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Sexual Behavior History Questionnaire (Read 9965 times)
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Sexual Behavior History Questionnaire
Sep 23rd, 2003 at 11:34pm
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I have just finished typing  a Sexual Behavior History Questionnaire used in some counties in my state into word format.  Would anyone be interested in reading it?  It is about 9 pages in length.  I have also just signed up for zip lip email service....do I use this to post with?
Thanks
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Paste User Name in Quick Reply Box George W. Maschke
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Re: Sexual Behavior History Questionnaire
Reply #1 - Sep 24th, 2003 at 1:27am
Mark & Quote Quote 
The message board software we are using does not presently allow files to be uploaded as attachments. However, you could use your new ZipLip e-mail account to send the file to any who request it. Alternatively, you might copy and paste the text into a message on this board.
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George W. Maschke
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Re: Sexual Behavior History Questionnaire
Reply #2 - Sep 25th, 2003 at 4:21am
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Thanks George, I will wait and see if anyone wants it....no sense flooding the board with nine pages of unwanted text.
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Re: Sexual Behavior History Questionnaire
Reply #3 - Sep 25th, 2003 at 4:57pm
Mark & Quote Quote 
i for one would like to see it
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Re: Sexual Behavior History Questionnaire
Reply #4 - Sep 26th, 2003 at 11:50pm
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SEXUAL BEHAVIOR HISTORY QUESTIONNAIRE

Answer the following questions as they pertain to you.  If a question does not pertain to you, just put "not applicable."  If the question does apply, a "yes" answer is not enough.  An explanation is necessary and expected.  Your responses to this questionnaire will be verified through a polygraph examination.  Please answer this questionnaire as thoroughly as possible.  An accurate representation of your sexual history and behavior is necessary for proper treatment and management.  If you run out of room for a question, you can continue  a question on another paper, but please put the question number along with your answer.  REMEMBER, sexual contact means any contact with another personís genitals or your own genitals ("private parts").  It does not just mean sexual intercourse.  Ask your counselor for any help you need.

Sexual Knowledge/Early Experience/Masturbation

1.  Where, when and how did you learn about sex?  Describe in detail, how you learned about sex, what happened, how did it happen, who was involved, and how old you were.
2.  Describe your first physical sexual contact with another person.  What was it?  How old were you?  What was the age and sex of the other person?  Was the sexual contact consensual or abusive?
3.  List the locations, other than your home, where you have engaged in sexual activities.  Describe the activities, your age at the time, who was involved in the activity.
4.  How old were you when you first engaged in masturbation?  Identify the location and frequency of masturbation and your thoughts/fantasies associated with masturbation.
5.  Describe times when the frequency of your masturbatory behaviors either increased or decreased.  Identify the ages at which the increase of decrease occurred.  Also describe the places where you would engage in masturbatory behaviors.
6.  How often do you currently masturbate?  List the current places you masturbate.  Describe the thoughts/fantasies associated with your masturbation.
7.  Describe what stimulus you have utilized when you masturbate (i. e. , magazines, stories, videos, movies.)
8.  Describe the sexual activities you have engaged in over the last three years prior to incarceration.
9.  Identify the sexual activities that you have been involved in over the last 12 months.
10.  Describe the sexual activities you have engaged in since you have been in prison.
11.  Identify each marriage or live-in relationship with an adult that you have been involved in.  For each relationship identify your age at the beginning, sex practices within the relationship, frequency of sex, any affairs during the relationship by either partner, and  why the relationship ended.  Circle his or her to identify the gender of your partner.
      (NOTE:  THERE IS A TABLE INSERTED HERE THAT I DID NOT INCLUDE.)

12.Describe any sexual interaction you have had with relatives.  This would include brothers, sisters, parents, cousins, grandparents, step-relatives.  Describe your age, your relatives age, sex and relationship with you, the type of sexual activity engaged in, frequency and why it ended.
     (NOTE:  THERE IS A TABLE INSERTED HERE THAT I DID NOT INCLUDE.)
13.What is the total number of consenting adult sexual partners that you have had over your sexually active life time?  Describe these contacts by describing your age, your partnerís age, sex, relationship with you , length of time you had know the person, the type of activity engaged in, and the frequency of the sexual contacts.
14.  Was there ever at time when non-relatives or extended family lived wit you?  If yes, was there sexual contact with that or those people?  Please describe.
15.  How often have you had sexual contact with someone who was drunk or high on drug?

