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“No More Victims” State Probation Service of Latvia Conference @ Riga 15 – 17 th March 2011. Changing Behaviour of Sex Offenders: Treatment Programmes Dawn Fisher and Elizabeth Hayes . Summary. Importance of programmes in Criminal Justice provision

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no more victims state probation service of latvia conference @ riga 15 17 th march 2011

“No More Victims”State Probation Service of Latvia Conference @ Riga 15 – 17th March 2011

Changing Behaviour of Sex Offenders: Treatment Programmes

Dawn Fisher and Elizabeth Hayes

  • Importance of programmes in Criminal Justice provision
  • What works - principles underlying effective programmes
  • Programmes overview
  • Interaction between custody and community treatment settings
  • New treatment approaches
sex offenders in the criminal justice system
Sex Offenders in the Criminal Justice System
  • Significant percentage of offenders i.e. 80,000 prisoners in English & Welsh prison system of which 6,000 are sexual offenders (13%)
  • Registered sex offenders in 2005/6 was 58 per 100,000 of the population in England Wales
  • Reconviction rates vary according to type of offence and level of risk deviancy i.e. RM2000:
  • Risk category –Very high – 60%

High - 40.5%

Medium - 18.1%

Low - 8%

importance of treatment in criminal justice systems
Importance of treatment in Criminal Justice systems
  • Public protection and risk management
  • Reducing the occurrence, severity and frequency of sexual offending
  • Rehabilitation
  • Restorative justice
cjs strategy in england wales
CJS Strategy in England & Wales
  • Prison and probation treatment programmes from 1990s onwards
  • Advisory panel - later became accreditation panel
  • Influence of ‘what works’ literature – 1998 – ‘what works for probation’
accreditation criteria
Accreditation Criteria
  • A Clear Model of Change
  • Selection of Offenders
  • Targeting a Range of Dynamic Risk Factors
  • Effective Methods
  • Skills Oriented
  • Sequencing Intensity and Duration
  • Engagement and Motivation
  • Continuity of Programmes and Services
  • Maintaining Integrity
  • Ongoing Evaluation
underlying principles what works
Underlying principles - What Works

Meta analysis (Hanson2002, Losel & Schmucker 2005, 2010)

  • Risk-Need-Responsivity
  • Cognitive Behavioural and Social Learning Theory
  • Skills based - generalisation and maintenance
  • Manualised
  • Trained and supported staff
  • Quality assured
  • Evaluated and monitored
risk principle who to treat
Risk Principle – who to treat?
  • Sexual offending treatment is prioritised for those who are at higher risk of re-offending.
  • The higher the risk, the greater the ‘dose’ of treatment.
  • Programmes have the most impact on high risk offenders and least impact on low risk offenders.
need principle what to treat
Need Principle – what to treat?
  • Treatment should focus on issues that that have been shown to raise risk of future offending.
  • These are called Dynamic Risk Factors or Criminogenic Needs, i.e. significant causal factors.
responsivity principle how to treat
Responsivity Principle – how to treat?
  • Structured, cognitive behavioural approach with strong emphasis on collaborative enquiry and active skill-building.
  • Motivational, conveying hope for the future. Emphasis on a constructive approach to future, rather than creating stigmatising shame about the past.
  • Warm, empathic, reinforcing and directive therapist style.
  • Adaptations for special needs, e.g. intellectual disabilities, personality disorders, mental health issues.
  • Purposeful eclecticism, adapting and using methods and techniques as appropriate to the offender and his learning style. ‘Finding the shoe that fits.’
treatment methods
Treatment Methods

