Transcript Let`s Do More Than Talk About Sex: Promoting

"Let's Do More Than Talk About
Sex: Promoting Good Lives In
Practice"
• Dr F Douds, Consultant LD
Psychiatrist, The State Hospital
• Dr M Doyle, Forensic
Psychologist, NHS Fife
Process for use when considering facilitating a sexual relationship between
community clients with forensic needs and other adults
Matter raised at forensic team meeting
Multi-agency discussion re community
forensic client. Key question:
•Level of risk posed by client to partner?
(given forensic history and/or previous
relationship history)
Multi-agency re partner. Key questions:
•Is partner unable to give informed consent to
sexual relationship?
•Is partner a vulnerable adult?
Yes to one or both questions
No to both questions
Convene vulnerable adults case
conference to consider appropriate
course of action
Convene multi-agency case conference to develop
action plan and necessary protocols
(action plan likely to include socio-sexual education
for one/both parties – some of which may be done jointly)
Take protocol to multi-agency risk management group
Relationship appropriate?
Attempt to facilitate relationship
No
Yes
Document reasons
Convene multi-agency case conference
(see above)
NB: Disclosure of previous sexual offending. At which point of pathway, if any, will this take place
What makes your life a ‘Good Life’?
• Choose three things
in you life that are
important to you.
(count partners as
one thing & children
as a different one )
• Nothing too sensitive!
• Write each one on a
separate post-it.
• What do they
contribute to your life?
Why are they
important?
• Which would you give
up first? Second?
Third?
$$ SURVEY OF US
LOTTERY WINNERS $$
• WHAT DO YOU VALUE
MOST?
• NUMBER ONE ANSWER?
• CAN MONEY BUY IT?
‘All meaningful human
action reflects
attempts to achieve
primary human
goods’
Ward & Mann (2005)
Good
Lives
Autonomy
Relationships &
Community
Inner Peace
Achievement
Purpose
The Good Lives Model
(GLM)

Key Argument
 Human behaviour is directed
towards goal of achieving
fundamental needs or
‘primary human goods’.
 Difficulties in achieving
primary goods in socially
appropriate ways will
possibly lead to anti-social or
offending behaviour.
 Strengthening the ability of
offenders to achieve primary
human goods in socially
appropriate ways will reduce
their offending behaviour
Achieving Primary Goods through Secondary Goods
Family
Intimate Partners
Secure
Social
skills
Consist
-ency
Relatednes
s
Money,
work
Friends
Staff
The Good Lives Model (GLM)
• Central role of construct of personal
identity and self-narrative.
‘…not enough to simply equip
individuals with skills
to control or manage risk factors, it
is imperative
they are also given the opportunity
to fashion a
more adaptive personal identity..’
Gannon (2006)
Ward &
Not ‘New me’ but perhaps ‘Better
me’.
The Good Lives Model (GLM)
• ‘Twin focus’
‘managing the delicate balance between
the ….
promoting offender goods and ..reducing
risk. Erring on
the side of either goal can have
disastrous social and
personal consequences…’
Ward, Mann &
Gannon, (2007)
• Human action is context-dependent.
Ability of an individual to implement
coping strategies is dependent on the
social and physical environments they
inhabit.
The Good Lives Model (GLM)
• Treatment plan needs to address all of
human goods needed for psychological
well-being and should be explicitly
constructed in form of a ‘good lives
formulation’. Goal of treatment is to
recognise individual agency and build
capacity and opportunity to meet
primary goods in socially appropriate
ways.
• Requires a strong ‘therapeutic alliance’
non-confrontational, motivational and
collaborative approach.
• Implies creating ‘bespoke’ personcentred holistic interventions to
address individual need.
SAPROF
(Structured Assessment of Protective Factors)
Internal factors
1. Intelligence ❑
2. Secure attachment in childhood
3. Empathy ❑ ❑
4. Coping ❑ ❑
5. Self-control ❑ ❑
Motivational factors
6. Work ❑ ❑
7. Leisure activities ❑ ❑
8. Financial management ❑ ❑
9. Motivation for treatment ❑ ❑
10. Attitudes towards authority
11. Life goals ❑ ❑
12. Medication ❑ n/a ❑ ❑
External factors
13. Social network ❑ ❑
14. Intimate relationship ❑ ❑
15. Professional care ❑ ❑
16. Living circumstances ❑ ❑
17. External control ❑ ❑
Good Lives Assessment & Formulation
‘Jim’
•
29 years old; ‘mild’ learning
disability
•
History of serious offences from
ages 9 years to 16 years
against female children.
•
Convicted age 17. (1998)
•
Lynebank Hospital (via HMP
Edinburgh)
1998 – 2003
•
Community-based CTO
2003 - 2008
24/7 ‘Core & Cluster’ Support
Package
•
2008 – 2009 Community
Outreach Support
Good Lives Assessment & Formulation
‘Jim’
•
‘Hopeless’ – ‘never get out’
•
Clear set of future goals
obscured by ‘anger balloon’
Marriage
Work
Family
Hom
e
Motorbik
e
Jim’s Good Lives Assessment &
Formulation
Proble
mSolvin
g
Sexual
Knowle
dge
Knowle
`
dge
Empat
hy
Insigh
t
Jim’s Good Lives Assessment &
Formulation
Motorbi
ke
Relationship
s with
female
peers
Autonom
`
y
Stepped
reduction
in
support
Tenanc
y
Jim’s Intervention History
Sex
Offences
Group
1999 - 2002
1:1
Emotiona
l
Regulatio
n
2003 - 2005
Social
ProblemSol
ving
2006 -2007
Engaged
to
Girlfriend
Motorbik
e
Work
Placemen
ts
The Good Lives Model (GLM)
‘Jim’ and SRAG/MAPPA
•
Jim and Anne.
•
Jim and Claire
•
Motorbike
•
Stepped reduction in support
Process for use when considering facilitating a sexual relationship between
community clients with forensic needs and other adults
Matter raised at forensic team meeting
Multi-agency discussion re community
forensic client. Key question:
•Level of risk posed by client to partner?
(given forensic history and/or previous
relationship history)
Multi-agency re partner. Key questions:
•Is partner unable to give informed consent to
sexual relationship?
•Is partner a vulnerable adult?
Yes to one or both questions
No to both questions
Convene vulnerable adults case
conference to consider appropriate
course of action
Convene multi-agency case conference to develop
action plan and necessary protocols
(action plan likely to include socio-sexual education
for one/both parties – some of which may be done jointly)
Take protocol to multi-agency risk management group
Relationship appropriate?
Attempt to facilitate relationship
No
Yes
Document reasons
Convene multi-agency case conference
(see above)
NB: Disclosure of previous sexual offending. At which point of pathway, if any, will this take place