Hope in the treatment of sexual offenders: the potential application of hope theory

Abstract

The present paper attempts to demonstrate how hope theory is conceptually consistent with current positive approaches to sexual offender treatment. Hope theory and its components of goals, pathways thinking, and agentic thinking is reviewed as defined by Snyder and his colleagues. A theoretical relationship exists between the role of hope and many aspects of sexual offending and treatment. Developmental course, attachment style, and the formation and maintenance of coping styles are reviewed as they relate to hope and sexual offending. A framework by which to apply hope theory to pre-treatment, treatment, and more specifically, self-management or relapse prevention for sexual offenders is proposed. Emphasis is placed on the use of techniques that target hope components, particularly in pre-treatment programs.     

Moral judgement,cognitive distortions and empathy in incarcerated delinquent and community control adolescents

Abstract

Immature moral judgements, cognitive distortions and low empathy could contribute to criminal offending and are often targeted in interventions aimed at reducing risk of recidivism. We compared 58 delinquent 13–18-year-olds, incarcerated in youth homes in Sweden (29 males, 29 females) with 58 (29 males, 29 females) community control adolescents individually matched on age, gender, ethnicity and socio-economic position. Self-report questionnaires examined moral judgement, cognitive distortions, and empathy. Delinquent adolescents exhibited less mature moral judgements and more cognitive distortions than control adolescents. However, no association between delinquency status and self-reported empathy was found. In addition, girls reported more mature moral judgements, less cognitive distortions and more empathy than boys did. Moral judgement and empathy were positively correlated and both measures were negatively correlated with cognitive distortions. Our data support the idea that moral judgement and cognitive distortions are important treatment targets for juvenile delinquents, whereas empathy may be less meaningful to address directly.     

Personal,background and treatment characteristics associated with offending after residential treatment: A 13-year follow up in adolescent males

Abstract

We report on delinquency for 270 males after residential treatment in a juvenile justice institution in the Netherlands. We describe personality characteristics, relations with peers, school and family, as well as treatment characteristics. Next, we describe post-release offending based on reconviction data, and relate this to background characteristics, differentiating between serious and violent offending. In doing so, we distinguish between incidental offenders, chronic offenders and desisters.     

The Treatment Engagement Rating scale (TER) for forensic outpatient treatment: Description,psychometric properties,and norms

Abstract

The Treatment Engagement Rating scale (TER) is a Dutch therapist rating instrument for treatment engagement (TE) of forensic outpatients. It yields scores for nine components of TE, which are aggregated in a total score. Following an analysis of the concept of TE, the TER is described, and various psychometric analyses of data from a forensic outpatient sample are reported. The nine component scores were found to constitute a homogeneous scale with good internal consistency (α=0.93, n=328) and adequate inter-rater reliability (intraclass correlation coefficient (ICC)=0.76, n=99). The validity of the TER is supported by correlations of 0.47, 0.66, and 0.91 (n=328) with measures for the motivation to engage in treatment. Applications for the TER in clinical practice and research are suggested.     

The impact of interpersonal style on aggression and treatment non-completion in patients with personality disorder admitted to a medium secure psychiatric unit

Abstract

The aim of this study was to examine the impact of interpersonal style and psychopathy on treatment non-completion and aggressive behaviour. Participants were patients with personality disorder admitted for treatment to a structured group program operating within a medium secure psychiatric hospital. Assessment of personality disorder and psychopathy occurred prior to admission. Interpersonal style was assessed on admission with the Impact Message Inventory (IMI), a self-report transactional inventory. Files were subsequently reviewed to determine whether patients were aggressive during their hospital stay and whether they were prematurely expelled from the unit and therefore did not complete treatment. Results showed that patients who completed treatment were more nurturing and help-seeking. Aggressive patients were more competitive and dominant. Psychopathy did not differentiate treatment completers from non-completers or aggressive from non-aggressive patients. Clinical implications and opportunities for further research are explored.     

Examining the effectiveness of a UK community-based sexual offender treatment programme for child abusers

Abstract

An analysis of psychometric data from a sample of 341 UK child abusers who had completed a probation-based sex offender treatment programme was carried out in order to assess the effectiveness of therapeutic treatment. A cluster analysis was also undertaken to examine the pattern of pre-treatment problems. Three clusters of offenders, with distinctly different psychometric profiles, were identified depending upon the number and extent of their offence-specific and social adequacy problems. These were labelled Low need, Medium need and High need. Pre–post analyses revealed clinically significant treatment effects for the entire sample, with differing effects found across the clusters as follows: 50–81% of the Low need group scored within the cut-off (or normative range) at the post stage, while between 3% and 26% had shifted to a clinically significant degree; 34–75% of the Medium need group scored within the cut-off range after treatment, while between 9% and 100% had shifted to a clinically significant degree; 16–52% of the High need sample scored within the cut-off at the post-treatment stage, and between 15% and 80% had shifted to a clinically significant degree.     

