Assessment and Treatment of High Risk Sexual Offenders: Practical Guidelines for Clinicians

Assessment and Treatment of High Risk Sexual Offenders: Practical Guidelines for Clinicians Jan Looman, Ph.D., C.Psych. Kingston, Ontario Jan1looman2@yahoo.ca

Assessment and Treatment of High Risk Sexual Offenders: Practical Guidelines for Clinicians • Note: The views expressed here are the views of the author and do not reflect the views of the Correctional Service of Canada

Outline • Models of Treatment - RNR vs. GLM • Describe triage process for sex offenders in Ontario/Canada • What do I mean by “high risk/needs”? • Describe treatment process for High Risk/Needs Sex Offenders • Link to community treatment – continuity of care

Models of Treatment • What really is RNR? • RNR vs. GLM • Is the Good Lives model different?

Models of Treatment • RNR model is not a theory of intervention in itself – it represents principles of effective correctional intervention (Andrews & Bonta, 2010) • derived from Andrews and Bonta’s general personality and cognitive social learning (GPCSL; Andrews & Bonta, 2010) theory of criminal behavior.

Models of Treatment • GPCSL posits that crime results when the personal, interpersonal, and community supports for behavior are favorable to crime • Strong influences - antisocial attitudes, antisocial associates, a history of offending, antisocial personality traits. • Weaker influences - familial difficulties, poor adjustment to work and school.

Models of Treatment RNR Principles – guide us in designing intervention within the GPCSL theory • The Risk Principle - that higher levels of intervention should be reserved for higher risk cases - low risk offenders should receive no, or very little intervention. • Risk is to be determined through validated actuarial assessment of static and dynamic risk

Models of Treatment • The Need Principle - interventions should target criminogenic needs (dynamic risk factors). • Central Eight risk/need factors (Andrews & Bonta, 2010): • antisocial associates, • antisocial cognitions, • antisocial personality pattern, • history of antisocial behavior, • substance abuse, • family–marital, • school–work, • leisure–recreation.

Models of Treatment • Sex offender specific criminogenic needs identified by Mann, Hanson & Thornton (2010) • Sexual preoccupation • Sexual deviance – esp. deviant arousal to children; multiple paraphilias • Offense-supportive attitudes • Emotional congruence with children

Models of Treatment • Sex offender specific criminogenic needs (con’t) • Lack of emotionally intimate relationships with adults • Lifestyle impulsiveness • Poor problem solving • Resistance to rules/supervision • Hostility • Negative social influences

Models of Treatment • Other factors identified as “Promising” criminogenic needs: • Hostility toward women • Machiavellianism • Lack of concern for others • Dysfunctional coping • Sexualized coping • Externalized coping

Models of Treatment Non –Criminogenic Needs Hanson & Morton-Bourgon (2005) • Force/violence in sex offending • Neglect or abuse during childhood • Sexual abuse during childhood • Loneliness* • Low self-esteem • Lack of victim empathy • Denial of sexual crime * • Low motivation for treatment at intake • Poor progress in treatment (post)

Models of Treatment • Within the Need Principle non-criminogenic needs not relevant targets for intervention • A caveat to this: dealing with a noncriminogenic need may be an important strategy in the context of addressing a specific responsivity factor. • Treatment providers must build on strengths and remove barriers to effective participation enhancing responsivity (Andrews, Bonta & Wormith (2011)

Models of Treatment The Responsivity Principle • general - the most effective interventions tend to be those based on cognitive, behavioral, and social learning theories • the relationship principle (Andrews, 1980) (establishing a warm, respectful and collaborative working alliance with the client) and, • the structuring principle (influence the direction of change towards the prosocial through appropriate modeling, reinforcement, problem-solving, etc.)

Models of Treatment The Responsivity Principle • specific responsivity - the treatment offered is matched not only to criminogenic need but to those attributes and circumstances of cases that render them likely to profit from that treatment

Models of Treatment Responsivity Factors (Looman, Dickie & Abracen, 2005; Olver, Stockdale & Wormith, 2011) • psychopathy • Low motivation/ denial/minimization • low intellectual functioning/lack of education • hostile interpersonal style/disruptive • Mental health difficulties • personality profile

Models of Treatment Summary RNR • Treatment directed toward higher risk clients • Addresses known criminogenic needs • Cognitive behavioural/social learning approaches • Emphasis on effective therapist characteristics and role modeling delivered in a manner appropriate for the client group

Evidence for RNR • Dowden and Andrews (1999) - meta-analysis of 25 studies of treatment for female offenders • effect sizes larger when criminogenic needs were targeted. • treatment services which adhered to all of the RNR principles found to be related to the greatest reductions in recidivism, while treatment rated as inappropriate had the weakest effects. • targeting vague personal/emotional targets, family interventions not addressing criminogenic needs, and other non-criminogenic personal treatment targets were associated with no reduction in recidivism.

