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Transcript of Treatment Components Anna C. Salter, Ph.D.. Agenda Treatment Components Good Lives Vs. RP Behavioral...
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Treatment ComponentsTreatment Components
Anna C. Salter, Ph.D.Anna C. Salter, Ph.D.
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AgendaAgenda
Treatment ComponentsTreatment Components
Good Lives Vs. RPGood Lives Vs. RP
Behavioral ConditioningBehavioral Conditioning
DenialDenial
Role of Family TherapyRole of Family Therapy
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How to DecideHow to Decide
Meta-analysis of factors related to recidivismMeta-analysis of factors related to recidivism
TheoryTheory
Skill Set of StaffSkill Set of Staff
TraditionTradition
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Key ResearchKey Research
Hanson & BussiereHanson & Bussiere 19981998
Hanson & Morton-BourgonHanson & Morton-Bourgon 20052005
HansonHanson 20092009
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Meta-analysisMeta-analysisHanson & Bussiere, 1998Hanson & Bussiere, 1998
61 Studies61 Studies
N = 28,972N = 28,972
Correlation coefficientsCorrelation coefficients
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Meta-analysisMeta-analysisHanson & Morton-Bourgnon, Hanson & Morton-Bourgnon,
20052005
Studies = 82Studies = 82
N = 29,450N = 29,450
35 from 1998 meta-analysis35 from 1998 meta-analysis
Mean differenceMean difference
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Traditional Clinical AssessmentTraditional Clinical Assessment P-graph deviant arousal pattern – childrenP-graph deviant arousal pattern – children Deviant arousal Deviant arousal Personality disorders, e.g., APDPersonality disorders, e.g., APD EmpathyEmpathy DenialDenial Family problemsFamily problems Psychological problemsPsychological problems Sexual abuse as a childSexual abuse as a child Social skillsSocial skills Substance abuseSubstance abuse
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Traditional Clinical AssessmentTraditional Clinical Assessment P-graph deviant arousal pattern – childrenP-graph deviant arousal pattern – children YesYes Deviant Sexual PreferenceDeviant Sexual Preference YesYes Personality disorders, e.g., APDPersonality disorders, e.g., APD YesYes EmpathyEmpathy No No DenialDenial No No Family problemsFamily problems No No Psychological problemsPsychological problems No No Sexual abuse as a childSexual abuse as a child No No Social skillsSocial skills No No Substance abuseSubstance abuse No No
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Traditional Clinical AssessmentTraditional Clinical Assessment Deviant arousal pattern – childrenDeviant arousal pattern – children .32.32 Deviant Sexual PreferenceDeviant Sexual Preference .22.22 Personality disorders, e.g., APDPersonality disorders, e.g., APD .16.16 EmpathyEmpathy .03 .03 DenialDenial .02 .02 Family problemsFamily problems .08 .08 Psychological problemsPsychological problems 0 0 Sexual abuse as a childSexual abuse as a child -.01-.01 Social skillsSocial skills -.04-.04 Substance abuseSubstance abuse .03 .03
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Clinical Vs. Actuarial Clinical Vs. Actuarial AssessmentAssessment
Dixon, 1974Dixon, 1974 Epperson, Kaul and Huot, 1995Epperson, Kaul and Huot, 1995 Florida Dept. of Health & Human Services, Florida Dept. of Health & Human Services,
19841984 Khanna, Brown, Malcolm & Williams, 1989Khanna, Brown, Malcolm & Williams, 1989
(Hanson & Bussiere, 1996)(Hanson & Bussiere, 1996)
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Clinical vs. Actuarial Clinical vs. Actuarial AssessmentAssessment
Reddon, Studer, and Estrada, 1995Reddon, Studer, and Estrada, 1995 Rice, Quinsey and Harris, 1989Rice, Quinsey and Harris, 1989 Ryan and Miyoshi, 1990Ryan and Miyoshi, 1990 Schram, Milloy and Rowe, 1991Schram, Milloy and Rowe, 1991 Smith & Monastersky, 1986Smith & Monastersky, 1986 Sturgeon & Taylor, 1986Sturgeon & Taylor, 1986
(Hanson & Bussiere, 1996)(Hanson & Bussiere, 1996)
