July 13, 2010

"Treatment": Backwards and upside down?

Don't focus on "denial" or "lack of empathy," warn sex offender treatment experts

Social scientists have long known about the human tendency to divide into in-groups and out-groups. Current popular fascination with so-called psychopaths illustrates this us-versus-them bent. If psychopaths represent evil, that makes the rest of us good. The non-criminal breathes a sigh of relief to discover a distinct "criminal brain" (unless, as neuroscientist Jim Fallon found, we share the abnormality).

Nowhere is this infrahumanisation more extreme than in regards to sex offenders, who are seen as a species apart. Infrahumanisation prevails not just among the general public, but among treatment providers as well. Sex offenders, the popular therapeutic wisdom holds, are likely to lie, distort, and manipulate. Thus, sex offender programs target these attributes in treatment. If a sex offender accepts responsibility and learns empathy, the theory goes, he will be less likely to reoffend.

Not so fast, say three highly experienced scholars and clinicians of sex offending: "As it turns out excuse-making is healthful and results in a reduction in reoffending. It may, therefore, not only be counter to accepted principles of offender treatment to attempt to change noncriminogenic distortions, it may result in increased rates of reoffending."

In their article in the most recent issue of Sexual Abuse in Australia and New Zealand, the researchers argue that many of the entrenched assumptions underlying sex offender treatment are not empirically supported and may actually impede therapeutic progress. Lead author Bill Marshall, an award-winning professor emeritus at Queen's University and Director of a sex offender treatment program in Kingston, Ontario, is one of the world's preeminent scholars of sex offending, with more than 300 publications (including 16 books) dating from long before the fad took hold. Liam Marshall is the primary therapist at the Sexual Offender Treatment Program at Millhaven Assessment Unit, a high-security federal penitentiary in Canada. Jayson Ware, a graduate student at the University of New South Wales who works in the Australian prison system, also specializes in the treatment of sex offenders.

Accepting responsibility. That has a nice moral ring to it. But what does it really mean? And does it translate into a reduction in crime? Most definitely not, the authors state:
[T]aking responsibility, as this is commonly understood in offender treatment, requires the offender to indicate that the behavior has an internal stable cause; that is the client offended because he is a "deviant" or a "bad person." Such attributions are not conducive to change but rather are likely to persuade the offender that his behavior is intractable…. Perhaps it is those sexual offenders who blithely, and readily, admit to all aspects of their offenses, that are the ones who should be given the most therapeutic attention and yet in most programs the full admitters are seen as ideal participants.
In practice, the authors point out, "taking responsibility" often means agreeing with the victim's version of events, which is automatically assumed to be Truth. Treatment manuals instruct clinicians to aggressively challenge any rejection of the victim's account. It is this therapeutic aggression, in turn, rather than the offender's initial minimization or excuse-making, that blocks effective treatment:
Sometimes these challenges are quite harsh and clearly imply that the offender is lying. This type of confrontational challenging has been shown to prevent progress toward the goals of treatment.... Whatever style of challenging is employed, the underlying assumption is that the official record of the offense is a veridical account which the offender must come to agree with if he is to progress further in treatment....

Overall it is hard to see the value in having sexual offenders provide offense details that match the victim's account.... [D]oing so may produce all manner of problems both for the target client and for the other group members. These potential problems might be tolerable if, indeed, overcoming denial and minimizations did result in an enhanced acceptance of responsibility but there is no evidence that it does. Most importantly, there is no evidence that an increase in acceptance of responsibility leads to a reduction in reoffending.…

Therapists may be better advised to change their views on this issue and alter their treatment approach. What we want sexual offenders to do is not blame themselves for their past but rather accept responsibility for their future....

Excuses are attempts to preserve the person's reputation, to prevent the erosion of self-esteem, and to avoid feelings of shame. Stigmatizing shame, where the person concludes they did something wrong because they are bad, leads to an increase in criminal behavior…. While therapists see excuses as examples of criminogenic thinking, extensive research shows that those offenders who offer excuses for their crimes are at lower risk to reoffend than those who accept full responsibility.
The authors similarly tackle the thorny issue of "empathy." Empathy training is a primary component of 94 percent of sex offender treatment programs in North America, according to one survey. Yet a supposed empathy deficit does not predict reoffending, and should not be a focus of treatment, the authors contend.

Finally, the authors address the widespread assumption that sex offenders elaborately plan their crimes. When sex offenders claim an offense "just happened," clinicians accuse them of lying or minimizing. But what if they are telling the truth, and "some, or even most, sexual offenses are not planned?" Again, therapists' insistence that clients adopt their version of reality is an adversarial stance that prevents therapy from succeeding. Offenders learn to keep their true thoughts to themselves and parrot the therapist's opinions, promoting cynicism rather than healing.

