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Treatment of sex offenders 1
SEX OFFENDER TREATMENT PROGRAMS
Anthony Beech
University of Birmingham
Email: [email protected]
Meta-analytic studies of sex offender treatment
Hanson et al. (2002) (N = 9,534) sexual recidivism rate for the treated groups was lower than that of the comparison groups (12.3% versus 16.8% respectively;)
Lösel & Schmucker, 2005 (N = 22,181) treated offenders showed 37% less sexual recidivism that untreated controls
Beech, Robertson and Freemantle (in preparation) (N = 14694) A positive effect of treatment in sexual reconviction reduction (9.39% in the treated group versus 15.61% in untreated controls)
The Beech et al. study has an odds ratio of 0.54, CI 0.43 - 0.69, p < 0.0001) indicating that the likelihood of individuals being reconvicted after treatment was around half that of those who had not undertaken treatment 2
Treatment of sex offenders 3
Aims of talk Give a description of the current approach to the
treatment of sexual offenders in Prison and Probation Services in the U.K. which is based on the “What Works’ approach
Outline some evidence as CBT’s effectiveness with sex offenders
Describe some innovations in treatment Describe a more critical take on the WW literature Future of sex offender treatment
Treatment of sex offenders 4
The ‘What Works’ initiative in the U.K. In June 1998 Probation Circular 25/1998
entitled ‘Effective Practice Initiative: National Implementation Plan for Supervising Offenders published by the Home Office
Starting what is know as the ‘What Works’ Initiative in the Probation Service
This approach broadly used in the Prison Service since the early 1991
Treatment of sex offenders 5
Basis of Initiative The development and implementation
on a national basis of a demonstrably ‘effective a core set of programmes of supervision for offenders (Mair, 2004)
Mair notes that such programmes are ‘heavily dependent upon a cognitive-behavioural treatment (CBT) approach’
Treatment of sex offenders 6
Principles associated with the “What Works’ approach
Risk treatment service is delivered to higher-risk (as opposed to lower risk cases
Need criminogenic needs are targetted for change (i.e., procriminal attitudes rather than self-esteem
Responsivity styles and modes of treatment are employed that are capable of influencing criminogenic needs
Appropriate treatment delivery the clinician reviews risk, need and responsivity, treatment decisions appropriate according to ethical, humanitarian, cost-efficiency and clinical standards
Cognitive-behavioural treatment according to this ‘risk-needs’ model
Treatment of sex offenders 7
Why target high risk individuals?
Andrews et al. (1990) if risk cases reported separately in studies then larger effects found for higher risk cases
Might be expected as these are the people who untreated are much more likely to recidivate
Treatment of sex offenders 8
Why target Need? Dowden (1998) found that targetting
‘more promising targets’ reduced recidivism more than ‘less promising targets’
Treatment of sex offenders 9
Promising targets for change
Changing antisocial attitudes Changing antisocial feelings Reducing antisocial peer associations Promoting identification/ association with anti-criminal role
models Increasing self-control, self- management, and problems
solving skills Reducing chemical dependency Changing other attributes that have been identified with
criminal conduct
Treatment of sex offenders 10
Less promising targets Increasing self-esteem without simultaneous reductions
in anti-social thinking, feeling and peer associations Focusing on vague emotional complaints that have not
been linked with criminal conduct Increasing the cohesiveness of antisocial peer groups Showing respect for anti-social thinking on the grounds
that the values of one (antisocial) culture are equally valid as the values of another culture
Attempting to turn the client into a better person when standards of being a better person do not link with recidivism
Treatment of sex offenders 11
Responsivity - learning styles In the broadest sense, this is taken to mean
that forensic rehabilitation programmes should be based on cognitive-behavioural/social learning principles
It also means, arguably, that programmes should be designed specifically for offenders who have learning difficulties, offenders from different cultural backgrounds, and for personality disorder offenders (Beech & Mann, 2002)
Treatment of sex offenders 12
Why address responsivity Identify offender characteristics such as
Interpersonal sensitivity Anxiety Verbal intelligence Cognitive maturity
By identifying personality and cognitive styles, treatment can be better matched to the client
Treatment of sex offenders 13
Appropriate treatment delivery
Here the clinician needs to review: Risk Need Responsivity And make decisions about treatment
according to ethical, humanitarian, cost-efficiency and clinical standards
Evidence supporting RNR sex offender work (Hanson, Bourgon, Helmus, & Hodgson (2009) )
• Hanson, Bourgon, Helmus and Hodgson (2009) report the most recent examination of effects of treatment examining 23 studies (n=6746) that met the basic criteria for quality of design
• All studies were rated on the extent to which they adhered to the risk, need, and responsivity (RNR) principles of the ‘What Works’ approach
• Hanson et al. found that the sexual recidivism rate in untreated samples was 19%, compared to 11% in treated samples
• Studies that adhered to all three RNR principles were found to produce recidivism rates that were less than half of the recidivism rates of comparison groups
• While studies that followed none of the RNR principles had little effect in reducing recidivism levels.
