Lecture 1: Approaches to Treating Forensic Populations

Why do we sentence people?

• Maintain the law & deter crime

• Punish misconduct

• Reparation and retribution

• Protect and separate

• Reform and rehabilitation.

Why should we help people who offend?

• to help with decision making

• to help rehabilitate

To help with decision making

• About release & management

• About reuinting with family

To help rehabilitate

• Make society safer

• Help those who offend lead meaningful lives without harm

Approaches to Psychotherapy

• Biological (psychopharmacology)

• Psychodynamic

• Behavioural

• Cognitive & Cognitive-Behavioural

• Humanistic

• Family & Social Interventions

• Group Interventions

Psychodynamic Theory - What did Freud propose that problematic behaviour is a result of?

• childhood experience

• sexual development

• disregulation of the id and superego

Psychodynamic Theory - In practice

• Intense & prolonged sessions

• Building a therapeutic alliance

• Learning through interactions with therapist

• Using techniques (e.g., dream analysis and free association) to uncover unconscious material

• Experiencing “catharsis”.

Behaviour = the problem

Maintained by patterns of antecedents, behaviours, and consequences (ABC).

Behavioural Therapy - How to fix the problem?

Action-oriented, teach new behaviours to fix the problem

What did Behavioural Therapy originally focus on?

using conditioning to change behaviours (e.g., reinforcement with reward and punishment).

What does Behavioural Therapy now include?

• modelling

• skills training

Cognitive Therapy - blank > behaviour

thought

blank lead to changes in mood & behaviour

thoughts (cognition)

Changing cognitions can alter how we feel and act which can lead us to?

Identify and challenge cognitive distortions

Cognitive Therapy - Techniques include:

• cognitive reappraisal

• situation modification

• mindfulness

• attention deployment

Core belief that psychological problems are

• Result of unhealthy thinking (cognitive distortions)

• Result of unhelpful learned behaviour

Changing one ABCs will do what?

influence the others

Which elements are added to Dialectical Behaviour Therapy?

• mindfulness

• acceptance

• distress tolerance

• interpersonal skills

What are the 4 core elements of DBT?

• mindfulness

• acceptance

• emotional regulation

• interpersonal effectiveness

What is the core believe of Humanism?

people have the capacity to make rational choices and develop their maximum potential

What are important factors of humanism?

• concern

• respect

Example of Humanism approach

Client-centered therapy

How does group psychotherapy help families (Family/Couples Therapy)?

• understand

• support

• work through difficulties

Family is understood as?

a system of complex interrelationships

Family/Couples Therapy is targeted when?

• Disorders are sustained by family dynamics.

• Individual behaviour affects the whole family

What is the goal of Family/Couples Therapy?

improving communication & relationships

How does Family/Couples Therapy work?

Guided by a therapist who will facilitate conversations and use therapeutic techniques to mediate (e.g., CBT)

Benefits of Group Therapy

• Support system

• Validating

• Diverse opinions

• Economical

  • cheaper

What works?

Nothing works

• Contributed to ending an optimistic era of corrections.

• The public began to doubt that change is possible.

• “What Works”: researchers started to investigate literature that shows treatment works

• A new era: tough on crime Punitive, ↑ in imprisonment

Tough on Crime is?

not effective

• causes more harm than good

• doesn’t address the risk factors

What is included in tough on crime?

• Boot camps

• Intense supervision

• “Scared Straight” programs

• Increased prison sentences

What treatments work?

evidence-based practices

• principles of effective intervention

Treatment should?

• Target high-risk individual

• Target criminogenic needs

• Be cognitive-behavioural

• Consider external factors (e.g., environment)

Examples of treatment that works

• CBT

• RNR

blank is better than non-behavioural treatments

CBT

CBT is effective across different types of blank

offenders

CBT - Meta-Analyses support:

• Landenberger & Lipsey (2005): 1.53x more likely not to recidivate if they received CBT (58 studies).

• Harrison et al. (2020): ↓ sexual & violent recidivism by ~36% compared to no CBT (25 studies, 12,811 participants).

• Papalia et al. (2019): ↓ general & violent recidivism (27 studies; 7,062 participants)

Risk is a blank factor

static

Risk - Probability that the individual will recidivate:

• # of events encountered with criminal legal system (e.g., arrest, conviction)

• Tallied

Need are blank factors

dynamic

How can be Need (dynamic factors) be shaped by?

• treatment

• maturation

• experience

Need - What should treatment target?

needs to reduce recidivism

Need - “Big Eight”:

• criminal history

• antisocial values

• antisocial peers

• substance use

• antisocial personality

• family history/dysfunction

• education and employment deficits

• leisure activities

Antisocial Personality Pattern - Indicators

Antisocial Personality Pattern - Intervention Goals

Procriminal Attitudes - Indicators

Procriminal Attitudes - Intervention Goals

Social Supports for Crime - Indicators

Social Supports for Crime - Intervention Goals

Substance Abuse - Indicators

Substance Abuse -Intervention Goals

Family/marital Relationships - Indicators

Family/marital Relationships - Intervention Goals

School/work - Indicators

School/work - Intervention Goals

Prosocial Recreational Activities - Indicators

Prosocial Recreational Activities - Intervention Goals

Responsivity - Enhance benefits from treatment using?

learning & CBT strategies tailored to their characteristics

What are the 2 types of responsivity?

• general

• specific

Example of Specific Responsivity

• psychological (e.g., mental illness, motivations)

• cognitive attributes (e.g., learning disabilities)

• biosocial (e.g., gender, race)

Risk: informs us blank should be assigned to what interventions

who

Need: inform us blank should be targeted in treatment

what

Responsivity: inform us blank treatment should be delivered

how

Does RNR work?

Yes

• When risk matches treatment intensity, recidivism reduces by ~10% more

• Risk + ↓ intensity = ~15% less recidivism compared to ↓ risk + ↑ intensity

  • Same pattern with ↑ risk offenders.

Problem with Risk

doesn’t take severity & systemic biases into account

• does not take into consideration the collective factors that result in how a person presents in terms of overall risk for recidivism

• the likeli hood of violent and/or dangerous behaviours and the impact on public safety that can come from higher- profile offences (i.e., sexual offences, drinking and driving, and gun violence) and individuals (i.e., those in gangs).

5 Issues with Risk:

1. the language of risk is complex and does not address public safety and dangerous issues part of everyday knowledge

2. risk is a malleable concept, which makes it difficult to define, and so definitions vary by user

3. the contradictory meanings of risk lead to conflicting practices

4. risk catalyses strong emotions that affect how it is used in everyday decisions

5. risk catalyses strong emotions that affect how it is used in everyday decisions

Problems with RNR

• Focusing on criminogenic needs ignores other needs that influence recidivism.

• Risk & need are not mutually exclusive.

• Not used by system actors.

• Overemphasis on deficit.

Problem with Responsivity

underexplained and overlooked

2010s - Now: Wave of Optimism

• Want to understand the origins of offending

• Case formulation

• Considerations include culture, systemic biases, trauma (e.g., ACEs), neurodiversity, gender, and others.

• Importance of building relationships, therapeutic outcomes, environmental stability, and instilling motivation & hope.

• Person first.

  • don’t want to highlight the bad they’ve done

Case formulation:

• predisposing vulnerabilities

• biological factors

• sociocultural influences

• conditioned responses

• beliefs.

The Good Lives Model Level 1: Core Values & Principles - Ethical Values

• Universal human rights: we are all entitled to wellbeing & respect.

• Human agency: dignity of decision-making promotes achieving therapeutic goals (e.g., formulating goals and planning).

The Good Lives Model Level 1: Core Values & Principles - 10 Primary Human Goods

• Life (including physical survival and healthy functioning)

• knowledge

• mastery (excellence in work and/or play)

• autonomy & self-directedness,

• inner peace (i.e., freedom from emotional turmoil or stress)

• relatedness (including intimate, family and friend relationships)

• community (i.e., a sense of belonging)

• spirituality (i.e., meaning and purpose in life)

• happiness

• creativity

The Good Lives Model Level 2: Knowledge Related Assumptions - Humans

goal-oriented

• All actions, therefore, are taken to secure PHGs.

  • Secondary Human Goods: means by which we obtain PHGs (good or bad).

  • behaviour is purposeful and related to prudential values; everyone lives according to an implicit or explicit Good Lives Plan centred on prioritised PHGs

The Good Lives Model Level 2: Knowledge Related Assumptions - Identity

understood by how PHGs are prioritized; Sense of identity is understood by how different PHGs are prioritised and sought

The Good Lives Model Level 2: Knowledge Related Assumptions - Offending

result of internal and external obstacles to PHGs in prosocial ways

• E.g., criminogenic needs

The Good Lives Model Level 2: Knowledge Related Assumptions - Risk Reduction

overcoming obstacles and securing PHGs; Overcoming obstacles and attaining PHGs in prosocial ways will enhance well- being and reduce risk

The Good Lives Model Level 3: Intervention Guides - People who have offended should be treated with blank and involved in blank.

respect; intervention planning

• People who have offended are ascribed the same moral status as everyone else; they are treated with respect (including freely consenting to treatment and spoken to and about using respectful language) and collaborate in all aspects of intervention planning

The Good Lives Model Level 3: Intervention Guides - Good Lives plan will act as a template for?

• treatment

  • intervention planning

• monitoring treatment progress

• future-oriented Good Lives/Risk Management plans

The Good Lives Model Level 3: Intervention Guides - Treatment focus:

strengthen internal/external resources to overcome obstacles and promote prosociality

The Good Lives Model Level 3: Intervention Guides - Evidence-based practice should guide selection of?

treatment models & strategies for overcoming specific obstacles

The Good Lives Model is more blank & holistic

motivation; holistic

blank is hard to inspire

motivation

It is difficult to evaluate The Good Lives Model due to?

too many variations

There is limited research for The Good Lives Model

Tentative support for GLM consistent interventions as effective

The Good Lives Model is not a treatment model but a blank

map

What is an important emerging consideration in recent years that relates to forensic risk assessment?

cultural issues

• ethnic minorities are overrepresented in correctional services that have emerged amidst a history of colonisation

• Ex: minorities have a tendency to score higher on actuarial measures of sexual risk; ethnic minorities may not inevitably be at increased risk of criminal behaviour

What does Case Formulation (CF) involve?

the inferences about predisposing vulnerabilities, a pathogenic learning history, biological or genetic factors, sociocultural influences, currently operating contingencies of reinforcement, conditioned stimulus- response relationships or schemas, working models, and beliefs about the self, others, the future or world

blank therapy has now become widely recognised as relevant within treatment services for those who have committed sexual (as well as other) offences

trauma-informed

Strength-based practices in Trauma-informed therapy for women include?

reframing questions and being non- judgemental, recognizing and mobilizing existing strengths, using motivational interviewing and working with the client in a collaborative nature as they are their own experts

Elements common to many psychological therapies have been noted to include:

1. confiding relationship with a professionally trained therapist

2. a rationale which contains an explanation for the client’s distress or difficulties and how treatment aims to relieve these

3. the provision of hope for the client that helps can be expected from therapy

4. an opportunity for experiencing a sense of mastery during the course of therapy

5. the facilitation of appropriate emotional arousal in the client.

What does ‘person-first’ language mean?

• This shift is driven by ethical concerns, the inaccuracy of labels implying an ongoing tendency to commit crimes, and alignment with guidelines like those from the American Psychological Association (APA) for reducing bias and promoting inclusive language.

• consistent with the goal of rehabilitation, as using an offense label contradicts the aim of helping someone change ("Why call someone by what we don’t want them to be?"

Offending Behaviour Programmes (OBPs) have expanded, incorporating knowledge of blank and blank to create "brain friendly" interventions that minimize overly literacy-centered, sedentary routines.

neurodiversity; forensic neuroscience

3 Principles of the RNR framework

1. one’s past history of involvement in criminal behaviour, should drive both the intensity and type of responses (e.g., punishments and treatment) that occur

2. needs should be assessed as dynamic factors, or those attributes that are malleable and the emphasis should be on those needs that are known to be related to involvement in criminal behaviour

3. responsivity refers to the use of social learning and cognitive behavioural strategies to facilitate growth and development, as well as to tailor responses to individual characteristics such as maturation, motivation, learning styles, learning disabilities, mental illness and other factors that affect receptivity and response to correctional control and services

Implementation Problems of RNR

1. line staff/officers tend to have a general lack of trust in the instruments that are used to assess risk and needs, as well as the categorisation

2. the lack of trust in the instrument is then coupled with officers circumventing assessment processes or recommendations when the results do not support the occupational or personal values of a line staff/officer

3. officers are very conscious of the competing demands on their time and efforts

Systemic Biases associated with Risk

1. policing is not equally distributed, and therefore individuals in some communities are more likely to be policed and therefore subject to arrest than in other communities

2. most individuals plea to an offence without a trial

3. many decisions about reincar ceration are due to technical violations of programme requirements rather than new convictions

Examples of Dynamic Risk Factors/Criminogenic Needs

antisocial personality, antisocial peers, antisocial values, substance use, educational or employment deficits, poor family functioning and poor leisure time activities

What is a factor that effects both the integrity & validity of the criminogenic need category?

the failure to recognise and account for social issues that affect the overall functioning of an individual

According to Taxman (2014) from the text, they called for a new generation of the 'criminogenic’ needs that should include?

social determinants of health

• economic stability, education access and quality, health care access and quality, neighbourhood and built environment and social and community context – and to consider these factors even though they may not directly predict recidivism (predictive validity)