Updates in JSO Treatment
Presentation to at the
OJACC conference
Dr. Tyffani Monford Dent
October 16, 2014
Before we start…
And…I talk in acronyms
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JSO-Juvenile Sexual Offender
ASO-Adolescent Sexual Offender
YSBP-Youth with Sexual Behavior Problems
AOD-Alcohol and Other Drugs
GLM-Good Lives Model
CBT-Cognitive Behavioral Therapy
RP-Relapse Prevention
Objectives
• Identify reasons for Juvenile sexual offending
• Gain of current beliefs about JSOs and JSO
treatment
• Identify emerging treatment areas/models in
JSO work
Called many things
– Adolescent sex offenders
– Sexually aggressive adolescents
– Juveniles with sexual aggression
– Juveniles with sexually aggressive behaviors
– Adolescents who have acted out sexually
– Juveniles with sexually inappropriate behaviors
– Juvenile sexual offenders
Most of what we hear about JSOs are
untrue because….
• Media does a good job of sensationalizing
• Sexual offending brings out emotional
responses vs. rational ones
• We often hear about the “worst of the
worse”---anecdotal
• Times change and so do kids---info has hard
time keeping up with the truth
Question
• Why do they do it?
JSOs
• Explanations for sexual offending
– General delinquency
– Sexually abused sexual abuser
– Poor childhood attachment
– Social problems
– Sexual development
– Atypical Sexual Interest
– Psychopathology
– Cognitive Abilities
General Delinquency
• Many have also committed non-sexual offenses
• Our most-quoted meta-analyses (Reitzel & Carbonell
(2006); Caldwell, M. F. (2010) indicate they are most
likely to recidivate in a nonsexual way
• Risk factors associated with recidivism in non-JSOs
also cited as in JSOs
– Antisocial beliefs
– Association with delinquent peers
• (Prentky, Pimental, & Cavanagh 2006 as cited in Seto &
Lalumeire, 2010)
Sexually Abused Themselves
• Male children who are sexually abused more
likely to engage in abusive behavior later in life
• Link of own abuse to later abuse
– Modeling of perpetrator
– Sexual stimulation=sexual abuse
– Adoption of permissive attitudes Re: child/adult sex
• Burton, D. L. (2003). Male adolescents: Sexual victimization
and subsequent sexual abuse. Child and Adolescent Social
Work Journal, 20,277–296
Poor Childhood Attachment
Vulnerable boys more likely to seek relationships
with other adults than their parents
Try to fulfill attachment need in inappropriate
ways
Reduce empathic ability, increase emotional
dysregulation, and be more coercive
Smallbone, S. W. (2006). Social and psychological factors in the development of
delinquency and sexual deviance. In H. E. Barbaree & W. L. Marshall (Eds.),
The juvenile sex offender (2nd ed., pp. 105–127). New York: Guilford Press.
Social Problems
• Lack appropriate social skills to engage in
relationships with same-age peers
Worling, J. R. (2001). Personality-based typology of adolescent
male sexual offenders: Differences in recidivism rates, victim
selection characteristics, and personal victimization histories.
Sexual Abuse: A Journal of Research and Treatment, 13, 149–
166.
Sexual Development
 Earlier onset of masturbatorY behavior
 Sex to cope with stress
Marshall, W. L., & Marshall, L. E. (2000). The origins of sexual
offending. Trauma, Violence, and Abuse: A Review Journal, 1,
250–263.
 More frequent and earlier exposure to sex (observing
others or porn use)
Beauregard, E., Lussier, P., & Proulx, J. (2004). An exploration of
developmental factors related to deviant sexual preferences
among adult rapists. Sexual Abuse: A Journal of Research and
Treatment, 16, 151– 161.
Seto, M. C., Maric, A., & Barbaree, H. E. (2001). The role of
pornography in the etiology of sexual aggression. Aggression
and Violent Behavior, 6, 35–53.
Atypical Sexual Interest
• Self-reported sexual interest in children
associated with sexual recidivism
– Worling, J. R., & Curwen, T. (2000). Adolescent sexual offender
recidivism. Success of specialized treatment and implications for risk
prediction. Child Abuse & Neglect: The International Journal, 24, 965–
982.
Question
• What are we supposed to do?
• Provide holistic treatment that stops sexually
harmful behavior
A Comprehensive Approach Can Effectively Manage
Sexually Abusive Youth In Their Community
oManaging sexually abusive youth in the
community is complex.
oA single strategy doesn’t have maximum impact.
oOne service system by itself cannot address all
issues effectively.
oMultiple systems working together result in more
effective management of these youth and better
outcomes
Treatment
Treatment Works
Recidivism (charges)
• 10 year follow-up
Treatment Comparison
Any
35% (20/58)
54% (49/90)
NonVi
21% (12/58)
50% (45/90)
Vinonsex19% (11/58)
32% (29/90)
Sexual
5% (3/58)
18% (16/90)
20 year follow-up, present
Treatment Comparison
38% (22/58)
57% (51/90)
28% (16/58)
52% (47/90)
22% (13/58)
39% (35/90)
9% (5/58)
21% (19/90)
Worling, Littlejohn & Bookalam (2010) 20-Year Prospective Follow-Up Study of
Specialized Treatment for Adolescents Who Offended Sexually Behav. Sci. Law 28: 46–57
Treating Juveniles vs. Adults
• Question?