Principally CBT plus elements of Social

Learning Theory

  • Self-analysis and cognitive restructuring
  • Modelling of alternative thinking/behaviour
  • Implementation of alternative thinking/behaviour
  • Modeling of anti-criminal attitudes/behaviours
  • Skills development
factors targeted in treatment programmes
Factors Targeted in Treatment Programmes
  • Cognitive support for offending
  • Deviant sexual interests, arousal patterns, sexual preoccupation
  • Difficulty in recognising personally relevant risk factors
  • Difficulty in generating or enacting appropriate coping strategies
  • Deficits in interpersonal, self-management or problem solving skills to cope with personally relevant risk factors
  • Social support for sexual offending
acquisition of skills to deal with
Acquisition of Skills to Deal With:
  • Inappropriate sexual preferences
  • Offence supportive attitudes
  • Overcoming intimacy deficits i.e. elevated emotional loneliness; relationship skills; insecure attachments
  • Management of emotions
  • Sexual preoccupation (to reduce where preoccupation sustains the offending)
  • Maintaining change
Successfully delivered programmes require
  • Skilled and enthusiastic group facilitators
  • Good communication - case managers and programme facilitators
  • Committed case management
  • Effective PSR authors
  • Good communication - workers and supervisors
  • Quality Control and Quality Assurance issues addressed
  • Programme providers supported
  • Programmes monitored and evaluated
  • Quality Control and Quality Assurance issues addressed
  • Programmes integrated within overall Probation supervision activity
Therapist behaviors that enhance treatment effectiveness
  • Empathic, genuine, warm, respectful, supportive, self disclosing
  • Asks open ended questions, directive, flexible, encourages participation, rewarding, use of humor
  • Attentive, confident, trustworthy, instills positive expectations, emotionally responsive
Therapist behaviors that reduce treatment effectiveness
  • Aggressive confrontation, rejection, manipulation of patient, low interest, critical, sarcastic, hostile/angry
  • Discomfort with silences, unresponsive, dishonest, judgmental, authoritarian, defensive
  • Need to be liked, nervous, does not wait for answers, boundary problems, rigidity, coldness
range of programmes
Range of Programmes
  • Prison – CORE 2000, Extended, Adapted, Rolling Programme, Healthy Sexual Functioning
  • Probation – TVSOG, N-SOG, C-SOG, Internet programme
  • All programmes currently under review

Statement of Purpose

To reduce risk of re-offending by:

  • Targeting offenders based on their risk, treatment needs and responsivity needs.
  • Increasing offenders opportunity of leading a more fulfilling life, meeting needs by pro-social means.


Cognitive Distortions

Sexual Arousal

Lack of Victim Empathy



Self esteem



Problem Solving

Self Management



Model of Change (based on original concept by Fisher & Beech)

  • Age = 18+‏
  • I.Q. = 80 plus
  • Mental Health - stabilised 6 months
  • Substance abuse stabilised
  • Some acceptance of his conviction
  • Recognition of need to change behaviour
  • Willingness to participate in group-work
  • Language requirement
  • NB – Literacy deficits do not exclude

The Change Process

Foundation Block

Taking responsibility for offending

Reduction in denial

Foundation Block & throughout programme

Addressing distortions

Pro-offending thinking patterns

Cognitive Restructuring

Victim empathy Block

Enhancing victim empathy

Life Skills, RP & skills rehearsal

Problem Solving, coping, strategies, relationship skills, conflict resolution

Addressing deficits in socio-affective functioning

Life Skills & Relapse Prevention

Identify & manage difficult situations, impulsivity, links to offence triggers

Addressing problems of self management

Develop/practice skills for positive lifestyle, risk management, support networks, keep safe plans

Better Lives Relapse Prevention Block

  • Sex offenders are heterogeneous so programme has to meet individual needs as far as possible – thus divided into blocks which can be attended/repeated as required i.e. offender requiring RP/maintenance can attend Better lives section
  • Pre-post treatment evaluation to identify treatment needs and evaluate change
programme structure
Programme Structure

Foundation Block

10 day programme

Monday – Friday 9.30am – 5.00pm x 2 weeks

Total group time = 60 hours



  • 1 Establishing the group 1
  • 2 Link between thoughts, feelings 2
  • and behaviours
  • 3 Sexual thoughts Finkelhor’s Preconditions
  • 4 Model
  • 5 Routes to offending
  • 6 Deciding to offend
  • 7 Consequences of offending 8
  • 8 Making change possible 8-9
  • 9 Progress review and planning 10
  • for the future


victim empathy block
Victim Empathy Block

Twice Weekly Sessions

8 sessions X 2 hrs,

Follow on from Foundation Block

Total group time =16 hours



  • 1 Introduction to Empathy
  • 2 Perspective Taking (Letter to Victim)‏
  • 3 The extent of victimisation
  • 4 The effects of sexual abuse
  • 5 Understanding the victims’ behaviour
  • 6 Victim perspective role-plays
  • 7 Victims’ Questions
  • 8 Letter to victim (not to be sent)‏


life skills block
Life Skills Block

Twice weekly sessions

20 sessions – 2 hours duration

Total group time = 40 hours



  • SESSIONS 1 - 2
  • Self Image
  • SESSIONS 3 - 6
  • Positive thinking & Problem Solving
  • SESSIONS 7 - 16
  • Interpersonal Skills
  • SESSIONS 17 - 19
  • Problems arising in intimate relationships
  • SESSION 20
  • Bringing it all together


relapse prevention better lives block
Relapse Prevention ‘Better Lives’ Block

One session per week

22 sessions - 2 hours duration

Total group time = 44 hours

NB: if the group is larger than 8 offenders, up to 4 extra sessions will be added


