Tag Archives: CCOSO

Voices of sex offender treatment meet

The monthly meeting of CCOSO, the California coalition on sex offending, takes place at 150th street in San Leandro, in the basement of a building that doubles (triples?) as a courthouse and juvenile hall. Indeed, the lobby resembles an airport terminal, complete with airport security. I was a guest speaker, there because my colleague was “lacking energy”, so he said. I wasn’t, I guess, though I would be by the end of the day. It was the end of August–hadn’t taken a vacation yet. Labor day’s around the corner, and then it’s on. It’s too late, isn’t it…to rest?

Well, I won’t be a sex offender treatment provider much longer, so maybe I can rest soon. Not that I mentioned this. As I looked about the room, at the one or two familiar, sympathetic faces, I felt the late summer languor, but also the resilient push of the twenty-deep audience. Some of these people–psychologists, mostly, plus a few probation officers– had been working this ugly corner of the business for quite some time. They had things to say, a backlog of knowledge and experience. But they were curious and open-minded, having heard my voice before, in previous meetings. The last time had been in January, when my colleagues and I from Impulse Treatment Center and Foundry showed up to scourge AB 1775, the execrable new law supposedly cracking down on child porn. Now I was back, all by my lonesome. My topic: “Assessment, modality, and course of treatment.” Sounds innocuous, doesn’t it? It wasn’t.

The assessment part was dry enough. Referring to the so-called Risk-Needs-Responsivity model, I outlined the differences between so-called static needs (criminal hx.) of cases, versus the dynamic risk factors (far more numerous) which are of increasing interest. It used to be different. Back in the day (meaning, like, the 80s) static factors were all that counted. A criminal was a criminal; they had anti-social personality disorder, and that was that. Treatment, or psychotherapy, was understood as a glorified act of babysitting, entailing regular discussions with offenders, reminding them to not do the things that get them in trouble–attending to the risk, their ‘criminogenic” needs. I shouldn’t  be so flippant. I wasn’t a therapist in the 80s, so I don’t really know that it was this flat and uninspired. Still, what’s true is that sex offender treatment has long been predicated on the paradoxical  notion that offenders aren’t treatable.

Latter day research is altering the methods, ethos of providers, even if public opinion about this population remains–excuse me–static. In particular, the work of researchers like Michael Seto and Karl Hanson has loosened the thinking somewhat. Their studies reveal profile differences between online child porn users and direct contact offenders: pointing out that online users only possess greater victim empathy capacity, lower scores on anti-social personality test assessments, lower recidivism rates with respect to sex offending behavior. With a nod to the POs, I kept using the word “recidivism” at the CCOSO meeting, knowing this construct held more currency with them.  Not without reason, actually: another researcher, Stephen Brake, cast doubt upon SO research in 2012, by pointing out in his meta-analysis that only two studies out of 37 in the last decade have  managed to correlate victim empathy with lowered recidivism. On the other hand, methodology of research on the whole is suspect. I note his skepticism about cognitive behavioral therapy as the treatment style of choice, and about the reliability of other factors. Inadequate control groups is one problem: standards of intervention  are poorly defined; the lack of long-term outcomes. He points out that the positive results of some programs (low recidivism rates) are attributed to psychotherapeutic method when many of these same SO programs concurrently use pharmacological, or hormonal treatments–the so-called chemical castration treatment–which are at least as likely to be the agents of change. I just crossed my legs, by the way.

Anyway, my pitch to my audience was for more flexibility in our approaches; more openness to alternative treatment methods: EFT, EMDR, narrative therapies that might address the trauma histories of offenders (example of a dynamic risk factor); even a psychoanalytically-derived approach that treated patients as if they were capable of achieving transference with a provider, or even a group of peers. My audience seemed to agree, noting that they, too, had been straying from the CBT workbook script from time to time. A great example of an intervention designed to induce victim empathy was volunteered: “Remember how it felt when you saw your name, and more importantly, your picture, on that public registry. I think that must be similar for someone in porn–particularly a minor: to know they’re being looked at”. One psychologist perhaps disliked my broader implications, my criticism of standards. She made cryptic appeals for retaining the bathwater. “I think it’s a matter of integration”, she said. However, most agreed that the internet phenomenon had done more than simply proliferate child porn; it had also diversified the offender population. Hanson, for example, points out that online offenders are likely to present more characteristics in common with compulsive sex addicts versus conventional offenders, hence the rationale for what I term “hybrid” therapy groups, mixing lower risk sex offenders with sex addicts who do not necessarily engage in illegal behaviors.

For my coup de grace, I turned further to the matter of group therapy, for which there are few standards, much less reliable research, largely because it’s so hard to isolate factors for success. Nonetheless, I turned my head to the stolid POs present, observed a few things that had bothered me in recent years about the model that places them in charge: the arbitrary transfer of probationers from one county to the next, which inevitably extricates clients from programs; the unnecessarily punitive incarcerations for trivial matters, token probation violations. If we are to think of SOs as those who merit care, then we can’t do therapy by half measures, I say. They must have some confidentiality. They must be allowed to make proper use of the therapeutic space, the chance to form a rapport and an alliance with professionals and peers. They must have continuity of care. I know that POs don’t have much more power than me, but they have a voice.

