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Working with Sex Offenders in Denial

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Working with Sexual Offenders in Denial
Dr. Susan Grey Smith, Ph.D. LMFT
2014 Sex Offender Risk Assessment Advisory Board
(SORAAB) Training
Date: May,9 2014

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Working with Sex Offenders in Denial

  1. 1. www.glencairnmft.com glencairn@mdofficemail.com Practical, competent and valid talk therapy
  2. 2. WORKING WITH THE SEX OFFENDER IN DENIAL Susan G. Smith, PHD, LMFT & Garnie Nickell, MA, LPCC
  3. 3. Denial is not a river in Egypt. Treatment resistance is largely the product of processes of denial. (Schneider & Wright 2004)
  4. 4. Webster’s defines denial as a statement saying that something is not true or real; in psychology denial is a condition where someone will not admit that something sad and painful is true or real; or the act of not allowing someone to have something.
  5. 5. Science . . . . is based on personal experience, or on the experience of others, reliably reported. - Werner Heisenberg
  6. 6. Denial is defined in the ATSA treatment manual as “the failure of sexual abusers to accept responsibility for their offenses.” Association for the Treatment of Sexual Abusers (ATSA; Practice Standards and Guidelines 2001) It is characterized as an obstacle to treatment progress and to compliance with treatment requirements.
  7. 7. While a person is responsible for acting in the world, s/he is not necessarily responsible for the cognitive, affective, and behavioral deficits that realistically constrain the range of options to pursue valued goals. (Levenson & D’Amora 2005)
  8. 8. Truth dwells in the deeps. - Niels Bohr
  9. 9. Anna Salter emphasized in her classic guide Treating Child Sex Offenders and Victims: A Practical Guide (1988) that “offenders must take responsibility for child sexual abuse without minimizing, externalizing or projecting blame onto others.” Salter also categorized denial as physical denial, psychological denial, and minimization of the extent and seriousness of the sexually offensive behavior.
  10. 10. The research does not convincingly demonstrate that denial is a risk factor for reoffending, nor that targeting denial in treatment is associated with improved treatment outcomes. (Yates 2009) Treatment must be concerned with responsivity – defined as the interaction between the individual and the treatment. The therapeutic relationship is the best predictor of treatment success.
  11. 11. Why do people deny? Freud’s Theory of Defense Mechanism A reality-distorting strategy unconsciously adopted to protect the ego from anxiety.
  12. 12. The relationship between anxiety and defense: Neurotic anxiety • Anxiety about our impulses signals the need for their repression • We want things we do not get; we fear our wants • Anxiety plays a functional role signaling the ego to take action (repress thoughts and feelings) before being overwhelmed Moral anxiety • Experienced as guilt or shame • Fear of (internal) punishment for failure to adhere to our own moral standards of conduct • When impulsive behavior gets us into trouble, we begin to fear our own instincts
  13. 13. Freud’s six types of defensiveness • Repression where unacceptable impulses and thoughts are pushed out of our awareness. • Projection places what may be unacceptable in one’s own mind into the mind of another. • Displacement redirects emotional responses onto a less dangerous substitute. • Reaction formation converts a feeling into its opposite. • Regression makes us retreat to an earlier, less threatening age or stage. • Rationalization invents a reason for bad behavior.
  14. 14. Depersonalization or the denial of planning, sexual deviancy, and relapse risk. Even after an offender has acknowledged responsibility for an offense, s/he may not be psychologically prepared to admit s/he is the type of person who could do something like that.
  15. 15. Being decent comes down to being brave. -Sakyong Mipham Rinpoche
  16. 16. The following factors related to psychological problems were found to have no relationship to recidivism. (Yates 2009) • Self-esteem • Anxiety • Loneliness • Negative mood • Motivation for treatment • Lack of victim empathy • Lack of remorse • Denial
  17. 17. ALL OUR SCIENCE, MEASURED AGAINST REALITY, IS PRIMITIVE AND CHILDLIKE. - ALBERT EINSTEIN
  18. 18. Rehabilitation interventions are directed at areas of deficit or dysfunction. (Ward & Salmon 2009) A major aim of therapeutic interventions with offenders is to provide them with an array of skills to effectively manage undesired states or to pursue desirable ones in socially acceptable and personally meaningful ways.