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Clinical vs. Actuarial Clinical vs. Actuarial AssessmentAssessment
rr
Clinical AssessmentClinical Assessment .10.10
Actuarial AssessmentActuarial Assessment .46.46
(Hanson & Bussiere, 1998)(Hanson & Bussiere, 1998)
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Accuracy of Clinical and Accuracy of Clinical and Actuarial Risk PredictionActuarial Risk Prediction
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
a b c d e f g h i j k l m
clinical
actuarial
r
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Hanson Clinical vs. ActuarialHanson Clinical vs. Actuarial
1.1. Variability of clinical greatVariability of clinical great
2.2. Some clinical worse than chanceSome clinical worse than chance
3.3. None of clinical showed results better None of clinical showed results better than worse of actuarials (ns)than worse of actuarials (ns)
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Meta-analysisMeta-analysisHanson & Morton-Bourgnon, Hanson & Morton-Bourgnon,
20052005
Studies = 82Studies = 82
N = 29,450N = 29,450
35 from 1998 meta-analysis35 from 1998 meta-analysis
Mean differenceMean difference
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Value of d is approximatelyValue of d is approximately
2 times the correlation coefficient2 times the correlation coefficient
from same datafrom same data
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LargeLarge > .30> .30
ModerateModerate >.20>.20
SmallSmall .10 .10
Not usefulNot useful <.10<.10
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005
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CategoriesCategories
Sexual deviancySexual deviancyAntisocial orientationAntisocial orientationSexual attitudesSexual attitudesIntimacy deficitsIntimacy deficitsAdverse childhood environmentAdverse childhood environmentGeneral psychological problemsGeneral psychological problemsClinical presentationClinical presentation
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CategoriesCategories
Sexual deviancySexual deviancy .30.30 Antisocial orientationAntisocial orientation .23.23 Sexual attitudesSexual attitudes .17.17 Intimacy deficitsIntimacy deficits .15.15 Adverse childhood environmentAdverse childhood environment .09.09 General psychological problemsGeneral psychological problems .02.02 Clinical presentationClinical presentation -.02 -.02
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005
Sexual DeviancySexual Deviancy
Sexual interest in childrenSexual interest in children.39.39
Any deviant sexual interestAny deviant sexual interest.31.31
Sexual preoccupationSexual preoccupation.21.21
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005
Anti-social Anti-social
General regulation problemsGeneral regulation problems .37 .37 PCL-RPCL-R .29.29 Antisocial personality disorderAntisocial personality disorder .21.21
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005
Intimacy DeficitsIntimacy Deficits
Emotional identification with childrenEmotional identification with children .42.42 Conflicts with intimate partnersConflicts with intimate partners .36.36 Social skills deficitsSocial skills deficits -.07 -.07 LonelinessLoneliness .03.03
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Attitudes towards sexual crimeAttitudes towards sexual crimeYesYes
Child molester attitudesChild molester attitudes NoNo
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005
No goNo go
Childhood neglect or abuseChildhood neglect or abuse.10.10
Sexual abuse in childhoodSexual abuse in childhood .09.09
Lack of empathyLack of empathy -.08 -.08
Low self-esteemLow self-esteem .04.04
LonelinessLoneliness .03.03
Denial of sexual crimeDenial of sexual crime .02.02
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““The prototypic sexual recidivist is not upset The prototypic sexual recidivist is not upset or lonely; instead, he leads an unstable, or lonely; instead, he leads an unstable, antisocial lifestyle and ruminates on sexually antisocial lifestyle and ruminates on sexually deviant themes.”deviant themes.”
