Exploring High-risk Offender Treatment and the Role of Music Therapy

Louise Sicard

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000404883
• Edition: 1
• Topic: Media & Performing Arts
• Subtopic: Music

Exploring High-risk Offender Treatment and the Role of Music Therapy explores the treatment delivered to high-risk offenders with complex needs, focusing on sex and violent offenders. The book advocates for the further use of less traditional and creative therapies, in particular, music therapy.

The higher the risk, the greater the needs. Offenders with complex needs have a range of factors impacting their abilities and well-being including mental health and learning disorders. Importantly, high-risk offenders commonly present with complex needs and, therefore, require treatment that is highly responsive. Guiding this book is the existing literature and qualitative research, conducted by the author, that sought to gain the perspectives and experiences of practitioners in the field. This included 38 interviews with those that deliver treatment to high-risk offenders and music therapy. This book examines the components of high-risk offender treatment, highlighting the effective elements and the limitations found within the literature and from the perspective of interviewed practitioners. Offering insight into less traditional therapies, the book presents literature surrounding mindfulness, psychodrama and art therapy for high-risk offenders. It is argued that there has been a recent shift towards a creative corrections approach, where less traditional therapies are gaining recognition within offender treatment, as they offer unique and supportive benefits to traditional treatment. This book focuses on examining the role of music therapy for high-risk offenders, mainly through a critical discussion on the relevant literature and qualitative practitioner data.

Advocating the further implementation of creative corrections approaches, this book will be of great interest to academics and researchers within the fields of offender treatment and penology, as well as forensic psychologists and those studying or practicing music therapy.

Part 1

Exploring high-risk offender treatment and creative corrections

1 The higher the risk, the greater the needs

High-risk offender treatment

This first chapter concentrates on the treatment for the focus population of this book: high-risk offenders (HROs), namely, violent and sex offenders. It is important that these offending populations be treated as effectively as possible, as the level of harm caused by high-risk offences is significant. This chapter offers a discussion on the definition and theories supporting the contemporary perspectives of violent and sex offender treatment. Then, moving forward, the core models and approaches to contemporary HRO treatment are examined, including the risk-need-responsivity (RNR) model, good lives model (GLM) and cognitive-behavioural theory (CBT). Additionally, there is an exploration of research that has presented therapeutic alliance (TA) and trauma-informed care (TIC) as important components of contemporary HRO treatment. Lastly, this chapter discusses the treatment of offenders with complex needs, particularly focusing on mental health needs and those with learning disabilities/difficulties.

High-risk offenders: Understanding violent and sex offenders

Contemporary violent and sex offender treatment commonly share various components; for example, they are founded on the what works literature that involves the RNR model, the GLM and use CBT-based approaches. However, there are differences in the definitions and theories which underpin treatment for violent and sex offenders. Thus, these varying elements will be explored first.

Exploring violent offending: Prevalence and perspectives

In 1996, violence was presented as a serious public health issue during the World Health Assembly (Krug et al., 2002). As a result, in 2002 the World Report on Violence and Health was released, which presented that roughly 4,400 people die daily due to various forms of violence (Krug et al., 2002). Additionally, it is asserted that this health problem is often hidden, with only around half of violent offences reported (Persson et al., 2017). This research employs the following definition of violence as outlined by the World Health Assembly (as cited by Krug et al., 2002, p. 1084):

The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.

It is expressed by Persson et al. (2017) that violence is overrepresented among offenders with complex needs, namely, those offenders with mental health disorders. Moreover, violence is common across forensic settings, within both psychiatric hospitals and other correctional settings (Persson et al., 2017). Focusing on Australia, it is noted that violent offenders are prevalent within prisons, with statistics demonstrating that almost 50 per cent of the imprisoned population were convicted of violent crimes, hence demonstrating the importance of effective treatment for this offending population (Chambers et al., 2008). In defining violent offences, the Australian Institute of Criminology (AIC) (2015) provided subcategories including alcohol- and drug-related violence, family/domestic violence, homicide, robbery, sexual assault and weapons. Although sexual assault is presented as a subcategory of violent crimes, this book examines sex offending in detail later in the chapter, as there is a vast amount of literature that focuses on sex offender theories and treatment.

Violent behaviours are overrepresented in those with mental health disorders and research has demonstrated a strong link between offenders with a personality disorder (PD) and higher levels of aggression as well as violence (Gilbert et al., 2015). Gilbert et al. (2015) stated that professionals within forensic settings have significant concerns in relation to the aggressive behaviours of offenders with PDs due to the prevalence. Further to this, research has demonstrated that PD is the second most common diagnosis of HROs within a forensic setting,¹ with 47 per cent of offenders diagnosed with a PD profile, predominately ASPD and borderline PD (Völlm et al., 2018). The following PDs have been found to be consistently associated with aggressiveness: ASPD, borderline PD, narcissistic PD, paranoid PD and psychopathy (Gilbert et al., 2015). Thus, Gilbert et al. (2015) asserted that treatment efficacy of violent offenders with PDs needs further research. Upon considering the harms caused, the rate of violent offending and the prevalence of violent offenders with PD, it is significant to treat this offending population effectively. As this book focuses on the treatment for HROs with complex needs – including offenders with PDs – the prevalence of violent offenders with PDs is significant.

