Sexual Offender Treatment

Biopsychosocial Perspectives

Edmond J Coleman, Michael Miner

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317720256
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychische Gesundheit in der Psychologie

Gain a better understanding of the biological, psychological, and social aspects of sex offenders, their crimes, and the treatments that can help them The treatment of sexual offenders varies from culture to culture and nation to nation. Sexual Offender Treatment: Biopsychosocial Perspectives assists sex therapists, counselors, psychiatrists, and psychologists working in sex offender treatment around the world in providing more effective services. This book looks at the behavior of sexual offenders and offers treatment approaches that will stimulate your thinking and help you improve your research and treatment methodologies. This valuable and informative book introduces and discusses the formation of the new International Association for the Treatment of Sexual Offenders, which will advance the existing knowledge about the nature of sexual offenders and sexual offenses, work to improve treatment methods and disseminate information about improved methods, and scientifically evaluate therapeutic methods advocate for the right of sex offenders to effective treatment. Sexual Offender Treatment: Biopsychosocial Perspectives presents an overview of recent research in the treatment of sexual offenders as presented at the 5th International Conference on the Treatment of Sexual Offenders in 1998 in Caracas, Venezuela. This book explores:

• the recently revised Standards of Care for the Treatment of Sexual Offenders
• self-perceived aggression in relation to brain abnormalities in a sample of incarcerated sexual offenders
• self-concepts and interpersonal perceptions of sexual offenders in relation to brain abnormalities
• brain abnormalities and violent behavior
• group family interventions for the treatment of adult male child molesters
• the experiences of adult and adolescent female sex offenders
• a 7 step system to treat pedophiles who are mentally retarded, mentally ill or physically handicapped

Sexual Offender Treatment: Biopsychosocial Perspectives provides you with valuable insights and a cross-cultural viewpoint as you benefit from the expertise and experience of international scholars who have set the standards for the treatment of sex offenders.

RESPECT ™:
A 7 Step System to Treat Pedophiles Who Are Mentally Retarded, Have Mental Illness, and Physical Handicaps

Thomas P. Keating, MA, LCSW, RT

SUMMARY. The RESPECT™ System is a 7 step program using a group setting to modify behavior and thinking patterns of pedophiles who are mentally retarded, have mental illness and physical handicaps. The System addresses issues of resistance, denial, empathy for the victim, self-esteem, plan development, and plan evaluation, by the entire group. Due to learning experiences many of the members have had in institutions and other environments at early stages of their development, the RESPECT™ program is one of habilitation. A perpetrator learns a graduated system of choices that empowers him to trust himself in his community. At the present time there are 14 pedophiles attending the group. Five have been adjudicated. Nine are in some type of supervised living program i.e., State Hospital, four live on their own; one is married. Other secondary diagnostic descriptions are Personality Disorder, Paranoid Personality Disorder, Schizophrenia, Paranoid Type, Schizophrenia, Disorganized Type, Alcohol Dependence, Impulse Control Disorder, ADHD, and Dysthymic Disorder. Also explored are certain counterresistenee issues experienced by the writer and their resolution. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected] <Website: http://www.haworthpressinc.com>]

KEYWORDS. Sex offenders, pedophiles, mental retardation, mental illness, treatment

Introduction

Many dually diagnosed individuals (pedophiles) in sex offender treatment have not learned the basics of community living and have actually learned sexually aberrant behaviors while in the institutions that were responsible for their welfare. Therefore, the RESPECT™ System is one of habilitation. Wettstein, (1998) reports:

Due to developmental impairments, the offender with mental retardation likely has never attained an adequate level of personal and societal independence A disproportionate percentage of defendants with mental retardation are poor, living at the margin, and powerless (McGee and Menolascino, 1992). The goal of habilitation becomes an educative or skill development one to ensure that the person acquires those personal-social and community-survival skills needed to ensure social independence and encourage respect for the code of conduct expected by the community.