Evidence for RNR • Dowden and Andrews (2000) - meta-analysis 35 studies of treatments for violent offenders • criminal sanctions alone no effect on recidivism • any human service delivery  significant positive effect. • programs which adhered to RNR principles were more effective than those which did not • Programs targeting criminogenic needs associated with a moderate effect size - those which did not produced no significant reduction in recidivism.

Evidence for RNR • Dowden and Andrews (2000) (con’t) • Programs that adhered to all three RNR principles produced the largest effect sizes. • correlation between effect size and number of criminogenic needs targeted was .69 (p <.001) • correlation between effect size and number of non-criminogenic needs was -.30 (p <.05).

Evidence for RNR • Hanson, et al. (2009) - 23 studies of sexual offender treatment • adherence to the RNR principles  greater reductions in recidivism • effect was linearly related to the number of RNR principles adhered to. • programs which adhered to none of the principles  a negative treatment effect.

Evidence for RNR • Dowden, Antonowitz and Andrews (2003) - meta-analysis of 24 studies of treatment programs which employed an RP approach in the delivery of treatment.- (7 addressed sex off). • moderate overall effect size for RP programs • Coded presence of various aspects of the RP approach (i.e., offence chain, relapse rehearsal, advanced relapse rehearsal, identification of high risk situations, training significant others, Booster sessions, coping with failure situations)

Evidence for RNR • Dowden et al (2003) • Overall, the greater the number of RP components employed in treatment, the stronger the treatment effect (r = .38, p < .01). • found that RP programs which adhered to all three RNR principles had the greatest impact, while those that adhered to none of the principles had no impact on recidivism.

Evidence for RNR Summary • Treatment approaches which adhere to RNR principles effective in reducing recidivism for violent offending, female offenders, sexual offenders • RP approaches which adhere to RNR principles also effective • Approaches which focus on noncriminogenic needs (for SOs internalizing psychological problems denial, low victim empathy, and social skills deficits) non-effective or even harmful

Models of Treatment Good Lives Model

Good Lives Model Assumptions about Human Nature • Assumes all human being are practical decision-makers and have similar aspirations and needs • one of the primary responsibilities of parents/teachers to equip people with the skills/tools to make their own way in the world

Good Lives ModelAssumptions about Human Nature (con’t) • People formulate plans and intentionally modify themselves and their environment in order to achieve goals • In order for people to function effectively their basic needs must be met

Good Lives ModelAssumptions about Human Nature (con’t) • Primary human goods – have their origins in human nature and have evolved in order to help people establish strong social networks, survive and reproduce • People derive a sense of who they are and what matters from what they do (Practical identity) • Therefore in rehab need to provide offenders with an opportunity to acquire a more adaptive practical identity

GLM on RNR Criticize RNR approaches • focus on risk reduction/management unlikely to motivate offenders – need to have approach goals • pay attention to offender as a whole - RNR sees offender as “disembodied bearer of risk” • Lack of focus on non-criminogenic needs – therapeutic relationship • RNR approaches “one-size fits-all”

What Does the GLM Say Nine* Primary Human Goods (Ward & Marshall (2004): • 1. life (including healthy living and optimal physical functioning, sexual satisfaction); • 2. knowledge; • 3. excellence in play and work (including mastery experiences); • 4. excellence in agency (i.e., autonomy and self-directedness);

GLM Nine Primary Human Goods (con’t) • 5. inner peace (i.e., freedom from emotional turmoil and stress); • 6. relatedness (including intimate, romantic and family relationships) and community; • 7. spirituality (in the broad sense of finding meaning and purpose in life); • 8. happiness; and • 9. creativity.

GLM & Offending • Criminogenic needs = internal or external obstacles that frustrate and block the acquisition of primary human goods • Individual lacks the ability to obtain the good in a prosocial manner and is unable to think about his life in a reflective manner • i.e. criminogenic needs =deficiency in agency and conditions that that support agency

GLM & Offending • 4 major difficulties with offender’s life plans that lead to offending • Means he uses to secure goods • Inappropriate strategies  Violation of norms • Lack of scope – important good missing e.g., lack if connectedness  feelings of loneliness/inadequacy

GLM & Offending • 4 major difficulties with offender’s life plans that lead to offending (con’t) • Conflict among goods sought – e.g. attempt to pursue good of autonomy leads to relationship issues • Lack of capability – knowledge/skills deficits