Alternative/Deviant/Criminal Sexual Behavior

Masturbation

16.Have you ever masturbated in public?  List all the locations you have ever masturbated.
17.  What age and gender of person do you prefer to masturbate in front of?
18.  Have you ever masturbated in front of children?  Describe.
19.  Have you ever taken pictures of yourself masturbating?
20.  Did you send these pictures to anyone?  If yes, who?

Sexual Contact with Animals

21.  How many times have you ever had or tried to have sexual contact with animals?
22.  Please complete the following:  Type of animal, Your age, # of contacts, Types of Sexual/Attempted Sex Acts
23.  Were any animals hurt during the acts?  Explain how, if so, and if it were on purpose.
24.  How many time have you had sex with dead animals?  Describe.
25.  Did you kill the animals before you had sex with them?  How?

Fetish Objects/Fetishism

26.  Have you ever dressed in the clothing of the opposite sex?  Describe.
27.  Describe any other clothing you used to provide sexual stimulation such as wearing diapers, leather, nail polish, wigs, makeup, high heels, stockings, or other things especially for sexual stimulation.
28.  How many times have you stolen an item of clothing from someone or their home?  What was it?  Why did you take it?  Include family members and whether the clothing was dirty.
29.  How many times have you cut up, burnt, or mutilated stolen or anotherís clothing?
30.  What did you do to the clothing?  Why?
31.  How many times have you ever masturbated into stolen clothing?  When was the last time?
32.  Describe times you were sexually aroused to a specific type of object or material.  This includes undergarments, footwear, personal possessions of another person, bicycle seats, leather, or other things.
33.  Describe any particular body part of another person that is very arousing to you, sometimes exclusively arousing (e. g. breasts, hair, feet).
34.  Describe times when you participated in or attempted, sexual activity when urine or feces  was involved.  This includes any times you have urinated or defecated on someone or had them urinate or defecate on you, and includes whether or not you have become excited and/or aroused when you observed or smelled someone urinating or defecating.
35.  What about this excited you?
36.  Describe times you used objects for sexual stimulation of yourself or another person.  This includes dildos, vibrators, candles, food.

Photography/Video/Pornography

37.  Describe when you have taken pictures of your own or otherís genitals.
38.  Describe times you have taken, or attempted to take, pictures or videos of anyone involved in sexual activity or posing in a sexual manner with their consent.
39.  Describe when you have taken pictures or videos of others without their permission.  Include the approximate age and gender of the person, the location, the situation, what you took (video or photo) and your reason for doing it.
40.  Describe your use of erotica an pornography.  This includes magazines/books, photographs, catalogues, advertisements, and or videos.  Identify age at time of involvement, frequency of use, and or activity while utilizing this material.
41.  What have you used to stimulate yourself that is not typical pornography, like childrenís television show or clothing catalogue?
42.  Have you ever posted pictures of people that were not your family in you home?  Describe.
43.  Have you ever manipulated a computer image or photograph to look in a way that was more stimulating for you?  Describe what it was and what you did to the image.
44.  Have you ever put any pornography on the Internet?  What?
45.  Have you ever traded or been involved with trading pornography?   What?
46.  Have you ever seen Child pornography?  How many times?   Describe whether it was a magazine or computer and describe the pornography.
47.  Have you ever purchased child pornography?  Describe.
48.  How many time have you made child pornography (taken pictures or videos of nude children or children engaged in sexual acts)?  Describe.
49.  Have you ever gone to another country to obtain any type of pornography?  Describe.
50.  Have you used any pornography displaying violence or death?  Describe in detail
51.  Have you ever seen a "snuff"film?  Describe.