(Hanson & Morton-Bourgon, 2005, p. 1158)(Hanson & Morton-Bourgon, 2005, p. 1158)
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005Not CorrelatedNot Correlated
Child molester attitudesChild molester attitudesGeneral psychological problemsGeneral psychological problemsSexually abused as a childSexually abused as a childSocial skill deficitsSocial skill deficitsLonelinessLonelinessAnxietyAnxiety
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Hanson & Morton-Bourgon 2005Hanson & Morton-Bourgon 2005
Not CorrelatedNot Correlated
DepressionDepressionLow self-esteemLow self-esteemVictim empathyVictim empathyDenialDenialMinimizationMinimizationPoor progress in treatmentPoor progress in treatment
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Survey of Treatment Programs Survey of Treatment Programs
Community ProgramsCommunity Programs
%%
Victim empathyVictim empathy 94.894.8
Social skills trainingSocial skills training 8080
Family support networksFamily support networks 72.872.8
Arousal controlArousal control 63.663.6
Antisocial attitudesAntisocial attitudes ??
(McGrath et al., 2003)(McGrath et al., 2003)
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Survey of Treatment Programs Survey of Treatment Programs
Residential ProgramsResidential Programs
%%
Social skills trainingSocial skills training 8989
Victim empathyVictim empathy 86.886.8
Arousal controlArousal control 59.659.6
Family support networksFamily support networks 43.343.3
Antisocial attitudesAntisocial attitudes ??
(McGrath et al., 2003)(McGrath et al., 2003)
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Arousal ControlArousal Control Com %Com % Res % Res %
Covert sensitizationCovert sensitization 50 50 48 48
Odor aversionOdor aversion 25 25 18 18
Masturbatory satiationMasturbatory satiation 24 24 19 19
Aversive behavioral rehearsalAversive behavioral rehearsal 23 23 18 18
Verbal satiationVerbal satiation 16 16 14 14
Minimal arousal conditioningMinimal arousal conditioning 18 18 19 19
Orgasmic conditioningOrgasmic conditioning 16 16 19 19
One or moreOne or more 63 63 60 60
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Growing ConsensusGrowing Consensus
Not correlated with general personality deficitsNot correlated with general personality deficits
But withBut with
Certain specific problemsCertain specific problems
Sexual deviancySexual deviancy
Antisocial attitudesAntisocial attitudes
Certain intimacy deficitsCertain intimacy deficits
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Motors & BrakesMotors & Brakes
Motor Motor Sexual attraction to Sexual attraction to childrenchildren
Faulty brakesFaulty brakes Antisocial attitudesAntisocial attitudes
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Sexual DeviancySexual Deviancy
Unrelated to personality traitsUnrelated to personality traits
Narcissistic or self-effacingNarcissistic or self-effacing
Outgoing or introvertedOutgoing or introverted
Depressed, anxious or hystericalDepressed, anxious or hysterical
Low self-esteem or highLow self-esteem or high
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Correlated Personality Traits Correlated Personality Traits
RecklessnessRecklessness
ImpulsivityImpulsivity
Poor problem solvingPoor problem solving
General regulation problemsGeneral regulation problems
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““Research has never found measures of general Research has never found measures of general psychological adjustment, such as self-esteem, psychological adjustment, such as self-esteem, depression, or social competence, to be related to depression, or social competence, to be related to sexual offense recidivism (Hanson & Bussiere, sexual offense recidivism (Hanson & Bussiere, 1998). Furthermore, treatment programs that 1998). Furthermore, treatment programs that improve general psychological adjustment do not improve general psychological adjustment do not result in reduced recidivism rates.”(Hanson, result in reduced recidivism rates.”(Hanson, Steffy, & Gauthier, 1993; Nicholaichuk, 1996).”Steffy, & Gauthier, 1993; Nicholaichuk, 1996).”
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““The distressed offenders are at no greater The distressed offenders are at no greater recidivism risk than the happy offenders, but recidivism risk than the happy offenders, but both types of offenders are at increased risk both types of offenders are at increased risk when their mood deteriorates. These results when their mood deteriorates. These results suggest that therapy should focus on weakening suggest that therapy should focus on weakening the association between negative affect and sex the association between negative affect and sex offending rather than on generally improving the offending rather than on generally improving the offenders’ psychological adjustment.” offenders’ psychological adjustment.”