14
Treatment of sex offenders 15
Settings Principles of effective interventions are
hypothesised to apply regardless of setting within which treatment was delivered
In fact setting seen as being of minimal significance in the control of recidivism
Treatment of sex offenders 16
CBT: The behavioural bit
Originally this was confined to the use of conditioning procedures to alter behaviour i.e. rewarding desired behaviours and punishing unwanted behaviours
But has since broadened out to include such things as modelling (demonstrating a desired behaviour) and skills training (teaching specific skills through behavioural rehearsal)
Treatment of sex offenders 17
CBT: The cognitive bit Concerns the thoughts or cognitions that individuals
experience and which are known to affect their mood state and determine their behaviour
Cognitive therapy thus aims to alter an individual’s behaviour by encouraging the individual to think differently about events, thus giving rise to different affect and behaviour
The use of self-instruction and self-monitoring, in addition to developing an awareness of how one thinks affects how one feels and behaves are vital components in cognitive therapy
Meta-analytic evidence base for CBT
18
Kenworthy et al. (2004) (N = 500+)CBT and behavioural treatment ↓ sexual recidivism psychodynamic n.s
Alexander (1999) recidivism rates (N = ????)Untreated 25.8% (119/461)Group/ behavioural 18.3% (96/254)Unspecified 13.6% (127/931)RP-CBT 8.1% (18/221
Lösel and Schmucker (2005) (N = 22,181 ) CBT and behavioural treatment ↓ sexual recidivism Insight oriented, therapeutic community, n.s.
other psychosocial
Robertson, Beech, & Freemantle (in preparation) (N = 14,694 ) CBT and behavioural treatment ↓ sexual recidivism psychodynamic n.s
19
Treatment of sex offenders 20
Dynamic risk level_
Static Risk level
Low Medium High
Low Rolling Programme
(c. 100 hours)
Rolling Programme
(c. 100 hours)
Rolling or Core
(100 – 180 hours)
Medium Rolling or Core
(100 – 180 hours)
Core Programme
(c. 180 hours)
Core
(c. 180 hours)
High Core + Extended
(c. 320 hours)
Core + Extended
(c. 320 hours)
Core + Extended
(c. 320 hours)
Very High Core + Extended
(c. 320 hours)
Core + Extended
(c. 320 hours)
Core + Extended
(c. 320 hours)
Treatment in practice
Treatment of sex offenders 21
Innovations in the Sex Offender Field regarding Treatment
Mann (2005) notes that the following Accreditation Schema-focused interventions Dynamic assessment Focus on process issues
While Beech & Mann (2002) note the importance of Matching offenders to treatment Engaging offenders in assessment and treatment
Treatment of sex offenders 22
Accreditation The Correctional Services Panel was
set-up in 1999 to accredit programmes for national use
Mair (2004) notes that while the panel does not rule out any effective method no doubt preference for CBT approach
Treatment of sex offenders 23
Accreditation Criteria 1 Clear model of change backed by research evidence Selection of offenders Targeting dynamic risk factors Range of targets Effective methods Skills oriented Proper sequencing, intensity and duration of
programmes
Treatment of sex offenders 24
Accreditation Criteria 2 Engagement and motivation Promote community integration Programme integrity Properly managed & resourced, administered by
trained staff who adhere to programme aims and objectives
Continuity of programmes and services Ongoing monitoring Ongoing evaluation
Treatment of sex offenders 25
Accreditation
The value of accreditation is that it has forced programme designers to think about how to incorporate these vital aspects of treatment into an overall design that also respects the need for programme integrity and systematic intervention (Mann, 2005)
Whilst it could be argued that such an approach is overly bureaucratic or stifles individuality and creativity in treatment in practice it has been found to increase accountability and insure that programmes are based on effective theoretical models (Mann, 2005)
Treatment of sex offenders 30
