February 28, 2011

Positive approach key to sex offender change

Trailblazing authors have walked the walk for 40 years

John distorts his offense history and refuses to accept his sexual deviance. Although the other members of his treatment group vigorously challenge him, they are not fully transparent in their own disclosures. The therapist feels stymied. What should she do?

First, she should abandon confrontation and negative labeling. Next, she should race lickety-split for her computer and order a radical new book that will help her succeed as a therapist and also feel better about herself.

The visionary book is Rehabilitating Sexual Offenders: A Strength-Based Approach, written by the team at Rockwood Psychological Services in Canada. Under the leadership of Bill Marshall, a pioneer in the field, the program has successfully treated sex offenders for 40 years. Unlike most sex offender treatment programs, Rockwood has a negligible refusal rate and a negligible dropout rate. Offenders enter therapy, they complete therapy, and when they get out they are very unlikely to reoffend.

Therapist is the key

As psychologists know from the general treatment research, the therapeutic alliance is a primary factor in successful therapy, with more impact than any specific theory or technique. With sex offenders, who are often mistrustful and reluctant to enter therapy or disclose information that may be used against them, the therapist is even more critical, accounting for between 30% to 60% of change.

Like anyone else (only more so), John isn’t going to benefit from confrontation or shaming. Instead of being critical or judgmental, an effective sex offender therapist is empathetic, warm, respectful, and even humorous at times.

Toss out those iatrogenic labels

Language is powerful. When we call people names -- pedophile, rapist, offender, sex offender, deviant – we encourage their negative and harmful beliefs about themselves. That certainly doesn’t reduce shame or foster change.

Instead, the Rockwood authors (Bill Marshall, his son Liam Marshall, Geris Serran, and Matt O’Brien) focus on strengths, invoking a vocabulary heavily influenced by the positive psychology movement and motivational interviewing.

Their guiding principle:

Inside every offender is a good person waiting to throw off the burden of his dysfunctional past. It is the therapist’s job to facilitate the emergence of that good person.

(Ironically, they do use the term “psychopath,” if only to say that scores on the Psychopathy Checklist  are NOT predictive of treatment failure or recidivism. Of the 70 offenders in their outcome research who scored high on psychopathy, only one reoffended during the 8-year follow-up period.)

The authors do not mince words in critiquing the dominant treatment approach that emphasizes deficits and avoidance. When treatment fails, they say, it is most likely because it was too confrontational. When confronted, patients learn to say what the therapist wants to hear, rather than to genuinely engage.

Denial: Not necessarily a bad thing

One of the most unusual features of the Rockwood program is its emphasis on helping men who continue to deny their offenses despite having been convicted. The therapists do not challenge these offenders to admit their crimes. In fact, they don’t think admissions are that big a deal. They offer several reasons for this:
  • Given what we know from the false-confession literature, some deniers truly are innocent. And it is impossible to know which ones.
  • Forcing an offender to match his account to his victim’s is silly, because we know from research that victim accounts are highly unreliable. 
  • Men who deny offending or offer excuses actually have lower rates of recidivism. As Shadd Maruna found in his research with criminal offenders in the UK, excuse-making is related to good mental health as well as to guilt, which (unlike shame) suggests prosocial values.

For those engaged in treatment, the manual gives loads of practical advice on how to structure and run a program. For forensic evaluators on the outside looking in, who have watched in mounting horror as iatrogenic practices are systematically mislabeled as “treatment,” this book lays out the research that can help you explain real treatment to judges, jurors, and attorneys.

Rehabilitating Sexual Offenders is an auspicious debut for the American Psychological Association series, Psychology, Crime, and Justice, edited by Shadd Maruna. I can’t wait to see what’s next.

If you found this review helpful, please visit my Amazon review (HERE) and click on "yes" (this review was helpful). 

The art on this page is by Ricky Romain, an internationally acclaimed human rights artist in the UK whose work focuses on themes of justice, alienation and sanctuary. Mr. Romain has kindly given permission to showcase his art here. I encourage you to check out his extensive online gallery (HERE).

