Transcript 1 10 anthony beech

SEX OFFENDER
TREATMENT PROGRAMS
Anthony Beech
University of Birmingham
Email: [email protected]
Treatment of sex offenders
1
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
2
half that of those who had not undertaken treatment
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
Treatment of sex offenders
3
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
Treatment of sex offenders
4
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 cognitivebehavioural treatment (CBT) approach’
Treatment of sex offenders
5
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
Treatment of sex offenders
6
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
Treatment of sex offenders
7
Why target Need?

Dowden (1998) found that targetting
‘more promising targets’ reduced
recidivism more than ‘less promising
targets’
Treatment of sex offenders
8
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
Treatment of sex offenders
9
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
Treatment of sex offenders
10
Responsivity - learning styles


In the broadest sense, this is taken to mean
that forensic rehabilitation programmes
should be based on cognitivebehavioural/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)
Treatment of sex offenders
11
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
Treatment of sex offenders
12
Appropriate treatment delivery

Here the clinician needs to review:
 Risk
 Need
 Responsivity
 And make decisions about treatment
according to ethical, humanitarian, costefficiency and clinical standards
Treatment of sex offenders
13
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
Treatment of sex offenders
15
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)
Treatment of sex offenders
16
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
Treatment of sex offenders
17
Meta-analytic evidence base for
CBT
Kenworthy et al. (2004) (N = 500+)
CBT and behavioural treatment
 psychodynamic
↓ sexual recidivism
n.s
Alexander (1999) recidivism rates (N = ????)
Untreated
Group/ behavioural
Unspecified
RP-CBT
25.8% (119/461)
18.3% (96/254)
13.6% (127/931)
8.1% (18/221
Lösel and Schmucker (2005) (N = 22,181 )
 CBT and behavioural treatment
 Insight oriented, therapeutic community,
other psychosocial
↓ sexual recidivism
n.s.
Robertson, Beech, & Freemantle (in preparation) (N = 14,694 )
 CBT and behavioural treatment
↓ sexual recidivism
 psychodynamic
n.s
18
19
Treatment in practice
Dy n am ic risk leve l_
Low
Me dium
Hi gh
Ro llin g P rogra m m e
Ro llin g P rogra m m e
Ro llin g or Core
(c. 100 h ou rs)
(c. 100 h ou rs)
(100 – 180 h ou rs )
Ro llin g or Core
Core P rogra m me
Core
(100 – 180 h ou rs )
(c. 180 h ou rs)
(c. 180 h ou rs)
Core + Ex tend ed
Core + Ex tend ed
Core + Ex tend ed
(c. 320 h ou rs)
(c. 320 h ou rs)
(c. 320 h ou rs)
Core + Ex tend ed
Core + Ex tend ed
Core + Ex tend ed
(c. 320 h ou rs)
(c. 320 h ou rs)
(c. 320 h ou rs)
S ta ti c R isk le ve l
Low
Me dium
Hi gh
Very Hi gh
Treatment of sex offenders
20
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
Treatment of sex offenders
21
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
Treatment of sex offenders
22
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
Treatment of sex offenders
23
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
Treatment of sex offenders
24
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)
Treatment of sex offenders
25
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 psychoeducational rather than psycho-therapeutic
Treatment of sex offenders
30
PREVIOUS FINDINGS WPPprecss ITH THE GES
Treatment of sex offenders
31
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
Treatment of sex offenders
36
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)
Treatment of sex offenders
37
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)
Treatment of sex offenders
38
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
Treatment of sex offenders
39
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
Treatment of sex offenders
40
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)
Treatment of sex offenders
41
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
Treatment of sex offenders
42
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 reoffending.
Strengths-based approaches
43
‘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
Strengths-based approaches
44
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’
Strengths-based approaches
45
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.
Treatment of sex offenders
46
‘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
Treatment of sex offenders
47
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
Treatment of sex offenders
48
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
Treatment of sex offenders
49
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.
Treatment of sex offenders
50