Forensic Psychology

by Graham M Davies

  Reviews of the available literature on the treatment of psychopaths have generally concluded that there is not enough evidence to support the view that men who score high on the PCL-R have a negative response to treatment (Abracen, Looman, & Langton, 2008; Doren & Yates, 2008; D’Silva, Duggan, & McCarthy, 2004; Loving, 2002; Olver & Wong, 2009; Polaschek, 2014; Thornton & Blud, 2007). It is possible that psychopathy presents an obstacle to therapy because psychopaths are more of a challenge to treat than non-psychopaths, but they may be treatable nonetheless. In particular, it is possible that psychopaths do not respond well to traditional treatment programmes, but may be more responsive to programmes designed specifically to meet their needs (Harkins, Beech, & Thornton, 2011; Polaschek, 2014; Thornton & Blud, 2007; Wong & Hare, 2005).

  19.5.2 Treatment Readiness

  Some suggest these responsivity issues should be considered under the broader term of “treatment readiness” (Serin, 1998; Ward, Day, Howells, Birgden, 2004). This concept incorporates a variety of person (e.g. beliefs, emotions, skills) and context (e.g. treatment setting and availability, external supports, availability of qualified therapists) factors that promote engagement and enhance change (Ward et al., 2004). According to this theory a person will be ready to change based on the extent to which they possess certain internal qualities in the context of external factors that promote the changes the person is trying to make (Ward et al., 2004; Ward et al., 2006).

  Ward et al. (2004) suggest that treatment outcome can be improved by addressing issues surrounding treatment readiness. Such issues might include learning difficulties, a lack of verbal skills and literacy deficits, cultural factors whereby the therapist is of a different culture, a genuine lack of motivation to change, denial of the violent offences have all been highlighted as important issues to address before an individual commences treatment (Howells et al., 1997; Serin & Preston, 2000). Any of all of these issues may result in an offender being “resistant” to therapeutic efforts. This is a critically important issue given that dangerous offenders who drop out of treatment are almost always found to have higher recidivism rates than offenders who did not receive any treatment (e.g. for violent offending, 40% vs. 17% respectively, Dowden & Serin, 2001).

  19.5.3 Therapeutic Climate

  The therapeutic climate of a group refers to the context in which treatment occurs. It encompasses factors such as therapist characteristics and the inter-relationships between individuals in a group. Therefore, in addition to characteristics of the offender being important, the characteristics of the therapist and the group itself should not be undervalued. From a review of the literature, Marshall, Fernandez, et al. (2003) suggest aggressively confrontational approaches should be avoided and a more empathic, respectful type of supportive but firmly challenging style should be employed. Marshall and colleagues (Marshall, et al., 2002; Marshall, Serran, Fernandez, Mulloy, Mann, & Thornton, 2003) found that a number of therapist features, including empathy, warmth, a rewarding style, and being directive were related to positive change within treatment. Harsh confrontation was adversely related to treatment change. This “motivational” approach is also supported by a number of other researchers, for both sex offenders (e.g. Drapeau, 2005; Fernandez, 2006; Garland & Dougher, 1991; Kear-Colwell & Pollock, 1997; Preston, 2000) and the general criminal population (e.g. Andrews & Bonta, 2003; Ginsberg, Mann, Rotgers, & Weekes, 2002; Mann, Ginsberg &Weekes, 2002). A motivational approach has also been related to positive group environment among sex offenders (Beech & Fordham, 1997).

  In terms of the group environment, Beech and Fordham (1997) examined the characteristics of successful sex offender treatment groups, demonstrating that effective groups instil a sense of hope in members, are cohesive, well-organised, have desirable group norms, and are well-led. Beech and Hamilton-Giachritsis (2005) examined whether the therapeutic environment of sexual offender groups was related to changes in pro-offending attitudes within treatment (Beech & Hamilton-Giachritsis, 2005). They found that significant treatment change on measures of criminogenic need (i.e. victim empathy, cognitive distortions, and emotional identification with children,) was associated with level of cohesiveness in the group and the extent that group members felt able and encouraged to express themselves within the group.

  19.5.4 Treatment Context

  Treatment programmes are often seen as the main route by which risk can be reduced, but the truth is that even the best designed programme will only be effective if it is delivered in a context that reinforces the messages of treatment and where the treatment participant feels safe and supported. Treatment programmes in correctional settings therefore pose a considerable challenge, perhaps particularly for sexual offenders, who are viewed as “the lowest of the low” by both their fellow offenders and many criminal justice personnel. As Glaser (2010) has pointed out, where programmes are required activities of a criminal justice system, they take on the features of punishment rather than rehabilitation: that is, they do not have the best interests of the participant as their first priority but rather they exist to support the social goal of public protection; they tend not to offer the same standards of confidentiality as non-forensic mental heath treatments; and attendance at treatment is often enforced by the courts and hence does not respect the offender’s autonomy or right to choice. Treatment programmes in prison face additional challenges, in that prison rules and codes often respect different principles than those promoted by treatment programmes. For instance, treatment programmes, as we have seen, often place considerable store on taking responsibility for offending, whereas survival in prison often depends on the offender providing acceptable excuses for his sexual crimes.