There are varying perspectives of violent offending in the literature. Roberton et al. (2015) argued that many of the theories and treatment approaches are focused on anger control, with scholars aligning anger with aggressive behaviours. The conceptual relationship between anger and aggression was examined, with Roberton et al. (2015) stating “anger is often accompanied by aggressive action tendencies such as an inclination to yell, wanting to hit someone, and wanting to hurt someone” (p. 2). Further, they posited that although anger and aggression overlap, anger is an emotion that can involve tendencies, while aggression is a behaviour (Roberton et al., 2015). They postulated that due to the focus on the relationship between anger and aggression, violent offender research and treatment commonly focuses on anger management (Roberton et al., 2015). However, Henwood et al. (2015) examined the link between anger and offending behaviour, stating that this area is not well understood. They further explained that anger does not always lead to aggression and not all aggressive acts are fuelled by anger (Henwood et al., 2015). Roberton et al. (2015) posited that research on the impact of other emotions and emotional processing on aggressive behaviours, besides anger, is limited.

Researching within this area, Roberton et al. (2015) investigated the potential relationship between the difficulty of attending to upsetting emotions (e.g. sadness, anger or fear) and aggression in violent offenders. The study examined 64 offenders, with results presenting that offenders with an extensive history of aggression indicated low emotion-regulation skills, high levels of trait anger and anger control issues (Roberton et al., 2015). Roberton et al. (2015) noted that an offender's “ability to control the outward expression of anger, but not their ability to control the anger feelings themselves, was predictive of aggression” (p. 8). Thus, it was posited that it is most significant for an offender to control their behaviour when feeling angry, not attempt to control the anger, when attempting to reduce aggressive behaviours (Roberton et al., 2015). Further, it was stated that difficulty attending to emotions did impact aggressive behaviours and offenders with limited emotion-regulation skills would likely continue to experience frustrations, whereby aggressive behaviours may manifest. Roberton et al. (2015) postulated that future research should investigate the influence of the ability to attend to specific emotions, as the study was limited to examining general upsetting emotions.

Focusing on aggression, it is argued that different forms of aggression displayed by violent offenders are useful in assessing the risk of recidivism, thus impacting the level of service provided (Swogger et al., 2015). It is noted that the following dichotomy of aggression has been empirically researched and acknowledged: reactive and proactive aggression² (Kockler et al., 2006). Reactive aggression refers to aggressive behaviour in reaction to provocation or a perceived threat (Kockler et al., 2006). This form of aggression “involves affective arousal and resulting disinhibition, leading to rapid and poorly considered behavioural response” (Swogger et al., 2015, p. 327). Swogger et al. (2015) discussed the frustration-aggression hypothesis, noting that this model explains the relationship between psychopathology and reactive aggression. The model denotes that negative affective states, which are formed from frustration or social stresses, may regress into anger, thus enhancing the likelihood of reactive aggression (Swogger et al., 2015). Contrastingly, proactive aggression pertains to aggression that is usually planned and acted out with an aim or purpose (Kockler et al., 2006). Swogger et al. (2015) suggested that this form of aggression can be understood through social-cognitive learning theory, where aggression is a behaviour that has been positively reinforced through reward. Proactive aggression is less common than reactive aggression and is linked to psychopathic personality traits, with offenders who have committed several proactive aggressive acts receiving high scores on Hare's Psychopathy Checklist Revised (PCL-R) (Swogger et al., 2015).

Further debating aggression, Gilbert and Daffern (2010) posited that despite being able to discern reoccurring aggressive behaviours early in an individual's life, aggressive behaviour should not be perceived as consistent. It was noted that even habitually aggressive offenders will demonstrate inconsistencies with their aggressive tendencies over time (Gilbert & Daffern, 2010). Furthermore, it was argued that contemporary violent offender treatment is in the process of accepting a mixed-motive aggressor, as aggression can be proactive and reactive in nature (Ireland & Ireland, 2018).

Providing a discussion on effective violent offender treatment, Ireland and Ireland (2018) presented five core elements to embrace: information processing; emotional acceptance, reactivity and regulation; developmental changes; aggression motivation; as well as relapse prevention and strength enhancement. It was stated that many violent offender programmes focus on addressing singular elements of violent offending behaviours, such as antisocial behaviours or subjective emotions, specifically anger (Ireland, 2009). Ireland and Ireland (2018) asserted that all therapeutic intervention, regardless of the specific approach, should address the five core elements to meet the needs of violent offenders. Another imperative element of violent offender treatment is implementing an individualised approach (Ireland, 2009). It was explained that although there may be similarities between violent offenders (e.g. when examining violent offender habitual aggressors), treatment must remain individualised throughout its development and delivery (Ireland, 2009). Moreover, Ireland and Ireland (2018) asserted that it is important to use creative-based learning activities in treatment programmes to increase skill development and treatment engagement. In chapter four of this book music therapy is presented within the literature as a treatment method that focuses on individualised goals and treatment. Music therapy is also beneficial in supporting skill building as well as increasing motivation, as it uses a range of dynamic, creative activities (see chapters four and five). Therefore, this book will later contend that music therapy should play a more active role as an intervention for violent offender treatment, as it implements an individualised approach to treatment, which is argued as core component of effective violent offender treatment within the literature and within the empirical work of the underpinning research (see chapter two).

Perspectives underpinning practice: Examining sex offending

In examining the prevalence of sex offending in Australia, the Australian Bure...

Table of contents

• Cover Page
• Half Title
• Series Page
• Title Page
• Copyright
• Contents
• Acknowledgements
• List of Abbreviations
• Introduction
• PART 1 Exploring high-risk offender treatment and creative corrections
• PART 2 Music therapy as a component of offender treatment
• Appendix A
• Appendix B
• Index