Training multi-disciplinary teams to work with sex offenders: Effects on staff attitudes

Abstract

A recent British Prison Service initiative has focused on providing sex offender programmes facilitated by multi-disciplinary teams of staff. A three week long training programme was designed to provide staff with the necessary knowledge, skills and experience to facilitate these structured treatment groups. Following the training, staff indicated they were more confident in their ability to provide treatment and showed a greater belief that treatment could be successful. In addition, they showed significantly more positive attitudes towards sexual offenders and to offenders in general. However, participants did not indicate undue concern about working in a sensitive treatment area. This pattern continued at six month follow-up, indicating that the training changed attitudes as expected, and that the training was seen by participants as adequately preparing them to undertake provision of a structured sex offender treatment programme in a secure setting.     

Predictors of sex offender treatment dropout: psychopathy,sex offender risk,and responsivity implications

Abstract

We examined sex offender treatment dropout predictors, in particular, the relationship of psychopathy and sex offender risk to treatment dropout in a sample of 154 federally incarcerated sex offenders treated in a high intensity sex offender treatment program. Demographic, criminal history, mental health and treatment-related data as well as data on risk assessment measures including the Static 99, Violence Risk Scale – Sexual Offender version (VRS-SO), and Psychopathy Checklist – Revised (PCL-R) were collected. Logistic regression and discriminant function analyses were used to identify predictors that made significant and unique contributions to dropout among all the variables under study. The Emotional facet of Factor 1 of the PCL-R and never being married were found to be the most salient predictors of treatment dropout and correctly identified about 70% of the cases. The implications of the findings for managing treatment dropout and for the treatment of psychopathic offenders are discussed.     

Delivering effective therapeutic interventions for men with severe personality disorder within a high secure prison

Abstract

The Fens Unit is a government-initiated facility for male prisoners reaching criteria for Dangerous and Severe Personality Disorder (DSPD). Prisoners are assessed using a standardised process; those meeting criteria engage in a five-year treatment programme using a cognitive interpersonal model. Personality disorder is seen as a combination of coping strategies, developed in response to experience, which results in dysfunctions of thinking, feeling, behaviour and interpersonal relationships. These dysfunctions are linked to offending. Therefore, in order to reduce risk, multiphasic interventions – individual and group therapies – specifically target each dysfunction area, focusing on the developmental experiences that generated them. Each man's individual risk factors become treatment targets that are addressed in every aspect of the programme. All staff on the unit, clinical and operational, attempt to improve the quality of interpersonal relationships the prisoner has access to in order to create remedial experiences that are necessary to attain the capacity to develop socially adaptive cognitive, emotional and behavioural responses. This paper describes the treatment provided to these prisoners and the outcomes for the first cohort to have completed treatment (n=18). Results indicate that there is a reduction in violent behaviour, a higher than expected attendance at therapy, a decrease in actuarial risk measures and the majority of men are successfully managed in lower security after programme completion.     

Using context and difference in sex offender treatment: An integrated systemic approach

Summary

The primary objective of this paper is to promote a re-examination of the current use of cognitive-behavioural programmes in work with men who have sexually offended against children or adults and to encourage the application of ideas from the systemic field. In order to support this objective, the paper puts forward and develops the following arguments:

1. That the current content of manualised programmes in this field has been distilled too far and left behind some of the most important principles of the cognitive approach. Returning to the work of Marshall et al (1999), the need for a thorough and broad-based assessment of each individual prior to deciding treatment goals is clearly recommended. Further, there is a need to pay much more attention to differences between, as well as similarities of those who sexually offend.

2. That ideas from within the systemic therapeutic field be integrated within existing approaches to attempt to address some of the limitations of cognitive-behaviour therapy as currently employed. Evidence for the potential benefits of this comes from a broad personal experience of working directly with offenders and consulting to group facilitators.

It is concluded that all therapeutic approaches reach a ‘moment of integration’ (Pinsof, 1994), when their failures are recognised and other approaches are drawn on. It is suggested that this moment may be upon us in this area.