Treatment Components Anna C. Salter, Ph.D.. Agenda What Works in Sex Offender Treatment Cost-Benefit Analysis Treatment Components RP versus Good Lives

Treatment ComponentsTreatment Components

Anna C. Salter, Ph.D.Anna C. Salter, Ph.D.

AgendaAgenda

What Works in Sex Offender TreatmentWhat Works in Sex Offender Treatment

Cost-Benefit AnalysisCost-Benefit Analysis

Treatment ComponentsTreatment Components

RP versus Good LivesRP versus Good Lives

Cost of RecidivismCost of Recidivism

To TaxpayersTo Taxpayers

To VictimsTo Victims

Computing Cost of RecidivismComputing Cost of Recidivism

–Police InvestigationPolice Investigation–AdjudicationAdjudication–CorrectionsCorrections–Medical Care of VictimsMedical Care of Victims–Mental Health Care of VictimsMental Health Care of Victims–Property DamageProperty Damage–Reduced Future EarningsReduced Future Earnings

(Aos, (Aos, 1999)1999)

Computing Victim Cost of RecidivismComputing Victim Cost of Recidivism

–Medical CareMedical Care

–Mental Health CareMental Health Care

–Property DamageProperty Damage

–Reduced Future EarningsReduced Future Earnings

–Pain and SufferingPain and Suffering

–Loss of LifeLoss of Life

(Aos, (Aos, 1999)1999)

Cost Effectiveness of Correctional Cost Effectiveness of Correctional ProgrammingProgramming

Every $1 Spent on Correctional ProgrammingEvery $1 Spent on Correctional Programming

Taxpayers Save $5Taxpayers Save $5

Victims Save $7Victims Save $7

(Aos, 1999)(Aos, 1999)

Cost Effectiveness of Vocational and Cost Effectiveness of Vocational and Basic Education ProgramsBasic Education Programs

For Every $1 SpentFor Every $1 Spent

Taxpayers save between $1.71 & $3.23Taxpayers save between $1.71 & $3.23

(Aos et al., 1999)(Aos et al., 1999)

Cost Effectiveness of Cognitive-Cost Effectiveness of Cognitive-Behavioral Treatment ProgramsBehavioral Treatment Programs

For Every $1 SpentFor Every $1 Spent

Taxpayers Save Between $2.54 and $11.48Taxpayers Save Between $2.54 and $11.48

(Aos et al., 1999)(Aos et al., 1999)

““We found the largest and most consistent We found the largest and most consistent returns are for programs designed for returns are for programs designed for juvenile offenders.”juvenile offenders.”

(Aos et al., 1999, p. 6)(Aos et al., 1999, p. 6)

Cost Effectiveness of Programming for Cost Effectiveness of Programming for JuvenilesJuveniles

For Every $1 Spent on Juvenile ProgramsFor Every $1 Spent on Juvenile Programs

Tax Payers Save Between $7.62 & $31.4Tax Payers Save Between $7.62 & $31.4

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Non Cost/Benefit of Adolescent Non Offender ProgramsOffender Programs

ProgramProgram TaxpayersTaxpayers Taxpayers Taxpayers &&

AloneAlone Victims Victims

QuantumQuantum $.09$.09 $.13$.13

Big BrothersBig Brothers $1.30$1.30 $2.12$2.12

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Non Cost/Benefit of Adolescent Non Offender ProgramsOffender Programs

ProgramProgram Cost/ Cost/ EffectEffect

ParticipantParticipant SizeSize

QuantumQuantum $18,292$18,292 -.42-.42

Big BrothersBig Brothers $1,009$1,009 -.05-.05

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Supervision Cost/Benefit of Adolescent Supervision ProgramsPrograms

ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers & AloneAlone Victims Victims

DiversionDiversion $7.62$7.62 $13.61$13.61Intensive Intensive

ProbationProbation .90 .90 1.49 1.49Boot CampBoot Camp .42 .42 .26 .26

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Treatment Cost/Benefit of Adolescent Treatment ProgramsPrograms

ProgramProgram TaxpayersTaxpayers Taxpayers Taxpayers &&

AloneAlone Victims Victims

ARPARP $19.57 $19.57 $31.40$31.40

Multi-SystemicMulti-Systemic 8.38 8.38 13.45 13.45

Functional FamFunctional Fam 6.85 6.85 10.99 10.99

Multi Tx FosterMulti Tx Foster 14.0714.07 22.58 22.58

Cost/Benefit of Adolescent Treatment Cost/Benefit of Adolescent Treatment ProgramsPrograms

ProgramProgram Cost/ Cost/ EffectEffectParticipantParticipant SizeSize

AggressionAggressionReplacementReplacementTrainingTraining $404$404 -.26-.26

Multi-SysMulti-SysFamily TxFamily Tx $4,540$4,540 -.68-.68

(Aos, 1999)(Aos, 1999)

What Does It Take to Break What Does It Take to Break EvenEven

Depends on the CostDepends on the Cost

Percent Reduction to Percent Reduction to Break EvenBreak Even

AggressionAggressionReplacement Replacement TrainingTraining 1.4%1.4%

Multi-SystemicMulti-SystemicFamily TherapyFamily Therapy 10.2%10.2%

How to DecideHow to Decide

Meta-analysis of factors related to recidivismMeta-analysis of factors related to recidivism