February 27, 2011

Encephalon carnival 84: Psychology-neuroscience roundup

The dominant theme of this month's Encephalon blog carnival is that no matter how straightforward something may appear, it is not always that simple. Among the intriguing offerings:
  • In The Mathematician in the Asylum, forensic psychologist Romeo Vitelli at Providentia explores the life of Andre Bloch, a leading French mathematician who spent 30 years in an asylum after knifing three family members to death.   
Hosting the 84th edition of Encephalon is Janet Kwasniak, who blogs about consciousness at “Thoughts on Thoughts.” Janet is in France, but wherever you are the content is just a click away – HERE.

February 25, 2011

Napa Hospital chief gets 248 years in prison

A year after police marched into California's largest psychiatric hospital and arrested its executive director, Claude Edward Foulk Jr. has been sentenced to 248 years in state prison. A jury had convicted him of sexually assaulting a foster son he adopted back in the 1960s.

Prosecutors said they identified more than a dozen other boys molested by Foulk over a 40-year period. Those cases were too old to prosecute. However, four of the now-grown men, all boys from abusive homes whom Foulk took in through the foster care system, testified against Foulk at trial.

"You are a sick, sick man," the judge told Foulk. "And the irony is you were director of the state hospital. How does that happen? You should have been the number one patient."

Foulk was appointed to head the beleaguered hospital in 2007, shortly after the U.S. Attorney General's Office negotiated a consent decree mandating sweeping changes aimed at improving patient care and reducing suicides and assaults. The federal investigation had revealed widespread civil rights violations at Napa, including generic "treatment" and massive overuse of seclusion and restraints. Napa is the only state psychiatric hospital in Northern California, and houses defendants undergoing competency restoration treatment and those found not guilty by reason of insanity.

At the time of his appointment, Faulk was lauded for his lengthy career in mental health services in both the public and private sectors.

February 23, 2011

Paint brushes and soap: The slippery slope of unfettered power

Courts rebuke detention centers for arbitrary and pretextual practices 

The case of the killer paint brush

When the government filed a petition seeking to civilly commit M.F. for sex crimes he might commit in the future, the elderly artist decided to go quietly. He gave up his right to a trial, in exchange for a legal order that he be allowed to do his art in his remaining years.

But officials at Missouri’s detention center resisted being told how to operate. M.F.’s security level was changed from green (low risk) to red (high risk), and his art supplies were taken away. When he challenged this in court, a government psychologist testified that the art supplies posed a threat to the institution’s security: Another patient could use them to hurt someone, or they might even block an evacuation route in the event of an emergency.

Calling the invocation of security “pretextual,”* a judge ordered the institution to return the paint brushes.

No soap unless we say so

In detention sites across the United States, objects far more innocuous than paint brushes are being wielded as weapons against captive sex offenders who -- like M.F. -- decline to enroll in proffered treatment.

In New Jersey, “A.J.,” a sex offender who declined treatment (insisting he is innocent) was denied basic hygiene items such as toilet paper, soap, shampoo, toothpaste, shaving cream and laundry detergent unless he could pay for them. The items were given free as prizes to sex offenders who enrolled in treatment. After a 3-day hearing, a judge ruled that the jailers were being “arbitrary and capricious”:

“Like food and clothing, personal hygiene items are central and core requirements of civilized existence. The refusal of the department of corrections to provide personal hygiene items to inmates at regular intervals is unreasonable. I also find that in this particular case the department of corrections sometimes observes its own rule and sometimes it doesn’t. So it’s capriciously applied as well.”

Tip of the iceberg

Arbitrary, vindictive, petty and sometimes just plain silly practices like these are not rare. Rather, they are commonplace experiences in the state hospitals where thousands of U.S. sex offenders are detained indefinitely based on future risk, after having finished their prison sentences.

The organizational culture is a setup for petty tyranny to run amok.