Adult Consensual Activity

52.Describe times you have, or attempted to have, sex with more than one person at a time.
53.  How many times have you been in topless bars, adult theaters and sex shows?  Describe your activities and your reason for going.
54.  How man times have you been in an adult bookstore?  Describe your reason for going and your activities in the bookstore.
55.  How many times have you had anonymous sex?  Describe this, including location, situation, and gender of the other person
56.  Describe times you paid someone for sex or offered to pay for sex.
57.  Describe times you were paid for sex, or been offered pay for sex.  Have you ever traded drugs for sex?  Describe.
58.  How man affairs have you had outside a committed relationship?

Frontage (Bumping or rubbing against people sexually)

59.  How old were you when you first rubbed against people in a sexual way?
60.  How many times have you done this?  Estimate:  per day, per week, per year.
61.  What are the situations were this usually takes place (elevator, bus, etc.)?  Describe.
62.  How many victims of each of the following groups have you had?

Adult females____  adult males____ teenage females__ teenage males___ girls under 12__ boys under 12__ females over 70__ males over 70__ authority figures__

63.When and where did you masturbate after these times?

Obscene Phone Calls/Sexual Calls or Internet Use

64.  How old were you when you made your first obscene phone call?
65.  How many obscene phone calls have you made in your lifetime?
66.  What do you say or do when the person answers the phone?  Describe in detail.
67.  Do you ever threaten the person or get him or her to do things on the phone?  Describe.
68.  How do you pick the people you call/
69.  How many of your victims do you call repeatedly? ___% What determines whether you will call them again or not.
70.  How many in each category do you have?  Boys__  girls__ men __ women__
71.  How many time have you called 900 numbers or other types of sex lines?
72.  How much money have you spent on them in your lifetime?
73.  There was no question listed, most likely due to typo error.
74.  What type of sexual behavior or fantasies do you participate in when you call?
75.  Do you call men, women, or both/
76.  Have these phone calls ever caused problems between you and others?  Describe.  Did you stop after the problems started.
77.  Describe any sexual contact, writing, or "chat" that you have had on the Internet
78.  Have you ever sent obscene e-mail to someone?
79.  Have you ever used the internet or a chat room to contact other sexual offenders or people with the same sexual interest as you?  Describe how, what you were looking for and the response.
80.  Describe times you have responded to or placed an ad in a newspaper, magazine, the internet, or a dating service to try to establish a friendship, romantic relationship or sexual relationship.

Exhibitionism

81.  How old were you when you first exposed you genitals to someone other than your sexual partner?  Who was it?
82.  Describe what you have done or do to expose yourself and where.  (Include dropping your pants, leaving the bathroom door open, urinating in public.)
83.  When was the last time you exposed yourself?
84.  How many times have you exposed yourself in your lifetime/
85.  How many victims do you have in each group?  Boys__ girls __ men __ women __.
86.  What have you done to cover or hide your behavior (e. g. pretend you donít know, lure, put holes in your clothes)?
87.  What do you like best about exposing yourself to others?

Voyeurism/Stalking

88.  How old were you when you first peeped on someone?  Who and where was it/
89.  Describe what you have done or do to try to peep on other people.  Include looking in a window, shower, open door, urinal, or other things in public or private.
90.  When was the last time you peeped on someone?
91.  How many times have you peeped in your lifetime?
92.  How many victims do you have in each group?  Boys __ girls __  men __ women __
93.  What have you done to cover or hide your behavior?
94.  What do you like best about peeping?  What are you looking for?
95.  Have you ever followed someone in order to peep on them?  Describe.
96.  Have you ever followed anyone in order to find out more information about them or have contact with them?  Describe.
97.  Have you ever followed anybody who became a victim to you (of any crime)?  Describe.

Sexual Contact with Children

98.  How many children have you had some from of sexual contact with in your lifetime?  Include anyone under 16 who was 3 or more years younger than you at the time.
99.  Please complete the following.  Attach other pages if necessary.