TheoryTheory

Skill Set of StaffSkill Set of Staff

TraditionTradition

Key ResearchKey Research

Hanson & BussiereHanson & Bussiere 19981998

Hanson & Morton-BourgonHanson & Morton-Bourgon 20052005

HansonHanson 20092009

Meta-analysisMeta-analysisHanson & Bussiere, 1998Hanson & Bussiere, 1998

61 Studies61 Studies

N = 28,972N = 28,972

Correlation coefficientsCorrelation coefficients

Meta-analysisMeta-analysisHanson & Morton-Bourgnon, Hanson & Morton-Bourgnon,

20052005

Studies = 82Studies = 82

N = 29,450N = 29,450

35 from 1998 meta-analysis35 from 1998 meta-analysis

Mean differenceMean difference

Traditional Clinical AssessmentTraditional Clinical Assessment P-graph deviant arousal pattern – childrenP-graph deviant arousal pattern – children Deviant arousal Deviant arousal Personality disorders, e.g., APDPersonality disorders, e.g., APD EmpathyEmpathy DenialDenial Family problemsFamily problems Psychological problemsPsychological problems Sexual abuse as a childSexual abuse as a child Social skillsSocial skills Substance abuseSubstance abuse

Traditional Clinical AssessmentTraditional Clinical Assessment P-graph deviant arousal pattern – childrenP-graph deviant arousal pattern – children YesYes Deviant Sexual PreferenceDeviant Sexual Preference YesYes Personality disorders, e.g., APDPersonality disorders, e.g., APD YesYes EmpathyEmpathy No No DenialDenial No No Family problemsFamily problems No No Psychological problemsPsychological problems No No Sexual abuse as a childSexual abuse as a child No No Social skillsSocial skills No No Substance abuseSubstance abuse No No

Traditional Clinical AssessmentTraditional Clinical Assessment Deviant arousal pattern – childrenDeviant arousal pattern – children .32.32 Deviant Sexual PreferenceDeviant Sexual Preference .22.22 Personality disorders, e.g., APDPersonality disorders, e.g., APD .16.16 EmpathyEmpathy .03 .03 DenialDenial .02 .02 Family problemsFamily problems .08 .08 Psychological problemsPsychological problems 0 0 Sexual abuse as a childSexual abuse as a child -.01-.01 Social skillsSocial skills -.04-.04 Substance abuseSubstance abuse .03 .03

Clinical Vs. Actuarial Clinical Vs. Actuarial AssessmentAssessment

Dixon, 1974Dixon, 1974 Epperson, Kaul and Huot, 1995Epperson, Kaul and Huot, 1995 Florida Dept. of Health & Human Services, Florida Dept. of Health & Human Services,

19841984 Khanna, Brown, Malcolm & Williams, 1989Khanna, Brown, Malcolm & Williams, 1989

(Hanson & Bussiere, 1996)(Hanson & Bussiere, 1996)

Clinical vs. Actuarial Clinical vs. Actuarial AssessmentAssessment

Reddon, Studer, and Estrada, 1995Reddon, Studer, and Estrada, 1995 Rice, Quinsey and Harris, 1989Rice, Quinsey and Harris, 1989 Ryan and Miyoshi, 1990Ryan and Miyoshi, 1990 Schram, Milloy and Rowe, 1991Schram, Milloy and Rowe, 1991 Smith & Monastersky, 1986Smith & Monastersky, 1986 Sturgeon & Taylor, 1986Sturgeon & Taylor, 1986


Clinical vs. Actuarial Clinical vs. Actuarial AssessmentAssessment

rr

Clinical AssessmentClinical Assessment .10.10

Actuarial AssessmentActuarial Assessment .46.46


Accuracy of Clinical and Accuracy of Clinical and Actuarial Risk PredictionActuarial Risk Prediction

-0.05

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

a b c d e f g h i j k l m

clinical

actuarial

r

Hanson Clinical vs. ActuarialHanson Clinical vs. Actuarial

1.1. Variability of clinical greatVariability of clinical great

2.2. Some clinical worse than chanceSome clinical worse than chance

3.3. None of clinical showed results better None of clinical showed results better than worse of actuarials (ns)than worse of actuarials (ns)

Meta-analysisMeta-analysisHanson & Morton-Bourgnon, Hanson & Morton-Bourgnon,

20052005

Studies = 82Studies = 82

N = 29,450N = 29,450

35 from 1998 meta-analysis35 from 1998 meta-analysis

Mean differenceMean difference

Value of d is approximatelyValue of d is approximately

2 times the correlation coefficient2 times the correlation coefficient

from same datafrom same data

LargeLarge > .30> .30

ModerateModerate >.20>.20

SmallSmall .10 .10

Not usefulNot useful <.10<.10

Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005

CategoriesCategories

Sexual deviancySexual deviancyAntisocial orientationAntisocial orientationSexual attitudesSexual attitudesIntimacy deficitsIntimacy deficitsAdverse childhood environmentAdverse childhood environmentGeneral psychological problemsGeneral psychological problemsClinical presentationClinical presentation

CategoriesCategories

Sexual deviancySexual deviancy .30.30 Antisocial orientationAntisocial orientation .23.23 Sexual attitudesSexual attitudes .17.17 Intimacy deficitsIntimacy deficits .15.15 Adverse childhood environmentAdverse childhood environment .09.09 General psychological problemsGeneral psychological problems .02.02 Clinical presentationClinical presentation -.02 -.02


