Integrating the Good Lives Model into Sexual Offender

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Integrating the Good Lives Model into Sexual Offender Treatment and Practice Pamela M. Yates,

Integrating the Good Lives Model into Sexual Offender Treatment and Practice Pamela M. Yates, Ph. D. Michigan Association for the Treatment of Sexual Abusers Workshop September 24, 2015

Agenda & Objectives Treatment of sexual offenders n Basics and application of Good Lives

Agenda & Objectives Treatment of sexual offenders n Basics and application of Good Lives Model (GLM) n Use of GLM to enhance client motivation, address denial n

Key Publications

Key Publications

Risk/Need/Responsivity Model

Risk/Need/Responsivity Model

Risk/Need/Responsivity Model (RNR) • Risk • Need Principles • Responsivity • Professional Discretion

Risk/Need/Responsivity Model (RNR) • Risk • Need Principles • Responsivity • Professional Discretion

RNR Approach Risk Principle • Offending behavior can be predicted • Treat only individuals

RNR Approach Risk Principle • Offending behavior can be predicted • Treat only individuals who are likely to reoffend (moderate risk or higher) • Match intensity of intervention to level of risk • Reserve higher levels of intervention for higher risk individuals • Static risk factors • Dynamic risk factors

RNR Approach Need Principle • Distinguishes between criminogenic and noncriminogenic needs • Target factors

RNR Approach Need Principle • Distinguishes between criminogenic and noncriminogenic needs • Target factors associated with offending • Changing criminogenic needs associated with changes in criminal behavior/ reducing recidivism • Focus on criminogenic needs • Do not focus on noncriminogenic needs*

RNR Approach Responsivity Principle • Interaction between individual and treatment/service • Use social learning/cognitive-behavioral

RNR Approach Responsivity Principle • Interaction between individual and treatment/service • Use social learning/cognitive-behavioral methods • Responsivity involves knowing your client and tailoring intervention • Deliver treatment using style/mode that matches individuals’ personal characteristics: • Anxiety, personality, learning ability/style, language, culture, literacy, etc.

RNR Approach Professional Discretion • Intended to account for unique circumstances to augment, improve

RNR Approach Professional Discretion • Intended to account for unique circumstances to augment, improve assessment • Not preferred option • Unstructured ≠ reliable • Structured ꞊ more reliable • Actuarial ꞊ most reliable • Ongoing research of overrides needed • ***Overrides should be rare***

Research n Many studies demonstrate that adherence to RNR model leads to improved treatment

Research n Many studies demonstrate that adherence to RNR model leads to improved treatment effectiveness: – Adults – Youth – Men, women – Violent, general offenders – Sex offenders

Research OR Recidivism Sexual 1. 70 Violent (Excluding Sexual) Any Treated Comparison 11. 1

Research OR Recidivism Sexual 1. 70 Violent (Excluding Sexual) Any Treated Comparison 11. 1 % 17. 5 % 1. 90 6. 6 % 11. 8 % 1. 67 22. 4 % 32. 5 % Schmucker & Losel (2008)

Research Recidivism Sexual Violent (Including Sexual) Any Treated Comparison 10. 9 % 19. 2

Research Recidivism Sexual Violent (Including Sexual) Any Treated Comparison 10. 9 % 19. 2 % 22. 9 % 32. 0 % 31. 8 % 48. 3 % Hanson et al. , 2009

Adherence to Risk/Need/Responsivity Number of Principles Adhered To None Odds Ratio (Sexual Recidivism) 1.

Adherence to Risk/Need/Responsivity Number of Principles Adhered To None Odds Ratio (Sexual Recidivism) 1. 17 One . 64 Two . 63 Three . 21 Hanson et al. , 2009

Cost-Effectiveness of Risk/Need/Responsivity Type of Service Mean cost for 1% reduction in recidivism Traditional

Cost-Effectiveness of Risk/Need/Responsivity Type of Service Mean cost for 1% reduction in recidivism Traditional punishment $40. 43 Inappropriate service $19. 67 Appropriate service $2. 80 Probation/parole* $. 25 Presanction intervention* $. 60 Youth detention centre* $9. 40 *Appropriate service only Romani et al. , 2011

Criminogenic and Non. Criminogenic Needs

Criminogenic and Non. Criminogenic Needs

Criminogenic Needs n Antisocial Personality – Impulsive, adventurous pleasure seeking, restlessly aggressive, callous disregard