Your Age  Vict. Age  F/F  Mo/yr 1st time  Freq. Per wk. Relation to Vic. Type of sexual Act.  Type of force or Manipulation used. (THERE WAS A FULL PAGE CHART INCLUDED FOR THIS QUESTION)

100.  How many children have you physically forced?  Describe what you did.
101.  How many children have you threatened with a weapon for sexual activity?  Describe.
102.  How many children have you threatened to beat, spank, or hurt with your hand/body to get them to be sexual with you?  Describe.
103.  How many children have you bribed for sexual activity?  Describe.
104.  How many children have you talked into or groomed for sexual activity?  Describe.
105.  What kind of rewards have you used for children for sexual behavior?
106.  What kinds of lies have you told children to get them to perform sexually for you?
107.  Did you ever use pornography with any of your child victims?  If yes, describe.
108.  Did you ever use cigarettes, drugs or alcohol w/ any of your child victims?  Describe.
109.  Did you ever drink or use before, during, or after your offenses with child victims?  Describe.
110.  How many times have you had contact with children at any place where you did not have to wear clothes, like a nudist or naturalist club?.
111.  How many times have you been involved with groups of adults who traded children for sex?  Describe.
112.  How many times have you had sexual contact with children with adults present?
113.  How many times have you watched other adults have sexual contact with children?  Describe.
114.  How many other adults do you know (outside of treatment) who have been sexual with children?  Describe.
115.  How many times have you had sexual contact with children in other countries?

Coerced/Forced Sex with Adults

Forced sex with an adult includes many situations-when someone told you "no" or that s/he did not want to continue, when you placed any kind of weapon in sight of the person, when you blocked someoneís exit or ability to leave (like taking the person to remote places in our car or a strangerís house), or when you have been or are a danger to the person (like right after you beat or assaulted them). In essence, forced sex in any time the person did not actively agree to sex with you of his or her own free will without threats (implied or not), show of force or actual physical force.

116.  How many time have you forced sex with an adult?  %Men__  %Women__
117.  How many times have you had contact with someone who was drunk?  Describe.
118.  How many time have you bribed someone with drugs or alcohol for sex?  Describe
119.  How many times have you had sex with someone unconscious?  Describe.
120.  How many time have you had sex with someone sleeping?  Describe.
121.  How many time have you had sex with someone bedridden?  Describe.
122.  How many time have you had sex with someone handicapped?  Describe.
123.  How many times have you had sex with someone who was your employee?  Describe.
124.  How many time have you had sex with a patient, student, or parishioner?  Describe.

Complete the below for all adult victims:
Your age.   Vict. Age.  M/F  Type of Sexual Acts    Types of Force used.

Sadism

126.  Describe your sexual activities where you caused pain or deliberately hurt a person during a sexual act.
127.  How many times have you caused physical pain or hurt someone during a physical act?
128.  How many time have you beaten or hit a person before, during, or after sex?
129.  Does physical violence sexually arouse you?
130.  How many times have you tied, handcuffed, or bound someone up?
131.  Describe the bindings that you used.
132.  How many times were against that personís will?
133.  Describe your sexual activities where you tried to humiliate, degrade, or shame that person, before, during, or after sexual contact.
134.  Describe any sexual contact you have used as a punishment for a person.
135.  How many times have you tortured someone?  Include intensive punishment (kneeling on rice for hours).  Was it sexually arousing?  Describe.
136.  Describe any sexual behavior you have forced your partner to do that s/he did not want to (watch pornography, do a threesome, have anal sex.)
137.  What is the worst thing you have ever done to someone to inflict pain.  Describe.
138.  Have you ever killed someone during or after sex?
139.  How many times have you tortured an animal?  Describe.
140.  Have you ever had sex with a dead person?  Describe.
141.  Have you ever had sex with a dead animal?  Describe.

Fantasies/Masturbation

142.  Describe your most exciting sexual thought or fantasy not yet experienced.
143.  Describe the thoughts and fantasies you have masturbated to of holding someone captive and/or torturing him or her.
144.  Describe any thoughts, fantasies, or images you have masturbated to of anyone struggling to breath or cutting of his/her air supply.
145.  Describe any thoughts, fantasies, or images you have masturbated to of killing someone.
146.  Have you ever masturbated during or after cutting off your own air supply?  Describe.
147.  Have you ever set fires for sexual arousal or masturbated to fantasies about setting fires?  Describe any actions or fantasies.