– Are children/adolescents different from adults?
– If so, how so?
• If juveniles are fundamentally different from
adults, why use adult interventions (or
consequences) on them?
Differences between juveniles and
adults with sexual aggression
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Patterns of sexual interest and arousal
Perpetration behaviors are less consistent and sophisticated
Situational and opportunity factors
Adolescent sexual abusers who have themselves been the
victims of sexual abuse are far closer in time to their own
abuse
• Adolescents have less developed sexual knowledge.
• Adolescents live in a world with different values, beliefs and
expectations.
• The role of the family is more critical
• Adolescents experience and expect a greater degree of
external control over their behaviors/interactions.
• More open and used to education and the acquisition of new
skills.
• Less research on juvenile offenders
Myths we have dispelled
Worling, J. (2013) What were we thinking? Five erroneous assumptions that have fueled specialized interventions for
adolescents who have sexually offended. International Journal of Behavioral Consultation and Therapy 8 (3-4), 80-86
• They are all sexually deviant-relapse
prevention/decrease deviant arousal/thoughtstopping
• They are all just delinquents-too focused on
criminal
• They all have psychiatric problems-mental issues
made them do it
• They are all just deficit-ridden-we only looked at
problem-reduction
• They are all deceitful-so we were confrontational
Sex Offender Treatment Today
• Need for sex-abuse-specific programming has
become accepted,
• Interventions more complex
• Developmentally-appropriate work
• Recognition of general juvenile delinquency
• Renewed focus on trauma and its impact
• Importance of therapeutic relationship
A Collaborative Approach for
Treatment
Retributive:
• Authoritarian
• Rigid protocol
• Imposed
• “Break denial”
• Deficit focused
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Restorative:
Facilitative
Self-determined pace
Collaborative
Empower strengths
Celebrate milestones
How are we achieving this?
• New/modified treatment models
• Change in how we provide treatment
• Change in view of sexuality
Emerging Models/Concepts
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Developmental Perspective
Trauma-focused
Healthy Sexuality
Motivational Interviewing
Risk-Needs-Responsivity
Good Lives Model
Treatment Curricula (examples)
Developmental Perspective
• Assess for developmental competence and
support maturation in
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Physical
Cognitive
Social
Emotional
Communication
Morality
• Functional Assessment
• Linear View
Trauma Focus
• Research suggests that early childhood trauma
common in lives of sex offenders
• History of trauma is a set of experience that
influence the identity of the individual (Creeden,
2009. How trauma and attachment can impact
neurodevelopment: Informing our understanding
and treatment of sexual behaviour problems. The
Journal of Sexual Aggression, 15, 261-273)
• Early trauma paves the way for maladaptive
coping and interpersonal deficits
• ACE-Adverse Childhood Experiences
– Article by Levinson indicates that adult criminals
experience significant ACE
• Higher rate of early trauma in adult SOs than general
population
• Treatment needs to incorporate how trauma
shapes beliefs and behaviors
– Healthy communication
– Explore how trauma influences assumptions about
the world
– Maladaptive skills=survival skills at one point that
now interfere with healthy
relationships/boundaries
– Defensiveness=helplessness & inadequacy
• Incorporate as components of other
treatment
– GLM, CBT, RP, etc.
Levenson, J. (2013). Incorporating trauma-informed care into evidence-based sex offender treatment. Jnl
of Sexual Aggression, 1-12.
Healthy Sexuality
What we were doing
• Decreasing understanding that there are
relationships not rooted in sex
• Not assisting clients in understanding that
there is such a thing as healthy sexuality
• Becoming worse than our clients
• Not permitting normal sexual development
• Sexual feelings=shame/guilt
Beliefs About Sexuality In Two Models
(Steve Brown, ATSA 2009)
Traditional Model
 Problem sexual behavior
mainly about power and
control
 Emphasis on control of
problem sexual behavior
 Sexuality regarded with
seriousness and gravity
 Education about sexuality
focused on consequences and
danger
New Paradigm
 Problem sexual behavior
mainly about relational needs
and attachment
 Balance focus on problem
sexual behavior and promoting
social and sexual competencies
 Sexuality associated with
seriousness as well as things
light and humorous
 Education about sexuality
balances focus on
consequences/dangers and
benefits/pleasures
Continued
Traditional Model
 Info about
sexuality=permission to
engage in sexual behavior
 Touch viewed as
dangerous-easily
sexualized leads to sexual
acting-out
 Sexuality is dangerous and
something to fear
New Paradigm
 Info about sexuality
satisfies curiosity and
decreases negative sexual
health outcomes
 Touch is a critical part of
relationships. Touch can
be non-sexual
 Sexuality is a critical life
force in all people that can
be used positively or
negatively
What is Motivational Interviewing
A directive, client-centered counseling style for
eliciting behavior change by helping clients to
explore and resolve ambivalence (Rollnick &
Miller, 1995).
