Community-based Treatment for Sex Offenders: an Evaluation of Seven Treatment Programmes.Home Office Research Findings
Crime and Prejudice: Can social workers stay true to the values of anti-discriminatory practice when engaging sex offenders’?
1.1 There is little argument that those who chose to commit sex offences are unpopular, considered by many to be ‘evil’, but also undeserving of support despite the high level of need to support and rehabilitation (Ward et al, 2007). As a group, sex offenders occupy only a small percentage of criminals within the community and in custody; however the nature of their offence generates the greatest concern and public outrage. As such the group often find themselves on the front pages of tabloids and elicit little to no sympathy. The past twenty years has seen a number of deplorable sexual offences brought to justice but also the public attention, with offenders more or less dehumanised; referred to as ‘subhuman’, ‘monsters’ or ‘animals’ by popular and widely read newspapers in the UK (The Sun, 2011). Whether painting these offenders as less than human is a media strategy to try to help the public make sense of the crime, or a means of justifying their sensationalist language in order to move units is open to further debate. However, high profile cases such as Ian Huntley and the Soham murders and the murder of Sarah Payne generated significant social narrative resulting in political pressure and subsequent change to legislation witnessed through Sarah’s Law which, as of this year, has been extended to the whole of the UK (Home Office, 2012).
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Media and press are the most significant resource for information gathering and, to some extent people are inclined to accept the mainstream media’s word on matters. Rawlinson (1998) argues that in areas such as crime, the media voice is the only insight the public have and as such stereotypes about sexual offenders as ‘weirdos’, ‘loaners’ and ‘outsiders’ have been allowed to manifest assisted by the need to allay moral panic. As such, sensationalism, compounded by the on-going tendency to focus only on the high-profile cases (which invariably involve young girls), have a direct and damaging impact on the practitioners who must work with these people and indeed how the work is undertaken (McCulloch and Kelly, 2007).
Sadly, social workers are sadly not immune from the influences of the media, society and their own personal values. Indeed, given the repellent nature of sexual offences, the gut reaction of many practitioners is to want to ‘kick their teeth in’ (Sheath, 1990. p 159). As such there is a difficult ethical tightrope in place for those who work with people who commit sexual offences; balancing both societal pressures and their own personal values and feelings alongside the professional values expected by the body they represent. Social work values differ from other practitioners who are called upon to work with sex offenders; most significantly due to the principles of anti-oppressive and anti-discriminatory practice which seek to empower the service user. These principles are the very essence of social work in both practice and training (Daltymple and Burke, 1995: Dominelli et al, 1995); however the equivalent does not exist within medical and psychological circles where there is much more emphasis placed on ethics of treatment. In fact, it is likely that most practitioners who come into contact with service users will represent different practice wisdom, personal values, knowledge base and professional values.
It was the politicization of social work in the 1970s that highlighted how social welfare individualized social problems. Thus, rather than being seen as due to the moral failings of the poor, poverty and marginalization were attributed to wider political and structural inequalities (McLaughlin, 2005). The agenda has since widened to include issues such as sexuality, disablism, ageism and gender amongst others. Anti-oppressive practice, like work with sex offenders has developed and evolved significantly over the past thirty years. The inherent ‘values’, while heavily debated (Beresford, 2008); still hold fast to principles of self-help, protection of the vulnerable, social inclusion and equality (Barnard et al, 2008). ‘Radicalization’ and protest in the 1960’s and 1970’s sought to re-address a power imbalance felt by minority groups and significant theory and models emerged which helped inform social work practice; with perhaps the most robust and reflected upon being that of anti-Discriminatory (ADP) and anti-oppressive practice (AOP). These are embodied as professional values held by social workers and, it is hoped that by adhering to them that discrimination and oppression can be restricted to a minimum within our own practice and challenged in others with view to emancipation of those we work with (Thompson, 2001). Today, ADP still holds true to its radical roots and value base and emphases ‘user control’, equality over equal rights and citizenship rather than respect (Preston Shoot, 1995).
