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Carr, Alan
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Carr, Alan
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Carr, Alan
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- PublicationProfiles of adolescent perpetrators of CSAStudies of the psychological adjustment of adolescents who sexually abuse other youngsters have shown that they differ from normal control groups, and hold some features in common with clinical control groups with other psychological problems and incarcerated control groups convicted of non-sexual offences. For example, they show more behaviour problems than normal controls but not incarcerated controls; they have difficulties with making and maintaining friendships and establishing empathy with others; they have problems with impulse control, anger management and assertiveness; and they come from families characterized by a variety of problems. Despite the burgeoning international literature in this area, few studies have been conducted on Irish adolescent sexual abusers and non-adjudicated abusers.
181 - PublicationProfiles of parents of adolescent perpetrators of CSAThe present study aimed to expand our knowledge about the profiles of families of adolescent CSA perpetrators by comparing a group of parents of adolescent sexual offenders (PASO); a clinical control group (CC) of parents of non-offending adolescents attending a child and adolescent mental health service; and a normal control group (NC) of parents of non-offending adolescents in the community on a range of demographic, developmental, personal adjustment and family environment variables.
241 - PublicationA comparison of two CSA treatment programmesThe development of effective treatment programmes to ameliorate the sequelae of CSA is imperative. Ideally such programmes should address intrapsychic psychological difficulties through individually based child-focused interventions; peer-related interpersonal problems through group-based interventions; and difficulties within the family and wider social network through family therapy and systemic interventions. It would be expected that some programmes might be more effective than others for young people with particular constellations of difficulties and that programmes that combined two or more therapeutic modalities might be more effective than more narrowly focused programmes.
179 - PublicationPerceptions of the criminal justice system and its association with well-being following a report of child sexual abuse(National Organisation for the Treatment of Abusers (NOTA Ireland), 2007)
; ; ; 103 - PublicationFamily–oriented treatment for people with alcohol problems in Ireland: a comparison of the effectiveness of residential and community–based programmesUsing a naturalistic design involving consecutive referrals self-selected for family-oriented treatment, 42 participants from a residential programme and 25 participants from a community-based programme were assessed on a range of alcohol-use and psychosocial measures before treatment. A proportion of these cases were assessed after treatment and at 6 months follow-up. At six months follow-up 79% of both the residential and community groups were either abstinent or drinking moderately. However, more members of the residential group (75%) were abstinent at follow-up compared with the community group (36%). In contrast, more members of the community group were moderate drinkers (43%) at follow-up compared with the residential group (4%). At six months follow-up, compared with the community group, more members of the residential group showed a clinically significant reduction in recent negative consequences of drinking and psychological adjustment problems. Both groups made significant mean gains on indices of alcohol abuse and psychosocial adjustment but there were important intergroup differences. The residential group showed a greater mean reduction in recent negative consequences from drinking but the community group showed a greater mean reduction in the percentage of days heavy drinking.
671Scopus© Citations 8 - PublicationEvaluation of functional family therapy in an Irish contextIn an Irish context we conducted a retrospective archival study of functional family therapy (FFT) for adolescents with behavioural problems. Strengths and difficulties questionnaire data were collected from 118 families at the beginning and end of therapy (at baseline and follow up for dropouts) in a community-based clinic in a socially disadvantaged Dublin suburb. Analyses of the improvement in mean scores and clinical recovery rates showed that the outcome was associated with treatment completion and the extent to which therapists adhered to the FFT treatment manual. Therapy completers treated by high-adherent therapists had the most favourable outcome. In contrast, the worst outcome occurred for dropouts. The outcome of cases treated by low-adherent therapists fell between these two extremes. These results show that FFT may be effectively implemented in an Irish context, and that the effectiveness of treatment is associated with families remaining in treatment for an average of seventeen sessions, and receiving treatment from therapists who implement FFT with a high degree of fidelity.
