How to Effectively Treat & Manage Sex Offenders in the Community Series (Part 1 of 3)

1. How to Effectively Treat & Manage Sex Offenders in the Community Series (Part 1 of 3) Timothy J. Wisniewski, Ph.D. Sex Offender Treatment: What is it and What do We Treat? NYS ATSA Conference May 24, 2011

2. 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

3. What is Sex Offender Treatment? • 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

4. Telling Myths from Facts • 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)

5. First-Time Offenders vs. Repeat Offenders (Sandler, Freeman, & Socia, 2008)

6. Sexual Recidivism in NYS (5 years)

7. Telling Myths from Facts • 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

8. Recidivism Rates by Crime Type (Hughes & Wilson, 2003)

9. Current Treatment Models

10. Bio-Medical Cognitive Behavioral Family Systems Good Lives Harm Reduction Multisystemic Psychodynamic Risk-Need-Responsivity Relapse Prevention Self-Regulation Sexual Addiction Sexual Trauma Psycho-Socio-Educational Current Treatment Models

11. Relapse Prevention • Cognitive-behavioral “maintenance strategy” that helps an offender identify Internal/external factors associated re-offending • 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

13. Problems with Relapse Prevention • 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

14. An Empirical Kiss of Death for RP • 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

15. An Empirical Kiss of Death for RP • Impact on Recidivism? • No Overall reduction due to RP Treatment • Relapse Prevention 22% • Control Group 20% • Refusers 19%

16. Risk-Need-Responsivity • Risk Principle – Higher level of services for higher risk cases • Need Principle – Target for change those characteristics directly related to re-offending • Responsivity Principle – Treatment is responsive to a person’s learning style

17. R-N-R Meta Analysis • Hanson, Bourgon, Helmus, & Hodgson, (2009) • Result: Sex Offender treatment that adheres to R-N-R leads to largest reductions in recidivism Sexual Recidivism • Treated (n=3,121) 10.9% • Untreated (n=3,625) 19.2%

18. 2009 Safer Society Survey 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?

19. United States – Top Three Theories that Best Describes Community Program (2009) n=324

20. Canada – Top Three Theories that Best Describes Community Program (2009) n=19

21. New York State SIST Providers Top Three Theories that Best Describes Community Program (2011) n=22

22. What to Treat

23. Psychological Risk Factors(criminogenic needs, dynamic risk factors) 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

24. What Works? 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)

25. What Works? 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)

26. What Works? INTIMACY DEFICITS Hostility toward Women (promising) Lack of Concern for Others (promising) Conflicts in Intimate Relationships Machiavellianism (promising) General Social Rejection

27. What doesn’t work? • 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

28. Individualizing Treatment

29. Moving from Group Results to Individuals in Treatment • 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

30. Case Conceptualization • 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.

31. Individual Working Models • 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)

32. Example: Two Individuals have the Following Risk Factors in Common • Hostility toward women • Use of Sex as Coping • Negative Emotionality • Lack of Social Supports • Lack of Concern for others

33. Example 1: 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.

34. Example 2: Hostility toward women, Use of Sex as Coping, Negative Emotionality, Lack of Social Supports, Lack of Concern for others 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.

35. Case Conceptualization to Comprehensive Risk Assessment • 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 re-offense occurs • How would the person most likely obtain a victim (e.g., grooming versus snatch and grab)

36. Mr. X 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.

37. Mr. Z 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.

38. Individualized Treatment and Supervision Plan • Treatment Plan? • Mr. X (Mr. Pathetic) • Mr. Z (Mr. Predator) • Supervision Plan? • Mr. X (Mr. Pathetic) • Mr. Z (Mr. Predator)

39. Phenomenological Criminology

40. What is it? • 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)

41. Desistance Narratives “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

42. Desisting Offenders’ Redemption Scripts 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.

43. Desisting Narratives • 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

44. Important Key Elements • 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)

45. Measuring Dynamic Factor Change

46. Measuring Dynamic Risk • 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

47. Stable 2007 and Acute 2007 • 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

48. 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 Items in Stable-2007

49. SEX/VIOLENCE Victim Access Hostility Sexual Preoccupation Rejection of Supervision GENERAL RECIDIVISM Emotional Collapse Collapse of Social Supports Substance Abuse SCORING 0 = None 1 = Maybe/Some 3 = Yes Intervene Now Categories of Risk Low Moderate High Items in the Acute 2007

50. Yields a new Risk Level Category Low, Moderate or High New Risk Level Category can be used to determine the relative risk in the next 45 days of the following: Sexual Crimes Any Sexual Breaches (Violations) Violent or Sexual Crimes Any Crime Any (Including Breaches/Violations) Combining Static/Stable/Acute