The Therapeutic Alliance and Criminogenic Change Michael Mitchell, LCSW Treating Criminogenic Risk, 2009 Treatment Criminogenic Risk, 20091

treatment components criminogenic treatment therapeutic relationship in criminogenic treatment treatment guidelines Treatment Criminogenic Risk, 20092

3 3 3 Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Definitions Criminogenic Stage of Change Behavioral Health Clinician/therapist

Treatment Criminogenic Risk, Treatment Components Criminogenic treatment Treatment factors Treatment 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, Treatment components Criminogenic treatment Treatment factors Treatment guidelines Behavioral Health Treatment research common factors client factors therapist factors Behavioral health treatment works! Behavioral health treatment works! Changes are sustained Changes are sustained No overall differences in approaches No overall differences in approaches Static factors Static factors Dynamic factors Dynamic factors Length of stay Length of stay Locus of change Locus of change Static factors Static factors Dynamic factors Dynamic factors Length of stay Length of stay Locus of change Locus of change Static factors Static factors Dynamic factors Dynamic factors “Necessary and Sufficient Conditions” “Necessary and Sufficient Conditions”

Treatment Criminogenic Risk, Treatment Components Criminogenic treatment Treatment factors Treatment guidelines The Therapeutic Alliance “…the quintessential integrative variable" ( Wolfe & Goldfried, 1988) Wolfe & Goldfried, 1988 Necessary but not sufficient Can be measured and it predicts outcome “…the quintessential integrative variable" ( Wolfe & Goldfried, 1988) Wolfe & Goldfried, 1988 Necessary but not sufficient Can be measured and it predicts outcome Four Core Components Four Core Components client’s emotional relationship with the clinician client’s ability to work in therapy the clinician’s empathic understanding and involvement The client-therapist agreement on the goals and task of therapy Gaston, 1990 Four Core Components Four Core Components client’s emotional relationship with the clinician client’s ability to work in therapy the clinician’s empathic understanding and involvement The 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, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Criminogenic Treatment and Anti-social Process

8888 Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Treatment Criminogenic Risk, 2009 Anti-Social Process Definition: 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. Definition: 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, Pro- Social Bond Development 9Criminogenic Change

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Need Invalidation Narcissistic Wounding EntitlementEntitlement InadequacyInadequacy Pro-social Disengagement Neutralizations Anti-social entrenchment Entrenched Anti-social Self

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Criminogenic Treatment “The intentional use of behavioral health interventions to identify and “The intentional use of behavioral health interventions to identify and collaboratively change entrenched anti-social behavior patterns to maximize pro-self identity and participation.” “The intentional use of behavioral health interventions to identify and “The intentional use of behavioral health interventions to identify and collaboratively change entrenched anti-social behavior patterns to maximize pro-self identity and participation.”

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment 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, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Recidivistic Risk Factors Andrews 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 StaticStatic DynamicDynamic Entrenched Anti-social Culture

Treatment Criminogenic Risk, Traditional Traditional : Symptom reductionCriminogenic: Pro-social engagement Primary Treatment Focus Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines

Treatment Criminogenic Risk, Pro-social need satisfaction Narcissistic Healing Pro-social Self Social capital & belonging Pro-social supports Increase pro- social engagement Pro-social treatment focus Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Criminogenic Treatment Factors

Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Criminogenic Treatment Factors Substance abuse Substance abuse Trauma Trauma Mental Health Mental Health Cognitive Cognitive Gender Differences Gender Differences Treatment disruptions Treatment disruptions “Convert in the fox hole” “Convert in the fox hole” Substance abuse Substance abuse Trauma Trauma Mental Health Mental Health Cognitive Cognitive Gender Differences Gender Differences Treatment disruptions Treatment disruptions “Convert in the fox hole” “Convert in the fox hole” “Captive audience” “Captive audience” Therapeutic leverage Therapeutic leverage Heightened stage of change Heightened stage of change Non-behavioral health systems Non-behavioral health systems “Captive audience” “Captive audience” Therapeutic leverage Therapeutic leverage Heightened stage of change Heightened stage of change Non-behavioral health systems Non-behavioral health systems

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment 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

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Stages of treatment EngagementInterventionTerminationAftercare 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, Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Treatment Guidelines 1.Individualized criminogenic process themes 2.Cultivate/enhance pro-social self image 3.Maintaining perspective 4.Communicate/collaborate 5.Responding to “anti-social pull” 6.Model pro-social inclusion

Treatment Criminogenic Risk, Treatment Criminogenic Risk, Therapeutic alliance Criminogenic treatment Treatment factors Treatment guidelines Extra-therapeutic factors Pro-social therapeutic alliance Hope, Expectancy and inclusion Technique Criminogenic Common Factors

ConclusionConclusion Treatment Criminogenic Risk,