Therapeutic Engagement
RUNNING HEAD: Therapeutic Engagement of Sexual Offenders
Therapeutic Engagement Styles of Child Sexual Offenders in a
Group Treatment Program: A Grounded Theory Study
Andrew Frost1
1Kia
Marama Special Treatment Unit
PO Box 45
Rolleston
Canterbury
New Zealand
Voice
Email
+64 3 347 7867
andrew.frost@corrections.govt.nz
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Abstract
It is widely observed that child sexual offenders typically exhibit considerable
reluctance to self-disclose at a level that reflects the full reality of their offending.
Their successful engagement in relapse prevention-based programs is therefore
problematic. This paper describes a study involving men undertaking a prototypical
group treatment program, facing the challenge of revealing to others the details of
their offense process. A procedure was developed to access their covert responses at
the time of this encounter. From a grounded theory analysis, participants were found
to employ various strategies to manage situations where self-disclosure was required.
Four distinct disclosure management styles emerged: exploratory, oppositional,
evasive and placatory; the latter three of which appear unfavorable to effective
engagement in treatment. As well as suggesting ways of influencing disclosure
management style, analysis indicated that it might be possible to predict these
different orientations during routine assessment.
Key words: therapeutic engagement; self-disclosure; child sexual offenders; disclosure
management style.
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Relapse prevention-based treatment has, over the last two decades, become the
preferred approach to working with sexual offenders (Laws, 1998; Marshall,
Fernandez, Hudson, & Ward, 1998). This is especially so in the treatment of those
whose victims are children (Marshall & Anderson, 2000). The relapse prevention
model as applied to sexual offending was originally adapted from the addictions field
as a treatment maintenance strategy (Pithers, Marques, Gibat & Marlatt, 1983). It has
since been developed as a more flexible and durable treatment conceptualization that
better reflects the self-management focus of cognitive behavioral therapy. In its most
recent manifestations the model incorporates recent work on self-regulation and
related constructs (Ward & Hudson, 2000) and has been seen to reliably respond to a
range of treatment needs (Bickley & Beech, 2002).
Treatment programs commonly involve a group therapy format and require
that each participant engages in detailed self disclosure about the processes involved
in his sexually abusive conduct (Barker & Morgan, 1993; Marshall, 1999). This is
typically the prelude to a rigorous process involving the examination and refinement
of each client’s understanding and “ownership” of his offending as a patterned and
predictable process.
However, it is clear both from practice experience and from the literature
(Scheela, 1992; Scheela & Stern, 1994) that the process of self-disclosure for these
clients tends to be experienced as particularly aversive. It follows, and is also well
documented (Garland & Dougher, 1991; Salter, 1988; Tierney & McCabe, 2002), that
such demand typically gives rise to considerable resistance. Although some impress as
motivated to reveal important sensitive information (such as undetected offending)
from an early stage in treatment, others present as reluctant even to acknowledge their
active role in the abuse for which they are convicted.
A willingness to openly confront factors that motivated and maintained
offending is generally seen as a key step to making the changes necessary to
addressing re-offending risk. Such openness is therefore a primary requirement of
treatment programs (Kear-Colwell & Pollock, 1997; Marshall & Anderson, 2000;
Marshall et al., 1998; Salter, 1988), and considerable effort is invested in facilitating
the shift from reluctance to compliance. This is the task of therapeutic engagement.
The process of engagement in sex offender treatment, however, is not well
understood. Marshall and others (Fernandez & Marshall, 2000; Marshall, et al., 2003)
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have drawn attention to the low emphasis on context and process issues in the relevant
literature. Extrapolating from the more general literature, they conclude that therapist
qualities, client perception of those qualities, and therapeutic alliance are the key
variables that predict positive treatment outcome. However, they acknowledge there is
little known about the qualities of group treatment specifically applied to work with
sex offenders. A rare study focusing on the “climate” of sex offender therapy groups
(Beech & Fordham, 1997) suggests that therapists generating a strong sense of
cohesiveness within groups were most successful. In short, conducive relationships,
and especially client perception of such relationships, in confronting the personally
daunting issues raised in sex offender therapy are likely to be important in
successfully engaging clients.
The study described in this paper represents an investigation of the experiences
of clients faced with the prospect of self-disclosure. Self-disclosure was viewed as a
critical aspect of the demonstrated willingness of men to participate functionally in an
intervention to promote behavioral change, and therefore as a key marker of
engagement. The aim of the research then was to shed light on how participants go
about addressing the dilemmas posed by the disclosure encounter at the time of the
encounter itself. Of particular interest were those qualities and processes present in
that context and at that time that influence clients in confronting this task.