Focus on Process Issues Over the last twenty years, the vast majority of the sex
offender treatment literature has focused on the content of treatment
Process issues were viewed with suspicion, partly because of the widely held view that sex offenders would manipulate and take advantage of any approach other than the firmly confrontational
Also because the fashion has been to see CBT as psycho-educational rather than psycho-therapeutic
Treatment of sex offenders 31
PROGRAM C30
40
50
60
70
80
PROGRAM C
PROGRAM D
PREVIOUS FINDINGS WPPprecss ITH THE GES
Treatment of sex offenders 36
A More Critical Take on the WW Literature
Use of meta-analyses The Accreditation Panel Use of positivist approach to treatment The CBT approach Gender and diversity issues
Treatment of sex offenders 37
Use of Meta-analysis ‘Meta-analysis offers a rigorous alternative to the causal, narrative
descriptions of research studies’ (Glass, 1976) but Get out what you put in Still a choice made about which studies to include How to code variables Different researchers come to different conclusions
on the basis of the same data set Whitehead & Lab (1989) - Treatment has little effect upon
recidivism Lösel (1993) - treatment does work
Problems in translating research into practice (Mair, 2004)
Treatment of sex offenders 38
The use of the Accreditation Panel
Biased in favour of CBT approaches It is more interested in rhetoric than reality It is too prescriptive Asked to move more quickly than such a
venture should have to Instead of encouraging exciting innovative
work it (the panel) could all to easily lead to such initiatives being suffocated
(Mair, 2004. p25)
Treatment of sex offenders 39
Positivist Approach A seeking to explain and predict behaviour of
individuals - a positivist approach That there is a single unified set of laws that best
explain behaviour Psychology, Psychiatry, and Social Work claim
expert knowledge over the human mind and are able to manipulate these in a benign way.
In fact the ‘psy’ disciplines have made it possible to deal with criminals in a liberal way. Such interventions are backed up by objective science
Treatment of sex offenders 40
Remoralisation in the ‘What Works’ approach Rose (1999) terms this ‘ethico-politics’ Which is becoming increasingly
reflected in the criminal justice system Offenders can either be remoralised Those deemed as being irredeemably
immoral deserve punishment and containment
Treatment of sex offenders 41
Remoralisation in the ‘What Works’ approach CBT works on the assumption that offenders have faulty or
deficient thinking which causes them to engage in immoral/ antisocial behaviour
Programmes therefore aim to remoralise or ethically reconstruct offenders by teaching them how to think pro-socially (Kendall, 2004)
Underpinning these ideas then are that all individuals are equally socially positioned to be rational, responsible , moral and self disciplined
The system is essentially about social construction of an offender’s perceived risk and interventions that in theory are meant to minimise or manage risk (Mair, 2004)
Treatment of sex offenders 42
Gender and diversity Some would argue that classification
practices and programmes inadequately address needs of women and minority ethnic groups
The whole ‘What Works’ scheme is is part of an escalating focus on managerialism, efficiency and accountability in correctional services and a move away from working with individual cases
Strengths-based approaches 43
Critique of the WW approach in sex offender work Probably the primary critic of just using the criminogenic
needs approach is Tony Ward (e.g., Ward, Mann & Gannon, 2007)
Who notes that current approaches regarding the identification risk factors and treatment to reduce the level of these risk factors is akin to a pin cushion approach
Where ‘each risk factor constitutes a pin and treatment focuses on the removal of each risk factor’
What has been rarely considered in this work is the relative strengths that individuals have to prevent themselves re-offending.
