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Treatment of sex offenders1 SEX OFFENDER TREATMENT PROGRAMS Anthony Beech University of Birmingham

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1 Treatment of sex offenders1 SEX OFFENDER TREATMENT PROGRAMS Anthony Beech University of Birmingham

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 2

3 Treatment of sex offenders3 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

4 Treatment of sex offenders4 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

5 Treatment of sex offenders5 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’

6 Treatment of sex offenders6 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

7 Treatment of sex offenders7 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

8 Treatment of sex offenders8 Why target Need? Dowden (1998) found that targetting ‘more promising targets’ reduced recidivism more than ‘less promising targets’

9 Treatment of sex offenders9 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

10 Treatment of sex offenders10 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

11 Treatment of sex offenders11 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)

12 Treatment of sex offenders12 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

13 Treatment of sex offenders13 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

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. 14

15 Treatment of sex offenders15 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

16 Treatment of sex offenders16 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)

17 Treatment of sex offenders17 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

18 Meta-analytic evidence base for CBT 18 Kenworthy et al. (2004) (N = 500+) CBT and behavioural treatment ↓ sexual recidivism psychodynamicn.s Alexander (1999) recidivism rates (N = ????) Untreated25.8% (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 psychodynamicn.s

19 19

20 Treatment of sex offenders20 Treatment in practice

21 Treatment of sex offenders21 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

22 Treatment of sex offenders22 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

23 Treatment of sex offenders23 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

24 Treatment of sex offenders24 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

25 Treatment of sex offenders25 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)

26 Treatment of sex offenders26 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)

27 Treatment of sex offenders27 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)

28 Treatment of sex offenders28 Dynamic assessment

29 Treatment of sex offenders29 Dynamic assessment

30 Treatment of sex offenders30 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

31 Treatment of sex offenders31 PREVIOUS FINDINGS WPPprecss ITH THE GES

32 Treatment of sex offenders32 COMPARING PROCESS VARIABLES WITH TREATMENT EFFECTIVENESS

33 Treatment of sex offenders33 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

34 Treatment of sex offenders34 Warm supportive therapists in sex offender work change level of mistrust of women sexual entitlement social adequacy personal distress rumination and impulsiveness

35 Treatment of sex offenders35

36 Treatment of sex offenders36 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

37 Treatment of sex offenders37 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)

38 Treatment of sex offenders38 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)

39 Treatment of sex offenders39 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

40 Treatment of sex offenders40 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

41 Treatment of sex offenders41 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)

42 Treatment of sex offenders42 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

43 Strengths-based approaches43 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.

44 Strengths-based approaches44 ‘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

45 Strengths-based approaches45 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’

46 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 offenders46

47 ‘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 offenders47

48 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 offenders48

49 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 offenders49

50 Treatment of sex offenders50 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,


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