Criminogenic Needs n Antisocial Personality – Impulsive, adventurous pleasure seeking, restlessly aggressive, callous disregard for others n n n n Grievance/hostility Antisocial associates Antisocial cognitions Low attachment to family/lovers Low engagement in school/work Aimless use of leisure time Substance abuse

Criminogenic Needs for Sexual Offenders n Deviant sexual interests – n n Sexual preoccupations

Criminogenic Needs for Sexual Offenders n Deviant sexual interests – n n Sexual preoccupations Antisocial orientation – n n Children; Paraphilias Lifestyle instability, rule violation, APD Attitudes tolerant of sexual assault Intimacy deficits – – Emotional identification with children Lack of stable love relationships

Dynamic Risk Factors (STABLE – 2007) n n n Significant social influences Capacity for

Dynamic Risk Factors (STABLE – 2007) n n n Significant social influences Capacity for relationship stability Emotional ID with children Hostility toward women General social rejection Lack of concern for others n n n n Impulsive Poor problem solving skills Negative emotionality Sex drive/preoccupation Sex as coping Deviant sexual preference Co-operation with supervision 18

Non-criminogenic needs n n n n Personal distress Major mental disorder Low self-esteem Low

Non-criminogenic needs n n n n Personal distress Major mental disorder Low self-esteem Low physical activity Poor physical living conditions Low conventional ambition Insufficient fear of official punishment

Factors Unrelated to Sexual Recidivism n n Psychological adjustment/personal distress (e. g. , self-esteem,

Factors Unrelated to Sexual Recidivism n n Psychological adjustment/personal distress (e. g. , self-esteem, anxiety, depression) Clinical presentation (victim empathy, denial, motivation for treatment) – Lack of empathy/remorse – Denial/minimisation of sexual offence – Lack of motivation for treatment n n Sexual abuse as a child Seriousness of index offence Insufficient fear of official punishment Major mental disorder Hanson & Bussiere, 1998; Hanson & Morton-Bourgon, 2005; Yates, 2009

Treatment of Sexual Offenders

Treatment of Sexual Offenders

Essential Construct: Goals n Offence-Related Goals: n Common Life Goals (GLM) Goals may be:

Essential Construct: Goals n Offence-Related Goals: n Common Life Goals (GLM) Goals may be: n – Avoidant – Approach – – Sexually deviant Non-sexual Appropriate Offending serves a purpose/function for the individual.

Essential Construct: Goals In traditional RP, focus is on avoidance goals – In GLM/SRM-R,

Essential Construct: Goals In traditional RP, focus is on avoidance goals – In GLM/SRM-R, focus is on what the offender can’t approach goals – actively do/what he must avoid working toward attaining important goals in pro-social manner

Treatment of Sexual Offenders: Context n n Cognitive-behavioral treatment has greatest effect in reducing

Treatment of Sexual Offenders: Context n n Cognitive-behavioral treatment has greatest effect in reducing recidivism (Hanson et al. , 2002; Lösel & Schmucker, 2005) Programs adhering to risk/need/responsivity principles are most effective (e. g. , Andrews & Bonta, 2010; Hanson et al. , 2009) Programs attending to therapeutic process issues are most effective (Hanson, 2006; Marshall et al. , 2002) Structured programs have highest program integrity and are most effective (general criminal behavior; Gendreau & Goggin, 1996)

Treatment of Sexual Offenders: Context n Treatment addresses raising awareness and building skills/strategies re:

Treatment of Sexual Offenders: Context n Treatment addresses raising awareness and building skills/strategies re: dynamic risk factors – – – – Deviant sexual interest/preference Antisocial orientation Significant social influences Intimacy deficits Sexual self-regulation Offence-supportive attitudes Cooperation with supervision General self-regulation

Treatment of Sexual Offenders: Context n n n Motivational enhancement approach/techniques Skills-oriented (cognitive, behavioral,

Treatment of Sexual Offenders: Context n n n Motivational enhancement approach/techniques Skills-oriented (cognitive, behavioral, emotional) Alter problematic patterns of affect, cognition, behaviour Development of pro-social/non-offending attitudes and beliefs Structured but individualized Within GLM/SRM-R framework = good lives, self -regulation, and risk management

Treatment of Sexual Offenders: Context n n GLM developed in response to limitations of