(p. 357)

The RESPECT™ system attempts to enhance personal accountability by including the following characteristics described by Wettstein (1998):

1. Teach or strengthens specific alternatives to offending behavior when confronted with conditions similar to those in which the behaviors previously occurred. Then develop more general problem-solving and coping skills. (Goldstein & Glick, 1987)
2. Teach/strengthen internalized standards against which the person can judge contemplated behaviors and which will provide the personal motivation to avoid unacceptable ways of acting. Including teaching/strengthening and internalizing rules that govern the person's social behaviors (Hayes, 1989). This can be accomplished in a program that (a) has clearly defined and understood rules of social living, (b) places responsibility on the person for respecting the rules, (c) systematically models and labels rule compliance and routinely reinforces it with valued consequences, and (d) routinely and promptly consequates rule breaking. (pp. 358-359)

It is also suggested that the initial phase of treatment should be in a secure environment. Many of the sex offenders in the RESPECT™ treatment system are in residential settings that are not secure.

The RESPECT™ treatment system is concrete, repetitive, and activates at least seven intelligences described by Gardner (1983): linguistic, logical/mathematical, intrapersonal, spatial, musical, bodily/kinesthetic, and interpersonal. The system integrates all of these learning possibilities and activates behavior using one word cues. Cognitive restructuring is highly effective with this high-risk population, in limited trials, when learning is adapted to their individual learning problems and resources Haaven, Little, and Miller (1990):

Linking emotion to the learning process. Residents retain what they are taught if the learning experience is fun, dramatic, or bizarre.

Teaching is keyed to the resident's multiple intelligences. . . Teaches concepts and skills using art, music, role-playing, and other creative nontraditional activities.

(p. 22)

Wettstein (1998):

The cognitive and motivational-emotional characteristics of the offender with mental retardation frequently have not developed sufficiently to effectively assimilate the lasting effects of incarceration. Again, the internalization of standards of societal conduct and the related cognitive-motivational skills to use these under future conditions will best be accomplished in a program environment that is designed specifically to teach these and related skills of personal or self-management.

(Gardner & Cole, 1989; Liberman, DeRisi, & Mueser, 1989) (p. 359)

The RESPECT™ System involves seven steps, which are mastered in sequence by group members, according to their own rate of progress, but with support and participation of the entire group. Groups vary in size from nine to fourteen members. Some members attend weekly, some attend only once a month, depending on their rate of progress and their learned ability to return safely to their communities. Several group members are remanded to the group for the period of their probation.

In summary Wettstein (1998) notes:

Treatment programs should address the constellation of individually specific personal features and community-survival skills deficits. To accomplish meaningful therapeutic results, the treatment program should be diagnostically based, reflect a competency enhancement (habilitation) focus, and place major emphasis on teaching personal responsibility for one's actions.

(p. 359)

Murphy, Coleman, and Haynes, (1983) note:

While experienced clinicians who work with both disabled and non disabled sex offenders recognize more similarities than differences between the two populations, there is an appalling lack of research, studies and treatment models in the literature to assist in treatment planning for intellectually disabled sex offenders compared to the treatment resources available for non disabled sex offenders.

(pp. 22-23)

Treatment information and resources become even more scarce when individuals are also carrying a Mental Illness diagnosis, and Physical Handicaps. Another challenge was to develop a model in an outpatient setting where the group meets only once weekly for one and one-half hours, and the client returns to his respective community. Although the habilitation model of the mental retardation service delivery system holds more promise of success than either punishment or illness models of the criminal justice and mental health systems (Wettstein, 1998), the typical habilitation programs are not sufficiently specialized and diverse to address the specific needs of the offender with mental retardation (Laski, 1992).

In summary, the usual programs offered by the criminal justice, mental health, and mental retardation systems seldom are satisfactory in meeting the special habilitation needs of the offender with mental retardation (Wettstein, 1998).

The critical starting point in the habilitation process is that the offender is accountable and responsible for his actions. The offender with mental retardation too frequently is not held accountable for his/her behavior by family and friends. This practice labeled as psychological welfarism by Gardner (1991) tends to reinforce the attitude that criminal behavior will be tolerated and overlooked. The result of this practice is repeated criminal behavior (Wettstein, 1998).

Internal control may also be lacking in the intellectually disabled individual with a mental illness and characterized by a greater degree of impulsivity than a non disabled offender. He may have a highly externalized "locus of control" perceiving many of the controlling factors in life as being "out there." As a result, he may feel frustrated and disempowered, unable to control what is happening to him; if he is in residential care, this perception may have been fostered by those very institutions. He is also more likely to use instrumental violence due to a lack of verbal skills, low tolerance for frustration and a tendency to panic in new situations.

Words and phrases often repeated and mimicked, by the disabled individual, can be confusing and contradictory.