  19. 19. The primary vehicle for assessing and modifying offenders’ cognitions is likely to be found in the explanations provided by offenders to account for their offenses. (Schneider & Wright 2004)
  20. 20. A key distinction in determining whether the offender will view treatment as helpful or as a punishment lies within the practitioner’s skill level. (Prescott & Levenson 2010) The process of change is difficult for most of us but especially difficult for those who have offended others sexually because it requires looking at our shadow side. Will they feel coerced or invited?
  21. 21. The universe can be best pictured . . . as consisting of pure thought. - Sir James Jeans
  22. 22. Treatment or Punishment? Problem reduction and well-being enhancement versus the infliction of pain as retribution for crimes committed.
  23. 23. Failure and deprivation are the best educators and purifiers. - Albert Einstein
  24. 24. Treatment providers cannot avoid confronting the ethical challenge created by the institution of punishment within the criminal justice system.
  25. 25. The issue of justifying punishment arises in part because harms inflicted on offenders may cause them significant suffering and set back their core interests, and also result in marked hardships to family, friends, and even the broader community. (Ward & Salmon 2009)
  26. 26. Sex offender treatment is not punishment but services are delivered within a punishment context. As service providers, we have to consider both. Rehabilitation revolves around skill acquisition, well-being enhancement, and building a better life in the future. Punishment is embedded in accountability for past actions and moral questions of right and wrong.
  27. 27. Science is the attempt to make the chaotic diversity of our sense-experience correspond to a logically uniform system of thought. . . The sense-experiences are the given subject matter. But the theory that shall interpret them is man- made. It is. . .hypothetical, never completely final, always subject to question and doubt. - Albert Einstein
  28. 28. Because of the correctional context of sex offender treatment, it is not possible to insulate the role of program deliverers or treatment providers from ethical issues associated with punishment. It is worthwhile for practitioners to have some general familiarity with the different theories of punishment and their clinical and ethical implications. (Ward & Salmon, 2009)
  29. 29. Punishment elements express censure and are intended to be harmful, resulting in a burden being placed on the offender that directly causes suffering, pain, and deprivation. Assumptions about punishment are reflected in the specific policies and practices embedded in the criminal justice system and directly shape the professional tasks constituting the roles of correctional practitioners. Treatment providers have an ethical obligation to do no harm and to seek to end unjustified harms to offenders. Failure would arguably make us complicit in unacceptable practices (Lazarus, 2004). In a real sense, good psychological practice is partly determined by policies underpinned by punishment assumptions including decisions on intervention priorities, sequencing, and timing. Punishment within the criminal justice system must be unpacked to help clinicians skillfully traverse ethical dilemmas.
  30. 30. Retribution theories Retribution theories: • Backward looking • Fact that punishment does not reduce crime not of major concern; fitting to punish to balance the moral ledger • Failure to hold offenders accountable is unacceptable • Offenders are viewed as morally deficient • Victim’s rights and community views are given priority • Punishment will result in acceptance of responsibility Practice implications: • Fails to satisfactorily unpack the notion of just deserts • May be threats to offenders’ human rights • Impulsivity characterized as failure of will rather than self- regulation impairment • Difficulty discriminating between crimes and private wrongs • Restricted funding for treatment and reintegration programs
  31. 31. America is the land of the second chance and when the gates of the prison open, the path ahead should lead to a better life. - George W. Bush, 43rd US President
  32. 32. Consequential theories Consequential theories: • Forward looking • Focused on crime prevention • Goal is to reduce crime • To deter, incapacitate, or reform offenders is seen as the most effective way to reduce the crime rate • Character reform Practice implications: • Reliably measure dynamic and static risk factors • Treatment is a means to ensure community safety • Looking for causal factors generating behavior • Extended supervision , geographical restrictions, and community notification • Interventions focus on offender and do not include families and the community
  33. 33. Problems with consequential theories • It is logically possible to countenance the punishment of innocent people if the overall effect may result in the reduction of crime. • Neglects the community’s obligation to offenders to provide and resource reintegration initiatives. • The impact of hard treatments on offenders and their families is rarely considered. • A desire to protect the community can lead to the lack of concern for the human dignity and intrinsic self-worth of offenders. • May result in confrontation rather than dialogue.
