Forensic Psychology
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Soothill, K., Rogers, P., & Dolan, M. (Eds.). (2000). Handbook of forensic mental health. Cullompton, Devon: Willan Publishing. This book provides an in-depth description of the field of forensic mental health. The first section considers the administrative and social framework, the second section covers the process and systems in place, the third section considers the key issues in forensic mental health and the final section covers the skills for forensic mental health practitioners.
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Pereira, S., Dawson, P., & Sarsam, M. (2006). The national survey of PICU and low secure services: Two unit characteristics. Journal of Intensive Care, 2, 13–19.
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Taylor, P., Walker, J., Dunn, E., Kissell, A., Williams, A., & Amos, T. (2010). Improving mental state in early imprisonment. Criminal Behaviour and Mental Health, 20, 215–231.
World Health Organization. (1992). ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva: author.
NOTE
1 In simple terms this latter group of patients typically develop mental illness subsequent to establishing their offending behaviour.
23 The Rehabilitation of Offenders: Good Lives and Risk Reduction
TONY WARD AND GWENDA M. WILLIS
23.1 CHAPTER OUTLINE
23.1 INTRODUCTION
23.2 WHAT IS THE NATURE OF OFFENDER REHABILITATION? 23.2.1 Values and Rehabilitation
23.3 WHAT ARE THE FEATURES OF EFFECTIVE OFFENDER REHABILITATION?
23.4 DESISTANCE FROM CRIME
23.5 THE RISK-NEED-RESPONSIVITY MODEL OF OFFENDER REHABILITATION
23.6 LIMITATIONS OF THE RISK- NEED-RESPONSIVITY MODEL
23.7 THE GOOD LIVES MODEL 23.7.1 General Assumptions of the GLM
23.7.2 Aetiological Assumptions of the GLM
23.7.3 Practical Implications of the GLM
23.7.4 Empirical Research Supporting the Utility of the GLM
23.8 SUMMARY
LEARNING OUTCOMES
BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO:
Describe the Good Lives Model of offender rehabilitation
Evaluate recent evidence for what works in offender rehabilitation, including contributions from the desistance literature
Understand the advantages of this model compared to a pure risk management approach.
23.1 INTRODUCTION
The rehabilitation of offenders is a multifaceted process involving re-entry, and ultimately reintegration, into social networks and the broader society. While offenders need to work hard at modifying their offence-related personal characteristics, the community also has an obligation to buttress this individual work with social supports and resources. Once amends have been made through undergoing punishment, individuals are entitled to have a chance at redemption and reconciliation (Ward & Salmon, 2009). The presumption of human beings’ equal value is a cornerstone of a decent and just society, and applies just as much to offenders as to the rest of us. Furthermore, the rehabilitation of offenders is a normative and capacity building process and therefore, from a practice perspective, both science and ethical judgment are equally important. In our view, the only legitimate place to start a journey that has involved the infliction of significant harm upon others is one where all human beings are regarded as equal in dignity and moral standing (Laws & Ward, 2011; Ward & Birgden, 2007).
PHOTO 23.1 Rehabilitation is a multifaceted process involving re-entry, and ultimately reintegration, into social networks and broader society.
Source © Keith Bell/Shutterstock
Practitioners require rehabilitation theories, essentially conceptual maps, to help them traverse the various challenges and problems that emerge when working with offenders (Ward & Maruna, 2007). Ideally, these maps will provide guidance on pressing matters such as the overall aims of intervention, what constitutes risk, what the general causes of crime are, how best to manage and work with individuals, and how to best balance offender needs with the interests of the community. In recent years, strengths-based or “restorative” approaches to working with offenders have been formulated as an alternative to the very popular Risk-Need-Responsivity model (RNR; Andrews & Bonta, 2010) of offender rehabilitation (see Ward, Gannon, & Fortune, 2015; Ward & Maruna, 2007). In a nutshell, the primary practice focus of risk management approaches lies in the detection and modification of dynamic risk factors (i.e. criminogenic needs), while strengths-based perspectives seek to create competencies in offenders and reduce risk more indirectly.
Offenders are people like us, and if we start relating to them in ways that reflect this attitude, correctional outcomes may well improve and reoffending rates drop. The desistance research is clear that offenders respond well to practitioners who demonstrate an interest in them and believe in their capacity to turn their lives around (McNeill, Batchelor, Burnett, & Knox, 2005). What is more, treating offenders with respect and decency rather than as sources of contamination to be quarantined (not cured), is likely to make us better people and lessen the risk that we might acquire some of the vices we despise in those who commit crimes.
