Transcript Reentry of sex offenders

Sex Offender Treatment: What is it
and What do We Treat?
How to Effectively Treat & Manage Sex Offenders in the
Community Series
(Part 1 of 3)
Timothy J. Wisniewski, Ph.D.
NYS ATSA Conference
May 24, 2011
Agenda

Define Sex Offender treatment

Address what works & what doesn’t work

What are programs in the United States, Canada
and New York State currently doing?

Case Conceptualization, Individualizing Treatment,
Supervision plans and Phenomenological
Criminology

Discuss the Fears, Challenges and Burdens that our
clients experience in the community

For the purposes of this talk, Sex Offender
Treatment is one or more interventions
designed to Reduce the Likelihood of Sexual
Recidivism
 It is not just therapy with SO clients

MYTH #1: Most sex offenders will re-offend
 FACT: Low recidivism rates (5% to 19%)
 96% of individuals arrested have no prior sexual
offense convictions
(CSOM, 2000; Hanson & Bussiere, 1998; Greenfield, 1997; Snyder, 2000)
Mo
les
tat
ion
Ra
pe
Ch
ild
An
y
Se
xO
ffe
ns
e
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
First Time Offender
Repeat Sex Offender
(Sandler, Freeman, & Socia, 2008)
9.00%
8.2%
8.00%
7.00%
6.00%
5.1%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
Re-Arrest
Reconviction

MYTH #2: Sex offenders re-offend at much
higher rates than other criminals
 FACT: Sex offenders are less likely to re-offend
than other types of offenders
73.80%
66.70%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
9.30%
20.00%
10.00%
0.00%
Sex Offenders
Property
Offenders
Drug Offenders
(Hughes & Wilson, 2003)
Bio-Medical
Cognitive
Behavioral
 Family Systems
 Good Lives
 Harm Reduction
 Multisystemic
 Psychodynamic


Risk-NeedResponsivity
 Relapse
Prevention
 Self-Regulation
 Sexual Addiction
 Sexual Trauma
 Psycho-SocioEducational


Cognitive-behavioral “maintenance strategy”
that helps an offender identify
Internal/external factors associated reoffending
 Conceptualizes behavioral patterns as a “cycle”
 Goal = learn to identify the “cycle” and intervene

Originally designed for substance abusers in
order to help them maintain treatment gains
and avoid relapsing

RP for sex offenses became a primary treatment
modality, rather than an adjunct to successful
treatment/change

RP IS NOT A PRIMARY TREATMENT APPROACH
 Not designed to stop problem behavior
 Not designed to persuade individual that he should
abstain from the problem behavior
 Not developed for individuals whose “commitment” to
abstain is externally imposed
 It became a “One Size Fits All” approach

Sex Offender Treatment and Evaluation Project
(SOTEP) study (Marques, et al. 2005)

Random assignment to two groups with
longitudinal follow-up looking at Re-offenses
with a mean follow up of 8 years

3 Groups
▪ Relapse Prevention
▪ Control Group
▪ Refusers

Impact on Recidivism?

No Overall reduction due to RP Treatment
▪ Relapse Prevention 22%
▪ Control Group
20%
▪ Refusers
19%

Risk Principle – Higher level of services for
higher risk cases

Need Principle – Target for change those
characteristics directly related to reoffending

Responsivity Principle – Treatment is
responsive to a person’s learning style

Hanson, Bourgon, Helmus, & Hodgson, (2009)

Result: Sex Offender treatment that adheres to RN-R leads to largest reductions in recidivism

Treated (n=3,121)

Untreated (n=3,625)
Sexual Recidivism
10.9%
19.2%
RNR “is the cornerstone of national adult sex
offender treatment programs in several
countries, including Canada, England,
Scotland, and Hong Kong, and more research
supports it than other models listed…”
…So what are programs in the United States,
Canada, and in New York State among the
Strict and Intensive Supervision and
Treatment (SIST) providers doing?
Cognitive Behavioral………………..
92.0 %
Relapse Prevention………………….
66.7 %
Psycho-Socio-Educational…………
30.2 %
Good Lives…………………………….
28.7 %
Self-Regulation……………………….
22.2 %
Risk-Need-Responsivity…………….
18.5 %
Sexual Addiction……………………..
9.3 %
Multisystemic…………………………
8.6 %
Family Systems……………………….
8.3 %
Psychodynamic……………………….
5.2 %
Sexual Trauma………………………..
3.7 %
Harm Reduction………………………
2.5 %
Bio-Medical…………………............
2.2 %
Relapse Prevention………………….
73.7 %
Cognitive Behavioral………………..
63.2 %
Good Lives……………………………..
52.6 %
Risk-Need-Responsivity…………….
26.3 %
Psycho-Socio-Educational…………
21.1 %
Self-Regulation……………………….
21.1 %
Bio-Medical…………………............
15.8 %
Multisystemic…………………………
15.8 %
Psychodynamic……………………….
5.3 %
Harm Reduction………………………
5.3 %
Sexual Addiction……………………..
0.0 %
Family Systems……………………….
0.0 %
Sexual Trauma………………………..
0.0 %
Cognitive Behavioral………………..
63.6 %
Relapse Prevention………………….
40.9 %
Risk-Need-Responsivity…………….
36.4 %
Psycho-Socio-Educational…………
27.3 %
Good Lives……………………………..
23.7 %
Multisystemic…………………………
18.2 %
Family Systems……………………….
13.6 %
Self-Regulation……………………….
13.6%
Psychodynamic……………………….
4.5 %
Social Learning.………………………
4.5 %
Trauma Aftermath…………………..
4.5 %