Sexual DeviancySexual Deviancy

Sexual interest in childrenSexual interest in children.39.39

Any deviant sexual interestAny deviant sexual interest.31.31

Sexual preoccupationSexual preoccupation.21.21


Anti-social Anti-social

General regulation problemsGeneral regulation problems .37 .37 PCL-RPCL-R .29.29 Antisocial personality disorderAntisocial personality disorder .21.21


Intimacy DeficitsIntimacy Deficits

Emotional identification with childrenEmotional identification with children .42.42 Conflicts with intimate partnersConflicts with intimate partners .36.36 Social skills deficitsSocial skills deficits -.07 -.07 LonelinessLoneliness .03.03

Attitudes towards sexual crimeAttitudes towards sexual crimeYesYes

Child molester attitudesChild molester attitudes NoNo


No goNo go

Childhood neglect or abuseChildhood neglect or abuse.10.10

Sexual abuse in childhoodSexual abuse in childhood .09.09

Lack of empathyLack of empathy -.08 -.08

Low self-esteemLow self-esteem .04.04

LonelinessLoneliness .03.03

Denial of sexual crimeDenial of sexual crime .02.02

““The prototypic sexual recidivist is not upset The prototypic sexual recidivist is not upset or lonely; instead, he leads an unstable, or lonely; instead, he leads an unstable, antisocial lifestyle and ruminates on sexually antisocial lifestyle and ruminates on sexually deviant themes.”deviant themes.”

(Hanson & Morton-Bourgon, 2005, p. 1158)(Hanson & Morton-Bourgon, 2005, p. 1158)

Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005Not CorrelatedNot Correlated

Child molester attitudesChild molester attitudesGeneral psychological problemsGeneral psychological problemsSexually abused as a childSexually abused as a childSocial skill deficitsSocial skill deficitsLonelinessLonelinessAnxietyAnxiety


Not CorrelatedNot Correlated

DepressionDepressionLow self-esteemLow self-esteemVictim empathyVictim empathyDenialDenialMinimizationMinimizationPoor progress in treatmentPoor progress in treatment

Survey of Treatment Programs Survey of Treatment Programs

Community ProgramsCommunity Programs

%%

Victim empathyVictim empathy 94.894.8

Social skills trainingSocial skills training 8080

Family support networksFamily support networks 72.872.8

Arousal controlArousal control 63.663.6

Antisocial attitudesAntisocial attitudes ??

(McGrath et al., 2003)(McGrath et al., 2003)

Survey of Treatment Programs Survey of Treatment Programs

Residential ProgramsResidential Programs

%%

Social skills trainingSocial skills training 8989

Victim empathyVictim empathy 86.886.8

Arousal controlArousal control 59.659.6

Family support networksFamily support networks 43.343.3

Antisocial attitudesAntisocial attitudes ??

(McGrath et al., 2003)(McGrath et al., 2003)

Arousal ControlArousal Control Com %Com % Res % Res %

Covert sensitizationCovert sensitization 50 50 48 48

Odor aversionOdor aversion 25 25 18 18

Masturbatory satiationMasturbatory satiation 24 24 19 19

Aversive behavioral rehearsalAversive behavioral rehearsal 23 23 18 18

Verbal satiationVerbal satiation 16 16 14 14

Minimal arousal conditioningMinimal arousal conditioning 18 18 19 19

Orgasmic conditioningOrgasmic conditioning 16 16 19 19

One or moreOne or more 63 63 60 60

Growing ConsensusGrowing Consensus

Not correlated with general personality deficitsNot correlated with general personality deficits

But withBut with

Certain specific problemsCertain specific problems

Sexual deviancySexual deviancy

Antisocial attitudesAntisocial attitudes

Certain intimacy deficitsCertain intimacy deficits

Motors & BrakesMotors & Brakes

Motor Motor Sexual attraction to Sexual attraction to childrenchildren

Faulty brakesFaulty brakes Antisocial attitudesAntisocial attitudes


Unrelated to personality traitsUnrelated to personality traits

Narcissistic or self-effacingNarcissistic or self-effacing

Outgoing or introvertedOutgoing or introverted

Depressed, anxious or hystericalDepressed, anxious or hysterical

Low self-esteem or highLow self-esteem or high

Correlated Personality Traits Correlated Personality Traits

RecklessnessRecklessness

ImpulsivityImpulsivity

Poor problem solvingPoor problem solving

General regulation problemsGeneral regulation problems

““Research has never found measures of general Research has never found measures of general psychological adjustment, such as self-esteem, psychological adjustment, such as self-esteem, depression, or social competence, to be related to depression, or social competence, to be related to sexual offense recidivism (Hanson & Bussiere, sexual offense recidivism (Hanson & Bussiere, 1998). Furthermore, treatment programs that 1998). Furthermore, treatment programs that improve general psychological adjustment do not improve general psychological adjustment do not result in reduced recidivism rates.”(Hanson, result in reduced recidivism rates.”(Hanson, Steffy, & Gauthier, 1993; Nicholaichuk, 1996).”Steffy, & Gauthier, 1993; Nicholaichuk, 1996).”

““The distressed offenders are at no greater The distressed offenders are at no greater recidivism risk than the happy offenders, but recidivism risk than the happy offenders, but both types of offenders are at increased risk both types of offenders are at increased risk when their mood deteriorates. These results when their mood deteriorates. These results suggest that therapy should focus on weakening suggest that therapy should focus on weakening the association between negative affect and sex the association between negative affect and sex offending rather than on generally improving the offending rather than on generally improving the offenders’ psychological adjustment.” offenders’ psychological adjustment.”