A lot has been written on the subject of ADP by many of the discipline’s most recognised academics (Thompson, 2001: Dominelli, 2002, Adams et al, 2009), and social work training includes training on how to recognise disadvantage and oppression (Wilson and Beresford, 2000). Indeed the social work code of ethics espouses doctrines such fairness, respect and equality (GSCC, 2012). However, the role also supports the importance of recognising individuals without consideration for wider personal or political ideologies (Leonard, 1976: Bolger et al, 1981: Simpkin, 1989). Social work values therefore assume that practitioners come from a position of being socially neutral (Smyth and Campbell, 1996). Thus, while the principles of ADP are theoretically sound and seemingly transparent, a lot is asked of the social worker given that, as human beings they are vulnerable to the same cynicism, objection and even repulsion as the rest of the populous.
My research aims to address how social workers are to apply the principles of ADP/AOP to engage those whose sexual offences would normally be subject to prejudice from society. I am to do this by completing a literature review of the relevant work; by looking at the research on writing around anti-discriminatory practice and its relationship with social work and then by looking at how the principles are, if at all, applied when working with sex offenders to better understand how they managed to overcome such moral dilemmas.
This critical literature review will commence with the methodology. This section will define the term secondary research along with providing a critical analysis of the varying methods used to conduct the review.
1.2 Research Question and objectives:
– Define the terms used; namely anti-oppressive, anti-discriminatory practice and sex offenders/offences.
– Provide historical, contextual and theoretical underpinnings of the work conducted with AOP/ADP and sex offenders
– Discuss the implications of Cognitive Behavioural Therapy with Sex offenders
– ADP in custody: Are convicted and remanded sex offenders in received from practice which is informed by ADP/AOP?
– ADP in the community: Are sex offenders who are managed in the community receiving practice which is informed by ADP/AOP?
– Models of intervention used
– Implications for social work
– Final conclusions
2. Methodology / Methods
2.1 Rationale for Literature review:
The research takes the format of a literature review using both quantitative and qualitative data collected from established researchers in the field of ADP, sexual offending and aggression, social work and probation (Bryman, 2008). Given the limited writing which refers to the specific area of my research it may be considered that the dissertation might be enhanced by the use of primary data research. However, significant and extensive searches found that there was a great deal of quality secondary data available which supports the two independent but also fundamentally linked areas of study which the research is situated; namely the difficulties of ADP in practice and engagement with both sex offenders and those who work with them. Thus, it was possible to locate sufficient information from relevant journal articles, books, social work based literature and Internet resources.
2.2 Resources:
There is significant data and information available to the researcher, however given the breath and variety it was necessary to narrow down the search in order to achieve the most significant and most relevant information. Approved websites were located through the University of Leicester portal to search for literature including ASSIA, Social Care Abstracts and the Leicester University Library databases using the search terms ‘social care’, ‘engagement’ and ‘anti-discriminatory (and or) oppressive practice’. Additional searches were undertaken by augmenting the search by adding terms such as ‘sex offender’ and ‘paedophiles’ in order to achieve better and more varied results. Understandably these terms generated a high level of results requiring the need to include or exclude based on the details within the abstract. Exclusion due to age was given some consideration; however given the recent evolution of sex offender practice and that of anti-discriminatory practice having a ‘cut off’ date became frustrating and unrealistic when giving a background and context. However, within the main literature review of the research the majority of resources do not predate 1997. Furthermore, as there is significantly more writing from an international medical, psychological and criminological perspective I aim not to limit by country thus allowing the opportunity for longitudinal, subgroup and cross-cultural analysis (Bryman, 2004). However, due to my own comprehension will only be using English texts.
Furthermore, while academic texts contain wealth of information it must be considered that given the time it takes to write, expense of publishing and the need for many researchers to achieve published works there is often a strong lean from academics to publish their thoughts and works in journals. The upshot of this is a huge wealth of available information which is digestible, peer reviewed, freely available and above all else able to be very current. The research contains a significant amount of information obtained from articles from journals including: Critical Social Policy, Journal of Sexual Aggression, journal of Correctional Health Care, Probation Journal and the British journal of Social Work.
While the Internet is a valuable tool for accessing information (Noaks et al, 2004), it is very difficult to find balanced, researched and peer reviewed information and opinion on the topic of sex offenders which has not been affected by bias or indeed threatening and abusive language. Therefore Internet websites which are not secure have been avoided with the caveat of newspaper sites which proved useful for gauging the temperature of public opinion which has been instrumental in how sex offenders are treated and perceived.
