step 3: an evaluation of the prison sex offender treatment programme

STEP 3:
AN EVALUATION OF THE PRISON
SEX OFFENDER TREATMENT PROGRAMME
A report for the Home Office
by the STEP team
Anthony Beech, Dawn Fisher and Richard Beckett
NOVEMBER 1998
STEP 3: AN EVALUATION OF THE PRISON
SEX OFFENDER TREATMENT PROGRAMME
A report for the Home Office
by the STEP team
Anthony Beech, Dawn Fisher and Richard Beckett
NOVEMBER 1998
The reproduction of this report has been undertaken by the Home Office for distribution to
Probation Services.
Additional copies can be obtained from the Home Office Information Publications Group,
Research Development Statistics Directorate, Room 201, 50 Queen Anne’s Gate,
London SW1H 9AT.
© Crown copyright 1999
First published 1999
ISBN 1 84082 190 6
The STEP (Sex Offender Treatment Evaluation Project) Group are:
Dr. Anthony Beech Senior Lecturer
(University of Birmingham) and Research Fellow (STEP team)
School of Psychology, University of Birmingham,
Edgbaston, Birmingham, B15 2TT
TEL. 0121-414-7215
FAX. 0121-414-4897
email: [email protected]
Dr. Dawn Fisher Consultant Forensic Clinical
Psychologist and Honorary Lecturer (University of Birmingham)
Department of Psychology, Llanarth Court Psychiatric Hospital,
Llanarth, Nr. Raglan, Gwent NP5 2YD
TEL. 01873-840555
FAX 01873-840591
Richard Beckett Consultant Forensic Clinical Psychologist
and Honorary Research Fellow (University of Birmingham)
Oxford Regional Forensic Service, Department of Forensic
Psychology, Fairmile Hospital, Wallingford, Oxon OX10 9HH
TEL. 01491-651281
FAX 01491-652336
CONTENTS
PAGE
ACKNOWLEDGEMENTS
4
EXECUTIVE SUMMARY
5
1. INTRODUCTION
9
1.1. DEVELOPMENT OF THE PRISON SEX OFFENDER TREATMENT PROGRAMME
1.2. COMPONENTS OF THE SEX OFFENDER TREATMENT PROGRAMME
9
10
1.3. CURRENT STATUS OF THE CORE SEX OFFENDER TREATMENT PROGRAMME
12
1.4. CLINICAL TARGETS FOR COGNITIVE-BEHAVIOURAL TREATMENT
13
1.5. TREATMENT METHODS
14
1.6. DESCRIPTION OF THE CURRENT STUDY
17
2. CENTRE DESCRIPTIONS AND TUTOR FEEDBACK
19
2.1. HMP CHANNINGS WOOD
19
2.2. HMP LITTLEHEY
23
2.3. HMP RISLEY
26
2.4. HMP USK
29
2.5. HMP WAYLAND
32
2.6. HMP WHATTON
35
2.7. TUTORS’ ATTITUDES TO THE CORE PROGRAMME
38
3. GROUP, SAMPLE, DESCRIPTION OF MEASURES AND PROCEDURE
41
3.1. DESCRIPTIONS OF GROUPS
41
3.2. GROUP COMPARISONS BY LENGTH OF TREATMENT
41
3.3. NUMBER IN SAMPLES
42
3.4. SAMPLE DESCRIPTIONS
43
3.5. MEASURES USED
44
3.6. PROCEDURE
50
4. OBSERVATIONS AND FINDINGS
53
4.1. ORGANISATIONAL ISSUES
53
4.2. ANALYSIS OF THE SCALES USED IN THE RESEARCH
54
4.3. OVERALL EFFECTIVENESS OF THERAPY
55
4.4. LENGTH OF TREATMENT AND EFFECTIVENESS OF THERAPY
58
4.5. LONG-TERM FOLLOW-UP
59
4.6. IDENTIFICATION OF ABUSER GROUPS BY DEVIANCE AND DENIAL
59
4.7. CATEGORIES OF DEVIANCE WITHIN THE PRISON SAMPLE
64
4.8. TREATMENT EFFECTIVENESS, DEVIANCY AND LENGTH OF TREATMENT
64
4.9. COMMUNITY SAMPLES COMPARED WITH THE CORE PROGRAMME
70
4.10. INVESTIGATION OF THE CLIMATE OF THE GROUPS
72
4.11. POST-RELEASE INTERVIEW OF CLIENT SAMPLE
76
4.12. PROBATION OFFICERS’ PERCEPTION OF THE PROGRAMME
79
1
5. SUMMARY OF FINDINGS
81
5.1. DESCRIPTION OF THE SAMPLE BEFORE TREATMENT
81
5.2. IMMEDIATE IMPACT OF TREATMENT
81
5.3. GROUP PROCESSES
82
5.4. MAINTENANCE OF TREATMENT GAINS
83
5.5. PRISON COMPARED TO COMMUNITY-BASED TREATMENT
83
5.6. SEXUAL OFFENDERS AGAINST ADULTS IN THE SAMPLE
85
5.7. SEXUAL OFFENDERS RETURNING TO THE COMMUNITY
85
5.8. OBSERVATIONS ABOUT TUTORS, CENTRES AND GROUPS
85
5.9. ETHNIC MINORITIES AND THE CORE PROGRAMME
88
5.10. CURRENT STATUS OF THE CORE PROGRAMME
89
6. RECOMMENDATIONS
91
REFERENCES
95
APPENDIX A: FURTHER DETAIL OF OVERALL TREATMENT EFFECTIVENESS
A.1. FACTOR ANALYSIS OF THE SCALES USED IN THE RESEARCH
101
101
A.2. OVERALL EFFECTIVENESS OF THERAPY
102
A.3. LENGTH OF THERAPY AND PRE/POST COMPARISONS
105
A.4. LONG-TERM EFFECTS OF TREATMENT
108
A.5. TREATMENT GAINS BY LENGTH OF THERAPY
111
A.6. PRISON AND COMMUNITY SAMPLES AT FOLLOW-UP
115
A.7. EFFECTS OF FOLLOW-UP SITUATION AND TREATMENT LENGTH
118
A.8. COMMUNITY FOLLOW-UP: LONG VERSUS SHORT THERAPY
119
APPENDIX B: PRE-TREATMENT ANALYSIS OF THE CHILD ABUSER SAMPLE
123
B.1. METHOD OF DERIVING MEANINGFUL GROUPS
123
B.2. RESULTS OF THE ANALYSES
125
B.3. CATEGORIES OF CHILD ABUSER BY DEVIANCE AND DENIAL
126
B.4. A QUICK METHOD OF IDENTIFYING DEVIANCY LEVEL
132
APPENDIX C: RESPONSE TO TREATMENT
135
C.1. INTRODUCTION
135
C.2. DERIVATION OF CLINICAL CUT-OFFS
135
C.3. CALCULATION OF RELIABLE CHANGE
136
C.4. CLINICALLY SIGNIFICANT CHANGES
136
APPENDIX D: GROUP ENVIRONMENT
141
D.1. BACKGROUND
141
D.2. MEASUREMENT OF GROUP PROCESSES
142
D.3. DATA ANALYSIS
142
D.4. RESULTS
143
APPENDIX E: DESCRIPTION OF THE MULTIPHASIC SEX INVENTORY (MSI)
2
153
APPENDIX F: RISK OF RECONVICTION ALGORITHM
157
APPENDIX G: BRIEF REPORT ON THE WOLVERCOTE UNIT
159
G.1. HOW MEN GET REFERRED TO THE CLINIC
159
G.2. PROFILES OF MEN ENTERING LONG-TERM TREATMENT
160
APPENDIX H: SEX OFFENDER TREATMENT PROGRAMME ACCREDITATION CRITERIA 1997-8
3
163
ACKNOWLEDGEMENTS
We would like to acknowledge the help of Ann Scott Fordham who was part of the team before she retired last
year. She gathered the observational data at HMP Risley and at HMP Wayland.
We are extremely grateful for the help and co-operation by the staff and group members of each of the
establishments participating in this study.
We would also like to thank Krissi Hartley-Morris for her help in the preparation of this manuscript, Debbie
Crisp and Rob Bailey for their help with data analysis.
Thanks are also due to the following for their support and patience: John Ditchfield, Dr. David Thornton,
Dr. Clive Hollin and Rita Palmer.
4
EXECUTIVE SUMMARY
This study was commissioned by the Home Office to evaluate the efficacy of treatment for sex offenders in
Category C prisons. The work is third part of the STEP (Sex Offender Treatment Evaluation Project) research.
The first part (reported by Barker & Morgan, 1993) outlined a framework for evaluating community-based
treatment. The second part (Beckett, Beech, Fisher & Fordham, 1994) reported an evaluation of seven
representative community treatment programmes run by, or for, the Probation Service. The STEP team is
currently investigating the impact of the Core Programme on a sample of men who have offended against
adult victims and/or are sexual murderers .
The Sex Of fender Treatment Programme (SOTP) began in 1991 as part of a national strategy for the integrated
assessment and treatment of sex offenders. It is currently run in 25 establishments.
The central part of the SOTP is the Core Programme, whose primary purpose is to increase the offender’s
m o t i vation to avoid re - o ffending and to develop the self-management skills necessary to ach i eve this.
Comprehensive assessment is also an integral part of the programme which informs decisions about the nature
of future risk of the offender. The ‘original’ version of the Core Programme consisted of 35 to 40 two-hour
sessions but was later ‘revised’ to approximately 86 sessions including additional elements such as role play.
Group-work, known to be an effective way of delivering treatment, has been central to the SOTP strategy, as by
joining a group, a sex offender publicly acknowledges his need to change. Group-work also provides a context
in which socially acceptable values are conveyed and ‘normal’ social interactions reinforced.
The treatment approach used is ‘cognitive-behavioural’ which research indicates to be particularly effective in
the treatment of child abusers.
• The ‘cognitive’ aspect invo l ves recognising the patterns of disto rted thinking which allow the
contemplation of illegal sexual acts and understanding the impact which sexually abusive behaviour has on
its victims.
• The ‘behavioural’ component of treatment involves reducing sexual arousal to inappropriate fantasies of
forced sexual activities with children and adults.
Establishments running the SOTP are subject to accreditation by an international panel of experts. The panel
assesses the quality of treatment, written outcome reports, tutor availability and management support. Prison
Governors cannot meet their Prison Service Key Performance targets unless they fulfil these accreditation
criteria.
AIMS OF THE CURRENT STUDY
The main objectives of the study were to:
•
examine the implementation of the Core Programme;
•
evaluate the clinical impact of the Core SOTP in a number of re p re s e n t a t i ve Catego r y C pri s o n
establishments by analysing the psychometric data gathered from men seen before and after treatment;
•
examine the extent to which the impact of the programme is related to treatment delivery (the ‘original’
version versus the ‘revised’ version of the programme);
•
measure how treatment change holds up over time;
• provide a framework for examining the relationship between short-term change achieved through treatment
and subsequent longer-term recidivism.
5
• make recommendations as to how programmes might improve their efficacy in the future and how this
might be achieved.
DESIGN OF THE STUDY
Six prisons were selected for study and within each prison two groups were studied in detail. Comprehensive
psychometric data were gathered from men starting groups and as there were approximately eight men pergroup this allowed for information to be gathered on 100 men prior to treatment. As most of these were child
abusers (82 men) most of the analyses in the report are on this sample.
The sample was seen again at the end of treatment to examine the impact of treatment. Five men either failed
to finish treatment or refused to be seen after the end of treatment, so complete interview and psychometric
data was available on 77 child abusers. The research was conducted at a time when there was changeover
between the original and the revised Core Programme, so some groups seen ran the original Core Programme,
some ran the revised programme. This allowed for a comparison to be made between shorter (approximately
80 hours of treatment) and longer therapy (160 hours of treatment).
A nine-month follow-up was also included as part of the research design, in which 56 men from the original
sample agreed to take part. These men were re-interviewed and further psychometric testing took place.
Roughly 40 per cent of the men had left prison by the time of this follow-up study, allowing for comparisons to
be made between those men still in prison and those that entered the community.
EFFECTIVENESS OF THERAPY
The psychometric tests administered before and after treatment were designed to measure change in four main
areas.
Denial/Admittance of deviant sexual interests and level of offending behaviours: scales here measured
the offender’s readiness to admit to sexual fantasising and manipulations of his victim(s); readiness to deny his
offending behaviours and the harm done to victims; level of deviant and non-deviant sexual drives and interests.
Pro-offending attitudes: scales here measured distorted thoughts about sexual contact with children and
their sexuality (cognitive distortions); level of denial of the impact which sexual abuse has on the offender’s
own victim (victim distortions); justifications used to excuse the offender’s sexual deviance.
Predisposing personality factors: scales here measured a number of personality dimensions which might
predispose to offending such as: low self esteem and under-assertiveness; inability to be intimate with other
people and cope with negative emotions; and failure to accept accountability for actions (in relationship to
offending and generally).
Relapse prevention skills: measuring the offender’s ability to: recognise situations where there is a risk of reoffending; generate effective strategies to get out of such potential risk situations; recognise that he is still a
potential offender even after treatment.
Significant improvements were found in nearly all of the measures used to assess level of denial/ admittance in
terms of being more honest about their offending behaviour. Similarly significant improvements were found in
terms of reduction in pro-offending attitudes and on most of the predisposing personality scales. Finally, relapse
prevention skills also showed significant improvement after treatment.
A second, more sophisticated, analysis considered to what extent the child abusers had, by the end of
treatment, a ‘treated’ profile. In order to qualify for this, an offender had to show changes across both proo ffending attitude measures and social competency/acceptance of accountability measures, which wa s
sufficient (by the end of treatment) to make him largely indistinguishable from the profile of a non-sexual
offender – an overall treatment effect. Change was also looked at just in terms of a reduction in pro-offending
attitudes – the ‘primary treatment targets’ of the Core Programme1.
1
The Core Programme does not currently specifically address ‘secondary treatment targets’ such as social competence
6
Using these rigorous criteria to judge treatment effectiveness, the study found that over two-thirds of the
sample were successfully treated with regard to a reduction in pro-offending attitudes’ with one-third of men
showing an overall treatment effect
CHILD ABUSER PROFILES
An analysis which made use of data from this and a previous study, identified four main groups of offenders
who could be distinguished in terms of their pre - t reatment levels of pro - o ffending attitudes and social
inadequacy measures (their level of ‘deviance’), and scores on the admittance/denial of offending behaviours
(their level of ‘denial’). Four groups were termed: low deviance/low denial; low deviance/high denial; high
deviance/low denial; and high deviance/high denial.
These analyses appeared to have validity in terms of offence histories, in that:
•
high deviancy men were found to have nearly three times as many victims and were twice as likely to have
been convicted of a previous sexual offence compared with low deviancy men. They were also twice as
likely to have committed offences outside of the family or a combination of offences inside and outside of
the family. In contrast, men in the low deviancy groups were nearly three times more likely to have
committed offences against daughters and/or stepdaughters within the family.
•
denial was not strongly related to patterns of offending in high or low deviancy categories.
LEVEL OF PROBLEMS AND TREATMENT CHANGE
Analyses were carried out looking at the impact of treatment on different deviancy/denial categories described
above. Because of the relatively small number of high deviancy cases in the prison sample the two high
deviancy categories are collapsed into one. It was found that in:
low deviancy/low denial men treatment was particularly effective: 59 per cent showing an overall treatment
effect; 84 per cent showing a significant reduction in pro-offending attitudes.
low deviancy/high denial men treatment was less successful: 17 per cent showing an overall treatment
effect; 71 per cent showing a significant reduction in pro-offending attitudes.
high deviancy men treatment was the least successful of these groups: 14 per cent showing an overall
treatment effect; 43 per cent showing a significant reduction in pro-offending attitudes.
LENGTH OF THERAPY AND TREATMENT CHANGE
Comparisons between the effectiveness of shorter (80 hours) and longer (160 hours) therapy found that:
• low deviancy/low denial men did equally well in both the shorter and longer groups, in terms of reductions
in pro-offending attitudes (83% in shorter groups, 86% in longer groups) and an overall treatment effect
(61% in shorter groups, 57% in longer groups).
• low deviance/high denial men did better in the longer groups in terms of reductions in pro-offending
attitudes (64% in shorter groups, 77% in longer groups) and an overall treatment effect (9% in shorter
groups, 23% in longer groups).
• high deviancy men did better in the longer groups in terms of reductions in pro-offending attitudes (27% in
shorter groups, 60% in longer groups) but did badly in terms of an overall treatment ef fect in both shorter
and longer groups (18% in shorter groups, 10% in longer groups).
The fact that men appeared to show greater change on the pro-offending attitudes (alone) rather than an overall
treatment effect (which encompasses both a reduction in pro-offending attitudes and an improvement in social
competence/acceptance of accountability) is perhaps to be expected gi ven that the Core Pro gra m m e
specifically focuses on offending and pro-offending attitudes and does not address social competence issues in
terms of behavioural skills training.
7
GROUP DYNAMICS AND RELATIONSHIP TO TREATMENT
It was found that most of the groups studied were highly cohesive and task-orientated. The leaders were
successful in encouraging high levels of disclosure by the men, whilst at the same time being perceived as
being supportive, and instilling hope in group members. These are the characteristics of successful therapeutic
groups as reported in the literature. Statistically it was also found, after adjusting for level of deviancy prior to
treatment and length of treatment, that the cohesiveness of the group was strongly related to treatment
outcome. This result suggests that members’ involvement, commitment and concern, and friendship they show
for each other are strongly related to a positive therapeutic outcome.
FOLLOW-UP STUDY
Of the 56 men agreed to be seen at the nine-month follow-up period, 32 were still in prison and 24 had been
released. Overall, the treatment changes brought about by the Core Programme were maintained. Those who
showed a significant reduction in pro-offending attitudes appeared to maintain their relapse prevention skills –
but men whose pro-offending attitudes had not changed quickly lost these skills. This suggests that failure to
recognise personal culpability for one’s offending behaviour was associated with a similar failure to recognise
one’s responsibility to avoid such offending in future. This effect was most noticeable among men who had
been released and who had been shorter in therapy (the ‘original’ Core Programme), indicating that longer
therapy may be more successful in changing attitudes and instilling effective relapse -prevention techniques.
OFFENDERS RETURNING TO THE COMMUNITY
Seventy-six percent of the men who had been released and agreed to be seen at the nine-month follow-up said
they had found the Core Programme ‘very helpful’, with a further 20 per cent saying that it had ‘helped quite a
lot’. These results are encouraging given that men who regard treatment positively are more likely to internalise
treatment messages, and maintain their motivation to remain offence-free.
Interviews with these mens’ probation officers found that 84 per cent had received written reports on their
clients who had attended the Core Programme. There was a high level of satisfaction with the quality of the
feedback given, and in the majority of cases the written reports concurred with the probation offi c e rs ’
assessment of their clients. Taken overall, these results suggest that field probation officers had a high level of
confidence and satisfaction in the quality of the Core Programme.
8
1. INTRODUCTION
1.1.
DEVELOPMENT OF THE PRISON SEX OFFENDER TREATMENT PROGRAMME
(SOTP)
The numbers of sex offenders in prisons in England and Wales has increased steadily over recent ye a rs ,
accounting for 4.7 per cent of the prison population in 1980 and 7.7 per cent in 1989 (Thornton & Hogue,
1993) – a rise of approximately 60 per cent. Alongside this increase there has also been growing public
awareness regarding the prevalence of sexual abuse. Also during the early 1990s public awareness was raised as
to the problems sex offenders routinely encountered in prisons. In 1990 there was a riot at HMP Strangeways in
Manchester, during which sex offenders were targeted by other prisoners and attacked. In 1991, the Woolfe
Report commented on the fact that sex offenders within the prison system frequently came to view themselves
as victims because of the way they were treated by other prisoners and that such an attitude drew their
attention away from what they had done, to concern for themselves. It was recommended in the report that
they should be required to confront their criminal conduct. Alongside this and against the background of
general concern about the recidivism of sex offenders once released from prison (Barker & Morgan, 1993), the
Home Secretary at the time (Kenneth Baker) announced the setting up of a major prison service treatment
programme for sex offenders.
The Sex Offender Treatment Programme (SOTP) began in 1991 as part of a new strategy for the integrated
assessment and treatment of sex offenders (Thornton, 1991; Grubin & Thornton, 1994). The programme
essentially serves three purposes: risk assessment; risk management; and risk reduction. Comprehensive
assessment is an integral part of SOTP and the information obtained enables improved decisions to be made
about its le vel and nature of risk posed by individual offenders, information of obvious value to such bodies as
parole boards and probation services. Participation in the programme ser ves both the purpose of informationgathering and aims to reduce risk, although it is acknowledged that this may not be possible with all individuals
and the extent to which risk is reduced will vary.
Mann and Thornton (in press) report that the SOTP was based on eight strategic decisions:
• Concentration The Prison Service sought to concentrate sex offenders in a limited number of prisons
where resources can be built up and expertise developed. Originally the programme was set up in 14
prisons but was subsequently expanded to include 25 prisons.
• Eligibility The SOTP is offered on a voluntary basis to all male prisoners convicted of a sexual offence or a
violent offence with a sexual element, who are serving a long enough sentence to enable them to complete
the programme. Initially the focus was on those serving sentences of at least four years but men serving
sentences of two or three years are now eligible if they have time to complete the programme. With the
advent of ‘fast-tracking’1 it has been possible to include more prisoners on shorter sentences. Offenders who
are mentally ill, or do not speak English, or have an I.Q. lower than 80, or are deemed to be a suicide risk, or
those with severe personality disorders are generally excluded as they are regarded as being unable to make
use of the SOTP as it has been designed.
• Prioritisation Where a prison has more eligible prisoners than treatment places available, priority is based
on risk of re-offending, seriousness of offences, nearness to release and likely response to treatment.
• R e s e a rc h - b a s e d Research is seen as an integral part of the SOTP. The content and structure of the
programme is subject to routine monitoring and evaluation and is revised accordingly. Since the SOTP
began, a panel of international experts has been set up who meet twice-yearly to review progress and make
recommendations based on their own research findings and clinical experience.
1
Running more sessions in a shorter period of time
9
• S t r u c t u red Group Wo r k The SOTP uses a structured group work approach augmented with some
individual work, as this method has been reported to be more effective than one-to-one working (Salter,
1988; Marshall, Hudson & Ward, 1992). A treatment team of three staff, known as ‘tutors’, work with a
group of usually eight offenders. Generally two tutors run each session and the third acts as a back-up when
needed. The group works through a series of exercises defined by a detailed treatment manual. Adherence
to the manual safeguards programme integrity.
• Cognitive-behavioural Methods The SOTP uses cognitive-behavioural procedures to address the range of
criminogenic factors considered relevant to sex offending. The cognitive-behavioural approach has generally
been found to be the most effective approach with sex offenders2 (Thornton, 1992). Losel (1993) reported
that cognitive-behavioural, skill-orientated, multi-modal programmes produced the best results and Hall
(1995), in a meta-analysis of studies, identified comprehensive cognitive-behavioural programmes as one of
the two treatment approaches (the other being hormonal treatment) that has been most effective in
reducing sexual re-offending.
• Multi-disciplinary Treatment teams are made up of a mixture of staff such as probation officers, teachers,
psychologists, chaplains and prison officers3. They are all subject to a careful selection procedure which
takes into account personality, attitude and ability to relate to and carry credibility with offenders. Potential
tutors are assessed on a range of competencies, based on research findings reported by Sacre (1995). The
range of competencies covers the following areas: understanding of cognitive-behavioural theory and
concepts; application of cognitive-behavioural techniques; warmth and empathy; impartiality; clear use of
language; flexibility of style; discussion-leading and presentation skills; team-working; agenda skills; skills for
giving feedback; questioning skills; maintenance of boundaries; tenacity; professionalism; preparation;
participation and open coping style; and openness to feedback. Having been selected on the basis of these
competencies they must then successfully complete the national training course for the SOTP, a two-week
intensive residential course. Staff are also expected to attend additional update courses on specific topics.
• Supervised Treatment teams work under the supervision of a management team which is comprised of a
Programme Manager (responsible for the availability of staff, prisoners and facilities as well as associated
p ractical issues), a Treatment Manager (re s p o n s i ble for assessment issues and for ensuring that the
p ro gramme runs pro p e r ly), and a Thro u g h c a re Manager (re s p o n s i ble for the interface between the
programme and the probation services involved with the offenders in the group). Treatment Managers may
either sit in on group sessions and offer supervision to the treatment team or view videos of the group
sessions. Video monitoring of the sessions has recently been introduced to further evaluate the programme,
prevent programme drift and ensure programme integrity.
1.2.
COMPONENTS OF THE SOTP
The SOTP is made up of four main components: the Core Programme; the Extended Programme; the Booster
Programme; and the Thinking Skills Programme.
a
The Core Programme
The original programme comprised 35 to 40 two-hour sessions but has been revised and expanded so that the
programme now comprises a total of around 864 sessions and generally provides well over 160 treatment hours.
The revised programme began implementation in late-1994.
The primary purposes of the Core Programme are to increase the offender’s motivation to avoid re-of fending
and to develop the self-management skills necessary to achieve this. Motivation is developed by undermining
the excuses and rationalisations (cognitive distortions) that offenders use to justify their offending, increasing
empathy with their victims by creating an emotional awareness of the victim’s experience of the offence, and
by examining the consequences of offending on their own lives. Self-management skills are increased by:
developing the offenders’ awareness of the behaviours, thoughts, feelings and situations that increase the
likelihood of re-offending; and teaching effective and realistic strategies to avoid or control these risk factors.
This is generally known as relapse prevention.
2
3
4
The key components of cognitive-behavioural programmes are detailed in the Clinical Targets for Cognitive-Behavioural Treatment section below.
Who are the largest group of SOTP tutors.
The Programme Development Section of Prison Service HQ recommends this figure, plus or minus ten sessions.
10
The programme is divided into 20 blocks which cover each of the target areas in detail. The key areas are:
• Minimisation Given the tendency for sex offenders to deny or minimise aspects of their offending it is
important to encourage the offender to take responsibility for his behaviour, to recognise the harm caused
to his victim and to get them to recognise that they are making excuses to justify their offending.
• Distortions The distorted thinking used by the offender to justify and excuse the offence behaviour is
identified and challenged, so that the individual can recognise and acknowledge the distortions for what
they are.
• Victim Empathy An important deficit in sex offenders is their inability to empathise with their victim(s).
Developing victim empathy is a central component of cognitive-behavioural treatment programmes, the
basic tenet being that if offenders have empathy with their victims this will have an inhibitory effect upon
their motivation to offend.
• Risk Factor Awareness Although offenders may become strongly motivated not to re-offend, this alone is
probably insufficient to prevent further offending. The individual needs to become aware of the factors such
as mood, thoughts, feelings and situations that led to previous offending.
• Coping Strategies H aving developed an awa reness of the fa c t o rs associated with re - o ffending, the
individual then needs to develop strategies that will enable him to cope effectively with these ‘risk factors’.
It is important that these strategies are developed and practised in advance so that the offender can employ
them in stressful situations where he may be most vulnerable to relapse.
• Coping Skills The effectiveness of coping strategies may rely on the various skills of the offender.
Treatment must therefore focus on developing and strengthening such skills that are relevant to the relapseprevention strategies.
• Maintenance It is recognised that maintaining treatment progress is vital and is best achieved by having
some fo rm of maintenance pro gramme once the main treatment pro gramme is completed. Furt h e r
treatment, support meetings and reviews of the relapse-prevention plan are suggested as being possible
methods of maintenance according to the needs of the offender. Following completion of the Core
Programme, individuals who remain in prison may participate in other treatment programmes and may
obtain some form of support by keeping in contact with tutors. Those serving long sentences may attend
the Booster Programme in the year prior to their release. Once in the community, maintenance depends on
whether or not they are on parole and have a suitable programme to attend.
In addition to the key treatment areas covered by the modules, the act of attending a group has an impact upon
the individual due to the effect of the group processes that occur. Groups offer a forum for support and sharing
p ro blems which may be a completely new ex p e rience for many offe n d e rs, who are ge n e ra l ly isolated
individuals, often with interpersonal deficits and feelings of inadequacy. Having the experience of being valued,
being a ble to help others, practising social skills and getting to know others in detail can greatly impr ove an
individual’s self-esteem and interpersonal functioning. Given that feelings of inadequacy and lack of appropriate
relationships may be important vulnerability factors for many sex offenders, improvement in these areas may
be significant in reducing risk of re-offending.
As the research took place in a period of changeover between the original and the revised programme, both
types of programme delivery were observed. The key differences, apart from treatment length, between the
methods of treatment delivery were as follows.
*
Victim empathy work, incorporating narratives from the victim’s point of view and role-playing were
included in the revised, but not the original, programme.
*
Relapse prevention was improved in the revised programme. The original programme involved a
functional analysis of the offence to elicit the offender’s cycle of abuse, but very little else in terms of
standard relapse-prevention work. The revised programme used the method of the cognitive-behavioural
(decision) chain rather than offence cycles, and followed this up with systematic risk identification and
planning of coping strategies using the ‘ACE’ (Avoidance, Control, Escape) model.
11
b
The Extended Programme
This was always intended for offenders who had completed the Core Programme but who still required further
work in other areas. It was originally planned to involve four modules: anger management; relationship skills;
fantasy modification; and further work on victim empathy and relapse prevention. The relationship skills
module was produced and was run by a few prisons, and other prisons have undertaken fantasy modification
with individual prisons when needed. However, more recently it was decided to convert all these modules into
one full-length treatment programme. This has now been completed but was not available during the period of
this study.
c
The Booster Programme
This is intended for individuals serving long sentences who may have already completed the Core Programme
and who will benefit from the programme being reinforced shortly before their release. It generally involves 60
hours’ treatment but varies according to the needs of the individual. Its main function is to develop a realistic
release and relapse-prevention plan.
d
The Thinking Skills Programme
This programme is designed to address repeated failures in coping with the problems of everyday life which
may be an important factor in producing the low-mood states which are frequently an important precursor to
offending. In particular it aims to improve the range of skills needed for effective problem-solving and decisionmaking (encouraging offenders to think through the consequences of their actions, to look for and consider
possible alternative strategies, and to anticipate the reaction of others), and also teaches productive ways of
coping when their attempts at problem-solving do not succeed. Completion of the programme enables
offenders to benefit more from subsequent treatment. The programme involves about 50 hours of treatment
time.
e
Other programmes
More recently the Sex Offender Programme has been adapted for offenders with learning difficulties and is
being piloted at a number of establishments. Programmes for those in complete denial and for extremely highrisk, violent offenders are also being developed.
1.3.
CURRENT STATUS OF THE CORE SOTP
The SOTP now treats approximately 600 offenders per year. Psychometric assessments are completed pre- and
post-treatment. Staff also complete behavioural checklists on group members and provide detailed reports to
the probation service when offenders are released. The data obtained also serve to promote a wide range of
research studies within the prison service.
Individual supportive counselling has been made available to all Core Programme staff to help ensure that any
adverse personal impact of the work is dealt with appropriately.
Initially there had been a certain amount of criticism of the SOTP from external agencies such as the probation
service. These were based on fears that staff were inadequately trained and that offenders would not co-operate
with further work on release as they might believe they were cured. These fears appear largely unfounded and
there is now an increasing acceptance of the programme and a willingness from external agencies to view the
SOTP positively. The setting up of a working party with the probation service to examine issues of release and
follow-up has helped a great deal.
In addition to the regular monitoring of programme effectiveness through the use of pre- and post-measures of
individual change, and the supervision of the staff delivering the programmes, accreditation of the SOTP was
introduced in 1996. An Accreditation Panel was set up to develop criteria which programmes had to meet in
order to be consistent with best practice. During 1996-97 all 25 establishments running the Core Programme
achieved accreditation (the accreditation criteria are listed in Appendix H).
12
1.4.
CLINICAL TARGETS FOR COGNITIVE-BEHAVIOURAL TREATMENT
The cognitive-behavioural approach has developed, as the name implies, from combining purely behavioural
treatment with cognitive therapy. Behavioural treatment is aimed at teaching offenders to control or modify
their deviant sexual arousal and fantasies and to develop appropriate fantasies as a substitute. Cognitive therapy
tackles the distorted thinking commonly found with sex offenders.
The following topics are generally addressed within cognitive-behavioural programmes.
• Denial and Minimisation Reduction of these is a primary target for sex offender treatment. Sex offenders
typically deny both the full extent of their sexually deviant behaviour and the risk they pose of re-offending
in the future (Nichols & Molinder, 1984). Breaking down denial is seen as an important prerequisite for
change as offenders need to admit to their deviant behaviour in order for them to take responsibility for
their offending. Without a clear understanding of what the offending behaviour involves the offender cannot
develop the skills necessary to prevent re-offending.
• Damage to Victims Sex offenders frequently demonstrate very little remorse for their behaviour and do not
appear to recognise the damage they do to their victims. They frequently blame the victims for the
offending and misinterpret the victims’ behaviour as provocative. Knopp, Freeman-Longo and Stevenson
(1992) report that 94 per cent of sex offender programmes in North America include victim empathy as a
treatment goal. It is argued that improving empathy by educating offenders as to the harmful effect of abuse
will strengthen the motivation not to offend (Salter, 1988).
• Justifications and Distorted Thinking About Offending Sex offenders typically develop a belief system
that ‘gives them permission’ to carry out their of fence(s), and justify their actions in order to minimise their
own feelings of guilt and responsibility. Over time these beliefs become deeply entrenched. Only through
treatment can offenders be made aware of their distorted patterns of thinking and be taught to recognise
and challenge them.
• Deviant Sexual Fantasies Finkelhor (1986) has suggested that the first precondition of offence behaviour
is motivation. This frequently takes the form of thoughts or fantasies about deviant activity, by which the
individual becomes sexually aroused. Treatment is aimed at teaching the offender to modify or control
deviant arousal and to develop arousal to appropriate, non-deviant fantasies as an alternative. Whilst the
presence of deviant sexual preference is known to underpin the behaviour of some sex offenders, its range
and intensity varies considerably between different types of sex offenders (Barbaree & Marshall, 1989;
Quinsey & Marshall, 1983). Sex offenders who re-offend are more likely to be those who show deviant
arousal (Rice, Quinsey & Harris, 1991).
• Relapse Prevention Based on the work of Marlatt and Gordon (1985) in the field of addictions, the
treatment aim is to get offenders to recognise situations, feelings, moods and types of thought which put
them at risk of re-offending. An ability to describe strategies to prevent relapse, along with an awareness of
risk situations and warning signs, has been shown to be correlated with a reduction in recidivism (Marques,
Day, Nelson, Miner & West, 1991; Ryan & Myoshi, 1990).
• Lifestyle and Personality Problems in being correctly assertive, low self-esteem, and the failure to develop
a capacity for intimacy in adult relationships appear to be common characteristics of sex offenders (Abel,
Mitteleman & Becker, 1985; Marshall, 1989: Pithers, Buell, Kashima, Cumming & Beal, 1987). They may
suffer from depression, anxiety and social isolation and lack the confidence and skills needed in adult, social
and intimate situations. Pithers et al report that general social skills deficits were the precursors of sex
offences in 59 per cent of child abusers and 50 per cent of rapists studied. Comprehensive cognitivebehavioural programmes address these deficits with a view to improving the offenders’ general level of
functioning in society
• Sex Education A number of offenders are likely to have poor knowledge about sex and will require sex
education. Understanding of the emotional aspects of sexual activity is also held to be beneficial in helping
offenders to function more appropriately in relationships and to improve their ability to understand the
viewpoint of their partner.
13
1.5.
TREATMENT METHODS
The following section briefly illustrates some of the interventions in therapy (see Beckett, 1994, for further
details). Such work is generally applied in a group setting as this is regarded as the most effective forum (Barker
& Beech, 1993).
Group techniques
A number of techniques are commonly used across different aspects of the programme.
Group discussion and brainstorming
The group is given topics to discuss and ideas to brainstorm which are usually written down on flip-charts by
the group leaders. The offenders are then asked to comment on how the ideas they have elicited as a group
relate to the individual.
Working in smaller groups
The offenders are given exercises or discussions to do in pairs or small groups which are then fed back to the
group as a whole. Working in smaller numbers helps to promote social skills, empathy and assertiveness.
Role-play exercises
The group leaders may role-play a situation which the group then comment upon or they themselves will do
the role-play and then reflect on their experiences and ideas about it.
Group focuses on an individual
One group member is chosen or volunteers to do a piece of work which is commented upon and perhaps
challenged by the rest of the group. This is known as the ‘hot seat’.
Use of videos and written materials by victims of abuse
The group is shown videos about aspects of sexual offending, such as victims talking about their feelings, or are
required to read material written by victims. They then discuss their ideas about the material.
Homework assignments
Group members are required to undertake some work on their offending between group sessions. This is
usually written work, such as keeping a diary. Homework can save time in the group session and also serves to
keep the offender working on his problems when not in the group.
Components of treatment
Some details about how the different aspects of cognitive-behavioural treatment are generally delivered are
given below.