(Hanson, 2000, p. 34-35)(Hanson, 2000, p. 34-35)
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Research SuggestsResearch Suggests
Treatment programs should addressTreatment programs should address
Sexual deviancySexual deviancy
Antisocial attitudes & beliefsAntisocial attitudes & beliefs
Certain intimacy deficits: Certain intimacy deficits:
Emotional identification with children, Emotional identification with children, Conflicts with partnersConflicts with partners
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Research SuggestsResearch Suggests
Not includingNot including
Empathy Empathy Social skillsSocial skillsSubstance abuseSubstance abusePersonal distress variablesPersonal distress variables
AnxietyAnxiety
DepressionDepression
Low self-esteemLow self-esteem
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Meta-analysis: Risk, Need & Meta-analysis: Risk, Need & ResponsivityResponsivity
Hanson, Bourgon, Helmus & Hodgson, 2009Hanson, Bourgon, Helmus & Hodgson, 2009
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Risk-Needs-ResponsivityRisk-Needs-Responsivity
Focus on high risk offendersFocus on high risk offenders
Target criminogenic needsTarget criminogenic needs
Use cognitive behavioral methods tailored Use cognitive behavioral methods tailored to individual learning styleto individual learning style
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Selection of StudiesSelection of Studies
Total = 130Total = 130
AcceptedAccepted
2323
AcceptedAccepted
18 weak18 weak
5 good5 good
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Adherence to RNR PrinciplesAdherence to RNR Principles
Risk: Little or no service to low riskRisk: Little or no service to low risk
(Tx participants of higher than average risk)(Tx participants of higher than average risk)
Needs: Sexual deviancy, antisocial attitudes, Needs: Sexual deviancy, antisocial attitudes, sexual attitudes, intimacy deficitssexual attitudes, intimacy deficits
Noncriminogenic: denial, empathy, social skillsNoncriminogenic: denial, empathy, social skills
Responsivity: Cognitive behavioral with firm-Responsivity: Cognitive behavioral with firm-but-fair therapistsbut-fair therapists
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Rater ReliabilityRater Reliability
Kappa Kappa % Agreement% Agreement RatingRating
RiskRisk .73.73 88%88% GoodGood
ResponsivityResponsivity .82.82 94%94% GoodGood
NeedsNeeds .42.42 75%75% FairFair
(Hanson et al., 2009)(Hanson et al., 2009)
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Hanson et al., 2009Hanson et al., 2009
Recidivism Treated%
Untreated%
Sexual 10.9 19.2%
Any 31.8 48.3
Violent 22.9 NS 32 NS
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Tx Effectiveness & RNR ModelTx Effectiveness & RNR Model
Sexual RecidivismSexual Recidivism
22 Studies22 Studies
NeedsNeeds More effectiveMore effective
ResponsivityResponsivity More effectiveMore effective
RiskRisk Not more Not more effectiveeffective
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Risk PrincipleRisk Principle
Least effective with general offendersLeast effective with general offenders
Least effective with sex offendersLeast effective with sex offenders
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Tx Effectiveness & RNR ModelTx Effectiveness & RNR Model
Number of Principles Number of Principles OddsOdds
Adhered ToAdhered To RatioRatio
None 1.17None 1.17
11 .64.64
22 .63.63
33 .21 .21
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Any RecidivismAny Recidivism ResponsivityResponsivity
NumberNumber
(Fixed (Fixed effects)effects)
Sexual & ViolentSexual & Violent No effectNo effect
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““If there is anything to be learned from the If there is anything to be learned from the broad debate over the effectiveness of broad debate over the effectiveness of correctional rehabilitation, it is that not all correctional rehabilitation, it is that not all interventions reduce recidivism.”interventions reduce recidivism.”
