1. SEX OFFENDER TREATMENT PROGRAMS
Anthony Beech
University of Birmingham
Treatment of sex offenders

2. 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 , p < ) indicating that the likelihood of individuals being reconvicted after treatment was around half that of those who had not undertaken treatment

3. Treatment of sex offenders
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. Treatment of sex offenders
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. Treatment of sex offenders
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
Treatment of sex offenders

14. 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.

15. Treatment of sex offenders
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. Treatment of sex offenders
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
Treatment of sex offenders

18. Meta-analytic evidence base for CBT
Kenworthy et al. (2004) (N = 500+)
CBT and behavioural treatment ↓ sexual recidivism
psychodynamic n.s
Alexander (1999) recidivism rates (N = ????)
Untreated % (119/461)
Group/ behavioural % (96/254)
Unspecified % (127/931)
RP-CBT % (18/221
Lösel and Schmucker (2005) (N = 22,181 )
Insight oriented, therapeutic community, n.s.
other psychosocial
Robertson, Beech, & Freemantle (in preparation) (N = 14,694 )

20. Treatment of sex offenders
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. Treatment of sex offenders
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. Treatment of sex offenders
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

26. Schema Focussed Interventions
Adopting a schema-based model of cognition in sexual assault leads to a treatment response that is targeted at the level of intermediate and core beliefs held by the offender (Mann & Beech, 2003)
Excellent cognitive and experiential therapy techniques have been developed to address this level of cognition (e.g. Young, 1999)
Treatment of sex offenders

27. Schema Focussed Interventions
The Prison Service has developed a treatment programme for high risk, high need sexual offenders based on a schema-focused approach
Preliminary evaluation of clinical impact has indicated that this approach reduces both schema-level dysfunctional cognition (such as entitlement and grievance thinking) and offence-related cognitive distortions (such as offence-justifying beliefs) (Thornton & Shingler, 2001)
Treatment of sex offenders

28. Treatment of sex offenders
Dynamic assessment
Treatment of sex offenders

29. Treatment of sex offenders
Dynamic assessment
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. PREVIOUS FINDINGS WPPprecss ITH THE GES
Treatment of sex offenders

32. COMPARING PROCESS VARIABLES WITH TREATMENT EFFECTIVENESS
Treatment of sex offenders

33. Focus on Process Issues
Thornton, Mann and Williams (2000) observed that both hostile/confrontational therapists and warm/supportive therapists brought about change in offence-related distorted beliefs
Treatment of sex offenders

34. Warm supportive therapists in sex offender work
change
level of mistrust of women
sexual entitlement
social adequacy
personal distress
rumination and impulsiveness
Treatment of sex offenders

35. 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. Treatment of sex offenders
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, p25)
Treatment of sex offenders

39. Treatment of sex offenders
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. Treatment of sex offenders
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
Treatment of sex offenders

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’
Strengths-based approaches

46. Treatment of sex offenders
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

47. Treatment of sex offenders
‘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

48. Treatment of sex offenders
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

49. Treatment of sex offenders
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

50. Treatment of sex offenders
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),
Lösel, F. & Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology, 1,
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,
Treatment of sex offenders