2.3 Advantages of a literature review:
Secondary data became preferable for several reasons; foremost due to the limited time in which to complete the research, but also because the quality of the information which found was excellent as well as peer reviewed and reliable. Indeed, the benefits of secondary data will allow me to draw from top flight professionals who may have had access to resources which I could not conceivably match. And, while some practitioners recognise drawbacks due to missing data and reliability (Rubin and Babbie, 2011); my searches have already concluded significant relevant writing, including much on practitioner experiences as well as just those of the service user.
I consider that perhaps the most significant drawback is that, given the contentious nature of the material there may be some misrepresentation of statistics (Silverman, 2001). Indeed, victims of sexual offences are less likely to report incidents to the police and therefore the true scope and breath of the study is undermined by the validity. This is however manageable and preferable to undertaking individual research for which may have struggled to gain ethical approval given the often ‘dangerous and manipulative’ nature of sex offender (Prendergast, 1991). Indeed, any attempt to conduct a primary research piece would, at this stage only yield a small scale sample which would not be representative and challenging to generalise which may prompt some researcher bias (Sarantakos, 2005: Bryman, 2009). To evaluate the data collected I will be using ‘grounded theory’ (Glaser & Strauss, 1967) which describes a theory that has been achieved from the gathering and analysis of research information.
Notwithstanding the aforementioned advantages, secondary data analysis, like any methodological approach has its limitations. Secondary researchers have no control over the data they use which may be well out long out of date, disregarded and also not directly relevant. Indeed, the following research was the product of significant trawling of journal articles and texts referring to obsolete legislation and priorities.
3. Literature review
3.1 Background and theoretical underpinnings
A sexual offence is the ‘act of a sexual nature against a person without that person’s consent’ (Hale, et al, 2005). It is an act which is universally un-tolerated and, as such any commission of it is met with seriousness. While there are significant differences in aetiological theories with regards sexual offenders and their treatment, there is some evidence that perpetrators consistently present with chronic and often habitual patterns of behaviour for which there is a potential for disruption (Knopp, 1984). The argument therefore is that all sex offenders are not inherently acting maliciously and, while their act is unforgivable and no attempt to justify their actions will be made within this paper; one must consider additional factors which may be contributory or perhaps self-enabling.
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Working with sex offenders has been linked to increased stress and, in some cases ‘burnout’ amongst practitioners leading understandably to high rate of illness; thus the longstanding search for suitable and sustainable treatment of sex offenders has seen both curious and questionable methods used. Wood et al (2000) locate the beginnings of sex offender treatment in 1930’s America where they were seen as ‘deranged’ and ‘psychopathic’ and therefore were routinely detained in asylums. This perception remained throughout the majority of the 20th Century until the 1970’s when social work practice changed and ADP emerged and the rise of feminist practice stemming from radicalism saw significant ‘progressions’ with treatment.
Quinsey, Bergensen and Steinman looked beyond the ‘psychopathic’ view and considered that behaviour could be altered by changing cognitive patters, and in 1976 they used electric shock aversion therapy in an attempt to do this. They undertook further work in 1980 ‘capitalising’ on the apparent successes of the previous application by treating 18 child sexual offenders using biofeedback and signalled-punishment aversion therapy with electric shock treatment. Again, this was reported to achieve positive results however there was no follow up following the intervention and it has not been revisited. While the idea of ‘shock’ therapy fills many people with horror, however the truth is that at the time this was widely considered to be effective treatment and is still routinely used in nearly every psychiatric hospital in the UK (DoH, 2008). Applying Electroconvulsive Therapy (ECT) to sex offenders was therefore significant as it showed recognition of sex offenders as people who were in need, albeit ‘sick’ ones.