(Hanson et al., 2009)(Hanson et al., 2009)
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““Of the three RNR principles, attention to the Of the three RNR principles, attention to the Need principle would motivate the largest Need principle would motivate the largest changes in the interventions currently given to changes in the interventions currently given to sex offenders. . . An empirical association with sex offenders. . . An empirical association with recidivism is a minimum criterion for a factor to recidivism is a minimum criterion for a factor to be considered a potential criminogenic need. . . be considered a potential criminogenic need. . . Many of the factors targeted in contemporary Many of the factors targeted in contemporary treatment programs do not meet this test.” treatment programs do not meet this test.” Offense responsibility, social skills training, and Offense responsibility, social skills training, and victim empathy are targets in 80% of sexual victim empathy are targets in 80% of sexual offender treatment programs . . . Yet none of offender treatment programs . . . Yet none of these have been found to predict sexual these have been found to predict sexual recidivism. (Hanson et al., 2009, p. 25)recidivism. (Hanson et al., 2009, p. 25)
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Attack on Attack on Risks/Needs/ResponsivityRisks/Needs/Responsivity
““Lack of Lack of unifying power unifying power and and external consistencyexternal consistency””
““Lack of Lack of fertilityfertility with respect to treatment with respect to treatment guidance”guidance”
““Lack of Lack of explanatory depthexplanatory depth””
““Incoherency;” “lack of Incoherency;” “lack of scope;scope;” “” “incompleteincomplete rehabilitation theoryrehabilitation theory (Ward et al., 2006)(Ward et al., 2006)
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Focus of TreatmentFocus of TreatmentReduction of Recidivism?Reduction of Recidivism?
““We believe that treating sexual offenders also We believe that treating sexual offenders also involves taking into consideration human involves taking into consideration human welfare issues, as well as recidivism issues.”welfare issues, as well as recidivism issues.”
(Ward et al., 2006, p.269)(Ward et al., 2006, p.269)
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““Individuals who are assessed as low risk may Individuals who are assessed as low risk may exhibit a number of significant problems that exhibit a number of significant problems that adversely impact on their functioning, for adversely impact on their functioning, for example, low mood or relationship conflict. example, low mood or relationship conflict. While such problems may not be criminogenic While such problems may not be criminogenic needs, individuals could still benefit from needs, individuals could still benefit from therapeutic attention.” therapeutic attention.”
(Ward et al., 2006, p. 269) (Ward et al., 2006, p. 269)
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Risk needs model “has resulted in the Risk needs model “has resulted in the development of a suite of empirically derived and development of a suite of empirically derived and effective treatment for a range of crimes, effective treatment for a range of crimes, including sexual offending.”including sexual offending.”
(Ward & Hudson, 1997)(Ward & Hudson, 1997)
““The difficulty is that in the absence of a The difficulty is that in the absence of a theoretical analysis we do not know why.”theoretical analysis we do not know why.”
(Ward et al., 2006, p. 270)(Ward et al., 2006, p. 270)
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““. . .the claim that a criminogenic need . . .the claim that a criminogenic need such as impulsivity is instrumentally such as impulsivity is instrumentally related to further offending suggests that related to further offending suggests that individuals choose to act in an impulsive individuals choose to act in an impulsive manner in order to achieve the further goal manner in order to achieve the further goal of offending.. .It is confusing to view what of offending.. .It is confusing to view what is essentially a loss of behavioural control is essentially a loss of behavioural control as an intentional action; individuals do not as an intentional action; individuals do not choose to behave impulsively.”choose to behave impulsively.”
(Ward et al., 2006, p. 274)(Ward et al., 2006, p. 274)
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Reply from Bonta and AndrewsReply from Bonta and Andrews
““We welcome such a debate on the We welcome such a debate on the relevance of various models to explain relevance of various models to explain criminal behaviour . However, that debate criminal behaviour . However, that debate should be structured by respect for should be structured by respect for evidence.”evidence.”
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““Theoreticism is the acceptance or rejection Theoreticism is the acceptance or rejection of knowledge in accordance with one’s of knowledge in accordance with one’s personal view personal view and not in accordance with and not in accordance with evidence.”evidence.”
