1. Remaking Relapse Prevention

2. Determinants of Relapse (Marlatt & Gordon, 1980) New type of cognitive-behavioral intervention Relapse prevention

3. Maintaining change in addicts Ceased Through other interventions

4. Relapse Rates for Addictions First 12 months after cessation 80% First 3 months 66% (Hunt et al., 1971)

5. Negative emotional states Interpersonal conflict Social pressure 71% of all relapses (drinkers, smokers, heroin addicts, compulsive gamblers, and over eaters) (Cummings et al, 1980)

6. Deviant Cycle Negative Affect Seemingly Unimportant Decisions (SUDS) High Risk Situations Target Selection Planning Passive/Active Grooming or Force Offense Remorse, Guilt, or Fear Thinking Errors Life Event

7. Developed for Offenders motivated to change Offenders motivated to change Already ceased offending Already ceased offending Offended through seemingly unimportant decisions Offended through seemingly unimportant decisions

8. Not Developed For Psychopaths Psychopaths Child molesters who want to continue Child molesters who want to continue

9. An important precondition for applying RP interventions is that the offender be motivated to stop offending. (George & Marlatt, 1980, p. 16)

10. In the Beginning the confidence and optimism we feel... are quite strong... the confidence and optimism we feel... are quite strong... our confidence... is without empirical support our confidence... is without empirical support (Gordon & Marlatt, p. 28)

11. What is RP today? Relapse Prevention Has little meaning In the past 15 years, those words have served as an umbrella under which a huge variety of clinical interventions that had little or nothing to do with the original notions of RP could be found. (Laws, 2000, 0. 16)

12. Nationwide Survey RPIncludes Primary RP Primary RP Community18% 97.9% Community18% 97.9% Residential25% 93.4% Residential25% 93.4% (McGrath et al., 2002)

13. Cognitive Behavioral Treatment Empathy Empathy Assertiveness Assertiveness Social skills Social skills Healthy sexuality Healthy sexuality Intimacy training Intimacy training Cognitive distortions Cognitive distortions Cognitive skills Cognitive skills Relapse Prevention Relapse Prevention

14. Relapse prevention performed a deep alchemy through which clinicians could look at rapidly declining survival curves and see mission, not despair. Relapse prevention performed a deep alchemy through which clinicians could look at rapidly declining survival curves and see mission, not despair. (Hanson, 2000, p. 36)

15. Instilling Knowledge of RP Satisfactory offense chains Initial testing 39% 3 repetitions 100% (Marques et al., 1989)

16. Test of Basic RP Concepts Initial testing 34% 3 rd testing 100% (Marques et al., 1989)

17. Sex Offender Treatment and Evaluation Project (Marques, 1999)

18. Why Was RP Adopted So Readily? No other game in town Northwest Treatment Associates Seattle, WA Gene Able & associates NY/Atlanta

19. Was SOTEP a Test of RP? Sex education Sex education Human sexuality Human sexuality Relaxation training Relaxation training Stress & anger management Stress & anger management Social skills Social skills Substance abuse Substance abuse Deviant arousal Deviant arousal RP RP

20. SOTEP Chronic offenders Mastered RP model Lower recidivism rates All offenders No relationship Mastering RP & recidivism

21. RP & Low Risk Offenders SOTEP Mastering RP No lowered recidivism No cycle?

22. Why Did SOTEP Fail? Failure to motivate offenders Failure to motivate offenders Lack of challenge of offenders Lack of challenge of offenders Too little focus on affective factors Too little focus on affective factors Lack of practice in coping skills Lack of practice in coping skills Lack of a strong conditional release component Lack of a strong conditional release component

23. Instilling Knowledge of RP Community based tx in England 27%

24. RP Too Complicated Abstinence violation effect Abstinence violation effect Success expectancy Success expectancy Erroneous attributions Erroneous attributions Apparently irrelevant decisions Apparently irrelevant decisions Negative emotional state Negative emotional state Problem of immediate gratification Problem of immediate gratification Adaptive coping response Adaptive coping response Increased probability of relapse Increased probability of relapse