Unlike in a real hospital, there is an inherent tension between detainees and staff. Under the civil commitment laws, detention sites are supposed to provide treatment to reduce the sex offenders' future risk. But most of the residents decline to engage in treatment. They are resentful about being detained, and see the generic group therapy as a humiliating sham. For staff, in turn, the impossibility of their task lowers morale and can spawn resentment of offenders.

It is hard not to feel morally superior to the offenders. Many are not sympathetic characters. They have assaulted their way through life, leaving behind a swath of psychic destruction to children and women. Their mistreatment is easy to justify as deserved, or in service to the greater good of public safety.

Add to this incendiary mix the few bad apples in any organizational barrel. Literary trickster Carlos Castaneda called them little petty tyrants, who persecute and inflict misery without causing death. If you have ever worked in a prison or mental hospital, you know that such environments provide fertile soil for pinches tiranitos.

As we saw at Abu Ghraib, a frustrated work force with unfettered power over a maligned and powerless population is a recipe for abuse. Indigent prisoners don’t exactly have a voice to complain about abuses of authority. This is especially true for sex offenders. No one wants to hear a victimizer whining about being a victim. 

Alienation and despair

When Martin Seligman played mind games on dogs, giving punishments arbitrarily and not allowing escape, the dogs became apathetic and depressed. "Learned helplessness" resulted from their absolute lack of control or agency. The same thing happens with humans.

The arbitrary and capricious treatment that sex offenders are subjected to creates a vicious cycle. It ramps up alienation, despair, and bitterness. And this mindset is not exactly conducive to the types of prosocial change that we want to see in offenders.

Conditions are so unbearable in these facilities ostensibly designed for care and treatment that three offenders are using “necessity” as a defense for an attempted escape. The three tried to escape from Minnesota’s Moose Lake facility, which was the subject of an ACLU complaint over alleged violations of patients’ rights.

Last week, the would-be escapers unsuccessfully pleaded with a judge to let them stay in the county jail rather than returning them to the hospital, where they said conditions were intolerable:

“Please don’t subject me to any more mental and physical abuse without recourse. Please don’t send me back. I’d rather be euthanized.”

The judge nonetheless ordered the man sent back:

“I don’t have the jurisdiction to address the conditions [at the detention site] or the circumstances of your placement there.”

And therein lies the rub. Legislatures enact civil detention laws and set their parameters. But once the massive and costly facilities are up and running, it is easy for administrators and staff to forget that they are just functionaries, beholden to higher authorities for guidance. When this happens, the courts should step up. They hold ultimate responsibility for making sure that government operations are legal and fair.

A.J. and M.F. were lucky to have tenacious lawyers protecting their rights. Even then, their victories were tiny -- the right to soap and paint brushes. More typically, detainees are out of sight and out of mind. No one is watching, and no one cares.

Back in the day, Russian writer Fyodor Dostoyevsky mused that the degree of civilization in a society could be judged by entering its prisons. I wonder what his verdict would be if he could travel through time and visit a modern civil detention facility.

Related posts:

*In the context of mental health law, legal scholar Michael Perlin defines pretexuality as “the ways in which courts accept—either implicitly or explicitly—testimonial dishonesty and engage similarly in dishonest and frequently meretricious decision-making, specifically where witnesses, especially expert witnesses, show a high propensity to purposely distort their testimony in order to achieve desired ends.” I used the term in the title of my just-published historical review of the term “hebephilia,” citing its use in court as a pretextual mental disorder.

February 19, 2011

Steffan's Alerts: New column features fresh scholarship

In a new column launching today, forensic psychologist Jarrod Steffan scours the academic journals as they roll off the presses and brings you his top choices for articles of interest to forensic practitioners. Just click on a title to go to the journal site and read the full abstract; click on an author's name to request the full article. Feel free to leave comments on this new feature in the comments section of the blog.

Expert testimony in false confession cases

Mock jurors perceive that coercive interrogation tactics elicit confessions from guilty but not innocent suspects. Authors Iris Blandon-Gitlin, Katheryn Sperry, and Richard Leo go on to report the effects of an actual disputed confession case on jurors’ perceptions of false confessions in the current issue of Psychology, Crime and Law.