Describing the offence
During the early stage of group treatment the offender is asked to describe, in detail, the events leading up to the
first assault in an offending episode in order to obtain a clear picture of what has occurred. This description
determines the form future work with him will take. Eliciting the account of the behaviour is frequently achieved
using an approach known as ‘A-B-C’ (Antecedents, Behaviours, Consequences) work. This involves the offender
giving a detailed account of the offence behaviour and the accompanying antecedents and consequences. Having
to describe offences in such detail helps the offender to acknowledge their responsibility for the offence and the
fact that it was unlikely to be a spontaneous event. This account can also be used to help offenders to understand
the pattern of their offending behaviour. Looking at offence behaviour in such a detailed way helps offenders to
14
recognise the accompanying thoughts and feelings which have been factors in leading to the offending.
Awareness of the precursors of offending is used later in the development of a relapse- prevention plan.
The Core Programme has revised the way in which detailed accounts are given by the offender regarding the
offence. Fo rm e r ly, a slightly more sophisticated version of an A-B-C account (a functional analysis) was
undertaken and later in the programme this was developed into a cycle of offending. In the revised version, the
A-B-C account was undertaken in the same way, but the cycle blocks were replaced within the decision chain
method modelled on the SOTP notion of the cognitive-behavioural chain. The A-B-C sessions (Block 5 of both
versions of the Core Programme) are colloquially known by the tutors as the ‘Active Account’; this is because
the offender is required to describe himself as having an active rather than a passive role in his offence(s),
thereby encouraging him to take responsibility for his behaviour. Offenders are required to develop a detailed
account of their offending by examining five different stages of their offence: the long-term antecedents;
immediate antecedents; the offence behaviour; immediate consequence;, long-term consequences. For each of
these stages the offender provides information on his behaviour, attitudes, relationships, emotions, physical
state, cognitions and sexual interests.
Eliciting the account of the offence is generally done by focusing on one individual at a time, a procedure known
as ‘hot seating’. The group leaders and other group members ask questions and may challenge the account in
order to obtain an accurate picture. The main objectives of this exercise are to enable the offender to admit he
has planned the offences, become sexually or emotionally preoccupied with the victim, that he is responsible for
the abuse, and for preventing the victim from disclosing. From this, future risk situations can be identified.
Challenging distorted thinking
In treatment, a range of techniques is used to reduce justifications and challenge distorted thinking. The client
is educated as to the relationship between his distorted thinking and his offending behaviour and asked to
provide evidence to support his distorted thinking. Offenders are encouraged to identify and challenge each
other’s distorted beliefs and to acknowledge how such beliefs are based upon underlying deviant sexual desires.
Child abusers are made to see how they misinterpret children's behaviour according to how the offender would
like them to be, i.e. sexually sophisticated and interested in (and not harmed by) sexual contact. Rapists are
challenged to re-evaluate their beliefs that, for example, a man has a right to sex if a woman accepts him paying
for her meal or invites him back to her flat. The process of challenging distorted thinking is often protracted as
offenders frequently have many distortions and justifications for their offending behaviour. For rapists and
exhibitionists who portray women as sexually provocative (i.e. saying 'no' when they mean 'yes') and who see
women as objects for their sexual gratification, such views are examined, not only on an individual basis, but
also on how they are reflected and maintained by the broader cultural milieu.
Understanding the harm done to victims – ‘victim empathy’ work
During treatment, offenders are shown video tapes of victims describing their abuse and the impact it had upon
them. They are further educated about the short- and long-term impact of sexual abuse by, for example, having
reading material provided and by having outside speakers describe the problems victims experience as a result
of abuse. Since many sex offenders have themselves been sexually abused, focusing upon offenders’ own
victimisation can be a powerful way of examining the confusion and distress victims feel, why they were
vulnerable to abuse, and why they had difficulty in disclosing what had happened to them. Offenders can also
be asked to write 'Victim Apology Letters'. These letters are usually written as homework assignments and are
not sent to the victim but discussed during group treatment. In these, offenders usually apologise to their
victims, accept responsibility for what they have done, express approval that the victim disclosed and explain
the sort of treatment they are cur rently receiving. In some treatment programmes offenders undertake role-play
exercises where they take the role of their own victim and describe to the group what was done during the
course of the offences (Pithers, 1994).
The victim empathy component of the revised programme has been expanded and progresses from using
written and video accounts through to the use of role-play. Tutors attend additional courses to learn how to run
the role-play sessions which aim to help the offender understand the short and long-term consequences of his
offending for his victims, and which culminate in the offender taking the part of his own victim in a role-play of
his own offence.
15
Fantasy modification
A significant proportion of child abusers have sexual preferences for children which are strengthened by
masturbating. Some rapists are also sexually aroused by thoughts of coercive and violent sex (Barbaree &
Marshall, 1991). During treatment the offender is helped to refocus sexual fantasies, and hence sexual arousal,
on to non-deviant sexual thoughts. These fantasy modification techniques include: masturbatory reconditioning
(i.e. altering sexual arousal from deviant to more appropriate fantasies by timing the appropriate fantasy to
coincide with the re i n fo rcement of orgasm); ave rs i ve thera py (presenting the deviant images with an
unpleasant event, e.g. a noxious smell); and covert sensitisation (the whole sequence of behaviours leading to
offending is coupled with the negative consequence of the behaviour in order to lessen the attractiveness of the
offence).
Fantasy modification is usually carried out on an individual basis and where this is not possible, group
programmes usually limit their efforts to educating offenders as to the relationship between masturbating to
deviant sexual thoughts and how this maintains sexual interest in children or rape. While this raises offenders’
awareness of the role of fantasy, education alone is unlikely to have any significant effect.
The Core Programme does not include a specific element on fantasy-modification, although the importance of
deviant fantasy is frequently highlighted. Offenders expressing difficulties with such fantasies may be offered
individual sessions as part of the extended programme.
Social skills, assertiveness and anger control
Men who sexually abuse children often have social difficulties, such as social anxiety and avoidance, underassertiveness, problems in making conversation and difficulties in making and sustaining personal relationships
with adults (Fisher & Howells, 1993). Men who rape adult women often have problems controlling their anger
and difficulties in interpersonal relationships (Knight & Prentky, 1990). In cognitive behavioural, therapy
o ffe n d e rs are taught more effe c t i ve social skills by identifying and examining these pro blems thro u g h
discussion and written work. Once identified, the problems are analysed both in terms of the behavioural skills
necessary (e.g. saying the right thing and using the correct body language) and in terms of the mental processes
(cognitions) which guide the overt behaviours (e.g. poor social problem-solving or misperception of social
cues). New skills and thinking are rehearsed in role-play situations, the offender being given feedback from
therapists and group members. The offender is encouraged to practice outside of treatment and report on his
p ro gress during subsequent sessions. The SOTP offers work in ‘life skills’ only as part of the Extended
Programme.
Relapse-prevention work
The overall goal of treatment is to reduce the likelihood of further sexual offences through teaching offenders
how to recognise, avoid and cope with situations in the future which could lead to further sexual assaults. All
such interventions are combined together into an 'individualised relapse-prevention plan'. Such a plan involves
the client recognising early warning signs of relapse, for example, the return of deviant fantasies, excuses and
distorted thinking. Analyses of previous offences and underlying sexual preoccupations help identify the
characteristics of potentially vulnerable children or women and situations which might lead to risk in the
future. For child abusers, certain situations, such as baby-sitting, are typically proscribed and the client
rehearses, preferably through role-play, how he might avoid these situations in the future (Beckett, 1994). He is
also taught how to cope with situations which he cannot avoid but might lead to risk, e.g. seeing an 'attractive'
child while out shopping. Where child abusers are returning to families 'partner alert checklists' may be drawn
up which specify proscribed behaviours and alert them to signs which might indicate to a non-abusing partner
that they are at risk of re-offending. Pithers (1990) has suggested that this is a critical component of relapse
prevention.
Once discharged from active treatment, comprehensive treatment programmes provide maintenance or
'booster' sessions to reinforce treatment gains over the longer term. During such sessions relapse-prevention
plans are used as a basis for questioning the client about possible risk situations and ch a n ges in life
circumstances. Support, encouragement and guidance are given as appropriate.
16
The revised Core Programme has greatly expanded the relapse-prevention component of the programme and it
now accounts for almost half of the sessions. Each offender is required to develop a detailed relapse-prevention
plan and to produce a detailed ‘decision chain’ which highlights each of the decision points that led to their
offending. They then try to find alternatives for each of these points. This enables offenders to see that there are
alternatives to offending and increases their awareness of the particular risk factors that are pertinent to them.
Ideally, once released from prison, relapse-prevention plans should be reviewed by the offenders’ probation
officers.
1.6.
DESCRIPTION OF THE CURRENT STUDY
The STEP (Sex Offender Treatment Evaluation Project) study was commissioned by the Home Office to evaluate
the treatment efficacy of a sample of Core Programmes being run in Category C prisons. Six prisons were
selected for study with two programmes studied in each prison.
In order to achieve these aims detailed demographic information was collected on each offender. Treatment
effect was measured by using a range of tests related to variables known to contribute to sex offending. These
tests were administered before and after treatment and, on average, some nine months after they had finished.
Objectives
The objectives of the study were to:
• examine the implementation of the programme;
• evaluate the clinical impact of the Core Programme in a number of representative Category C prison
establishments by collecting psychometric data from a cohort of men seen before and after treatment;
• examine the extent to which the impact of the Core Programme was related to treatment delivery (original
versus revised);
• measure how treatment change due to the Core Programme held up over a nine-month follow-up period;
• examine the relationship between the short - t e rm clinical ch a n ge ach i eved through treatment and
subsequent longer-term recidivism;
• make recommendations as to how programmes might be improved;
• examine how the Core Programme was perceived by probation officers responsible for mens’ throughcare
after they left prison;
• collect information about the impact of the Core Programme on tutors.
In order to achieve these goals the STEP team employed the following procedures.
Client sample
All of fenders participating in the study were given a structured personal history interview which asked about
their developmental experiences, including their history of physical and sexual abuse and their pattern of social
and sexual relationships. Known criminal histories also provided statistical predictions of risk of further sexual
c o nvictions using the Thornton Risk Algo rithm (Fisher & Thornton, 1993; Thornton & Trave rs, 1991).
Offenders’ personality, use of alcohol and level of intellectual functioning were also assessed.
Measuring treatment change
Before treatment all offenders were interviewed in depth about their personal history and given a battery of
standardised psychological tests. These tests covered the problem areas typically exhibited by sex offenders,
such as their patterns of denial and minimisation, their deficits in victim empathy, their pattern of distorted
17
thinking, and their appreciation of how to avoid or cope effectively with situations that could lead to further
sexual offences. In addition to the offence-specific measures they were also given a range of tests to measure
personality problems. These included level of self-esteem, emotional loneliness, locus of control, capacity for
general empathy and assertiveness. Offenders were retested on these measures after completion of treatment to
determine the extent to which these problems had been resolved, and again after a nine-month period to
examine the extent to which treatment changes were maintained following completion of treatment.
Characteristics of treatment groups
Although the groups seen were following the procedures as detailed by the Programme Manual, it was
anticipated that they might vary according to the way the programme was delivered. In a study of community
sex offender treatment, Beech and Fordham (1997) reported that the most successful groups were those where
the therapists were perceived as being warm and supportive, and in control without being over-directive. In the
present study the attitudes and experience of the staff running the programme were assessed by interviews
with the staff, obser vation and completion of questionnaires designed to evaluate the ‘therapeutic climate’ of
each group. Staff at the different establishments also completed a questionnaire regarding how they felt they
had been affected by the work and their attitudes towards the programme in general. This information was
combined to provide descriptions of the programme and recommendations on how the centres might improve
their effectiveness.
Offenders after release from prison
For many prisoners, returning to the community presents significant challenges of social adjustment, and
acceptance. To examine this issue, all offenders discharged into the community were given a standard interview
to determine their living circumstances, and their level of social and probation support. Further questions were
concerned with their attitudes to the programme, whether they had received further treatment, whether they
had told others about their offending and their confidence in remaining offence-free in the future.
Probation Officers’ perception of the Core Programme
Probation officers responsible for supervising men discharged from the programme were asked about their
level of experience of working with sexual offenders and the extent to which they saw their clients as having
benefited from the treatment programme. Further questions were asked about the quality of liaison that had
taken place between themselves and the programme, and the adequacy of the treatment summaries they had
received when their clients had been discharged from prison. Probation officers were asked whether their own
assessment concurred with that of the Core Programme tutors – differences in this regard having the potential
to undermine confidence in the programme.
18
2. CENTRE DESCRIPTIONS AND TUTOR FEEDBACK
2.1. HMP CHANNINGS WOOD
Introduction
Two groups were observed at HMP Channings Wood. Both groups were run according to the revised version of
the Core Programme. The first group was observed over the course of three days and the second over the
course of four days. Sessions obser ved included introductory, brief of fender accounts, active accounts (detailed
analysis of offence chains), victim empathy, and recognising individual risk factors. In addition, pre-group
planning meetings, post-group debriefing sessions, and a meeting attended by tutors and the Treatment and
Programme Manager were also observed. Individual interviews were also undertaken with all the Treatment and
Programme Managers and with all the programme tutors.
The first group ran two days a week, for a total of 80 sessions. The active accounts were particularly extended
in this programme with each inmate working for six to eight hours on this module. Although the group began
with a female tutor, she only attended twice and, in practice, the group was run by one male probation officer
and one male prison officer. The second group observed had three male tutors: two prison officers and one
probation officer. This group ran for two days a week over a six-month period (98 sessions).
During the period of observation a lack of available trained tutors restricted the number of treatment groups
that could be run1. At the beginning of the assessment period four probation officers, one chaplain, four senior
officers and nine main grade prison officers had been trained, mostly to deliver the original Core Programme.
Of these 18 tutors, only three main grade officers and two probation officers were available to run groups. Of
the remainder, the majority had only run one group and had subsequently withdrawn or been transfer red from
the prison. The shortage of female tutors was particularly acute, and in the second group observed no female
tutor had been available to participate.
Observations
The team found universal commitment and enthusiasm from the Core Programme tutors. There were many
accounts of tutors coming in on their day off and extending their working hours in order to ensure their
availability for the groups. Moreover, their commitment extended beyond the running of the groups, to
ensuring they were readily available to speak to the men and offer individual support and counselling to help
them work through issues which had been raised during the course of the groups. Although it is difficult to
quantify this area of their work, it is probable that this level of commitment and sensitivity to the men’s needs
contributed to the very low drop-out rate from the treatment groups. This ‘out-of-group’ support may have also
helped ensure the low level of overt psychiatric problems in the men participating in these often powerful, and
potentially emotionally disturbing treatment groups.
The first group obser ved was straight forward and business like, and achieved a high level of disclosure. The
‘contracting exercise’ set the tone for a high level of participation by the men. Group members who felt
unclear about the material felt sufficiently confident to ask questions when they did not understand it. The
Governor in charge of the treatment programmes (Governor Grade 5) attended part of the initial session, a
gesture which conferred status and value to the group, and which was appreciated by both tutors and men
alike. Even by the end of the first two sessions the group had started to develop a sense of cohesiveness which
grew stronger as the programme progressed. By the time the active account sessions were observed, the group
was very cohesive2, and there was a generally high level of participation. Some group members took notes to
help prepare themselves for their own ‘active account’ exercises. During the course of this exercise the inmate
concerned talked about how he had ‘enjoyed’ his own abuse as a child. This was noted by the tutors who
discussed during their coffee break how this issue might be addressed. The issue of some perpetrators
1
2
Although there was a considerable backlog of motivated and eligible inmates to attend the treatment groups
This cohesiveness is reflected by the findings of the Group Environment Scale (Appendix D) for this group, where it was found to have one of the best profiles of
all the groups in the current study
19
‘enjoying’ their own abuse is not uncommon, particularly in more fixated child abusers. However, it is unclear
how much attention is given to this issue during tutor training and it is recommended that Treatment Managers
discuss therapeutic strategies to deal with this issue in order to assist tutors when such themes arise.
The ‘active account’ sessions also highlighted the extent to which the men had a history of sexually fantasising
about their victims. Although the role of fantasies was acknowledged by tutors and men as an important aspect
of their offending, there were not the resources available to undertake individual fantasy modification with
those who needed it. As a consequence it was questionable whether the men, when constructing their relapseprevention plans, had sufficient strategies available to deal with ‘illegal’ sexual fantasies should they re-emerge.
The tutors had only recently received training in victim empathy role-play and did not have the confidence, nor
the level of supervision backup, required to fully carry out all the role-play enactments of this module.
Nonetheless, the role-plays that were undertaken (what the victim would say to their abuser) and watching the
video recordings of victims did have a powerful effect on the men who attended.
Sessions on developing coping strategies produced some problems for the tutors. In particular, their relative
lack of experience in cognitive therapy and poor Treatment Manager availability meant that they did not have a
good grasp of the range of coping strategies that could be used and, therefore, became too restricted to the
training manual. More tutor notes on cognitive coping and self-reinforcing strategies would help tutors to
become more sophisticated in delivering this part of the treatment programme.
The second treatment group was also characterised by a high level of tutor commitment and enthusiasm.
During the ‘active accounts’ sessions the leaders created an attentive and supportive therapeutic environment,
and conducted a highly detailed analysis of the offender’s offence chain and confronted him appropriately
when distortions of his account emerged. Group leaders also made excellent use of spontaneous role-plays to
clarify details of the inmate’s account of his behaviour. As the group evolved, it became somewhat characterised
by ‘macho bonhomie’. In the event this group culture prevented one of the group members, a homosexual,
working effectively on his difficulties. As the group went on he became increasingly resistant to treatment,
perceiving the group as homophobic.
As in the first group (and for similar reasons) not all the victim empathy component of the programme was
completed. Moreover, with the resistant homosexual client the tutors took a high-risk strategy by blindfolding
him during a role-play enactment. Although in the event this strategy appeared to have moved the man on
therapeutically, there was a danger that the approach might have left him feeling even more alienated from the
group. By the time of the relapse-prevention module the group was sophisticated in its understanding of risk
and risk factors. The inmates were conversant in the language of ‘seemingly irrelevant decisions’, and tutors
fluently wove together different aspects of the material previously covered into coherent relapse-prevention
plans. Tutors did however, as in Group 1, have some difficulty in using the cognitive coping strategy notes
provided in the manual. There also remained a continuing problem of sexist attitudes within the group.
Staff comments
Training
All the staff were complimentary and enthusiastic about the training received. Concern was ex p re s s e d ,
however, about the number of tutors that had been trained and who had not subsequently taken part in a
group, or who had dropped out after having run only one group. Further concern was expressed about trained
tutors moving up through the management system, and thus no longer being available to tutor, though it was
recognised that in the longer term the Prison Service in general would benefit from as many staff as possible
being familiar with the content of the treatment programme. Although the training was generally well-received,
several tutors commented on the advantage of refresher courses. Some of the more experienced tutors believed
that insufficient time had been gi ven during training to the ex p l o ration of sexual fantasies, and their
modification. Comments were also made regarding the lack of guidance over the content of ‘victim empathy’
letters, and the need for more detailed guidance about the effect of sexual abuse on its victims. These requests
h ave subsequently been addressed by the Pro gramme Development Section at Prison Service HQ. The
introduction of victim empathy role plays into the revised programme was welcomed by all staff, though
viewed with some trepidation by the less-experienced tutors. Several tutors thought that the revised Core
Programme Manual should contain more details of the victim empathy role-plays, how to structure them, and
20
notes on the key techniques used. There was general agreement that it was important to be involved early on in
the running of a treatment group. If this did not occur there was concern that confidence and motivation to
become involved in the programme might be lost. Finally, some tutors expressed the view that not enough
emphasis was given during training on the potential emotional impact of the work on tutors. These comments
were made against the background of one tutor having been emotionally traumatised during the course of one
of the groups observed.
Management and organisation
Substantial changes took place in both the organisation of the prison and the level of management support
provided to the tutors during the period of the evaluation. During 1994, when the first group was observed,
there were general criticisms of the level of management knowledge and support for the programme. Central
detailing had re c e n t ly been introduced and tutors ex p ressed concern over how this might reduce the
availability of staff to run the programme. In practice, there were indeed problems of prison officer tutor
availability for this group and as a result the other (probation officer) tutor ran a number of groups alone. The
Programme Manager was regarded by the tutors as sympathetic to the programme but lacking in detailed
knowledge of its emotional impact on tutors, and the amount of time required for planning and debriefing. The
Governor (with overall responsibility for the Vulnerable Prisoner Unit) was perceived as having insufficient
knowledge of the Core Programme, and being ambivalent towards it. The Governor Five had, as previously
mentioned, sat in on some of the groups, an initiative which was well-received by tutors.
By the time the second group was observed substantial changes were taking place in management support for
the programme. The Programme Mana ger was now attending three-monthly meetings at Prison Headquarters
and had started to convene monthly (sometimes fortnightly) tutor meetings, which were also attended by the
Treatment Manager. He was now perceived as supportive and protective of the programme, although there
remained concerns about the amount of time allocated to planning and debriefing. At interview the Programme
Manager was found to be very aware of tutor needs, the need to ensure all staff on the Vulnerable Prisoner Unit
were supportive of the programme, the problem of engaging rapists in treatment, and the issue of how to
maintain treatment gains in prisoners who had attended the Core Programme but still had substantial portions
of their sentence to serve. The Governor in charge of treatment programmes and the Governor with overall
responsibility for the Vulnerable Prisoner Unit and Governor One were also perceived as supportive and
protective of the programme. The problems of lack of available trained tutors and a full-time Treatment
Manager, however, still remained. At the end of the obser vation period, new ring-fenced money had been made
available for the appointment of a new full-time tutor and a full-time Treatment Manager.
Resources and facilities
All staff were generally satisfied with the resources and facilities provided. The treatment room was of a good
size, bright and well furnished. There was a plentiful supply of pens, paper and flip charts, and the automated
dry-wipe board which prints the notes recorded was especially welcomed as an efficient and labour-saving
device. Coffee and tea-making facilities were close by the treatment room, which meant that the men did not
have to leave the general therapeutic area during their breaks. Whilst the therapy room was away from the
wing, it suffered from lack of sound-proofing. Although the inmates were unaware of this, and although they
could not be overheard by other prisoners, it did result in some distraction for staff working adjacent to the
treatment room. The video-tape recordings used for the victim empathy work were of poor quality and had
degraded as a result of repeated copying. This could be improved by the Programme Development Section of
the Prison Service providing good quality copies of video material. Tu t o r s had collected, and used
appropriately, additional video material taped from television programmes or gathered from other treatment
programmes to supplement the videos supplied with the Core Programme Manual. It might be useful for the
Programme Development Section to survey the range of video material currently available, and to ask tutors to
recommend additional material that they may have come across during the course of their work.
Support and supervision
D u ring the period of observation both treatment groups suffe red from the lack of ava i l ability of the
psychologist who acted as Treatment Manager. The psychologist’s time was split between Channings Wood and
HMP Dartmoor and he had only one day a week to provide support and supervision for the tutors. Towards the
21
end of the study period plans were in hand to appoint a full-time psychologist to Channings Wood, an
innovation very much welcomed by the tutors. The availability of a full-time Treatment Manager might have
helped ensure that the victim empathy role-plays which tutors had recently learnt were put fully into practice.
In the event the lack of availability of the Treatment Manager meant that the tutors were not sufficiently
confident to embark on all the victim role-play exercises.
With regard to supportive counselling for tutors, now established as part of the basic structure of the Core
Programme, this had also not been introduced during the time the first period group was running. Tutors
generally were in favour of this forthcoming innovation because of the potential personal impact the treatment
programme could have upon them. In practice tutors gave each other considerable mutual support, and no
tutor reported adverse personal consequences as a result of running the first programme observed.
The effect of not having a readily available Treatment Manager was particularly evident in the second treatment
programme observed. Closer Treatment Manager supervision may have helped ensure that the victim empathy
module was carried out according to the Treatment Manual and that the homosexual offender could have
been more effectively worked with. Lack of sufficient supervision and Treatment Manager support, particularly
in the victim empathy role-plays, and subsequent debriefing, resulted in adverse psychological consequences
for one of the tutors. This was exacerbated by the lack of external counselling for tutors, which has now been
introduced. Although video-tape recording of the sessions had been introduced during the course of the second
treatment group and the Treatment Manager made every effort to review as many of the tapes as possible, the
time pressures placed upon him meant that full advantage could not be taken of the video tapes for supervisory
purposes. Both the first and the second groups observed ran considerably over the allocated 160 hours. On the
one hand the STEP team felt this time was well-utilised given the depth of work inmates achieved during the
extended ‘active account’ sessions. It might have been, however, that closer supervision would have helped the
tutors reduce this time whilst not sacrificing the depth of therapeutic work achieved.
Effectiveness of the programme
All tutors appeared to have a realistic attitude towards the programme, and made clear distinctions between
group members who had made different degrees of therapeutic change. They recognised that some inmates
would remain at high risk in the longe r - t e rm, and saw the pro gramme as but one, albeit substantial,
intervention which needed to be seen in the context of a general management plan for inmates extending
beyond prison into the community. They perceived the programme as well-designed and well-received by the
men who participated in it. There was considerable enthusiasm for greater training, particularly given that at
the time of these observations, victim empathy training was limited. There was also some concern that the
programme appeared to ‘peter out’ towards the end, and that more attention needed to be paid to enlivening
the later modules to help maintain the men’s concentration, and enthusiasm. More generally, tutors felt that
there needed to be a continued drive to increase the institutions’ support and sensitivity to the programme, and
to increase the number of trained tutors available to prevent staff burn-out. The mixing of child abusers and
rapists within the programme was not seen as problematic, although there was concern that insufficient rapists
would become engaged in treatment. It was suggested that more written material and conceivably a video-tape
be prepared and be made available to new inmates, introducing them to the Core Programme, as this might
increase the number of rapists willing to participate.
Conclusions
The team found universal commitment and enthusiasm from the tutors, who were all complimentary and
enthusiastic about the training received. In the first programme observed the tutors had only recently received
victim empathy role-play training and did not feel they had the confidence, nor the level of supervision, to carry
out all the role-play enactments of this module. For similar reasons, not all role-play enactments were carried
out in the second treatment group observed. Channings Wood suffered from the lack of full-time availability of
the Treatment Mana ger, whose time was split between Channings Wood and HMP Dartmoor. However, at the
time, plans we re in hand to appoint a full-time psych o l o gi s t / Treatment Manage r. During the period of
observation, substantial changes took place in both the organisation of the prison and the level of management
and support provided to the Core Programme tutors. During the first group observed, there was general
criticism of the level of management knowledge and support for the programme, and the introduction of
central detailing reduced the availability of tutors to run the programme. By the time the second group was
22
observed substantial changes were taking place. The Programme Manager was starting to convene regular tutor
meetings where he and other prison governors were perceived as supportive, protective and knowledgeable
about the treatment programme. There remained, however, a continuing problem of lack of female tutors.
2.2. HMP LITTLEHEY
Introduction
Two groups were observed at HMP Littlehey. The first group was observed during 1994-95 and the second
group (which suffered very considerable disruption) was observed during 1995-96. The first group was
observed on four occasions and the second on three occasions. Across the two programmes a variety of
sessions were observed, these were: A-B-C (Antecedents, Behaviours, Consequences) work, active accounts
(detailed analysis of offence chains), victim awareness, offence cycle and victim role-play. In addition to
interviews with group leaders, the Programme Manager, Governor Five and Wing Manager (who left during the
period of the study) were also interviewed.
The first treatment group employed the original version of the Core Programme with an enhanced victim
empathy module. In particular, they extended the time given over to the A-B-C work. Sessions were run twice
weekly and a total of 45 sessions were held in all. There were three group tutors, two male prison officers and a
female probation officer. Eight men attended the group, of whom seven were child abusers and the other an
adult rapist. Two of the eight men originally selected for this group did not complete it. One was removed after
twelve weeks for breaking confidentiality; he had also apparently failed at HMP Grendon Underwood for similar
reasons. The second individual was removed from prison after approximately twelve weeks of attending the
group. He was removed to maintain his safety after he had come into conflict with other prisoners on a matter
unrelated to his group attendance. The remaining six men attended on a regular basis.
The second group was led by a male and female probation officer and a male prison officer. During the course of
the group the female probation officer left to go on maternity leave and her place was taken by another
experienced female tutor. One of the male tutors was also replaced. The group consisted of six child abusers and
two rapists, who all completed the group. The group was run according to the revised Manual but suffered
considerable disruption, primarily because of the introduction of central detailing, but also because of the
introduction of mandatory drug tests and staff shortages, all of which diverted allocated tutors from running the
group. These disruptions also interrupted planned observation visits by the team and, as a consequence,
observations were not as thorough as had been originally planned. However, the group members were attentive and
supportive to other members in the sessions observed, which attested to the high level of commitment the tutors
had engendered in the men. Fifty-four sessions were run in total, but the whole group took over a year to complete.
As the recommended length of the revised programme is 86 sessions the full revised programme was not delivered3.
There was a lack of an on-site Treatment Manager support for both groups during the period of study. During
the fi rst group the psych o l o gi s t / Treatment Manager allocated to the pro gramme, although pers o n a l ly
committed, was based 60 miles away at HMP Whitemoor. Tutors felt that this made her insufficiently available
to give advice and, if necessary, to provide specialist intervention if needed. During the second group, a
Governor Five acted as the Treatment Mana ger as a full-time psychologist had still not been appointed to the
programme.
Observations
The team was highly impressed with the competence and skills of the tutors, particularly the tutors who had
experience of running previous groups. These tutors impressed with their sensitivity, their concern for the
men, and the amount of time they put in outside the groups themselves to provide additional support and
counselling when required. The language used by the tutors was clear, appropriate, free from jargon and sexist
l a n g u age, and when more technical terms we re used, e.g. ‘cognitive distortions’, ‘seemingly irre l eva n t
decisions’, etc., these were clearly explained and integrated into the group dialogue.
3
Because of the number of sessions this group’s data are included with the five other original core groups looked at in this study.
23
The contracting session in the first programme was well done, and the tutors worked hard to ensure that all
men participated in drawing up comprehensive and well-considered contracts. Another exercise, which invited
men to consider whether rape or child abuse was worse, also worked well, and the men finished the group by
expressing relief at being able to talk about their offences. This was particularly the case for men not on A
Wing4 (the wing which housed most sex offenders).
The A-B-C (active account) session of the first group worked on a rapist’s account of his own offence. Prior to
this session he had disclosed his own abuse and also previously unknown offences. As a result he had become
distressed and the tutors expressed concern that he might have general difficulty coping. The tutors believed
this man might have benefited from more specialised help than they themselves could provide, although he
appeared to be coping well. In total, five sessions were given over to eliciting this man’s active account, as
opposed to the two sessions allotted in the Treatment Manual. The lead tutor demonstrated considerable skills
at helping the man and remained supportive and enabling throughout, and at the end of the session the client
expressed his appreciation. The other male and female tutors were not very active and missed opportunities to
draw out comments from the less-engaged group members. Opportunities were also missed to connect material
arising from the active account with Fi n ke l h o r ’s model of offending (1984) which had been previously
examined in the group.
Work on the active accounts observed in the second group was also of a high standard. The most experienced
tutor demonstrated considerable skill in working with a highly resistant client, whilst the other group leader s
complemented this leadership by encouraging other group members to selectively question and challenge the
minimising and distorted accounts of the inmate’s offence.
In the first group, the tutors had had only one day’s training in victim empathy role-play and did not feel
equipped to introduce this into therapy. The victim empathy tape used in the sessions was of poor quality and
the content was not particularly good. Some of the issues raised during the discussion of the video tape were not
explored to their full potential; for example, opportunities were missed to discuss why victims might wait a long
time before disclosing, and why some victims returned repeatedly to their abuser or appeared to become
sexually aroused during the course of their abuse. In the second group, victims’ statements were not available for
four of the men despite considerable efforts to obtain them. In one case a Probation Service had refused on nine
occasions to release the relevant papers, and in another case a solicitor had attempted to charge £50 for the work
involved in obtaining the depositions. The victim empathy role-play observed in the second group was powerful
and extremely well-facilitated by the female prison officer tutor. In addition to the standard Core Programme roleplay enactment methods, this tutor had introduced a large soft-bodied doll to the group. This was used to very
good effect to help group members demonstrate which parts of the victim they had touched during their
assaults. This tutor had also introduced a short exercise designed to illustrate the emotional impact sexual abuse
has upon victims. This worked very well, and could usefully be considered for inclusion in all tutor-training.
The extent to which group members were helped to develop fantasy modification techniques was of concern
to both group members and tutors. Some group members had long standing histories of deviant fantasy, and it
is unlikely that the group discussions themselves, and the limited advice given, would be sufficient to equip the
men to deal with this problem over the longer term. Detailed analysis and modification of sexual fantasies
requires individual work and is most commonly undertaken by psychologists experienced in this area. The lack
of a psychologist at the prison prevented this work being undertaken.
Staff comments
Training
Staff were generally very positive about the training they had received. Two of the tutors on the first group felt,
however, that insufficient written material had been provided for some sections of the programme, in particular
for the victim, empathy module. They felt it would have been helpful to have had some written handouts
describing in more detail the short- and long-term impact of sexual abuse on victims, rather than having to rely
on their informal reading and general knowledge base. Two of the first-group tutors had received training on
the extended Core Programme. Both expressed concern over what they felt to be inadequate training to deliver
4
It is usually the case that men on main location would keep quiet about the nature of their offences (for fear of being attacked for being a sex of fender) so the y
would be unlikely to discuss them with anybody else, prisoners or staff
24
the expanded victim-empathy module. At this point they had only received one day’s training and, as a result,
they lacked confidence to fully deliver this component. One tutor also expressed some confusion about
‘decision chains’. Two tutors on the second group had been fully trained in the revised programme and had also
had extra training in delivering the victim-empathy module; they felt satisfied with this training. They saw it,
however, as very important to have the Treatment Manager available to consult on the fine detail of victimempathy role-plays.
Management and organisation
The staff running the first group felt well-supported and managed by senior staff. The tutors felt that adequate
time had been allocated for planning group sessions and, despite competing priorities, no group sessions had
been cancelled because of staff shortages or because they had been allocated to other duties. They felt the level
of support partly reflected the fact that the Senior Wing Officer (Programme Manager) had himself been trained
and had tutored a group. The tutors also commented on the high level of rapport and support they received
from their Governor Five. A Wing, Littlehey had a number of staff trained as tutors for the Core Programme and
this was felt to have helped ensure that the general environment on the wing was sensitive and responsive to
the needs of the men.
As described previously, there were major organisational problems during the time the second group was
observed. These resulted in many treatment sessions being cancelled, not only by the group obser ved, but by
the other groups that were being run at the same time, or which were being planned. Despite this, the second
group was (albeit over a long period of time) completed, attesting to the commitment of the tutors and men
who took part in this group.
Resources and facilities
All tutors were satisfied with the resources and facilities provided for them. There was no shortage of basic
materials, flip charts, pens and paper, and access to video equipment. The quality of the video recordings used
for the victim-empathy training was, however, poor and appeared to have been debased through repeated
copying. The Core Programme was always given priority for room space, though one of the rooms used was on
the ground floor and was overlooked by part of the wing. Although this initially gave rise to some concern, it
did not appear to cause any major problems or complaints during the groups.
Supervision and support
Although the opportunity of personal counselling was not available for tutors in the first group, they felt
extremely well-supported by colleagues and management. The Programme Manager had regular meetings with
tutors and he, in turn, was closely supported by the Governor Five. Both these of ficers had left by the time the
second group was observed. Their replacements were supportive of the programme, but were unable to
protect it from cancellations and disruptions.
All tutors were aware of the personal impact of the work and the emotional demands it placed upon them.
They believed it was inadvisable for a tutor to run two core groups ‘back to back’ because of the personal
commitments and psychological demands it would place upon an individual. In this regard they expressed
concern that the number of treatment groups planned at HMP Littlehey could place too many demands on staff
and result in staff burnout. The use of video-monitoring of sessions for supervisory purposes had not been
introduced at the time of the first group. It was, however, used by the second group, although in the absence of
a psychologist/Treatment Manager, its supervisory potential was not fully realised. In the first treatment group
adequate time was set aside for planning, debriefing and report-writing. During the second group, however,
tutors complained of inadequate time for planning and sometimes debriefing following treatment sessions
because of other duties.
Effectiveness of the programme
All tutors interviewed appeared to have realistic attitudes towards the programme and the different degrees of
progress the group members had achieved. Conscious of the limitations of the original programme, they
seemed to welcome the longer revised programme, particularly the extended victim-empathy module. A
25
number commented that the victim-empathy role-plays had produced fundamental therapeutic changes in men
who, at the beginning of treatment, appeared fundamentally lacking in empathy for their victims. Some
offenders also made comments to the effect that the victim empathy component had been the most profound
experience they had had during the course of treatment. Tutors generally accepted the advantage of moving
from the model of ‘cycle of abuse’ to the ‘cognitive-behavioural chain’ of offending, as set out by the revised
Programme Manual. However, it was evident that less-experienced tutors, particularly where a psychologist’s
supervision was not available, had become over-dependent on the Programme Manual, and could not think
creatively and flexibly outside it, in order to adjust its contents to the needs of a particular group member. This
problem was recognised by some of the tutors interviewed. What was felt to be the somewhat repetitive nature
of the later sessions was also commented upon. Less able group members tended towards being somewhat
concrete in their thinking, and appeared to have difficulty in grasping some of the more complex elements of
the relapse-pr evention module. This issue would benefit from consideration by the Programme Development
Section of Prison HQ. Moreover, particularly with less able clients, there may well be an advantage in increasing
role-play rehearsals of coping with risk situations to ensure that what is understood intellectually can be carried
out at the behavioural level. Finally, at the time of the team’s observations, there was an issue regarding tutor
selection, and what to do with trained tutors who were found to be unsatisfactory5.