25. RP Can Be Taught Awareness of high-risk thoughts Awareness of high-risk thoughts Willingness to admit planning Willingness to admit planning Recognition of high risk factors Recognition of high risk factors Knowledge of motivation for offending Knowledge of motivation for offending Ability to think of coping strategies Ability to think of coping strategies Ability to tell others when at risk Ability to tell others when at risk Exposure to RP greater skills (Mann, 1996)

26. Summary RP dominant tx strategy for 15 years RP dominant tx strategy for 15 years Rarely as a solo program Rarely as a solo program Hard to teach Hard to teach When mastered, ability to think of coping strategies and tell others risk level When mastered, ability to think of coping strategies and tell others risk level

27. Losel & Schmucker 2005 Treated N = 9,512 Untreated N = 12,669 All programs Sexual Sexual11.1%16.8% General General27.9%39.2%

28. Negative Results Kenworthy, Adams, Brooks-Gordon & Fenton, 2004 Rice and Harris, 2003

29. Does Tx Work Long Term? 12 Year Follow-Up TreatedUntreated (403)(321) Sexual21.1%21.8 Violent42.9%44.5% General56.6%60.4% (Hanson et al., 2004)

30. Updated Relapse Prevention

31. Deviant Cycle Negative Affect Seemingly Unimportant Decisions (SUDS) High Risk Situations Target Selection Planning Passive/Active Grooming or Force Offense Remorse, Guilt, or Fear Thinking Errors Life Event

32. Sometimes Desire for Offensive Sex Self Regulation Model of Relapse Prevention (Ward & Hudson, 1998)

33. Self Regulation Model of Relapse Prevention Desire for Offensive Sex Avoidance Goals Approach Goals (Ward & Hudson, 1998)

34. Treatment Components

35. Agenda RP & Good Lives Minimal Arousal Conditioning Denial Role of Family Treatment

36. A. We weighed it up and made sure that each unit weighed a kilo and did a general purity test on it. A. We weighed it up and made sure that each unit weighed a kilo and did a general purity test on it. Q. How do you do a general purity test? Q. How do you do a general purity test? A. Well, we snorted a bunch of it. A. Well, we snorted a bunch of it.

37. The Court: Now you are entitled to a speedy and public trial by jury or by court. You know what a jury trial is? The Court: Now you are entitled to a speedy and public trial by jury or by court. You know what a jury trial is? Defendant: Yes Court: Whats a jury trial? Defendant: A jury trial, twelve people find you guilty. Court. Yeah that is about right.

38. Court: You were picked up on a new 245? Defendant: I dont know if it was a 245, 645, 345. They picked me up on something, all right? Okay? Then when they also had me on that, he gave me a motherfucking charge for prostitution. Counsel: Dont use language like that to the judge. Defendant: Prostitution? What? Prostitution? What do you want me to say? They picked me up for prostitution.

39. Police Report I observed defendant driving without headlights on. Defendants vehicle was swaying from westbound curb lane to eastbound # 1. As defendants vehicle passed, I observed defendant with a large dog helping defendant drive (dog had front paws on steering wheel, possibly trying to save its own life.). Upon stopping defendants vehicle, defendant began yelling, Fuck Skippy [the dog]. You really got me fucked this time. Skippy had no statement. I observed defendant driving without headlights on. Defendants vehicle was swaying from westbound curb lane to eastbound # 1. As defendants vehicle passed, I observed defendant with a large dog helping defendant drive (dog had front paws on steering wheel, possibly trying to save its own life.). Upon stopping defendants vehicle, defendant began yelling, Fuck Skippy [the dog]. You really got me fucked this time. Skippy had no statement.

40. Self Regulation Model of Relapse Prevention Avoidant PassiveActiveAutomaticExplicit (Ward & Hudson, 1998) Approach

41. Type of Offense Pathway: Roger Unemployed Unemployed Bar from 12 to 3 pm Bar from 12 to 3 pm Left drunk Left drunk Boarded a train as knew girls would be there Boarded a train as knew girls would be there Goals: get one to perform oral sex Goals: get one to perform oral sex

42. Type of Offense Pathway: Roger Sat behind two 13-year-olds Touched their hair and masturbated Tapped one on shoulder They got up and left Got off train, saw a 13-year-old Began masturbating

43. Type of Offense Pathway: Roger Walked up to her with penis out of pants Walked up to her with penis out of pants Wanted her to perform oral sex Wanted her to perform oral sex She called out and other girls joined her She called out and other girls joined her Bus arrived and they left Bus arrived and they left They reported to bus driver They reported to bus driver

44. Type of Offense Pathway: Roger I just do things for no reason. I wish I could put into words how I feel, and understand what it is all about.