Given that the present investigation sought to build theory rather than test it, a
grounded theory method (Glaser, 1978; Glaser & Strauss, 1967; Strauss & Corbin,
1990) was employed. This method has enjoyed support as a vehicle for this type of
social science research goal (Gilgun, 1992; Henwood & Pidgeon, 1992; Rennie,
Phillips, & Quartaro, 1988; Riessman, 1994). Typically, studies carried out according
to a grounded theory regime generate a considerable quantity of raw data gathered
from a relatively small number of research participants. Using this method, data
analysis proceeds alongside collection. The two procedures cross-pollinate,
contributing to an emergent explanation, which may eventually contribute to broader
theory. Analysis begins with an initial set of raw data, which are divided according to
units of meaning and subsequently grouped into categories. These categories are
named according to the semantic content of each, and relationships are sought
between the labeled categories. At the same time, the categories are regularly checked
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against the data to ensure a “grounded” match. Gaps in the emerging information also
provide a guide to decisions for subsequent data collection.
The primary purpose of the current paper is to present this research, along with
a brief overview of some of the outcomes. The methodology developed to carry out
the investigation is described, and a significant outcome of the research, the discovery
of distinct disclosure management styles, is presented in the form of a descriptive
model. The significance of this model is proposed in relation to issues of treatment
process and context, and especially the process of engagement. Finally, implications,
limitations and proposals for further research are discussed.
Method
Context of the Research
The site for conducting the research was the Kia Marama program (Hudson,
Wales & Ward, 1998), based at Rolleston Prison, Aotearoa New Zealand. This is a
prototypical and successful prison-based program employing a relapse preventionbased model in the context of an interpersonal group therapy modality.
The point of investigation was the “Understanding your Offending” (or
“Offense Chain”) program module. The particular focus for the study was offense
pattern disclosure, and the attendant processes of group feedback and refinement. It
was considered that this module provides the opportunity to access some of the richest
and most concentrated sources of information about the man’s response to the
invitation to engage in treatment.
The direct research objective then was to identify personal and interpersonal
factors that impact on therapeutic engagement in this instance, and to explore the
group processes that contribute to those factors. The intended process of the study was
to identify such events experienced by research participants as salient, as they occur in
the context of group treatment. These events, along with observations and the
subjective experience surrounding them, were then to become the subject of ongoing
analysis.
In order to access the experience of participants as directly as possible, a
method of gathering the data from the articulated thoughts (Davison, Robins &
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Johnson, 1983) of participants was devised, and these data were developed using a
grounded theory analysis.
Research Participants
Participants were incarcerated offenders convicted of one or more sexual
crimes against persons under the age of 16. Prior to their inclusion in this study, each
had volunteered for inclusion in the Kia Marama program, which is based in a standalone prison unit. Over the course of the study, treatment groups were commencing
every one to two months. Inmates accepted for treatment were transferred to Rolleston
from regional prisons. Of the 16 primary participants, their ages ranged from 23 to 65
with a mean age of 40.2 (SD = 12.7). The convictions of this group involved indecent
assault, unlawful sexual connection and sexual violation. Two were Maori and 14
were of Pakeha (non-Maori, generally European) ethnicity. Length of sentence ranged
from 24 to 72 months, with the mean being 40.3 (SD = 14.8). Number of victims
ranged between one and eight, with a mean of 2.75 (SD = 2.2). None of the primary
participant group had a current psychiatric illness, although five had psychiatric
histories.
Procedure
Treatment intake groups targeted for inclusion in this research were
approached and invited to take part in the study. Participation essentially involved
being videotaped during a group therapy session, followed by an interview with
respect to personal experiences of that session. Because other members of each
participant’s treatment group would figure in this process (by providing the context in
which interviews with primary participants would take place) their consent was also
necessary.
Where such dual consent was gained, each primary participant was videotaped
in the context of a group therapy session that was dedicated to eliciting details of the
offense chain for that participant.
Following the group therapy session, the participant was asked to carry out a
series of tasks. The central aspect of these tasks was to nominate and record features
of three events from that session that he considered to be the most personally salient.
These salient events were defined in terms of discrete episodes, those that maximally
engaged the participant’s attention at the time the event occurred, according to his
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own appraisal. These events and certain contextual information were recorded
(written) by the participant on a form designed for this purpose. Each participant was
also asked to record (voice) onto a dictaphone a general account of the events of the
session immediately following it. It was intended that this data would function as a
check on the validity of his appraisal, on the assumption that for an event to be
accepted in the data as genuinely salient it could be expected to figure in the
participant’s general account.
Before the next group therapy session the participant joined the researcher in
the room where the session had taken place. Here, he was asked to view the video
recording and to identify the three episodes he had nominated.
Once located on the videotape by the participant, the identified material was
indexed according to the counter on the tape recorder so that it could be readily
located.
For this exercise, the participant was encouraged to imagine himself as vividly
as possible as though he were re-experiencing the session itself. Efforts were made by
the researcher to elaborate the experience by verbally eliciting from the participant the
detail of his emotional responses associated with the session, along with his recall of
sensory information. In this way the goal was to recreate the “tone” of the earlier
encounter in therapy so that the participant was best primed to respond as if he were
again in that situation.
The salient episodes from therapy selected by the participant were then replayed on the TV monitor as sections of video in the presence of both participant and
researcher. Each of the episodes was started and stopped (freeze-framed) at frequent
intervals in order for the man to articulate his subjective experiences (to “think
aloud”) throughout that part of the encounter. He was also encouraged to elaborate
thoroughly on these experiences throughout the episode. An interview guide was
developed to assist in this process based on a number of prompts:
General

What are you noticing there/what’s going on?

