Upload
jerome-kelly
View
220
Download
0
Embed Size (px)
Citation preview
Treatment Criminogenic Risk, 2009 1
HOLDING BOTH SIDES OF THE MIRROR: The Therapeutic Alliance and Criminogenic Change
Michael Mitchell, LCSWTreating Criminogenic Risk , 2009
Treatment Criminogenic Risk, 2009 2
treatment components
criminogenic treatment
therapeutic relationship in criminogenic treatment
treatment guidelines
Treatment Criminogenic Risk, 2009 3Treatment Criminogenic Risk, 2009 3Treatment Criminogenic Risk, 2009 3
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Definitions
• Criminogenic• Stage of Change• Behavioral Health• Clinician/therapist
Treatment Criminogenic Risk, 2009 4Treatment Criminogenic Risk, 2009 4
Treatment Components Criminogenic treatmentTreatment factorsTreatment guidelines
TREATMENT COMPONENTS
Behavioral Health Treatment occurs in:
a) Emotionally charged and confiding relationship with a “helping person”
b) Healing setting with that fits with the expectation of being helped
c) Plausible explanation of presenting issue
d) Mutually agreed upon procedure that is intended to address the concern
Frank &Frank, 1991
The Genus of Psychotherapy• Therapeutic contract• Therapeutic operations• Therapeutic bond• Self relatedness• In session impacts• Sequential flow
Orlinsky, et al 1994
Treatment Criminogenic Risk, 2009 5
Treatment components Criminogenic treatmentTreatment factorsTreatment guidelines
Behavioral Health Treatment• research• common factors• client factors• therapist factors
Behavioral health treatment works!Changes are sustainedNo overall differences in approaches
40%
30%
15%
15%
Common Factors
Extra-thera-peutic Change
Therapeutic Relationship
Hope and Expectancy
Technique
Static factors Dynamic factors Length of stay Locus of change
Static factorsDynamic factors“Necessary and Sufficient Conditions”
Treatment Criminogenic Risk, 2009 6Treatment Criminogenic Risk, 2009 6Treatment Criminogenic Risk, 2009 6
Treatment ComponentsCriminogenic treatmentTreatment factorsTreatment guidelines
The Therapeutic Alliance
• “…the quintessential integrative variable" (Wolfe & Goldfried, 1988)• Necessary but not sufficient• Can be measured and it predicts outcome
Four Core Components client’s emotional relationship with the clinician client’s ability to work in therapy the clinician’s empathic understanding and involvementThe client-therapist agreement on the goals and task of therapy
Gaston, 1990
“The working environment that embodies mutual trust, respect and efforts for healing and change”
Treatment Criminogenic Risk, 2009 7
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Criminogenic Treatment and
Anti-social Process
8888
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Treatment Criminogenic Risk, 2009
Anti-Social Process
• Definition:– Anti-social behavior is a
pervasive pattern of behavior that intentionally or carelessly creates immediate and/or eventual harm to individuals or the social fabric through actions that defy social norms, mores, morals and laws.
Treatment Criminogenic Risk, 2009 9
Social Bond
Pro- Social Bond Development
Attachment Commitment
Involvement Belief
Family Effect
Individual Effect Contextual
Effect
9Criminogenic Change
Treatment Criminogenic Risk, 2009 10Treatment Criminogenic Risk, 2009 10Treatment Criminogenic Risk, 2009 10Treatment Criminogenic Risk, 2009 10
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Need Invalidation
Narcissistic Wounding
Entitlement
Inadequacy
Pro-social Disengagement
Neutralizations
Anti-social entrenchment
Entrenched Anti-social
Self
Treatment Criminogenic Risk, 2009 11Treatment Criminogenic Risk, 2009 11Treatment Criminogenic Risk, 2009 11
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Criminogenic Treatment
“The intentional use of behavioral health interventions to identify
and collaboratively change entrenched
anti-social behavior patterns to maximize pro-self identity and
participation.”
Facility based
Re-entry based
Community Based
Diversion
Treatment Criminogenic Risk, 2009 12Treatment Criminogenic Risk, 2009 12
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Criminogenic Treatment
It works! Community more effective than institutional based Tangible, structured, skill based programs more effective Must be criminogenically informed
RiskNeedResponsivityProfessional discretion
Best Practice Characteristics Behavioral/experiential in nature Intensity based on risk and need of offender Occupy 40-70% of the offender’s time Duration: 3 and 9 months Disrupt anti-social processes Family/significant other involvement Aftercare
Treatment Criminogenic Risk, 2009 13Treatment Criminogenic Risk, 2009 13Treatment Criminogenic Risk, 2009 13
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Recidivistic Risk FactorsAndrews and Bonta,
Big Five• Criminal History• Anti-social Attitudes• Anti-social Associates• Anti-social Behaviors• Anti-social personality traits
Central Eight
• Substance Abuse• Family/Relationship• Recreation/Leisure
13Criminogenic Change
Static
Dynamic
Entrenched Anti-social
Culture
Treatment Criminogenic Risk, 2009 14
Traditional:Symptom reduction
Criminogenic:Pro-social
engagement
Primary Treatment Focus
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Treatment Criminogenic Risk, 2009 15
Pro-social need
satisfaction
Narcissistic Healing
Pro-social Self
Social capital &
belonging
Pro-social supports
Increase pro-social
engagement
Pro-social treatment focus
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Treatment Criminogenic Risk, 2009 16Treatment Criminogenic Risk, 2009 16
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
The RealitiesCriminogenic Treatment Factors
Treatment Criminogenic Risk, 2009 17
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Criminogenic Treatment Factors
• Substance abuse• Trauma• Mental Health• Cognitive• Gender Differences• Treatment disruptions• “Convert in the fox hole”
• “Captive audience”• Therapeutic leverage• Heightened stage of change• Non-behavioral health systems
Treatment Criminogenic Risk, 2009 18Treatment Criminogenic Risk, 2009 18Treatment Criminogenic Risk, 2009 18
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
You are from the Pro-social Club!
Criminogenic process is more powerful than a vague desire to change
Pro-social consequences
Sustainable change is relationship based
Things to keep in mind
Treatment Criminogenic Risk, 2009 19Treatment Criminogenic Risk, 2009 19Treatment Criminogenic Risk, 2009 19
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Stages of treatmentEngagement Intervention Termination Aftercare
• Clear therapeutic contract• Reason for involvement• Stage of change• Pro-social priority• Gender differences
• Enactment• Compassionate dispassion• Cost of success• Counter-transference
• Planned/unplanned• Attachment/loss issues• “Welcoming” for future work
• Team approach• Extra-therapeutic demands• Stages of change
Treatment Criminogenic Risk, 2009 20Treatment Criminogenic Risk, 2009 20Treatment Criminogenic Risk, 2009 20
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
Treatment Guidelines
1. Individualized criminogenic process themes
2. Cultivate/enhance pro-social self image
3. Maintaining perspective4. Communicate/collaborate5. Responding to “anti-social
pull”6. Model pro-social inclusion
Treatment Criminogenic Risk, 2009 21Treatment Criminogenic Risk, 2009 21
Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines
40%
30%
15%
15%
Common Factors
Extra-thera-peutic Change
Therapeutic Relationship
Hope and Expectancy
Technique
Extra-therapeutic factors Pro-social therapeutic
alliance Hope, Expectancy and
inclusion Technique
Criminogenic Common Factors
Treatment Criminogenic Risk, 2009 22
Conclusion
THANKS!!