Miscellaneous

148.  Describe times you have written to movie or TV stars or joined a fan club.
149.  Describe your involvement with nudist camps or members of a nudist camp.
150.  Describe organizations and literature received from any organization whose primary function revolved around sexual behavior.  (Examples would be Nambla, Guion, Diaper Pail, sexual interest clubs.)
151.  Describe your involvement in sexual activity associated with occult, ritualistic, or religious groups.
152.  Describe your involvement in sexual activity as part of a gang activity or initiation.
153.  Have you ever engaged in sexual behavior as part of a gang activity or initiation?  Describe.
154.  Describe any type of sexual encounters not covered by the previous questions.  This might include group masturbation, massage parlors.  Be specific.
155.  Have you ever committed a sexual abuse/assault with a co-participant?  Describe.
156.  Describe any sexual abuse/assaults that you have thought about or planned that you have not successfully initiated or completed.
157.  Did you ever ask your victims if the enjoyed the sexual acts you committed?
158.  Describe times you have felt guilty about your sexual behavior and what you did to feel less guilty.
159.  Have you ever cross-dress during a sex offense?  At any other time?
160.  Do you have thoughts or interest in being a member of the opposite sex?
161.  Have you ever committed the following behaviors:  Murder, assault, child abuse, substance abuse.
162.  Have you ever been violent in a relationship?  Physical violence including slapping?  Non physical controlling tactics (controlling money, access to transportation, friendships?  Sexual abuse?
163.  List any other criminal activity you have ever engaged in.

Cognition about your sexual behavior

164.  Did you think your victims ever enjoyed the sexual acts you committed on them?  Rate on a ten point scale.
165.  Rate the level of satisfaction you felt during your sex crimes.  Rate on a ten point scale
166.  Did you ever experience sexual dysfunction during your sex crimes?  Describe.
167.  Did you think your consenting sexual partners ever enjoyed the sexual activity with you? Ten point scale.
168.  Rate the level of satisfaction you felt during consenting sexual activity.  Ten point scale.
169.  Did you experience sexual dysfunction during consenting sexual activity?  Describe.
170.  List any other relevant information you think will be useful to your treatment.


Have you withheld, omitted or misrepresented anything in your answers to these questions?  Is this a complete and accurate account of your sexual history/

Do you understand that this history is going to be verify with polygraph examination?

Please make any comments or questions below.

Signature________________________________ Date______________
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Re: Sexual Behavior History Questionnaire
Reply #5 - Sep 29th, 2003 at 11:26am
Mark & Quote Quote 
poochai,
Thanks for the info. Looks very much like the one I had to fill out for my poly. One of the questions during the exam of course was "Other than what we have already discussed, did you tell the truth on the questionnaire?"
The polygraphers have yet to explain just how they can detect that a person was "deceptive" on one particular question on the questionnaire  based on the response to the above "all-inclusive" question.
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Re: Sexual Behavior History Questionnaire
Reply #6 - Oct 5th, 2003 at 2:59pm
Mark & Quote Quote 
And they think something is wrong with you? they sound like the sickest idiots in the whole dam country.
If the info is about the offence,ok otherwise it is none of their dam business, what when where or with whom you did anything.
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Re: Sexual Behavior History Questionnaire
Reply #7 - Oct 5th, 2003 at 5:22pm
Mark & Quote Quote 
Well, that's part of the price for your admission ticket into a treatment program - you get to look at and talk about **everything** you've ever done related to sexual behavior.
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Re: Sexual Behavior History Questionnaire
Reply #8 - Oct 6th, 2003 at 2:05pm
Mark & Quote Quote 
Quote:
And they think something is wrong with you?


I agree. Pretty "sick" mind that dreamed up this questionnaire.
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Re: Sexual Behavior History Questionnaire
Reply #9 - Oct 6th, 2003 at 4:03pm
Mark & Quote Quote 
I agree and disagree. The behaviors are not thought up, rather, they are behaviors exhibited by offenders. Of course, "offenders" doesn't mean just those people who have been caught, but they just happen to be the ones in the spotlight (typically because of criminal conviction bonus that goes along with having to complete one of these surveys in the first place). And that doesn't mean every offender exhibits every behavior, but it does mean every offender is put into a one-size-fits-all category/presumption of deviant behavior until shown/proven/demonstrated otherwise. For example, just because (and I know saying "just" is a treatment no-no because it minimizes, rationalizes, ad nauseum) you were caught doing one thing doesn't mean you have other deviant behaviors.