45. Type of Offense Pathway: Roger Knew by heart the routes home of children from local schools and holidays and breaks Knew by heart the routes home of children from local schools and holidays and breaks It was familiar territory so never had to plan It was familiar territory so never had to plan Says thousands of victims Says thousands of victims Convicted 13 times Convicted 13 times

46. Type of Offense Pathway: Roger Says he felt children enjoyed the experience Says he felt children enjoyed the experience I dont hurt anyone and people quite like what I do. I never carry out my fantasies about rape and hurting people in real life. I dont hurt anyone and people quite like what I do. I never carry out my fantasies about rape and hurting people in real life.

47. Roger: What Kind of Offender? Approach Automatic

48. What Kind of Treatment?

49. Type of Offense Pathway: Dave 40 year-old 40 year-old Confident and outgoing Confident and outgoing Worked abroad in a program to help teen prostitutes Worked abroad in a program to help teen prostitutes Talked to pimps Talked to pimps They made a powerful case They made a powerful case Felt his values had become contaminated Felt his values had become contaminated

50. Type of Offense Pathway: Dave Some of the younger girls I was trying to help said that things about the life were good. Intellectually I knew that that was about comparisons with the life they had before, extreme poverty and so on, but at another level I got interested – although I never did anything wrong to them.

51. What Type of Offender: Dave In past had baby-sat for 11-year-old In past had baby-sat for 11-year-old Went in bedroom aroused and watched child sleep Went in bedroom aroused and watched child sleep Told wife Told wife Agreed never to babysit again Agreed never to babysit again

52. Type of Offense Pathway: Dave I talked to my wife about the babysitting experience before we had the children. That was good, but then I sort of laid the responsibility for stopping it happening again on her. I did that again after our daughter told her what Id been doing. I talked to my wife about the babysitting experience before we had the children. That was good, but then I sort of laid the responsibility for stopping it happening again on her. I did that again after our daughter told her what Id been doing.

53. Type of Offense Pathway: Dave Family living in an open-plan home in hot climate Family living in an open-plan home in hot climate Kids often undressed Kids often undressed Felt 10-year-old daughter was seductive Felt 10-year-old daughter was seductive Knew his arousal was wrong Knew his arousal was wrong Tried to avoid situations where he might abuse her Tried to avoid situations where he might abuse her

54. Type of Offense Pathway: Dave Refused to share a tent with her on camping trip Refused to share a tent with her on camping trip Other times he fondled her genitals Other times he fondled her genitals Once persuaded her to straddle him Once persuaded her to straddle him Told himself knew what was happening and agreed Told himself knew what was happening and agreed

55. Type of Offense Pathway: Dave When wife gone, got into daughters bed to have intercourse When wife gone, got into daughters bed to have intercourse Realized what he was doing and stopped Realized what he was doing and stopped Shaken that he almost raped her Shaken that he almost raped her

56. Type of Offense Pathway: Dave I thought that carrying on with my work would help me get my head straight – instead it was just making it worse. I thought that carrying on with my work would help me get my head straight – instead it was just making it worse.

57. Type of Offense Pathway: Dave I kept away from my daughter – wouldnt take any interest in her. She wondered what was wrong with me – my wife says that made her more likely to want affection from me. Then when she came to me I misread what she wanted, because my thinking was getting so messed up.

58. Dave: What Kind of Offender? Avoidant Active

59. What Kind of Treatment?

60. Type of Offense Pathway: Joe 40-year-old 40-year-old 6 cts against one boy, now 19 6 cts against one boy, now 19 Over 8 years Over 8 years Fondling, oral sex, anal intercourse Fondling, oral sex, anal intercourse Working as handyman at boys house Working as handyman at boys house Boy began to hang around him Boy began to hang around him

61. Type of Offense Pathway: Joe Urinated in bushes and boy saw it Urinated in bushes and boy saw it Boy watching excited him Boy watching excited him Asked boy to touch his penis Asked boy to touch his penis Boy compliant Boy compliant Escalated to anal intercourse Escalated to anal intercourse Boy told him he didnt want to do these things Boy told him he didnt want to do these things