Stable features that can change with effortful
intervention

Individual characteristics proven to be related to
sexual recidivism

These characteristics interact with a person’s
environment
▪ May not always see them until outside stressor occurs

SEXUAL SELF-REGULATION
 Sexual Preoccupation
 Deviant Sexual Interests
 Using Sex to Cope (promising)
 Sexualized Violence
 Offense Supportive Attitudes (Cognitive
Distortions)
 Emotional Congruence with Children
(Mann et al. 2010)

GENERAL SELF-REGULATION
 Grievance Thinking - Hostility
 Negative Social Influences
 Poor Problem Solving Skills
 Employment Instability
 Impulsivity & Recklessness
 Non-Compliance with Supervision
 Violation of Conditional Release
 Externalizing (promising)

INTIMACY DEFICITS
 Hostility toward Women (promising)
 Lack of Concern for Others (promising)
 Conflicts in Intimate Relationships
 Machiavellianism (promising)
 General Social Rejection







Major mental illness
Low Self-Esteem
Depression
Poor social skills
Victim Empathy
Lack of motivation
Denial
 Does not want to accept responsibility
 May be a risk factor for intrafamilial offenders
 “Redemption Script” – Distancing themselves from prior
misdeeds

Determining a list of empirically based
dynamic risk factors tells us little about how
to treat them in a particular individual

Clients can have identical sets of risk factors,
yet those factors are being generated by
different psychological mechanisms

Risk factors need to be understood within a
Case Conceptualization of the client

Risk factors are best understood within the
context of an individual’s past and present
biopsychosocial functioning.

The context helps to generate a Working
Model on how and why (etiology) this
individual behaves as he does.

A Working Model is a constantly evolving
theory of a particular individual.

Makes predictions as to how the individual will
behave in various situations

Constantly evolving over time due to:
 Unsupported Predictions
 New information obtained in treatment
 Client responding to treatment of risk factors

Informs how to concentrate your therapeutic effort
in the areas of risk (i.e., treatment plans)

Hostility toward women

Use of Sex as Coping

Negative Emotionality

Lack of Social Supports

Lack of Concern for others
Mr. X came from an upbringing in which harsh and random
punishments came from his alcoholic mother. His
resentment over this treatment came to be generalized
toward all women as a way to protect himself from
further emotional pain that he cannot predict.
Paradoxically, he craves attention and nurturance from
women, yet he will not make himself emotionally
vulnerable in relationships. Given his lack of emotional
coping skills, he often feels aggrieved and perceives
himself as a victim. Few positive people have gravitated
toward his negative outlook. He will often turn to sex
with others as a means to escape his negative emotions.
If he hurts others it is from a sense that he has been hurt
and no one cared or protected him.
Mr. Z feels he is superior toward women and that
they lack the capacity to refuse him and his
immediate desires. He is always looking out for #1
and uses his anger to intimidate and extract what
he wants from others. As a result few people
gravitate toward his exploitive personality. When
he does not feel in control of situations (such as
with an employer) he tends to then seek out
sexual activities to reestablish his sense of
superiority and dominance. Other people are not
seen as individuals with their own set of interests
or feelings but rather as objects with which to
pleasure him.