Groth, Hobson and Gary (1982, p. 140) recognised that there were limitations within the electroconvulsive psychoanalytic approaches with sex offenders and worked on an assumption that these individuals had clinical or psychological problems. This thinking was later validated by the work of Saunders, McClure and Murphy (1986), who confirmed beliefs that only a very small percentage of non-incarcerated sexual offenders against children had definable psychiatric conditions. In 1984, Finkelhor’s was the first to consider sociological and psychological variations in relation to sex offenders and crucially acknowledged that individual psychopathology linked a history of child sexual abuse was only be linked to some of cases; thereby nullifying the notion at all sex offenders were victims of sexual abuse themselves which is a perceived misconception.
Concurrently, Marquis (1970) was experimenting with the idea of orgasmic reconditioning. This process requires the subject to masturbate whilst thinking about their deviance and then alter their thoughts to something more ‘suitable’ at point of climax. Marshall and Barbaree also took a different approach to their work with sex offenders concluding positive evidence of the effectiveness of the widely contentious ‘satiation therapies’ which include verbal and masturbatory techniques (1978, p. 303). The verbal process is intended to decrease the sex-offender’s need for deviant sexual arousal and incorporates them simply describing scenarios which they find exciting over and over until these apparently deviant act become boring and pedestrian to them. The masturbatory element involves the client masturbating over non-deviant material and continuing past the point of ejaculation. This was considered to be highly successful and many researchers believed these methods should be used as common practice in rehabilitation. However, while there has been noted success in relation to the interventions, most studies accessed made reference to fetishism as opposed to the sort of sexual abuse which I would consider high on the public’s agenda.
The 1980’s became a significant time for the development of work with sex offenders; characterised mainly by the work of Salter (1988) and Finkelhor’s (1984). Though it had been considered important to sex offender treatment with cautionary intervention up, both recognised the importance of cognitive distortion in tackling sex offender’s perception of their offence. While today the term tends to be used quite broadly, Finkelhor’s application was that if reservations about the offence were to be overcome and, the perpetrator must desist making excuses and justifying the act and acknowledge it as simply deviant (Beech et al, 1998). He emphasised the importance of the societal and cultural pervasive socialisation patters, difference in values and morality as well as biological factors. The model therefore provided a clear framework for practitioners to work within, targeting sexual arousal, emotional regulation and helping offenders to understand, identify and avoid situations which might put them or potential victims at risk (Ward, 2003). This represents a style of working which is clearly identifiable as social work; and this new holistic approach to working with sex offenders was progressive in acknowledging the needs and to an extent ‘rights’ to the offender.
Unsurprisingly other practitioners followed suit and Salter’s thinking advised practitioners that, while some offenders may acknowledge their deviance, they may also lay blame on alcohol, stress and other factors and therefore minimise their culpability. Salter’s work is further validated by more recent studies which indicate cognitive distortion is recognised as highly common in sexual offenders; Hudson et al (1993) conducted a study whereby ‘child molesters’ claimed that they thought that unresponsiveness was a sign that they were not bothered and alarmingly another study where rapists had apparently claimed that they perceived distress as a sign of enjoyment. This said, more usually the ‘distortions’ which are referred to are normally made by offenders to rationalise, justify or deny offence behaviours (Berliner and Conte, 1990, p. 34). The reduction and tackling of cognitive distortions is essential with effective CBT and is shown to aid recidivism rates (Marshall et al, 1999). As such CBT became central to work around sex offenders.
4.1 The rise of CBT
Cognitive behavioural therapies derived from relapse prevention therapy which had become popular following successes in areas such as self-esteem and substance use (McCulloch et al, 2007). Its use with sex offenders reflected some progression away from the previous methods as it recognised social and environmental influences upon sexual offending as opposed to simply deeming it a mental illness (Moster et al, 2008). Since the 1980’s, the use of CBT has gained respect and usage from agencies making it the most common intervention used (Andrews & Bonta, 1998; 1998; Freeman-Longo & Knopp, 1992; Laws, 1989). Hanson (2002) found, after significant meta-analysis a recidivism rate of 9.9% compared to 17.4% for those who had not undergone CBT interventions. This evidence was reinforced by Lösel and Schmucker’s (2005) whose meta-analytical study of sexual offender program espoused similar findings giving further kudos. The emergence of CBT as a means of sex offender treatment coincided with a new socio-political climate which sought to promote and publicise ‘what works’ with offenders. CBT is the most commonly used intervention with sex offenders, and widely considered to be the most effective (Andrews and Bonta, 1998; Becker and Murphy, 1998; Freeman-Longo & Knopp, 1992; Home Office, 2010), it does however still remain much less used than initially planned.