The history portion is a good process - if you are willing to look at your past and evaluate/examine what you did in the past and how it may relate to your referring offense, plus it gives you a better understanding of yourself, kind of like "what makes me tick?" It's almost like L. Ron Hubbard's book, Dianetics, those commercials you see on TV once in a while ("Why am I so f**ked up?" page 454).

I know, from what I've seen, most people claim one (or a few) victims, but when looking back in retrospect, being armed with knowledge about what is appropriate or not using certain guidelines, people find they did have more than the stated number of victims. Granted, not all of them, or even any of them, were criminal in nature, but you can see where it leads (childhood roughhousing, teenaged agression, fondling as an adult, as an example). That woman you met in a bar, both of you were tipsy from alcohol, went to her place and had sex, she says no several times just before you climax because she's all of a sudden concerned about pregnancy, but you're too far gone to stop, and you continue to date for several months after that, engaging in unprotected sex again - was that rape?

What makes the process suck is the use of the polygraph. Being scored deceptive time and time again about what you've gone over and over in exquisite detail makes you ask why you were trying to drain the swamp in the first place. But other tools, like the plethysmograph, supposedly are accurate enough to show what arouses you. But on the other hand, the story line you have to listen too is pretty lame - I think the pl-graph only catches fairly unintelligent people, or people who really do have a deviant arousal pattern. For the rest, people who acted out for other reasons, sex being the drug of choice, whose interests are fundamentally adult, consensual contact, it is a waste of time and is insulting, not to mention demeaning.
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Re: Sexual Behavior History Questionnaire
Reply #10 - Oct 26th, 2003 at 3:15pm
Mark & Quote Quote 
Yes I am interested in receiving that questionaire, as I am developing a website that will include secret recordings of probation officers, polygraph examiners, and sex offense specific treatment therapist. I want to expose all these frauds, and the States that utilize them to strip people of their integrity, liberties, and human rights.

Please send to me that questionaire. Please ensure it is free of viruses, trojans, and other pests.

Better yet, why not put it on a low cost hosted website? If you don't want to do that then please let me know how to receive this questionaire. I will compare it with the one I will eventually have to take, and then upload both onto my website for all to see what people are being put through  in the name of public safety, warranted or not.
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Re: Sexual Behavior History Questionnaire
Reply #11 - Oct 26th, 2003 at 3:25pm
Mark & Quote Quote 
Bennie,
Have you seen sexcriminals.com?
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Re: Sexual Behavior History Questionnaire
Reply #12 - Nov 7th, 2003 at 7:11pm
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Bennie.....the questionaire is near the top of the string.  Feel free to copy and paste it to where ever you would like.  I am not sure if this is a standard form or not..but the county I reside in uses it...or at least the ppl providing S. O. classes.....  Oh, and by the way, every document they use is marked...."Do Not Reproduce".  We should get together and open our own S. O. program...it's gotta be a gold mine......@ $80 / Session...and there are 14 in my group...which meets on a weekly basis, plus individual sessions with the "Counsler" Roll Eyes
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Re: Sexual Behavior History Questionnaire
Reply #13 - May 27th, 2004 at 9:55pm
Mark & Quote Quote 
Alright this questionaire has to be the most messed up thing ever to impose on someones personal life. And to add insult to injury you have to sit there and explain in detail to a polygraph examiner what you were thinking. Does this mean you tell all to someone you dont know and in the end he tells you that you are a sick human being and that you dont get the job? I can see that if you beat someone and raped them or molested a 10 year old but some of this stuff is off the wall. Someone give me some insight here on what is going on, is this to find out if your sexual activity has continued or what? Or is admitting to anything on here just going to get you dq'd from a job period?
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Re: Sexual Behavior History Questionnaire
Reply #14 - May 27th, 2004 at 11:20pm
Mark & Quote Quote 
Alright X that last post it took me a sec to figure out what forum i was in as pertaining to a job. But that stuff is still out of the question no ones business regardless.

Sorry about that
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