So what is left, if therapists ignore excuses, denials, or deficient empathy? Research has established two stable sets of distortions as highly predictive of reoffending, the authors remind us: attitudes tolerant of rape or of child sexual abuse, and emotional identification with children. It is these distorted attitudes, as well as many individual-specific factors -- such as depression, substance abuse, and/or trauma histories -- that put offenders at risk. These empirically established factors, then, should be the foci of treatment aimed at reducing risk.

I highly recommend the full article, "Cognitive Distortions in Sexual Offenders: Should They All Be Treatment Targets?" It is available upon request from the authors. Jayson Ware, one of the authors, will be presenting at the upcoming conference of the Association for the Treatment of Sexual Abusers in Phoenix, Arizona. His Oct. 21 presentation is in the session, "Re-Examining Sexual Offender Treatment Targets," chaired by Ruth E. Mann, PhD of Her Majesty’s Prison Service (UK).


Melissa said...

Very interesting. A couple of thoughts:

The article mentions that perpetrators who openly admit responsibility are more likely to re-offend. That makes sense - the worst offenders are hardened to it, and have no scruples about doing so again, and no problem telling people so. But then the authors have argued for a cause and effect relationship, and suggest that learning to talk openly and take responsibility will provoke reoffending, which I don't see evidence for in this summary of the article. Talking openly at the beginning of therapy may be an indicator of reoffense, but I don't see why it would be a cause of it.

The section that addresses preplanned offenses is interesting. In my inexpert opinion, it seems that sexual crimes of opportunity are still rooted in unhealthy thought patterns - a healthy individual won't take advantage of an opportunity. So while I agree with the authors that the degree of preplanning may not be as certain or as important as current treatments portray, it's still important to consider what thought processes led up to the event.

The authors' argument appears to be wrapped up in one sentence: "Offenders learn to keep their true thoughts to themselves and parrot the therapist's opinions, promoting cynicism rather than healing." This is certainly true. If the therapist fails to establish a connection with the offender, the therapy can be worse than useless. But this is true of any type of therapy. "Accusing [the patient] of lying and minimizing" doesn't work, but there's a very fine line between that and challenging mental distortions, which are essential to good therapy. I'm glad the authors are asking the therapeutic community to question that line.

Anonymous said...

Another point I would like to make as a therapist is that one can be "not responsible" and also not be a 'bad'person. We make a clear distinction between behavior, which can be altered, and character, a much more intractable part of a person's make-up, and something which we never malign. Also, many offenders admit responsibility, and are emotionally congruent when they do so. That makes all the difference in their risk of reoffense.

Anonymous said...

Glad to see the current beliefs being challenged. As it now stands, at least with the system and therapists of which I have knowledge, agreeing with the "victim's" version of events is essential. Feeling like a scum-bag is essential. This at least gives food for thought.

matthewhobbs444 said...

Very interesting article. It stated that through research, two distorted factors were evident in those that would reoffend. One who is tolerant of rape of a child and sexual abuse. And one who identifies with children emotionally. That said I know many offenders that find rape of a child untolerable, even in the prison systems. It is a discusssion that has come up many times and in many different ways. This is a true fact. And this fact alone should be a guide as to who is at high risk to offend. Out of all the Registered offenders on the registry, only a few would be tolerable of child rape, and sexual abuse. There are two very clear facts between a rapist and a child rapist. the rapist dispise the child molesters. Now as crazy as this sounds it is the way it is. I believe this study is onto to something, big.

Tusau said...

My crime was child pornography, pictures that were scattered among adult pornography. In my case, there is the assumption of a hands-on offense.

Therefore, the courts, the PO department, and my church all believe that I am a bad person… that I must have touched a child. I show them the evidence: Two therapists who say I am not a threat to children, comprehensive psychological tests saying the same thing, two lie detectors tests that indicate no hands on offenses against children.

I remember trying to explain to the judge in my court case that I was not a threat to children… he became irate because I was not sorry enough for my crime. I refuse to think of myself as a sex offender… I also will not accept the guilt trip that the establishment puts on me.

Most men convicted of sexual offenses want to return to a productive life. It is impossible for most of them so because of the insidious stigma, hysteria that are associated with this crime. They hole up in their apartments, under some bridge or at a shelter… broken men and women who are condemned and not allowed to redeem themselves… where is the Christian forgiveness, the justice that should be on the side of these men.