Authors such as Sparrow (2002) suggest that such a shortfall from initial expectations, is, at least in part, due to a prevailing negative media response, unhappy with anything seen than ‘less than’ the most draconian of interventions and punishments, alongside a centralized, managerialist government unwilling to work with agencies they felt to be ‘untrustworthy’ and preferring to focus on more punitive measures which sought to minimising risk rather than therapeutic intervention.
CBT with elements of Relapse Therapy (RT) are the most common interventions with sex offenders in both the UK, Canada and US and generally involve group and individual therapy, work on victim empathy, learning about abuse cycles, cognitive restructuring, anger management and assertiveness, interpersonal skills and changing deviant sexual arousal patterns (Moster et al, 2008).
4.2 Ethical conflicts within CBT
CBT is postulated on the idea that all our emotional responses and behaviours are determined by pre-existing attitudes and beliefs which we may have developed or ‘picked up’ along the way (Beck, 1995). Thus, if we are to change how we react to experiences and emotions then we must change both our thoughts and how we perceive the matter (Moster, 2008). Facilitating this requires the use a number of techniques and constructs to help the subject examine and understand their cognitive processes and the subsequent link between these thoughts and their behaviour. Beck (1995) suggests that some of the most effective techniques are cognitive restructure, reversal of behaviours and directive role play which aims to confront the individual with the consequences of their behaviour and engender a reflective stance to be developed. While motivational methods of treatment do exist, some practitioners prefer the well-established confrontative approach which can raise questions in relation of social work ethics (Sheath, 1990; Moster et al, 2008).
With some offender treatments for example, practitioners may be required to adopt a set of principles which may differ from the core values of their profession. This includes, but is not limited to mandatory participation in treatment which contradicts traditional mental health ethics and confrontative CBT intervention which has been criticised for its apparent manipulative nature (Sheath, 1990; Glaser, 2003). While this may present a dilemma for social work where values of empowerment and respect are fundamental; Holmes and Lindley (1991) contend that clinicians should feel ‘no shame’ and that even if some of the techniques used are perceived to be ethically dubious, if they result in individuals gaining better understanding and capacity to make rational and informed choices with the client group, then they should be encouraged. Indeed many writers share this notion and discuss the idea that the offender learning from their own ‘internal management’ rather than dependence of external control is key to the reduction of recidivism (Marshall et al, 1999).
While the main goal of CBT with sex offenders is recidivism there are other goals for social workers to be mindful of; essential to CBT is that offenders are able to retain (or perhaps regain) self-worth. This requires intervention which both serves to protect the public and, at the same time, helps nurture the offender (Moster et al, 2008). While areas of CBT do encourage the client to create ‘false realities’ and pasts, the client is actively encouraged to think positively about their lives post-therapy; be this in the near future or following release from custody (Marshall, Anderson and Fernandez, 1999).
Another potentially contentious issue arises from the fact that CBT with Sex Offenders has to date unapologetically focused on directly challenging and changing opinions, actions and attitudes focusing on reactionary intervention which aims to modify existing behaviours but also questions the underlying conflicts that facilitate. Sheath (1990) refers to this form of intensely confrontative treatment as being nothing short of a ‘legitimate form of nonce bashing’ and discusses his own feelings of prejudice and repulsion which no doubt blur the quality of intervention being delivered. This is one of the fundamental conflicts of intervention with sex offenders and an area which requires practitioners to be open, honest and reflective about their abilities to put their feelings aside. Whilst social work is built around the principles of non-discrimination, managers and teams must also be realistic about the expectations of their staff.
Sheath is not the only practitioner to recognise the shortcomings of CBT; Payne discusses some of the problems of the intervention from another ethical position, critiquing the process as simply a manipulation of offenders’ behaviour rather than progress achieved as a result of the client rather than the professional retaining control (1997). Payne does not however clarify his position as to whether he feels the right maintain to self-determination can be incorporated within CBT, or indeed if it’s incompatible, stating only that it is only achieved when the client’s one aim is to ‘free themselves from behaviour’ (1997: p. 123). Such tension might reasonably be held to present social workers, for whom issues of self-determination are central to the value base of the profession, with a very difficult ‘circle to square’ when attempting to justify the use of CBT in this manner.