  34. 34. Shifting Paradigms It is important to pay attention to the rights of all stakeholders in the criminal justice system including offenders because of their equal moral status; thus communication theories of punishment have a relationship focus. (Ward & Salmon, 2009) From this perspective, offenders are viewed as one of us.
  35. 35. Communication theory A hybrid theory of Anthony Duff (2002) Communication theory: • Forward and backward looking • Punishment seeks to persuade rather than force offenders to take responsibility for crimes • Offenders viewed as valued members of the community • Repair individual, relational and social harm caused by the offense • Wipe slate clean and obtain redemption with dignity • Community obliged to facilitate reintegration Practice implications: • Engage in process of intense self- reflection and self-censure • Remorse and self-blame will motivate to acquire skills to achieve in lawful ways • Realization they have caused people to suffer will lead to firm resolution to not do this again • Apology and restitution • Better lives mean safer communities • Strength-based community oriented treatment approach
  36. 36. It is better to conquer yourself than to win a thousand battles. Then the victory is yours. It cannot be taken from you, not be angels or by demons, heaven or hell. -Buddha
  37. 37. THE SECOND CHANCE ACT of 2007 formalizes President Bush’s Prisoner Re-entry Initiative (PRI) • Ensures returning prisoners have opportunities to transform their life and build safer communities. • Helps offenders break the cycle and start a new life as a productive member of society through individualized case plans and services. • Develops programs that encourage offenders toward safe, healthy, and responsible family and parent-child relations.
  38. 38. “I might have did it . . . ,” “Maybe I did it . . . ,” “I don’t remember. . .but let’s just say I did,” are not admissions but they are stepping stones suggesting that further discussion is needed.
  39. 39. Although many have focused on denial as a black and white construct, a large number of clinicians and scholars have acknowledged that denial is not an all-or-nothing phenomenon but rather a complex, multifaceted thought process.
  40. 40. Accountability and denial as treatment obstacle or treatment target? (Schneider & Wright) Denial as a dichotomous variable • Disavowal of having committed an offense (full denial, absolute denial, or categorical denial). A person is either in or out of denial. • Assumes denial results from deliberate attempts to avoid blame by deceiving • Indicates poor treatment amenability • Offenders have to admit they engaged in inappropriate sexual behavior before entering treatment. • Otherwise clinicians are reinforcing the illusion that offenders can benefit from treatment without taking responsibility for their offense. Denial as continuous variable • Refers to a broader range of explanations provided by offenders to justify or minimize offense-related behavior. • Likely to be grounded in cognitive distortions. • Requiring offender to be out of denial before starting treatment is like requiring them to cure themselves. • Practice of not treating or dismissing deniers from treatment increases risk to the community by preventing participation in treatment programs that lower recidivism.