(Hanson, 2000, p. 34-35)(Hanson, 2000, p. 34-35)

Research SuggestsResearch Suggests

Treatment programs should addressTreatment programs should address

Sexual deviancySexual deviancy

Antisocial attitudes & beliefsAntisocial attitudes & beliefs

Certain intimacy deficits: Certain intimacy deficits:

Emotional identification with children, Emotional identification with children, Conflicts with partnersConflicts with partners

Research SuggestsResearch Suggests

Not includingNot including

Empathy Empathy Social skillsSocial skillsSubstance abuseSubstance abusePersonal distress variablesPersonal distress variables

AnxietyAnxiety

DepressionDepression

Low self-esteemLow self-esteem

Meta-analysis: Risk, Need & Meta-analysis: Risk, Need & ResponsivityResponsivity

Hanson, Bourgon, Helmus & Hodgson, 2009Hanson, Bourgon, Helmus & Hodgson, 2009

Risk-Needs-ResponsivityRisk-Needs-Responsivity

Focus on high risk offendersFocus on high risk offenders

Target criminogenic needsTarget criminogenic needs

Use cognitive behavioral methods tailored Use cognitive behavioral methods tailored to individual learning styleto individual learning style

Selection of StudiesSelection of Studies

Total = 130Total = 130

AcceptedAccepted

2323

AcceptedAccepted

18 weak18 weak

5 good5 good

Adherence to RNR PrinciplesAdherence to RNR Principles

Risk: Little or no service to low riskRisk: Little or no service to low risk

(Tx participants of higher than average risk)(Tx participants of higher than average risk)

Needs: Sexual deviancy, antisocial attitudes, Needs: Sexual deviancy, antisocial attitudes, sexual attitudes, intimacy deficitssexual attitudes, intimacy deficits

Noncriminogenic: denial, empathy, social skillsNoncriminogenic: denial, empathy, social skills

Responsivity: Cognitive behavioral with firm-Responsivity: Cognitive behavioral with firm-but-fair therapistsbut-fair therapists

Rater ReliabilityRater Reliability

Kappa Kappa % Agreement% Agreement RatingRating

RiskRisk .73.73 88%88% GoodGood

ResponsivityResponsivity .82.82 94%94% GoodGood

NeedsNeeds .42.42 75%75% FairFair

(Hanson et al., 2009)(Hanson et al., 2009)

Hanson et al., 2009Hanson et al., 2009

Recidivism Treated%

Untreated%

Sexual 10.9 19.2%

Any 31.8 48.3

Violent 22.9 NS 32 NS

Tx Effectiveness & RNR ModelTx Effectiveness & RNR Model

Sexual RecidivismSexual Recidivism


NeedsNeeds More effectiveMore effective

ResponsivityResponsivity More effectiveMore effective

RiskRisk Not more Not more effectiveeffective

Risk PrincipleRisk Principle

Least effective with general offendersLeast effective with general offenders

Least effective with sex offendersLeast effective with sex offenders

Tx Effectiveness & RNR ModelTx Effectiveness & RNR Model

Number of Principles Number of Principles OddsOdds

Adhered ToAdhered To RatioRatio

None 1.17None 1.17

11 .64.64

22 .63.63

33 .21 .21

Any RecidivismAny Recidivism ResponsivityResponsivity

NumberNumber

(Fixed (Fixed effects)effects)

Sexual & ViolentSexual & Violent No effectNo effect

““If there is anything to be learned from the If there is anything to be learned from the broad debate over the effectiveness of broad debate over the effectiveness of correctional rehabilitation, it is that not all correctional rehabilitation, it is that not all interventions reduce recidivism.”interventions reduce recidivism.”

(Hanson et al., 2009)(Hanson et al., 2009)

““Of the three RNR principles, attention to the Of the three RNR principles, attention to the Need principle would motivate the largest Need principle would motivate the largest changes in the interventions currently given to changes in the interventions currently given to sex offenders. . . An empirical association with sex offenders. . . An empirical association with recidivism is a minimum criterion for a factor to recidivism is a minimum criterion for a factor to be considered a potential criminogenic need. . . be considered a potential criminogenic need. . . Many of the factors targeted in contemporary Many of the factors targeted in contemporary treatment programs do not meet this test.” treatment programs do not meet this test.” Offense responsibility, social skills training, and Offense responsibility, social skills training, and victim empathy are targets in 80% of sexual victim empathy are targets in 80% of sexual offender treatment programs . . . Yet none of offender treatment programs . . . Yet none of these have been found to predict sexual these have been found to predict sexual recidivism. (Hanson et al., 2009, p. 25)recidivism. (Hanson et al., 2009, p. 25)

Attack on Attack on Risks/Needs/ResponsivityRisks/Needs/Responsivity

““Lack of Lack of unifying power unifying power and and external consistencyexternal consistency””

““Lack of Lack of fertilityfertility with respect to treatment with respect to treatment guidance”guidance”

““Lack of Lack of explanatory depthexplanatory depth””

““Incoherency;” “lack of Incoherency;” “lack of scope;scope;” “” “incompleteincomplete rehabilitation theoryrehabilitation theory (Ward et al., 2006)(Ward et al., 2006)

Focus of TreatmentFocus of TreatmentReduction of Recidivism?Reduction of Recidivism?