What are you thinking here/what’s on your mind at this point?

How did that leave you feeling?
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What did that mean to you?
Elaboration

Tell me more about that/what else?

What is that leading you to think about there?

How did you see that/what did you make of it?

What is significant about that to you?

What did you want to do/what was your intention?
The participant was encouraged to refer to salient moments occurring in the
recorded material as they became apparent during the tape play back. The researcher
also intervened to elicit the articulation and elaboration of experiences.
This interview was audio-recorded, transcribed, and considered alongside
other data for grounded theory analysis.
Analysis. A grounded theory approach was the main organizing principle for
analysis. The wealth of data from the diverse sources were integrated, matched, and
combined into analyzable categories in the procedure explained. Strauss and Corbin’s
(1990) monograph was used as the first point of reference for the procedure. Interview
transcripts were collected, one batch at a time, as successive treatment groups passed
through the relevant stage in the program. On each occasion that this occurred the
transcripts were placed alongside other sources of data and “fractured” (Strauss &
Corbin, 1990) into meaning units (or “chunks” of meaning). Initially, these chunks
were derived from a line-by-line analysis (Charmaz, 1995), being divided according to
the smallest possible sequence of text that still retained individual meaning as
illustrated:
I suppose that is what his job is, to try and see if he can change
your mind, or have another thought about it. / Perhaps seeking
me to become uneasy about the situation, / that I might say
something I might not have said something previously, / or to try
to get me angry; / I’m not quite sure. / He is trying to make you
feel uncomfortable; / he is trying to get you to say something,
that possibly might not have intended to say. /
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Each unit was initially labeled with a note relating to its semantic quality and
the units were then grouped together according to their labels. As this proceeded, the
groups were condensed into clusters at a higher level of abstraction to capture and
combine categories of similar meaning. That is, sub-categories were combined with
similar sub-categories into broader categories.
The process of collating categories was followed by preliminary attempts to
identify potential relationships between them, employing “concept mapping”
techniques (Maykut & Morehouse, 1994). Data continued to be assigned to categories
as each data source was analyzed.
The gradual nature of the data collection facilitated a process of analysis
involving the alternate compressing and expanding of the data in a semantic sense.
This process is explained. As the data were accumulated, hypothesized relationships
between categories were postulated (compression), then the categories were “trialed”
by re-opening the categories (expansion) in order to test the hypotheses for goodness
of fit with the data themselves. The relationships validated from this process directed
subsequent data collection, by for example guiding more direct and specific
questioning along the lines of the themes that had emerged.
Employing Strauss & Corbin’s (1990) axial coding paradigm, which defines
the elements of a causal sequence and applies them to the categories of data, these
procedures gradually revealed a narrative. The narrative described how participants in
the study navigated a pathway through the disclosure session according to their
expectations and experience of it. The elements of this narrative are made explicit in
the results section. As analysis by these means progressed, the central principle to this
“navigation” process was established. Participants, it was revealed from analysis,
decided how to manage the session by what one man referred to as “getting it right”: a
combination of the participant’s goals for the session and the strategies for achieving
those goals. This principle was tested and confirmed using the procedures described
above as a central category to which all others related, and which was axiomatic to the
emerging account of how engagement occurred. This super-category is referred to in
the grounded theory literature as the “core” category. Once this was revealed, the
process could be described in terms of a flowing, sequential account of what was
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going on when participants confronted the disclosure encounter. Each of the primary
participants’ narrative accounts could then be identified.
Eventually, following this method, no new categories around the disclosure
management sequence were being formed and no further refinement was occurring.
That is, all newly culled units of meaning were codable into existing categories.
Strauss & Corbin (1990) refer to this stage of the categorization as “saturation”.
The resulting narrative accounts were found to fall into four broad categories,
resulting in four disclosure management styles. A model describing these styles is
outlined in the next section, following a brief account of the process and findings from
which the model emerged.
Results
Analytic Process
Initial stages of the data analysis revealed a number of common themes as the
men faced the disclosure process. These were the “raw”, preliminary categories that
directed ongoing collection and analysis. One of these, labeled experience of
psychological overload, is illustrated with examples from meaning units:
“It seems like you are getting questions from every direction, but there isn’t
really that many people speaking.”
“ It’s a bit like an interrogation; it’s like being overloaded.”
“So between J and the therapist I was getting beaten: like a bat and ball - like
punch drunk”
“I didn’t realize that W had gone on - I heard, but I didn’t take it in.”
The analysis at this point was in its early stages. The research task was to
develop a refined understanding of these initial themes, to make sense of their
influence, and to discover dynamics operating in this situation that would account for
their incidence and their course. For example, the category labeled experience of
psychological overload was combined with other rudimentary categories and became
subsumed under the label reactions to impact.