Treatment of Sexual Offenders: Context n n GLM developed in response to limitations of RNR model as applied to treatment GLM/SRM-R integrated model: – To address both goal promotion (a “good/better life”) and risk management – To ensure treatment is focused on goals in addition to risk – To ensure goals are included understanding sexual offending – To ensure assessment, treatment, and supervision address integrated good life/self-regulation plan

Principles of Good Lives Model

Principles of Good Lives Model

Good Lives Model Strengths-based, positive approach n Collaborative, motivational approach n Focuses on: n

Good Lives Model Strengths-based, positive approach n Collaborative, motivational approach n Focuses on: n – Attaining a fulfilling life, psychological well -being – Managing risk n Focuses on how treatment will benefit client/what client will gain from treatment

Good Lives Model Good life attained by understanding what is important to client and

Good Lives Model Good life attained by understanding what is important to client and helping client to obtain these goals n Risk managed by changing and monitoring known risk factors n Risk management assisted by helping client to attain what is important in his life n Both attained by overcoming obstacles and developing capacity n

Good Lives Model n Aims of Treatment and Supervision: – Develop a plan for

Good Lives Model n Aims of Treatment and Supervision: – Develop a plan for life (a good life plan) that is meaningful to individual and includes risk management plan – Establish positive goals and work toward building capacity and opportunities to attain these – Monitor successful implementation of good life plan in community

Good Lives Model n n n Offending = pursuit of legitimate goals via inappropriate

Good Lives Model n n n Offending = pursuit of legitimate goals via inappropriate means Common life goals = circumstances, states of being, etc. that all humans seek for their own sake Secondary goods/goals = instrumental means to attain common life goals

Common Life Goals* n n n GLM proposes 10 common life goals – things

Common Life Goals* n n n GLM proposes 10 common life goals – things individuals seek to obtain for their own sake Value or importance placed on various goals determines good life plan Good life plan = individual roadmap to fulfilling, wellbalanced life *Originally termed primary human goods (Ward & Stewart, 2003)

Common Life Goals n n Goals may be important to an individual to have

Common Life Goals n n Goals may be important to an individual to have in his life Goals may be related to sexual offending by their presence or their absence n Offending, not implementing GLP related to specific flaws attaining goals (4)

Common Life Goals Please go to Handout 2

Common Life Goals Please go to Handout 2

Life: Living and Surviving

Life: Living and Surviving

Knowledge: Learning & Knowing

Knowledge: Learning & Knowing

Being Good at Work and Play

Being Good at Work and Play

Personal Choice and Independence

Personal Choice and Independence

Peace of Mind

Peace of Mind

Relationships and Friendships

Relationships and Friendships

Community: Being Part of a Group

Community: Being Part of a Group

Spirituality: Having Meaning in Life

Spirituality: Having Meaning in Life

Happiness

Happiness

Creativity

Creativity

Flaws in Good Life Plan: When Things Don’t Go As Planned

Flaws in Good Life Plan: When Things Don’t Go As Planned

Harmful/Problematic Means

Harmful/Problematic Means

Narrow Scope: Putting all your eggs in one basket

Narrow Scope: Putting all your eggs in one basket

Conflict: Pursuit of one goal interferes with pursuit of another goal

Conflict: Pursuit of one goal interferes with pursuit of another goal

Lack of Capacity Internal External

Lack of Capacity Internal External

Enhancing Motivation Using GLM Approach

Enhancing Motivation Using GLM Approach

Enhancing Motivation n Basic/standard MI strategies: – Demonstrate empathy – “Roll with resistance” –

Enhancing Motivation n Basic/standard MI strategies: – Demonstrate empathy – “Roll with resistance” – Understand ambivalence – Be collaborative – Supportive challenging vs confrontation – Guide vs direct treatment – Etc.

Enhancing Motivation Using GLM n Benefits of treatment for client – What client will

Enhancing Motivation Using GLM n Benefits of treatment for client – What client will gain from treatment n Fully integrate GLM into all components of treatment – vs “add-on” approach Support client autonomy/independence n Frame treatment in approach goals n – E. g. , healthy relationships vs intimacy deficits

Enhancing Motivation Using GLM What CLGs does client hope to attain? n How important

Enhancing Motivation Using GLM What CLGs does client hope to attain? n How important are these goals? n Any additional goals? n What is missing from life? n How would client like life to be different? n What is important that would motivate change? n

Enhancing Motivation Using GLM n What are client’s strengths – To embark on change/maintain

Enhancing Motivation Using GLM n What are client’s strengths – To embark on change/maintain motivation? – On which treatment can build? n Understanding function of offending for client: – What goal(s) was he trying to attain? n How can CLGs be attained differently?