Unbeknownst to them, it was a parting comment, this criticism of the so-called Containment model. In December, my credential for treating this population will expire, and I’ve chosen not to renew. My bad if things indeed get better.

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Sex Offender Treatment: Just Say No to the Dodo

 

Talk about reductionist thinking: try this corner of the mental health industry. It’s a dark little corner, where the journeymen and women of our profession go…because someone has to, supposedly. Not that therapists are wanted, necessarily. As in the treatment mileus depicted in my book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment, administrators and directors of SO treatment programs, or the “supervising officers” (euphemism for correctional officers) that are actually in charge of the three-headed mon–sorry–treatment team, want straightforward instructors for implementing of program protocols. They want containment based upon a structured approach designed to elicit successful behavioral outcomes–a teleological perspective.
       Recidivism: the repetition of offending behavior. That’s the operative concept in sex offender treatment: the standard by which this entire arena of care is judged, or will be judged, if it is indeed on trial. And why not? you may ask. Surely the problem of sexual abuse needs to be addressed as aggressively as possible, with a behavioral lens front and center; with recidivism the criteria for assessing everyone in the process, participants and providers alike.
       The problem is with the research, and thereafter with the spinning upon said research for anxious listeners. At a recent presentation of sex offender treatment protocols at a CCOSO (California Coalition on Sex Offending) conference, I listened to program officials assert the need to implement a structured treatment program consisting of an RNR (Risk Needs Responsivity) model, in conjunction with Cognitive Behavioral Therapy (CBT), and that unstructured psychotherapy (unclear what that was referring to–perhaps the aforementioned “Freud stuff”) was contra-indicated (meaning, ill-advised), because its methods were not associated with a significant decrease in recidivism. By RNR model, presenters were alluding to the work of criminologists Don Andrews and James Bonta, who outlined what are termed dynamic risk factors central to treatment, alongside corresponding so-called criminogenic needs. The list of factors include some of the following: antisocial personality, antisocial cognitions, social support for crime (meaning, friends or family with criminal attitudes), impulsive behavior, family dysfunction–again, such as criminality, low education. Other factors of ancillary importance are early childhood negative experiences, family of origin stressors, age, gender, and ethnicity. Spot the issue yet? Well, the likes of Ward, Melser, and Yates (2007) did, opining that the RNR etiological theory was too general to explain criminal conduct, and as a result, was unfalsiable–meaning, not especially useful.
        As for recidivism, the research here is generally thin and unconvincing. According to Duwe and Goldman (2009), a reduction of 18% in sexual recidivism existed for one in-prison treatment program. But researcher Stephen Brake, who in 2010 published his examination of 37 studies of sex offender treatment outcomes conducted over a quarter century, found that only 41% of such studies indicated reductions in recidivism, with 37% not significantly reducing recidivism, and a remainder of studies indicating mixed, partial evidence based upon different factors (violent versus non-violent recidivism, for example). Overall, it’s been known since the early 90s (via federal reports) that sex offenders exhibit among the lowest recidivism rates (4-12%–tracked over 5 years), compared to other criminal profiles. But it’s unclear whether such findings can be attributed to specific treatment models. The authors of another meta-analysis study, Losel and Schumacker (2005), concluded that there is a significant effect of treatment on recidivism, but the studies they examined indicated treatment programs that featured not only CBT methods, but also surgical castration. Pardon me while I imagine the principals of each intervention strategy arguing over whose method worked best.
       Several critics point out basic problems with research into sex offender treatment: findings that indicate as much effect upon recidivism for no-treatment versus treatment; inadequate control groups; the fact that sex crimes are the least reported types of crimes (thus confounding statistics on recidivism). Add to this discrepancies in study designs, outcome measurement protocols, time-frames for follow-up, and what researchers have is a messy globule of information that strains against the community’s desire for straightforward action. Critics of the RNR model point out its limitations: the opinion that attention to criminogenic needs is insufficient, and that attention must be paid to individual needs, self-esteem issues, personal distress; that treatment alliance is an unassailable factor in positive treatment outcomes. Amen, I say. However, these are borderline heresies for those presenting on the topic of sex offender treatment, for sex offenders aren’t really allowed to talk about personal distress and low self esteem–at least, not until they’ve admitted to all of their crimes and then said they were sorry…like, really sorry. And so, with all this in mind, I wade into this dodgy realm of care, becoming a ‘certified’ provider of sex offender treatment. Why? because I have some clients who fit the profile, and because they are people about whom I care. I’ll nod my head at the pronouncements of those looking to codify practices and reign in the unconscious. I’ve got my eye on the Dodo.
* Stephen Brake (2010) The Effectiveness of Treatment for Adult Sex Offenders.

* Ward, Melser, and Yates (2007) Aggression and Violent Behavior, 12, 208-228.

* Losel and Schumacker (2005) The effectiveness of treatment for sexual offenders. Journal of Experimental Criminology, 1, 117-146.

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