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Once all the transcripts were categorized, relationships were established
between the categories. As relationships were observed to occur, some categories
were re-labeled, or were telescoped together, and some new categories were
identified. At this intermediate stage, a dynamic process was revealed by which
participants were seen to confront the various risks and opportunities they perceived
in the disclosure encounter. Essentially, orientation to the task of disclosure appeared
to be founded on certain predispositional factors (a category) comprising
motivational, assumptive and perceptual elements (sub-categories) brought to the
encounter by participants. Subsequently, participants were observed to adopt
particular goals and strategies with respect to the risks and opportunities they
perceived. These goals and strategies manifested in a set of distinctive response
styles. Response styles were, in turn, seen to be characterized by particular markers of
progress, sources of impact and reactions to impact, reported by participants as they
experienced events salient to them during the session.
Disclosure Orientation
An outcome of progressive grounded theory analysis was that the common
imperative among participants (to “get it right”) was established as the core category
and found to be identified with a range of goals. These goals were observed to be
combined with a range of strategies for achieving them. The combinations and
permutations of these goals and strategies form the basis for understanding the
construct of disclosure orientation. The disclosure encounter can be seen to represent a
range of challenges to participants. The particular nature of the challenge depends on
the immediate concerns and priorities of the individual, thereby establishing his
approach to the task. The range of approaches came to be defined in the study as
dimensions of disclosure orientation. The disclosure orientation concept itself denotes
intention and can be viewed as the dominant stance adopted by the man,
characterizing his approach to the encounter.
Figure 1 presents the research outcomes in a conceptualized form, representing
the disclosure orientation model and incorporating the four disclosure management
styles, one associated with each orientation. The two axes of goal and strategy,
generate four broad disclosure orientations, which are depicted as discreet elements. It
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follows that the disclosure orientation associated with any individual can be plotted on
this graph.
----------------------------------Please figure 1 about here
------------------------------------
According to this model, disclosure goal relates to matters of personal
validation, and particularly, to the principle source of such validation. That is to say,
these goals are influenced principally by whether the individual puts greater emphasis
on the evaluation of others or, alternatively, on his own evaluation to this end. Where
he looks principally to others for such validation he is said to be other-directed; where
the man emphasizes a self-validating approach he is seen as self-directed.
The self / other continuum intersects with the second dimension of Figure 1:
that of the disclosure strategy continuum. This latter notion describes the full set of
active responses of participants to managing the challenges that the session represents
to them. The two extremities on the strategy continuum are labeled as open and
closed. In the course of the disclosure encounter, opportunities are created for sharing
ideas, hypotheses, suggestions, enquiries, advice and explanations. Whereas some
clients favor relative openness to such exchange of information during the session,
others are seen to adopt a more circumspect or closed approach.
Disclosure Management Style
According to the model, the combination of predispositional factors, as
exhibited by any one client, is closely associated with disclosure orientation.
However, as well as denoting intention, disclosure orientation also influences means:
how the client goes about managing the encounter. In this way, predispositional
factors have a direct bearing on the way in which, in a behavioral sense, he navigates a
course through the encounter. There emerge then four discrete disclosure management
styles, arising directly from the four permutations of goals and strategy pairings. The
constraints operating on the course of their disclosure again reflect the intensity of this
experience for the men involved, as they seek to balance their need to provide an
explanation for their behavior and themselves (whether this is driven by an “internal”
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need to make sense of their offending or an “external” one to be acceptable to others)
with the perceived demands of the immediate environment. Irrespective of the
particular goals and strategies involved then, their predicament engenders a
compelling sense of the need to “get it right.” Depending on the particular disclosure
orientation, getting it right can involve a range of approaches from finessing one’s
way through the encounter with a minimal level of exposure to harmful selfrevelation, through to grasping the nettle of disclosure and therefore maximizing
opportunities to elicit helpful feedback from other participants in the encounter.
Providing “correct” responses in the “right” way therefore is a common concern of the
men in this situation, whether their purpose is to oppose, evade, placate or explore.
A brief profile of each of these disclosure management styles, along with a
summary of relevant characteristics derived from data in the study is described in the
next section.
The Four Disclosure Management Styles
Exploratory style (self-directed / open strategy)
After W [group member] had said, “I’m lost”, I said, “good!” At
that particular stage, I turned introspective…. I said “good”
…because I could see an opportunity to enlarge on what I had
just done. On this occasion, it is someone who is lost; the group
can get together now with me, with W to fill in the gaps, get
something to work on. The people can put a little piece of
information here and there to fill in the gaps. W’s lost, I’m lost;
but others can have a brainstorm.
The exploratory disclosure style is characterized by both a relative openness
around disclosure and an inclination to interpret information in ways that are
consistent with self-discovery. Those who are inclined toward this approach tend to
encourage exchange and the free flow of information in the session.
As they seek to make sense of their situation, such individuals look to integrate
information from external sources with existing understandings, and even a
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preparedness to replace such understandings, in a search for greater clarity or
accuracy.
They seek to manage the encounter with a spirit of enquiry, and a reflective
and considered attitude to feedback. Emerging issues are met with a curiosity-driven
stance, as they endeavor to build on or to modify pre-existing understandings.