““We believe that treating sexual offenders also We believe that treating sexual offenders also involves taking into consideration human involves taking into consideration human welfare issues, as well as recidivism issues.”welfare issues, as well as recidivism issues.”

(Ward et al., 2006, p.269)(Ward et al., 2006, p.269)

““Individuals who are assessed as low risk may Individuals who are assessed as low risk may exhibit a number of significant problems that exhibit a number of significant problems that adversely impact on their functioning, for adversely impact on their functioning, for example, low mood or relationship conflict. example, low mood or relationship conflict. While such problems may not be criminogenic While such problems may not be criminogenic needs, individuals could still benefit from needs, individuals could still benefit from therapeutic attention.” therapeutic attention.”

(Ward et al., 2006, p. 269) (Ward et al., 2006, p. 269)

Risk needs model “has resulted in the Risk needs model “has resulted in the development of a suite of empirically derived and development of a suite of empirically derived and effective treatment for a range of crimes, effective treatment for a range of crimes, including sexual offending.”including sexual offending.”

(Ward & Hudson, 1997)(Ward & Hudson, 1997)

““The difficulty is that in the absence of a The difficulty is that in the absence of a theoretical analysis we do not know why.”theoretical analysis we do not know why.”

(Ward et al., 2006, p. 270)(Ward et al., 2006, p. 270)

““. . .the claim that a criminogenic need . . .the claim that a criminogenic need such as impulsivity is instrumentally such as impulsivity is instrumentally related to further offending suggests that related to further offending suggests that individuals choose to act in an impulsive individuals choose to act in an impulsive manner in order to achieve the further goal manner in order to achieve the further goal of offending.. .It is confusing to view what of offending.. .It is confusing to view what is essentially a loss of behavioural control is essentially a loss of behavioural control as an intentional action; individuals do not as an intentional action; individuals do not choose to behave impulsively.”choose to behave impulsively.”

(Ward et al., 2006, p. 274)(Ward et al., 2006, p. 274)

Reply from Bonta and AndrewsReply from Bonta and Andrews

““We welcome such a debate on the We welcome such a debate on the relevance of various models to explain relevance of various models to explain criminal behaviour . However, that debate criminal behaviour . However, that debate should be structured by respect for should be structured by respect for evidence.”evidence.”

““Theoreticism is the acceptance or rejection Theoreticism is the acceptance or rejection of knowledge in accordance with one’s of knowledge in accordance with one’s personal view personal view and not in accordance with and not in accordance with evidence.”evidence.”

(Bonta & Andrews, 2003, p. 215)(Bonta & Andrews, 2003, p. 215)

““Here we see theoreticism operating at its Here we see theoreticism operating at its best. Ignore the evidence that reductions best. Ignore the evidence that reductions in criminogenic needs are associated with in criminogenic needs are associated with reduced criminal behaviour, turn a blind reduced criminal behaviour, turn a blind eye to the fact that there is not a shred of eye to the fact that there is not a shred of evidence that psychodynamic evidence that psychodynamic interventions reduce recidivism and simply interventions reduce recidivism and simply assert that your approach makes the most assert that your approach makes the most sense.”sense.”

““Ward and Stewart appear to be arguing for Ward and Stewart appear to be arguing for a return to the good old days when a return to the good old days when treatment providers relied on nondirective, treatment providers relied on nondirective, relationship-oriented techniques to build relationship-oriented techniques to build feelings of well-being.”feelings of well-being.”

(Bonta & Andrews, 2003, p. 217)(Bonta & Andrews, 2003, p. 217)

Impact of Appropriate Vs. Impact of Appropriate Vs. Inappropriate TreatmentInappropriate Treatment

(Andrews, 1998)(Andrews, 1998)

-0.1

-0.05

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Combined Tx

Appropriate

Inappropriate

Sanctions

Type of TreatmentType of Treatment

0

0.05

0.1

0.15

0.2

0.25

0.3

Non Behavioral

CognitiveBehavioral

Andrew, 1994

Type of Treatment & Young OffendersType of Treatment & Young Offenders

0

0.05

0.1

0.15

0.2

0.25

Non Behavioral

CognitiveBehavioral

Dowden & Andrews, 1999

Targeting Criminogenic NeedsTargeting Criminogenic Needs

Criminogenic NeedsCriminogenic Needs

CriminogenicCriminogenic Non Non CriminogenicCriminogenic

Antisocial AttitudesAntisocial Attitudes Self-EsteemSelf-Esteem

Antisocial FriendsAntisocial Friends AnxietyAnxiety

Substance AbuseSubstance Abuse DepressionDepression

ImpulsivityImpulsivity

Targeting Criminogenic NeedsTargeting Criminogenic Needs

-0.05

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Targets 1 - 3Noncriminogenic Needs

Targets 4 - 6CriminogenicNeeds

Gendreau, French & Taylor, 2002

Self Esteem Vs. Criminogenic NeedsSelf Esteem Vs. Criminogenic Needs

-0.1-0.05

00.050.1

0.150.2

0.250.3

0.350.4

Self Esteem

CriminogenicNeeds

Appropriate Treatment TargetsAppropriate Treatment Targets

Sexual deviancySexual deviancy Sexual pre-occupationSexual pre-occupation Low self-controlLow self-control Grievance thinkingGrievance thinking Lack of meaningful adult relationshipsLack of meaningful adult relationships

(Hanson & Morton-Bourgon, 2004)(Hanson & Morton-Bourgon, 2004)

Proponents of Personal Distress Proponents of Personal Distress VariablesVariables

““Some combinations of these experiences lead Some combinations of these experiences lead the emerging sexual offender to acquire: a low the emerging sexual offender to acquire: a low sense of self-worth; a failure to internalize the sense of self-worth; a failure to internalize the confidence, attitudes, and skills necessary to confidence, attitudes, and skills necessary to meet his needs prosocially; and a self-meet his needs prosocially; and a self-interested disposition or a sense of interested disposition or a sense of entitlement.”entitlement.”