Example: A client's face, flushed grim; hands balled into fists, in a loud, threatening, voice, says, "I love you! I love you!"

The concept/thought of RESPECT™ connects specific body movements to concrete actions. The action is a martial arts bow taught to me by a client who is deaf, mildly mentally retarded, and schizophrenic, who took nine years to earn his Black Belt in Tai Kwon Do Karate. It is a combination of 7 distinct body movements ending with verbal and American sign language, "Respect Community." This is an example of respecting and using the client's frame of reference; creating an action where thoughts are congruent and concretely connected to body movement. The Bow takes 7 seconds to perform and is called, by the offender group, the RESPECT™ Bow. Each group begins and ends with RESPECT™.

D.M. Cull, Forensic Psychologist, Australia, (personal communication, September, 2, 1997) response to RESPECT™ (Forum, 1997):

A baby is born with dignity. It presumes its needs will be met. It has a birthright to be loved, protected, guided supported and instilled with a sense of integrity. The dignity with which that child is born is very frequently eroded through life's events. Some such individuals go on to become sex offenders. A few years ago I was informed, by a sex offender nonetheless, of the actual definition of the word rehabilitation. To quote this man-whose mental faculties are certainly not impaired, whose attitude in defining this word was well intended and respectful, "Rehabilitation is to reinvest with dignity." Whilst confrontation and direct challenge is frequently necessary to break through the barrier of defensive resistance to change, the process I believe most importantly must serve to recognize the damaged ego and serve to reinvest rather than to further damage the dignity of the person with whom the work is being done.

Regardless of whether the client is a pedophile, rapist, exhibitionist or any other offender of similar ilk, I invite the therapist to explore the issues which may well have ('I believe will have') underpinned or seriously damaged the dignity with which the client is born.

. . . I am even more appreciative, in fact indebted, to my client, B..., wherever he may now be, for teaching me the simplest yet most important piece of learning which all my formal training somehow forgot to impart. He came to me for learning and in the process gave to me the greatest piece of learning of my career.

Finally, the lesson to be learnt from this realization, I believe, is that we lose ourselves in all of all the theory and doctrine which is available, and essential, within this professionally precise field of endeavor, and overlook this simple yet vital aspect of our work within the field of rehabilitation of sex offenders. May our own presumably intact egos not be so inflated that we close our eyes and our ears to the opportunity to learn from the true experts in the field-our client group. I will remember that to rehabilitate is to reinvest with dignity.

The central concept of the RESPECT™ System is habilitative, i.e., to start from the beginning; invest with dignity. If an offender reoffends after completing the RESPECT™ System, and returns to the group, we reinvest with dignity. The process now is rehabilitative and he begins the entire process again.

Psychological treatments work best when they provide not specific remedies for particular problems but tools for managing any situation that might arise (Bandura, 1997). Treatment should equip people to take control of their lives and start a process of self-regulative change guided by a resilient sense of personal efficacy.

The RESPECT^TM System is referred to by the therapist and participants as a tool to use over and over again when challenging thoughts, impulses, and behaviors surface. When an individual completes the entire program and has completed Step 7, the TRUST step, he has solved only one problem/reality. The first time through the entire system is only an introduction to the RESPECT tool. Everyone in the group knows that pedophilia is forever and there is no cure. If a new reality/problem presents itself, the offender will begin with Step 1, REALITY, to solve the new problem, but keep Step 7, TRUST. If he reoffends, he loses Step 7, TRUST. Once an offender has earned TRUST he struggles to keep it by using his program and not...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Introduction: Promoting Sexual Offender Treatment Around the World
• Standards of Care for the Treatment of Adult Sex Offenders
• The Psychoneuroendocrinology of (Sexual) Aggression
• Social Information Processed Self-Perceived Aggression in Relation to Brain Abnormalities in a Sample of Incarcerated Sexual Offenders
• Self-Concepts and Interpersonal Perceptions of Sexual Offenders in Relation to Brain Abnormalities
• Brain Abnormalities and Violent Behavior
• The Treatment of Adult Male Child Molesters Through Group Family Intervention
• Adult and Adolescent Female Sex Offenders: Experiences Compared to Other Female and Male Sex Offenders
• RESPECT™: A 7 Step System to Treat Pedophiles Who Are Mentally Retarded, Have Mental Illness, and Physical Handicaps
• Index