Although they are primarily concerned with discovery, these participants are
nevertheless at times wary of the potential for painful experience such as rejection by
others. But while they may feel some ambivalence toward revealing themselves, they
tend to welcome the prospect of unburdening, and savor a sense of cathartic release in
doing so. Those events representing opportunities to integrate new information are
generally the most salient for these participants. Such events are associated with a
positive sense of stimulation and appear to enhance engagement in this case.
Oppositional style (self-directed / closed strategy)
I felt that he’s not believing me; this is not me ….He was trying
to make it the truth, something that it wasn’t. He was twisting it
all around, changing the outcome of it…. I think it was a lot of
bullshit - constructing something that’s not there.
This disclosure management style contrasts markedly with the previous one in
that it is associated with an orientation characterized by an intention to pursue a policy
of resistance to re-interpretative or confrontative input generated in the disclosure
forum. In common with the exploratory style, however, self-directed validation is still
to the fore.
Those participants who come to the encounter emphasizing a self-directed
approach combined with a closed disclosure strategy exhibit a concern with promoting
the status quo. Generally, they habitually and explicitly oppose feedback that is
contradictory of their opening position, typically viewing it as personal attack. By
adopting this oppositional style of managing the situation, they seek to prevent the
admittance of alternative constructions of their account, and may actively counter such
challenges. In this way, their experience of the session comes to be dominated by a
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sense of being under siege, which they are inclined respond to by further entrenching
their position. From the playing out of such interaction, these men are likely to emerge
with their understanding of themselves and their behavior minimally changed.
Evasive style (other-directed / closed strategy)
All those years of fighting to put it behind me. It’s been in there
somewhere, but I’ve trained myself all those years to cover it up,
in case someone found out - being exposed, made public. I’ve
hidden these things for all these years. Even from myself…. But
my mind is going over and over about [year of original
offending]. I’m [age] now, a lot of my life has happened since
then, and I have hidden this away for so long. When I got out of
borstal and came back home it wasn’t discussed.... Here it [the
offense] is being exposed for everybody; stuff even I’ve hidden
from myself. It is bloody terrifying.
The core features of those who predominantly display this orientation are their
fear of negative evaluation, and their inclination to adopt a strategy of concealment or
deception. Research participants adopting this mode tended to cite a concern with
social exposure and subsequent emotional harm as the justification for this response to
the encounter.
A key predispositional feature is ambivalence. The men who adopt this
orientation appear both drawn to the benefits of disclosure and repelled by the fear of
experiencing distress.
In essence, there prevails a pervasive sense of personal fragility surrounding
the continual threat of exposure. The therapy session is construed as an ordeal, and
emotional survival is considered paramount.
There are active and passive forms of response to this perceived plight. Some
resort to a range of active subterfuges designed to manipulate the focus of the
encounter as they seek to evade or avoid the disclosure of information associated with
shame. In its passive form the evasive style is expressed in terms of suppressing
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painful emotion, or attempting to supply the minimal response gauged to be
acceptable.
Clients whose approach to self-disclosure is characterized by an evasive style
appear to be motivated by some desire to profit from the experience while attempting
to avoid revealing key aspects of their personal history. Primarily they are avoidance
driven. They enter the encounter having anticipated a range of personally damaging
contingencies, and often having planned responses to these contingencies in a
despairing attempt to avoid the expected harm.
On being confronted with the objects of their fears in the course of the
encounter, these participants typically experience an urge to physically escape it.
Placatory style (other-directed / open strategy)
It was accepted by [Therapist]; he would have said if he hadn’t
accepted it. [Therapist] turns back to the board there, and I’ve got
a sense of relief for me that he has gone to the board to address
the board and put whatever I had answered him on the board.
And think about it - of how he had put it on the board for the
group to see. A relief that I’ve come out with the right answer.
[Had I got it wrong,] I would have felt put down because my
thinking was wrong. I led [Therapist] to believe that - I led him to
believe that I was just thinking it was all right to do that what I
did. I was quite relieved that I got away with that answer, and
explained to the group that I have changed over the last ten years.
Those participants who, during the disclosure encounter, emphasize a
placatory management style exhibit a primary concern with maximizing opportunities
to secure the support of others. This priority promotes the attraction for these
participants of presenting in a favorable or sympathetic light. To this end, their
participation often conveys what are ostensibly commendable levels of self-disclosure.
They are sensitively aware of the presence of others and conscious of the fact that they
are continuously generating a socially evaluated impression. The need to manage this
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impression is an immediate concern and tends to over-ride more self-directed
priorities.
There exist similarities between this disclosure management style and the
evasive style. For instance, while in fact both approaches are concerned with the goal
of satisfying the expectations of others, participants of either orientation may, in
certain circumstances attempt to convey an impression of being self-directed.