(Marshall, Marshall, Serran, & Fernandez, 2006, (Marshall, Marshall, Serran, & Fernandez, 2006, p. 15)p. 15)

Theory of Low Self-EsteemTheory of Low Self-Esteem

Low Self-esteem = Low Self-esteem =

Seeking sex from non-threatening partnersSeeking sex from non-threatening partners

Seeking coerced sexSeeking coerced sex

Research on Low Self-EsteemResearch on Low Self-Esteem

Study 1Study 1 Child molesters lowerChild molesters lower

Study 2Study 2 Child molestersChild molesters

normal rangenormal range

(Marshall et al., 2003)(Marshall et al., 2003)

Contrary ResearchContrary Research

People with low self-esteemPeople with low self-esteem

Do not typically undertake novel activitiesDo not typically undertake novel activities

That require persistenceThat require persistence

(Baumeister et al., 1989)(Baumeister et al., 1989)

Rapists & Nonsex OffendersRapists & Nonsex Offenders

No differences in self-esteemNo differences in self-esteem

(Fernandez & Marshall, 2003) (Fernandez & Marshall, 2003)

Research on Self-EsteemResearch on Self-Esteem

Rapists and nonsexual offendersRapists and nonsexual offenders

No differencesNo differences

(Fernandez & Marshall, 2003)(Fernandez & Marshall, 2003)

““With self-esteem we encourage and With self-esteem we encourage and facilitate the expression of behaviors such facilitate the expression of behaviors such as engaging in social and pleasurable as engaging in social and pleasurable activities, as well as verbal (or subvocal) activities, as well as verbal (or subvocal) behaviors such as complementing behaviors such as complementing themselves when they do things that themselves when they do things that deserve rewards and repeating positive deserve rewards and repeating positive self-statements throughout each day.” self-statements throughout each day.” (Marshall et al., 2006, pp. 28-29).(Marshall et al., 2006, pp. 28-29).

Outcome of Self-Esteem TreatmentOutcome of Self-Esteem Treatment

Increased self-esteem on inventoriesIncreased self-esteem on inventories

Reductions in lonelinessReductions in loneliness

Increases in intimacy skillsIncreases in intimacy skills

No increase in victim empathyNo increase in victim empathy

(Marshall et al., 1997)(Marshall et al., 1997)

Thornton , Beech & MarshallThornton , Beech & Marshall20042004

Pre-treatment self esteem correlated with recidivismPre-treatment self esteem correlated with recidivism

All offenders in community sample in treatmentAll offenders in community sample in treatment

85% graduation rate85% graduation rate

Self-esteem improved during treatmentSelf-esteem improved during treatment

Why Treat Self Esteem?Why Treat Self Esteem?

Self-esteem after treatmentSelf-esteem after treatment ??

Self-esteem before treatment RecidivismSelf-esteem before treatment Recidivism

Conclusions: Treating self-esteem did not Conclusions: Treating self-esteem did not change correlation between pre-treatment self-change correlation between pre-treatment self-esteem and recidivismesteem and recidivism

(Info not available on incarcerated sample.)(Info not available on incarcerated sample.)

Does Treatment of Self-Esteem Does Treatment of Self-Esteem Reduce Deviant ArousalReduce Deviant Arousal

Offenders with low self-esteem & deviant Offenders with low self-esteem & deviant arousalarousal

This “required the processing of a This “required the processing of a substantial number of offenders before a substantial number of offenders before a sufficient number of participants was sufficient number of participants was detected who met criteria.”detected who met criteria.”

(Marshal, 1997, p. 88)(Marshal, 1997, p. 88)

““Our theory, then, suggests that the sexual Our theory, then, suggests that the sexual aspects of child molestation may not be aspects of child molestation may not be central to the motivational forces that drive central to the motivational forces that drive these offenders.” (Marshall, p. 87)these offenders.” (Marshall, p. 87)

SubjectsSubjects

Female victims onlyFemale victims only

Pre-pubescentPre-pubescent

Out of homeOut of home

Only 2 had more than 3 victimsOnly 2 had more than 3 victims

Self-esteem Reduce Deviant Self-esteem Reduce Deviant Arousal?Arousal?

Attending treatment programAttending treatment program

WithWith

Cognitive distortions, relapse prevention, Cognitive distortions, relapse prevention, self-esteem & other interventionsself-esteem & other interventions

Minus deviant arousalMinus deviant arousal

(Marshall, 1997)(Marshall, 1997)

What Causes Recidivism?What Causes Recidivism?Low Self-esteem or HighLow Self-esteem or High

““Today, it is common to propose that low self-Today, it is common to propose that low self-esteem causes violence, but the evidence esteem causes violence, but the evidence shows plainly that this idea is false. Violent shows plainly that this idea is false. Violent acts follow from high self-esteem, not from low acts follow from high self-esteem, not from low self-esteem. This is true across a broad self-esteem. This is true across a broad spectrum of violence, from playground bullying spectrum of violence, from playground bullying to national tyranny, from domestic abuse to to national tyranny, from domestic abuse to genocide, from warfare to murder and rape. genocide, from warfare to murder and rape. Perpetrators of violence are typically people Perpetrators of violence are typically people who think very highly of themselves.who think very highly of themselves.