  41. 41. Types of Denial Schneider & Wright 2004 Denial is a multifaceted construct: • Denial of the offense • Denial of harm to the victim • Denial of the extent of the abusive behavior • Denial of responsibility, intent, or premeditation • Denial of receiving sexual pleasure • Denial of relapse potential Deeply ingrained forms of denial: • Planning • Grooming • Deviant arousal • Fantasizing • Sexual gratification • Need for help • Future risk of harming someone else
  42. 42.  For incest offenders, denial was associated with increased sexual recidivism. Effect sizes were extremely small suggesting it could be a minor risk factor. Denial was not associated with increased recidivism for offenders with unrelated victims. (Nunes et. al. 2007)  Child molesters tend to admit more frequently than rapists. (Nugent & Kroner 1996)
  43. 43. Denial decreases over the course of treatment. (Barbaree 1991; Marshall et al 2001)
  44. 44. Denial is best viewed as a source of rich clinical information about the offender’s view of the world rather than as an obstacle that interferes with treatment. (Schneider & Wright 2004)
  45. 45. Clinical approaches for addressing denial and treatment resistance (Deming 2013) The INSOMM Approach • Motivation based • Future focused • “Good Lives” Model • Address shame • Address fear of consequences • Process the value and purpose of taking responsibility and its role in treatment
  46. 46. Let us get down to the bedrock facts. The beginning of every act of knowing, and therefore the starting point of every science, must be in our own personal experience. - Max Planck
  47. 47. Myth or fact? • Denial and minimization are efficient predictors of recidivism. • Greater denial / minimization is associated with lower motivation and more negative perceptions of treatment. • Denial increases over the course of treatment. • Denial is better related to internal processes of anxiety than to the external process of deception. • Only sex offenders minimize and deny harmful behavior. • The only way for a sex offender to get the help they need is for them to take responsibility for what they did. • Denial in treatment has been upheld by the courts as a reason to revoke probation. • Denial is related to punishment models of accountability. • Clinicians can ethically treat sex offenders without considering the ethics of punishment. • Offenders who complete treatment have lower recidivism rates than those who do not. • More justifications and less treatment rejection can reflect acknowledgment of personal / psychological problems.
  48. 48. It is the very essence of our striving for understanding that, on the one hand, it attempts to encompass the great and complex variety of man’s experience, and on the other, it looks for simplicity and economy in the basic assumptions. The belief that those two objectives can exist side by side is, in the primitive view of our scientific knowledge, a matter of faith. -Albert Einstein
  49. 49. References: Deming, Adam (January 29, 2013). Working effectively with the treatment resistant sex offender. ACA Houston, Texas. Freeman, James, Palk, Gavan, & Davey, Jeremy (2010). Sex offenders in denial: A study into a group of forensic psychologists’ attitudes regarding the corresponding impact upon risk assessment calculations and parole eligibility. The Journal of Forensic Psychiatry & Psychology, 21:1, 39-51. Routledge. Glaser, Bill (2010). Sex offender programmes: New technology coping with old ethics. Journal of Sexual Aggression, 16:3, 261-274. Routledge. Jung, Sandy & Nunes, Kevin (2012). Denial and its relationship with treatment perceptions among sex offenders. The Journal of Forensic Psychiatry & Psychology, 23:4, 485-496. Routledge. Levenson, Jill & D’Amora, David (2005). An ethical paradigm for sex offender treatment: Response to Glaser. Western Criminology Review, 6:1, 145-153.
  50. 50. Nugent, Patricia M. & Kroner, Daryl G. (1996). Denial, response styles, and admittance of offenses among child molesters and rapists. Journal of Interpersonal Violence, 11:4, 475-486. Sage. Nunes, Kevin, Hanson, Karl, Firestone, Philip, Moulden, Heather, Greenberg, David, & Bradford, John (2007). Denial predicts recidivism for some sexual offenders. Sex Abuse, 19:91-105. Springer. Prescott, David & Levenson, Jill ( 2010). Sex offender treatment is not punishment. Journal of Sexual Aggression , 16:3, 275-285. Routledge. Schneider, Sandra & Wright, Robert (2004) Understanding denial in sex offenders. A review of cognitive and motivational processes to avoid responsibility. Trauma, Violence & Abuse, 5:1, 3-20. Sage. Ward, Tony & Salmon, Karen (2009). The ethics of punishment: Correctional practice implications. Aggression and Violent Behavior, 14:4, 239-247. Yates, Pamela M. (2009). Is sexual offender denial related to sex offense risk and recidivism? A review and treatment implications. Psychology, Crime & Law, 15:2-3, 183-199. Routledge.
  51. 51. I can treat others with kindness, gentleness, and without judgment, starting with myself!

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