However, the distinguishing feature of action associated with the placatory style is the
concern with securing emotional support. The goal here is approach-motivated: to
have oneself acknowledged, heard, affirmed; in short, to be acceptable to others. In
contrast to the strategy associated with the evasive style (which emphasizes avoidant,
reactive attempts to stymie information), here there is a proactive focus on creating a
favorable impression. The emphasis is on aligning oneself with others rather than
insulation from emotional harm. Of course, to publicly accept the identity of a child
molester is likely to be viewed as inviting threat to positive evaluation. However,
social survival tends to be valued above the intra-personal risks associated with
personal disclosure, and there is a danger that these men may accede to inaccurate
accounts of themselves or their behavior purely for the purpose of avoiding
interpersonal rejection in the immediate context.
Personalities and relatedness are the important catalysts to therapeutic
engagement here, as favorable conditions are created when the experience of social
approval is paired with therapeutically relevant disclosure.
Discussion
The present study set out to explore issues surrounding the therapeutic
engagement of incarcerated child sex offenders in a group-based relapse prevention
program. Specifically, the research examined how participants responded to the
definitive challenge of comprehensive self-disclosure. The question was addressed
from the point of view of participants themselves. It is suggested here that the
disclosure management model generated from the study is a useful heuristic in
approaching the engagement issue.
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A key indicator of the functional engagement of child sex offenders in a
relapse prevention-based group treatment program, it is argued here, is the accurate
and comprehensive disclosure of certain personal information. Such information is
required to be of a type, and presented in a way, that facilitates open exchange in the
group, pertinent to enhancing the discloser’s understanding of his offense process, and
conveying his sole responsibility for his offending.
The model depicts four distinct orientations to disclosure, and each is
associated with a particular coping response, or management style. The first disclosure
management style grouping is represented by those participants whose approach is
characterized by an apparent inclination to confront abusive behavior relatively
directly. In contrast to the denial, evasion or unreflective compliance characteristic of
the others, this group exhibited an exploratory posture toward the factors that had
motivated and maintained offending . The three remaining disclosure management
styles might be described as essentially “resistant” in nature. One of these is an overtly
oppositional style. While associated with denial and minimization, and commonly
predicted in the literature as the standard approach of these clients, this style may
represent the dominant approach for only a proportion of those men in treatment who
actively avoid open and direct self-disclosure.
The two other “resistant” styles of disclosure management (placatory and
evasive) emerged as more covert, and perhaps less readily identifiable, means of
avoiding engagement. These latter approaches suggest a more ambivalent attitude
toward committing to change.
Limitations of the Research
The study was conducted in a single prison-based location with a relatively
small number of research participants. We must assume that offenders who are
represented (that is, those who are detected, convicted, incarcerated and volunteer for
treatment) comprise only a narrow cross-section of the child sex abuser population.
Applicability of the findings to those falling outside of this category is, as yet,
untested. The model remains tentative and of provisional applicability to other
settings.
Therapeutic Engagement
19
Since the completion of this initial study, further data have been collected at
the site of the original study, involving a further six research participants. Analysis is
currently underway, providing an opportunity to test the model and to introduce such
checks as inter-rater reliability.
Some Implications of the Four Styles of Disclosure Management for Therapeutic
Engagement
Child sex offenders as a population have often been considered uniformly
resistant toward responsible self-disclosure (Salter, 1988). The disclosure
management model paints a more complex picture. It challenges the simplistic notion
that “resistance” in child sex offenders is a monolithic phenomenon. A reluctance to
reveal emotions, intentions and planning with respect to this type of offending is here
presented as multi-faceted. The model also generates a picture of resistance that is not
static but relational and dynamic. That is to say, the model provides a view that such
practices as evasion and placation appear to be directly influenced by interpersonal
responses to them.
Identifying the approach to disclosure management in a client and an
awareness of the associated feelings and beliefs may be important to understanding
how to promote functional engagement. This view suggests the importance of
developing sensitivity to how the individual perceives personal and interpersonal risks
in this situation, as well as the ways in which he attempts to protect himself, or by
other means to advance his goals. In this way, accurate early assessment of a client’s
disclosure management style could make treatment more efficient and effective by
neutralizing time-consuming and often fruitless confrontation. Hopefully, clients can
learn alternative ways of promoting their interests by engaging in collaborative
practices and thereby freeing up intervention resources to be expended on matters of
relevant content.
A General Clinical Approach
The model also has implications for a more general clinical approach to
providing an environment that is more conducive to disclosive practices among
participants.
Therapeutic Engagement
20
The promotion of an overall climate of interpersonal openness appears
warranted. This should apply not only to those presenting sensitive information, but
also to the responses of other group members to that disclosure. That is, transparency
of social response to the discloser appears desirable, as well as feedback that
encourages broader, more diverse considerations. These considerations might embrace
evaluations of group members, concerning how they view the fact of the disclosures
and what new light they may see the discloser in. Where such transparency is
unavailable, clients appear motivated to invest energy and resources unproductively
into monitoring such evaluations. In any case, where the group “climate” (Beech &
Fordham, 1997) has been well developed one could be optimistic that such
evaluations would be inclusionary of the discloser. Enhanced transparency may assist
in neutralizing mistrust and avoidance, and may encourage self-disclosure in relevant
domains.