Conclusions
The team was impressed with the competence and skills of the more experienced tutors running the Core
Programme at HMP Littlehey. In the first group observed, the tutors had only received basic training in the
victim-empathy role-play module, and did not feel skilled or confident enough to introduce this into the
therapeutic programme. In the second group observed, the victim-empathy role-play was powerful and
extremely well-facilitated by a female prison officer tutor. Both groups observed suffered from the lack of
availability of a psychologist/Treatment Manager. The first group received a very high level of support and
commitment from governors of all grades throughout the prison, and this resulted in a high level of tutor
morale. However, by the time of the second group there were major organisational problems; the introduction
of central detailing, mandatory drug tests and staff shortages all contributed to allocated tutors being diverted
from running the treatment programme. New governors, whilst perceived as supportive, were unable to
protect the programme from these disruptions, and as a result a considerable number of treatment sessions
were cancelled and time for planning and debriefing sessions was reduced as tutors had to move on rapidly to
other duties.
2.3.
HMP RISLEY
Introduction
HMP Risley was visited on nine occasions between Fe b ru a ry 1995 and March 1996. During this period,
members of the psychology department, probation officers and prison officers involved with running the
programme, were interviewed. Obser vations were also made and the opportunity was taken to sit in on two
groups. The sessions observed were active accounts, victim role-play and individual ‘chains’.
Observations
Staff running the group were highly committed to the work. There were photographs on the wall of of all the
staff of the Core Programme, together with their names, which ensured that the men knew who they could
approach should they feel the need for support. Treatment took place in the mornings (8.30–11.00). Here, it
was generally thought helpful to have a third person present to ‘bounce’ ideas off. The work was recorded by
one of the tutors on a ‘white board’ which then generated a photocopy which was used by the tutors as a
record of the session. None of the men asked for copies. In the afternoon, for approximately an hour,
debriefing/review sessions were held. Establishing the initial contract was delayed because a group member
had decided to appeal against two of his convictions. He had admitted to one charge, but confusion occurred
because the staff thought his reluctance to admit to two further charges was because he was in denial. This
issue was discussed with the group and its significance noted. It was decided that he could continue in the
group since he had admitted responsibility for one offence, and this would be the one that would be covered in
the sessions.
5
This is now perhaps a historical problem given that the Programme Development Section of Prison H.Q. has introduced a standard procedure for selecting tutors
26
All the men contributed to the work in hand, some of them making very useful and perceptive comments.
However, there was apparent collusion between two of the men in early sessions of the first group which the
tutors were aware of but declined to address at the time, waiting for a more appropriate opportunity. One
member’s attitude in this group was also very negative in the early sessions he said that he did not feel he
belonged in the group. The tutors were aware of his attitude but were confident that they could engage him
successfully as the group progressed.
Active accounts
Tutors ran this part of the programme very skillfully; for example, one tutor directed a group member to avoid using
clichés such as ‘emotional blackmail,’ and to explain in simple direct terms the account of his offence. Inmates were
encouraged to use ‘I’ statements more frequently in order to avoid giving an impersonal account of what had
happened. It was observed that the tutors, although they kept to their planned strategy for the sessions, were also
able to promote general discussion about issues such as when a child should be regarded as an adult. During one of
these discussions, the tutor was careful to move the session on but also allowed time for a member to share with
the group his thoughts and memories of being a victim himself (of bullying). In these sessions, the tutors asked
questions about the inmates’ sexual fantasies and masturbatory habits. This part of the work was done in an open
and direct way, and exploration of this subject was undertaken in reasonable depth. During one active account
exercise the group member who had been in the ‘hot seat’ was clearly distressed and remained so at the end of the
session. The tutor was very supportive, and told him that since she was on duty that weekend she was available at
any time should he want to talk things over with her. Some of the men remained silent throughout an entire session.
Their lack of contribution was not commented on by the tutors, although it was remarked on by other group
m e m b e rs. It is an important part of the group process that eve ryone should contribute, and tutors are
recommended to encourage active participation by all members of the group in all sessions.
Victim role-play
A series of these sessions of the first group were observed. The fi rst session was conducted very skillfully. One
of the group leaders (probation officer) was very adept at helping the men through the process and although
there was some resistance from the inmates this was overcome by careful reassurance. One man adamantly
refused to take part. This man had been a disruptive influence in the group on previous occasions, and he
ultimately dropped out. However, the probation officer was able to persuade him to go through the initial stage
of the role-play by co-opting other members of the group who contributed well. It was helpful that other men
had tasks to enact during the role-play so that it actively involved a large proportion of them
At the end of this session the men spoke enthusiastically about the exercise. One man, who had been the
subject of the role-play in the previous week, said that the ‘enactment’ stage of the role-play, where the tutor
had taken him through the initial stages of his offence, had brought back to him many details of what
happened, and the full impact of his offending had become much clearer.
The role-play session run by the second group observed was more problematic. The main difficulty seemed to
be that neither of the staff were confident in their skills. Although one female tutor was fully trained, she felt
self-conscious in front of the video camera and also in guiding the men through the ‘walk and talk’ exercise6.
The other tutor, who ran the group with her, was newly trained and had not had any direct experience with the
group. The first problem they encountered was inmates’ resistance to taking part in the role-play. They listened
to the prison officer’s description of the exercise, and most of the men soon realised that despite the tutor not
using the term ‘role-play,’ this was exactly what was going to happen. One man said that they had been told by
the Treatment Manager they did not have to participate. The tutors managed, however, to persuade one of the
men to begin, and the exercise continued.
During the role-plays the men appeared absorbed; their concentration was good, they all took the session
seriously, and they clearly saw its relevance to their own of fending. However, the lack of skill on the part of the
tutors meant they held so rigidly to the session plan that they missed many opportunities to productively
explore inmates comments. For example, an offender had targeted a child he knew had been already abused,
and he compared this to how some adult women go on to marry another abusing partner. He was told that this
was not relevant, so in this regard the full therapeutic potential of the role-plays was not realised.
6
This is when the tutor leads the inmate through a series of mimed activities representing his offence whilst he describes his actions to the group.
27
At the end of the session the debriefing exercise was too superficial and did not give the men enough time to
‘de-role’, i.e. the tutors appeared to rush, and jolly the inmates along, and omitted to check out their thoughts
and feelings after the exercise. The tutors reported that they had not received sufficient training or instruction
on the importance of de-roling.
The role-play was generally acknowledged to represent the emotional peak of the programme. This was
perhaps inevitable given that the following treatment blocks were mainly concerned with examining the shortand long-term consequences of offending, and relapse-prevention. In contrast with the highly emotive role-play
sessions, these exercises were seen as rather repetitive.
Individual chains
In order for an offender to understand how a sequence or chain of decisions can lead to an offence, each
decision is examined in terms of three elements: its situational context; accompanying thoughts; and behaviour.
The main problem to emerge in this block was a difficulty which tutors and men had in distinguishing between
situations and behaviour. For example, one of the inmates turned and said: ‘I turned around and parked up’. He
put this into the ‘situation’ box, and was told it should go in the ‘behaviour’ box. Much, not always productive,
discussion then took place on this topic which could have been avoided if group members had been more
conversant with the concept of situation, thoughts and behaviour.
Selection of individuals for exercises
Tutors regarded it as particularly important to select a suitable inmate to be the first one to undertake role-play and
other exercises. If someone is selected who is unco-operative or feels threatened, then this can have a deleterious
effect on other inmates’ confidence and co-operation. Tutors considered this selection process to require skill and
a knowledge of how the men functioned, both individually and in relation to other members of their group.
Integration policy
The tutors reported that the integ rated regime policy (whereby vulnerable inmates share activities and, in some
cases, accommodation with other inmates) had increased the amount of stress on sex offenders. Some
offenders reported to the tutors that they felt frightened and threatened by this integration policy, and
complained of feeling unprotected by staff7. Treatment groups are invariably affected by the general atmosphere
within the prison; for example, the feelings of unrest which arise following the tightening of home leave
regulations. Sexual offenders are often targeted by other prisoners for blame and ‘scape-goating’ when policies
are introduced which are unpopular and which in turn can impair their performance in the treatment
programme. However, the Treatment Manager at Risley reports that the integrated accommodation has now
settled considerably and is not having the same negative effect as it was at the time of the team’s visit.
Staff comments
The staff at Risley we re ve ry enthusiastic about the Core Pro gramme which seemed to have made a
considerable impact on the professional life of some of the staff interviewed. Although there had been some
problems in staff availability which entailed staff having to return to general prison duties immediately the
group finished, in general the staff thought the programme was well-organised. The staff praised the Treatment
Manager for the thorough preparation of the group sessions.
Supervision and support
The staff said that the Core Programme at HMP Risley was well-supervised and supported. Two of the prison
officers interviewed, however, had not been satisfied with the counselling sessions provided. They felt the
sessions had been too intrusive in their personal lives; neither of them had wished to discuss personal matters
with the counsellor, but had felt under pressure to do so. They felt a refusal on their part would be taken as
evidence that they were having problems, and they were wary regarding confidentiality issues. Both felt the
support they gave each other was much more useful. The Treatment Manager reports that the counselling
service has now been changed and all the tutors concerned are much happier with the present arrangements.
7
A survey of inmates’ views on the integrated regime at HMP Risley has been reported by Newall (1994).
28
Training
The staff thought the training was excellent, and appreciated the opportunity they had been given to attend the
courses. A problem arose occasionally when a tutor completed a training course but was not assigned to a
group for several months. In one case the period in question was six months and the tutor concerned
understandably felt a little ‘rusty.’ It was noted that amongst the tutors at Risley there is prestige attached to
being selected to run a group.
Resources and facilities
The resources and facilities were reported to be satisfactory. The two treatment rooms were large and airy. The
rooms were on a separate suite of keys so that only Core Programme staff had access. The rooms at the time
occupied a central position in the wing (currently one of the treatment rooms is situated in a portacabin) and
the doors through this area were locked throughout the session thus preventing casual traf fic. In addition, the
windows in the doors had been covered by opaque material, making it impossible to see through clearly.
Operating the video equipment was a problem for some tutors, who had to engage the assistance of more
technically minded group members. One tutor reported that she felt self-conscious, and under scrutiny when
video-recording was introduced into the sessions. The tea and coffee breaks took place in the treatment room.
The staff stayed there, and this ena bled informal discussions and support to take place. This was useful as some
of the group members were quite distressed during the group breaks.
Most of the staff expressed optimism that the programme would have a real impact on the lives of the men
attending the group, but they were aware that their differing levels of commitment could affect their eventual
outcomes.
Conclusions
The Core Programme at Risley was well-organised, thoroughly planned and well-supported by management.
Most minor problems were resolved by discussion and open communication across disciplines and grades. The
inmates appeared to be affected by the introduction of the integrated regime and were noticeably restive at
times. It was remarked that under this policy there was more pressure for sexual offenders to not admit to their
sexual offences. However, as previously noted, the integrated policy is reported as causing less problems than at
the time of the team’s visit.
Professional morale was high amongst the tutors. Some staff took it personally if they were not selected to run a
group. It was significant that tutors said that they felt just cohesive as a group, as did the inmates who
participated in the programme.
2.4.
HMP USK
Introduction
Two groups were observed at HMP Usk. They both followed the revised programme and were originally held at
the rate of two sessions per week, although this was later changed to five sessions per week. This ‘fast-tracking’
became necessary due to the requirement to run a set number of groups per year. Two groups were run
concurrently, with the target of running five groups a year. The sessions observed were the introductory
session, active accounts (A-B-Cs), victim-empathy role-plays and the decision matrix. Fourteen staff were
interviewed regarding their views of the programme and these included prison officers and probation officers
who were tutors, the Treatment Manager and the Programme Manager.
Observations
One of the groups observed contained an extremely difficult offender who was at times highly disruptive to the
group, took up a lot of time, presented management problems and was very hostile to the female tutor. He had
the effect of intimidating the group generally and it is likely that he affected the group’s progress overall8. The
issue of whether or not he should have been taken off the group was never satisfactorily resolved due to his
variable performance. At times he would work well and, as he appeared motivated, it was felt he should be
29
allowed to continue in the group. He therefore remained part of the group and caused the tutors a great deal of
anxiety. Due to the lack of a full-time Treatment Manager the tutors felt particularly vulnerable, although they
commented that the part-time Treatment Manager did all she could in the little time available to her. It is to the
tutors’ credit that they coped with the of fender as well as they did. There is now a full-time Treatment Manager,
at the prison and so the problem of lack of support and supervision should not arise again.
Overall the tutors were impressive in their running of both groups. They all appeared to have a good grasp of
the material and were effective in their communication with the group members. They ran the sessions as
planned and all co-worked ef fectively, with one tending to lead a particular exercise and the other writing on
the board. The use of the comparison exercise in the introductory session which illustrates the equally
devastating effects upon victims of both child abuse and rape was powerful and made the point very clearly.
This had a profound impact upon the group in terms of preventing one type of offender feeling superior to
another.
The active account sessions were rather lengthy, and there was a danger that some of the group became bored
and not fully involved. Tutors varied in their ability to involve other group members and it was obviously
difficult to maintain a balance between focusing on the individual in the ‘hot seat’ and encouraging him to
describe his behaviour honestly, and ensuring the rest of the group were involved. One of the tutors reported
that one offender had completed ten active accounts due to the extent and variety of his offending.
The victim-empathy role-plays were extremely powerful and the tutors conducting them were skilled and
sensitive to the needs and feelings of offenders. The impression gained was that the group felt safe in the roleplay situation and took the exercise seriously. The tutors also handled emotional upset from the offenders very
well and whilst acknowledging their feelings were able to focus the offender on the victim’s feelings and
experiences. Offenders were offered further support outside the group should they need it following their roleplay sessions. While the tutors were excellent at dealing with the offenders involved in the role-plays there was
a tendency to neglect those who were not involved. It is important to monitor the ‘audience’ as there is a
danger that, if neglected, they may either disengage from the process or become distressed.
The decision matrix appeared to cause some confusion for the group when they were asked to complete it as a
h o m ewo rk task, despite having had it explained to them in the previous session. For group members
functioning at a low intellectual level this exercise is probably too complex and requires simplification.
Staff comments
General comments
All the staff were unanimous in their praise of the programme, and all felt that it was extremely worthwhile.
They regarded the revised programme as superior to the original Core Programme, particularly with regard to
the victim-empathy block. However, there was some concern over the use of offence chains rather than cycles,
with several tutors commenting that the offenders found the cycle easier to understand than the concept of
offending chains. There was also a feeling that following on from the high emotion and active participation of
the victim-empathy block the lengthy relapse-prevention block was tedious in comparison. It was suggested
that this block be amended to include more active participation and interesting exercises.
The advent of ‘fast-tracking’ (five sessions rather than the original two sessions per week) apparently led to
mixed feelings amongst the staff at the time. Some welcomed it and thought that it prevented sections of the
programme from becoming too boring and stopped the groups dragging on too long. Others thought the
intensity of sessions was too much for both the offenders and the tutors and this would lead to both feeling
exhausted. Many thought that fast-tracking was too intense for the victim-empathy block. However, it should be
noted that the cur rent Treatment Manager reports that, in both these cases, this is not the view now expressed
by tutors.
A further difficulty was that the offenders did not have enough time to complete their homework tasks and the
tutors did not have enough time to go through the homework to give feedback. A number of tutors thought
8
this man was closest in personality profile to that of a primary psychopath, using the SHAPS (Special Hospital Assessment of personality and Socialisation,
Blackburn, 1982).
30
that offenders with lower levels of intellectual functioning could not cope with fast-tracking (although the
current Treatment Manager reports that in her view this has not turned out to be the case), and some suggested
that there should be a number of breaks to give offenders time to assimilate their learning. However, fasttracking has restricted the amount of time that the Treatment Manager and tutors have available for extra oneto-one work with such men to help them keep up with the programme.
Tutors all expressed their anxieties about running the victim-empathy role-plays but stated that this section of
the programme had the most profound effect upon the offenders.
Training
Staff were generally positive about the training they received. Several commented that it was the best training
they had ever received and that the tutors were excellent. However, others thought it was rushed, with too
little time for practical rehearsal and that at least another week was required. Staff found the additional courses
valuable and all were eager to receive as much training as possible. A number of staff commented that there
should be training on the impact the work could have on them personally. There was also a general feeling that
gaps between the training course and running a first group were too long and led to a loss of confidence. Staff
suggested that there should be more opportunity to sit in on groups or observe sessions regularly, perhaps
using the videos.
Management and organisation
Staff generally regarded management in a positive light and felt that they were valued and that their work was
recognised. There had been difficulties at the time of the team’s visits organising staffing of the groups around
the shift system but these were subsequently resolved.
Staff generally felt that the planning and debriefing time was adequate, although many would have liked more.
The point was made that certain sessions and individuals required more planning time and this was not always
possible. Staff generally commented on the difficulties of writing up individually, although now some time
should be made available to write up as a group. Several commented that they had to write up in their own
time, often at home. The current Treatment Manager reports that this now no longer the case. Staff did not
express any concerns over the way offenders were selected for the group, but they did comment upon the fact
that they would have liked input into the decision-making process regarding Category D status, giving the
example of offenders who did well on the programme being rejected and others who refused the programme
being accepted for Category D status. Staff experienced difficulties obtaining depositions prior to the start of
groups.
Resources and facilities
Over the period of time that the groups were being observed the facilities were increased from one group room
and an office to include an additional office – together they became the SOTP suite. Staff were pleased by this
as they regarded it as a form of recognition from management and felt that it heightened the profile of their
work. Not surprisingly staff had few complaints about the facilities, except to state that a second group room
would be helpful. The room was well equipped and private, although it could be noisy if the window was open
and too hot if it was closed (air conditioning has now improved this situation). Computer-literate staff have the
use of a computer for report-writing, others hand-write their reports which are then prepared by a typist .
Supervision and support
Although staff stated that there had been some difficulties with not having a full-time psychologist acting as
Treatment Manager at the time of the research, they described the necessity of having to ‘fend for themselves’,
as in some way unifying them as a group. However, they were pleased when a full-time Treatment Manager was
appointed and thought that this would lead to more effe c t i ve running of groups as there was now an
identifiable person to organise and provide supervision.
During the time that the groups were being observed counselling had not been implemented. Staff were
ambivalent regarding the need for counselling, with some thinking it an excellent idea and others feeling they
31
got all the support they needed from other tutors. There was some anxiety expressed about the information
gained from the counsellor and whether that would be shared with management. The Treatment Manager
reports that the counsellor has earned her stripes and is well-accepted now.
There was a strong awareness of how tutors could be affected personally and several stated that they knew of
tutors who felt that they could not behave ‘normally’ with their children and would not allow their children to
do such things as sitting on their lap. One individual commented that ‘the monsters in their heads may try
climbing into yours’. It should be noted that counselling is now ongoing, with staff being offered three sessions
over the course of a group.
Effectiveness of the programme
In general, staff were extremely positive about the programme and one commented that it was ‘the most
positive and rewarding thing in the prison’. The revised programme was seen as a great improvement in terms
of the victim-empathy block, but relapse-prevention was regarded as being too inactive and boring and there
was a general dislike of the use of the decision chains and a preference for the cycle to be retained. Some tutors
also thought that the decision matrix was too complicated for the men. Staff accepted the use of video-taping
sessions but there had been a lot of unease about how it would be used. Although staff felt that mixing child
abusers and rapists was not a problem, many felt that the inclusion of those with a low intelligence caused
problems. There were suggestions that specific groups should cater for such offenders and perhaps for other
special groups as well, such as men on life sentences. The Treatment Manager reports that the current situation
is that lifers are put on in pairs and that this has been successful and has been accepted by tutors.
While staff viewed the programme as being positive, many of them expressed the view that outside agencies,
probation in particular, were dismissive and under-rated the programme. This led to feelings of annoyance and
frustration in that they feared that the work that had been done in prison would be lost without the support
and existence of booster programmes for the offenders in the community. They felt that the liaison with other
agencies needed improving and they themselves also wanted follow-up information on the offenders they had
worked with. The current situation is now changing with talks having been given to outside probation services
about the Programme.
Conclusions
The staff at HMP Usk were highly enthusiastic and committed to the programme. They felt well-supported by
management and were pleased with the facilities, although they would have liked a second group room. There
was a belief that some aspects of the expanded programme were difficult and tedious; namely the decision
matrix and the relapse-prevention block. Tutors expressed ambivalence about fast-tracking and believed that it
caused problems in that group members had little time to complete their homework and to assimilate the
things they were learning in the sessions.
The lack of a full-time Treatment Manager had caused some difficulties with one group who had had a
particularly difficult group member to deal with and this raised questions as to whether such personality
disordered individuals should be taken on to the Core Programme. There is now a full-time Treatment Manager.
From the observations of the group sessions it was concluded that the tutors were very competent but that the
focus of the ‘hot seat’ method led to other group members being somewhat neglected and difficult to involve.
2.5.
HMP WAYLAND
Introduction
The following report is based on information gathered from observations during five visits to HMP Wayland, and
interviewing staff involved with the programme. The sessions observed included: introductory; ‘brief accounts’;
and victim empathy. E Wing (the Vulnerable Prisoners’ Unit) met fortnightly to discuss the programme and
general matters arising in wing. This meeting was also attended by, and the minutes were made available to, the
researchers. The following people were interviewed: the Governor; the Programme Manager; the Treatment
Manager; prison officers; and the group tutors (two of whom were experienced probation officers – one a coleader of one of the groups obser ved, the other the co-leader of the other group obser ved). No female tutors
were working on the programme during the period under review.
32
The two groups observed were run concurrently. Each group ran three sessions a week; one group ran for 43
sessions the other group ran for 45 sessions. One group ran an ex t ra session a week to complete the
programme in the time available before some group members’ release from prison.
Observations
Tutors had introduced an additional introductory session prior to the beginning of the programme. The
purpose of this pre-group session was to dispel myths and fears about what might take place in the group, to
discuss practical arrangements for the programme, and how information from it might be disseminated, for
example, to supervising field probation officers. The introductory group session was attended by everyone
involved in running the group to provide an opportunity for the men to see the whole team. The staff running
the groups were committed to the work. There were many examples of how staff had put themselves out to
help inmates who were unable to attend the sessions and to support group members who had found particular
sessions distressing.
In the ‘contracting’ sessions, the group formed their own agreement and this was written on a flip chart which
was pinned to the wall for future reference. One tutor commented that although the men made their own
decisions as to how the group was to be run, and tutors encouraged them to ‘own’ the contracts, they steered
them in the desired direction. The tutors began by asking the men if they felt tense or stressed during the
session thus, from the outset, encouraging the open expression of emotion. The men were praised and given
recognition for the difficulties that the work would have for them. Inappropriate behaviour such as joking or
snide remarks was ignored by the tutors, and reinforcement was given for authentic statements made by the
men when describing their own behaviour. In this way an atmosphere of honest openness was gradually
established.
No noticeable use of jargon was evident; the tutors explained carefully the purpose of each exercise and
activity, and provided everyday examples in a clear manner .
In the victim-empathy session, tutors skillfully drew feelings from the group about the victim’s experience, and
those who had been victimised themselves were able to share this with the group. Although the victim’s
thoughts and feelings were discussed in detail, and in a sensitive way, a female tutor’s contribution to the
session may have improved sensitivity to these issues. There were some misgivings about the content of the
victim accounts used in the victim-empathy block.
By far the biggest problem reported by staff related to central detailing. During visits to the prison in October
1994 and February and March 1995, the availability of tutors for the programme was sporadic, with no prison
officer tutor in attendance at 27 per cent of sessions of one group and 23 per cent of sessions of the other
group. It appeared that the general attitude of prison management was that as long as someone was available to
carry out the session there was no problem and that the need to use only trained tutors was not fully
appreciated. Difficulties also arose when staff left or were ill. Trained tutors had to relieve other E Wing officers
for routine prison duties. This situation was exacerbated in HMP Wayland because E Wing was separate from
the main wing, being a ‘prison within a prison’. The shortage of staff meant that some Core Programme
activities, for example debriefing and writing up, were not given adequate time. The tutors said that any
planning that they did was ad hoc, and that they did not have the opportunity to discuss with each other
matters to do with the group. They said that the burden thus fell heavily on the two probation officer tutors and
the Treatment Manager. On several occasions the probationer officers had to cover for their colleagues’ group
because of the absence of prison officer tutors.
Staff comments
There was a high level of morale evident in the staff interviewed despite some of the problems that had been
encountered in the delivery of the programme. One tutor felt that the success of the programme for staff and
inmates alike was that they were volunteers and not ‘pressed men’. Professionally, they believed they had
gained much from the opportunity to receive good-quality training, and they valued their new skills. Above all,
they appreciated the camaraderie of working closely with their colleagues.
33
Group selection
Prison officer tutors said that considerable effort was taken to ensure that group members were compatible and
well-matched. These tutors took pride in their ability to know enough about the inmates’ intelligence, offence,
and interpersonal relationships to be able to allocate to them what they believed was the most appropriate
group. One of the tutors said it was important that groups were equally well-matched in terms of their spread of
abilities.
Training
All tutors were satisfied with the training they had received. Several remarked how important it was for staff
who were not directly involved with the programme to receive some form of awareness training. One tutor said
he had written to the Home Office to complain about the counter-therapeutic and sexist attitudes expressed by
untrained prison staff.
All but two of the tutors had received the training for the revised programme. Despite this, some tutors
expressed uncertainty about delivering the role-play sessions of the revised programme, and the Treatment
Manager had planned extra sessions to familiarise staff with these techniques and to increase confidence in
their use.
Decision chains had been introduced to replace offence cycles, though some tutors believed that the cycle was
useful for illustrating the repetitive and addictive nature of sexual offending. Consequently, some tutors did not
wish to entirely abandon the concept of ‘offence cycles.’
The Treatment Manager had attended the training course on supervision, and the Principal Prison Officer and
the Governor had attended the ‘Managers Awareness Course’ run by Programme Development Section of
Prison HQ. The Governor was perceived as offering considerable support to the treatment programme and
expressed satisfaction with its progress.
Supervision
Tutors said that there was very little time or opportunity for supervision, but that arrangements were being
made to address this problem. Despite the lack of time available for supervision, when it was given by the
Treatment Manager, it was regarded as thorough, helpful and supportive. Tutors felt that any difficulties that did
arise on the programme could be discussed and resolved with the advice of the Treatment Manager. At the time
of the observations, individual counselling for tutors had not been introduced. The prospect of its introduction
was, however, generally welcomed by tutors, who recognised that within the general ‘macho’ culture of the
prison it was not always easy to seek support from colleagues.
Effectiveness of the programme
In general the tutors running the programme saw it as effective, but expressed some scepticism regarding the
programme’s ability to reduce sexual re-offending. Staff believed it would have an impact on some of the
offenders, depending on their commitment and motivation, and was definitely worth doing.
Resources and facilities
The lack of a dedicated treatment room at the time of some of the earlier team visits presented a major
problem. Before a dedicated treatment room had been set-up some staff said they felt like goldfish in a bowl
because as people passed the room they would look in. Occasionally other prisoners had commented to group
members that they had seen them in the ‘hot seat’. When a dedicated treatment room was set-up screening was
introduced at the outset. At times the tannoy was disruptive
Tutors reported that some of the video tapes were of poor technical quality and this was enough to detract
from their full effectiveness. There was, however, no shortage of materials such as felt pens and flip charts.
There was no secretarial support available except for that provided for the probation officers when writing up
their final report.
34
Conclusions
The atmosphere on E Wing was positive, supportive and friendly. A major strength of the programme at
Wayland was the quality of professional input from the Treatment Manager and the two probation officer tutors.
The latter worked closely together, and provided a consistent approach to the work of the groups, promoting
friendly rivalry between them. Difficulties in staffing led to insufficient time being available for planning and
debriefing, especially for the prison officer tutors. These problems had arisen because of central detailing, and
are believed to have been largely resolved since this study took place. The absence of a female tutor could have
limited the men’s insight into the victim’s perspective. Finally, an unexpected finding, given an all-male group
(members and tutors), was the way both the leaders and the men seemed able to talk about strong feelings
without believing this was unmanly. They seemed to have developed their own culture within the overall
macho prison culture so that it was perfectly acceptable to talk about deeply personal feelings, and be
supported rather than ridiculed.
2.6.
HMP WHATTON
Introduction
Two groups were observed at HMP Whatton for three sessions each; these included the introductory sessions,
‘A-B-C’, victim awareness, offence cycle and review sessions. Both groups delivered the original version of the
Core Programme. Eleven of the staff involved with the groups were also interviewed.
At the time the groups were obser ved, staff were aiming to run three groups at any one time. Two groups ran
parallel to each other, taking up two full days a week, one group ran for one day a week. The frequency of
groups was later increased so that seven groups were run per year at a rate of six sessions (mornings or
afternoons) per week. Due to an increase in the intensity of the programme the sessions came to be run by
three tutors instead of two.
Observations
Overall, the way the tutors ran the groups was very impressive. All the staff were highly committed to the work
and interested in what they were doing. They appeared sensitive to the way the inmates reacted to different
parts of the prog ramme, explained things clearly and simply, and checked that the group had understood what
had gone on. However, in one group’s introductory session tutors spent time consulting inmates about the
contract, but only included the items that accorded with what they wanted. There was also a tendency in the
groups observed jargon terms to be used early on, before the inmates understood what they meant, such as
‘relapse-prevention’ and ‘cognitive distortions’.
In the victim session the video tape was extremely poor quality and was not especially relevant. It is important
to use far better quality material and it is noted that in the revised programme there are improved victim
e m p a t hy materials and more appro p riate video material. It was also felt that there needed to be more
opportunities to explain why victims sometimes behaved in ways that offenders could use to justify their abuse,
for example, retracting statements, not disclosing for a long time, behaving ‘provocatively’, becoming sexually
aroused and putting themselves in situations in which they could be further abused. The original ‘debates’ tried
to address these issues but were discontinued because they were unsuccessful and problematic. Such sessions
perhaps need to be run by more experienced staff such as the Treatment Manager (a psychologist), but all the
tutors needed to be aware of such issues so that they could explain them if offenders tried to use them as
excuses.
The tutors were very impressive in their handling of a man who was hiding much of his offending. They knew
that if he was confronted in the group this would lead to denial and the rest of the group taking his side, so
they carefully planned a strategy to help him admit. They told him outside the group that they knew he was not
being truthful which allowed him to tell the group without the group witnessing any pressure, which might
have led to increased defensiveness.
The review exercise appeared very good as it clearly worked through each inmate’s knowledge of each
component of the programme and seemed helpful in demonstrating to the group what each person had
35
learned. It was a good way to bring the whole programme together and summarise for each individual what he
had learned.
Attendance at the groups observed was very high; and no inmate was removed from a group.
Staff comments
Overall, the staff were very positive about the work. Their suggestions for improvements tended to cover the
same themes, showing that there was a high level of agreement amongst all the staff. All staff felt that the
revised programme was a great improvement and commented particularly on the use of offence chains, the
revised-victim empathy block and the relapse-prevention block. One tutor stated that the chains were better for
rapists as their behaviour often did not fit the cycle. Many staff also commented that the new relapseprevention block was dull and repetitive.
Training
All the staff thought the training they received was excellent, being well-delivered and of high quality. They
generally felt confident about running a group after the training but for those where there was a gap, sometimes
of a year, before they ran a group they felt more anxious. A couple of staff felt that the training was rushed and
another week would have made a big difference. It was noticeable that the prison officers were unanimous in
their praise of the training whilst other disciplines were slightly more reserved, and one person commented
that for those staff starting from scratch the utility of two weeks training was dubious. All staff were keen to
attend further training and many had been on update training which was highly spoken of by them.
Management and organisation
All the staff thought that the groups were well-managed and supported by management and thought that the
prison could provide many more groups if further staff were trained. Staff felt quite strongly that management
staff should also be ‘trained’ so that they understood what the work involved; it was felt that as HMP Whatton
was a ‘specialist’ prison for sex offenders all staff should have some form of awareness training so that even
those not involved in programme delivery would know what was being done and could endorse the messages
from the group work.
The staff were appreciative of the system of assigning prison officers to the group work programme and
relieving them of other duties. Officers worked a four-day week and were available to inmates in the evenings,
which proved a much-used resource. There had been an issue over pay and some ill-feeling from officers not
involved in the programme, but this has been largely resolved. Other disciplines were also relieved of some of
their usual duties whilst in the group. They felt that this was very important as they did not think they could
have managed to cope satisfactorily with running a group in addition to their usual duties.
All staff felt there was adequate time for preparation, debriefing and documentation.
Resources and facilities
All staff were pleased with the resources and facilities provided to them and they commented on how this
facilitated the smooth running of the groups. There was a plentiful supply of flip charts, pens and paper and
access to video equipment when needed. However, the quality of the video material was very poor and staff felt
the victim-awareness module could be improved by the use of better materials. This was achieved with the
introduction of the revised programme. Sound-proofing of the rooms was also a problem but staff believed that
something was being done about this. Secretarial support was very good and staff had no problems producing
reports on inmates.
Supervision and support
Staff felt that they obtained much support from their colleagues working on the same group. Teams of tutors
were chosen on an ad hoc basis from a pool of about 20 tutors, of which a third were women. This led to a
gender bias among tutors in that there were more male staff than female. Many of the staff were concerned that
36
no account was taken of the staff dynamics. In particular there seemed little appreciation of the advantage of
keeping together combinations of staff who worked well together as tutors. Moreover, where they did not work
well together, they felt that this issue was ignored, leaving staff unsupported in having to cope with such a
dynamic.
Staff were happy with being debriefed by the Treatment Manager, but there was some confusion as to whether
this was about the content of the programme and their delivery of it or more personal issues to do with how
they were coping with the work. The Treatment Manager aimed to sit in on each group, once every ten
sessions, i.e. approximately once a fortnight.
Staff felt the presence of observers in the group could cause problems. For example, there had been a recent
occasion when staff had objected strongly to a supervisor observing the group who was not ‘Core Programme
trained’; but it was suggested by some that this was really more to do with the personality of the individual
concerned rather than their lack of training.
Staff were open-minded about the idea of attending a counselling session once a month, a service which was
being set up for tutors during the period the groups were being obser ved. At that time some staff felt that they
did not really need it, whilst others thought it should be compulsory so that those making use of it were not
seen as having a problem. Following the introduction of the counselling the general opinion was that it was
very beneficial and should be more frequent. Some staff expressed concern that if they admitted to the
counsellor that they had problems then this may result in them being taken off the groups. Some staff stated
that they had been subject to unpleasant remarks such as ‘you can’t cope’ when going to their counselling
sessions.
Several tutors commented that running a group two days in a row was quite tiring for both the group leaders
and members and thought that the sessions should be spaced throughout the week. However, there were no
strong feelings about this.
The Treatment Manager commented that since the advent of accreditation tutors tended to come for advice,
whereas previously they would have tried to have sorted any problems out for themselves and improvise. The
use of video-monitoring of sessions had also caused anxiety among tutors but had been accepted without any
problems. Similarly the victim-empathy role-plays were the source of much tutor anxiety and two had dropped
out of running groups as a result.
Staff commented that they no longer experienced difficulties with non-programme staff causing problems or
trying to sabotage the groups. There was still some hostility from a few prison officers and the occasional
negative comment, but generally the Core Programme had been accepted and was viewed as a desirable thing
to be involved with.
Effectiveness of the programme
Staff felt that the programme was well-designed and made logical sense to the inmates. They felt that many
inmates benefited but were unsure as to whether this was enough to stop them re-offending and knew that a
number of them were still high-risk after the programme. Most staff thought that mixing child abusers and men
who had committed offences against adults did not present any problems and that having only one type of
offender might lead to the group becoming highly collusive.
Initially, the problems with the Core Programme were seen as being to do with the victim-awareness and the
re l a p s e - p revention modules. Howeve r, staff ack n ow l e d ged that the revised pro gramme was a gre a t
improvement in this respect. Staff were generally happy to adhere to the programme but some made some
minor amendments. An example of this was the introductory session which was an extra session at the start of
the programme. Tutors held a single session the first week, in order to explain the purpose of the group, allay
fears and agree a contract. They then started the group the following week. They found this was helpful as it
calmed the anxieties of the inmates and also provided time for tutors to get to know each other and plan how
they would run the group. Staff were very enthusiastic about the programme and most were keen to expand
the range of groups on offer.
37
Conclusions
The Core Programme at HMP Whatton appeared to be well-run and well-organised. The tutors appreciated
being able to work solely on the programme when they were running groups and thought the five-day week
was beneficial to them. All the staff presented as very committed, competent and enthusiastic. They felt wellsupported by management and thought their facilities were good. There was unanimous agreement that the
revised programme was a great improvement and staff particularly liked the introduction of the offence chains,
the expanded victim-empathy block and the focus on relapse-prevention. However, there were some anxieties
about the use of role-plays and many staff commented that the relapse-prevention block was repetitive and dull.
