Attachment & sex offending

1. Attachment & sex offending Jackie Craissati Jackie.craissati@oxleas.nhs.uk

2. Why bother with attachment theory? • What is attachment theory? • how to apply it to the treatment and management of sex offenders

3. Why bother? • Higher risk sex offenders are more likely to be personality disordered. • PD is strongly linked to • Increase risk of sexual/violent re-offending • Increased likelihood of failure/drop out/non-compliance

4. The underlying premise - 1 • Personality disorder is an interpersonal dysfunction - emerging from the interplay between temperament, early environmental influences, and subsequent trauma - leading to the development of attachment difficulties

5. Why bother? • Sex offenders with attachment problems are more likely to • Be hypervigilent to ‘shaming’ (problems with disclosure) • Say one thing and do another (failure of mentalising) • Display antagonism towards authority • Engage in excessive or irrational lying and disclosures • Be rule breakers (paradoxical response to heavy handed licence conditions) • Fare badly in standard treatment programmes

6. Why bother? • Understanding attachment theory improves our understanding of the sexual offending • Underlying Premise 2 • Sexual and violent offending contains within it a relationship between the perpetrator and victim – real, symbolic, enduring, fleeting – which mirrors the underlying attachment problems for the offender

7. Why bother? • The evidence base for treatment models (PD) contains attachment theory at its core • Mentalisation based therapy • Schema therapy • Transference focussed psychotherapy • Dialectical behaviour therapy

8. What is attachment theory? • A biopsychosocial model of human development • Rooted in evolutionary psychology • Transcending individual theoretical models • Incorporating a growing evidence base from both psychology and neurosciences

9. Key features • Role of primary carer in establishing secure or insecure relating to important others • Development of sense of self in relation to others leading to habitual patterns of relating, particularly in relation to understanding the thoughts and emotions of others • Development of capacity to self-sooth, and thereby manage emotional states, stress and behaviour • Influences the capacity to process and resolve later trauma

10. Video

11. Implications for treatment & management Attachment triangle ‘transference triangle’

12. Management • MAPPA is a particular type of parent: • High levels of over control • Low levels of nurturing/affection • Highly conditional approval • Unwittingly duplicitous (‘confide in me’) • Emphasises ‘shaming’ methods (disclosure)

13. A psychoanalytic perspective • “The view is taken that professionals who deal with offenders are not free agents but potential actors who have been assigned roles in the individual offender’s own re-enactment of their internal world drama. The professionals have the choice not to perform but they can only make this choice when they have a good idea of what the role is they are trying to avoid. Until they can work this out they are likely to be drawn into the plan..” (Davies)

14. Treatment implications • Shifts the focus of treatment • Reduced emphasis on the acquisition of ‘appropriate’ cognitions & mutually agreed insight • Increased emphasis on treatment as a small part of a wider psychological informed management plan • Recognising the likelihood that what someone says and what they do are entirely different things

15. The framework (3) • Offending occurs as a result of URGE ACTION in which emotional arousal leads to a failure in thinking. Treatment aims to • identify the urge • Acknowledge the action • Control the level of emotional arousal • Increase the capacity to think • Thereby increasing choice

16. Treatment content • Development of a personal narrative with a beginning (development), middle (problems in adult life) and end (the index offence) • Using the attachment triangle for a relationships module • Emphasising self as victim more than offence victim • Focus on doing rather than saying the right thing (less discussion/homework, more on perspective taking skills

17. Treatment process • Difficulties with theory of mind means the therapists MUST explicitly demonstrate their thinking in the group • Dysfunctional/habitual thoughts and feelings are encouraged in the group (bring the pathology into the room) and worked with, using the group • It’s not what you say, it’s what you do • Helping with benefits/travel expenses • Letter writing to recalled members • Follow up and aftercare

18. Case examples • The cup cake problem • A child molester in a probation group places cup cakes on the facilitators chairs every week. • He generally causes considerable problems, with arrogance, taking the therapist role, blocking direct interventions etc • In childhood, placed into care by mum and visited by her. Other kids fostered, but he was promised a return home which never materialised

19. Implications for treatment & management Attachment triangle ‘transference triangle’

20. Case example • When letters aren’t enough • Jeff is a high risk rapist, who started the group after 30 years of refusing treatment and was then recalled for drinking • Letter writing spiraled out of control, increasingly menacing responses on a daily basis • Most striking aspect of childhood was his mother’s disapproval of him leading to her silence over many years • Rejected MH team aggressively and case closed • Prison visit, and subsequent representations to Parole Board