PHOTO 23.2 Offenders respond well to practitioners who demonstrate an interest in them, and their capacity to turn their lives around.
Source: © Dima Sidelnikov/Shutterstock
The purpose of this chapter is to (1) consider the nature of offender rehabilitation and the efficacy of interventions in reducing reoffending rates, (2) briefly review desistance research, (3) describe the Risk-Need-Responsivity Model (RNR) and highlight its limitations, in
cluding its weak fit with desistance theory and research, and (4) provide a detailed description of a recent strength-oriented theory of offender rehabilitation, the Good Lives Model (GLM). In the following discussion we often refer to the literature on sexual offending to buttress our argument. This is merely for ease of exposition, however, and our comments are intended to apply more generally to all types of offenders.
23.2 WHAT IS THE NATURE OF OFFENDER REHABILITATION?
A bewildering number of terms have been used and different theoretical justifications given for rehabilitation practices. Terms such as rehabilitation, reintegration, re-entry, and desistance, among others, have been employed to refer to the social and psychological processes involved in assisting individuals to cease criminal activity and pursue productive, socially responsible lives (Ward & Maruna, 2007). Psychologists tend to prefer the term rehabilitation while criminologists are understandably suspicious of its connotation that individuals are being returned to a previously acceptable functional state, opting for the less question-begging terms of integration or desistance (Laws & Ward, 2011; Ward & Laws, 2010). While appreciating the points being made in the above debate, we have decided to stick with the label of rehabilitation, as it captures the mainstream discourse in correctional and forensic practice settings.
But exactly what is a rehabilitation theory? Aside from the terminological disputes mentioned above, there has also been a reluctance to analyse the concept of a rehabilitation theory and to outline its core features. This is problematic because unless some kind of analysis is provided, it is almost impossible to critically compare or evaluate different rehabilitation theories. In brief, we view a rehabilitation theory as depicting the overarching aims, values, principles, justifications, and etiological assumptions used to guide forensic and correctional interventions and help practitioners translate these principles into day-to-day practice (Ward & Maruna, 2007). Rehabilitation theories are essentially hybrid theories, containing a mixture of theoretical, ethical, scientific and practice elements. They can be distinguished from types of aetiological theory (e.g. cognitive-behavioural or psychodynamic) or treatment theories, which are more specific in nature and involve the application of principles and practical strategies to change an aspect of the behaviour of individuals. Based on this analysis, the questions posed in Box 23.1 should be asked when evaluating the adequacy of rehabilitation interventions in the forensic and correctional domains.
BOX 23.1 EVALUATING THE ADEQUACY OF INTERVENTION IN CRIMINAL JUSTICE SETTINGS
Is there a rehabilitation theory underpinning practitioners’ actions?
Can this theory explain in general terms the origins of the relevant offending behaviour in the context of mental illness?
What are the broad aims of rehabilitation? How do they relate to the causes of offending?
What are the proposed change mechanisms at work in the rehabilitation process?
Does the rehabilitation theory specify the attitudinal, motivational and relational aspects of treatment? Is there guidance on the therapeutic alliance, including how to manage issues relating to the process of therapy? Is there an integration of content and process?
What are the ethical/philosophical values embedded in the rehabilitation theory? For example, how are offenders represented? Is punishment or treatment emphasised? What is the relative balance between individual and societal rights? How is the risk conceptualised?
23.2.1 Values and Rehabilitation
The task of engaging individuals in efforts to change their criminal attitudes and dispositions is a normative (i.e. value-laden) and capacity building process that has as its primary focus the construction of personally meaningful and socially acceptable practical identities (Laws & Ward, 2011; Lösel, 2010; Ward & Laws, 2011). The “normative” dimension of rehabilitation is illustrated in Box 23.2.
BOX 23.2 CONCEPTS BEHIND REHABILITATION AS IT IS CURRENTLY PRACTICED
The concept of an offender is a moral one, where individuals have been judged to have acted wrongly (and illegally) and have been punished accordingly.
The successful pursuit of a meaningful life relies on individuals identifying what is truly valuable and constructing ways of living that can help them to achieve the outcomes, activities and traits that reflect these values.
The notion of risk reduction, which is typically a major aim of all correctional programmes and intervention efforts, is a value-laden one in the sense that the aim is to reduce, manage and monitor the probability of harmful outcomes to the offender and the community.
Practical or narrative identities that have been demonstrated to be important components of successful desistance are constituted by a diverse range of values (e.g. role standards or expectations, personal traits, activities, practices).