Problems regarding the poor-quality victim-empathy materials have been resolved with the advent of the revised
programme.
Although staff felt well-managed and supported they felt that management and staff not involved in the
programme should have some form of awareness training. The counselling sessions were seen as beneficial but
some staff had anxieties about the sessions. There was also some confusion over the purpose of debriefing and
how much of their personal feelings should be expressed in these sessions. All staff agreed that the training
they had received was excellent and were keen to attend further courses.
2.7.
TUTORS’ ATTITUDES TO THE CORE PROGRAMME
Tutors involved in running the programme were invited to complete a brief questionnaire – the Tutor Attitude
Questionnaire (TAQ, Fordham, unpublished) – regarding their attitude towards the Core Programme. The
questionnaires were completed anonymously but respondents were required to provide brief details, such as
their gender, whether or not they were parents and the number of groups they had run.
A total of 45 tutors completed the TAQ, comprising 11 women and 34 men. Due to the small numbers of
completed questionnaires from some prisons it was not possible to statistically analyse the differences between
establishments, but where differences are apparent they will be discussed. The results were notable for their
consistency across tutors, although there were a number of differences on specific questions. These will be
discussed before going on to discuss each question separately
There was a significant difference (p < 0.05) between tutors with children and those without regarding the
degree to which they believed sex offenders could be helped by treatment, those with children being more
hopeful than those without. There was also a gender difference on this question, with men being more
optimistic about the effects than women. Regarding the effect of level of experience, tutors who had run more
than three groups rated themselves as significantly more upset knowing how the offences affected the victim
than those with less experience, and felt less able to protect children by knowing how offences took place than
those with less experience.
Looking at individual items, there was virtually unanimous agreement that working on the Core Programme led
to an increase in knowledge of sexual offending and that it was important to give sex offenders hope that they
can change. About half felt that they had more understanding and empathy for inmates since becoming Core
Programme tutors. The majority felt that it was easy to experience anger towards offenders who were not
prepared to change and reported that it was difficult to be patient with offenders who continued to deny their
offences. There was variation regarding the extent to which tutors felt that they could become cynical if
inmates went on to commit further offences after attending the Core Programme, with about half agreeing that
they would become cynical and the remainder disagreeing.
The majority of tutors agreed that it was upsetting to know how the offence affects the victim, although there
were some group differences, which were discussed above. All tutors agreed that treatment can go a long way
to help sex offenders but differed in the extent to which they supported this statement, according to whether
or not they had children themselves (those that had children being more optimistic), and gender, with women
being more pessimistic. Tutors all agreed that knowledge about how sex offences occur could make parents
more protective towards their own children and approximately two-thirds felt that tutors can help to protect
children in general because they learn how offences are committed.
38
With the exception of a few staff from HMP Whatton, most of the tutors felt that not enough time was given to
group leaders to run the groups and the majority also felt that they would benefit from more supervision and
support than they currently receive. Most stated that they did not feel confident about their own knowledge
and skills in this area and that the work was made more difficult because of the negative attitudes towards sex
offenders within the prison system9. With regard to how tutors were affected by their work, there was almost
unanimous agreement that the work provided a great deal of job satisfaction. However, there was universal
agreement that there was a high level of stress associated with the work and that it was hard to ‘switch off’ after
running a group. Tutors also reported that they had become self-conscious of both their behaviour with
children and how other people might interpret such behaviour.
Comparing these findings with a similar study by Turner (1992), who reported on 82 programme tutors in 16
different sites, there would seem to be a number of consistent findings. Turner found that tutors expressed
feelings of anger towards group members, felt they lacked confidence when the group members did not seem
to make progress and wanted more support from their managers than they received. He also reported that
tutors felt self-conscious regarding their own behaviour with their children and 39 per cent of parents stated
that their parenting had been affected, in terms of them becoming over-protective, and a number also reported
being unable to bathe their children or play physically with them as they had previously. In Turner’s study onethird of tutors reported that their intimate relationships had been affected in such ways as finding it difficult to
communicate about their work due to feeling that they should protect partners from the unpleasant details, and
feeling preoccupied over group issues at home in a way that disturbed family life. Up to 30 per cent of the
sample described loss of interest in sex and some even experienced sexual impotence as a result of working
with sex offenders.
9
It was notable that none of the staff at HMP Littlehey had this view and disagreed with the statement
39
40
3. GROUP, SAMPLE, DESCRIPTION OF MEASURES AND PROCEDURES
3.1. DESCRIPTIONS OF GROUPS
Twelve groups were examined, running in six different Category C prisons. Most of these groups took place in
specialised sex offender units. The sample consisted of 100 men who had been convicted of serious sexual
offences, i.e. rape, buggery, incest, indecent assault, gross indecency. There were no refusals to participate
prior to treatment. The research was undertaken during the period of changeover from the original SOTP
programme to the revised version, which potentially allowed for a comparison of the effectiveness of long-term
treatment (approximately 160 hours of group-work, with a role-play component) with short-term treatment
(roughly 80 hours).
Table 3.1. shows the groups seen, whether they were receiving the original or the revised programme, the
number of sessions (of approximately two hours each) completed and category of sex offender, i.e., those
whose known offences were against children (82 men), those whose known offences were against adults (14
men), or those who had committed offences against both adults and children (4 men).
TABLE 3.1:
LENGTH OF THERAPY AND MAKE-UP OF GROUP
GROUP
TYPE
SESSIONS
NUMBER IN
GROUP
CHILD
ABUSERS
ADULT
OFFENDERS
BOTH
Channings Wood 1
Channings Wood 2
Littlehey 1
Littlehey 2
Risley 1
Risley 2
Usk 1
Usk 2
Wayland 1
Wayland 2
Whatton 1
Whatton 2
Revised
Revised
Original
Revised
Revised
Revised
Revised
Revised
Original
Original
Original
Original
80
98
45
54
70
80
72
72
45
43
40
37
8
9
8
8
7
8
8
8
10
10
8
8
8
9
7
6
6
8
5
4
8
8
7
6
1
2
1
3
2
2
1
1
1
2
1
1
100
82
14
4
TOTAL
It can be seen from Table 3.1. that most of the men were child abusers, with most groups containing usually
one or two men who had offended against adults. The only exceptions to this were the two groups at HMP Usk,
where there was a greater representation of men who had offended against adults or against both adults and
children.
3.2.
GROUP COMPARISONS BY LENGTH OF TREATMENT
As can be seen from Table 3.1. the 12 groups fall into two sets by treatment length.
Shorter groups
Littlehey 1, Littlehey 2, Wayland 1, Wayland 2, Whatton 1 and Whatton 2, average length of treatment per man;
42 sessions or 84 hours (range 37 to 54 sessions). Littlehey 2 is included here as it was considerably shorter
than the other revised groups (54 sessions); with this number of sessions it is not possible to deliver the
programme as set out in the revised manual (Programme Development Section, personal communication).
41
Longer groups
Channings Wood 1, Channings Wood 2, Risley 1, Risley 2, Usk 1 and Usk 2, average length of treatment per man:
80 sessions or 160 hours (range 70 to 98). Channings Wood 1 was classified as a longer group because it ran for an
equivalent number of hours to the other revised programmes, with the therapists switching to the revised manual
part-way through the group. However, it should be noted that there was no role-play module in this group.
3.3.
NUMBER IN SAMPLES
Prior to treatment
One hundred and three men were seen before the commencement of treatment. There were no refusals to
participate in the research at the pre-treatment stage of testing. Three men, after completing the assessment
pack, were not admitted to a group because of their high levels of denial. The sample before treatment
consisted of 100 men who had been convicted of serious ‘hands on’ sexual offences, i.e. rape, bugger y, incest,
indecent assault, gross indecency. As can be seen from Table 3.1, 82 men had committed sexual offences
against children (child abusers), 14 men had committed offences against adults (adult offenders) and four men
had committed offences against both adults and children. A child is defined here as anybody under the age of
16. An individual is defined as a child abuser if he had admitted to starting the abuse against a child before that
child (male or female) had reached the age of 16. Because of the small number of men in the sample who had
committed offences against adults or against both adults and children the subsequent analyses reported in
Chapter 4 will only report the child abuser data.
Of the sample of 100 men who commenced treatment, three were black, one was South Asian and one was Greek.
After treatment
Of the original sample of 100 men, three men refused to take part in the evaluation after treatment (refusals).
Four men were removed or left their respective groups (treatment drop-outs). Table 3.2. shows the overall
follow-up rates by type of offender.
TABLE 3.2.
FOLLOW-UP RATES BY TYPE OF OFFENDER
ORIGINAL
SAMPLE
CHILD ABUSERS
ADULT OFFENDERS
CHILD + ADULT
TOTAL
TREATMENT
DROP-OUTS
REFUSALS
FOLLOW-UP
4
4
1
2
3
77 (94%)
12 (86%)
4 (100%)
93 (93%)
82
14
4
100
More details on the treatment drop-outs and refusers are given below:
• Treatment dropouts1 Littlehey 6 breached the confidentiality of the group, he was moved to another
prison before release and had no further treatment; Risley 1 reverted back to denying the offences took
place and was removed from the group; Risley 5 left the group saying he ‘was not getting anything out of
the group’ – he was transferred to another prison and to date has not attended a further course; Risley 12
started offending behaviours in prison, he was moved to another prison and to date has not attended a
further course.
• Refusals after treatment2 Littlehey 15 left prison and has now finished his very short probation order; Usk
2 said he would the complete his questionnaires after a move to another prison but did not do so; Whatton
1 said he had ‘problems’ with the prison governor and attempted to bargain his co-operation in exchange
for home leave (which was not an option) – he agreed to see a researcher as soon as he had left prison but
reneged on that agreement.
1
2
This section describes the men who did not complete the core treatment programme.
Refusals after treatment means that the men refused to complete the post-treatment set of questionnaires. Therefore these men could not be included in any
prepost-comparisons.
42
Long-term retest after treatment completion
Part of the study involved long-term follow-up to see whether any treatment gains held up over a nine-month
period in the 93 men seen after the treatment. As the second Littlehey group took so long to complete, a longterm follow-up was not possible with the seven men who had been seen at the post-treatment stage of testing
in that group; therefore the total of number of men that could be seen at this stage was 86; of these 64 agreed
to complete a further set of questionnaires (see Table 3.3).
TABLE 3.3
LONG-TERM FOLLOW-UP RATE BY TYPE OF OFFENDER
NUMBER
SEEN POST-TEST
CHILD ABUSERS
ADULT OFFENDERS
CHILD + ADULT
TOTAL
3.4.
NUMBER
AT FOLLOW-UP
71
11
4
86
56
5
3
64
(79%)
(45%)
(75%)
(74%)
SAMPLE DESCRIPTIONS
Child abuser Sample
Table 3.4. shows the total sample of child ab u s e rs bro ken down by style of offending – intra fa m i l i a l ,
extrafamilial or both.
TABLE 3.4.
CHILD ABUSER CHARACTERISTICS
TOTAL
SAMPLE SIZE4
82
OFFENDER CHARACTERISTICS
I.Q. (SD)5
98.3
LENGTH OF SENTENCE (SD)
4.8
NUMBER OF VICTIMS (SD)
3.0
AGE AT FIRST KNOWN OFFENCE (SD)
35.0
% PREVIOUS SEX CONVICTIONS
27
% PREVIOUS NON-SEXUAL CONVICTIONS
46
RISK OF RECONVICTION ALGORITHM6
1.0
ABUSE HISTORY
% SEXUALLY ABUSED
51
% PHYSICALLY ABUSED
33
VICTIM CHARACTERISTICS
AGE OF YOUNGEST VICTIM (SD)
10.0
% FEMALE VICTIMS
66
% MALE VICTIMS
21
% MALE + FEMALE VICTIMS
13
PERSONALITY TYPE7
% INHIBITED
24
% OVER-CONTROLLED
42
% PRIMARY PSYCHOPATH
16
% SECONDARY NEUROTIC
18
4
5
6
7
INTRA
50
(11.8)
(2.0)
(2.9)
(11.6)
96.5
5.2
2.3
33.5
20
56
1.0
(9.5)
(1.8)
(2.0)
(9.5)
52
40
(3.2)
10.1
84
6
10
22
48
12
18
EXTRA
BOTH
27
5
103.0 (13.9)
3.8 (2.0)
4.3
(4.2)
38.1 (14.5)
30
22
1.3
50
25
(3.2)
10.4
37
44
19
26
37
22
15
89.4
5.1
3.8
34.7
80
80
2.0
(11.9)
(2.4)
(2.9)
(11.8)
60
40
(3.1)
7.4
40
40
20
(3.9)
40
20
40
Of the five treatment drop-outs four were extrafamilial abusers and one was an intrafamilial abusers. So any pre-/post-comparisons are on 49 intrafamilial
offenders and 28 extra or extra + intrafamilial offenders.
SD Standard Deviation, an index of the spread of scores from the mean value. One SD each side of the mean accounts for approximately two-thirds of the sample,
two SDS account for 95% of the sample.
This IS a measure of level of risk of reconviction for a sexual offence (maximum = 3). The method for working out this risk or reconviction level is reported in
Appendix F.
As measured by the SHAPS (Special Hospital Assessment of Personality and Socialisation Questionnaire, Blackburn, 1982) described in Section 3.5.
43
It can be seen from Table 3.4 that:
• most of the child abusers were intrafamilial offenders (61% of the total sample);
• intrafamilial offenders were much more likely to have female victims;
• intrafamilial offenders were much more likely to have been convicted for a previous non-sexual offence
c o m p a red with ex t ra familial offe n d e rs, suggesting a more ge n e ral pattern of criminality in the
intrafamilial group.
• men who had committed both intra- and extrafamilial offences had higher ‘risk of reconviction’ scores
than intra- or extrafamilial offenders.
• most of the child abusers seen were over-controlled (as measured by the SHAPS questionnaire) – that is
to say they tended to be defensive, and tried to present themselves in a socially desirable way by denying
p ro blems and emotions such as anxiety, depression and anger. There were nearly twice as many
psychopathic men (again measured by the SHAPS questionnaire) in the extrafamilial sample compared
with the intrafamilial sample.
Non-offender sample
To improve the validity of the questionnaires used in the study (reported below in Section 3.5), they were given
to a large sample of men who were ‘non-offenders’, in order to determine what constitutes a range of nonoffending responses on the measures used8. This enabled comparisons to be made in terms of the level of
problems that child abusers reported compared with non-offenders. It also ena bled analysis of the cut-off point
to be calculated, where an individual could be considered to have moved from a ‘deviant’ to a ‘non-deviant’
response on a particular measure.
This sample consisted of a group of 81 newly recruited male prison officers who were in the third week of their
induction programme and who had not had any prior experience of working with prisoners. This sample was
regarded as representative of a cross-section of ‘normal’ non-offending males.
3.5.
MEASURES USED
Overview of measures used
All the programmes studied were based on a ‘cognitive-behavioural’ approach to treatment. This approach
targets a number of areas as important in the treatment of sex offenders, including promoting victim empathy,
reducing distorted thinking, reducing denial and minimisation, developing an awareness of the pattern of
o ffending, developing stra t e gies to deal with deviant arousal, developing altern a t i ves to offending and
developing the skills to cope appropriately with situations in which an offence is more likely to occur. In order
to evaluate the programmes’ effectiveness, measures were used that could detect change in each of the target
areas outlined below. They fell broadly into ‘primary treatment’ targets which are specifically focused on by the
core SOTP programme and ‘secondary treatment’ targets (more general aspects of dysfunctional personality)
which might not be specifically targeted but might be important in preventing the recurrence of offence
behaviours.
Admittance or denial of sexual interests and behaviours (primary treatment targets)
Scales to measure this area comprised: general admittance and openness of sex drives and interests (Multiphasic
Sex Inventory (MSI) Social & Sexual Desirability); admittance to fantasising, manipulation and coercion (MSI:
Sex Deviance Admittance); level of denial of victim harm, planning, future risk and overall denial (Sex Offence
Admittance Questionnaire); and level of sexual obsessions (MSI: Sexual Obsessions).
8
As reported in Beckett et al (1994).
44
Pro-offending attitudes (primary treatment targets)
Scales to measure this area comprised: distorted thoughts about sexual contact with children and children’s
sexuality (Children & Sex: Cognitive Distortions); level of denial of the impact of sexual abuse on victims
(Victim Empathy Distortions); level of fixation on children (Children & Sex: Emotional Identification); and
justifications for sexual deviance (MSI: Justifications).
Relapse prevention skills (primary treatment targets)
Scales to measure this area covered Awareness of risk situations, Generation of sensible strategies to deal with
such situations and Recognition of future risk (Relapse-Prevention Questionnaire).
Social competence (secondary treatment targets)
Scales covered self-esteem, emotional loneliness, under-assertiveness and inability to deal with negative
emotions (Personal Distress)
Acceptance of accountability for behaviours (secondary treatment targets)
Scales covered the extent to which a person feels he has control over his actions (Locus of Control), and
specifically his own offence behaviours (MSI: Cognitive Distortions and Immaturity).
A detailed personal history was also examined with each offender, to collect demographic details, including
offence history and own victimisation experiences, i.e. whether he had been sexually or physically abused.
As sex offenders are notorious for lying about their offending and trying to present themselves in the best
possible light (a process generally referred to as ‘faking good’ and used in that sense in the rest of this report), it
was considered vital to include measures which would indicate this. Thus a number of ‘lie scales’ and social
desirability measures were inserted in some of the scales used. In addition to indicating where subjects were
faking good the repetition of these measures indicated how reliable and consistent the subjects were in their
responses across pre- and post-testing. The importance of building-in such measures is discussed by Hanson,
Cox and Woszcsyna (1991).
Measures used in detail
Social Desirability Measure: Personal Reaction Inventory
In order to overcome the problem of response bias, this scale was devised. It is a 12-item scale based on items
f rom Gre e n wald and Satow (1970). Saunders (1991) describes a pro c e d u re for adjusting self-re p o rt
questionnaires for response bias using a measure of social desirability to calculate a true measure of responding.
No significant differences were found between child abusers and non-offending men using this measure in the
first STEP Study (Beckett, Beech, Fisher & Fordham, 1994).
I.Q. Measure: Ammons’ Quick Test
To obtain an estimate of each subject’s Intelligence Quotient the Ammons’ Quick Test (Ammons & Ammons,
1962) was used as it provides a fast and reliable IQ estimate.
Multiphasic Sex Inventory (MSI)
This is a 300-item questionnaire specifically designed to be used with sex offenders. Developed by Nichols and
Molinder (1984), it is divided into 20 scales which measure Sexual Deviance Admittance (Child Molest, Rape
and Exhibitionism), Treatment Attitudes, Social and Sexual Desirability, Sexual Obsessions, a Lie Scale, Cognitive
Distortions and Immaturity, Justifications, Paraphilias, Sexual Dysfunction, Sex Knowledge and Beliefs, and
Sexual History.
45
The following scales were found to be the most useful in the evaluation of community-based sex offender
treatment programmes (Beckett et al 1994):
MSI: Sex Deviance Admittance Scale (SDA)
This scale is based on the concept that a sex offender goes through an identifiable cognitive and behavioural
progression leading up to a sexual offence. The sex offender's cognitions follow a path, beginning with the
thought or fantasy of committing a sexual assault (antecedent thought), through a series of self-justifying
positions on to planning and executing the assault. His behaviour follows the same sequence, beginning by
stalking the victim (cruising), grooming, or preparing an opportunity for the sexual abuse, and finally assaulting
the victim. The SDA scale assesses the style, magnitude and duration of sexually deviant behaviour. The scale
has the following sub-tests measuring sexually deviant patterns: Fantasy, Cruising/Grooming, Sexual Assault,
Aggravated Assault, Victim's Gender (Gender Type) and Incest Type. Low scores on the scales are typical of
untreated sex offenders.
The standardisation sample of the SDA for child abusers was composed of 250 untreated paedophiles from state
hospitals and the community (Nichols & Molinder). Psychometric evaluation has high internal consistency
(Kalichman, Henderson, Shealy & Dwyer, 1992). In order to investigate the SDA’s constructive validity,
Henderson et a. compared it with other tests and it was found to correlate with self-esteem. The higher the SDA
score the lower the self-esteem score. They also found that SDA scores correlated with the age of youngest
victims. The higher the SDA score, i.e. the more deviant the offender, the lower the age of his youngest victim.
A significant improvement was found in SDA between pre- and post-treatment scores in a group of child abusers
by Beckett et al (1994). It has also been found that men who showed ‘a significant treatment effect’ sho wed
significantly more admittance to fantasy and cruising and grooming items between pre- and post-testing (Beech,
Beckett & Fisher, in press). The men that did not show a treatment effect did not show any change on the SDA
subscales in this study.
MSI: Lie Scale
The MSI contains a set of Lie Scales for Child Molestation, Rape and Exhibitionism. The Child Molester Lie Scale
correlates with clinical ratings of denial and minimisation (Simkins, Ward, Bowman & Rinck, 1989). Nichols and
Molinder (1984) found that child abusers and rapists who completed treatment scored lower on this scale
(admitted more deviance) than did an unselected group of untreated sex offenders. In the previous STEP study
a significant reduction in Lie Scale scores was found in child abusers attending treatment groups.
MSI: Cognitive Distortions and Immaturity scale (CDI)
This scale addresses the extent to which an offender adopts a victim stance in relationship to his present
offence, e.g. ‘In some ways I was used by the person who reported me’. As Hanson, Cox and Woszcsyna (1991)
noted, however, the items are quite heterogeneous. Simkins et al (1989) found that low CDI scores prior to
treatment predicted positive outcome in incest abusers. Miner, Marques, Day and Wilson (1990) and Walbek,
Haroldson and Johnson (unpublished) found CDI scores decreased during treatment.
MSI: Justifications Scale (Ju)
The Ju scale of the MSI is a 24-item scale containing various justifications that sex offenders may use to explain
their offences. Such justifications include blaming one’s offending upon external causes, for example, marital
problems, alcohol, life stresses or having been sexually abused as a child. The MSI Manual provides a mean and
standard deviation for 31 untreated sex offenders. Miner et al (1990) found that the Ju score decreased with
treatment and that treated child abusers had lower post-treatment scores than an untreated control group.
Walbek et a. found the Ju scores continued to reduce, but not at a statistically significant level, over a three year
in-patient treatment programme. Simkins et al (1989) found the scale weakly correlated with treatment
outcome and that it did not change with treatment. Beckett et al (1994) found that the Ju scale positively
correlated with the CDI scale of the MSI (p < 0.01), with the Victim Distortions scale described below (p <
0.05), and was inversely related to I.Q. (p < 0.05).
46
MSI: Sexual Obsessions
This scale has two aims – to measure an offender’s obsession with sex, and any tendency to exaggerate his
problem. It consists of a range of responses from no obsessions, or ‘fake good’, score (0–2) where the client
denies that he has any interest in sex, to a malingering, or ‘fake bad’, response set (17–20). Sex offenders who
are honest about their high interest in sex are expected to score in the expected deviant range (3–9). Clients
scoring in the (10–16) range are seen as being sexually obsessed, i.e. having difficulty controlling sexual
thoughts and impulses.
Special Hospitals Assessment of Personality and Socialisation (SHAPS)
For the purposes of describing the personality types of the sex offender sample this instrument wa s
administered pre-treatment. The SHAPS is a 213-item questionnaire developed by Blackburn (1982). It is divided
into ten scales: Lie, Anxiety, Extroversion, Hostility, Introversion, Depression, Tension, Psychopathic Deviate,
Impulsivity and Aggression. The scores can be used to identify four antisocial/asocial personality types:
Primary Psychopath, Secondary/Neurotic Personality, Over-controlled and Inhibited.
Self-Esteem Scale
This eight-item questionnaire devised by Thornton (unpublished) was used to measure self-esteem. Offenders
answer true or false to questions regarding how they feel about themselves; for example ‘Do you ever wish you
were someone else?’. Thornton (personal communication) reports the scale has high internal reliability
(Cronbach alpha 0.8) and that the scale correlates with, but is identifiably different from, the Neuroticism scale
of the Eysenck Personality Questionnaire (Eysenck & Eysenck, 1975). Results for the previous STEP study
(Beckett et al) found that low self-esteem positively correlated with I.Q. (p < 0.05) and length of time in
treatment (p < 0.05). It was also found (unpublished data) that this measure was just as sensitive to treatment
change as the more extensive Culture Free Self-Esteem Inventory (Battle, 1990).
Emotional Loneliness Scale
Sex offenders are frequently socially inadequate people, whose offending may partly be a response to their
inability to form appropriate relationships with adults. To measure possible social inadequacy the UCLA
(University of California, Los Angeles) Emotional Loneliness Scale (Russell, Peplau & Cutrona, 1980) was used.
The scale was derived to detect variations in loneliness that occur in everyday life. The offender was required to
indicate how often he feels in the way described by 20 statements, e.g. 'I am unhappy being so withdrawn'.
Russell et al report that the scale has high internal consistency (alpha = .94). Beckett et al reported that they
found that improvements in emotional loneliness correlated with treatment length (p < .05) and that clients
with high pre-treatment levels of denial did not improve in levels of emotional loneliness.
Assertiveness– Social Response Inventory
Sex offenders who molest children are often regarded as being under-assertive, while rapists are viewed as
aggressive. It was therefore seen as important to measure this aspect of offenders’ functioning. The Social
Response Inventory (Keltner, Marshall & Marshall, 1981) was used. This is a self-report questionnaire that
measures assertive behaviour in a variety of social situations. The questionnaire asks the subjects what they will
do in a given social situation (intention) and tests their knowledge as to what they believe they should do. The
i n s t rument consists of 22 situations, each accompanied by fi ve altern a t i ve responses, with ratings of
assertiveness from (–2), extremely under-assertive, to (+2), extremely over assertive. Marshall found that when
three independent judges were asked to rank each set by alternatives along an assertiveness dimension there
was 100 per cent concordance in their ratings. The scores give a measure of both Under-assertiveness and
Over-assertiveness. It has previously been found (Beckett et al. 1994) that it is only the Under-assertiveness
scale that is sensitive to treatment change and so this is the only one reported on in any depth in Chapter 4.
47
Empathy– Interpersonal Reactivity Index
Sex offenders’ ability to develop empathy is regarded as an important aim of therapy but it is not known if sex
offenders lack empathy generally or just in relation to their own victim(s). In order to look at this aspect the
Interpersonal Reactivity Index (IRI, Davis, 1980) was used. This is a 28-item questionnaire that measures four
components of empathy: Perspective Taking, Empathic Concern, Fantasy and Personal Distress. The value of
these subscales is in their ability to divide the generic term ‘empathy’ into its cognitive and emotional
components. Perspective Taking measures the ability to assume cognitively the role of the other. Empathic
Concern measures feelings of warmth, compassion and concern for another, and Fantasy addresses the ability of
the respondent to identify with fictional characters. Personal Distress addresses anxiety and negative emotions
resulting from feelings of distress of another. However, as Salter (1988) has observed, it is more accurate to view
this subscale as measuring an individual’s inability to cope with negative feelings, rather than to identify with
them per se. The results obtained in the previous STEP study (Beckett et al) show that child abusers differ
significantly from non-offenders in three ways. In particular they showed deficits in perspective taking and had
difficulty in coping with the negative feelings of others. These two characteristics may help explain their
clinically observed difficulties in recognising distress in the victims they assault. There was no overall treatment
effect, although there was a trend towards clients improving their confidence in coping with the negative
feelings of others, as measured by the Personal Distress scale. Hence it is this scale, out of the IRI, that will be
primarily reported upon in Chapter 4.
Locus of Control scale
This is a 40-item questionnaire developed by Nowicki and Strickland (Nowicki, 1976) which measures ‘the
extent to which subjects feel that events are contingent on their behaviour and the extent to which they feel
events are controlled externally’. It has been found (Fisher, Beech & Browne, 1998) that having an internal
locus of control after treatment is predictive of change on a number of measures measuring treatment success,
indicating that owning responsibility for one’s actions is an important component of change.
Children and Sex Scales
Sex offenders who offend against children tend to justify their behaviour by developing distorted beliefs about
children’s sexuality. Fixated sex offenders are also prone to have a high level of emotional identification with
children. Beckett (unpublished) developed two scales to measure these problems: a Cognitive Distortions scale
and an Emotional Identification scale. Twelve ‘lie items’ are also embedded in the questionnaire. These were
used to look at the reliability of answers across testing sessions (pre/post-treatment) as the responses on these
items were not expected to change during treatment. These items were also used in conjunction with the Lie
items on the SHAPS questionnaire and four items embedded in the Self-esteem questionnaire, to measure the
reliability of responding across the questionnaires on each testing session.
Children and Sex: Cognitive Distortions Scale
This is a 15-item scale designed to assess an individual’s beliefs about children and their sexuality. Questions are
scored on a four-point scale and include items such as ‘children can lead adults on’, ‘there is nothing wrong
with sexual contact between children and adults if the child agrees to it. (The scale has high internal reliability
(alpha 0.9) and a correlation coefficient of 0.7 with the Cognitive Distortion Scale of Marshall's Sex with
Children Scale, Thornton, personal communication.) High scorers on this scale depict children as sexually
sophisticated, interested in having sexual contact with adults and able to consent to and be unharmed by such
sexual contact. In the previous STEP study it was found that individuals with high scores had low empathy for
their own victims, as measured by the Victim Distortions Questionnaire (p < .01). It was also found that there
was a significant decrease in distortion score pre-test to post-test (p < .005). At post-treatment there was no
difference between child abusers’ scores and non-offenders on this measure.
Children and Sex: Emotional Identification Scale
This is a 15-item scale designed to measure the extent to which individuals can understand, relate to, and identify
with what they believe to be the thoughts, feelings and concerns of children. Moderate levels can be viewed as
normal, especially for parents, since it confers a sensitivity to children’s needs. However, relatively high and
48
relatively low levels have been found in child abusers as in the previous STEP study (Beckett et al 1994):
extrafamilial abusers, (usually with no children of their own) appeared emotionally as well as sexually fixated on
children and had significantly higher levels of emotional identification than non-offending men who were not
parents; in comparison, men who had abused their own children had significantly lower levels of emotional
identification compared with non-offending parents. This latter finding perhaps suggests that emotional withdrawal
from children makes it either easier to abuse or deal with the effects of the abuse on incest perpetrators’ own
children. Therefore, two a priori predictions of treatment effect emerge from this: extrafamilial men should show a
decrease in their level of emotional identification with children; and intrafamilial men should show an increase.
Victim Distortions Scale
In order to measure empathy for victims of sexual assault a questionnaire was devised by Beckett and Fisher
(1994) to gauge sex offenders’ views of the impact of their offending on victims. It is a 28-item scale and has
items about the extent to which offenders believe victims enjoy such sexual contact, encourage it, are able to
stop it, experience fear and guilt, and whether victims wish to have similar experiences in the future. Clients
complete questionnaires from the point of view of their own most typical victim. The scale has high internal
reliability (coefficient alpha = .9).
In the previous STEP study, it was found that child abusers, prior to treatment, had significantly less empathy for
victims of sexual abuse than a non-offending sample, while at post-treatment they were not significantly
different. Men who had abused outside the family, or who had abused both inside and outside the family, and/or
who had offended against high numbers of victims showed the least amount of empathy for victims. In
contrast, intrafamilial offenders, of fending primarily against girls, tended to have le vels of victim-empathy that
were not that different from a non-offending sample of men.
Sex Offence Attitudes Questionnaire
This is a 30-item questionnaire developed by Proctor (1994) which measures aspects of denial in sex offenders.
It is made up of four sub-scales measuring: Denial of Planning, Minimisation of Victim Harm, Denial of
Future Risk and Absolute Denial.
Relapse Prevention Questionnaire
This questionnaire was devised by Beckett, Fisher, Thornton and Mann (1997) to assess three areas. The first
covers the subjects’ awareness of thoughts and feelings which lead to offending, their willingness to admit to
planning, recognition of where an offence is most likely to occur and the characteristics of the victims they are
most likely to offend against. They are also asked about how other people might know that they were at risk of
re-offending and their motivation for offending. The second examines the strategies the offender would use to
cope with risk situations and deviant thoughts and feelings. A third section consists of a question about the
offender’s own perception of level of risk of re-offending. The data below are reported on these three sections:
Awareness of Risk Situations, Generation of Strategies and Recognition of Future Risk.
In the previous STEP study, 30 per cent of the clients in the sample were able to demonstrate some knowledge
of relapse-pr evention strategies at the post-test stage, with 18 per cent of the sample having scores that had
improved by at least one standard deviation as a result of treatment. When subjects were examined in terms of
whether they showed an overall treatment effect on the other measures outlined above, the ‘treated group’
showed a significant improvement (p < 0.05), whereas the ‘untreated group’ (24 men) did not.
Group Environment Scale (GES)
In order to obtain a measure of how both group leaders and offenders viewed the group, the GES was
administered towards the end of treatment. The GES is a 90-item questionnaire developed by Moos (1986)
which comprises ten scales. These are centred around three conceptual dimensions: relationship dimensions,
personal growth dimensions and system maintenance and system change dimensions. The GES can be used to
describe or to compare the social environments of group settings, to compare member and leader perceptions,
to compare actual and pre fe rred group milieus and to assess and to facilitate ch a n ge in group social
environments. More details of this measure can be found in Appendix D.
49
National Association for the Development of Work with Sex Offenders (NOTA) Database
This interview schedule was used to gather information about each offender, both from interviews with
offenders and from offenders’ files.
Treatment Attitudes Questionnaire (Core Programme Tutors Questionnaire)
This brief questionnaire, devised by Fordham (unpublished), was used to measure tutor attitudes towards the
Core Programme. It covered two broad areas: attitudes towards sexual offending and the personal impact of
working with sex offenders. The questionnaires were completed anonymously, but tutors were required to
provide brief details such as gender, whether they were parents, and the number of groups they had run.
Perception of the Core Programme (Probation Officers Questionnaire)
This questionnaire was completed by the external probation officers of men who had been released from
prison after they had completed the treatment programme. The questionnaire covered areas such as what they
thought of the SOTP programme, the information they received from the group leaders, their perception of the
benefits received by their clients and the level of risk they perceived their clients to pose after treatment.
Post-Prison Release Interview
This interview was carried out with men who had agreed to be seen in the follow-up stage of the research and
who had been released into the community. It was devised to make an assessment of an individual’s current
situation in terms of accommodation, relationships, recreational activities, personal support, openness about
their previous offence(s), perception of need of further therapy, and their level of optimism about the future. It
also included questions about their perceived level and quality of professional support from the Probation
Service, and their retrospective attitudes to the Core Programme.
Test-retest reliability of the measures
In order to assess the usefulness of measures developed by the STEP team for the assessment of treatment
change in sex offenders (Children and Sex Questionnaire; Victim Distortions Questionnaire) and where the testretest reliability of the measure has not been reported (Self-Esteem Scale; Social Response – Assertiveness
Inventory), the questionnaires concerned were administered to a group of 54 untreated child abusers who had
volunteered to take part in this part of the research. The tests were re-administered two months later to 47 men
who had agreed to complete the questionnaires again (follow-up rate of 87%). The test-retest reliability for these
measures is reported in Appendix C, Table C.3.
3.6.
PROCEDURE
In order to arrange data collection, each programme was initially visited by one of the team, to meet with
managers and group leaders and discuss the study. The forensic psychologist allocated to each programme then
arranged further visits as required in order to interview group leaders, to ‘sit-in’ on group sessions, to collect
i n fo rmation on the Treatment Attitudes Questionnaire and where possible to co llect pro gra m m e
documentation. Each group was visited three times,9 timed to coincide (where possible) with an introductory
session, an A–B–C session and a victim-empathy role play-session. The GES scale was administered to both
members and leaders of each group about a month before the end of treatment in order to measure the
environment of a mature group.
Men waiting to go on to a treatment group were approached individually and asked to participate. Subjects
were seen at both pre- and post-treatment and required to complete a number of questionnaires and to be
interviewed. Men who had finished the group were approached some months after the end of therapy and
asked if they would like to participate in the follow-up study. In a lot of cases, men had left prison and
arrangements were made via the individual’s probation officer to see them. This afforded the opportunity to ask
probation officers to fill out the Perception of the SOTP questionnaire10.
9
10
The information obtained in these visits is described in Chapter 2.
There was only one probation officer out of the group of 51 who refused to fill out the questionnaire.
50
All the men were seen by the research psychologist to ensure continuity. The initial, post and follow-up
interviews took approximately one hour and completing the questionnaires took on average (for the men) two
to three hours.
51
52
4. OBSERVATIONS AND FINDINGS
4.1.
ORGANISATIONAL ISSUES
Tutor training
Tutors generally reported favourably on the quality of training received during the two-week residential training
course. In 1994-95, during the course of the study, the training was changed to reflect the revised programme.
This introduced a more detailed analysis of sexual offending (‘offence chains’) to replace the original 'cycle of
offending' approach. The initial training for role-play in the victim-empathy module was also rather brief and
resulted in a number of tutors lacking the confidence to put all the elements of this module into operation. In
response, additional training was introduced.