62. Type of Offense Pathway: Joe Told boy it was normal Told boy it was normal Told him no one would believe him Told him no one would believe him Told boy, why had he done it if didnt want to Told boy, why had he done it if didnt want to Told boy if reported, they would blame him Told boy if reported, they would blame him Told boy that he (the boy) was gay Told boy that he (the boy) was gay Youre just a little queer! Why dont you accept that? a

63. Type of Offense Pathway: Joe 2 previous convictions 2 previous convictions

64. Type of Offense Pathway: Joe Previous Treatment Youre got to go along to get along. If I was ever going to get out of there, I realized that I was going to have to learn to say what they wanted to hear. Psychologist: Did well and was able to freely share his experiences and mistakes with other group members and to take responsibility for his actions.

65. Type of Offense Pathway: Joe showing them what real life was like You need to know how to get that feeling of being in charge – the world is a frightening place Of course, I took my fee

66. Joe: What Kind of Offender? Approach Explicit

67. What Kind of Treatment?

68. Type of Offense Pathway: Ben 25-year-old 25-year-old Police called to residence – found father of a 5-year-old holding Ben in custody Police called to residence – found father of a 5-year-old holding Ben in custody Ben was babysitting Ben was babysitting Returned to find him in bed with son Returned to find him in bed with son Boy crying; told parents Ben had touched my thing and sucked on it. Boy crying; told parents Ben had touched my thing and sucked on it.

69. Type of Offense Pathway: Ben 3 arrests at ages 15, 22 and 23: all victims boys under 10 3 arrests at ages 15, 22 and 23: all victims boys under 10 No other criminal history No other criminal history

70. Type of Offense Pathway: Ben 1 st offense: met 6-year-old when he was coming home from school. Bought him ice cream, took him to a park, pulled down his pants and fellated him 1 st offense: met 6-year-old when he was coming home from school. Bought him ice cream, took him to a park, pulled down his pants and fellated him After graduating from university, picked up a boy, took him for a ride, drove to a park, fondled him and fellated him After graduating from university, picked up a boy, took him for a ride, drove to a park, fondled him and fellated him

71. Type of Offense Pathway: Ben Uncomfortable around adults his age Uncomfortable around adults his age They seemed so much more grown up than I was. I felt awkward, like I couldnt get one foot in front of the other. Children: They werent trying to live up to some social standard. I envied them because they seemed so free, so at ease in their world.

72. Type of Offense Pathway: Ben I will admit that I especially liked looking at the boys. They were so cute, bright eyed, smooth skin. It sounds silly, but I wished that I could look like that, rather than a hulky, almost adult male. It must have been then that I began to think about them sexually.

73. Type of Offense Pathway: Ben When I jerked off, I tried to fantasize about girls my age in my classes, but it didnt work. When I thought about kids, I felt guilty, but I got really aroused and I could ejaculate. Although I didnt really want them to be, the fantasies were about feeling these kids up and sucking their dicks. The more I did it, the easier it got.

74. Type of Offense Pathway: Ben When I saw that kid in 1989, I dont know, I guess I just felt that I had to do it. I conned him and I took him to the park and went down on him. I felt like shit after that.

75. Type of Offense Pathway: Ben Cruised while at university, but didnt pick up any kids. Afraid of getting kicked out. Cruised while at university, but didnt pick up any kids. Afraid of getting kicked out. After I graduated from university and couldnt find a job, I felt worthless. So I started cruising again. This time I was afraid something would happen, and it did. After I graduated from university and couldnt find a job, I felt worthless. So I started cruising again. This time I was afraid something would happen, and it did.

76. Type of Offense Pathway: Ben Felt guilty. Boy couldnt identify him. Felt guilty. Boy couldnt identify him. I should have said, Hey! I did it! but I didnt. I should have said, Hey! I did it! but I didnt.

77. Type of Offense Pathway: Ben Last offense, asked boy, Do you want to learn about sex? It seemed to me that he was fine with it until his old man burst into the room.

78. Type of Offense Pathway: Ben Still masturbating to fantasies. I cant seem to stop it. Still masturbating to fantasies. I cant seem to stop it. Response to first arrest: I just wanted to forget about it. Response to first arrest: I just wanted to forget about it.