Open speculation on the values and intentions of the discloser toward his task
would also seem to be helpful. It is not suggested that this be carried out in a
personally evaluative way, but in a manner that provides the opening up of
possibilities for clients to revise their actions in relation to their intentions. These
could be offered to the client in terms of reflections and alternatives rather than
pronouncements, so that the client is freed to match his intentions with broader goals
and values. This proposed strategy may empower clients to identify their sense of
agency and personal accountability. It provides a possible counter to any inclination
toward passivity or apathy, and a way of promoting personal responsibility for riskmanagement.
In order to establish a climate of mutual curiosity, it is suggested that a context
of safety needs to be established and manifestly demonstrated. For clients to
participate in open and direct disclosure, as well as to attend to challenging feedback,
a forum for personal acceptance is indicated. This could be reflected in the general
sub-culture of the milieu of the therapy facility as a whole, as should the notion of
strengthening the treatment context as a community of concern around the issue of
child sex offending.
Suggestions for Further Research
Therapeutic Engagement
21
Beyond replication of this study, a two-tier approach to extending the research
around disclosure management style is suggested here. The first tier concerns the
durability and stability of disclosure management style as the client progresses
through treatment. We might expect to detect here a pattern of clinical response that
relates to the identified disclosure style.
The second tier relates to the investigation of relationships between this
construct and other substantive areas in the field of sex offender treatment. Should the
construct prove robust, some useful second-tier areas for investigation relate to its
correspondence with other identified etiological variables, such as schema and
interpersonal style. A promising stratum here is the investigation of the relationship
between disclosure management and attachment theory (Ainsworth & Bowlby, 1991;
Bartholomew, 1990). The development of theory around this latter construct in the
field of sex offending has guided research, for example, into the attachment styles
exhibited by different types of offender (for instance, Smallbone & Dadds, 1998), and
is widely influential in the assessment and treatment of offenders in programs (Fisher
& Beech, 1999; Marshall, 1999). Attachment styles, as strategies for conducting
emotional relationships, are hypothesized by Ward, Hudson, Marshall, & Siegert
(1995) to account for the various means by which adult relationships succeed or fail,
and may be predictive of the kind of sexual offending perpetrated. On the face of it,
there is a marked correspondence between attachment style and disclosure
management style. For example, features of those characterized as exhibiting
“preoccupied” and “fearful” attachment styles as originally described by Bartholomew
(1990) are characteristically reflected in those participants in the current study who
were observed respectively to display placatory and evasive disclosure features. The
placatory disclosure management style for instance is characterized by otherdirectedness and capitulatory attempts to meet the expectations of others. These
features are consistent with the expectations of someone whose sense of personal
unworthiness in relation to others motivates focused approval seeking.
Conclusions
The early and accurate identification of disclosure management style in
clinical settings may promote more efficient and effective use of therapy time. A more
Therapeutic Engagement
22
general task for treatment providers is to establish the sort of clinical context that is
most likely to attract clients to commit to open and direct self-disclosure. As therapists
we must attune more sensitively to client phenomenology around disclosure. More
specifically, we need to attend to the experiences and concerns of the discloser. Thus,
we can respond more effectively to promote engagement.
Therapeutic Engagement
23
References
Ainsworth, M. D. S., & Bowlby, J. (1991). An Ethological Approach to Personality
Development. American Psychologist, 46, 333-341.
Barker, M., & Morgan, R. (1993). Sex Offenders: A Framework for the Evaluation of
Community-Based Treatment. London: Home Office.
Bartholomew, K. (1990). Avoidance of Intimacy: An Attachment Perspective. Journal
of Social and Personal Relationships, 7, 147-178.
Beech, A., & Fordham, A. S. (1997). Therapeutic Climate of Sexual Offender
Treatment Programs. Sexual Abuse: A Journal; of Research and Treatment, 9,
219-223.
Bickley, J. A., & Beech, A. R. (2002). An Investigation of the Ward and Hudson
Pathways Model of the Sexual Offense Process With Child Abusers. Journal of
Interpersonal Violence, 17(4), 371-393.
Charmaz, K. (1995). Grounded Theory. In J.A. Smith, R. Harre, & L.V. Langenhove
(Eds.), Rethinking Methods in Psychology. London: Sage.
Davison, D. C., Robins, C., & Johnson, M. K. (1983). Articulated Thoughts During
Simulated Situations: A Paradigm for Studying Cognition in Emotion and
Behavior. Cognitive Therapy and Research, 7(1), 17-40.
Fernandez, Y. M., & Marshall, W. L. (2000). Contextual Issues in Relapse Prevention
Treatment. In D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking Relapse
Prevention with Sex Offenders: A Sourcebook. Thousand Oaks: Sage.
Fisher, D., & Beech, A. R. (1999). Current Practice in Britain with Sexual Offenders.
Journal of Interpersonal Violence, 14(3), 240-256.
Garland, R. J., & Dougher, (1991). Motivational Interventions in The Treatment Of
Sex Offenders. In W. R. Miller & M. S. Rollnick (Eds.), Motivational
Interviewing: Preparing People to Change Addictive Behavior (pp. 303-313)
New York: Guildford Press.