Tutor commitment
The STEP team found universal commitment and enthusiasm from Core Programme tutors. There were many
accounts of tutors coming in on their days off, or extending their working hours, in order to ensure their
availability for the groups. Tutor commitment was also reflected in the amount of time they made available to
speak to men and offer individual support and counselling outside of the group-work. Although difficult to
quantify, this level of tutor commitment and sensitivity to the men's needs probably contributed to the very low
drop-out rate (5%) that was found in the groups examined. This high level of support may have also helped to
ensure the low rate of overt psychological problems in offenders participating in these emotionally powerful
and challenging treatment groups.
Experienced tutors were typically paired with a less-experienced tutor(s), which has helped to ensure that
inexperienced tutors have a chance to observe and selectively participate in treatment, while their confidence
and skills develop. Experienced tutors impressed the team in their ability to work in depth with men who
were, initially, often guarded, mistrustful, resistant and occasionally disruptive.
Impact of the work on tutors
A number of tutors drew attention to the personal impact which sex offender treatment work had upon them,
especially the stress arising out of the need to review their own personal sexual behaviour and attitudes, and
their behaviour as parents and partners. Treatment Managers (a role taken by prison psychologists) have an
important part to play in tutor support, particularly following highly charged, emotional group sessions, or
where tutors conflict in leadership styles (this issue has perhaps become more important with the advent of
role-plays during the victim-empathy module). At the start of the research, the team found variable levels of
support available to tutors. This improved as full-time psychologists were appointed to every prison running
the Core Programme. General support also appears to have increased as a consequence of more prison
governors receiving training in the nature of the Core Programme and its potential impact on tutors. Individual
counselling sessions have also been offered to all programme tutors, who are expected to attend at least three
such sessions during the course of a group.
Facilities
In a minority of prisons, facilities have not been of sufficient quality or availability. Provision of rooms which are
private and free from noise and interruption is particularly important given the material discussed during the
course of treatment. For example, in one establishment the prison tannoy system was disruptive, and in another
treatment sessions were cancelled because the room designated for the Core Programme had been doublebooked for a Discretionary Lifer Panel meeting. This caused considerable resentment amongst the programme
tutors, who felt the allocation of the room for another activity was symptomatic of the management’s lack of
support for the programme. Generally speaking, however, there have been no major complaints about the
facilities provided.
53
Management support
Tutors varied considerably in their perception of management's support. In some establishments tutors felt
well- supported and managed by senior staff, but in others tutors felt support (particularly at Governor 5 level)
was inadequate. Despite the va ri able level of perceived support by Governor Five grades, there appears a
consensus that most senior prison officers are supportive of their staff. It is likely that management support will
improve as it is realised that Key Performance Indicator (KPI) targets cannot now be met without treatment
programmes being accredited by the International Accreditation Panel.
Accreditation of the programme
The International Accreditation Panel consists of sexual offender treatment experts drawn from North America
and the UK. Its role has been to draw up criteria for accrediting the treatment programmes, and to evaluate the
extent to which prisons providing treatment meet the accreditation targets. Programmes are accredited along a
number of dimensions, including the quality of treatment, written outcome reports, tutor availability and
supervision, and management support. Prison governors cannot meet their KPI targets unless the programmes
run in their prisons reach these accreditation criteria. The panel meets twice-yearly, and in future it is intended
that panel members will visit prisons running the Core Programme to meet tutors and their managers.
Staffing problems
Problems caused by ‘Central Detailing’ produced more comment by tutors than any other single organisational
issue. Whereas in the past tutors were allocated to treatment programmes by (typically) senior officers on the
unit, the responsibility for allocating staff has shifted towards Central Detailing officers. This produced
disruption at a number of levels. In some prisons, trained tutors had been directed towards other duties, and in
at least one prison this resulted in a decline in the number of staff available to run the programme. Central
Detailing also resulted in some prison officers, allocated to the Core Programme, finding that they did not have
sufficient time to plan treatment sessions or debrief afterwards as they had to move rapidly on to other duties.
There was also a trend for staff having to extend their working hours, and to come in on their days off, to meet
their commitment to the programme. Some prison officer tutors at the time of the research were owed
significant amounts of time off in lieu – which could lead to problems of tutor morale in the long term.
4.2.
ANALYSIS OF THE SCALES USED IN THE RESEARCH
The pre-treatment data from the sample were combined with comparable data from a group of child abusers
who had undergone community-based treatment for sexual offending (from Beckett et al. 1994). This gave a
total sample size of 140 men. Factor analysis of the scales (reported in Chapter 3) found that they measured
three main areas1:
a. denial/admittance of offending behaviours;
b. distorted thoughts/justifications about offending;
c. level of social competence and accountability that might predispose to offending in the presence of prooffending attitudes.
Contrary to expectation the Children and Sex: Emotional Identification scale did not load on the same factor as
the other offence-related scales, but loaded on the denial/admittance factor. This result indicated that offenders
have to be very open about their level of offending before they will admit to levels of emotional identification
with children2.
1
2
The results of the factor analysis can be found in Appendix A Table A.1. The relapse prevention questionnaire was not included in the factor analysis as it had
been subject to extensive changes between the current and the Beckett et al study.
Separate analysis of the data found that there were stronger relationships between these measures in extrafamilial offenders compared to intrafamilial of fenders.
It might be expected that extrafamilial offenders would have higher levels of emotional identification with children than intrafamilial offenders, therefore the
result supports the idea put forward here.
54
4.3.
OVERALL EFFECTIVENESS OF THERAPY3
The tables below show the mean and standard deviation (SD)4 of the pre- and post-treatment scores on the main
scales used in the evaluation and whether these changes were statistically significant. Data from five men seen
at pre-treatment were not collected; three of these men were removed from the programme because of non-cooperation, one man left a group before the end of treatment and one man refused to take part in the posttreatment sta ge of the research. The figures in the second column of the tables are non-offender means and
SDs5, or recognised treatment limits on scales in the Multiphasic Sex Inventory (MSI, Nichols & Molinder, 1984)
or the Sex Offence Admittance Questionnaire (Proctor, 1994).
Changes in denial/admittance
An analysis car ried out on these measures, comparing pre- to post-treatment, found a significant overall change
in terms of less denial and more admittance at post-treatment (F(3/74) = 41.1, p < .0001)6. Table 4.1 shows the
results of univariate analyses of the scales within this main result.
TABLE 4.1:
DENIAL/ADMITTANCE MEASURES
MEASURES
PRE-MEAN
(SD)
POSTMEAN(SD)
DIRECTION OF CHANGE
TO TREATED PROFILE
SIGNIFICANT
CHANGE7
MSI: Sex Deviance
Admittance
50.1 (15.9)
55.4 (14.4)
POST > 50
YES
(10.3)**
MSI: Social & Sexual
Desirability
21.8 (8.1)
23.3 (8.7)
POST > 27
YES
(8.7)**
MSI: Lie8
8.0 3.6)
6.1 (3.4)
POST < 3
YES
(36.5)****
Sex Offence Admittance
Questionnaire
93.0 (16.9)
78.5 (18.0)
POST < 87
YES
(8. 7)****
MSI: Sexual
Obsessions
2.3 (2.6)
3.0 (4.4)
POST BETWEEN
3 and 9
NO
** p < .01
**** p <.0001
Table 4.1 shows that significant improvements were found in all of the denial/admittance measures except for
the Sexual Obsessions scale; however this does almost move into the ‘expected deviant’ range after treatment.
The scores on the Sex Deviance Admittance and the Sexual Offence Admittance scales show that at posttreatment the overall mean for the 77 men is within the range for ‘treated’ child abusers.
3
4
5
6
7
8
Full details of the analyses reported in this section may be found in Appendix A.
The SD of a measure gives an indication of the range of dispersion from the mean.
As reported in Appendix C Tables C.1 and C.2..
The main ef fects reported in this whole section were analysed using multivariate analyses of variance, where multiple pre– post-comparisons can be measured.
The ‘F’ value reported here is the ‘variance ratio’, i.e. the bigger the F the bigger the difference between the spread of scores due to the variability in subjects’
responses and the spread of scores due the experimental manipulation (in this case comparing pre and post-test results).
Any significant effects reported in this column in Tables 4.1 to 4.5 are the results of univariate F-tests within the main multivariate analyses. The figures brac keted
in this column are the value for F for the associated measure.
About sexual interests
55
Change in pro-offending attitudes
An analysis carried out on the pro-offending attitude variables, pre- to post-treatment, found a significant
decrease in pro-offending attitudes (F(3/74) = 41.1, p < .0001). Table 4.2 shows the results of the univariate Ftests within this analysis.
TABLE 4.2:
PRO-OFFENDING ATTITUDES
MEASURES
NONOFFENDER
MEAN (SD)
PRE-MEAN
(SD)
POST-MEANS- DIRECTION OF CHANGE
(SD)
TO SHOWMEAN (SD)
IMPROVEMENT
SIGNIFICANT
CHANGE
Cognitive
Distortions
13.1 (8.8)
15.4 (10.9)
8.4 (8.9)
POST < PRE
YES
(6.1)****
Victim
Distortions
18.0 (9.6)
39.5 (23.7)
16.5 (16.7)
POST < PRE
YES
(10.9)****
MSI: Justifications
TREATMENT
LIMITS < 2
4.9 (4.4)
3.7 (4.1)
POST < PRE
YES
(3.0)**
** p < .01 **** p < .0001
It can be seen from Table 4.2 that all the pro-offending attitude measures show significant improvements in the
right direction (i.e. decreasing). Attention should also be drawn to the shifts in the Cognitive Distortions and
Victim Distortions measures, with post-treatment scores being lower than those found in non-offenders.
Changes in social competence/accountability
An overall analysis carried out pre/post on the variables found a highly significant improvement on the social
competence/acceptance of accountability measures (F(6/71) = 4.0, p < .01). Univariate F-tests within this main
result are reported in Tables 4.3 and 4.4.
TABLE 4.3:
SOCIAL COMPETENCE/ACCOUNTABILITY
MEASURES
NONOFFENDER
MEAN (SD)
PRE-MEAN
(SD)
POST-MEANS DIRECTION OF CHANGE
(SD)
TO SHOWMEAN (SD)
IMPROVEMENT
SIGNIFICANT
CHANGE
SelfEsteem
7.1 (1.4)
4.2 (2.5)
4.8 (2.6)
POST > PRE
YES
(5.4)*
Emotional
Loneliness
33.8 (7.0)
43.6 (10.6)
42.7 (11.8)
POST < PRE
NO
Underassertiveness
8.8 (5.4)
11.5 (7.4)
10.0 (6.8)
POST < PRE
YES
(4.8)*
Personal
Distress
7.5 (3.8)
11.8 (5.7)
10.1 (5.7)
POST < PRE
YES
(6.8)*
* p < .05
It can be seen from Table 4.3 that all the social competence measures, apart from the Emotional Loneliness
scale, show significant improvements and all move in the right direction: Self-Esteem significantly increases and
Under-assertiveness and level of Personal Distress significantly decrease. However, it should be noted that
56
overall post-treatment mean scores on Self-Esteem still lower than the non-offender mean score and the Underassertiveness, Personal Distress and Emotional Loneliness scores are a lot higher than the non-offender means.
As for the lack of change on the Emotional Loneliness measure, if there had been a significant change this may
have suggested that as a group these men were becoming more emotionally intimate with, perhaps, the other
sexual offenders in the group. Although it may not be seen as being a positive change for men in prison to
become less emotionally lonely due to the fact that they only have other sexual offenders to relate to, it is to be
expected that having spent time together on a group and having got to know the tutors well, they would be
more likely to feel that they had others who they could turn to, who they could trust and who they felt
understood them, and to whom they could talk and perhaps confide. It is not necessarily a bad thing for an
individual to experience the positive side of developing friendships as these are skills that will be needed in the
future. The level of emotional loneliness experienced may be complicated by the situation changing once the
group has ended, where group members perhaps have less access to each other and less opportunities to talk
to each other. They therefore lose the closeness and security of the group and hence experience more
loneliness and isolation.
TABLE 4.4:
ACCEPTANCE OF ACCOUNTABILITY
MEASURES
NONOFFENDER
MEAN (SD)
PRE-MEAN
(SD)
POST-MEANS DIRECTION OF CHANGE
(SD)
TO SHOWMEAN(SD)
IMPROVEMENT
SIGNIFICANT
CHANGE
Locus of
Control
11.0 (5.6)
14.8 (5.1)
13.4 (5.8)
POST < PRE
YES
(7.1)**
MSI: Cognitive
Distortions
& Immaturity
TREATMENT
LIMITS < 4
6.2 (3.4)
5.7 (3.2)
POST < PRE
YES
(5.3)*
* p < .05 ** p < .01
It can be seen from Table 4.4. that the acceptance of accountability measures were found to show a significant
change as measured by both scales, again both moving in the right direction, i.e. decreasing. Again it should be
noted that the mean post-treatment score on the Locus of Control measure is still well above that found in the
non-offender sample and the post-treatment mean score on the MSI: Cognitive Distortions and Immaturity scale
is above the ‘acceptable range of accountability’ for this measure.
Changes in emotional identification
This measure was treated separately because of the different predictions for intrafamilial and extrafamilial
offenders in terms of treatment effects. An overall analysis was carried out on the data with pre/post change as
one factor in the analysis and type of abuse (intra- or extrafamilial) as the other factor. This analysis found a
marginally significant difference between intra- and extrafamilial abusers (F(1/70) = 3.7, p = 0.55) in that
intrafamilial abusers had lower mean levels of emotional identification with children at both pre- and posttreatment than extrafamilial abusers9, no other significant differences were found. Table 4.5 shows comparisons
between intra- and extrafamilial offenders pre- and post-treatment. Non-offender comparisons are also given
where the non-offending comparison groups for the extrafamilial offenders were men without children, and the
comparison group for intrafamilial offenders were men with children.
9
As per Beckett et al 1994s findings
57
TABLE 4.5:
EMOTIONAL IDENTIFICATION WITH CHILDREN
N
NONOFFENDER
MEAN (SD)
PRE-MEAN
(SD)
POST-MEANS DIRECTION OF CHANGE
(SD)
TO SHOWMEAN (SD)
IMPROVEMENT
SIGNIFICANT
CHANGE
Intrafamilial
49
23.4 (11.4)*
12.0 (10.1)
11.6 (10.7)
POST > PRE
NO
Extrafamilial
28
16.1 (9.3)**
18.0 (14.4)
15.7 (12.6)
POST < PRE
NO
* parents ** non-parents
It can be seen from Table 4.5. that intrafamilial abusers stayed at the same low level of emotional identification
prior to, and after, treatment. In comparison, extrafamilial offenders and those that had committed intra- and
extrafamilial offences10 had higher levels of emotional identification than the control sample prior to treatment,
but this moved as predicted (although not significantly) to within the normal range after treatment.
Changes in relapse prevention knowledge
The data below are reported on the three sections concerned with measuring treatment change in relapse:
Awareness of Risk Situations (maximum score 18); Generation of Stra t e gi e s11 (maximum score 16); and
Recognition as Future Risk (maximum score 2). Table 4.6 shows the results for these three areas.
TABLE 4.6:
RELAPSE PREVENTION KNOWLEDGE
AREAS
COVERED
PRE-MEAN
(SD)
POSTMEAN(SD)
DIRECTION OF CHANGE
TO SHOWMEAN IMPROVEMENT
SIGNIFICANT
CHANGE (T)12
Awareness of
Risk Situations
5.8 (4.9)
11.9 (4.8)
POST > PRE
YES (11.8)****
Generation of
Effective Strategies
5.6 (4.3)
10.8 (4.0)
POST > PRE
YES (11.1)****
Recognition of
Future Risk
0.5 (0.8)
0.7 (0.9)
POST > PRE
YES (3.0)**
** p < .01
**** p <.0001
It can be seen from Table 4.6 that relapse-prevention skills showed significant improvements in the right
direction (i.e. increasing), in terms of Awareness of Risk Situations and Generation of Effective Strategies and
Recognition of Future [Potential] Risk. Offenders also saw themselves significantly more of a potential risk after
treatment than before treatment. This latter result can also be seen as an improvement, in that offenders
appeared to be more aware that treatment is not a cure, but provides effective strategies to prevent relapse.
4.4. LENGTH OF TREATMENT AND EFFECTIVENESS OF THERAPY
Men undergoing shorter- (N = 40) and longer-term treatment (N = 37) were compared in terms of the measures
reported above. Analysis of the levels at which men started found no overall statistical dif ference between the
scores of the men in the shorter and men in the longer-term groups, suggesting that any changes observed were
10
11
12
Men who have committed both intra- and extrafamilial offences have been assigned to the extrafamilial category as their pre-treatment level of emotional
identification broadly corresponds to extrafamilial cases, plus, in the case of four of the five men who had ‘crossed over’, their intrafamilial offences were against
step-children.
To deal with risk situations.
The statistic used was a ‘T’ test, which in this case measures whether the means of two related samples (i.e. data from the same men pre- and post-treatment)
differ significantly. The larger the ‘T’ value the more likely that the difference is significant
58
the result of the different treatment deliveries rather than inter-group differences. The results, in terms of
producing pre-post changes for the different measures, are shown in Table 4.7 where a ‘+’ indicates a significant
change.
TABLE 4.7:
CHANGE IN SHORTER AND LONGER GROUPS
Deviance Admittance
Social & Sexual Desirability
Lie
Offence Admittance
Sexual Obsessions
Cognitive Distortions
Victim Distortions
Justifications
Self-Esteem
Emotional Loneliness
Under-assertiveness
Personal Distress
Recognition of Risk
Generation of Strategies
SHORTER
LONGER
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Table 4.7 shows that both the shorter- and longer-term groups were effective in producing significant change
on nearly all of the measures concerned, with the shorter groups being marginally better at producing change
in the Self-Esteem and Assertiveness measures pre- to post-test, than longer-term groups. The longer term
groups can be seen to be better at producing change in the Denial/Admittance measures.
4.5.
LONG-TERM FOLLOW-UP
Men who had finished treatment were contacted and asked to fill out the questionnaire battery again, on
average nine months (range eight to 11 months) after the end of treatment. The follow-up rate here was 79 per
cent13; of the 56 child abusers who agreed to be seen, 32 were still in prison and 24 had been released. It was
found that, overall, the treatment changes found pre- to post-treatment held up over this time period. However,
c o n t rasts between men still in prison and men who had been released showed that the latter had go t
significantly worse in their relapse-prevention skills (both in terms of awareness and strategies), although these
had not returned to the levels found prior to treatment. Further investigation found that this effect was
confined to men who had undergone shorter therapy, indicating that the longer programme appears to have
greater impact in terms of instilling effective relapse-prevention techniques. In-depth results of this component
of the study are reported in Appendix A.
4.6.
IDENTIFICATION OF ABUSER GROUPS BY DEVIANCE AND DENIAL
The lar ge spread of scores for the pro-offending attitude measures found at the pre-treatment stage of testing
suggested that offenders started with differing kinds of problems. Therefore the data were analysed in order to
see whether there were meaningful subgroups of abuser. The pre-treatment data from the sample were
combined with comparable data from a group of child abusers who had undergone community-based treatment
for sexual offending (from Beckett et al. 1994). This gave a sample size of 140 men.
Analysis of the psychometric data
In order to assess that the sample was not simply responding in a socially approved way the data from the test
battery were adjusted for ‘social desirability response bias’ (SDRB; Saunders, 1991)14. SDRB occurs when
individuals give answers in order to make a good impression. Saunders suggests that SDRB is more likely to
13
14
This percentage is 56 out of a possible 71 men, as the second Littlehey group (containing six child abusers) took 14 months to finish. Because of the time
constraints of the research it was not possible to see these men after a further nine months had elapsed.
The procedure for adjusting the data is described in full in Appendix B.
59
occur when an individual has behaved in a socially unacceptable way, such as being angry or aggressive. He also
suggests that if SDRB is taken into account, a truer level of a person’s endorsement of interpersonal violence
attitudes can be measured.
The main va ri ables were entered into a cluster analysis, a statistical technique which enables cases to be
grouped in terms of underlying similarities. Four groups were identified. These were clearly differentiated in
terms of:
•
levels of pro-offending attitudes and social competence/acceptance of accountability personality (deviancy);
•
and level of denial/admittance of offence behaviours (denial).
The four groups were termed:
HIGH DEVIANCE/LOW DENIAL
HIGH DEVIANCE/HIGH DENIAL
LOW DEVIANCE/LOW DENIAL
LOW DEVIANCE/HIGH DENIAL
Table 4.8 shows the mean scores for the four groups on the measures used.
TABLE 4.8:
GROUPS IDENTIFIED BY DEVIANCE AND DENIAL
Non-offender mean and SD or
acceptable limits after treatment*
NUMBER IN GROUP
DENIAL/ADMITTANCE
MSI: Sex Deviance Admittance (> 50)*
Social & Sexual Desirability (< 27)
Lie (< 3)*
Offence Admittance (< 88 extrafamilial;
< 83 intrafamilial)*
Sexual Obsessions (3–9)*
PRO-OFFENDING ATTITUDES
Cognitive Distortions (13.1, SD 8.8)
Victim Distortions (18.0, SD 9.6)
Justifications (< 2)*
SOCIAL COMPETENCE
Self-Esteem (7.1, SD 1.4)
Emotional Loneliness (33.8, SD 7.0)
Under-assertiveness (8.8, SD 5.4)
Personal Distress (7.5, SD 3.8)
ACCOUNTABILITY
Locus of Control (11.0, SD 5.6)
Cog. Dis. & Immaturity (< 4)
EMOTIONAL IDENTIFICATION (19.0)
HIGH
DEVIANCE/
LOW DENIAL
41
HIGH
DEVIANCE/
HIGH DENIAL
10
LOW
DEVIANCE/
LOW DENIAL
LOW
DEVIANCE/
HIGH DENIAL
54
35
63.8
22.1
4.6
77.8
33.0
21.8
11.3
105.9
55.8
26.6
6.1
82.7
36.6
16.8
10.6
100.5
6.6
1.7
2.0
1.4
22.8
40.0
7.4
23.0
48.3
10.0
9.9
28.8
3.6
14.3
31.3
3.2
3.0
51.7
17.5
13.9
5.9
44.4
11.1
9.2
4.5
41.1
8.5
10.6
4.8
43.7
12.1
13.6
19.9
10.4
29.3
16.5
7.3
14.6
12.2
4.5
13.4
16.5
5.9
9.2
60
As regards the four categories, the following can be seen from Table 4.8.
HIGH DEVIANCE/LOW DENIAL men were relatively open about their offending, but exhibited high levels of
distorted thoughts about children (Cognitive Distortions), distorted thoughts (about their victims) and little
empathy for their victims (Victim Distortions), and high levels of Emotional Identification (with children).
These men also had low social competence as evidenced by their low Self-Esteem and high Under-assertiveness
and Emotional Loneliness scores. They also showed little accountability for their actions either in a general
sense (Locus of Control) or about their own offending (their score on the MSI: Cognitive Distortions &
Immaturity scale placing them in the ‘character disturbance/victim stance category’ on this measure).
HIGH DEVIANCE/HIGH DENIAL men had levels of Cognitive Distortions and Victim Distortions scales that
were equivalent to HIGH DEVIANCE/LOW DENIAL men, but were in a high level of denial about their level of
deviance and their offending behaviours. They also appeared to over-report their level of social competence as
their score on Self-Esteem was much higher than the other groups, and their reported levels of Emotional
Loneliness and Under-assertiveness on the associated scales were equivalent to both of the low deviancy
groups. To check whether these men were really over-reporting their level of social competence, they were
rated as on their level of social adequacy, using a revised version of Knight and Prentky’s (Knight, Carter &
Prentky, 1989) system for the classification of social competence in child abusers15. The method used here
employed data from a structured interview gathered as part of the research. It was found that eight of the ten
men in this group were classified as low social competence, suggesting that the social/affective adjustment in
nearly all of the group was actually quite poor, in tending to over-report their level of social competence on the
psychometric measures. They also appeared to under-report their Emotional Identification (with children), as
the score on this measure was roughly equivalent to the LOW DEVIANCE/LOW DENIAL group.
LOW DEVIANCE/LOW DENIAL men had scores that were significantly lower than the high deviance groups on
both the pro-offending and social competence measures (although these scores were still a lot higher than
those found in the non-offender sample). The only exception to this pattern was their mean score on the
Emotional Identification (with children) measure, which was significantly lower than the non-offender sample.
LOW DEVIANCE/HIGH DENIAL men in this group, while denying their level of offending behaviours, had
scores on the rest of the measures that were broadly similar to the LOW DEVIANCE/LOW DENIAL group.
Evidence for the validity of the categories
Data from of fence histories were used to provide external validity for the clusters of offenders identified in the
analyses. These offence indices were:
a. number of victims;
b. any convictions for previous sexual offences;
c. whether an offender had been convicted of offences against female, male or both male and female victims.
d. whether an offender had been convicted of intrafamilial, extrafamilial or both intra- and extrafamilial
offences;
e. any convictions for violent offences;
f. four or more preconvictions for (serious) non-sexual offences.
15
In order to rate as high social competence an individual has to meet two of the four following criteria: had a single job for more than three years; a sexual
relationship with an appropriate partner involving cohabitation for at least one year; evidence of significant responsibility in parenting a child for three or more
years; been an active member in an adult-oriented organisation for at least a year. There is a fifth criteria in the original system; however, this was found very
difficult to validate – had a friendship with an adult not involving marriage or cohabitation lasting at least one year – so this was not used
61
62
These criteria were chosen because they can be established from official records and indicate the breadth and degree
of sexual offending16. Data from these offence histories comparing the deviancy cases are shown in Table 4.9.
Comparison of LOW DEVIANCY/LOW DENIAL and LOW DEVIANCY/HIGH DENIAL men
No dif ference was found between the low deviancy groups in terms of number of victims and sex of victim,
with both groups having offended mainly against girls. A significant difference was found between these two
groups in terms of whether the offences were inside or outside of the family (Goodman-Kruskal Tau (T) 17 = 5.8,
p < .05) with LOW DEVIANCY/HIGH DENIAL men, as a group, having committed relatively more extrafamilial
or extrafamilial plus intrafamilial offences than the LOW DEVIANCY/LOW DENIAL men.
Comparison of HIGH DEVIANCY/LOW DENIAL and HIGH DEVIANCY/HIGH DENIAL men
No differences were found between the high deviancy groups in terms of sex of victim or familiarity and
whether they had been convicted of a previous sexual offence, although there was a significant differences
between the mean number of victims in the two groups, with the HIGH DEVIANCY/LOW DENIAL men having
a significantly higher number of victims (t(40.4) = 2.6, p < .05) compared with HIGH DEVIANCY/HIGH
DENIAL men. This result was due to the men in the latter group who had: only been convicted for offences
against a single victim, even though there were a number of further allegations about them; offended abroad;
offended against one victim for a number of years; spent a considerable number of years in prison.
Comparing deviancy categories
Table 4.10. shows a comparison between all the HIGH DEVIANCY/LOW DENIAL and HIGH DEVIANCY/HIGH
DENIAL men combined into one High deviancy category and all of the LOW DEVIANCY/LOW DENIAL and
LOW DEVIANCY/HIGH DENIAL men combined into one Low deviancy category.
TABLE 4.10:
COMPARISON OF DEVIANCY BY OFFENCE CHARACTERISTICS
NUMBER IN GROUP
IQ
AVERAGE NUMBER OF VICTIMS
CONVICTION FOR A PREVIOUS SEX. OFFENCE (%)
INTRAFAMILIAL OFFENCES (%)
EXTRAFAMILIAL OR EXTRA + INTRA (%)
FEMALE VICTIMS (%)
MALE OR MALE + FEMALE VICTIMS (%)
INTRAFAMILIAL OFFENCES AGAINST GIRLS (%)
HIGH
LOW
51
99.3
6.9
41
39
61
39
61
24
89
101.0
2.7
26
70
30
74
26
62
It can be seen that comparisons of the type and nature of the sexual convictions of the groups in terms of
deviancy (collapsing across denial) showed the following:
• High deviancy men had two and a half times as many victims and were nearly twice as likely to have been
convicted of a previous sexual offence compared with low deviancy men. They were also twice as likely to
have committed offences against boys or both boys and girls, and twice as likely as low deviancy men to
have committed offences outside or outside and inside of the family.
• Low deviancy men were nearly twice as likely to have female victims and twice as likely to have committed
intrafamilial offences compared with high deviancy men. In fact the low deviancy sample were three times
more likely to have committed of fences against daughters and/or stepdaughters within the family than high
deviancy men.
16
17
Criteria c). and d). were of interest, as crossovers in terms of committing offences against own and others peoples’ children and having molested both boys and
girls were, together with molesting both children and adolescents and committing ‘hands on’ offences, highly predictive of treatment dropouts, reported by
Abel, Mittleman, Becker, Rathner & Rouleau (1988). While criteria a), b), e), and f) were used a part of a risk of reconviction algorithm (Fisher & Thornton,
1993, see Appendix F for further details).
A statistical measure of the difference in frequency of the occurrence of these behaviours between the groups
63
This conve rgence of deviancy found in both the psych o m e t ric data and the offence data in terms of
distinguishing high and low deviancy men shows the utility of this method. However, it is important to point
out that over one-third of the high deviance sample had been convicted of offences within the family,
suggesting that it cannot be automatically assumed that all intrafamilial offenders will be less deviant than
extrafamilial offenders.
4.7.
CATEGORIES OF DEVIANCE WITHIN THE PRISON SAMPLE
Table 4.11. shows the prison sample of 82 child abusers by the four derived categories. It can be seen from this
table that the biggest category were LOW DEVIANCY/LOW DENIAL men (39%). Because of the small number of
HIGH DEVIANCY/HIGH DENIAL men (7) this category is collapsed into an overall HIGH deviancy category
with the HIGH DEVIANCY/LOW DENIAL men in the subsequent analyses.
TABLE 4.11:
Channings Wood 1
Channings Wood 2
Littlehey 1
Littlehey 2
Risley 1
Risley 2
Usk 1
Usk 2
Wayland 1
Wayland 2
Whatton 1
Whatton 2
TOTAL
DEVIANCY BY GROUP
HIGH DEVIANCY
LOW DENIANCY.
HIGH DEVIANCY
HIGH DENIANCY
LOW DENIANCY
LOW DENIANCY
LOW DEVIANCY
HIGH DENIANCY
1
3
2
1
1
1
0
2
1
3
1
1
1
1
1
1
1
1
1
-
3
3
3
2
2
5
1
0
5
2
4
2
3
3
2
2
2
2
3
2
1
2
1
3
17
7
32
26
There were five treatment drop-outs between pre- and post-treatment phases: two LOW DEVIANCY/HIGH
DENIAL, two HIGH DEVIANCY/LOW DENIAL, one HIGH DEVIANCY/HIGH DENIAL. Therefore the data
reported in Section 4.8. in terms of deviancy categories are on: 32 LOW DEVIANCY/LOW DENIAL men; 24
LOW DEVIANCY/HIGH DENIAL men; and 21 HIGH DEVIANCY/(HIGH and LOW DENIAL) men.
4.8.
TREATMENT EFFECTIVENESS, DEVIANCY AND LENGTH OF TREATMENT18
This section is concerned with the 77 men in the prison sample who completed the post-tre a t m e n t
questionnaires. Recent work on the nature of change in psychotherapy outcome research (see Hanson &
Lambert, 1996, for a review) is used in the present study to assess whether clients have shifted significantly in
their attitudes as a result of the treatment programme. The way of assessing clinical change is to (a) work out a
cut-off point between normal and dysfunctional responding 19 on the measure concerned and (b) to decide, if an
individual crosses the cut-off point, whether that change is reliable20.
This methodology is restricted to the measures that have non-offender means and SDs21. These measures fall
into two main categories:
18
19
20
21
The full details of the analyses reported in this section can be found in Appendix C.
The cut-off point is defined when a score on a particular scale crosses from a dysfunctional to a functional level. The cut-off points were worked out in the
following way:
cut-off =
(SD 1)(MEAN 2) + (SD 2)(MEAN 1)
SD1 + SD2
where SD1 and MEAN1 are from 81 non-offenders (Beckett et al., 1994) and MEAN2 and SD2 from 106 untreated child abusers.
Here any pre – post change is significant if the reliability change index (RC) is greater than 1.64 for a one-tailed test. The method of calculating RC is as follows:
RC = (post-treatment) – (pre-treatment)
*SE
*SE = SD √(1 – rxx)
{where rxx = the test-retest reliability of the measure}
So it is not possible to look at the denial/admittance measures or the relapse-prevention measure in this way.
64
Pro-offending attitudes as measured by the following scales: Cognitive Distortions – about children; Victim
Distortions and Emotional Identification with children22. These scales measure the attitudes held by child
abusers which support their offending behaviour. Lack of empathy for the victim, and distorted thinking
regarding the effects of abuse, blaming external sources or minimising the seriousness of their behaviour are all
examples of the way in which sex offenders attempt to justify their offending and thus lessen their guilt (or
feelings of responsibility).
Social competence/acceptance of accountability (as measured by the following scales: Self-Esteem, Emotional
Loneliness, Under-assertiveness, Personal Distress and Locus of Control). These measures cover the areas of
social functioning reported to be lacking in many child abusers. As previously discussed many child abusers
appear to have low self-esteem, are emotionally lonely and isolated, are under-assertive and have difficulties
coping with their own emotional distress, and report little personal accountability for their actions. Such
individuals can be regarded as having low social competence/acceptance of accountability.
The scoring for each measure was worked out as follows:
• a score of one was given if there was a clinically significant change pre- to post-test on the measure
concerned, i.e. the score after treatment was within the cut-off for the measure concerned and the amount
of change was greater than the reliability change index (RC);
• if the offender’s score prior to treatment on a particular measure was already within the non-offending range
of responding at the pre-treatment phase of testing, a score of one was given;
• if no clinically significant change had occurred, a score of zero was given on the particular measure;
• a score of minus one was given to an individual who had become worse, on a particular measure, by having
a score that deteriorated by greater than the RC amount for a particular measure pre- to post-treatment, or
who still had a score outside of the cut-off point on the emotional identification measure after treatment.
Deriving a score for reduction in pro-offending attitudes
Here the score on the Cognitive Distortions, Victim-Empathy and Emotional Identification (with children)
measures were added together. The total score that could be obtained here was three. A significant reduction in
pro-offending attitudes was judged to have taken place if an offender had achieved a score of at least two on the
pro-offending attitudes measures. The score of minus one given to somebody who still had high levels of
emotional identification after treatment made sure that somebody was not classified as treated, even if they had
changed significantly, on the other two measures.
Deriving a score for an overall treatment effect
First an individual must have had a score of at least two on the pro-offending attitudes measures. The scores for
the social competence/ acceptance of accountability measures (Self-Esteem, Under-assertiveness, Emotional
Loneliness, Pe rsonal Distress and Locus of Control) we re then added toge t h e r. The total score for the
improvements on the social competence/acceptance of accountability measures was out of five. An overall
treatment effect was defined as taking place if an offender had achieved a score of at least three on the social
competence/acceptance of accountability measures, plus a score of least two on the pro-offending attitudes
measures. It is of note that pro-offending attitudes relate to the cognitive aspects of offending, while social
competence/acceptance of accountability relates more to the behavioural aspects. Thus, effective treatment
must target both the cognitions that support offending and pro-of fending attitudes and the behavioural skills to
develop appropriate relationships and social competence.
22
This measure is included in the pro-offending attitudes as an a priori assumption. The measure was found to load with the denial/admittance scales in the factor
analysis reported in Appendix A. However it appears that this measure is susceptible to faking. This is illustrated by the finding that in extrafamilial men (who ar e
more likely to be emotionally fixated on children) there were strong correlations between this measure and the MSI: Lie scale (r = -0.6, p < .001), the Sex Of fence
Attitudes questionnaire (SOAQ, r = -0.4, p < .01) and the MSI: Sex Deviance Admittance scale (r = 0.7, p < .001); whereas in intrafamilial offenders the
relationship between emotional identification and these measures was a lot lo wer (MSI: Lie scale, r = 0.2, non-significant; SOAQ, r = -0.2, non-significant; MSI: Sex
Deviance Admittance scale, r = 0.2, non-significant).
65
No treatment effect was judged to have taken place even if an offender’s scores did not meet the criteria
outlined above.
Treatment effects in the total sample
Table 4.12 summarises the overall treatment changes and/or pro-offending treatment changes by pre-treatment
deviancy levels.
TABLE 4.12:
TREATMENT EFFECTS BY PRE-TREATMENT DEVIANCY LEVELS
N
LOW DEVIANCY/
LOW DENIAL
LOW DEVIANCY/
HIGH DENIAL
HIGH DEVIANCY
TOTAL SAMPLE
REDUCTION IN
PRO-OFFENDING
ATTITUDES
OVERALL
TREATMENT
EFFECT
NO
TREATMENT
EFFECT
32
27
(84%)
19
(59%)
5
(16%)
24
17
(71%)
4
(17%)
7
(29%)
21
77
9
53
(43%)
(69%)
3
26
(14%)
(34%)
12
24
(57%)
(31%)
It can be seen from Table 4.12 that 53 men showed an offence-specific treatment effect, 26 showed an overall
treatment ef fect and 24 showed no treatment effect at all23. The section below discusses the possible reasons
why these men did not respond to treatment.