79. Ben: What Kind of Offender? Avoidant Passive

80. What Kind of Treatment?

81. Good Lives Model

82. RPAvoidant RPAvoidant Good lives modelApproach Good lives modelApproach

83. Primary Goods People seek primary goods

84. Primary Goods Experiences, states of mind, activities Sought for their own sake Increase psychological well-being

85. Sexual Offending Attempts to pursue primary human goods Socially unacceptable Personally frustrating

86. What Are Primary Goods Relatedness Relatedness Health Health Autonomy Autonomy Creativity Creativity Knowledge Knowledge

87. Tender Minded Theory People are good Bad acts are an attempt to meet same needs as everybody else

88. Theoretical Position It is true that we did not cite any study applying the ideas of Deci and Ryan [human needs and self-determination] to an offender population – to our knowledge there are no such studies yet. (Ward & Stewart, 2003, p. 222)

89. Theoretical Position...there is little or no evidence for the assessment and treatment aspects of the theory other than the rationally based reasons outlined above. This weakness reveals that the theory lacks empirical adequacy. (Ward et al., 2006, p. 311)

90. Deci & Ryan (2000) Nonoffenders Autonomy, competence & relatedness Correlated with Indices of well-being (Negatively correlated with anxiety and depression; positively correlated with self- esteem)

91. Innate needs Correlated with Noncriminogenic needs ( Bonta and Andrews, 2003)

92. I plain and simple needed to get some good, hot, kinky sex but resented having to rely on the generosity of women to hit on their pussies... My days of begging... Were over. (Athens, 1997, p. 10)

93. Applying the Good Lives Model What goods are associated with offending? Pursuit of emotional equilibrium Intimacy Personal control Grievance Sexual pleasure (goods of health & body) Play (to get a thrill)

94. What Prevents Meeting These Appropriately? Socially isolated Lack skills for relationships Overly aggressive when mood low

95. Identifying Overarching Primary Goods Mechanically Inclined In this example, he might enroll in a night course on practical mechanics (knowledge), join a car club (relatedness), and eventually train as a car mechanic (mastery at work). (Ward et al., 2006, p. 308)

96. Identify Environment Needed Info about opportunities for work Info about opportunities for work Social supports Social supports Living arrangements Living arrangements Culture of the community Culture of the community

97. People are What They Do To forge a more adaptive personal identity Must live a better life

98. Rehabilitation Involves Looking at past life Looking at past life Developing a new good lives plan Developing a new good lives plan

99. Must Take into Account Offenders strengths Offenders strengths Primary Goods Primary Goods Relevant Environments Relevant Environments What competencies & resources? What competencies & resources?

100. The problem does not reside in the primary human goods that underlie offending, but in the way individuals seek these goods. (Ward et. Al, 2006, p. 307)

101. Secondary Goods Ways primary goods are translated into action Primary goods:work Secondary goods: Training in computers

102. At Its Best Loneliness:Risk factor Loneliness:Risk factor How to build a life with social connection How to build a life with social connection

103. At Its Worse Takes sex out of sexual offending Takes sex out of sexual offending Exercise, eat well, get a job – youll be fine Exercise, eat well, get a job – youll be fine

104. Assumptions Lost Souls or Predators Lost Souls Only Need Apply

105. Is All Offending from Frustration? PsychopathicPredatorsSadists

106. I like to live on the edge. I like being wanted by the police. I like being chased by the police. When you live that kind of life you really cant stop to think. You never think. You just do, do, do. If you stop you wont do it. I never stop to analyze it. I like to live on the edge. I like being wanted by the police. I like being chased by the police. When you live that kind of life you really cant stop to think. You never think. You just do, do, do. If you stop you wont do it. I never stop to analyze it.

107. Id have to say I did get a high out of violent behavior. I got – I got a high out of any controlling and dominating situation. Any, any situation that I was able to control – right? – I got a high out of. I had like an adrenaline rush. I felt powerful, in charge, where in a consensual sexual relationship, sure orgasm was achieved, ejaculation was achieved, and then its over. But the feeling of power and control lasts, it would last a lot longer. And its something I knew that I could achieve at any given point in time. All I, I knew what I had to do. All I had to do was control somebody or dominate, and that high was there.