GLM & Offending • Two routes to the onset of offending • Direct – offending is the primary focus – e.g., offender may lack the relevant competencies and understanding to obtain the good of intimacy with an adult – offending = striving for fundamental goods – intentionally seeks goods through criminal activity. • Indirect – pursuit of a good increases the pressure to re-offend – e.g. conflict between good of relatedness and autonomy leads to break-up of relationship  loneliness/distress alcohol use  offending

GLM & Offending • Offenders search for primary goods in their environments under the guidance and constraint of their practical identity • Act in ways that they think will satisfy them • Sex offending arises because people make faulty judgements • Lack of forethought or knowledge concerning relevant facts

GLM & Intervention • Should be a direct relationship between goods promotion and risk management • Rehabilitation = holistic reconstruction of the self  new practical identity • Focus on promotion of goods is likely to automatically eliminate or modify risk factors • Attitude of therapist – offender viewed as someone attempting to live a meaningful, worthwhile life in the best way he can in the specific circumstances confronting him

GLM & Intervention • Tailoring of therapy to match the individual client’s life plan and their risk factors • Therapeutic task shaped to suit the person in question • Focus on approach goals rather than avoidance of risk factors

GLM & Intervention Assumptions/Considerations (Laws & Ward, 2011) • Offenders lack many of the essential skill/capabilities to achieve a fulfilling life • Criminal behaviour = attempt to achieve desired goods but the skills/abilities absent – alternatively: • Criminal behaviour arises from an attempt to relieve a sense of incompetence, conflict, or dissatisfaction that arises from not achieving valued human goods.

GLM & Intervention Assumptions/Considerations (con’t) • Laws & Ward (2011) • The absence of certain goods more strongly related to offending**: • Self-efficacy/sense of agency • Inner peace • Personal dignity/social esteem • Generative roles and relationships (work, leisure) • Social relatedness (associates).

GLM & Intervention Assumptions/Considerations (con’t) • Risk of offending reduced by assisting individuals to develop the skills/abilities to achieve the full range of human goods • Intervention = activity that adds to an individual’s repertoire of personal functioning rather than simply removing a problem or managing a problem

Evidence for the GLM • Laws & Ward (2011) indicate (p. 202) that the GLM has empirical support – however they fail to offer any citations • The area of positive psychology generally is empirically based however this cannot be taken as evidence that such approaches are effective with offenders • E.g. Deci & Ryan (2000) - self-determination is positively correlated with personal well-being

Evidence for the GLM Specific to Offenders? • Case studies – which do not tell us whether or not effective in reducing recidivism or more effective in addressing criminogenic needs • E.g. White, Ward & Collie, 2007 – Mr. C. gang member with long criminal history of violence including sexual violence • Noted that he had engaged in RNR based interventions on previous sentences • Remained in pre-contemplation and rigid antisocial attitudes, continued drug use

Evidence for GLM • Mr. C. (con’t) • Treatment according to GLM • Outcome – 14 months following release • Disclosed two violent incidents • “The first involved a retaliatory action after being pushed to the ground at a party. … The second relapse occurred in response to his partner being insulted and offended. Mr. C’s reaction included “smashing” the victim and entering an emotional state synonymous with the abstinence violation effect

Evidence for the GLM Specific to Offenders? • Harkins, Flak, Beech & Woodhams (2012) • 76 men who participated in GLM based community SO treatment • 701 who participated in an RP oriented treatment

Evidence for GLM Harkins et al.(2012) (con’t) • pre-post treatment psychometric assessment – measures which previous research demonstrated associated with recidivism • Attrition rates • Facilitators perception of the program and offender’s motivation • Offender’s perception of the program

Evidence for GLM Harkins et al.(2012) (con’t) • Attrition rates did not differ significantly • No difference in rates of change on psychometric measures • Facilitators liked the GLM-based module • 63.7% did not think it would be appropriate for high-risk/unmotivated clients

Evidence for GLM • Harkins et al.(2012) (con’t) • Clients rating of improved understanding of their offending - 80% of RP group compared to 46% GLM • better understanding of the positive aspects of themselves 61% for GLM compared to 20% for RP

Evidence for GLM • Harkins et al.(2012) (con’t) • Rating re: changing thoughts and attitudes in a way that they were better able to manage themselves or their reoffending 80% for RP, vs. 27% for the GLM module • thoughts and attitudes about themselves or the future were more positive - 47% for GLM vs. 20% for the RP module.

Evidence for GLM • Harkins et al.(2012) (con’t) • Summary • GLM module led to offenders who feel better about themselves and their future, however did not improve their awareness of risk factors and self-management strategies • Opposite was true for RP/RNR based program • no differences overall in terms of attrition or change on risk factors

Assessment and Treatment of High Risk Sexual Offenders: Practical Guidelines for Clinicians