Enhancing Motivation Using GLM n Build integrated risk management/good life plan – Client’s “roadmap”

Enhancing Motivation Using GLM n Build integrated risk management/good life plan – Client’s “roadmap” to better life – Reduce & manage risk – Achieve goals n Monitor implementation of good life plan in supervision – In addition to monitoring & managing risk

Enhancing Motivation Using GLM: Example

Enhancing Motivation Using GLM: Example

Case Illustration: “Rakesh” 30 -year-old male, East Indian decent n Index offending = sexual

Case Illustration: “Rakesh” 30 -year-old male, East Indian decent n Index offending = sexual penetration of a child under 16 years n Victim = 12 -year-old sister-in-law n Prior convictions for common assault, producing false documents n

Rakesh: RNR Assessment Static-99 R: Moderate-high n Stable-2007: Moderate n – Capacity for relationship

Rakesh: RNR Assessment Static-99 R: Moderate-high n Stable-2007: Moderate n – Capacity for relationship stability, poor problem-solving skills, negative emotionality, sex as coping, sexual preoccupation n Responsivity factors: some language barriers, motivation, cultural norms and values

Case Analysis: Rakesh n Common Life Goals Important to Rakesh: n – – –

Case Analysis: Rakesh n Common Life Goals Important to Rakesh: n – – – – Relationships Spirituality Community Personal Choice and Independence – Life n Common Life Goals Implicated in Offending: – – Relationships Peace of Mind Happiness/pleasure Knowledge (absent) Flaws in Good Life Plan: n Conflict Means Capacity (internal) Dynamic Risk Factors: – Sexual self-regulation (sex as coping, sexual preoccupation) – General self-regulation (negative emotionality, poor problem solving)

Dealing with Denial

Dealing with Denial

Definition of Denial (Miriam Webster) n n n n n de·ni·al Pronunciation: di-nī(-ə)l, dē-

Definition of Denial (Miriam Webster) n n n n n de·ni·al Pronunciation: di-nī(-ə)l, dē- Function: noun Date: 1528 1: refusal to satisfy a request or desire 2 a (1): refusal to admit the truth or reality (as of a statement or charge) (2): assertion that an allegation is false b: refusal to acknowledge a person or a thing : disavowal 3: the opposing by the defendant of an allegation of the opposite party in a lawsuit 4: self-denial 5: negation in logic 6: a psychological defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality – — in denial n : refusing to admit the truth or reality of something unpleasant <a patient in denial about his health problems>

Defining Denial n n Many types of denial have been identified in the literature.

Defining Denial n n Many types of denial have been identified in the literature. Marshall et al. (2006) identified multiple types of denial, each with subtypes: – Complete denial (e. g. , false accusation, misidentification, memory loss) – Partial denial (e. g. , memory loss, denial that it was abuse, denial of having a problem) – Minimization (e. g. , of offending, of responsibility, of harm caused, of planning) – Denial of denial!

Quiz n What are some examples of denial in everyday life? Or perhaps politics?

Quiz n What are some examples of denial in everyday life? Or perhaps politics?

Denial? “… But the other thing is that we have to have the capacity

Denial? “… But the other thing is that we have to have the capacity to interrogate — not torture, but interrogate people to learn information…. I've said to the people that we don't torture, and we don't. " George W. Bush to Katie Couric, CBS Evening News, September 6, 2006

Denial? n “… global warming [is] the worst "market failure" ever”…. the "climate-change" scare

Denial? n “… global warming [is] the worst "market failure" ever”…. the "climate-change" scare is less about saving the planet than, in Jacques Chirac's chilling phrase, "creating world government". – Gordon Brown, UK Prime Minister and his chief economist, 2006 n “[Climate change] occurred naturally and was not manmade … Resources should be used to adapt to the consequences of climate change, rather than King Canutestyle vainly trying to stop it … The tactic used by the 'green gang' is to label anyone who dares disagree with their view of climate change as some kind of nutcase who denies scientific fact". n Northern Ireland Environment Minister Sammy Wilson BBC News, September 5, 2008