(Bonta & Andrews, 2003, p. 215)(Bonta & Andrews, 2003, p. 215)
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““Here we see theoreticism operating at its Here we see theoreticism operating at its best. Ignore the evidence that reductions best. Ignore the evidence that reductions in criminogenic needs are associated with in criminogenic needs are associated with reduced criminal behaviour, turn a blind reduced criminal behaviour, turn a blind eye to the fact that there is not a shred of eye to the fact that there is not a shred of evidence that psychodynamic evidence that psychodynamic interventions reduce recidivism and simply interventions reduce recidivism and simply assert that your approach makes the most assert that your approach makes the most sense.”sense.”
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““Ward and Stewart appear to be arguing for Ward and Stewart appear to be arguing for a return to the good old days when a return to the good old days when treatment providers relied on nondirective, treatment providers relied on nondirective, relationship-oriented techniques to build relationship-oriented techniques to build feelings of well-being.”feelings of well-being.”
(Bonta & Andrews, 2003, p. 217)(Bonta & Andrews, 2003, p. 217)
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Impact of Appropriate Vs. Impact of Appropriate Vs. Inappropriate TreatmentInappropriate Treatment
(Andrews, 1998)(Andrews, 1998)
-0.1
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Combined Tx
Appropriate
Inappropriate
Sanctions
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Type of TreatmentType of Treatment
0
0.05
0.1
0.15
0.2
0.25
0.3
Non Behavioral
CognitiveBehavioral
Andrew, 1994
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Type of Treatment & Young OffendersType of Treatment & Young Offenders
0
0.05
0.1
0.15
0.2
0.25
Non Behavioral
CognitiveBehavioral
Dowden & Andrews, 1999
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Targeting Criminogenic NeedsTargeting Criminogenic Needs
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Criminogenic NeedsCriminogenic Needs
CriminogenicCriminogenic Non Non CriminogenicCriminogenic
Antisocial AttitudesAntisocial Attitudes Self-EsteemSelf-Esteem
Antisocial FriendsAntisocial Friends AnxietyAnxiety
Substance AbuseSubstance Abuse DepressionDepression
ImpulsivityImpulsivity
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Targeting Criminogenic NeedsTargeting Criminogenic Needs
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Targets 1 - 3Noncriminogenic Needs
Targets 4 - 6CriminogenicNeeds
Gendreau, French & Taylor, 2002
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Self Esteem Vs. Criminogenic NeedsSelf Esteem Vs. Criminogenic Needs
-0.1-0.05
00.050.1
0.150.2
0.250.3
0.350.4
Self Esteem
CriminogenicNeeds
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Appropriate Treatment TargetsAppropriate Treatment Targets
Sexual deviancySexual deviancy Sexual pre-occupationSexual pre-occupation Low self-controlLow self-control Grievance thinkingGrievance thinking Lack of meaningful adult relationshipsLack of meaningful adult relationships
(Hanson & Morton-Bourgon, 2004)(Hanson & Morton-Bourgon, 2004)
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Proponents of Personal Distress Proponents of Personal Distress VariablesVariables
““Some combinations of these experiences lead Some combinations of these experiences lead the emerging sexual offender to acquire: a low the emerging sexual offender to acquire: a low sense of self-worth; a failure to internalize the sense of self-worth; a failure to internalize the confidence, attitudes, and skills necessary to confidence, attitudes, and skills necessary to meet his needs prosocially; and a self-meet his needs prosocially; and a self-interested disposition or a sense of interested disposition or a sense of entitlement.”entitlement.”