Hackett (2008) suggests that the predominance of CBT in this area has also contributed to the homogenisation of sex offenders, as many of the key interventions, such as the cycle of abuse (Ryan et al, 1987) and Finkelhor’s four preconditions model, have a tendency to focus on the offence, rather than the offender. Thus a fundamental flaw in the approach would seem to be that a series of highly contentious and questionable assumptions are required about offenders as a group and how they operate, which fundamentally fail to recognise that every single sexual offender is a different person with their own issues, but also an offender with their own issues, agenda, perception of their offence and perception of their victims (Sheath, 1990). Indeed, it might plausibly be argued that a reactive, ‘one size fits all’, application of CBT side-steps what is often the crux of the client’s problems; sexual orientation, self-perception, sexually deviant and unfulfilled fantasy. Attempting to ‘decode’ a sexual offender while they are still in a state of defensiveness may as a result be, as Sheath puts it, a ‘nihilistic exercise and at worst counter-productive’ (p. 161).
Given the ethical issues raised above, whose overall implication would appear to be that the ‘ends justify the means’, with regard to the use of CBT, it would seem reasonable to question the extent to which such a positive duality of outcome can in reality ever be more than ‘wishful thinking’, as it would seem that public protection will inevitably be given higher priority.
4.3 Beyond CBT
Research by Marshall (2002) and Craissati et al (2002) adds to the discourse thatin suggestsing that it is an inability to form adult relationships which sometimes results in the pursuit of intimacy in other, maladaptive ways. Marshall (1989; 1993; 1996; 2002) uses the insights offered through the application of attachment theory to explain how sexual offenders are frequently emotionally distant and ‘superficial’ in intimate relationships. Going on to suggest a link between early attachment experiences and the development of internal working models which support the forming and maintenance of relationships in adolescence and adulthood (Bowlby, 1969). Such working models contribute not only to our own attitudes and beliefs, but also to how we recognise and respect the roles of others. Popular attachment debate discusses three main ‘styles’ of attachment; the secure which is thought to stem from warm and consistent parenting and then two types of insecure attachments, namely anxious which is thought to be rooted in inconsistent parenting and the avoidant which is linked to unresponsively in parenting (Ainsworth, 1979; Alexander, 1992).
Insecure attachments are considered to be a vulnerability factor with offending in general (Alexander, 1992) and Marshall suggests this can pose challenges in adolescence and can make children ill-equipped for the challenges of puberty, and thus less likely to achieve a satisfactory level of understanding of relationships and intimacy amongst peers and other relationships. He suggest that can result in confusing sex with intimacy which, combined with pre-existing loneliness, frustration and natural sexual urges may lead to inappropriate sexual promiscuity and violence (Marshall, 1989). Indeed, the pioneering practitioner on attachment, Bowlby (1944) published research based on a cohort of 47 young offenders, proposing that the absence of a secure attachment figure can ostensibly result in an ‘affectionless psychopathy’. A condition characterised by a lack of empathy and an inability to form relationships.
Considering sexual offenders within a frame of attachment may enable practitioners who struggle to separate the offence and the offender to work more effectively with them. Indeed, there significant evidence which links insecure and disorganised attachment anti-social behaviour and aggression in adulthood. Using Attachment Theory in which a way with sex offenders does not serve to justify their actions or behaviour, however when considered amongst the myriad of other social and psychological factors, some understanding of cognition and behaviour may be observed which is something that practitioners struggle with (Sheath, 1990; Hudson, 2005). As such, attachment theory does not give us a set of rules for dealing with sex offenders but is does support better understanding as well as support a better understanding on their own behaviour.
5.1 Working with sex offenders in custody
Whether it be increased awareness, less tolerance, changes in attitudes or the rise of DNA testing – there has been a gradual increase since the 1980’s of incarcerated sex offenders, putting increased pressure on prison structures, agencies who work with the client group and the need to find su
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