  Mann (2009b) has outlined some of the key contextual issues for prison programmes in particular. These include: the mistrust that prisoners often feel for prison staff, which extends to programme staff; the expectation of hostile reactions from others; and the fear of stigma. Mann suggested that some simple alterations to the way in which sex offenders are managed in prison could increase treatment take-up, including: taking more time to listen and understand the sex offender’s experience of prison; taking more action to counter popular prison myths about treatment; communicating the strength-based aims of treatment; making referrals quickly and sensitively; educating non-treatment staff about the purpose, principles and effectiveness of treatment; and ensuring that prison leaders encourage pro-social modelling and a supportive environment.

  While programmes for violent offenders, and programmes in community settings, are probably less vulnerable than sex offender programmes in prison, they also share the feature that “treatment” is inextricably intertwined with punishment, and hence the context of treatment inevitably works against rather than with the personal aims and priorities of the offender.

  19.6 SUMMARY

  This chapter has highlighted the importance of providing effective treatment for dangerous offenders.

  In spite of criticisms for all treatment approaches, it would appear that the best approaches to treatment are those that take an integrated or multi-modal approach, use an overall RNR framework for delivering treatment, and have programme goals that are appealing and attainable by those attending treatment.

  The best current evidence suggests that some of the best treatment targets (i.e. criminogenic needs) for sexual offenders include sexual preoccupation, a sexual preference for children or sexualised violence, emotional congruence with children, lack of emotionally intimate relationships, and lifestyle impulsivity.

  Evidence from the various approaches to treating violent offenders is limited and inconsistent, but does suggest some of the approaches (Anger management, Cognitive skills, and multi-modal approaches) are promising.

  The most promising treatment targets for violent offenders include anger, hostility, impulsivity, substance abuse and relationship instability, amongst others.

  Meta-analyses provide support for the effectiveness of Risk-Needs-Responsivity, CBT, physical, behaviour
al and systemic approaches to treating sex offenders.

  For all treatment approaches aimed at dangerous offenders, it is useful to consider the potential influence of psychopathy and the offender’s level of treatment readiness.

  It is also important to attend to the therapeutic climate of a group including the characteristics of the therapist and the context in which treatment is provided. Attention to these factors should take us some of the way towards preventing or reducing future harm, alongside improving the future prospects of individuals who have committed dangerous offences.

  ESSAY/DISCUSSION QUESTIONS

  Critically discuss treatment approaches for violent offenders.

  What are important considerations in delivering effective sex offender treatment?

  What is the evidence for the effectiveness of treatment approaches for dangerous offenders?

  What is the evidence for the effectiveness of treatment approaches for sexual offenders?

  What are the main considerations when working with dangerous offenders?

  ANNOTATED READING LIST

  Marshall, W. L., & Laws, D. R. (2003). A brief history of behavioural and cognitive approaches to sexual offenders: Part 2, the modern era. Sexual Abuse: A Journal of Research and Treatment, 15, 93–120. This paper provides a historical perspective on the development and implementation of many treatment approaches that are currently in use with sex offenders.

  McGrath, R. J., Cumming, G. F., Burchard, B. L., Zeoli, S., & Ellerby, L. (2010). Current practices and emerging trends in sexual abuser management: The Safer Society 2009 North American Survey. Brandon, VT: Safer Society Press. This paper outlines a number of the sex offender treatment approaches that are currently used and provides evidence for their use in practice in the United States and Canada.

  McGuire, J. (2008). A review of effective interventions for reducing aggression and violence. Philosophical Transactions of the Royal Society B, 363, 2577–2597. A useful review of the effectiveness of aggression and violence treatments.

  Polaschek, D. L. L., & Collie, R. M. (2004). Rehabilitating serious violent adult

  offenders: An empirical and theoretical stocktake. Psychology, Crime and Law, 10, 321–334. This paper usefully distinguished violent offender treatment on the basis of their theoretical approaches and provides summaries of studies they deem to be of the highest methodological rigour.

  Ward, T., Polachek, D. L. L., & Beech, A. R. (2006). Theories of sexual offending. Chichester: Wiley. The book outlines and critiques all the historical and current theories of relevance in treating sexual offenders.

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  Abracen, J., Looman, J., & Langton, C. M. (2008). Treatment of sexual offenders with psychopathic traits: Recent developments and clinical implications. Trauma, Violence, and Abuse, 9, 144–166.

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