(Baumeister, 1997, pp. 25-26(Baumeister, 1997, pp. 25-26

Self-Esteem & ViolenceSelf-Esteem & ViolenceBaumeister ArgumentBaumeister Argument

Contradictory ClaimsContradictory Claims

TochToch

““Self-doubts” and “a sense of inadequacy”Self-doubts” and “a sense of inadequacy”

““Exaggerated self-esteem”Exaggerated self-esteem”


Higher in men than women but women < Higher in men than women but women < violenceviolence

Depressions is correlated with self-esteemDepressions is correlated with self-esteem

Depressed individuals do not commit more Depressed individuals do not commit more violenceviolence

Psychopathy correlated with violencePsychopathy correlated with violence

Grossly inflated self-esteemGrossly inflated self-esteem


High self-esteem not correlated with violenceHigh self-esteem not correlated with violence

Grossly inflated and unstable self-esteemGrossly inflated and unstable self-esteem

Stability of Self-esteemStability of Self-esteem

High but unstable self-esteem = highest level High but unstable self-esteem = highest level of self-reported angry/hostile responsesof self-reported angry/hostile responses

High but stable self-esteem = lowest ratesHigh but stable self-esteem = lowest rates

(Kernis et al., 1989)(Kernis et al., 1989)

Grandiosity & AggressivenessGrandiosity & Aggressiveness

Grandiosity correlated with aggressivenessGrandiosity correlated with aggressiveness

(Wink, 1991)(Wink, 1991)

Dominance and hostility correlated with Dominance and hostility correlated with grandiosity and narcissismgrandiosity and narcissism

(Novacek & Hogan, 1991)(Novacek & Hogan, 1991)

High self-esteem based on grandiosity High self-esteem based on grandiosity (not achievement)(not achievement)

Disconfirming evidenceDisconfirming evidence

= Negative reaction= Negative reaction

(Baumeister,1997) (Baumeister,1997)

High but unstable self-esteem – most likely to High but unstable self-esteem – most likely to respond defensively to negative feedback.respond defensively to negative feedback.

(Kernis, Cornell, Sun, Berry and Harlow, 1993)(Kernis, Cornell, Sun, Berry and Harlow, 1993)

Why Do We?Why Do We?

Despite empirical evidence – still treatDespite empirical evidence – still treat

Self-esteemSelf-esteem

Social skillsSocial skills

Offense responsibilityOffense responsibility

Tough or Tender MindedTough or Tender MindedWilliam JamesWilliam James

Tender mindedTender minded

PrincipledPrincipled IdealisticIdealistic OptimisticOptimistic DogmaticalDogmatical

Tough MindedTough Minded

EmpiricalEmpirical PessimisticPessimistic SkepticalSkeptical

Lost Souls or PredatorsLost Souls or Predators

What to Treat?What to Treat?

Self-esteem?Self-esteem?Instability of self-esteem?Instability of self-esteem?Mood deterioration?Mood deterioration?Sexualizing mood deterioration?Sexualizing mood deterioration?

What to TreatWhat to Treat


Behavioral reconditioningBehavioral reconditioning

Minimal arousal conditioningMinimal arousal conditioning

Covert sensitizationCovert sensitization

Olfactory satiationOlfactory satiation

MedicationMedication

What to TreatWhat to Treat

Antisocial Attitudes & BeliefsAntisocial Attitudes & Beliefs

Treatment of Antisocial Attitudes Treatment of Antisocial Attitudes & Beliefs& Beliefs

Cognitive Self-ChangeCognitive Self-Change

vs.vs.

Cognitive DistortionsCognitive Distortions

DenialDenial

To treat or not to treatTo treat or not to treat

DenialDenial

Correlated with recidivismCorrelated with recidivism

Incest offendersIncest offenders

Not extrafamilialNot extrafamilial

(Nunes et al., 2007)(Nunes et al., 2007)

STEP Dynamic Assessment STEP Dynamic Assessment

Report on British outpatient community Report on British outpatient community sex offender treatment programs 1994sex offender treatment programs 1994

Report on British incarcerated community Report on British incarcerated community sex offender treatment programs 1999 sex offender treatment programs 1999

STEP BatterySTEP Battery Self EsteemSelf Esteem UCLA Emotional Loneliness ScaleUCLA Emotional Loneliness Scale Social Response InventorySocial Response Inventory Personal Distress (Interpersonal Reactivity)Personal Distress (Interpersonal Reactivity) Locus of ControlLocus of Control Admittance/Denial (MSI)Admittance/Denial (MSI) Beckett Victim Empathy ScaleBeckett Victim Empathy Scale Social Desirability ScaleSocial Desirability Scale

(Beech, 1998)(Beech, 1998)

STEP DomainsSTEP Domains

Admittance/DenialAdmittance/Denial

Pro-offending attitudesPro-offending attitudes

Social competence/accountabilitySocial competence/accountability

(Beech, 1999)(Beech, 1999)