(Marshall, Marshall, Serran, & Fernandez, 2006, (Marshall, Marshall, Serran, & Fernandez, 2006, p. 15)p. 15)
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Theory of Low Self-EsteemTheory of Low Self-Esteem
Low Self-esteem = Low Self-esteem =
Seeking sex from non-threatening partnersSeeking sex from non-threatening partners
Seeking coerced sexSeeking coerced sex
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Research on Low Self-EsteemResearch on Low Self-Esteem
Study 1Study 1 Child molesters lowerChild molesters lower
Study 2Study 2 Child molestersChild molesters
normal rangenormal range
(Marshall et al., 2003)(Marshall et al., 2003)
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Contrary ResearchContrary Research
People with low self-esteemPeople with low self-esteem
Do not typically undertake novel activitiesDo not typically undertake novel activities
That require persistenceThat require persistence
(Baumeister et al., 1989)(Baumeister et al., 1989)
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Rapists & Nonsex OffendersRapists & Nonsex Offenders
No differences in self-esteemNo differences in self-esteem
(Fernandez & Marshall, 2003) (Fernandez & Marshall, 2003)
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Research on Self-EsteemResearch on Self-Esteem
Rapists and nonsexual offendersRapists and nonsexual offenders
No differencesNo differences
(Fernandez & Marshall, 2003)(Fernandez & Marshall, 2003)
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““With self-esteem we encourage and With self-esteem we encourage and facilitate the expression of behaviors such facilitate the expression of behaviors such as engaging in social and pleasurable as engaging in social and pleasurable activities, as well as verbal (or subvocal) activities, as well as verbal (or subvocal) behaviors such as complementing behaviors such as complementing themselves when they do things that themselves when they do things that deserve rewards and repeating positive deserve rewards and repeating positive self-statements throughout each day.” self-statements throughout each day.” (Marshall et al., 2006, pp. 28-29).(Marshall et al., 2006, pp. 28-29).
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Outcome of Self-Esteem TreatmentOutcome of Self-Esteem Treatment
Increased self-esteem on inventoriesIncreased self-esteem on inventories
Reductions in lonelinessReductions in loneliness
Increases in intimacy skillsIncreases in intimacy skills
No increase in victim empathyNo increase in victim empathy
(Marshall et al., 1997)(Marshall et al., 1997)
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Thornton , Beech & MarshallThornton , Beech & Marshall20042004
Pre-treatment self esteem correlated with recidivismPre-treatment self esteem correlated with recidivism
All offenders in community sample in treatmentAll offenders in community sample in treatment
85% graduation rate85% graduation rate
Self-esteem improved during treatmentSelf-esteem improved during treatment
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Why Treat Self Esteem?Why Treat Self Esteem?
Self-esteem after treatmentSelf-esteem after treatment ??
Self-esteem before treatment RecidivismSelf-esteem before treatment Recidivism
Conclusions: Treating self-esteem did not Conclusions: Treating self-esteem did not change correlation between pre-treatment self-change correlation between pre-treatment self-esteem and recidivismesteem and recidivism
(Info not available on incarcerated sample.)(Info not available on incarcerated sample.)
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Does Treatment of Self-Esteem Does Treatment of Self-Esteem Reduce Deviant ArousalReduce Deviant Arousal
Offenders with low self-esteem & deviant Offenders with low self-esteem & deviant arousalarousal
This “required the processing of a This “required the processing of a substantial number of offenders before a substantial number of offenders before a sufficient number of participants was sufficient number of participants was detected who met criteria.”detected who met criteria.”
(Marshal, 1997, p. 88)(Marshal, 1997, p. 88)
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““Our theory, then, suggests that the sexual Our theory, then, suggests that the sexual aspects of child molestation may not be aspects of child molestation may not be central to the motivational forces that drive central to the motivational forces that drive these offenders.” (Marshall, p. 87)these offenders.” (Marshall, p. 87)
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SubjectsSubjects
Female victims onlyFemale victims only
Pre-pubescentPre-pubescent
Out of homeOut of home
Only 2 had more than 3 victimsOnly 2 had more than 3 victims
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Self-esteem Reduce Deviant Self-esteem Reduce Deviant Arousal?Arousal?
Attending treatment programAttending treatment program
WithWith
Cognitive distortions, relapse prevention, Cognitive distortions, relapse prevention, self-esteem & other interventionsself-esteem & other interventions
Minus deviant arousalMinus deviant arousal
(Marshall, 1997)(Marshall, 1997)
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What Causes Recidivism?What Causes Recidivism?Low Self-esteem or HighLow Self-esteem or High
““Today, it is common to propose that low self-Today, it is common to propose that low self-esteem causes violence, but the evidence esteem causes violence, but the evidence shows plainly that this idea is false. Violent shows plainly that this idea is false. Violent acts follow from high self-esteem, not from low acts follow from high self-esteem, not from low self-esteem. This is true across a broad self-esteem. This is true across a broad spectrum of violence, from playground bullying spectrum of violence, from playground bullying to national tyranny, from domestic abuse to to national tyranny, from domestic abuse to genocide, from warfare to murder and rape. genocide, from warfare to murder and rape. Perpetrators of violence are typically people Perpetrators of violence are typically people who think very highly of themselves.who think very highly of themselves.