An Individual Working Model helps leads to a
Comprehensive Risk Assessment, a Treatment Plan,
and a Supervision strategy

Comprehensive Risk Assessment
 What is the person’s overall risk to re-offend
 What are the internal and external conditions under which
a re-offense is most likely to occur
 Who are the likely victims of a re-offense
 What is the likely degree of harm to the victim if a reoffense occurs
 How would the person most likely obtain a victim (e.g.,
grooming versus snatch and grab)
Mr. X has a Moderate-High likelihood of re-offending. He is
most likely to re-offend during periods of relationship
difficulties wherein he has experienced high levels of
frustration and anger over a prolonged period of time. He is
most likely to choose an adult woman as a victim that is not a
stranger to him. The two of them probably have spoken
several times or perhaps even regularly. He will most likely
engage the victim in dating like behavior and maneuver to an
isolated place. Physical intimacies will probably start off
consensually but end with him ignoring her communications
that he is moving too fast and other signs of non-consent.
Physical battering of the victim is unlikely and only enough
force will be used to gain compliance.
Mr. Z is at a Very High risk to re-offend. He will most likely
offend during periods of boredom, especially when he is
confidant he has sufficiently groomed his parole officer to
reduce his level of monitoring. His victim will typically be an
adult stranger that he has assessed as vulnerable. He might
use persuasion in the earlier stages of the offense, however,
victim rejection will quickly lead to physical escalation and
probably will result in an overall more violent attack. During
the attack, he will attend to victim non-consent reactions in
order to fuel and maintain his arousal. This will likely lead to
him using more violence than is necessary to simply control
the victim during the sexual assault.

Treatment Plan?
 Mr. X (Mr. Pathetic)
 Mr. Z (Mr. Predator)

Supervision Plan?
 Mr. X (Mr. Pathetic)
 Mr. Z (Mr. Predator)

Fundamental tenet is that different individuals
exposed to the same environment experience it,
interpret it, and react to it differently

Phenomenological criminology is an attempt to
understand criminal decision making by examining
the offender’s “self-project,” the self image they are
hoping to uphold, the ends they aim to achieve and
their strategies for creating meaning in their lives
(i.e., their personal narrative)
“Essentially, people construct stories to
account for what they do and why they did it.
These narratives impose an order on people’s
behavior with a sequence of events that
connect up to explanatory goals,
motivations, and feelings”

Maruna (2001) compared the narratives of
individuals who desist from crime to those
who persist
The redemption script begins by establishing the goodness and
conventionality of the narrator – a victim of society who gets
involved with crime and drugs to achieve some sort of power
over otherwise bleak circumstances. This deviance
eventually becomes its own trap, however, as the narrator
becomes ensnared in the vicious cycle of crime and
imprisonment. Yet, with the help of some outside force,
someone who “believed in” the ex-offender, the narrator is
able to accomplish what he or she was “always meant to do.”
Newly empowered, he now also seeks to “give something
back” to society as a display of gratitude.

Differ in 3 fundamental ways:
 1) An establishment of the core beliefs that
characterize the person’s “true self”
 2) An optimistic perception (some might say
useful “illusion”) of personal control over one’s
destiny
 3) The desire to be productive and give something
back to society, particularly the next generation

Even when the offenders were “at their worst,” the
desisting narrators emphasized that “deep down”
they were good people

Offenders look to their past to find some redeeming
value or “essential core of normalcy”

Instead of discovering a “new me,” the desisting
offender reaches back into early experiences to find
and reestablish an “old me” in order to desist (i.e.,
reverting to an unspoiled identity)

Stable 2007 & Acute 2007
 Nice Feature: Combines with the Static-99

Vermont Treatment Needs and Progress Scale
(TPS)

Structured Risk Assessment (SRA)

Violence Risk Scale: Sexual Offender Version
 Nice Feature: Incorporates Stage of Change into Each Item

Stable 2007 assesses change in
“intermediate-term risk status,” treatment
needs and helps predict recidivism
 Measure Every 6 to 12 Months

Acute 2007 assesses change in short-term
risk status and help predict recidivism
 Measure Every Time You See the Client

Significant Social
Influences

Cooperation with
Supervision
INTIMACY DEFICITS
 Capacity for Relationship
Stability
 Emotional ID with Children
 Hostility toward Women
 General Social Rejection
 Lack of Concern for Others
GENERAL SELF-REGULATION
 Impulsivity
 Poor Problem Solving
 Negative Emotionality
SEXUAL SELF-REGULATION
 Sexual Preoccupation
 Use of Sex as Coping
 Deviant Sexual Preference
Categories
 Low
 Moderate
 High
SEX/VIOLENCE
 Victim Access
 Hostility
 Sexual Preoccupation
 Rejection of Supervision
SCORING
 0 = None
 1 = Maybe/Some
 3 = Yes
 Intervene Now
GENERAL RECIDIVISM
 Emotional Collapse
 Collapse of Social Supports
 Substance Abuse
Categories of Risk
 Low
 Moderate
 High


