THE THEORETICAL, EMPIRICAL, AND PROCEDURAL BASES OF TREAMENT
Revised: November, 2014
Copyright held by:
W. L. Marshall, PhD, OC, FRSC, C.Psych
L. E. Marshall, PhD, RP, ATSAF
Rockwood Psychotherapy & Consulting
518 Dominion Avenue
Midland, Ontario, L4R 1P8, Canada
rockwoodpsyc.com; admin@rockwoodpsyc.com
HIGH LEVEL TOC
ABOUT THIS MANUAL
INTRODUCTION
MODELS OF TREATMENT
PROCEDURAL ASPECTS
TARGETED SKILLS
GENERAL TREATMENT FEATURES
SPECIFIC TREATMENT TARGETS
CONCLUSION
REFERENCES
APPENDICES
The Rockwood Psychotherapy & Consulting Sexual Offender Treatment Program Manuals are based on our extensive experience working with sexual offenders of all risk levels in a variety of settings. Although the manuals are based on what is known about effective delivery of treatment for sexual offenders, no warranties are made regarding the efficacy of the manuals for any specific population or setting. However, if the manuals are adhered to in the motivational spirit in which they are intended, they are expected to enhance the chances of positive outcomes.
License to use this material includes the ability to make multiple copies of the manual for yourself and/or your organization but does not allow for the resale or transfer of the license to any other person, persons, or organizations. It is your responsibility to ensure that this manual remains in your exclusive possession and is not improperly distributed.
Training on the use of the manuals is available. This training involves orientation to content and demonstration of therapeutic processes discussed in the manuals. Please contact Rockwood Director, Liam E. Marshall, at 
liam@rockwoodpsyc.com for more information.
This volume provides the theoretical, empirical, and procedural bases for all of our treatment manuals. The specific programs are described in the manuals and their implementation is guided by this manual. The manuals can readily be adapted for specific groups, such as developmentally challenged clients where repetition, the use of extensive visual aids, and concrete examples are necessary. The goal of this generic volume is to describe the models on which the approach to treatment is based, the characteristics of effective delivery style, various procedural features, and the components of targeted skills...
MODELS OF TREATMENT
The Risk, Need, Responsivity Model
All treatment programs described in the accompanying manuals follow the Principles of Effective Offender Treatment derived by Andrews and his colleagues from a series of meta-analyses (see Andrews & Bonta, 2006, for a summary). These meta-analyses allowed Andrews to identify the effective elements of offender treatment which they summarized as involving the appropriate application of three principles: Risk, Need and Responsivity. These three principles were shown to account for the effectiveness of programs for various types of adult male offenders (Andrews, Zinger et al., 1990; Andrews, Bonta, & Hoge, 1990), adult female offenders (Andrews & Dowden, 1999), and juvenile offenders (Dowden & Andrews, 2003), as well as for programs operated within institutional settings and for community-based programs (Andrews & Bonta, 2006). Other reports (Lipsey & Wilson, 1998; Lösel, 1995; Redondo, Garrido, & Sanchez-Meca, 1999) have confirmed the relevance of these three principles. Of particular importance to the accompanying manuals, the appropriate application of these principles has been specifically shown to be crucial to the treatment of sexual offenders (Hanson, Bourgon, Helmus & Hodgson, 2009)...
The Good Lives Model
The Good Lives Model (GLM) as described by Ward in a series of articles (Ward, 2002; Ward & Gannon, 2006; Ward & Mann, 2004; Ward & Marshall, 2004; Ward & Stewart, 2003) serves as a framework for treatment. The GLM was derived by Ward from research on human striving (Emmons, 1999; Schmuck & Sheldon, 2001) that was originally initiated by Maslow's (1968) description of the human pursuit of self-fulfillment. From this literature, Ward identified nine domains of functioning within which people strive to succeed. These nine domains involve: (1) optimal mental, physical, and sexual health; (2) knowledge of one or another field of endeavor; (3) mastery in work and leisure activities; (4) autonomy; (5) inner peace; (6) creativity; (7) relatedness; (8) spirituality; and (9) happiness. In terms of the constantly adjusted goals associated with these domains, each individual is encouraged to measure success against himself rather than against the achievements of others or against some ideal level of functioning. Like Maslow, Ward saw this striving toward self-attainment as a lifelong process. This point is quite important as we want our clients to accept that after they have completed a treatment program further efforts on their part are required to stay offence-free. The GLM insists that treatment simply initiates a process that the clients must continue to develop throughout their lives if they are to attain a good life...
Motivational Interviewing
The following sections describe in some detail various important procedural features of the treatment programs.
Group or Individual Treatment
A question of importance that has to be resolved concerns whether programs should be run in groups or offered as individual therapy, or whether a combination of these two approaches is best. A survey of North American sexual offender programs revealed that group therapy was by far the most popular (89.9%) choice (McGrath, Cumming, & Burchard, 2003), and this appears to be particularly true in correctional settings (Morgan, Winterowd, & Ferrell, 1999). The two large scale meta-analyses (appraising in total 112 reports) of treatment outcome with sexual offenders (Hanson et al., 2002; Lösel & Schmucker, 2005) found only eight programs used individual therapy alone while another eight programs used "mainly" individual treatment. In an edited book (Marshall, Fernandez, Hudson, & Ward, 1998) devoted to describing sexual offender treatment programs within various settings and covering specialized programs for sexual offenders with specific associated difficulties, 15 of the 28 programs offered group therapy and nine provided additional individual treatment.