• LOW DEVIANCY/LOW DENIAL Here treatment was generally effective; over 80 per cent of this sample
exhibited a reduction in pro-offending attitudes and approximately two-thirds showed an overall treatment
effect. Only 12 per cent of this sample showed no treatment effects.
• LOW DEVIANCY/HIGH DENIAL Here over two-thirds of this category showed a reduction in pro-offending
attitudes but only one-fifth showed an overall treatment effect.
• HIGH DEVIANCE here Just over 40 per cent showed a reduction in pro-offending attitudes, with only 14
per cent showing overall treatment effect.
Factors affecting treatment success
Of the 24 men who did not respond to treatment as measured by the clinical change method reported above,
two main factors appear to account for most of the treatment failures.
• L evel of deviance prior to tre a t m e n t Twenty-one men were classified as HIGH DEVIANCY prior to
treatment; of these only nine responded to treatment. It has been found in the current and previous research
by the team that this type of child abuser is the most difficult to treat and that treatment success is related to
length of therapy. In terms of treatment failures, eight were in shorter programme (73%), four were in the
longer programme (failure rate 40%). Perhaps if these men had been on longer groups then more might have
responded to treatment.
• Emotional Identification Seven men were classified as LOW DEVIANCY/HIGH DENIAL prior to treatment.
Inspection of the data in these cases reveals that the level of emotional identification reported by four of
these men changes from a ‘fake good’ (i.e. a very low level prior to treatment) to an extremely high level
after therapy. Of the five men classified as LOW DEVIANCY/LOW DENIAL, who were treatment failures,
three showed big increases in emotional identification with children through treatment. Again, these results
may be due to the men becoming more honest about their level of identification with children. It may also
be the case that such men have not felt that they have made progress in treatment and as a result have felt
more isolated and cut off from their peers, which in turn has led to an increase in their identification with
children.
23
It is also of interest that ten of these men were still in quite high levels of denial as measured by the MSI: Sex Deviance Admittance measure. This was due to them
still disputing the actual extent of their offences.
66
Table 4.13 shows treatment success by personality type (as measured by the SHAPS questionnaire, Blackburn,
1982).
TABLE 4.13:
TREATMENT SUCCESS BY PERSONALITY TYPE
PERSONALITY TYPE
% TREATMENT SUCCESS
PRIMARY PSYCHOPATHS
SECONDARY NEUROTIC PERSONALITY
INHIBITED
OVER-CONTROLLED
58
69
63
78
It can be seen from Table 4.13 that ‘over-controlled’ men show the greatest treatment response, ‘primary
psychopaths’ show the lowest rate. Interestingly psychopathy might also be block to treatment as it was
observed in Chapter 2 that one very psychopathic man had a detrimental effect upon that particular group,
which was also found not to be a very cohesive group and produced treatment change in just 35 per cent of its
members (see section 4.10).
Treatment effects by length of therapy
Here comparisons were made of treatment effectiveness in the shorter groups (average length of treatment 84
hours) and longer groups (average length of treatment per man 80 sessions or 160 hours) and pre-treatment
deviancy levels. The results of this analysis are shown in Table 4.14.
TABLE 4.14:
TREATMENT EFFECTS IN SHORTER AND LONGER GROUPS BY
PRE-TREATMENT DEVIANCY LEVELS
N
SHORTER GROUPS
LOW DEVIANCY/
LOW DENIAL
LOW DEVIANCY/
HIGH DENIAL
HIGH DEVIANCY
TOTAL
LONGER GROUPS
LOW DEVIANCY/
LOW DENIAL
LOW DEVIANCY/
HIGH DENIAL
HIGH DEVIANCY
TOTAL
REDUCTION IN
PRO-OFFENDING
ATTITUDES
OVERALL
TREATMENT
EFFECT
NO TREATMENT
EFFECT
18
15
(83%)
11
(61%)
3
(17%)
11
7
(64%)
1
(9%)
4
(36%)
11
40
3
25
(27%)
(63%)
2
14
(18%)
(35%)
8
15
(73%)
(37%)
14
12
(86%)
8
(57%)
2
(14%)
13
10
(77%)
3
(23%)
3
(23%)
10
37
6
28
(60%)
(76%)
1
12
(10%)
(32%)
4
9
(40%)
(24%)
It can be seen from Table 4.14 that the longer groups and shorter groups were about the same in producing
change in LOW DEVIANCY/LOW DENIAL men. Longer groups were somewhat better at producing a reduction
in pro - o ffending attitudes in the LOW DEVIANCY/HIGH DENIAL men, and over twice as successful at
producing reductions in pro-offending attitudes in HIGH DEVIANCY men.
In terms of an overall treatment effect, the longer groups were about the same in terms of producing change in
LOW DEVIANCY/LOW DENIAL men. Both the shorter and the longer groups produced little overall change in
the LOW DEVIANCY/HIGH DENIAL and the HIGH DEVIANCY men suggesting, that these men are a very
67
difficult group to treat. This difficulty in treating HIGH DEVIANCY men in residential programmes such as the
Gracewell Clinic and the Wolvercote Unit (see Section 4.9) where they performed at about the same level in
producing reduction in pro-offending attitudes as the core SOTP programme, but do somewhat better in terms
of producing change in secondary treatment targets.
Analysis of data – removing men who feel into the treated range prior to therapy
In the analysis reported of the 13 men who were within the treatment limits on at least two of the three offence
measures prior to therapy, nine were LOW DEVIANCY/LOW DENIAL (all intrafamilial abusers), and four were
LOW DEVIANCY/HIGH DENIAL (two intrafamilial, two extrafamilial abusers). These were counted as treated
cases in terms of reduction of pro-offending attitudes. All 13 scored very low on the emotional identification
measure before and after treatment. The data from these men were included in the previous analyses for the
following reasons.
a. There was significant overall improvement shown on the Children and Sex: Cognitive Distortions measure
pre- to post-test (t = 4.5, p <.001; average score pre-test = 4.9 (3.7); average score post-test = 2.5 (3.9)) in
these men, with 12 showing an improvement and one reporting zero distortions pre- and post-test24.
b. There was significant improvement shown on the Victim-Empathy Distortions measure pre- to post-test (t =
5.7, p <.0001; average score pre-test = 12.1 (5.7); average score post-test = 6.3 (3.8)) in these men, with ten
showing an improvement, two remaining at the same low level of distortions as at pre-test, and one
reporting zero distortions at pre- and post-test.
When these cases were removed and the data re-analysed a similar pattern of results occurred in terms of
reduction in pro-offending attitudes, with the LOW DEVIANCY/LOW DENIAL showing a 78 per cent success
rate and the LOW DEVIANCY/HIGH DENIAL men showing a 65 per cent success rate. Obviously none of the
HIGH DEVIANCY men were removed for having scores on the measures that were within the cut-off point at
pre-treatment, as they would not have been initially categorised as ‘high deviancy’.
When the men who were within the ‘treated limits’ on the offence-related measures were removed from the
analysis the results for longer and shorter groups are as in Table 4.15.
TABLE 4.15:
TREATMENT EFFECTS BY GROUP AND PRE-TREATMENT
DEVIANCY LEVELS
N
SHORTER GROUPS
LOW DEVIANCY/
LOW DENIAL
LOW DEVIANCY/
HIGH DENIAL
HIGH DEVIANCY
TOTAL
LONGER GROUPS
LOW DEVIANCY/
LOW DENIAL
LOW DEVIANCY/
HIGH DENIAL
HIGH DEVIANCY
TOTAL
24
REDUCTION IN
PRO-OFFENDING ATTITUDES
NO TREATMENT
EFFECT
13
10 (77%) [5 men removed]
3
(23%)
10
6 (60%) [1 man removed]
4
(40%)
11
34
3 (27%)
19 (56%) [6 men removed]
8
15
(73%)
(34%)
10
8 (80%)[4 men removed]
2
(20%)
10
7 (70%) [3 men removed]
3
(30%)
10
30
6 (60%)
21 (70%) [7 men removed]
4
9
(40%)
(30%)
This man (classified as LOW DEVIANCY/HIGH DENIAL prior to treatment) also reported zero victim-empathy distortions and low emotional identification with
children, suggesting he may have been faking on all of the offence-related measures.
68
Again it can be seen that the pattern of results across deviancy categories and length of treatment as shown in
Table 4.14. holds up.
Long-term treatment gains in ‘successfully treated’ versus ‘unsuccessfully
treated’ men
Evidence for the effectiveness of therapy was found when the long-term follow-up (nine months after the end
of treatment) relapse-prevention (RP) questionnaire results were examined. Table 4.16 shows comparisons
between the scores for the Recognition of Risk Situations, Generation of Strategies (to cope with risk situations)
and Recognition of Future Risk scales for men who showed clinical significant change on the pro-offending
attitudes measures compared with those who did not.
TABLE 4.16:
COMPARISON OF GROUPS ON RELAPSE-PREVENTION SUB-SCALES
BASELINE (SD)
POST (SD)
FOLLOW-UP
TREATED (N = 36)
AWARENESS
STRATEGIES
RISK
6.1
5.9
0.4
(5.0)
(4.6)
(0.8)
12.7
11.4
0.6
(4.4)
(4.1)
(0.8)
12.8
11.7
0.5
(4.3)
(3.6)
(0.8)
UNTREATED (N = 13)
AWARENESS
STRATEGIES
RISK
7.1
6.1
0.7
(6.2)
(5.4)
(0.9)
12.2
11.4
1.1
(4.7)
(3.7)
(1.0)
10.3
7.8
1.1
(4.8)
(4.4)
(1.0)
CHANGE (t)
NO
NO
NO
YES
YES
(2.3)*
(3.5)*
N
* p < .05
Statistical analysis found that the untreated sample got significantly worse in terms of both awareness of risk
situations and generation of strategies (to deal with such potential risk situations). In comparison, the men that
showed a reduction in pro-offending attitudes and/or an overall treatment change did not show any change in
level from the post-test stage of testing to the long-term follow-up25.
These results indicate that the untreated cases had shown an initial acquisition of relapse-prevention skills
during treatment but had lost these by the time the nine-month follow-up testing took place, while men whose
pro-offending attitudes had changed also retained their relapse-prevention skills when measured at long-term
follow-up.
Relapse-prevention gains in ‘treated men’ by length of therapy
Further analysis looked at whether the treated and untreated samples had been through longer or shorter
groups. The results of this analysis are shown in Table 4.17 for the treated men and Table 4.18 for the untreated
men.
25
Comparisons between the groups found that the untreated group had lo wer scores on both the recognition of risk situations and generation of strategies scales
compared to men who showed an overall treatment ef fect at long-term follow-up (awareness: t = 2.3, p < .05; strategies: t = 3.7, p < .01); significant differences
were also found between the untreated men and those who showed reductions in pro-offending attitudes (awareness: t = 1.7, p < .05 {one tail}; strategies: t = 2.8,
p <.05), whereas no difference was found between these groups immediately after treatment.
69
TABLE 4.17:
RELAPSE-PREVENTION PERFORMANCE IN TREATED MEN IN
SHORTER AND LONGER GROUPS
SHORTER (N = 16)
BASELINE (SD)
AWARENESS
STRATEGIES
RISK
5.4
5.6
0.3
(6.2)
(5.5)
(0.6)
12.1
11.4
0.6
(5.3)
(4.2)
(0.9)
12.2
10.9
0.4
(4.5)
(4.0)
(0.8)
NO
NO
N
6.6
6.1
0.5
(4.8)
(3.9)
(0.9)
13.2
11.4
0.6
(3.4)
(4.2)
(0.8)
13.2
12.3
0.6
(4.2)
(3.2)
(0.7)
NO
NO
NO
POST (SD)
FOLLOW-UP
CHANGE (t)
LONGER (N = 20)
AWARENESS
STRATEGIES
RISK
Although these differences were not statistically significant, it can be seen from Table 4.17 that treated men
who had been through a longer group had slightly higher levels of RP skills (in terms of awareness and
strategies) at both post-treatment and long-term follow-up.
TABLE 4.18:
RP PERFORMANCE IN UNTREATED MEN IN SHORTER AND
LONGER GROUPS
SHORTER (N = 7)
BASELINE (SD)
AWARENESS
STRATEGIES
RISK
6.1
5.6
1.0
(6.2)
(5.5)
(1.0)
9.9
9.3
1.0
(4.9)
(3.5)
(1.0)
8.1
5.6
1.0
(4.4)
(3.9)
(1.0)
8.2
6.7
0.3
(6.7)
(5.7)
(0.8)
15.0
13.8
1.2
(2.5)
(2.2)
(1.0)
12.8
10.5
1.2
(4.2)
(3.4)
(1.0)
POST (SD)
FOLLOW-UP
CHANGE (t)
YES
NO
(2.3)*
NO
LONGER (N = 6)
AWARENESS
STRATEGIES
RISK
YES
YES
(2.1)*
(2.5)*
NO
* p < .05
Although it should be noted that the results in Table 4.18 are from very small sample sizes, it can be seen that
there is a deterioration at nine months whether men have been on longer or shorter groups. However, it is
important to note that untreated men who had been on the longer groups had much higher RP scores after
treatment, in fact equivalent to those found in treated men who had been through a shorter group (as shown in
Table 4.17). Significant differences between longer and shorter groups in both Awareness (post-test: t = 2.4, p <
.05; nine-month follow-up: t = 1.97, p < .05, one-tailed test) and Strategies (post-test: t = 2.9, p < .05; ninemonth follow-up: t = 2.4, p < .05) suggest that the longer groups were able to instill a better level of RP skills in
the untreated men than shorter groups.
4.9.
COMMUNITY SAMPLES OUTCOME DATA COMPARED WITH THE
CORE PROGRAMME
Here, child abuser data from the previous team’s research (Beckett et al. 1994) on the effectiveness of
community-based treatment programmes were re-analysed and compared with data from the prison project,
using the methodology reported in Section 4.8.
In the Beckett et al study, 32 child abusers who had completed a short probation-based programme and 20 men
who had undergone a long period of treatment at the Gracewell Clinic (a residential centre for the treatment of
child abusers) were seen. More recent data are also included on 25 men from the Lucy Faithfull Foundation’s
70
residential unit for the treatment of child abusers (Wolvercote Unit26). Here the residential treatment centre men
(average 462 hours of group therapy per man for the Gracewell Clinic and an average of 765 hours of group
therapy per man for the Wolvercote Unit) were compared with the longer groups (average 160 hours of group
therapy per man), and the probation groups (roughly 60 hours of group therapy) were compared with the
shorter groups (average 80 hours of group therapy).
Residential treatment compared with the longer Core Programme
Of the 45 men seen at the residential centres 18 (40%) were classified as LOW DEVIANCY/LOW DENIAL 27
(60%) were classified as HIGH DEVIANCY and none were classified as LOW DEVIANCY/HIGH DENIAL. Table
4.19 shows the comparisons in terms of treatment effectiveness between long-term treatment at the residential
centres and the longer Core Programme groups.
TABLE 4.19:
TREATMENT EFFECTS BY PRE-TREATMENT DEVIANCY LEVELS IN
LONGER GROUPS
DEVIANCY/
DENIAL GROUP
TREATMENT
DELIVERY
N
LOW DEVIANCY/
LOW DENIAL
RESIDENTIAL
18
14
14
12
(78%)
(86%)
13
9
(72%)
(64%)
4
2
(22%)
(14%)
RESIDENTIAL
LONGER CORE
27
10
13
6
(48%)
(60%)
7
1
(26%)
(10%)
14
4
(52%)
(40%)
HIGH
DEVIANCY
REDUCTION IN
PRO-OFFENDING
ATTITUDES
OVERALL
TREATMENT
EFFECT
NO
TREATMENT
EFFECT
From Table 4.19 the following can be seen by comparing across deviancy categories.
LOW DEVIANCY/LOW DENIAL The longer core prison programme and the residential centres are roughly
comparable in terms of producing a reduction in pro-offending attitudes (86% compared with 78%) .
HIGH DEVIANCY The residential centres do two and a half times better in producing an overall treatment
effect than the longer core prison programme (26% compared with 10%).
These results suggest that the longer Core Programme groups and the residential treatment programme wer e
roughly equivalent at reducing pro-offending attitudes in both LOW and HIGH DEVIANCY men. But the
residential programme was better at producing an overall treatment ef fect in HIGH DEVIANCY men. It should
be borne in mind that the Core Programme does not currently target le vel of social competence; therefore it
should not be expected that this programme would be as effective in producing an overall treatment change.
Probation compared with the shorter Core Programme
Thirty-two men were seen on six probation groups: 13 (41%) were classified as LOW DEVIANCY/LOW DENIAL;
13 (41%) were classified as HIGH DEVIANCY six (19%) were classified as LOW DEVIANCY/HIGH DENIAL.
Table 4.20 compares men who had been in probation programmes with the shorter Core Programme groups,
by pre-treatment deviancy level..
26
A report on the current status of the Wolvercote Unit is included in this report as Appendix G
71
TABLE 4.20:
DEVIANCY/
DENIAL GROUP
TREATMENT EFFECTS BY PRE-TREATMENT DEVIANCY LEVELS
TREATMENT
DELIVERY
N
REDUCTION IN
PRO-OFFENDING
ATTITUDES
OVERALL
TREATMENT
EFFECT
LOW DEVIANCY/
LOW DENIAL
PROBATION
SHORTER CORE
13
18
7
15
(54%)
(83%)
5
11
(39%)
(61%)
6
3
(46%)
(17%)
LOW DEVIANCY/
HIGH DENIAL
PROBATION
SHORTER CORE
6
11
2
7
(33%)
(64%)
1
1
(17%)
(9%)
4
4
(67%)
(36%)
HIGH
DEVIANCY
PROBATION
SHORTER CORE
13
11
2
3
(15%)
(27%)
1
(9%)
11
8
(85%)
(73%)
ALL
PROBATION
SHORTER CORE
32
40
11
25
(34%)
(63%)
6
13
(19%)
(33%)
21
15
(66%)
(37%)
–
NO
TREATMENT
EFFECT
Comparing across deviance categories the following was found.
LOW DEVIANCY/LOW DENIAL The shorter Core Programme groups were a lot better at producing reductions
in pro-offending attitudes compared with the probation groups (83% against 54%) and in producing an overall
treatment effect (61% against 38%).
LOW DEVIANCY/HIGH DENIAL The shorter Core Programme groups were a lot better at producing reductions
in pro-offending attitudes compared with the probation groups (64% against 33%) and but not as good in
producing an overall treatment effect (9% against 17%).
HIGH DEVIANCY The shorter Core Programme groups were a lot better at producing reductions in prooffending attitudes compared with the probation groups (27% against 15%) and somewhat better at producing
an overall treatment effect (9% against none).
These results suggest that the shorter Core Programme groups were better at producing reductions in prooffending attitudes in all three deviancy categories and somewhat better (overall) in producing an overall
treatment effect.
4.10.
INVESTIGATION OF THE CLIMATE OF THE GROUPS
There has not been a great deal of research about the processes in operation within sexual offender treatment
p ro grammes, although it has been found in the team’s previous research (Beech & Fordham, 1997) that
treatment groups that are cohesive, well-organised and well-led, with encouragement of desirable group norms
by leaders and the instillation of hope, are more effective than those that do not possess these characteristics.
Measurement of group processes
The instrument used was the Group Environment Scale (GES; Moos, 1986). The GES contains a number of subscales that describe, and can be used to compare, the overall climate of different groups. Because of the large
number of groups examined by Moos and his colleagues, each of the ten GES sub-scales have been
standardised, enabling interpretation of group profiles. The scales of the GES are as follows:
1. Cohesion measures the members’ group involvement and commitment to the group and concern and
friendship they show for each other;
2. Leader-Support measures the help and friendship shown by group leaders;
3. Expressiveness measures the extent to which freedom of action and expression of feelings are encouraged
in the group;
72
4. Independence measures the encouragement of independent action and expression;
5. Task-Orientation assesses the emphasis placed on practical tasks and decision-making in the group;
6. Self-Discovery assesses the extent to which the group encourages members’ revelations and discussions of
personal information;
7. Anger and Aggression measures the tolerance of open expression of negative feelings and inter-member
disagreement;
8. Order and Organisation measures the structure of the group and explicitness of its rules;
9. Leader-Control measures leader direction and enforcement of the group’s rules;
10.Innovation measures leaders’ encouragement of change in group activities.
These scales assess the following dimensions of group atmosphere: relationships within the group (Scales 1 to
3); personal growth of group members (Scales 4 to 7); and system maintenance and system change (Scales 8 to
10).
The GES was administered to all groups about a month before the end of treatment in order that a mature group
could be measured.
Results of the group processes measure
Eighty-eight GES forms were filled in anonymously27 by members and 35 forms were filled in by leaders. Analysis
of the data was concerned with comparing how members’ and leaders’ perceptions of the groups differed, the
differences there might be between groups and how that related to treatment outcome, how leadership style
affected group processes, and what constituted a successful group.
An overall analysis was carried out on the data which found significant differences between members and
leaders (F(10,90) = 3.6, p < .001), indicating that members and leaders perceived their groups differently.
Further analysis found significant differences on three scales: Independence; Leader Control; and Order and
Organisation (F(1,99) = 7.4, p < .01). The results suggest that the leaders saw themselves as more controlling
than members; that they saw the groups as better organised than did members; and that they saw themselves as
promoting more independent activity in members than members did themselves.
Significant differences were also found between the groups (F(110/990) = 2.0, p < .0001), indicating different
climates across groups. Further analysis found that this effect was due to significant differences on eight scales:
Anger; Expressiveness; Innovation; Leader Control; Leader Support; Self-Discovery; and Task-Orientation. The
only scales where no significant differences were found were; Independence and Order and Organisation,
suggesting that these were very tightly structured groups.
27
This was in order to get the most honest opinions from members about their respective groups. The downside to this was that it was not possible to identify
group members who had finished a group but did not fill in the questionnaire. Refusals took place on four groups: Channings Wood 1 – one refusal (13%);
Channings Wood 2 – four refusals (50%); Wayland 2 – one refusal (13%) Whatton 1 – two refusals (25%).
73
74
Each group’s profile can be found in Appendix D; the profile of each combined group score was calculated as
being LOW, MEDIUM or HIGH on each of the eight significant GES scales.28 Table 4.21 shows the results for
each scale across all 12 groups. It can be seen from this table that:
Leader-Support, Task-Orientation and Self-Discovery was medium or high in all groups;
Cohesion was generally high in all groups except Usk 1 and Whatton 2 where it was low;
Expressiveness was medium or high in all groups except Risley 2, Usk 1, and Whatton 2 where it was low;
Independence and Innovation was medium or high in all groups except Littlehey 2, Usk 1, Whatton 1 and
Whatton 2 where it was low;
Leader-Control was seen as medium or high in all groups except Risley 2;
Anger and Aggression was low in most groups, only reaching a medium level in four groups: Channings Wood
1, Littlehey 1, Usk 1 and Whatton 2.
Overall these results suggest that most of the groups were perceived to be highly cohesive, very task-orientated
and encouraged group members to disclose. Leaders we re perc e i ved to be highly support i ve of gro u p
members. However, most groups were also seen to have high level of leader-control, which was in contrast to
the team’s previous findings (Beech & Fordham, 1997) where a medium level was found in the more successful
groups. The main exceptions to this pattern were Usk 1 and Whatton 2 where low scores were found on a
number of the dimensions, suggesting some difficulties in these groups (see Chapter 2 for observational data
concerning these groups).
Group climate and treatment effectiveness
Group climate variables were looked at separately and in combination to see how predictive they were of
treatment success (as described in Section 4.8). However, there were several confounding variables that had to
be considered in this analysis.
• Length of treatment, where it has been previously reported that longer groups were slightly more effective
at producing treatment change than shorter groups. For the offence-specific change, the overall success rate
was 76% in the longer groups and 63% in the shorter groups).
• Level of deviancy prior to treatment.
In order to take these potentially confounding effects into account the shorter groups, level of treatment
success was adjusted29 to take into account that longer groups showed greater overall treatment change.
Deviancy was taken into consideration by giving a weighting according to the different levels treatment change
in the HIGH DEVIANCY, LOW DEVIANCY/HIGH DENIAL and LOW DEVIANCY/LOW DENIAL men30.
It was found that Cohesiveness as reported by group members was the best predictor of treatment success
across the 12 groups (Spearman’s rs = .71, p <.01). The relationship between Cohesiveness and treatment
success is clearly indicated in the following tables: Table 4.22. shows the rank order of Cohesiveness and the
rate of treatment success for the shorter groups; and Table 4.23 shows the rank order for the longer groups, of
Cohesiveness by treatment success.
28
29
30
In order to do this data from the groups were converted into standardised T scores (mean = 50, SD = 10) on the basis of group norms provided in the GES manual
(Moos, 1986, Appendix A). A low score indicates that the mean score on the variable of interest is at least half a standard deviation below the mean (i.e., below
45), a medium score indicates that the score is between 46 and 55, a high score indicates that the score is at least half a standard deviation above the mean (i.e,
above 55).
Multiplied by 1.2, to take into account 76 per cent compared to 63 per cent success rates in the longer versus shorter groups respectively.
Instead of this just being the percentage of child molesters successfully treated in the group, the lower percentage of change, in terms of reduction in prooffending attitudes, in the HIGH DEVIANCY and the LOW DEVIANCY/HIGH DENIAL men, compared to the LOW DEVIANCY/LOW DENIAL was taken into
consideration . This was achieved by giving: a value of 1.0 to all LOW DEVIANCY/LOW DENIAL men; a value of 1.3 in the shorter groups and 1.1 in the longer
groups to the LOW DEVIANCY/HIGH DENIAL men; and a value of 3.1 in the shorter groups and 1.4 in the longer groups to the HIGH DEVIANCY men (from
Table 4.14). The total score for the men who showed treatment change was then added together and divided by the total score for the group.
75
TABLE 4.22:
TREATMENT SUCCESS BY COHESIVENESS IN THE SHORTER GROUPS
WHATTON 1
WHATTON 2
LITTLEHEY 1
LITTLEHEY 2
WAYLAND 1
WAYLAND 2
TABLE 4.23:
% TREATMENT
SUCCESS
1
2
5
6
9
12
85
71
60
36
34
41
TREATMENT SUCCESS BY COHESIVENESS IN THE LONGER GROUPS
CHANNINGS WOOD 1
CHANNINGS WOOD 2
RISLEY 2
USK 1
USK 2
RISLEY 1
4.11.
RANK ORDER OF
COHESIVENESS
RANK ORDER OF
COHESIVENESS
% TREATMENT
SUCCESS
3
4
7
8
10
11
100
72
75
35
78
40
POST-RELEASE INTERVIEW OF CLIENT SAMPLE
Of the 100 men assessed in this study, 60 had been released from prison after undertaking the Core Programme.
Of these, 4131 agreed to be seen in the community (68% follow-up rate). Men were reassessed, on average, 9.2
months after the end of treatment (range eight to 11 months), except for the Littlehey 2 men who were seen at
post-test in the community - the average time since their release was 6.0 months (range one to 12 months).
The purpose of the post-release interview was to determine the men’s living circumstances, their level of social
and probationary support, their attitudes to the Core Programme, whether they had received any further
t reatment and, import a n t ly, the extent to which they had told others about their offending, and their
confidence in remaining offence-free in the future.
Domestic circumstances
The men’s current living circumstances at the time of interview are shown in Table 4.24.
TABLE 4.24:
CURRENT LIVING ARRANGEMENTS (N = 41)
CATEGORY
N.
%
ALONE
NEW PARTNER NO CHILDREN
NEW PARTNER WITH CHILDREN
ORIGINAL RELATIONSHIP VICTIM NOT PRESENT
ORIGINAL RELATIONSHIP VICTIM PRESENCE NOT KNOWN
ORIGINAL RELATIONSHIP VICTIM PRESENT
ORIGINAL RELATIONSHIP OTHER CHILDREN PRESENT
GAY RELATIONSHIP
LIVING WITH OTHER MEN (HOSTEL SITUATION)
LIVING WITH MOTHER
EXTENDED FAMILY
21
5
1
4
2
1
1
1
2
2
1
51
12
2
10
5
2
2
2
5
5
2
31
Of this sample 25 child abusers, four rapists and one crossover (rapist and child molester) completed the long-term follow-up interview and five men from the
second delayed Littlehey group completed the post-testing in the comm u n i t y. Six men declined to complete the questionnaires (all nine-month
follow-up men) even though they had agreed to be interviewed.
76
Table 4.24. shows that just over half the men released were living alone at the time of post-prison assessment.
The remaining men were living in a wide variety of situations. Twenty per cent (8) had returned to their
original relationship, and of this group, one was living with his original victim. In a further two cases it was not
clear whether the victim was still living with the offender.
Social support
Table 4.25. shows the mens’ perceived level of social support.
TABLE 4.25:
PERCEIVED LEVEL OF SOCIAL SUPPORT
CATEGORY
N
%
LONELY
SOME SUPPORTIVE FAMILY MEMBERS
A FEW ACQUAINTANCES (NO CLOSE FRIENDS)
SOME CLOSE FRIENDS/ LOTS OF FRIENDS
0
3
14
24
0
7
34
59
None of the men assessed described themselves as feeling lonely, though just over one-third said they had no
close friends, only acquaintances. The largest group, however, 58 per cent (24) described themselves as having
the support of at least some close friends, if not many.
Sexual relationships
Table 4.26. shows status of the samples’ relationships at the time of testing.
TABLE 4.26:
RELATIONSHIPS
CATEGORY
N.
%
CURRENT SEXUAL RELATIONSHIP
NO SEXUAL RELATIONSHIP CURRENTLY
NO SEXUAL RELATIONSHIP SINCE RELEASE
17
17
7
41
41
17
Under one-fifth of the men said they had not been in a sexual relationship since their release from prison.
Eighty-three per cent of the men (34) had re-established some sexual relationships since their release. Of this
latter group, half were in a sexual relationship at the time of the reassessment, and half were not.
Offence disclosure
The principles of relapse-prevention suggest that those closest to a treated sexual offender should, at a
minimum, be told of his offences, and more preferably be given details of his relapse-prevention plan. In this
way they are in a position to monitor the offender, exercise appropriate caution, and protect vulnerable others.
Consequently offenders at post-release were asked who knew or had been told about their offending, and who
they believed ought to know in order to help them remain offence-free in the future. Table 4.27 shows the
number of other people who knew about the offender’s offences at the time of testing.
TABLE 4.27:
OTHERS KNOWLEDGE OF OFFENDER’S OFFENCES
CATEGORY
N.
%
NOBODY
PROFESSIONALS ONLY
IMMEDIATE CIRCLE (PARENTS/ FRIENDS)
MOST PEOPLE KNOWN TO OFFENDER
0
2
22
17
0
5
54
41
77
Table 4.27 shows that just over 40 per cent said that most people known to the offender knew about their
offences, while just over half said that their immediate circle were aware of their conviction. A small number
said that only ‘professionals’ knew about their offences.
Seven of the men were, at the time of reassessment, living with new female partners and all but one said their
partner was aware of their conviction. Whilst this is encouraging, clinical experience suggests that the validity
of this self-report cannot be taken for granted and should be cross-checked with partners. Interestingly, whilst
all men living with new partners indicated their partners knew about their previous offences, two of them
believed that only professionals needed know the details of what they had done. All bar two of the offenders
claimed that they had family members, friends or acquaintances who knew of their previous offences, with
only two saying they were in a situation where only professionals knew of their previous history.
Subjects were also asked to rate their optimism about staying offence-free in the future. Ten men (24%) said
they were hopeful, but anticipated difficulties in the future, with a further 34 per cent saying they were ‘pretty
confident’ about their ability to cope. The largest group, 17 men (41%), said they were very confident about
coping in the future, and none of the men disclosed being highly pessimistic.
Further treatment on release
Of the 41 men released from prison who were interviewed, 28 were child abusers who had completed
treatment. It is this group which is now discussed. Given the cost of sexual offender group treatment, the
psychological profiles of men after they had finished the Core Programme, and any relationship to the offer of
further treatment by the Probation Service post-release, was examined. The results of this analysis are shown in
Table 4.28.
TABLE 4.28:
FURTHER TREATMENT SINCE RELEASE
SIGNIFICANTLY TREATED ON
PRO-OFFENDING ATTITUDES
OFFERED FURTHER TREATMENT
ON RELEASE
N
% TREATED
CASES
YES
YES
YES
YES
NO
NO
GROUP TREATMENT
MAINTENANCE GROUP
INDIVIDUAL WORK
NO
YES
NO
12
1
5
4
3
3
55
4
23
18
0
0
28
100
TOTAL
The following can be seen from Table 4.28.
• Within the group of 28 child abusers interviewed who had completed the programme, 22 (79%) had
finished the Core Programme with treated profiles. Of this group, just over half (12) were subsequently
offered a place on a community-based sexual offender treatment programme. This finding raises the
question as to whether such an expensive resource was best targeted on these individuals. Also it should be
noted that three of these men had started to get worse in terms of their relapse-prevention strategies at the
nine-month follow-up and so needed some further treatment.
• Six men had been released from prison with untreated profiles, three (50% of the untreated sample) had not
been offered any further offence-specific treatment.
78
Although probation officers use a variety of means to assess offender needs; such as interviews, examining
relapse-prevention plans, SOTP Core Programme reports, etc, none employed (in fairness, they were not
available) any systematic psychometric procedure to examine the extent to which men had treated profiles.
While it is not suggested that psychometric testing should be the only way of helping decide whether men
need further treatment, it seems that it should form some part of the post-release assessment procedure. This
would help ensure that apparently treated men do not take up valuable space on community-based treatment
programmes. For such men, maintenance groups or individual support may be more appropriate. On the basis
of these findings, it is recommended that the Core Programme treatment summary report contains details of
psychometrically assessed treatment change, together with recommendations as to whether offenders need
further offence-specific work.
Probation support
The large majority of men interviewed (88%) said they had received a lot or a great deal of support from their
supervising probation officer. Although all these men were released on statutory supervision (which enforced
some degree of contact between them and their probation officer) the team felt that this represented a
considerable compliment to the probation officers concerned.
Men’s perception of the programme
At the post-release interview, subjects were asked whether they had found the programme supportive and
helpful to them in addressing their offending behaviour, the hypothesis being that men who regard treatment
positively are much more likely to internalise treatment messages, and maintain their motivation to remain
offence-free. It was encouraging, therefore, to find that 31 men (76%) said they had found the programme ‘very
helpful,’ with a further eight (20%) saying that it had ‘helped quite a lot’.
4.12. PROBATION OFFICERS’ PERCEPTION OF THE PROGRAMME
Fifty-one probation officers responsible for supervising the men discharged from the Core Programme groups
under study were surveyed and their perceptions sought regarding the Core Programme.
Quality of risk assessments
Each probation officer completed a questionnaire asking their views on whether they thought their client had
benefited from the programme, the quality of liaison and type of feedback received, and the extent to which
their own risk assessment concurred with those produced by the Core Programme outcome reports. The
extent to which risk assessments, conducted by Core Programme tutors, are accepted by fieldwork probation
officers has important implications. If, for example, the probation officer arrives at a different view as to the
level of risk of her/his client, this could result in lack of confidence in the Core Programme. Probation officers
were asked, therefore, to what extent the feedback they received concurred with their own assessment. It was
found that 30 (59%) agreed ‘totally’ or ‘mostly’ with the Core Programme assessments. Fourteen (28%) said they
agreed with some of the assessments; only three probation officers said that there was little agreement between
the outcome assessments and their own (in these cases probation officers seeing their clients as being at higher
risk of re-offending than the Core Programme assessment reports).
Information and liaison
Probation officers were asked to report on the type of information they had received on their clients from the
Core Programme tutors. Forty-eight (97%) said they had received written reports or both written and verbal
reports. Only three probation officers said they had received no information at all. Forty-one (88%) described
the feedback they had received from the tutors as ‘good’ or ‘acceptable’. Finally, probation officers were asked
to comment upon the quality of liaison between themselves and the tutors during the time their clients were on
the programme. Twenty-seven (53%) described the quality of liaison as ‘moderately good’, with a further eight
(18%) describing it as ‘very good’. However, eight (15%) described the quality of liaison as ‘poor’ or ‘very
inadequate’.
79
Conclusions of probation officer survey
The results of this survey of probation officers produced very encouraging results. Approximately threeq u a rt e rs of probation officers said their clients had benefited from the Core Programme, and a similar
percentage reported that their clients viewed the prog ramme as a positive therapeutic experience. Ninety-four
percent of probation officers had received written reports on their clients, following completion of the Core
P ro gramme, and of this group nearly half had also received verbal feedback. There was a high level of
satisfaction with the quality of the information given, and in the majority of cases the Core Programme reports
concurred with probation officers’ assessments of their clients. Overall, these results suggest that, at least
among the probation officers surveyed, there appeared to be a reasonably high level of confidence and
satisfaction in the quality of the Core Programme. This is an important finding, given some of the previously
voiced criticism (e.g. Waite, 1994).