780Scopus© Citations 25 - PublicationChild maltreatment and adult psychopathology in an Irish context(Elsevier, 2015-07)
; ; ; ; ; ; One-hundred-ninety-nine adult mental health service users were interviewed with a protocol that included the Childhood Trauma Questionnaire, the Structured Clinical Interviews for Axis I and II DSM-IV disorders, the Global Assessment of Functioning scale, the SCORE family assessment measure, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Compared to a U.S. normative sample, Irish clinical cases had higher levels of maltreatment. Cases with comorbid axis I and II disorders reported more child maltreatment than those with axis I disorders only. There was no association between types of CM and types of psychopathology. Current family adjustment and service needs (but not global functioning and motivation for psychotherapy) were correlated with a CM history. It was concluded that child maltreatment may contribute to the development of adult psychopathology, and higher levels of trauma are associated with co-morbid personality disorder, greater service needs and poorer family adjustment. A history of child maltreatment should routinely be determined when assessing adult mental health service users, especially those with personality disorders and where appropriate evidence-based psychotherapy which addresses childhood trauma should be offered.479Scopus© Citations 5 - PublicationSupporting parents of adolescent perpetrators of CSAThe importance of parental involvement in the treatment of their adolescent CSA perpetrators cannot be underestimated. One of the defining differences between the fields of adult and adolescent sexual offending is the fact that adolescents are still in a formative stage of development. Parents can still exercise a major influence in re-engaging children back on a normative developmental pathway and reducing future risk to a minimum. It is also important to include parents of adolescent CSA perpetrators in treatment programmes because it is well documented in Irish and international studies that some have significant problems.
420 - PublicationThe Waterford mental health survey(University College Dublin. School of Psychology; Health Services Executive, 2015-02)
; ; ; The primary objective of the Waterford Mental Health Survey was to document the prevalence of co-morbid personality disorders in a sample of inpatients and outpatients attending the HSE mental health service in Waterford and outline the implications of this for service development. Between July 2011 and June 2014, 100 inpatients and 99 outpatients were evaluated with the Structured Clinical Interviews for DSM-IV axis I and II disorders, the Childhood Trauma Questionnaire, the Global Assessment of Functioning rating scale, the SCORE family assessment instrument, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Participants were consenting, consecutive referrals who were not too unwell to engage with the study. The sample interviewed was probably slightly higher functioning than all cases attending the service. With regard to the primary objective of the study, we found that 98.4% of cases had DSM-IV axis I psychiatric disorders and 39.3% of these had comorbid axis II personality disorders. Between approximately a half and three-quarters of cases with personality disorders had comorbid anxiety, depressive or alcohol and substance use disorders. Compared to those without personality disorders, cases with personality disorders had experienced more child maltreatment; had poorer personal and family functioning and more severe presenting problems; and reported greater unmet service needs and motivation for psychotherapy. In terms of service development, approximately 2 out of 5 patients attending the public mental health services in Waterford require specialist psychological therapy for personality disorders which addresses low levels of personal and family functioning and past history ofchild maltreatment. Specialist psychological therapies include dialectical behaviour therapy (Linehan, 1993. 2014), schema therapy (Young et al., 2007), cognitive behaviour therapy (Beck et al., 2004) and brief psychodynamic psychotherapy such as mentalization-based treatment (Bateman & Fonagy, 2006; Clarkin et al., 2010). A review of psychology staffing levels is required to determine the number of psychologists required to provide this type of service in line with recommendations in the national mental health policy - Vision for Change (Department of Health & Children, 2006) - and the HPSI Psychology briefing paper for the HSE mental health division (Heads of Psychology Services Ireland, 2014). Intensive initial staff training and ongoing supervision are required for psychologists to provide these specialist evidence-based interventions.1082 - PublicationFactor structures of measures of cognitive distortions, emotional congruence, and victim empathy based on data from Irish child sex offenders(Routledge (Taylor & Francis), 2006)
; ; ; ; ; This study evaluated the factor structures of three instruments from the Sexual Offender Assessment Pack. The Children and Sex Cognitive Distortions Scale, the Children and Sex Emotional Congruence Scale, and the Child Victim Empathy Distortions Scale were administered to 203 sex offenders in Ireland. Confirmatory factor analyses did not support the proposed single factor structure for each of the three scales. Exploratory factor analyses suggested more complex factor structures. The Children and Sex Cognitive Distortions Scale was found to have two factors: (a) Perceptions of Children as Sexually Mature and (b) General Justifications for Sex With Children. The Children and Sex Emotional Congruence Scale was found to have three factors: (a) Positive Affect From Children, (b) Special Relationships With Children and (c) Preference for Relationships With Children. The Victim Empathy Scale was found to have two factors: (a) Positive Misattributions of Pleasure and (b) Denial of Negative Feelings in the Child. In clinical settings, the more complex factor structures identified in this study may used in scoring and interpreting responses to the three instruments investigated here. Our results require replication and further research should focus on the correlates of the factorial scales identified in this study.985Scopus© Citations 9