comfortable with us. We rarely expect to discover all relevant
information in a matter of a few short hours, and further expect that our assessment
and understanding of our patients’ concerns will change as treatment progresses.
Indeed, many mental-health clinicians readily admit that the DSM diagnosis they
may assign to any given patient at intake may be quite different than the DSM
diagnosis they may assign at some point during the course of treatment.
The forensic assessment, however, is seen as a relatively quick and static process.
The forensic examiner will likely have little time with the patient, rarely more than a
few hours. During this short period it is expected that we will be able to accurately
assess and diagnose the patient seated before us. While sexuality clinicians typically see
assessment as a complex and dynamic process, the forensic sexologist sees assessment
as a more static endeavor. In other words, the forensic assessment assumes that all
relevant data can be collected in a matter of hours during which there may be a records
review, clinical interview, psychometric testing, and/or collateral interviews. In that
period of time, the examiner will render a diagnosis, as well as treatment suggestions.

Difference #4
‘‘In clinical work, we often find ourselves trying to provide a tone that is ‘sex positive.’
In forensic work, we often find ourselves creating an environment that is ‘sex
negative’.’’

Most clinicians in the field of sexology would likely agree that they try to create an
environment for their patients that are more ‘‘sex positive.’’ That is, in our clinical
work we are usually trying to either help patients ‘‘fix a problem’’ or find some way to
enjoy the expression of their sexuality. We tend to see sexuality and sexual behavior in
a positive light, and encourage our patients to feel free and comfortable in expressing
the sexuality with which they feel most comfortable, and they most desire.
In forensic work, however, we are usually not trying to help patients ‘‘fix a
problem’’ or enjoy the expression of their sexuality. Indeed, we are typically working
with the mindset that we are trying to assist people in ‘‘controlling’’ their sexual
behavior. Rather than encouraging people to feel free in the demonstration of their
sexual behavior, we find ourselves looking for ways to get them to stop manifesting
the sexuality that they may feel most comfortable with, or desire most. As a result, the
messages we often give in forensic sexology are seen as more ‘‘sex negative’’ in that we
are trying to stifle our patient’s sexuality, as opposed to encouraging freer expression.
146 D. N. Watter

Difference #5
‘‘In clinical sexology, we are dealing with patients who usually motivated for
treatment. In forensic sexology, we are often dealing with patients who are mandated
for treatment/evaluation.’’

In clinical practice, we are usually working with a patient who is motivated for
treatment and wants to be helped. While it is certainly true that not every patient
is motivated to begin treatment, most at least come to believe that it is in their
best interest to be there. For example, most sexuality clinicians have worked with
couples in which one person is more highly distressed than their spouse/partner.
However, the other spouse/partner often recognizes that treatment may be
indicated in an effort to save/repair the relationship. In other words, in clinical
sexology we usually assume that the patient is participating in an essentially
voluntary manner.
In forensic sexology, however, the person we are working with is typically
mandated for treatment/evaluation. Whether it is required by law enforcement, a
defense attorney, or some other source, the patient typically feels as if they have little
choice but to participate. It is difficult enough for patients to be honest in treatment
when they want to be there; imagine the difficulties in fettering out the truth with
patients that are often hostile to the entire process. This dilemma is somewhat similar
to difference #1 above in that we often find ourselves working with a patient who we
must assume may be ‘‘lying’’ to us. Such patients are clearly invested in presenting a
good front and hoping to come out of the assessment process with as little punitive
action being recommended as possible.

Difference #6
‘‘In clinical work, we are usually dealing with patients who are in personal distress. In
forensic work, we are often dealing with patients who may cause society distress, but
would most likely be happy to continue what they are doing.’’

As sexuality clinicians, we are accustomed to seeing patients who are in pain and are
looking to change some aspect of how they think, feel, and/or behave. Indeed, it is
their sense of personal uneasiness that often motivates them to enter into treatment
and to do the work that is necessary for change.
Most forensic patients, however, are often not uneasy about the way they may
think, feel, or behave. Rather, their biggest source of discomfort may be that they have
been caught/arrested for their behavior and are now facing the possibility of
incarceration or some other serious punishment. Again, we must question the
veracity of what we are told by these patients, as well as the likelihood that any
‘‘changes’’ they may make are genuine. Clearly, these patients would seem motivated
to express remorse, distress, and or pain, but we always struggle with the awareness
that we may be the recipient of ‘‘lip-service’’ as opposed to genuine understanding,
insight, and commitment to change.
 Forensic sexology versus clinical sexology 147

What is being asked of us as forensic examiners?

In addition to the above-mentioned differences between clinical sexology and forensic
sexology, we must also be cognizant of the differences with regard to what is being
asked of us as clinicians. In clinical sexology, we are accustomed to being asked to
assist someone in dealing with a particular difficulty. However, in forensic sexology,
we are often asked to ‘‘find the truth’’ and/or ‘‘predict the future.’’ While it may be
tempting to try to answer these questions, we must be careful to not go beyond the
limits of our science when trying to be helpful.
With regard to what is ‘‘truth,’’ we must remember that we are severely limited in
our ability to discern fact from fabrication. As mentioned above, in forensic work we
are often dealing with a patient population who may not view being truthful as being
in their best interest. Therefore, we may be dealing with people who are often less
than forthcoming, and may be downright deceitful. Even with a great deal of
collateral information, we are never able to fully ascertain the veracity of what our
patient is telling us. Indeed, as health care providers, there is little in our training or
our science that makes us any better equipped than the average person to be able to
tell fact from fiction (Szasz, 2001).
In addition to the question of what is ‘‘truth’’ we are often asked to assess a
person’s level of ‘‘dangerousness,’’ and/or the likelihood that they will commit future
offenses. Here, again, we are moving into dangerous territory as these are questions
that suggest we can somehow ‘‘see into the future.’’ While we have advanced quite a
bit in our ability to assess risk (Quinsey et al., 1998), the reader is reminded that our
training and science affords us no special ability to predict what has not yet happened.
Research has shown us that one of the best predictors of future behavior is past
behavior (Hanson, 1998; Hanson and Bussiere, 1998). In addition, the forensic
literature suggests that evidence of psychopathy is also somewhat correlated with an
increased likelihood of future offenses (Hare, 1993; Hanson, 1998). Still we have
little data that suggests that our ability to predict future offenses is consistently
reliable (Zimring, 2004). In other words, while we can be somewhat helpful in the
determination of one’s level of ‘‘dangerousness’’ and the possibility of future offenses,
we must always recognize the limits of what we can state with any certainty.

Conclusions
In this article, I have reviewed several of the differences between clinical sexology and
forensic sexology. While the forensic area can be extremely challenging and worth-
while, it is clearly different from the clinical arena. The clinician’s values of trust,
confidentiality, depth, motivation, and helping those in distress are severely tested.
The forensic examiner approaches his/her task with a mindset that is often counter to
that of the clinician.
As a result, the sexuality clinician needs to ask him/herself if the forensic
examination process is one that is within his/her level of comfort. The sexologist who
wishes to pursue forensic work would be well advised to seek out specialty training
and consultation before adding this type of work to their clinical practice.
148 D. N. Watter

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Contributor
DANIEL N. WATTER, ED. D., Clinical and Forensic Psychologist, Private Practice, Morris
Psychological Group, Parsippany, NJ, USA.