Yields a new Risk Level
Category
 Sexual Crimes
 Low, Moderate or High
(Violations)
 Violent or Sexual Crimes
 Any Crime
 Any (Including
Breaches/Violations)
New Risk Level
Category can be used
to determine the
relative risk in the next
45 days of the
following:
 Any Sexual Breaches
Structured Risk Assessment (SRA)…………..
9.1 %
Stable 2007 and Acute 2007……………………
34.5 %
Treatment Needs & Progress Scale (TPS)…
18.5%
Use One or More of the Above……………….. 48.5 %
Structured Risk Assessment (SRA)………….. 15.8 %
Stable 2007 and Acute 2007……………………
57.9 %
Treatment Needs & Progress Scale (TPS)…
10.5%
Use One or More of the Above……………….. 63.3 %
Structured Risk Assessment (SRA)…………..
4.5 %
Stable 2007 and Acute 2007……………………
23.7 %
Treatment Needs & Progress Scale (TPS)…
63.6%
Use One or More of the Above……………….. 63.6 %

Extremely Afraid that EVERYONE knows they
are a sex offender
 Often take elaborate routes to avoid places where
people might know them and their crimes
▪ CAREFUL not to automatically conclude that they are
cruising for a new victim
 Rejection of former friends
 Fearful of even engaging in prosocial activities

Afraid of Physical Attacks
 Extends to their family members
▪ Daddy’s picture is often hung somewhere in their
children’s schools

Fear that they might accidentally violate and get
immediately returned to prison
 A hyper-vigilance that becomes paralyzing and destroys
their quality of life

Fear that they will always be romantically alone
because no one will stay around after the “I have to
tell you that I committed a sex offense” speech

Offenders often say that community living is much
harder than prison or inpatient treatment centers

Exposure of their crimes to important people in their
lives who don’t know

They fear that life will NEVER get better because
their life seems so impossible and difficult at the
beginning.

It is normal for an offender to have recurrent deviant
sexual thoughts
 We need them to report these thoughts to us so we can
treat them
 Not a reason by itself to violate
▪ Unless they report them as uncontrollable
▪ Unless they are engaging in high risk BEHAVIOR

We cannot “cure” many forms of sexual deviance, just
lessen its intensity and frequency
 Through Behavioral Interventions
 Through Medication Interventions
Offenders need a reason NOT to act on their
urges
 Nothing to lose, no reason to control themselves
 They need to build a life worth protecting
 Find out what is important to them and help them
protect or attain these things

Recognize and validate their struggles
 Imagine that you were told that you could only have sex
with men if you are heterosexual or sex with women if you
are gay for the rest of your life
 Imagine having to walk around with your greatest mistake
visible to the entire world
▪ We do not have registries for murderers, batterers, drunk drivers,
substance abusers
 Acknowledge their burden and the weight they need to carry
around everyday

Mandated clients not motivated for treatment
 Must learn how to make treatment “work for their lives”

Clients will see the therapist as an authority figure initially

Challenges of forming RAPPORT in a situation with angry
clients who have done horrific things to innocent people

Manipulative and Secretive Clients Adept at Leading Double
Lives
 Some will SUCCEED in FOOLING you

Burn Out
 The Toxicity of dealing with Horrific crimes
 Paranoia about your own friends and family
 Paranoia about your offenders re-offending

Maintaining the appropriate balance of scrutiny and
support (especially after being fooled by a client)
 Do not confuse LIKING someone with TRUSTING them
 Having the “Trust Talk”
▪ Offender using trust in the past to exploit people
▪ You will be little help to them if you fall into trusting them

Physical, emotional, or mental exhaustion especially
in one’s job or career, accompanied by decreased
motivation, lowered performance, and negative
attitudes towards oneself and others
 Early sign of Burnout: Sudden increase in work effort and
hours without an increase in productivity
 Can be particularly acute in therapists who feel
overwhelmed by the cumulative secondary trauma






Emotional, Physical
and Mental Exhaustion
Lower Productivity
Consistently Late for
Work
Complaining,
Negativity & Cynicism
Decreased
Concentration
Forgetfulness
Apathy
Dread of Coming to
Work
 Feelings of Low
Personal
Accomplishment
 Feeling Overwhelmed
 Tension and
Frustration



Willingness to Collaborate
 Open to other people’s observations and
interpretations (does not explain away your
observations)
 Alert PO when there is a problem or change of
functioning

They are upfront with their clients
 “I will be regularly communicating with your PO”
 “If something is a problem for you then I will be
the first to tell you”

Egos are not tied to offender progress
 Their reports on offenders are balanced (both





good and bad aspects)
Their clients are not divided into “Good” clients
and “Bad” clients
Not afraid to be the “bad guy” for their clients
Does not Collude with Clients
Firm Boundaries with clients
Vigilant to staff splitting
Contact information:
[email protected]