Modules of ‘Better lives’ block

  • Familiarisation with the ‘Better Lives’ Model
  • Identifying risk factors
  • Coping strategies
  • Keep-safe Plan & Time Planning
  • Guest Speaker
  • Development of individual treatment targets
  • Skills practice
  • Addressing Dynamic Risk Domains
  • ‘Bringing it all together’
  • Develop Good Life & Keep-safe Plans
  • Presentations to Offender Managers, who attend the last session


substantial emphasis on training and supervision
Substantial Emphasis on Training and Supervision

(particularly important when moving to scale)

  • Staff to demonstrate required competence prior to acceptance into training
  • Training is assessed, staff to demonstrate required competence on training
  • Supervision ongoing for staff skills and support and to maintain programme integrity
quality assurance
Quality Assurance

Treatment Management

Supervision and video monitoring

To protect

  • Programme integrity

To prevent

  • Programme drift, reversal, non-compliance

To promote

  • Treatment style
quality assurance34
Quality Assurance


  • All programmes audited for compliance and clinical quality
  • Programmes designed to have auditable products
audit criteria
Audit Criteria


  • is the programme being managed properly
  • is the programme being delivered as designed with the right length of treatment (dose), frequency, length of session, size of group, number of facilitators

Clinical audit

  • looks at the quality of delivery
  • 20 factors, under 4 headings:

adherence to manuals

treatment style

group work delivery skills


evaluation and monitoring
Evaluation and Monitoring


  • Used to determine treatment needs pre-treatment
  • Used as a measure of progress post-treatment
  • Used to evaluate programmes
evaluation and monitoring37
Evaluation and Monitoring

Recidivism - reconviction data

  • desistance
  • frequency
  • intensity
making changes in programmes
Making Changes in Programmes
  • Role of TM

– where a change needs planning outside the group session

  • Change Control

– for substantial changes

  • Accreditation Panel guidance for the biggest changes

– redesign, replacement programmes

  • Revisions + new programmes
new treatment approaches recent
New Treatment Approaches - recent
  • Reduced focus on denial, offence accounts and ‘cognitive distortions’
  • Reconsideration of ‘victim empathy’
  • Increased focus on therapist style – ‘who works’ v ‘what works ‘
  • Second generation programmes - increased Individualization within a standardised approach
  • Development of strengths-based approaches i.e. GLM
  • Enhanced focus on skills training
  • Increased attention to contextual support, ‘wrap-around’ services
new treatment approaches future
New Treatment Approaches - future
  • Rethinking victim empathy
  • Low risk offenders - less treatment, more management
  • ‘Brain-informed’, reflecting neuro-science developments
  • Incorporate alternative techniques: mindfulness and self-compassion, non verbal therapies i.e. arts therapies (music, art, drama)
  • Increased application of desistance theories
  • Cross-setting versus single strand approaches
low risk
Low Risk
  • Reconviction rate is < 1% over 4 years
  • Dangers of over-treating
  • Low risk ≠ no risk
  • Public expectations + victim’s expectations
  • Some LRSOs request treatment – ethics?
  • Exclude LRSOs – message that some sexual crimes are ‘not serious’
  • Risk assessment tools apply to groups not individuals
  • How to assess 10% high risk-low risk
low risk42
Low Risk


  • Motivation
  • Problem Solving
  • Resettlement
  • Risk management – especially acute risk factors
  • Improve cooperation with CJ and other agencies
challenges for efficient programmes
Challenges for Efficient Programmes
  • integrity and innovation
  • Supply versus demand – access to treatment timely and sufficient
  • Providing for diversity
  • Staying good, getting better – continuous professional development for treatment staff and organisation
  • Adaptation to changing environment – political and knowledge base
  • Targets – inputs, outputs , outcomes
  • Case management on board
  • Meeting need managing resources – how to respond to risk and need of those not in treatment
  • Managing expectations and aspirations
custody community treatment interaction
Custody-Community Treatment Interaction


    • Coherence, Continuity, Consistency
  • Integrated or seamless treatment
  • ‘Through the gate’ provisions
  • Programmes in institutions and community combined to enable different doses of treatment, follow-up, ongoing risk management
  • Joint training and delivery
custody community treatment interaction45
Custody-Community Treatment Interaction


  • Same tools needed for risk & need assessment and common outcome measures
  • Gaps and duplication in provision
  • Differing emphases eg.

- deniers, refusers

- voluntary versus mandated treatment

- risk management

  • Culture, Confidence
contact details
Contact details