Gilgun, J. F. (1992). Hypothesis Generation in Social Work Research. Journal of
Social Service Research, 15 (3/4), 113-135.
Therapeutic Engagement
24
Glaser, B. (1978). Theoretical Sensitivity: Advances in the Methodology of Grounded
Theory. San Francisco: Sociology Press.
Glaser, B., & Strauss, A. (1967). The Discovery of Grounded Theory. Chicago:
Aldine.
Henwood, K. L., & Pidgeon, N. F. (1992). Qualitative Research and Psychological
Theorising. British Journal of Psychology, 83, 97-111.
Hudson, S. M., Wales, D. S., & Ward, T. (1998). Kia Marama: A Treatment Program
for Child Molesters in New Zealand. In W. L. Marshall, Y. M. Fernandez, S. M.
Hudson, & T. Ward (Eds.), Sourcebook of Treatment for Sexual Offenders (pp.
17-28). New York: Plenum.
Kear-Colwell, J., & Pollock, P. (1997). Motivation or Confrontation: Which
Approach to the Child Sex Offender? Criminal Justice and Behavior, 24(1), 20
- 33.
Laws, D. R. (1998). Relapse Prevention: the State of the Art. Journal of Interpersonal
Violence, 14(3), 285-302.
Marshall, W. L. (1999). Current Status of North American Assessment and Treatment
Programs for Sexual Offenders. Journal of Interpersonal Violence, 14(3),
221-239.
Marshall, W. L., & Anderson, D. (2000). Do Relapse Prevention Components
Enhance Treatment Effectiveness? In R. Laws, S. Hudson, & T. Ward (Eds.),
Remaking Relapse Prevention with Sex Offenders: A Sourcebook . Newbury
Park: Sage.
Marshall, W. L., Fernandez, Y. M., Serran, G. A., Mulloy, R., Thornton, D., Mann,
R.E., & Anderson, D. (2003). Process Variables in the Treatment of Sexual
Offenders: A Review of the Relevant Literature. Aggression and Violent
Behavior, 8, 205-234.
Marshall, W. L., Fernandez, Y. M., Hudson, S. M., & Ward, T. (Eds.). (1998).
Sourcebook of Treatment for Sexual Offenders. New York: Plenum.
Maykut, P., & Morehouse, R. (1994). Beginning Qualitative Research: A Philosophic
and Practical Guide. London: Falmer Press.
Pithers,W. D., Marques, J. K., Gibat, C. C. & Marlatt, G. A. (1983). Relapse
Prevention with Sexual Aggressives: A Self-Control Model of Treatment and
Therapeutic Engagement
25
Maintenance of Change. In J. G. Greer & I. R. Stuart (Eds.), The Sexual
Aggressor: Current Perspectives on Treatment (pp. 214-234). New York: Van
Nostrand Reinhold
Rennie, D. L., Phillips, J. R., & Quartaro, G. K. (1988). Grounded Theory: A
Promising Approach to Conceptualisation in Psychology? Canadian
Psychology/Psychologie Canadienne, 29(2), 139-150.
Riessman, C. K. (Ed.). (1994). Qualitative Studies in Social Work Research.
Thousand Oaks: Sage.
Salter, A. C. (1988). Treating Child Sex Offenders and Victims: a Practical Guide.
Newbury Park: Sage.
Scheela, R. A. (1992). The Remodelling Process: A Grounded Theory Study of
Perceptions of Treatment Among Adult Male Incest Offenders. Journal of
Offender Rehabilitation, 18(3/4), 167-189.
Scheela, R. A., & Stern, P. N. (1994). Falling Apart: A Process Integral to the
Remodelling of Male Incest Offenders. Archives of Psychiatric Nursing, 8(2),
91-100.
Smallbone, S. W., & Dadds, M. R. (1998). Childhood Attachment and Adult
Attachment in Incarcerated Adult Male Sex Offenders. Journal of Interpersonal
Violence, 13(5), 555-573.
Strauss, A., & Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory
Procedures and Techniques. Newbury Park: Sage.
Tierney, D. W. & McCabe, M. P. (2002) Motivation for Behavior Change Among Sex
Offenders: A Review of the Literature. Clinical Psychological Review, 22, 113129.
Ward, T. & Hudson, S. M. (2000). A Self-Regulation Model of Relapse Prevention. In
D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking Relapse Prevention
with Sex Offenders: A Sourcebook. Thousand Oaks: Sage.
Ward, T., Hudson, S. M., & McCormack, J. (1995). Attachment Style, Intimacy
Deficits, and Sexual Offending. In B. K. Schwartz & R. Cellini (Eds.), The Sex
Offender: Corrections, Treatment and Legal Practice (Vol. 2, pp. 2.1-2.14).
New Jersey: Civic Research Institute, Inc.
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Figure 1: Disclosure Orientation and Disclosure Management Style
Self-Directed
Goals
Opposition
Exploratory Style
Open
Strategy
Placatory Style
Evasiv
Other-Directed
Goals