Denial? “Because I exercise regularly, eating this [insert name of dessert here] will not

Denial? “Because I exercise regularly, eating this [insert name of dessert here] will not affect my diet. ” n. Pamela M. Yates, to friends anytime, anyplace

Denial? “I didn’t mean to sexually assault her. I had just gotten out of

Denial? “I didn’t mean to sexually assault her. I had just gotten out of the shower and was walking and I tripped and fell down the stairs. She happened to be at the bottom of the stairs. As I was falling, my bathrobe fell open and my penis fell out and fell into her mouth. ” n Adapted from A. Salter, date unknown

Quiz n n n n What are some examples of denial you use personally?

Quiz n n n n What are some examples of denial you use personally? Was there an occasion when you denied something outright even though you knew you had really done it? Why did you do it? What were you protecting? What emotions and thoughts were behind this decision? What did you have to lose? Why did you not then become honest later?

What Research Says: The Bottom Line n Offenders who complete treatment reoffend at lower

What Research Says: The Bottom Line n Offenders who complete treatment reoffend at lower recidivism rates than those who do not complete treatment (Hanson & Bussière, 1998). n Denial has not been convincingly demonstrated to be related to recidivism, except possibly among lower risk offenders (requires replication)

What Research Says: The Bottom Line n n Research on relationship between denial and

What Research Says: The Bottom Line n n Research on relationship between denial and treatment success is inconclusive due to methodological and measurement, problems, confounding factors, etc. But no convincing evidence yet that denial interferes with treatment progress, attaining treatment gains, or treatment success or that denial cannot be changed through treatment. Yates, P. M. (2009). Is Sexual Offender Denial Related to Sex Offence Risk and Recidivism? A Review and Treatment Implications. Psychology Crime and Law Special Issue: Cognition and Emotion, 15, 183 -199.

The Bottom Line There too great a focus in treatment on denial given the

The Bottom Line There too great a focus in treatment on denial given the lack of support for its influence on progress and recidivism, at the expense of targeting known risk factors with stronger demonstrated relationships to recidivism

So What Now? Understand Origins of Denial Why deny/minimize? n n n n Avoid

So What Now? Understand Origins of Denial Why deny/minimize? n n n n Avoid judgments by others Self-presentation in face of wrongdoing Present self in more acceptable way Understanding behavior is wrong Alleviate guilt, shame Treatment expectations Motivation/commitment to change Relationship to cognitive schema

So What Now? Treatment n Do not exclude from treatment n Develop effective therapeutic/working

So What Now? Treatment n Do not exclude from treatment n Develop effective therapeutic/working alliance Use motivational enhancement approach/techniques Determine function denial/minimization serves for individual Treat as common cognitive distortion Treat as responsivity factor n n – Minimize number of categorical deniers in group – Separate categorical deniers’ group

So What Now? Treatment n Use GLM approach: – Determine function/purpose of offending for

So What Now? Treatment n Use GLM approach: – Determine function/purpose of offending for individual – What individual will gain from disclosure (cost-benefit analysis) – How disclosure will contribute to goal attainment, better life – Risk of having a “crappy life”

So What Now? Treatment Methods n Do not approach denial/minimization as intentional deception Validate

So What Now? Treatment Methods n Do not approach denial/minimization as intentional deception Validate client’s experience Understand openly discuss ambivalence n Encourage emotional expression n Supportively challenge cognitive distortions Understand dismantle underlying cognitive schema n n n – Cost-benefit analysis – vs CBT rational/logical approach

So What Now? Treatment Methods n n n Do not focus on full disclosure

So What Now? Treatment Methods n n n Do not focus on full disclosure of all details of all offences Conduct disclosure exercises in steps Use “face-saving” methods – Memory’s “filing system” – Explore offence hypothetically Recall day of offence Provide immediate reinforcement of any evidence of accepting responsibility DO NOT punish disclosure when it occurs!

So What Now? Therapist Ask yourself: Am I considering denial to be more problematic/pathological

So What Now? Therapist Ask yourself: Am I considering denial to be more problematic/pathological than the offence? n Am I punishing rather than treating? n Am I expecting too much of client? n Am I confronting client or supportively challenging? n How do I react when confronted with denial/minimization? n

Thank-you for your participation!

Thank-you for your participation!