High Deviance OffendersHigh Deviance Offenders

Previous conviction for sexual assaultPrevious conviction for sexual assault Large number of victimsLarge number of victims Committed offenses outside home (or both Committed offenses outside home (or both

inside & outside)inside & outside) Boys or both sexesBoys or both sexes

(Beckett, 1994)(Beckett, 1994)

Low Deviance OffendersLow Deviance Offenders

Girls within the familyGirls within the family

Not likely to have had a previous Not likely to have had a previous convictionconviction


High Deviancy OffendersHigh Deviancy Offenders

1/3 incest offenders1/3 incest offenders


STEP Dynamic AssessmentSTEP Dynamic Assessment

N = 140 N = 140

Child MolestersChild Molesters

(Beech, 1999)(Beech, 1999)

High Deviance OffendersHigh Deviance Offenders

More victims than low deviancyMore victims than low deviancy Offenses outside or inside & outside Offenses outside or inside & outside

familyfamily Offenses against boys or both sexesOffenses against boys or both sexes Higher risk to reoffendHigher risk to reoffend

(Beech, 1998)(Beech, 1998)

Impact of TreatmentImpact of Treatment

GroupGroup Over-allOver-all

Tx EffectTx Effect Low Deviancy/Low Deviancy/

Low DenialLow Denial 59% 59%

Low Deviancy/Low Deviancy/

High DenialHigh Denial 17% 17%

(Beech, 1999)(Beech, 1999)

Over-all Treatment EffectOver-all Treatment Effect

Changed to non-offending normsChanged to non-offending norms

Changes on both pro-offending attitudes Changes on both pro-offending attitudes and social competence measuresand social competence measures

(Beech, 1999)(Beech, 1999)

Impact of TreatmentImpact of Treatment

GroupGroup Pro-offending Pro-offending Over-all Over-all

AttitudesAttitudes Tx Effect Tx Effect

High DeviancyHigh Deviancy 43%43% 14%14%

(Beech, 1999)(Beech, 1999)

Reasons for IncarcerationReasons for Incarceration

PunishmentPunishmentJustice for VictimJustice for VictimIncapacitationIncapacitationImpact on Potential OffendersImpact on Potential OffendersReduction of RecidivismReduction of Recidivism

Impact of More Severe Sanctions on Impact of More Severe Sanctions on RecidivismRecidivism

Incarceration vs. ProbationIncarceration vs. Probation

Intermediate Sanctions vs. Intermediate Sanctions vs. Standard SupervisionStandard Supervision

(Smith, (Smith, 2002)2002)

Characteristics of StudiesCharacteristics of Studies


N = 442,471N = 442,471

(Smith, 2002)(Smith, 2002)

Impact of Incarceration on Impact of Incarceration on RecidivismRecidivism

N = 268,806N = 268,806

68% American Studies68% American Studies

No Change in RecidivismNo Change in Recidivism

or Slight Increase in Recidivismor Slight Increase in Recidivism

(Smith, 2002)(Smith, 2002)

High Quality vs. Low Quality StudiesHigh Quality vs. Low Quality Studies

High QualityHigh Quality

Random AssignmentRandom Assignment Comparison Group DesignsComparison Group Designs

AgeAgeCriminal HistoryCriminal HistoryAntisocial ValuesAntisocial Values

(Smith, 2002)(Smith, 2002)

Random Assignment StudiesRandom Assignment Studies

2 Studies2 Studies

Incarceration Vs CommunityIncarceration Vs Community

Slight increases in recidivism Slight increases in recidivism

(Smith, 2002)(Smith, 2002)

Intermediate SanctionsIntermediate Sanctions

Electronic MonitoringElectronic MonitoringFinesFinesRestitutionRestitutionIntensive SurveillanceIntensive SurveillanceScared StraightScared StraightDrug TestingDrug TestingBoot campBoot camp

(Smith, (Smith, 2002)2002)

Intermediate Sanctions vs. Standard Intermediate Sanctions vs. Standard SupervisionSupervision

N = 66,500 N = 66,500

American Studies 80%American Studies 80%

Slight Decrease in Recidivism Slight Decrease in Recidivism

Or No DifferenceOr No Difference

Boot Camps Vs. RestitutionBoot Camps Vs. Restitution

Scared StraightScared Straight No ImpactNo Impact

Boot campsBoot camps No ImpactNo Impact

RestitutionRestitution 5% Decrease 5% Decrease

(Latimer et al., 2001; MacKenzie et al., 2001)(Latimer et al., 2001; MacKenzie et al., 2001)

Same FindingsSame Findings

Juveniles vs. AdultsJuveniles vs. Adults

Men or Women (maybe)Men or Women (maybe)

White or Minority Race (few studies)White or Minority Race (few studies)

Low and High Risk OffendersLow and High Risk Offenders

(Smith, 2002)(Smith, 2002)

WomenWomen

More Severe Punishment More Severe Punishment

May Increase Recidivism in Women More May Increase Recidivism in Women More than Menthan Men

(Smith, 2002)(Smith, 2002)

ExceptionException

Intensive Supervision plus treatmentIntensive Supervision plus treatment

Slight decrease in recidivism (10%)Slight decrease in recidivism (10%)

(Smith, 2002)(Smith, 2002)

Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions(Andrews, 1998)(Andrews, 1998)

-0.1

-0.05

0

0.05

0.1

0.15

0.2

Treatment

Sanctions

Documents

Treatment Components Anna C. Salter, Ph.D.. Agenda What Works in Sex Offender Treatment Cost-Benefit Analysis Treatment Components RP versus Good Lives