The Spirit of Motivational Interviewing
 Motivation is elicited from the client, not imposed from
without.
 It is the client’s task, not the therapist's, to articulate and
resolve ambivalence.
 Persuasion is not effective for resolving ambivalence.
 The counseling style is generally a quiet & eliciting one.
 The therapist is directive in helping the client to examine and
resolve ambivalence.
 Readiness to change is not a client trait, but a fluctuating
product of interpersonal interaction.
 The therapeutic relationship is a partnership.
Risk-Needs-Responsivity
• Canada, 1980s
• Not a “treatment model” but a way of
identifying how treatment should occur
• Risk principle: Match the level of service to the
offender's risk to re-offend.
• Need principle: Assess criminogenic needs and
target them in treatment.
• Responsivity principle: Maximize the offender's
ability to learn from a rehabilitative intervention
by providing cognitive behavioural treatment and
tailoring the intervention to the learning style,
motivation, abilities and strengths of the
offender.
Risk
• the possibility of harmful consequences
occurring
• Components
– The existence of potentially harmful agents
(people, animals, diseases, toxins, situations, etc.)
– the possibility that the hazards associated with
the agents in question will actually occur
How we see it
• Likelihood that something bad is gonna
happen
• Reserve more intensive treatment for those
more likely to do it again—based on risk
assessment
Sooo….look at risk factors
(Andrews and Bonta, 1998; Blackburn,
2000; Hollin, 1999; McGuire, 2000).
Categories (broad)
1) dispositional factors such as psychopathic or antisocial personality
characteristics, cognitive variables, and demographic
data;
(2) historical factors such as adverse developmental
history, prior history of crime and violence, prior hospitalization,
and poor treatment compliance;
(3) contextual
antecedents to violence such as criminogenic needs (risk
factors of criminal behavior), deviant social networks, and
lack of positive social supports;
(4) clinical factors such
as psychological disorders, poor level of functioning, and
substance abuse
Divide risk
• Static-can’t change
• Dynamic-have the ability to change
Need
• Criminogenic
– AOD
– Hx of criminal behavior
– Antisocial Attitudes/beliefs
– Antisocial relationships
– Family life/chaotic or problematic
– School
Responsivity
• How an individual interacts with the
treatment environment, covering a range of
factors and situations.
– Motivation
– Learning style
– Language skills
– Maturity (emotional, developmental)
Criticism of RNR
• Focus was primarily on risk
• Need to incorporate/recognize what “good”
person may have been attempting to achieve in a
“bad” way
• Focus on elimination of negative
attitudes/behaviors without replacing it with
anything
Laws & Ward (2011) Desistance from sex offending: alternatives to throwing away the
key. Guilford Press: NY
Ward, Mann, & Gannon (2007). The good lives model of offender rehabilitation:
Clinical implications. Aggression and Violent Behavior, 12, 87-107
• patient-centered, holistic approach to
rehabilitation, which emphasizes the qualities
of life that are important to the client
Premise
• strengths-based approach
– build capabilities and strengths in people, in order to
reduce their risk of reoffending.
• people offend because they are attempting to secure
some kind of valued outcome in their life.
– Manifests it in an antisocial, harmful way
• offenders, like all humans, value certain states of
mind, personal characteristics, and experiences,
which are defined in the GLM as primary goods
The Goods
1. life (including healthy living and functioning)
2.knowledge (how well informed one feels about things that are important to
them)
3.excellence in play (hobbies and recreational pursuits)
4.excellence in work (including mastery experiences)
5.excellence in agency (autonomy, power and self-directedness)
6.inner peace (freedom from emotional turmoil and stress)
7.relatedness (including intimate, romantic, and familial relationships)
8.community (connection to wider social groups)
9.spirituality (in the broad sense of finding meaning and purpose in life)
10.pleasure (feeling good in the here and now)
11.creativity (expressing oneself through alternative forms).
Routes to offending
• Direct
– offender actively attempts (often implicitly) to satisfy
primary goods through his or her offending behavior
• Want intimacy, socially awkward so seek with younger child
• Indirect
– through the pursuit of one or more goods, something goes
awry which creates a ripple or cascading effect leading to
the commission of a criminal offense
• Drinking to cope with stress leads to loss of control, resulting in
sexual offense
Goals
• determining the Primary Goods that are important to
the client and reinforcing their importance,
• helping the client see and overcome barriers to
obtaining these goods,
• helping the client understand the relationship of
primary goods to their offending behavior,
• and ultimately building each client’s capacity to
attain the goods they want in socially acceptable,
non-offensive ways.
Popular Treatment Curricula
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Pathways
Stages of Accomplishment
Social Responsibility Therapy
Growing Beyond
Trauma Outcome Process/TOP for Sexual
Health
DrTyff@yahoo.com
www.MonfordDentConsulting.com