Closed or Rolling Groups
Operating Principles
The final procedural issues that require decisions, involve what might be thought of as a number of operating principles. These include: how many sessions per week is optimal; how long each session should be; the total length of treatment (or how many total hours of treatment); and the number of therapists and clients per group. There is, unfortunately, little in the way of empirical guidance on any of these issues although several authors have offered suggestions...
TARGETED SKILLS
The treatment approach described in the accompanying manuals employs skills-oriented interventions based upon cognitive, behavioral, emotional, and social learning approaches. The skills-oriented methods and techniques are chosen based on both the empirical literature and clinical experience. Each group targets a complex array of behavioral, cognitive and emotional skills. To illustrate, let us take the example of empathy enhancement. First clients are helped to recognize their own emotional states as well as the emotional states of others, and in doing so this facilitates and encourages the regulated expression of emotions. Next clients are assisted in modifying their cognitions by having them identify (i.e., incorporate within their conceptual framework) the negative consequences to their victims, as well as having them modify their perceptions of the victim’s behaviors at the time of the offense. Over time these changes alter the schemas the clients have about other people, particularly those who belong to the class of potential victims. Clients are then expected to behaviorally display empathy both by their actions (e.g., comforting other distressed group members) and by their verbal behavior (e.g., expressing remorse about the harm they have caused).
Behavioral Skills
The approach to the enhancement of behavioral skills, as well as the therapist’s enactment of various pro-therapeutic behavioral skills, rests on the comprehensive knowledge of effective behavior-change procedures derived from studies of animal and human learning (O’Donohue, 1998). These behaviorally-based techniques derive from two streams of learning-based procedures: operant conditioning (Skinner, 1938); and classical conditioning (Pavlov, 1906)...
Cognitive Skills
The understanding, and modification, of cognitive processes rests on general cognitive science (Nelson, 1995; Oakhill & Garnham, 1996) as well as research in social cognition (Augoustinos & Walker, 1995; Forgas, Williams & von Hippel, 2003; Kunda, 1999), and, particularly, on the application of cognitive processing models to clinical phenomena (Abramson, 1988; Ingram, 1986). More specifically the approach derives from cognitive theories and research that identifies the important role of schema in guiding perception and in generating attitudes, beliefs and behaviors (Neisser, 1982; Thorndyke & Hayes-Roth, 1979), and on the application of research and theories about the role of schemas in psychological problems by various authors (Beck, 1999; Huesmann, 1988; Mann & Beech, 2003; Young, 1999)...
Emotional Skills
The third aspect of the program concerns the development of emotional (and thereby more general) self-regulation. There is now a considerable body of literature on self-regulation (Baumeister & Vohs, 2004) and also on emotions (Lewis & Haviland-Jones, 2000) and emotional expression (Kennedy-Moore & Watson, 1999). Research on emotions has demonstrated a clear relationship between mood control and other important aspects of healthy functioning such as: social judgment (Forgas & Vargas, 2000), general well-being (Diener & Lucas, 2000), as well as physical health (Booth & Pennebaker, 2000; Leventhal & Patrick-Miller, 2000) and mental health (Keenan, 2000). Poor self-regulation, including inadequate regulation of emotions, is significantly related to criminal behaviour (Hirschi, 2004), inappropriate sexual behavior (Wiederman, 2004), the abuse of alcohol and other substances (Hull & Slone, 2004; Sayette, 2004), and the failure to form effective attachment relationships (Calkins, 2004)...
GENERAL TREATMENT FEATURES
SPECIFIC TREATMENT TARGETS
Problematic Cognitions
Some sexual offenders categorically deny they committed the offense(s) for which they have been convicted. Others minimize various aspects of the offense in a way that presents them as less culpable. Of course it is possible that some of the categorical deniers are telling the truth, since wrongful convictions have been identified. However, clear cases of wrongful convictions are statistically rare. Nevertheless, denial is not a criminogenic factor (Hanson, & Bussière, 1998), so it serves no useful purpose to challenge it. Similarly, minimizations are not criminogenic (Hanson, & Bussière, 1998). In fact, to describe some aspects of a sexual offender’s report of his offense as “minimizations” relies on an unquestioning acceptance of the veridicality of the victim’s statement or the police officer’s report. Marshall and Marshall (Marshall, Marshall & Kingston, 2011; Marshall, Marshall & Ware, 2009) have described evidence from a variety of sources indicating that victims of crime are unlikely to accurately recall the events and circumstances of the offence, and the same appears to be true of the offenders. Maruna (2001, 2004) has also shown that those offenders who accept full responsibility for their crimes are, surprisingly, the ones who are most likely to continue their criminal careers whereas those offenders who offer excuses or deny having had committed a crime are unlikely to reoffend. Despite this evidence, clinicians working with sexual offenders assume that their clients must take responsibility for their past offending behaviors by agreeing with the official description of offences. Attempts to essentially coerce clients into producing precisely the same description of events as the victim, may not only be misplaced but is likely to force the offender into saying what he thinks the therapist wishes to hear. This is definitely not how we want offenders to respond.
Self-Management Plans
References
Conclusion
This, then, concludes the overview of this Generic Manual. All manuals, including the Generic Manual, should be read by therapists regardless of the program in which they are involved.