(Baumeister, 1997, pp. 25-26(Baumeister, 1997, pp. 25-26
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Self-Esteem & ViolenceSelf-Esteem & ViolenceBaumeister ArgumentBaumeister Argument
Contradictory ClaimsContradictory Claims
TochToch
““Self-doubts” and “a sense of inadequacy”Self-doubts” and “a sense of inadequacy”
““Exaggerated self-esteem”Exaggerated self-esteem”
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Self-Esteem & ViolenceSelf-Esteem & ViolenceBaumeister ArgumentBaumeister Argument
Higher in men than women but women < Higher in men than women but women < violenceviolence
Depressions is correlated with self-esteemDepressions is correlated with self-esteem
Depressed individuals do not commit more Depressed individuals do not commit more violenceviolence
Psychopathy correlated with violencePsychopathy correlated with violence
Grossly inflated self-esteemGrossly inflated self-esteem
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Self-Esteem & ViolenceSelf-Esteem & ViolenceBaumeister ArgumentBaumeister Argument
High self-esteem not correlated with violenceHigh self-esteem not correlated with violence
Grossly inflated and unstable self-esteemGrossly inflated and unstable self-esteem
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Stability of Self-esteemStability of Self-esteem
High but unstable self-esteem = highest level High but unstable self-esteem = highest level of self-reported angry/hostile responsesof self-reported angry/hostile responses
High but stable self-esteem = lowest ratesHigh but stable self-esteem = lowest rates
(Kernis et al., 1989)(Kernis et al., 1989)
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Grandiosity & AggressivenessGrandiosity & Aggressiveness
Grandiosity correlated with aggressivenessGrandiosity correlated with aggressiveness
(Wink, 1991)(Wink, 1991)
Dominance and hostility correlated with Dominance and hostility correlated with grandiosity and narcissismgrandiosity and narcissism
(Novacek & Hogan, 1991)(Novacek & Hogan, 1991)
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High self-esteem based on grandiosity High self-esteem based on grandiosity (not achievement)(not achievement)
Disconfirming evidenceDisconfirming evidence
= Negative reaction= Negative reaction
(Baumeister,1997) (Baumeister,1997)
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High but unstable self-esteem – most likely to High but unstable self-esteem – most likely to respond defensively to negative feedback.respond defensively to negative feedback.
(Kernis, Cornell, Sun, Berry and Harlow, 1993)(Kernis, Cornell, Sun, Berry and Harlow, 1993)
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Why Do We?Why Do We?
Despite empirical evidence – still treatDespite empirical evidence – still treat
Self-esteemSelf-esteem
Social skillsSocial skills
Offense responsibilityOffense responsibility
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Tough or Tender MindedTough or Tender MindedWilliam JamesWilliam James
Tender mindedTender minded
PrincipledPrincipled IdealisticIdealistic OptimisticOptimistic DogmaticalDogmatical
Tough MindedTough Minded
EmpiricalEmpirical PessimisticPessimistic SkepticalSkeptical
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Lost Souls or PredatorsLost Souls or Predators
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What to Treat?What to Treat?
Self-esteem?Self-esteem?Instability of self-esteem?Instability of self-esteem?Mood deterioration?Mood deterioration?Sexualizing mood deterioration?Sexualizing mood deterioration?
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What to TreatWhat to Treat
Sexual DeviancySexual Deviancy
Behavioral reconditioningBehavioral reconditioning
Minimal arousal conditioningMinimal arousal conditioning
Covert sensitizationCovert sensitization
Olfactory satiationOlfactory satiation
MedicationMedication
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What to TreatWhat to Treat
Antisocial Attitudes & BeliefsAntisocial Attitudes & Beliefs