Strengths-based approaches 44
‘What Works’ and Strengths based approaches Therefore, according to Ward et al. the treatment
of sexual offenders should be the combination of both the ‘What Works’ principles in order to reduce risk
As well as applying ‘Good Lives’ principles in order to enhance the strengths of the individual being worked with
Strengths-based approaches 45
Ward’s ‘Good Lives’ approach Applying positive psychology’s aims in the treatment of
mainstream sexual offenders has been described by Ward and colleagues
Ward et al. (2006) note that human beings are naturally inclined to seek certain types of experiences or ‘human goods’ and experience high levels of well being if these good are obtained
Ward et al. (2007) note that primary goods are defined as ‘states of affairs, states of mind, personal characteristics, activities, or experiences that are sought for their own sake and are likely to achieve psychological well-being if achieved’
Ward’s 10 primary goods (1) life (i.e., healthy living and a high level of personal functioning) (2) knowledge acquisition (3) achievements both in work and play (4) excellence in agency (i.e., being in control and the ability to be able to
get things accomplished (5) inner peace (i.e., lack of stress and inner tension/ emotional
dysregulation) (6) friendship (including intimate, romantic and family relationships) (7) community (i.e., involvement with others beyond intimate/ family
relationships) (8) spirituality (in its broadest sense of finding meaning and purpose in life) (9) happiness (10) creativity.
Treatment of sex offenders 46
‘Bad lives’ All kinds of problems (psychological, social and lifestyle) can
emerge when these primary goods are pursued in inappropriate ways
Therefore, sexual offence behaviours become ways of achieving human goods either through a direct route where an individual does not have the skills or competencies to achieve these in an appropriate manner
Or through an indirect route where offending takes place to relieve the negative thoughts and feelings individuals have about their inabilities of achieving human goods
Treatment of sex offenders 47
Bad lives 2 Ward and Mann (2004) note that the absence of certain
goods such as: agency (i.e., a low level of interpersonal functioning [lack of] inner peace (high level of stress and tension) low level of relatedness (low level of intimate/ romantic
involvement with others) Have been strongly related to inappropriate, dysfunctional
ways Therefore, Ward et al. argue that obtaining a good life and
achieving a sense of well-being should be a key determinant in how sex offenders’ treatment is conducted
Treatment of sex offenders 48
Conclusions Treatment of sexual offenders a large undertaking in the U.K. Some overall evidence to suggest that it works However, there are criticisms of the whole approach The strongest being that the whole approach focuses on deficits
rather than strengths Idea is to now address risk while also building upon strengths To early to assess the relative merits of the ‘Good Lives’
approach which has been suggested as a new innovation to the treatment of offenders, particularly sex offenders
Treatment of sex offenders 49
Treatment of sex offenders 50
Key references Andrew, D. & Bonta, A. (2004). The psychology of criminal conduct. Cincinatti, OH:
Anderson. Hanson, R.K., Gordon, A., Harris, A.J.R., Marques, J.K., Murphy, W., Quinsey, V.L. &
Seto, M.C. (2002). First Report of the Collaborative Outcome Data Project on the Effectiveness of Psychological Treatment for Sex Offenders. Sexual Abuse: A Journal of Research and Treatment, 14 (2), 169-197.
Lösel, F. & Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology, 1, 117-146.
Mair, G. (2004). What matters in probation. Cullompton: Willan. Mann, R.E. (2005). Innovations in sex offender treatment. Journal of Sexual Aggression
(special issue). Ward, T. & Gannon, T.A. (2006). Rehabilitation, etiology, and self-regulation: The
comprehensive good lives model of treatment for sexual offenders. Aggression and Violent Behavior, 11, 77-94.