The capacity building dimension of rehabilitation is intimately connected to the normative one by virtue of its stress on the provision of resources and opportunities. The aim is to provide offenders with the internal (i.e. skills, knowledge, attitudes, beliefs etc.) and external (i.e. social supports, employment, education, intimate relationships, leisure activities etc.) conditions to secure their personally endorsed goals, and in this process, result in better or ‘good lives’. Good lives can be described as ones that are characterised by individuals having a sense of purpose, higher levels of wellbeing, and adherence to socially proscribed norms (Ward & Maruna, 2007).
23.3 WHAT ARE THE FEATURES OF EFFECTIVE OFFENDER REHABILITATION?
In his recent review of what works in offender rehabilitation, Lösel (2010) systematically evaluated the theoretical and empirical literature in the correctional domain. His review of the available research evidence indicates that a combination of effective rehabilitation programmes, a greater use of community measures, and adopting a developmental perspective on prevention are likely to culminate in lower levels of crime. Lösel (2010) and other correctional researchers such as Bonta and Andrews (2010) have also identified the features that contribute to the effectiveness of certain types of correctional interventions, and the inadequacy of others. In brief, the outcome literature on general and violent offenders reveals that programmes that are based on a social learning model of offending, are structured, skills-oriented, delivered with manuals by qualified staff, and that operate within supportive environments can result in between 10% and 30% reductions in offending (Lösel, 2010). For example, there have been a number of recent methodologically sound evaluations of the effectiveness of sex offender treatment programmes, all reaching similar conclusions. In their meta-analytic review of sex offender treatment, Lösel and Schmucker (2005) set out to improve on previous reviews by broadening the scope of studies included and increasing the size of the sample pool. They ultimately incorporated 69 studies (n = 22,181) up until 2003 into their meta-analysis, a third of which came from countries outside North America. The results supported the efficacy of treatment, with sex offenders reoffending at a significantly lower rate (11.1%) than the various comparison groups (17.5%). Furthermore, similar results were evident for general offending and also suggested that cognitive behaviour therapy (a skills oriented method) was more effective than other types of treatment. By way of contrast, there was no evidence for the efficacy of purely punitive or deterrent measures such as boot camps, or psychodynamic treatment for sex offenders or other types of offenders (Bonta & Andrews, 2010; Hanson, Bourgon, Helmus, & Hodgson, 2009).
More recently, research has broadened the scope of evaluation and looked more critically at the content of standard intervention programmes. Porporino (2010) argues that the field may have reached a point where further refinement of so-called evidence-based programmes will not produce significant improvements because there is too much uncertainty about how such programmes exert their effect. In relation to the RNR model, he states that “unattended to in that paradigm is how exactly offenders go about constructing new prosocial identities for themselves, what might spark them to do this, what are the motivational pressures that migh
t support the change, where these pressures come from, and how is a new identity (and the future prosocial self it implies) reconciled with the criminal past it is choosing to abandon” (p. 63). Porporino highlights problems with our current knowledge base including that we do not know how evidence-based programmes influence life outcomes years after they were delivered (he cites Farral, 2004, who found that when offenders were asked, they only gave passing credit to these programmes). Porporino draws on the desistance literature to suggest different ways of working with offenders, including developing programmes that do not aim to change or fix offenders, but rather aim simply to help them “look at their lives though some new lenses, sort out their needs and wants, refine their vague wishes and commit to some SMART goals…” (p. 78). He emphasises the importance of contexts – and highlights that teaching skills in isolation serves little purpose: “We seem to believe that once they have the recipe, the meal they cook will be tasty automatically” (p. 80).
Martin, Hernandez, Hernandez-Fernaud, Arregui, and Hernandez (2010) used a quasi-experimental design to investigate whether inclusion of an intervention targeting social and employment integration was more efficacious than social cognitive training (a Spanish adaptation of the Reasoning and Rehabilitation programme) alone. The total sample consisted of 117 repeat offenders, including 87 males and 30 females, mostly convicted for property/drug offences, but also offences against the person. Social and employment integration was facilitated by a social worker and included contact with employers and work places to secure jobs (this group was small – n = 12). There was a six-year follow up. Survival analyses used to investigate time to reoffence showed that the Reasoning and Rehabilitation (R&R) programme produced a statistically significant delay in time to reoffence compared to the control group. Although not significant (perhaps due to low statistical power), participants receiving R&R and the social and employment integration intervention displayed a lengthier time to reoffence (and lower percentage of reoffences) than participants receiving R&R alone. Thus, social and employment integration appeared to strengthen the effects of the social cognitive training programme. These findings provide a positive view of R&R, but suggest the programme fails to take into account an individual’s social and economic context.