Meta-analysis of mental health courts

Are mental health courts working? Preliminary analyses point in the direction of success, according to an article by Christine Sarteschi and colleagues published in the Journal of Criminal Justice.

In the new issue of Criminal Justice and Behavior, Claudia E. Van Der Put and colleagues provide data showing that dynamic risk of adolescents' decreases as they age, thereby affecting the effectiveness of risk assessment and related interventions.

Preliminary data, reported by lead author Randy Otto in Assessment, suggest that a new measure called the Inventory of Legal Knowledge may assist evaluators in appraising defendants’ response style in competency to stand trial evaluations.
  • A previous blog post on the new instrument is HERE.

Compared to killers of nonprostitutes, serial murderers of prostitutes have killed more and for longer periods of time, according to a study by Kenna Quinet published in Homicide Studies.

In Aggression and Violent Behavior, Kathleen Fox, Matt Nobles, and Bonnie Fisher take stock of the literature on stalking assessment and, based on their review of 56 studies, recommend guidelines for future research.

Steffan's alerts are brought to you by Jarrod Steffan, Ph.D., a forensic and clinical psychologist whose practice is based out of Wichita, Kansas. For more information about Dr. Steffan, please visit his website.

February 13, 2011

Justice perverted: Sex offense law, psychology and public policy

 Oxford University Press has just released this provocative new title of likely interest to many of my readers. It's written by esteemed forensic psychologist and attorney Charles Patrick Ewing, a law professor at The State University of New York, University at Buffalo Law School.

Over the past quarter century Congress, state legislatures and the courts have radically reshaped America's laws dealing with sex offenders in an effort to reduce the prevalence of sex offenses. Most convicted sex offenders must now register with the authorities, who then make information about them available to the public. Possession of child pornography has been made an extremely serious crime often punishable by prison sentences that dwarf those meted out to child molesters, rapists, robbers, and even killers. Federal law now imposes a minimum sentence of ten years in prison for those convicted of using the internet to attempt to lure minors for sex. And the federal government and 20 states have "sexually violent predator" laws that allow the indefinite civil commitment of convicted sex offenders to secure institutions for treatment after they have served their full criminal sentences.

All of these changes in sex offender law, as well as numerous others, have been based at least in part on input from psychology, psychiatry and the social sciences. Moreover, enforcement and administration of many of these laws relies to a large extent on the efforts of mental health professionals. However, many questions about this involvement remain largely unanswered:
  • Are these laws supported by empirical evidence, or even by well-reasoned psychological theories? Do these laws actually work? 
  • Are mental health professionals capable of reliably determining an offender's future behavior, and how best to manage it? 
  • Are experts capable of providing effective treatment for sex offenders -- i.e., treatment that actually reduces the likelihood that an identified sex offender will re-offend?
Drawing on research from across the social and behavioral sciences, Dr. Ewing weighs the evidence for the spectrum of sex offense laws, to occasionally surprising results. A rational look at an intensely emotional subject, Justice Perverted is an essential book for anyone interested in the science behind public practice.

What others are saying:
Ewing …gives a lucid, objective analysis of the laws, easily separating myth from reality in this intensely emotional area.
-- Philip H. Witt, Ph.D., ABPP, President, American Academy of Forensic Psychology, co-author, Evaluation of Sexually Violent Predators
A remarkable, eye-opener of a book—Professor Ewing brings to this highly controversial subject his knowledge as both a law professor and as a practicing forensic mental health expert.
--Alan M. Goldstein, Ph.D., ABPP, Professor Emeritus, John Jay College of Criminal Justice
This book is a breath of fresh air. It debunks the media-driven frenzy of fear, hate mongering, and utterly irrational laws that do far more harm than good. Professor Ewing writes thoughtfully, carefully, and persuasively. This book should be read by all who care about—and think about—this topic.
 --Michael L. Perlin, Law Professor, Director of International Mental Disability Law Reform Project, New York Law School
 Ewing is a prolific author, and never disappoints. His other recent books, which I have reviewed, include:

February 11, 2011

New site features competency rogues' gallery

At long last, I have completed a WordPress redesign of my decrepit old website. The new site features a compilation of publicly accessible resources on legal competencies, including reports, videos, and court transcripts on cases ranging from Ted Kaczynski (the Unabomber) To boxer Mike Tyson to suspected "dirty bomber" Jose Padilla. These resources, most free and online, are available for instructors, students, practitioners, and anyone else who is interested. For training purposes, it’s hard to beat real-life reports and videos, especially from high-profile or otherwise fascinating cases. To see the full gallery, go to my new website -- HERE -- and click on the Resources tab. Have fun exploring. And please submit a comment on this page if you know of any other resources that I didn't list.

Thanks to all of you who helped with this project by giving me leads -- Denis, Steve, Frank, Eileen, Christina, Ronna, and others.

February 7, 2011

Special issue, Current Directions in Psychological Science

The February issue offers a cutting-edge roundup of psychology-law topics, with contributions from many luminaries. Click on an author link to request a reprint.
  • Expert Psychological Testimony by Brian L. Cutler and Margaret Bull Kovera (I haven't finished reading this one yet, but I see that it discusses the critical issue of adversarial allegiance, identified by Murrie, Boccaccini and their colleagues in regard to the Psychopathy Checklist)
  • Future Directions in the Restoration of Competency to Stand Trial by Patricia A. Zapf and Ronald Roesch
  • Current Directions in Violence Risk Assessment by Jennifer L. Skeem and John Monahan
  • Jury Decision Making: Implications For and From Psychology by Brian H. Borstein and Edie Greene
  • The Utility of Scientific Jury Selection: Still Murky After 30 Years by Joel D. Lieberman
  • Resolving the Offender "Profiling Equations" and the Emergence of an Investigative Psychology by David V. Canter
  • Forensic Interviewing Aids: Do Props Help Children Answer Questions About Touching? by Debra Ann Poole, Maggie Bruck, Margaret-Ellen Pipe
  • Interviewing Cooperative Witnesses by Ronald P. Fisher, Rebecca Milne, and Ray Bull
  • Current Issues and Advances in Misinformation Research by Steven J. Frenda, Rebecca M. Nichols, and Elizabeth F. Loftus
  • Eyewitness Identification by Neil Brewer and Gary L. Wells
  • Outsmarting the Liars: Toward A Cognitive Lie Detection Approach by Aldert Vrjj, Par Anders Granhag, Samantha Mann, and Sharon Leal

February 6, 2011

This blogger to give keynotes in Australia, UK

I am excited to announce that I will be delivering keynote addresses at forensic conferences in Australia and the United Kingdom later this year. I hope to be able to meet some of you in person at one or the other.

After the floods and cyclone -- join me on the Sunshine Coast

I will be giving both a keynote address and an all-day training at Australia's national forensic psychology conference, taking place from August 4-6 in Noosa, in the state of Queensland. Other keynote speakers are Australian forensic psychologists Paul Wilson, Don Thomson and Alfred Allan, and fellow Americans Tom Grisso and Leslie Morey.

This year's theme is "Diversity and Specialism in Forensic Psychology." If you think you have a good idea for a forensic talk or workshop, I would encourage you to submit a proposal. Be quick about it, though, as the deadline is the end of February.

Along with an exciting scientific program, the organizers are promising fun social functions and a chance to network "in a friendly and relaxed environment." Noosa is not too far away from the recent catastrophic flooding and Cyclone Yasi, but I'm sure flood waters will have receded by August. I'll be sharing more details in coming months.

Next up: Sexual violence conference in London

On September 8, I will be delivering another keynote at a Sexual Violence conference sponsored by the Forensic Psychological Services program at Middlesex University in London. My focus will be the role of culture and masculinity in multiple-perpetrator rape (the topic of my 2004 theoretical article). Again, stay tuned for more details.

