Treatment of sex offenders1 SEX OFFENDER TREATMENT PROGRAMS Anthony Beech University of Birmingham Email: [email protected]

Treatment of sex offenders 1

SEX OFFENDER TREATMENT PROGRAMS

Anthony Beech

University of Birmingham

Email: [email protected]

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 0.43 - 0.69, p < 0.0001) indicating that the likelihood of individuals being reconvicted after treatment was around half that of those who had not undertaken treatment 2


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


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


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’


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


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


Why target Need? Dowden (1998) found that targetting

‘more promising targets’ reduced recidivism more than ‘less promising targets’


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


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


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)


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


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

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


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


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)


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

Meta-analytic evidence base for CBT

18

Kenworthy et al. (2004) (N = 500+)CBT and behavioural treatment ↓ sexual recidivism psychodynamic n.s

Alexander (1999) recidivism rates (N = ????)Untreated 25.8% (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 psychodynamic n.s

19


Dynamic risk level_

Static Risk level

Low Medium High

Low Rolling Programme

(c. 100 hours)

Rolling Programme

(c. 100 hours)

Rolling or Core

(100 – 180 hours)

Medium Rolling or Core

(100 – 180 hours)

Core Programme

(c. 180 hours)

Core

(c. 180 hours)

High Core + Extended

(c. 320 hours)

Core + Extended

(c. 320 hours)

Core + Extended

(c. 320 hours)

Very High Core + Extended

(c. 320 hours)

Core + Extended

(c. 320 hours)

Core + Extended

(c. 320 hours)

Treatment in practice


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


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


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


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


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)


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


PROGRAM C30

40

50

60

70

80

PROGRAM C

PROGRAM D

PREVIOUS FINDINGS WPPprecss ITH THE GES


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


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)


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, 2004. p25)


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


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


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)


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

Strengths-based approaches 43

Critique of the WW approach in sex offender work Probably the primary critic of just using the criminogenic

needs approach is Tony Ward (e.g., Ward, Mann & Gannon, 2007)

Who notes that current approaches regarding the identification risk factors and treatment to reduce the level of these risk factors is akin to a pin cushion approach

Where ‘each risk factor constitutes a pin and treatment focuses on the removal of each risk factor’

What has been rarely considered in this work is the relative strengths that individuals have to prevent themselves re-offending.


‘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


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’

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.


‘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


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


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



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), 169-197.

Lösel, F. & Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology, 1, 117-146.

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, 77-94.

Documents

Treatment of sex offenders1 SEX OFFENDER TREATMENT PROGRAMS Anthony Beech University of Birmingham Email: [email protected]