80
5. SUMMARY OF FINDINGS
5.1.
DESCRIPTION OF THE SAMPLE BEFORE TREATMENT
The study found that child abusers could be classified according to the extent to which they differed from nonoffending men, and by the extent to which they denied their problems. Men who differed very considerably
from non-offending men were classified as High Deviancy, whereas men who differed relatively little from nonoffenders were classified as Low Deviancy. High Deviancy men had two and a half times the number of victims,
and were nearly twice as likely to have been convicted of a previous sexual of fence than Low Deviancy men.
They were also twice as likely to have committed offences against boys, or against both boys and girls, and to
have committed offences outside, or both inside and outside, the family. In contrast, Low Deviancy men were
twice as likely to have female victims and to have committed intrafamilial offences. Hanson and Bussiére (1996),
in a meta-analysis of predictors of sexual recidivism, found that the number of prior sexual offences, previous
convictions, relationship to victim and sex of victim were significantly related to sexual offence recidivism;
those who had committed offences against girls and/or incest offences were at lower risk of re-offending than
those who had committed offences against boys and/or strangers. These results suggest that the High Deviancy
cases identified in the current study are at a higher risk of re-offending than the Low Deviancy cases.
However, it is important to note that roughly one-third of the High Deviancy men identified psychometrically
had only been convicted of offences within the family, showing that it cannot be automatically assumed that all
intrafamilial offenders will be less deviant than extrafamilial offenders. This finding has important implications
for risk assessment, as it shows that a substantial minority of incest abusers present a potentially high risk of
further sexual offending in future.
5.2.
IMMEDIATE IMPACT OF TREATMENT
Two approaches were used to evaluate treatment impact. The first approach examined the extent to which
treated child abusers showed statistically significant changes in their levels of denial, pro-offending attitudes,
and social competency/acceptance of accountability. Using this approach it was found that both shorter (80
hours) and longer treatment groups (160 hours) were effective in producing statistically significant reductions
in these areas.
The second, and more sophisticated, analysis considered to what extent the child abusers had, by the end of
treatment, a ‘treated’ profile. In order to qualify for this, an offender had to show an overall treatment effect
(see Section 4.8 for details) across both pro-offending attitude measures and social competency/acceptance of
accountability measures, which was sufficient (by the end of treatment) to make him largely indistinguishable
from the profile of a non-sexual offender. Change was also looked at just in terms of a reduction in prooffending attitudes ‘primary treatment targets’ of the Core Programme1.
Using this rigorous criteria to judge treatment effectiveness the study found that:•
Two-thirds of men were successfully treated with regard to a reduction in pro-offending attitudes with onethird of men showing an overall treatment effect.
•
Treatment was particularly effective for Low Deviancy men who were relatively open about their offending;
(however, this may not be surprising given that they entered treatment with relatively less severe problems
than men with High Deviancy profiles). Of the Low Deviancy/Low Denial group, 84 per cent showed
significant reductions in pro-offending attitudes, compared with 43 per cent of the High Deviancy men.
Fifty-nine percent of Low Deviancy/Low Denial men showed an overall treatment ef fect compared with 14
per cent of High Deviancy men.
•
The extent to which men denied their problems at the beginning of treatment was found to strongly
influence whether they benefited from treatment. Men who had Low Deviancy profiles but who were also
1
The Core Programme does not specifically target, at the present time, ‘secondary treatment targets’ such social competence.
81
in quite high levels of denial about their offences made considerably less progress in treatment than their
Low Deviancy counterparts who, were more open about the extent of their offending: 84 per cent of Low
Deviancy/Low Denial offenders showed pro-offending attitude changes compared with 71 per cent of the
Low Deviancy/High Denial men; while over a half (59%) of Low Deviancy/Low Denial men showed an
overall treatment effect compared with less than one-fifth (17%) of the Low Deviancy/High Denial offenders.
Because the period of this study encompassed the transition between the original and the revised Core
Programme, it was possible to make comparisons between the effectiveness of shorter (80 hours) and longer
(160 hours) treatment deliveries.
• L ow Dev i a n c y / L ow Denial men did equally well in both the shorter and longer groups, in terms of
reductions in pro-offending attitudes (83% in shorter groups, 86% in longer groups) and an overall treatment
effect (61% in shorter groups, 57% in longer groups).
• Low Deviancy/High Denial men did better in the longer groups in terms of reductions in pro-offending
attitudes (64% in shorter groups, 77% in longer groups) and an overall treatment effect (9% in shorter
groups, 23% in longer groups).
• High Deviancy men did better in the longer groups in terms of reductions in pro-offending attitudes (27% in
shorter groups, 60% in longer groups) but did badly in terms of an overall treatment effect in both shorter
and longer groups (18% in shorter groups, 10% in longer groups).
The fact that men appeared to show greater change on the pro-offending attitudes (alone) rather than an overall
treatment effect,(which encompasses both a reduction in pro-offending attitudes and an improvement in social
competency/acceptance of accountability) is perhaps to be expected gi ven that the Core Pro gra m m e
specifically focuses on offending and pro-offending attitudes and does not address social competence issues in
terms of behavioural skills training. However, simply by being part of a group for a considerable length of time
and having the experience of being listened to, supported and helped to control offending is likely to have the
effect of improving social competency/ acceptance of accountability to a certain extent.
5.3.
GROUP PROCESSES
Assessment of group processes undertaken during the course of this study found that the treatment groups
could be characterised as highly cohesive and task-orientated. The leaders were successful in encouraging high
levels of disclosure by the men, whilst at the same time being perceived as being supportive, and instilling hope
in group members. These are the characteristics of successful therapeutic groups as reported in the literature.
Statistically it was also found that, after adjusting for level of deviancy prior to treatment and length of
treatment, the cohesiveness of the groups was strongly related to treatment outcome. This result suggests that
members’ involvement, commitment and concern and the friendship they show for each other is strongly
related to treatment outcome. It was also found that the treatment group that was most successful in producing
therapeutic change differed from the least successful group in that it was more tolerant of, and better able to
deal with, the open expression of negative feelings and disagreements that arose between group members.
One of the groups observed contained an extremely difficult adult of fender who was at times highly disruptive
to the group and was very hostile to the female tutor. He had the effect of intimidating the group generally and
it is likely that he affected the group’s progress overall. The level of cohesiveness of this group was noticeably
below that of the other groups (except for one), suggesting that the assessment of group environment during
the course of a treatment group may be a useful method of determining whether group processes are working
effectively.
2
Here drop-outs were high with only 56 of the 77 men (73%) seen at post-test agreeing to be seen again.
82
5.4.
MAINTENANCE OF TREATMENT GAINS
Overall
Where possible the sample of child abusers were reassessed approximately nine months after having completed
treatment in order to determine the extent to which treatment gains were maintained over time 2. Overall, the
results were encouraging, suggesting that men who had shown significant reductions in pro-offending attitudes
through treatment (treated men) did not show any significant deterioration in their levels of denial, social
competence, or pro-offending attitudes. Indeed, with regard to justifications for sexual offences, men at followup had fewer justifications than when they had initially finished treatment.
Also, this group of ‘treated’ men retained their abilities, learned in therapy, to recognise and ex t ri c a t e
themselves from situations which might put them at risk of re-offending (relapse-prevention skills). However,
men whose pro-offending attitudes had not changed through treatment (untreated men) quickly lost the
relapse-prevention skills acquired in treatment. These results suggest that treated men had developed long-term
skills to deal with any future potential risk situations, which may put them at less risk of re-offending, while
untreated men had not retained these skills over time and may therefore be at the same risk of re-offending as
they were before entering treatment.
A number of more detailed analyses were also undertaken in order to determine whether length of treatment
had any effect on the maintenance of treatment gains.
Length of treatment
Men attending the longer treatment groups did not show any deterioration in terms of their openness about
their previous sexual offending, their level of social competence, or their pro-offending attitudes. However,
men attending the shorter groups showed a tendency to become less open about their sexual offences at the
follow-up point. With regard to relapse-prevention knowledge and skills, neither the short- nor long-term
treated groups showed any deterioration in these areas at the nine-month follow-up point.
Discharge into the community
Men discharged directly into the community maintained treatment gains with respect to openness, reductions
in pro-offending attitudes and social competence. However, with regard to relapse-prevention skills, men
returning to the community (as opposed to those who remained in prison) showed significant reductions in
their awareness of risk situations and in their capacity to cope with such situations. These reductions in relapseprevention awareness and strategies were particularly pronounced in men who had attended the shorter-term
treatment groups.
5.5.
PRISON COMPARED WITH COMMUNITY-BASED TREATMENT
Child abuser data from the team’s previous research (Beckett et al. 1994) on the effectiveness of communitybased treatment programmes were re-analysed and compared with data from the current project, using the
methodology reported in Section 4.8. Here, 45 men who had undergone residential treatment (20 at the
Gracewell Clinic, average 462 hours of group therapy per man, and 25 at the Wolvercote Unit, average 765
hours of group therapy per man), and 32 men who been treated in probation-based groups (roughly 60 hours
of group therapy) were compared with the groups running either the longer (160 hours) or the shorter Core
Programme. The results for reductions in pro-offending attitude changes are shown in Figure 5.1.
83
FIGURE 5.1:
PERCENTAGE SHOWING CHANGE IN PRO-OFFENDING ATTITUDES
Both Wolvercote and Gracewell clinics did not have nay Low Deviancy/High Denial men, therefore no effect of treatment change is shown her for this group.
In terms of producing change in pro-offending attitudes, it can be seen from Figure 5.1 that for all deviancy
cases, those completing the longer Core Programme had the best results (even compared with the residential
programmes) and the probation groups the poorest. These findings suggest that longer treatment is better than
shorter treatment and that 160 hours may be the optimum for producing reductions in pro-offending attitudes.
As regards the percentage of men that did not show overall treatment change across the different treatment
deliveries, this is shown in Figure 5.2.
FIGURE 5.2:
PERCENTAGE SHOWING OVERALL CHANGE
Both Wolvercote and Gracewell clinics did not have nay Low Deviancy/High Denial men, therefore no effect of treatment change is shown her for this group.
It can be seen from Figure 5.2. that the residential programmes were the most effective with both Low and
High Deviancy men in producing overall change. This latter result suggests that many hours of treatment are
needed to produce overall change in these very difficult cases.
84
5.6.
SEXUAL OFFENDERS AGAINST ADULTS IN THE SAMPLE
The prisons in the study were Category C (medium secure) establishments and only 14 of the 100 men
attending the groups studied had committed sexual offences against adults. Previous research (Grubin & Gunn,
1990) has shown that a greater proportion of imprisoned rapists, as opposed to child abusers, are in denial, and
probably less inclined to elect for treatment. The problem of engaging rapists in treatment is worthy of further
study.
5.7.
SEXUAL OFFENDERS RETURNING TO THE COMMUNITY
Interviews with the offender group
Seventy-six percent of the men surveyed at the nine-month follow-up said they had found the Core Programme
‘very helpful’, with a further 20 per cent saying that it had ‘helped quite a lot’. These results are encouraging
given that men who regard treatment positively are more likely to internalise treatment messages, and maintain
their motivation to remain offence-free.
The principles of relapse-prevention dictate that an offender is at least risk when those close to him are fully
aware of his previous offences and the details of his relapse-prevention plan. The majority of men said they had
told family, friends, or partners about their sexual offences upon release, though it was beyond the scope of this
study to determine the full extent of information divulged.
The large majority of men surveyed said they had received considerable help and support on discharge from
their supervising probation officer, a considerable compliment to the probation officers working with these
men.
Fifty-eight per cent of the men said they had received further therapy since their release from prison, one-third
of them joining a sexual offender treatment programme. This study found, however, that 55 per cent of men
offered further treatment appeared not to need further offence-specific treatment. Conversely, 50 per cent of
men leaving prison with untreated profiles had not been offered further treatment.
Interviews with offenders’ probation officers
Eighty-four per cent of probation officers had received written reports on their clients who had attended the
Core Programme. There was a high level of satisfaction with the quality of the feedback given, and in the
majority of cases the written reports concurred with the probation officers’ assessment of their clients. Taken
overall, these results suggest that field probation officers had a high level of confidence and satisfaction in the
quality of the Core Programme.
5.8.
OBSERVATIONS ABOUT TUTORS, CENTRES AND GROUPS
This study took place over a two-year period, when the Core Programme was evolving from shorter- to longerterm treatment, and when significant organisational and operational changes were taking place within the
prison service. The following observations about the groups need to be considered within this context.
Observations about tutors
Tutor commitment
The STEP team found universal commitment and enthusiasm from the Core Programme tutors; there were
many accounts of tutors coming in on their days off, or extending their working hours in order to ensure their
availability for the programme and to provide additional support for the men outside the groups. This level of
tutor commitment, and sensitivity to the men’s needs may well have contributed to the very low drop-out rate
from treatment.
85
Tutor training and competence
The Core Programme training was generally well received by the tutors, though not all tutors felt confident in
delivering the victim-empathy role-plays. Some tutors also had difficulty with carrying out the detailed analysis
required in the ‘offence chains’ exercises (fuller details of these exercises are given in the ‘components of
treatment’ section of Chapter 1), though this was less of a problem for more experienced tutors. Problems were
most likely to arise when there was not a Treatment Manager to provide consultation and support. The
experienced tutors (in particular) impressed with their ability to work in-depth with men who were often
mistrustful, and occasionally disruptive.
Loss of trained tutors
This was an issue of concern. It was noted that where tutors had been trained, but then did not have a relatively
immediate opportunity to run a treatment programme, a proportion of them failed ever to run a treatment
programme, possibly because their confidence and motivation declined.
Lack of female tutors
There were not enough female tutors available, and some groups ran with male-only staff. Female tutors bring
an important perspective to work with child abusers, such as modelling appropriate social interactions
between men and women (Pietz & Mann, 1989). In one programme observed, the lack of a female tutor
resulted in the group developing a ‘macho’ group culture.
Tutor counselling and support
During the early part of this study Treatment Managers (usually psychologists) were not sufficiently available to
provide supervision and support for tutors. This problem has since been largely resolved, with the appointment
of more psychologists as Treatment Managers to work in prisons which run the Core Programme. Where a
Treatment Manager was available, he/she generally enjo yed good relationships with tutors, and their input was
well-received. Treatment Mana gers were found to have a particularly important role in helping tutors prepare
for the victim-empathy block, in helping develop clients’ coping skills, and in debriefing tutors after treatment
sessions.
Tutors running the Core Programme initially varied considerably in their perception of management support. In
some establishments tutors felt well-supported and managed by senior staff. In other establishments, tutors
complained of ambivalent attitudes to the Core Programme, particularly from more senior governor grades.
There was, however, a consensus that senior prison officers were supportive of their staff, partly because they
were closer to them in the management hierarchy, but also because increasing numbers of them had been
trained in delivering the Core Programme.
Personal impact of the work
Where the number of available tutors was low, and particularly where they had to run two groups ‘back-toback’, some became ‘burnt out’. The personal impact of this work is well recognised in the literature (e.g.
Erooga, 1994). and the team commonly heard accounts from tutors as to the effect this work had upon them,
and how they had been ch a l l e n ged to evaluate their role as parents, and part n e rs. Tu t o rs relied ve ry
considerably on each other for personal support when running groups, and Treatment Managers were seen as
having an important role in supporting and debriefing them. During the course of the study, mandatory
counselling was introduced for tutors, an innovation which was generally welcomed amongst staff.
Attitudes to the Core Programme
As part of the study, tutors completed an anonymous questionnaire canvassing their attitudes to the
programme. In many ways, the views obtained anonymously were similar to those expressed during face-to-face
interviews. There was virtually unanimous agreement amongst tutors that working on the Core Programme was
extremely rewarding and those tutors who were prison officers saw it as the most rewarding part of their job.
86
The results of this questionnaire also concurred with a similar study of Core Programme tutors (Turner, 1992),
which showed that despite training tutors could continue to lack confidence in their ability to deliver treatment
effectively. It also found (like the previous study) that whatever the le vel of the tutor’s experience, they would
have liked higher levels of support from Treatment Manager and Programme Managers, and Governors.
As a result of the training received, tutors who were also parents said they had become more sensitive and
protective towards their own children and to children in general. Interestingly, the more experienced tutors
became, the more upset they reported feeling over the consequences for victims of sexual abuse. They also
became more concerned over their capacity to protect children.
Facilities and resources
The standard of rooms provided to run the Core Programme was generally good, but even within the better
equipped facilities disruption through noise and lack of soundproofing was a common problem.
With regard to resources, the electronic ‘wipe boards’ which photocopy notes made by the programme tutors
were universally appreciated; however, the quality of video tapes available for victim-empathy training was
often poor, since many of the tapes had been copied several times and had degraded in quality. Tutors also felt
they needed more detailed guidance about the content of an adequate ‘victim apology’ letter3. They also felt
that more information on the short- and long-term impact of sexual assaults on victims and more expansive
notes on role play exercises would have been helpful.
Programme content
Regarding the content of the Core Programme it was noted that a great deal of time was taken up using the ‘hot
seat’ technique of focusing on one individual at a time. While this can be an effective technique, there is a
danger of other group members becoming bored and not being involved in the sessions. Thus, instead of the
session being run as a group it becomes a dialogue between the group member and tutors, with an audience.
The problem of repetition and boredom was highlighted by the tutors as being particularly acute during the
relapse-prevention block.
Central detailing
During the period of the time spent gathering data in prisons (Summer 1994 to December 1996) no other
single organisational issue produced so much comment by Core Programme tutors. Prior to the introduction of
central detailing, tutors were allocated to treatment programmes by (typically) their own senior offi c e rs .
Following the introduction of central detailing, responsibility for staff allocation moved towards centraldetailing officers. At many prisons, the introduction of central detailing produced disruption at a number of
levels. The problems caused by central detailing were not seen in all prison. but HMP Waylan, and, in particular,
HMP Littlehey suffered from very serious problems which, in the latter case, were compounded by the
introduction of mandatory drug testing which further diverted staff from running treatment groups. In some
prisons, trained tutors allocated to the programme were directed towards other duties, resulting in cancellation
of planning sessions and treatment groups, and the time for debri e fing after treatment sessions. As
responsibility for allocating staff moved to central detailing, there appeared a trend for staff having to extend
their working hours, and to come in on their days off to meet their commitment to the Core Programme. This
resulted in some prison officer tutors being owed up to 30 hours time in lieu, with pessimism being expressed
as to whether this time could be retrieved.
3
4
The Programme Development Section of Prison Service HQ has since circulated more detailed guidance on what constitutes an adequate victim apology letter.
In general it would appear that approximately one-third of all recorded rapes are against children (Grubin & Gunn, 1990).
87
5.9
ETHNIC MINORITIES AND THE CORE PROGRAMME
Home Office statistics for 1996 recorded 3,939 prisoners serving sentences for sexual offences (source: Home
Office Statistics Directorate). Of this group 1,930 (49%) had been convicted of rape against either an adult or a
child. With regard to the ethnic origin of these offenders, the majority (3,446 (87%)) were classified as
Caucasian, 353 (9%) were classified as Black, 76 (2%) were classified as South Asian, 56 (1%) were classified as
Chinese/Other; the remaining eight cases were unclassified. As for the black sexual offenders, 283 (80%) had
been convicted of rape, although it was not possible to determine what proportion of these offences had been
committed against children4.
In the present study only 5 per cent of the sample, seen prior to treatment, were from ethnic minorities, a
lower percentage than would have been expected given the proportion of ethnic minority sexual offenders
(13%) within the prison system. While Cowburn (1996) found that of a total of 144 black sexual offenders
situated in six prisons running the Core Programme (three Category C, two Category B and one dispersal
prison), only 14 of these (10%) were on the programme.
There is a range of potential explanations for the apparently low numbers of ethnic minority offenders
attending the Core Programme. The present study focused upon Category C prisons, while it may be the case
that a disproportionate number of ethnic minority sexual offenders, particularly adult rapists, are Category A or
C a t e go r y B pri s o n e r s. Howeve r, as Grubin and Gunn (op. cit.) point out, there may also be cert a i n
characteristics of ethnic minority sexual offenders which could account for their relatively low level of
participation in the Core Programme. In their study, black rapists were found to be younger than white rapists,
and significantly fewer admitted to having raped. The victims of black rapists had more frequently been
drinking, and more frequently drinking with their attackers; thus the rapes committed more often arose in
social contexts. Significantly more black than white rapists pleaded not guilty to rape: 42 per cent claiming a
misunderstanding, or that consent had taken place, with 36 per cent absolutely denying that intercourse had
occurred. Such patterns of denial or extensive rationalisations may result in fewer black rapists accepting
treatment.
Some authors (e.g. Cowburn, op. cit.) have proposed that the low number of black sexual offenders attending
the Core Programme might be due to cultural and institutional racism, and black men’s response to this. He
suggests that the prison environment is perceived as 'unsafe' by black sexual offenders, who have the double
stigma of being both a sexual offender and black. Under these circumstances, he argues, black sexual offenders
are more likely to seek alliance with their own ethnic group within prison, rather than go into the 'protected'
environment of a Vulnerable Prisoner Unit.
Further resistance to joining the Core Programme, according to Cowburn, might be caused by delivering the
Core Programme in environments which do not recognise racial difference, and the subtle and complex ways in
which racism finds expression. Problems are likely to be exacerbated in circumstances where ethnic minority
offenders do not have workers of the same race with whom to talk about their offences and their anxieties of
receiving treatment in a predominantly white environment. Cowburn found that in 1995 only 0.8 per cent of
prison staff described themselves as black. It is beyond the scope of the present study to determine why ethnic
minority sexual offenders were under-represented in the groups studied. However, there is evidence (Wilson &
Shine, 1990) that young black offenders appear unwilling to look at their offending behaviour.
While there may be cogent grounds on which to argue that racism exists within society and institutions, there is
no systematic evidence to support Cowburn's propositions that the prison service allocation system potentially
excludes black offenders from locations where the Core Programme is being run.
On a policy level, the Prison Service within England and Wales has taken the issue of racism and race relations
seriously for some years. The Annual Report on the work of the Prison Service (source: Home Office, 1989)
reported all establishments to have Race Relations Liaison Officers, and most had Race Relations Management
Teams which report to the Governor. Most establishments monitor the allocation of work within prisons to
detect and eliminate discrimination, and guidance on how to deal with racially offensive remarks in written
reports was issued in October 1988. Prison Department Standing Order No. 4Bl1 gives prison governors clear
authority to prevent the display of 'offensive' material, whether it be indecent, violent or racist in content.
88
Although Cowburn found that all prison staff interviewed recognised that the Prison Service took a serious
view of all allegations of racism, be they from staff or inmates, the extent to which racism might be expressed
through stereotyping, humour or unspoken discrimination is more difficult to determine, as is its impact on the
selection of candidates for the Core Programme. While Patel (1997) found, in her study of 24 ethnic minority
prisoners who had completed the Core Programme, that although the majority of her sample felt that the
programme did meet the specific treatment needs of ethnic minority sex offenders, most felt that they were
treated differently by tutors, feeling victimised, stereotyped and patronised, and that cultural differences were
not taken into account, although if the particular offender was not the sole ethnic minority member ethnicity
was less of an issue. Patel suggests that having more than one ethnic minority member pre-group was more
likely to meet the treatment needs of these men.
In order to address such issues, Programme Development Section of HQ has setup a ‘SOTP Multi-Racial
Advisory Group’. The purpose of which is to ‘improve the accessibility and relevance of the SOTP to all
prisoners and eliminate discrimination within treatment’ by coordinating/ arranging training to raise awareness
in working with diversity; coordinating/ arranging research and turning research recommendations into action;
receiving and responding to specific or general enquires or concerns, from anyone involved in the programme
or its throughcare, about multiracial relevance or discrimination.
5.10.
CURRENT STATUS OF THE CORE PROGRAMME
The present study was conducted at a time when the Core Programme underwent a significant change,
increasing the number of treatment hours it provided from 80 to 160. This required a major training initiative.
In addition to this development, this period saw an increasing number of psychologists becoming appointed as
Treatment Managers, the introduction of counselling for tutors, and initiatives for increasing organisational
sensitivity and commitment to the programme. More recently, a thorough and well-considered accreditation
procedure has been developed which is carried out by an international panel of experts in the field of sexual
abuse. Areas required to meet high standards include the selection and training of tutors, the availability of
support and supervision for tutors, the quality of written treatment outcome reports, and the level of liaison
with community-based probation services. Importantly, management support as well as adequate facilities are
specified as accreditation criteria. The Core Programme is recognised internationally as probably the most
s y s t e m a t i c a l ly delive red, we l l - m a n aged and evaluated sexual offender treatment pro gramme. The Core
Programme is particularly distinguished by the political and organisational commitment that has been given to
it during the last seven years. There is consensus that those responsible for designing, organising and delivering
the Core Programme are to be congratulated upon their work.
89
90
6. RECOMMENDATIONS
1.
The results of this study justify the Prison Service’s decision to extend the Core Treatment Programme
from 80 to 160 hours. Although both treatment lengths were found to have an equally high treatment
impact on Low Deviancy sexual offenders, who were relatively open about their problems, the longer
groups were found to be superior in a number of important ways. They were more successful in treating
Low Deviancy offenders with high levels of denial, and were over twice as successful at producing
reductions in pro-offending attitudes in High Deviancy men. Furthermore, it was found that offenders
attending longer groups had better relapse-prevention skills than those attending the shorter groups.
2.
It was found in this study that one-third of men identified prior to treatment as Low Deviancy, but in
relatively high levels of denial about the extent of their offending, failed to show reductions in their prooffending attitudes. It is recommended that such men are identified at assessment (for suitability for the
Core Programme), and that they successfully complete a specialised treatment module concerning denial
before starting the SOTP. Such a module could be based upon the ‘Deniers Group’ currently being piloted
at some prisons.
3.
It is recommended that those men who do not show reductions in pro-offending attitudes, having
completed the Core Programme, are identified by systematic testing, and that these men are required to
repeat the programme.
4.
An overall treatment effect was only found in 14 per cent of High Deviancy men. This was because most of
the High Deviancy sample were still relatively socially incompetent by the end of treatment, i.e., they
continued to exhibit low self-esteem, high levels of under-assertiveness and emotional loneliness, and still
had high levels of emotional identification with children. While on the one hand it must be recognised that
the Core Programme is not designed to target social competence, it must remain a concern when socially
inadequate child abusers return to the community, since it has been suggested that social inadequacy and a
continuing inability to form adult attachments may contribute to the risk of re-offending (Marshall, 1989).
On the basis of the findings of the current report, it is recommended that such offenders are given priority
for admission into the Extended Programme1 component of the SOTP.
5.
It is also recommended that the SOTP Extended Programme be evaluated with regard to its impact on
social inadequacy, and that additional treatment modules be developed, if necessary, to specifically target
self-esteem, social skills and assertiveness.
6.
Notwithstanding the above, there are fundamental issues regarding the emphasis that should be given to
changing social competence in the treatment of sexual offenders. If a high number of offenders with
significant social competency problems re-offend, this would suggest that social competency needs to be a
core treatment target. However, if such men do not have a high re-offence rate, it would suggest that social
competency issues are of secondary importance. Therefore it is recommended that a reconviction study be
undertaken to resolve this issue.
7. It was found that the therapeutic ‘climate’ of the group, in particular the extent to which offenders
described the group as ‘cohesive’, was a strong predictor of treatment success. It is recommended that the
therapeutic climate of treatment groups be routinely assessed, and when it is found to be less than optimal,
tutors (in discussion with Treatment Managers) should consider how they might adjust their group
leadership accordingly.
8.
The SOTP is designed to treat sometimes resistant, and occasionally disruptive, offenders. However,
offenders who are highly treatment-resistive can thwart the efforts of the most experienced tutors2. In
order to minimise this problem, it is recommended that offenders be formally assessed for psychopathy on
1.
This programme has a number of treatment goals including identifying and moderating those deeply held dysfunctional thinking patterns (schemas) which
underpin sexual offending, improving emotional control, and developing intimacy skills and motivation to adopt secure adult attachments..
of Chapter 2: Usk Group 1 where a man identified as a primary psychopath according to the SHAPS criteria was very disruptive in the group.
2
91
the Hare Psychopathy Checklist (PCL; Hare, 1991) as there is some evidence that therapeutic change is
inversely related to PCL score (Hughes, Hogue & Hollin, in press3). It is also recommended that individuals
who score highly on the PCL measure should only be admitted to the SOTP after careful consideration and
that continued study should be undertaken to identify the characteristics of offenders who are found to be
disruptive and treatment-resistant4.
9.
The study found evidence that normal location encourages rapists to maintain denial and avoid treatment.
It is recommended that all rapists (except those with high psychopathy scores) are placed on Vulnerable
Prisoner Units or their equivalent.
10. In order to ensure that ethnic minorities gain equal access to the Core Programme, it is recommended that:
•
the Home Office gathers details of ethnic minority sexual offenders, identifying the type of offence,
i.e. whether against adults or children;
•
monitoring takes place to ensure that all ethnic minority sexual offenders are offered the Core
Programme, and any reasons for refusal are recorded;
•
on the basis of this information, that the Home Office considers what strategies might be employed to
increase ethnic minority participation in the SOTP; this might include running particular treatment
programmes for ethic minority offenders, which may necessitate recruiting more ethnic minority
SOTP tutors;
•
that the SOTP Accreditation Panel considers how to monitor ethnic minority participation as part of
the accreditation criteria.
11. In the light of comments made by tutors during the course of this study it is recommended, that in
addition to the existing personal counselling, Core Programme tutor training incorporates a session(s) on
the psychological impact of working with sexual offenders. Such a module could include experienced
tutors talking about the impact it had upon them, and the coping strategies they developed in order to deal
with them.
12. There was a serious shortage of female tutors in some prisons. Female tutors are important in maintaining
healthy, non-sexist values and attitudes within the programmes. It is recommended that particular efforts
are made to recruit and train female staff.
13. To avoid staff ‘burn out’ it is recommended that tutors should not run two treatment groups in a row.
14. It is recommended that prison and probation officers who train as tutors become actively involved in
running a treatment group as early as possible. This would help minimise the number of trained tutors
who drop out before running a treatment group.
15. Given the problems some tutors had in helping offenders develop cognitive (as opposed to behavioural)
coping strategies, it is recommended that psychologists, in addition to the supervision they provide as
Treatment Managers, co-lead coping skills sessions to help tutors become more sophisticated in this area of
treatment.
16. Individual sexual fantasy modification was not available to the offenders in this study. It is recommended
that, as the number of on-site psychologists increase, they undertake more individual fantasy modification
work with offenders.
17. It is recommended that the Programme De velopment Section circulates to tutors written guidance about
the short- and long-term impact that sexual abuse has on victims (see, for example, Finkelhor & Associates,
1986).
3
4
Although it should be noted that this study was an evaluation of a treatment programme for personality disordered offenders.
Of the 25 treatment failures in the current study 12 were High Deviancy eight were Low Deviancy/High Denial and two low Deviancy men were identified as
closest in personality type to primary psychopaths.
92
18. Given the poor quality of the video material used by the programmes observed, it is recommended that the
P ro gramme Development Section reproduces high-quality video tapes for use in the victim-empathy
module. It is further recommended that the material used is periodically updated.
19. A number of tutors commented that the Core Programme felt repetitive and lost momentum during its
later sessions. It is recommended that this problem be considered by the Programme Development
Section. The later modules could be enlivened by introducing more role-play, particularly in modules
dealing with coping strategies. This would also help to ensure that intellectual appreciation of coping
strategies is matched by behavioural competence to carry them out. Furthermore, it would minimise overreliance on the use of the ‘hot-seat’ technique, which can easily lead to group members becoming bored
and unmotivated.
20. The study found that over half (55%) of offenders discharged from the SOTP, with apparently treated
profiles, were offered places on group treatment programmes in the community. At the same time 50 per
cent of offenders without treatment profiles appear not to have been offered any treatment at all. It is
recommended that that SOTP summary documents, which are sent to probation services, contain details of
the impact of the programme on the offender, together with a recommendation as to what further
t reatment is re q u i red. For offe n d e rs with treated pro files this might be a place on a maintenance
programme (see below) as opposed to further offence-specific treatment.
21. It is recommended that probation services develop maintenance programmes for offenders who have
successfully completed treatment, whether through the prison core treatment programme or via other
routes (e.g. community-based programmes). Such programmes (e.g., Beckett, 1994) focus upon relapseprevention plans developed during the course of treatment, reinforce coping strategies, support clients
and help them anticipate future threats to their relapse-prevention plan. Moreover,taking into account the
role of non-abusing partners in protecting children within family systems, it is recommended that, where
offenders are considered for return to their family, probation services develop programmes to help
enhance the protective abilities of non-abusing partners (Beckett, in press). The main objectives of such
programmes are to enhance and consolidate the effectiveness of the offender’s relapse-prevention plan by
actively developing the role of the non-abusing partner. This is achieved by informing the non-abusing
partner of the offender’s modus operandi, improving their awareness of signs of future risk, and helping
them develop the skills and resolve to challenge their partner when appropriate.
22. An important goal of the core treatment programme, and indeed all treatment programmes, is to equip the
offender with a viable relapse-prevention plan. Relapse-prevention plans can be considered to have two
main components: internal self-monitoring and external supervision (Pithers, 1994). The Core Programme,
in line with most other treatment programmes, focuses upon developing internal self-control and the
monitoring of relapse-prevention signs, and helping the client develop coping, avoidance and escape
strategies. It is recommended that greater emphasis is given to external monitoring and supervision,
particularly by partners, families and other social support systems. To this end, it is recommended that
further research be undertaken to determine how much of an offender’s relapse-prevention plan is actually
shared with partners, families or social systems, and how the sharing of this information can be best
facilitated. The research might be best funded as a collaborative project between probation and prison
services, and might be considered to be a natural extension of the current work.
23. It is recommended that sufficient funds are made available to ensure that fieldwork probation officers, who
are charged with supervising men who have finished the core treatment programme, are sufficiently wellresourced to enable them to attend prison-based meetings where there is an opportunity of receiving
feedback as to how their client progressed through the programme.
24. This study compared the effectiveness of the Core Programme with the probation programmes previously
studied by the research team (Beckett, et al 1994). The results showed that even the shorter core
programme (80 hours) was more effective than the average community-based (approximately 60 hours)
treatment groups. Although probation groups varied considerably in their effectiveness, it is recommended
that where probation services are considering developing treatment programmes for child abusers, they
look at the structure and content of the Core Programme as a model of an effective treatment programme.
93
25. The ultimate test of the effectiveness of the Core Programme is the extent to which it reduces further
sexual offending. It is recommended that recidivism studies take place at two-, five- and ten-year intervals
to determine whether the Core Programme has been effective in reducing the rate of sexual reconviction.
However, given the inadequacy of reconviction data, it is strongly recommended that this should not only
look at the official rates of sexual reconviction (as gathered from criminal statistics), but also gather
information from: charges not proceeded with by the Crown Prosecution Service; Findings of Fact (of
sexual abuse) as determined in the civil courts; and information from Social Service records which contain
suspicions or allegations of sexual abuse.
94
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99
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100
APPENDIX A: FURTHER DETAILS OF OVERALL TREATMENT
EFFECTIVENESS
A.1.
FACTOR ANALYSIS OF THE SCALES USED IN THE RESEARCH
Factor analysis of all of the variables (except for the Relapse Prevention measure) on 140 child abusers from the
first study (Beckett et al. 1994) and the current sample found a three-factor solution, shown in Table A.1. This
solution explains 58 per cent of the variance of the scales.
TABLE A.1:
RESULTS OF FACTOR ANALYSIS
FACTOR 1
(Denial/
Admittance)
SELF-ESTEEM
EMOTIONAL LONELINESS
UNDER-ASSERTIVENESS
PERSONAL DISTRESS
LOCUS OF CONTROL
MSI: COGNITIVE DISTORTIONS
COGNITIVE DISTORTIONS
VICTIM DISTORTIONS
MSI: JUSTIFICATIONS
EMOTIONAL IDENTIFICATION
MSI: SOCIAL & SEXUAL DESIRABILITY
MSI: SEX DEVIANCE ADMITTANCE
MSI: LIE
SEX OFFENCE ADMITTANCE
MSI: SEXUAL OBSESSIONS
-0.5
0.4
0.1
-0.1
0.0
0.4
0.0
0.0
0.0
0.7
0.6
0.8
-0.9
-0.8
0.7
FACTOR 2
(Social
Competence)
-0.5
0.6
0.7
0.7
0.7
0.6
0.2
-0.2
0.1
0.2
-0.4
0.0
-0.1
-0.1
0.4
FACTOR 3
(Pro-offending
Attitudes)
0.1
-0.1
0.1
-0.2
0.3
0.5
0.8
0.7
0.8
0.3
-0.2
0.0
0.0
0.3
-0.2
It can be seen from Table A.1 that the denial/admittance measures load onto Factor 1, the social competence/
acceptance of accountability measures load onto Factor 2 and the pro-offending attitude to measures onto
Factor 3. A scale is assumed to load primarily onto a factor if the value is greater than 0.5.