I am excited to be a part of this program because of the organizers' cutting-edge efforts toward preventing sexual violence, especially rape by multiple perpetrators. The Forensic Psychological Services Program at Middlesex University sponsored similar conferences on hate crimes in 2008 and 2010, with an innovative focus on offender motivations and prevention.

You can get involved in this one, too. The organizers are inviting proposals for papers and debate panels pertaining to sexual violence, especially those based on empirical research and/or involving new and emerging topics. One of their major goals is to foster more exchange of ideas among practitioners, academics and policy makers. The deadline for submissions is April 15 (Tax Day, here on the other side of the Atlantic).

February 4, 2011

Parolees retain right to confidential therapy, court holds

"The SVP Act does not include its own special exception"

Ramiro Gonzales had no idea how far the news would travel, when he confided to his therapist that he had molested more children than those for which he had been convicted and served time in prison.

After all, confidentiality is the cornerstone of psychological treatment. Would you disclose information in therapy if you thought your darkest thoughts and most shameful misdeeds would be trumpeted to the world?

But in response to a subpoena, Mr. Gonzales's therapist handed over his entire treatment record to a prosecutor who was seeking to civilly detain him as a sexually violent predator (SVP), after a judge overruled a defense objection. The government's two psychologists then used the damaging admissions to bolster their trial testimony about future dangerousness, and a jury voted to civilly commit him.

Not so fast, an appellate court ruled last week. "The SVP Act does not include its own special exception" to established rules of patient-therapist confidentiality. Just like everyone else, a parolee is entitled to expect confidentiality in therapy, except as necessary to keep parole authorities informed about whether he is complying with any mandatory treatment requirements. Such information, the court added, must be as minimal as possible, and certainly does not include details of therapy or statements made in therapy.

Mr. Gonzales's admission was so highly prejudicial that the civil commitment must be overturned and he must get a new trial, the appellate court ordered, especially since the government's case overall was "not compelling." There was no evidence that he had molested any children since paroling from prison.

Mr. Gonzales, who is developmentally disabled due to spinal meningitis as a boy, was required to be in treatment as a condition of his parole. The state had already tried to civilly commit him upon his initial parole from prison, but a jury rejected that attempt. It was trying for the second time, after he violated parole by drinking alcohol and being around children, including his sister's children when they came over to visit his mother, where he lived.

The court clarified that people who have been civilly committed, as well as prison inmates, cannot expect the same level of privacy in therapy as parolees or probationers, because they have been found to be dangerous.

The ruling is good news for psychology ethics. Too many therapists seem to harbor the misimpression that a contract with a parole or probation agency trumps our professional ethics codes, giving them carte blanche to discuss their client's confidential business with authorities.

This ruling should serve as a vivid reminder: A subpoena is just a piece of paper filled out by an attorney. You aren't supposed to blindly obey it when it is improper. Indeed, you have an obligation to actively resist turning over confidential records of therapy. The therapist in this case should have voiced an objection, and brought her own attorney to court to fight the subpoena.

The case, People v. Ramiro Gonzales out of Santa Clara County, gives an excellent overview of both federal and California case law on confidentiality in forensic cases. It is online HERE.

Related blog posts:  

February 3, 2011

International readers: Diagnostic survey please

I am curious about diagnostic practices outside of the United States, as I prepare to give some international trainings later this year. If you are in forensic practice somewhere other than the USA, I would like to invite you to complete this very brief online survey. It is only 10 items, and should take you less than 5 minutes. It will help me out a lot. I will even share the results. I know a convenience sample like this is not scientific, but the more of you who complete it the more educational it will be.

You Americans, please refrain. I already know which manual you use. As a consolation prize, you can complete the one-item trivia poll just below the diagnostic survey. Make your best guess, and instantly learn how others voted.

And if you could pass this along to other colleagues outside of the United States, I would greatly appreciate it. Here's a convenient url that you can just cut and paste to share: http://3.ly/diagnosis. Or, if you would like to bypass this blog page and go directly to the survey site, you can use this url: http://3.ly/diagnosis2.

Thank you very much for your help.

And now, the one-item consolation poll for all readers: