National Judicial College of Australia Session 2: Engaging Behaviour Change

1. Solution-Focussed Judging National Judicial College of AustraliaSession 2: Engaging Behaviour Change Dr Astrid Birgden Forensic Psychology Consultant astrid99@hotmail.com

2. Overview

3. Therapeutic Jurisprudence • The work of Wexler & Winick (US) • Legal theory = concern for physical and psychological well-being of individuals affected by the law • Utilises social science knowledge to determine ways in which the law can enhance psychological well-being • Focus on the law, legal procedures and legal roles emphasises increased well-being in individuals in contact with the law

4. 1. The Law When the law seeks to promote therapeutic objectives, the impact of the law should be carefully examined to see whether it does so. e.g. does criminalisation of drug use result in anti-therapeutic consequences?(Wexler , 1990)

5. 2. The Legal System The legal system should be examined and perhaps be restructured to maximise its therapeutic effects and minimise its anti-therapeutic consequences. e.g. should the law be reformed to ensure therapeutic consequences for defendants?

6. 3. Legal Roles The roles and behaviours of judges and lawyers may need to change to mesh better with professional ethics and to be therapeutically beneficial. e.g. can judges harness the law to engage defendants in behaviour change?

7. 5 Principles The law can increase, decrease or have a neutral effect on well-being. The law should capitalise on the “teachable moment” to trigger pro-social lifestyles. The law should be a multidisciplinary endeavour that is cooperative not antagonistic. The law balances community protection and individual rights. TJ is values-based and maximises the aims of the law (treatment/therapy does not trump the law). (Birgden, 2002)

8. Example Piano Stairs http://www.youtube.com/watch?v=2lXh2n0aPyw

9. The Will + The Way (Motivation) (Skills) = Behaviour Change Defendants

10. The Will & The Way

11. The Will & The Way

12. The Theory • Natural Justice • Contingency Contracting

13. Procedural Justice cont Those who experience a legal procedure they consider unfair, have less respect for the law and legal authorities and are less likely to accept judicial decisions. This can undermine the potential for rehabilitation = ‘learned helplessness’:- leads to apathy, restricts change and causes individuals to give up. (Gould, 1993; Seligman, 1992)

14. Example THIS AMERICAN LIFE- ‘VERY TOUGH LOVE’- A DRUG COURT IN GEORGIA- 25/3/11 Charlie at 19yo was caught in a police sting buying LSD. He was in the last 3 months of the Drug Court Program and obtained a +ve drug test result. Charlie denied drug use and 2 more tests were immediately taken that were –ve. He had never missed a meeting or failed a previous drug test. Charlie was told by Judge Williams that she did not believe him, he was sentenced 17 days to prison, and directed to spend 3.5 years instead of 2 years in the Program when he was close to finishing. The journalists (Ira) stated: “it is exactly the result that research studies show is the problem with an overly punitive approach: it made him rebel... ...it [the Drug Court] took a model participant and turned him into a failure”.

15. Example cont Charlie: “Once that day came it was a big, it was like a big slap in the face. You know, everything I'd pretty much put my trust into had turned its back on me. I'd sat here and dedicated 22 months of my life to changing it. I felt like everything I'd done was for nothing”. Ira: “And then December of that year you screen positive for marijuana”. Charlie: “Yeah. Yeah, I smoked some pot. At that time, I was over it. I was just disappointed, extremely disappointed”. ► A month later Charlie missed his first group meeting and a warrant was issued for his arrest. It took him 4 years to finish the Program.

16. Procedural Justice cont Conversely, those who feel they have been treated fairly, respectfully and with dignity: have greater satisfaction and (b) are more inclined to accept responsibility for their behaviour. (Tyler, 1990; Ronner, 2001)

17. Procedural Justice cont Due process is made up of: Participation- present their own view and share in decision-making, so they perceive the procedure as fair (even if it may not influence the outcome). Dignity, respect, and politeness- defendant rights and values as a competent, equal citizen, and human being are acknowledged. Trust- the authority that allows the person to present evidence, displays dignity and respect, and clearly explains decisions is considered more trustworthy. ► Greater compliance with the law. (Tyler, 1990, 1996)

18. Procedural Justice cont Put another way, the 3 “Vs”: Voice-a chance to tell their story to the decision-maker. Validation- if they feel heard and listened to then more likely to feel a sense of validation. Voluntariness-voice + validation = experience the procedure as less coercive . ► Greater compliance with the law. (Ronner, 2001)

19. MacArthur Foundation Studies (US) Coercion Involuntary treatment and the patient’s perception of coercion. Risk Enhanced risk assessment and management of violence (MI does not equal violent offending). Competence The capacity for the person to: (a) understand information, (b) appreciate the implications, (c) make rational decisions. www.macarthur.virginia.edu/home.html

20. Perceived Coercion Don’t ask “Is involuntary treatment effective?” (for medical patients) but ask “how can leverage best be used to assist?” (Zdanowicz, 2006) Leverage = access to government disability benefits, government housing, specifying treatment preferences in advance or having a proxy decision-maker, and avoiding gaol or hospital (for psychiatric patients). (Monahan, Redlich & Swanson et al, 2005)

21. Perceived Coercion cont Interviewed 433 psychiatric patients within 48 hours admission into hospital (+ clinicians and family members). Administered MacArthur Admission Experience Interview (perceived coercion scale). * Force and -ve pressure (legal force, threats, and giving orders) = feelings of coercion * Persuasion and +ve pressure = does not result in feelings of coercion. (Lidz, Mulvey & Hoge et al., 1998) [http://ness.sys.virginia.edu/macarthur/members. html - MacArthur Research Network on Mental Health and Law]

22. Twisting Arms? OR Helping Hand? Legal coercion is OK. Psychological coercion through –ve pressure to compel change is not OK. But psychological coercion through +ve pressure is OK- motivate/persuade/induce through rewards (Winick, 2003) Coercion

23. Decision-Making Capacity • Understand- paraphrase what’s been disclosed about the disorder + recommended treatment + risks and benefits • Appreciate- explore whether fully understands because of delusions or distorted thinking. • Reason- recheck the patient’s initial choice, including no-treatment option, and look for logic. Medical Decision-Making Understand + appreciate + reason + communicate a choice (Appelbaum & Grisso, 1995; Grisso, Appelbaum, Mulvey, & Fletcher, 1995).

24. Making Choices • Although this may be “hard choice” within a coercive context, it is a legally voluntary choice- not “benevolent coercion”- as long as there is no duress or improper inducements:- • “once the individual chooses in favour of such a • treatment option, of course, his or her future • actions are constrained, but they are constrained • as result of a choice voluntarily entered into” • (Winick, 2003c, p. 184). The decision to enter a PSC must be based on an informed decision/genuine choice = serves therapeutic + dignity ends. (Boldt, 1998).

25. Driving Reinforcement 54 secs http://www.youtube.com/watch?v=KcaKocRXCB4&feature=related Example

26. A positive approach to behaviour change. • Empirically-based approach for increasing motivation to change. • Systematic method of consequences (rewards + sanctions) which are unique, not mirror images. • Emphasise rewards not sanctions (4:1 ratio). • The systematic application of +ve reinforcement immediately follows a desired behaviour. • Try to be stronger than offending behaviour + natural reinforcers. • Reinforcement schedule = escalating rewards for target behaviours and a “reset” for a lapse. • Only sanction violation of (institutional) rules. • Developing behavioural contract with the defendant. Contingency Contracting

27. 1. Set the ground rules to reduce confrontation/ confusion. 2. Retain consistency in program delivery (integrity). 3. Ensure that consistent responses to behaviour can be anticipated (predictability & control). 4. Ensure accountability (defendant for behaviour, judicial officers toward participant). 5. Empower participant to take responsibility and staff to manage program. 6. Be pragmatic in placing realistic expectations on the participant. 7. Utilise partnership between judicial officers and the defendant. Contingency contracting cont

28. The Practice • Stages of Change • Motivational Interviewing

29. Triggering Change It is expected that defendants will experience psychological discomfort or distress when appearing before the law. With psychological distress comes contemplation of change (Draycott & Dabbs, 1998). While some individuals respond to environmental pressure to change, others will become defensive (Prochaska & DiClemente, 1982; Miller, 1985). The court can harness the potential “teachable moment” to promote a therapeutic outcome (Rottman & Casey, 1998) if the defendant asks “how can I live my life differently?” (Ward & Stewart, 2003).

30. The Process + The Stage (the right thing) (the right time) = Behaviour Change Engaging Change

31. The Process (Verbal) Dramatic Relief Emotional arousal about current behaviour and change ►psychodrama techniques Environmental Re-evaluation Affective and cognitive assessments of the impact of behaviour ► empathy training Consciousness-raising Increase awareness of causes, consequences and strategies for offending behaviour ► mild confrontation Self Re-evaluation Affective and cognitive assessment of long-standing lifestyle ► self-narrative to support a pro-social lifestyle Self Liberation The belief that change can occur and act on that belief (self-efficacy) ►drug treatment court as a public commitment

32. The Process (Behavioural) Contingency Contracting Systematic rewards and sanctions with rewards emphasised ► contingency management Counter conditioning Replace anti-social behaviour with pro-social behaviour ► counter negative self-statements Helping Relationships Combine care, openness, trust, acceptance and support for change ► therapeutic alliance or ethic of care (the helping hand) Stimulus Control Increase cues to prompt pro-social behaviours and decrease cues that tempt anti-social behaviours ► remove drug-using implements from the environment (Prochaska & Levesque, 2002)

33. Any Questions?

34. Think of a behaviour.... • You have changed 2. Are in the midst of changing 3. Are thinking about changing

35. Contemplation Intend to take change in the future (next 6 months) ► “I think I have a problem, but….”. The Stage Preparation Intend to change in the immediate future (next 1 month) ► “I have started to take small steps to stop offending”. Pre-contemplation Do not intend to change in the forseeable future (next 6 months) ►“I don’t have a problem”. Action Have made specific changes to behaviour (past 6 months) ► “I’m actively developing a plan to stop offending”. Maintenance Work to maintain change and avoid relapse for the future (6 months - 5 years) ►“I’ll keep maintaining my rehabilitation plan”. (Miller & Rollnick, 2002; Prochaska & Norcross, 1994)

36. Stages of Change Model

41. Motivational Interviewing Techniques cont Person-centred: how the client views the world. Directive: the judicial officer works specifically on resolving ambivalence. (Miller & Rollnick, 2002; Farrall et al, 2003)

44. Communication orientation and its impact on motivation and engagement: combining influence and authority Influence is the capacity to carry out a task with others by recruiting their interest, energy and commitment to a common goal or purpose Authority is the power to achieve an end or carry out a responsibility through others Authority emerges from a role; influence from personal qualities, communicative abilities and ultimately, from authenticity. Being present (engaged) and bringing your experience to bear on these interactions enables program participants to engage with the process.

45. Motivational Interactions: A short/sharp strategy • Skills (reflective listening and core Qs) • Concepts (cycle of change) • Strategies (develop/maintain motivation) • Process (‘how to’) Farrall, M. Emlyn-Jones, L., & Emlyn-Jones, R. (2003). ignition Creative Learning (for Corrections Victoria)

47. Exercise 1 (5 mins) In pairs:- Person A is a researcher who has read that using a mobile phone may cause brain tumours. Strongly persuade Person B to cease using a mobile phone.

48. Exercise 1 Debrief Feedback re how mobile phone user/researcher: • Felt • Behaved • Relationship between them • What happened to resistance