The only exception to this pattern was the Emotional Identification measure which, contrary to expectation,
actually loaded onto Factor 1 (denial/admittance). This measure is therefore given its own section for this lack
of expected fit, and also for the following reasons. The scale measures the extent to which individuals can
understand, relate to and identify with what they believe are the thoughts, feelings and concerns of children.
Moderate le vels can be viewed as normal, especially for parents, since that confers a sensitivity to children’s
needs. However, relatively high and relatively low levels have been found in child abusers (Beckett et al. 1994).
Extrafamilial abusers (usually with no children of their own) appeared emotionally as well as sexually fixated on
children and had significantly higher levels of emotional identification with children than non-offending men
who did not have children. In comparison, it was found that men who had abused their own children had
significantly lower le vels of emotional identification with children compared with non-offending parents. This
latter finding perhaps suggests that emotional withdrawal from children made it either easier to abuse, or deal
with the effects that their abuse had on, their own children. Therefore, two a priori predictions of a treatment
effect in the present study are that: extrafamilial men would decrease in their level of emotional identification
through treatment; and that intrafamilial men would increase in their level of emotional identification through
treatment.
101
A.2.
OVERALL EFFECTIVENESS OF THERAPY
Data from 77 child molesters are described here, as one man from the original cohort of 82 child abusers
refused to be re-tested, three men were removed and one men left. Tables A.2 to A.7 below show the mean and
standard deviation (SD) scores pre- and post-treatment on the main scales used in the evaluation, and whether
the change was statistically significant. The numbers in square brackets in the first column of the tables below
are either non-of fender scores from 81 volunteers1 (reported in Beckett et al. 1994), or an acceptable range of
scores for treated child molesters (reported by Nichols and Molinder, 1984 for the MSI measures, and Proctor,
1994, for the SOAQ measure). The measures used have been previously been found to measure a treatment
effect in a probation sample of child molesters (Beckett et al). The effect size in the table was worked out by
taking the the difference of the pre-treatment score and the post-treatment score and dividing by (where
possible) non-offender standard deviations for the particular measure (Tables A.3; A.4 {Locus of Control}; A.5;
A.6), or the standard deviation of an untreated sample of child abusers from STEP12 (Table A.2; A.5. {MSI:
Justification}) or if neither of these were available the pre-treatment SD of the current sample was used (Table
A.7).
Factor 1 variables
A Multiple Analysis of Variance (MANOVA) carried out on the Factor 1 denial/admittance) measures pre- to posttreatment found an overall significant impr ovement (F(3/74) = 41.1, p < .0001). Table A.2 shows the results of
the univariate F-tests within the MANOVA.
TABLE A.2:
DENIAL/ADMITTANCE
MEASURES (acceptable limits after
treatment in brackets)
MSI: Soc. & Sex. Des. [28-35]
MSI: Lie [0-2]
MSI: Sex Deviance Admit. [51-60]
MSI: Sexual Obsessions [3-9]
Sex Offence Attitudes
Questionnaire (SOAQ) [82-87]
PREMEAN (SD)
21.7
8.0
50.1
2.3
93.0
(8.1)
(3.6)
(16.0)
(2.6)
(17.0)
POSTMEAN (SD)
23.3
6.1
55.5
3.0
78.5
(8.7)
(3.4)
(14.4)
(4.4)
(18.0)
EFFECT
SIZE
0.2
0.5
0.3
0.2
0.6
SIGNIFICANT
CHANGE (F)
YES
YES
YES
NO
YES
(8.7)**
(36.5)****
(10.3)**
(75.1)****
** p < .01 *** p <.001 **** p <.0001
Table A.2 shows that significant improvements were found in nearly all of the denial/admittance measures in
terms of less denial or more admittance. However, it should be noted that it is only on the MSI: Sex Deviance
Admittance and the SOAQ scales that the post-treatment scores are within the range for ‘treated’ child molesters.
However, to qualify these observations, the overall change on these measures pre- to post-treatment is, in
general, under 0.5 of a standard deviation, suggesting that the changes, although significant, are not very large.
Factor 2 variables
A MANOVA carried out pre-post on the variables (social competence/acceptance of accountability) loading
p ri m a ri ly on Factor 2 found a highly significant improvement on the social competence/acceptance of
accountability measures (F(6/71) = 4.0, p < .01). Univariate F-tests within the MANOVA for the five varia bles
loading on Factor 2 are reported in Table A.3 and Table A.4.
1
2
The standard deviations are shown in Appendix C, Tables C.1 and C.2.
MSI: Social and Sexual Desirability = 7.4; MSI: Lie = 4.0; MSI: Sex Deviance Admittance = 17.4; MSI: Sexual Obsessions = 3.9; Sex Of fence Attitudes Questionnaire
23.8; MSI: Cognitive Distortions & Immaturity = 4.3.; MSI: Justifications = 4.6).
102
TABLE A.3:
SOCIAL COMPETENCE
MEASURES
(non-offender mean in brackets)
Self-Esteem [7.1]
Emotional Loneliness [33.8]
Under-assertiveness [8.8]
Personal Distress [7.5]
PREMEAN (SD)
4.2
43.6
11.5
11.8
(2.5)
(10.6)
(7.4)
(5.7)
POSTMEAN (SD)
4.8
42.7
10.0
10.1
(2.6)
(11.8)
(6.8)
(5.7)
EFFECT
SIZE
0.4
0.1
0.3
0.5
SIGNIFICANT
CHANGE (F)
YES
NO
YES
YES
(5.4)*
(4.8)*
(6.8)*
* p < .05
It can be seen from Table A.3 that all the social competence measures, apart from the Emotional Loneliness
scale, show significant improvements pre- to post-treatment. It is only on two of the scales that the effect size is
over 0.4 SD (viz Self-Esteem, Personal Distress).
TABLE A.4:
ACCEPTANCE OF ACCOUNTABILITY
MEASURES (non-offender mean or
acceptable limits after treatment
in brackets)
Locus of Control [11.0]
MSI: Cog. Dis. & Imm. [0 to 3]
PREMEAN (SD)
14.8
6.3
(5.1)
(3.4)
POSTMEAN (SD)
13.4
5.7
(5.8)
(3.2)
EFFECT
SIZE
0.2
0.1
SIGNIFICANT
CHANGE (F)
YES
YES
(7.1)**
(5.4)*
* p < .05 ** p < .01
It can be seen from Table A.4 that acceptance of accountability was found to show a significant improvement
pre- to post-treatment as measured by both the offence-related and the non-of fence-related measures. However,
again the effect sizes for these changes are small.
Factor 3 variables
A MANOVA carried out on the Factor 3 variables (pro-offending attitudes) pre- to post-treatment found an
overall significant decrease in pro-offending attitudes (F(3/74) = 41.1, p <.0001). Table A.5 shows the results of
the univariate F-tests within the MANOVA.
TABLE A.5:
PRO-OFFENDING ATTITUDES
MEASURES (non-offender mean in
brackets or acceptable limits in brackets)
Cognitive Distortions[13.10]
Victim Distortions [18.00]
MSI: Justifications [0 to 1]
PREMEAN (SD)
15.4
39.5
4.9
(10.9)
(23.7)
(4.4)
** p < .01
POSTMEAN (SD)
8.4
16.5
3.7
(8.9)
(16.7)
(4.1)
EFFECT
SIZE
0.8
2.4
0.3
SIGNIFICANT
CHANGE (F)
YES (36.6)****
YES (118.8)****
YES
(8.8)**
**** p < .0001
it can be seen from Table A.5 that all the pro-offending attitudes measures show significant improvements.
Attention should be drawn particularly to the findings that there were big shifts in terms of reduction of the
level of distorted thoughts about having sexual contact with children and about children’s sexuality, and the
level of denial of the impact that the offenders’ sexual abuse has had on their own victims, with post-treatment
values being better than that found in non-offenders (mean scores in square brackets). Here, the effect size for
the changes on the Cognitive Distortions measure, and especially the Victim Distortions measure are, quite
large, suggesting that treatment is having a big impact upon reducing cognitive distortions about children and
distortions about victims.
103
Emotional Identification measure
This measure was treated separately, as explained above. A MANOVA carried out on the data with pre/-post
change as a within, subjects factor and type of abuse (intra/extrafamilial) found a marginally significant
difference between intra- and extrafamilial abusers (F(1/70) = 3.7, p = 0.55), but no significant pre/-post change
or significant interaction between pre/-post change and type of abuse, suggesting that different types of abuser
did not respond differentially to treatment. The results for the total group and for planned comparisons pre- to
post-treatment for both the intra- and extrafamilial cases are shown in Table A.6. Men who have committed
both intra- and extrafamilial offences have been assigned to the extrafamilial category as their pre-treatment
level of emotional identification broadly corresponds to extrafamilial cases; plus, in the case of four of the five
men who had ‘crossed over’, their intrafamilial offences were against step-children.
TABLE A.6:
EMOTIONAL IDENTIFICATION
MEASURES (non-offender mean in
brackets for: ••parents, •non-parents)
Emotional Identification [19.0]
Extrafamilial abusers [16.1•]
Intrafamilial abusers [23.4••]
N
PREMEAN (SD)
77
28
49
14.4
18.0
12.0
POSTMEAN (SD)
(12.1)
(14.4)
(10.1)
12.6
15.7
11.6
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
0.1
0.2
0.0
NON-SIG
NON-SIG
NON-SIG
(11.2)
(12.6)
(10.7)
* p < .05 {one-tail}
It can be seen from Table A.6. that overall no significant changes were observed in either the intrafamilial or
extrafamilial group when considered separately.
Relapse-Prevention Questionnaire
This instrument looks at three areas. The first covers the subjects’ awareness of the thoughts and feelings which
lead to offending, their willingness to admit to planning, recognition of where an offence is most likely to occur
and the characteristics of the victims they are most likely to offend against. They were also asked about how
other people might know that they were at risk of re-offending and their motivation for offending. The second
examines the strategies the offender would use to cope with risk situations and deviant thoughts and feelings. A
third section comprises a question that asks the offender about his own perception of level of risk of reoffending. The data below are therefore reported on these three sections: Recognition of Risk Situations
(maximum score 18), Generation of Strategies (max. score 16) and Recognition as Future Risk (max. score 2).
A MANOVA carried out on the RP data found an overall significant change pre/-post (F(3/70) = 52.0, p
<. 00001). Univariate F-tests within the MANOVA are shown in Table A.7.
TABLE A.7:
RELAPSE-PREVENTION SKILLS
RELAPSE-PREVENTION SKILLS
PREMEAN (SD)
Recognition of Risk Situations
Generation of Strategies
Recognition as Future Risk
5.8
5.6
0.5
POSTMEAN (SD)
(4.9)
(4.3)
(0.8)
** p < .01
11.9
10.8
0.7
(4.8)
(4.0)
(0.9)
EFFECT
SIZE
1.3
1.2
0.4
SIGNIFICANT
CHANGE (F)
YES (127.8)****
YES (116.7)****
YES
(7.7)**
****p <.0001
It should also be noted that the effect size of the changes in Recognition of Risk Situations and Generation of
Strategies is greater than one SD.
104
A.3.
LENGTH OF THERAPY AND PRE/-POST COMPARISONS
Men undergoing shorter and longer treatment were compared in terms of level of change on the measures.
Analysis, using MANOVA, comparing the level at which men started prior to treatment, found no overall
statistical diffe rence between the men in the shorter and longer groups, suggesting that any furt h e r
comparisons are valid. Univariate F-tests within the MANOVA found that there was only one significant
difference in all of the variables – this was on the Personal Distress scale (F(1/75) = 4.1, p < .05); here the men
in the longer groups had a significantly higher level of Personal Distress prior to treatment compared with men
in the shorter groups.
When the shorter and longer programmes were compared in terms of overall treatment effectiveness the
following results were found.
Factor 1
A MANOVA carried out on the pre/-post change of five of the Factor 1 variables, with Length of Therapy
(shorter or longer) as an independent factor, found a significant change effect as described above but no
significant difference in Length of Therapy factor and no significant interaction between Length of Therapy and
pre/-post change. This latter result indicated that there was not a differential effect of treatment by length of
group. Even though there was no overall interaction effect, planned comparisons were carried out using the
univariate F-tests within the MANOVA; these found one significant effect (in terms of pre/-post change by
Length of Therapy) in the MSI: Sex Deviance Admittance scale (F(1/75) = 4.5, p < .05). Further analysis using ttests found that this result was due to the longer groups effecting greater change on this measure than the
shorter groups. Table A.8 also shows pre/-post results for all the denial/admittance measures for comparison.
TABLE A.8:
DENIAL/ADMITTANCE
MEASURES (acceptable limits
after treatment in brackets)
PREMEAN (SD)
POSTMEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER (N = 40)
MSI: Social & Sex. Des.[28 to 35]
MSI: Lie [0 to 2]
MSI: Sex Dev. Admitt. [51 to 60]
SOAQ [82 to 87]
MSI: Sexual Obsessions [3 to 9]
22.8
7.9
52.9
94.0
2.2
(7.8)
(3.9)
(15.0)
(16.6)
(2.1)
23.9
6.4
54.9
81.9
2.9
(8.7)
(3.6)
(15.5)
(19.0)
(5.2)
0.2
0.4
0.1
0.5
0.2
NO
YES
NO
YES
NO
LONGER (N = 37)
MSI: Social & Sex. Des. [28 to 35]
MSI: Lie [0 to2]
MSI: Sex Deviance Admit. [51 to 60]
SOAQ [8 to -87]
MSI: Sexual Obsessions [3 to 9]
20.6
8.0
47.2
92.0
2.5
(8.3)
(3.4)
(16.4)
(17.5)
(3.1)
22.6
(8.7)
5.8
(3.2)
56.0 (13.4)
74. 9 (16.4)
3.0
(3.4)
0.3
0.6
0.5
0.7
0.1
YES
YES
YES
YES
NO
(3.9)****
(5.7)****
(2.6)*
(4.7)****
(3.6)***
(6.7)****
** p < .01 *** p < .001 **** p < .0001
It can be seen from Table A.8 that longer treatment produced slightly better results compared with shorter
treatment on the MSI: Social & Sexual Desirability, as well as, the MSI: Sex Deviance Admittance scale. It should
also be noted that men in the shorter groups appear to be in higher levels of denial after treatment on the
SOAQ and the MSI: Lie scales than men in the longer groups. However, these differences were not found to be
significant. As for the MSI: Sexual Obsessions scale, although the change is not significant it is worth noting that
in the longer groups the mean at post-treatment is within the ‘expected deviant’ range, whereas in the shorter
groups it is still in the ‘questionable-fake good’ range. It also worth noting that the effect size of the changes in
the MSI: Lie, MSI: Sex Deviance Admittance and the SOAQ scales are all above 0.5 SD in the longer groups,
whereas this was only found in the SOAQ scale in the shorter groups.
105
Factor 2
A MANOVA carried out on the pre/-post change of the six Factor 2 variables, with Length of Therapy (shorter
or longer) as an independent factor found a significant change effect as described in A.2, Section on Factor 2
but no significant difference in Length of Therapy factor and no significant interaction between Length of
therapy and pre/-post change. This latter result indicated that there was not a differential effect of treatment by
length of group. Table A.9 also shows pre/-post results for denial/admittance measures, and Table A.10 those for
the accountability measures for completeness.
TABLE A.9:
SOCIAL COMPETENCE BY TREATMENT LENGTH
MEASURES
(non-offender mean in brackets)
PREMEAN (SD)
SHORTER (N = 40)
Self-Esteem [7.1]
Emotional Loneliness [33.8]
Under-assertiveness [8.8]
Personal Distress [7.5]
4.2
42.1
10.4
10.5
(2.7)
(9.1)
(7.0)
(5.7)
LONGER (N = 37)
Self Esteem [7.1]
Emotional Loneliness [33.8]
Under-assertiveness [8.8]
Personal Distress [7.5]
4.2
45.1
12.8
11.8
(2.4)
(11.9)
(7.6)
(5.7)
* p < .05
POSTMEAN (SD)
5.0
43.1
9.4
9.4
(2.6)
(11.6)
(6.6)
(5.0)
4.63 (2.6)
42.3 (12.1)
10.7
(6.9)
10.1
(5.7)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
0.6
0.1
0.2
0.3
YES
NO
NO
NO
0.3
0.4
0.39
0.4
NO
NO
YES
YES
(2.3)*
(1.8)*•
(2.6)*
*• p < .05 {one-tail}
Although there was no significant overall difference between the longer and shorter groups, it can be seen from
Table A.9 when comparing the effect sizes of the changes shown by planned comparisons using t-tests between
the measures, that it is in the longer treatment groups that the biggest effect sizes are found.
TABLE A.10:
ACCEPTANCE OF ACCOUNTABILITY
MEASURES (non-offender mean or
acceptable limits after treatment in
brackets)
PREMEAN (SD)
POSTMEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER (N = 40)
Locus of Control [11.0]
MSI: Cog. Dis. & Imm. [0 to 3]
15.0
6.5
(5.1)
(3.0)
14.5
5.6
(5.7)
(3.0)
0.0
0.2
NO
YES
LONGER (N = 37)
Locus of Control [10.96]
MSI: Cog. Dis. & Imm. [0 to 3]
14.5
6.0
(5.1)
(3.5)
12.2
5.8
(5.8)
(3.3)
0.4
0.1
YES
NO
(2.4)*
(2.9)**
*p < .05 ** p < .01
It can be seen from Table A.10 that the effect size for the amount of Locus of Control in the longer groups is a
lot higher than that found in the shorter groups.
Factor 3
A MANOVA carried out on the pre/-post change of the three Factor 3 variables, with Length of Therapy (shorter
or longer) as an independent factor, found a significant change effect as described in A.2, Section to Factor 3
106
but no significant difference in Length of therapy factor and no significant interaction between Length of
Therapy and pre/-post change. This latter result indicated that there was not a differential effect of treatment by
length of group. Table A.11 also shows pre/-post results for the pro-offending measures for the longer and
shorter groups for comparison.
TABLE A.11:
PRO-OFFENDING ATTITUDES
MEASURES (non-offender mean or
acceptable limits after treatment in)
brackets)
PREMEAN (SD)
POSTMEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER (N = 40)
Cognitive Distortions [13.1]
Victim Distortions [18.0]
MSI: Justifications [0 to 1]
15.4
41.0
5.7
(10.1)
(22.5)
(5.0)
9.0
16.1
4.2
(8.9)
(16.7)
(4.3)
0.7
2.6
0.3
YES
YES
YES
(4.0)****
(8.9)****
(2.0)*
LONGER (N = 37)
Cognitive Distortions [13.1]
Victim Distortions [18.0]
MSI: Justifications [0 to 1]
15.3
38.0
4.2
(11.8)
(25.0)
(3.6)
7.7
17.0
3.1
(8.9)
(16.9)
(3.7)
0.9
2.2
0.23
YES
YES
YES
(4.5)****
(6.6)****
(2.3)*
* p < .05
**** p <. 0001
It can be seen from Table A.1. that both longer and shorter groups were highly effective at producing treatment
change in the sample on the pro-offending attitudes measures, with the Cognitive Distortions and Victim
Distortions measures showing big effect size changes.
Emotional Identification
A MANOVA carried out on the pre/-post data by type of abuse (intra/extrafamilial) and length of treatment found
that the overall pre/-post change was significant at p < .05 level (F(1/73) = 3.1 p = 0.08) and that there was a
significant difference between intra- and extrafamilial abusers in terms of Emotional Identification scores (F(1/73)
= 4.0, p < .05). However no significant interactions were found. Comparisons between the intrafamilial and
extrafamilial abusers pre- to post-test using planned comparison t-tests are shown in Table A.12.
TABLE A.12:
EMOTIONAL IDENTIFICATION
MEASURES (non-offender mean
in brackets for:
* parents, **non-parents)
N
PREMEAN (SD)
POSTMEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER GROUPS
Emotional Identification All
Extrafamilial abusers [16.1**]
Intrafamilial abusers [23.4*]
40
14
26
14.9
16.3
10.8
(12.3)
(12.4)
(10.5)
12.2
14.4
11.0
(11.7)
(14.1)
(10.5)
0.3
0.2
0.0
NO
NO
NO
LONGER GROUPS
Emotional Identification All
Extrafamilial abusers [16.1**]
Intrafamilial abusers [23.4*]
37
14
23
18.3
20.5
12.9
(17.0)
(15.3)
(12.9)
12.9
14.6
11.7
(10.7)
(10.1)
(11.1)
0.5
0.6
0.1
YES
YES
NO
* p < .05
(2.0)*
(1.7)*•
*• p < .05 {one-tail}
It can be seen from Table A.12 that when the men are split into intra- and extrafamilial abusers it is the
extrafamilial abusers who are tending to show change on this measure. However, it is only the extrafamilial
107
abusers in the longer groups who show the significant change. It should also be noted that the effect size of the
change in extrafamilial abusers in the long-term groups is greater than 0.5 SD.
Relapse-Prevention (RP) skills
A MANOVA carried out on the pre/-post data for the recognition of risk situations, Generation of Strategies and
Recognition as Future Risk measures, comparing longer and shorter groups, found a significant overall change
(F(3/69 = 51.22, p < .0001) on all of the three aspects of RP but no difference between the longer and shorter
groups and no interaction, indicating that there did not appear to be a dif ferential impact of length of treatment
upon RP skills. Table A.13 shows the pre/-post changes.
TABLE A.13:
RELAPSE-PREVENTION SKILLS
RELAPSE-PREVENTION SKILLS
PREMEAN (SD)
POSTMEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER (N = 40)
Recognition of risk situations
Generation of Strategies
Recognition as Future Risk
5.8
5.5
0.6
(4.9)
(4.5)
(0.8)
11.6
10.4
0.8
(4.9)
(3.8)
(0.9)
1.2
1.1
0.3
YES
YES
YES
(7.6)****
(7.2)****
(2.3)*
LONGER (N = 37)
Recognition of risk situations
Generation of Strategies
Recognition as Future Risk
5.5
5.8
0.4
(5.1)
(4.2)
(0.8)
12.1
11.3
0.6
(4.7)
(4.2)
(0.9)
1.3
1.3
0.3
YES
YES
YES
(8.3)****
(7.3)****
(1.9)*•
*• p < .05 {one-tail} * p < .05
**** p < .0001
It can be seen from Table A.13 that in terms of effect size, recognition of risk situations, Generation of Strategies
and Recognition as Future Risk are somewhat better in the longer groups compared with the shorter groups.
A.4.
LONG-TERM EFFECTS OF TREATMENT
Scores which the group of child abusers achieved after treatment and their scores at long-term follow-up
(average 9.2 months, range 8 to 11 months) on the measures reported in the previous section were compared.
Tables A.14 to A.18 show the results of these comparisons. Data are from the 56 men who agreed to be seen
approximately nine months after the end of treatment. Column 2 of the tables shows the baseline pre-treatment
mean and standard deviation score for this sample.
Factor 1
A MANOVA carried out on the Factor 1 variables (denial/admittance) was not found to be significant (F(5/51) =
2.1). Univariate F-tests comparing post-test scores with long-term follow-up scores are shown in Table A.14.
TABLE A.14:
MEASURES
Soc. & Sex. Des.
Sex Dev. Admit.
Lie
Offence Admit.
Sexual Obs.
DENIAL/ ADMITTANCE
BASELINE
MEAN (SD)
20.6
48.9
8.1
92.9
2.3
(8.3)
16.2)
(3.7)
(16.9)
(2.9)
POSTMEAN (SD)
LONG-TERM
MEAN (SD)
22.3
55.4
6.1
77.9
2.6
21.7
52.3
6.9
78.8
1.8
(9.0)
(14.9)
(3.5)
(17.7)
(3.1)
* p < .05
** p < .01
108
(8.3)
(15.8)
(3.5)
(19.1)
(2.2)
EFFECT
SIZE
0.1
0.2
0.2
0.0
0.2
SIGNIFICANT
CHANGE
NO
NO
YES
NO
YES
(5.2)*
(8.6)**
Overall these results suggest that men did not change in the areas of denial and admittance at long-term followup-remaining in the ‘treated’ range on the MSI: Sex Deviance Admittance and Offence Admittance scales and
not returning to pre-treatment/baseline levels. However, it can be seen from Table A.14 that there were changes
on two measures: the MSI: Sexual Obsessions scale which has moved from the ‘expected deviant’ range into the
‘questionable-fake good’ and the MSI: Lie scale which has become somewhat higher but remained in the
‘sexually deviant interests suppressed’ range.
Factor 2
A MANOVA car ried out on the Factor 2 variables (social competence/acceptance of accountability) was found
to be significant (F(6/50) = 2.9, p < .05). Univariate F-tests comparing post-test scores with long-term follow-up
scores are shown in Table A.15.
TABLE A.15:
SOCIAL COMPETENCE MEASURES
MEASURES
BASELINE
MEAN (SD)
Self-Esteem
Emotional Loneliness
Under-assertiviness
Personal Distress
4.2
43.2
12.4
11.9
(2.5)
(10.1)
(7.8)
(6.0)
POSTMEAN (SD)
LONG-TERM
MEAN (SD)
4.9
41.7
10.0
10.4
5.3
39.0
9.4
9.6
(2.5)
(10.6)
(7.3)
(6.2)
(2.3)
(12.1)
(6.7)
(5.4)
EFFECT
SIZE
0.3
0.1
0.1
0.2
SIGNIFICANT
CHANGE (F)
NO
YES
NO
NO
(5.19)*
* p < .05
It can be seen from Table A.15 that the levels of social competence achieved after treatment hold up over time,
in that there was no significant change back to pre-treatment levels. Inspection of the mean suggests that the
scores on these measures are actually better at long-term follow-up than at post-test with the Emotional
Loneliness scale actually showing a significant improvement.
TABLE A.16:
ACCOUNTABILITY MEASURES
MEASURES
Locus of Control
MSI: Cog. Dis. & Imm.
BASELINE
MEAN (SD)
14.8
6.2
(5.1)
(3.3)
POSTMEAN (SD)
LONG-TERM
MEAN (SD)
13.1
5.5
13.6
4.8
(5.8)
(3.2)
(5.7)
(3.3)
EFFECT
SIZE
0.1
0.2
SIGNIFICANT
CHANGE (F)
NO
YES
(5.8)*
* p < .05
It can be seen from Table A.16 that acceptance of accountability for offence-related behaviours (MSI: Cognitive
Distortions & Immaturity scale) has significantly improved from post-test to follow-up; however, the mean score
on this scale at follow-up still falls in the ‘Cognitive Distortions and Immaturity’ range. The Locus of Control
scale shows no significant change, and so remains below pre-treatment baseline level.
Factor 3
A MANOVA carried out on the Factor 3 va ri ables (pro-offending attitudes) was not found to be significant
(F(3/53) = 1.9). Univariate F-tests comparing post-test scores with long-term follow-up scores are shown in
Table A.17.
109
TABLE A.17:
PRO-OFFENDING ATTITUDES
MEASURES
BASELINE
MEAN (SD)
Cognitive Distortions
Victim Distortions
Justifications
16.3
38.6
5. 4
(10.7)
(23.3)
(4.6)
POSTMEAN (SD)
LONG-TERM
MEAN (SD)
8.7
14.9
4.6
8.9
15.1
3.7
(9.6)
(17.3)
(4.9)
(8.9)
(16.7)
(4.6)
EFFECT
SIZE
0.03
0.02
0.20
SIGNIFICANT
CHANGE (F)
NO
NO
YES
(5.1)*
* p < .05
It can be seen from Table A.17 that there were no changes in the Cognitive Distortions and Victim Distortions
measures from post-test to follow-up and that the levels on these scales remain well below pre-treatment,
baseline levels. There was a significant improvement on the MSI: Justifications scale.
Emotional Identification
A MANOVA carried out on the data with post- long-term follow-up change as a within subjects factor, and type
of abuse (intra/extrafamilial) as between-subjects factor, found a significant overall change post-test to follow-up
(F(1,55) = 4.3, p < .05), but no significant difference between intra- and extrafamilial abusers and no significant
interaction between prepost change and type of abuse. The results for the mean for the total group and
planned comparisons post-treatment to long-term follow-up, using t-tests, for both the intra- and extrafamilial
cases, are shown in Table A.18.
TABLE A.18:
EMOTIONAL IDENTIFICATION
MEANS FOR
N
ALL [19.0]
Extrafamilial
Intrafamilial
56
18
38
BASELINE
MEAN (SD)
14.0
17.8
12.3
(11.1)
(12.0)
(10.3)
POSTMEAN (SD)
12.2
12.7
12.0
(10.4)
(10.3)
(10.6)
LONG-TERM
MEAN (SD)
10.1
9.5
10.4
(9.4)
(8.6)
(9.8)
EFFECT
SIZE
0.2
0.3
0.1
SIGNIFICANT
CHANGE (F)
YES
NO
NO
(4.9)*
* p < .05 {one-tail}
It can be seen from Table A.18. that both the intra- and extrafamilial abusers report less emotional identification
with children at long-term follow-up than at the post-treatment stage of testing.
Relapse-Prevention skills
Table A.19 below shows the results for the relapse-prevention measures. The maximum scores for the scales are
as follows: recognition of risk situations (maximum score 18, Generation of Strategies (max. score 16) and
Recognition as Future Risk (max. score 2).
TABLE A.19:
RELAPSE PREVENTION SKILLS
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
LONG-TERM
MEAN (SD)
Recog. risk situations
Gen. Strategies
Recog. Future Risk
6.3
5.9
0.5
12.6
11.4
0.7
12.1
10.7
0.7
(5.3)
(4.8)
(0.8)
(4.4)
(4.0)
(0.9)
110
(4.5)
(4.1)
(0.8)
EFFECT
SIZE
0.1
0.1
0.0
SIGNIFICANT
CHANGE (t)
NO
NO
NO
It can be seen that no significant changes were found at the nine-month follow-up suggesting the overall gains
in awareness, of recognition of risk situations, Generation of Strategies and Recognition as Future Risk held up
over time. These can be seen as being a lot higher than the levels found using this measure prior to treatment
A.5.
TREATMENT GAINS BY LENGTH OF THERAPY
Here comparisons were made in how treatment gains hold up over time in men who had undergone shorter (N
= 26) or longer therapy (N = 30) and who had agreed to be seen at the nine-month follow-up.
Factor 1
A MANOVA carried out on the Factor 1 (denial/admittanc e) va ri ables with length of pro gra m m e
(shorter/longer) as an independent factor and pre/-post change as a within-subjects factor. This analysis found
no significant post-follow-up change as described in Section A.4. However, a significant difference in the Length
of Programme factor (F(5/50) = 2.5, p < .05) suggests that there were overall differences in the mean between
the longer and shorter groups on the five measures comprising this factor. Univariate F-tests within this result
found that this result was due to significant differences in the MSI: Lie scale (F(1,54) = 5.1, p < .05) and the
SOAQ scale (F(1,54) = 8.1, p < .05). It can be seen from Table A.20 that these results were due to a higher level
of denial as measured by these two scales in the shorter groups at both post-treatment and long-term follow-up.
A significant interaction between Length of Programme and pre/-post change (F(5/50) = 3.3, p < .05) was also
found. Univariate F-tests within this interaction found that there were significant differences on two of the
va ri ables: SOAQ (F(1/54) = 8.1, p < .05) and MSI: Sexual Obsessions (F(1/54) = 6.0, p < 0.05). Planned
comparisons between these measures, using t-tests are shown in Table A.20. It can also be seen from this table
that the significant interaction effect found in the SOAQ measure was due to men in the shorter groups getting
significantly worse on this measure, while in the longer groups results remained more or less constant from
post-test to long-term follow-up. While the interaction found in the MSI: Sexual Obsessions scale was due to
change happening in the longer groups in terms of a decrease of the level of sexual obsessions3, no change had
occurred in the shorter groups.
TABLE A.20:
DENIAL/ADMITTANCE
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOW
UP (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER (N = 40)
MSI: Soc. & Sex. Des.
MSI: Lie
MSI: Sex Dev. Admitt.
SOAQ
MSI: Sexual Obs.
21.2
8.6
51.7
96.9
2.1
(8.2)
(8.2)
(14.4)
(16.7)
(2.2)
23.0
7.0
52.6
83.1
2.2
(8.9)
(3.4)
(17.1)
(19.2)
(2.6)
22.8
8.2
47.6
87.5
2.0
(9.1)
(3.5)
(18.3)
(20.7)
(2.3)
0.0
0.3
0.3
0.2
0.0
NO
YES
NO
YES
NO
LONGER (N = 37)
MSI: Soc. & Sex. Des.
MSI: Lie
MSI: Sex Dev. Admitt.
SOAQ
MSI: Sexual Obs.
20.0
7.7
46.5
89.4
2.5
(8. 6)
(3.7)
(17.5)
(16.5)
(3.4)
21.7
5.4
57.9
73.4
3.0
(9.3)
(3.4)
(12.5)
(15.1)
(3.4)
20.7
5.8
56.5
71.3
1.6
(7.6)
(3.2)
(12.1)
(13.9)
(2.2)
0.1
0.1
0.1
0.1
0.3
NO
NO
NO
NO
YES
* p < .05
(2.1)*
(2.2)*
(3.6)**
** p < .01
As a general observation the results for the Factor 1 variables heldup a lot better in the longer group compared
with the shorter group sample. From Table A.20 it can be seen that men who had undergone shorter therapy
actually got significantly worse on the MSI: Lie and SOAQ scales between post-test and follow-up, suggesting a
drift back to pre-treatment levels when comparisons with baseline levels are made. In comparison, the results
3
This result moves this group from the ‘expected deviant’ range into the ‘questionable-fake good’ range
111
held up in men who had undergone longer therapy. Further analysis between longer- and shorter-term therapy
found that at follow-up the shorter groups were in significantly higher levels of denial on the these two
measures (SOAQ, t = 3.4, p < .002; MSI: Lie, 2.7, p < .009) compared with the longer groups. Although it
should be noted that men in the shorter groups were in higher levels of denial immediately after treatment
compared with men in longer treatment, this was only significant on the SOAQ scale (t = 2.1, p < .05).
Factor 2
A MANOVA was carried out on the Factor 2 (social competence/acceptance of accountability) variables with
length of programme (shorter/longer) as an independent factor and post-follow-up change as a within-subjects
factor. A significant effect was found in terms of post-follow-up change as described in Section A.4. No
significant difference was found between the longer and shorter groups and no interaction between length of
programme and post-follow-up change as described in Section A.4. Planned comparisons using univariate F-tests
within the MANOVA found only one significant interaction in the Emotional Loneliness scale (F(1/54) = 4.1, p <
.05). Table A.21. shows that this result was due to men in the shorter groups improving significantly on this
measure from post-treatment to long-term follow-up. Comparisons between the longer and shorter groups for
the other measures are shown in this table for completeness.
TABLE A.21:
SOCIAL COMPETENCE
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOW-UP
MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Self-Esteem
Emotional Loneliness
Under-assertion
Personal Distress
4.5
41.7
11.1
10.4
(2.6)
(9.9)
(7.9)
(6.0)
5.3
41.4
9.1
9.4
(2.3)
(11.2)
(7.0)
(5.3)
5.7
36.1
7.7
7.8
(2.3)
(11.2)
(6.8)
(5.1)
0.2
0.8
0.3
0.4
NO
YES
NO
YES
LONGER
Self-Esteem
Emotional. Loneliness
Under-assertion
Personal Distress
4.0
44.6
13.4
13.2
(2.4)
(10.3)
(7.6)
(5.8)
4.5
42.0
10.8
11.3
(2.6)
(10.2)
(7.6)
(6.9)
4.9
41.8
10.8
11.1
(2.3)
(13.2)
(6.9)
(5.3)
0.3
0.02
0.005
0.06
NO
NO
NO
NO
* p < .05
(4.1)**
(2.6)*
** p < .0001
It can be seen from Table A.21 that men in the shorter groups had significantly improved after therapy in the
areas of emotional loneliness and personal distress. However, it should be noted that the compliance rate was
higher in the longer groups (79%) than the shorter groups, therefore the significant changes in the shorter
groups may be due to interv i ewing highly motivated men from the shorter groups. Table A.22 show s
comparisons between the acceptance of accountability measures by programme length.
4
Although it should be noted that this still outside the acceptable range of accountability in the ‘cognitive distortions & immaturity’ range of this scale
112
TABLE A.22:
ACCEPTANCE OF ACCOUNTABILITY
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Locus of Control
MSI: Cog. Dis. & Imm.
14.8
6.4
(5.3)
(3.6)
14.0
5.2
(6.1)
(3.2)
14.0
4.9
(6.1)
(3.6)
0.0
0.1
NO
NO
LONGER
Locus of Control
MSI: Cog. Dis. & Imm.
14.8
6.1
(4.9)
(3.2)
12.4
5.8
(5.4)
(3.2)
13.3
4.7
(5.4)
(3.15)
0.2
0.2
NO
YES
(2.6)*
* p < .05
It can be seen from Table A.22 that the overall significant improvement found in the total samples change on
the MSI: Cognitive Distortions scale seen in Table A.16 was due to the change in the longer group4.
Factor 3
A MANOVA was carried out on the Factor 3 (pro-offending attitudes) variables with length of programme
(shorter/longer) as an independent factor and post-follow-up change as a within-subjects factor. No significant
effects were found in terms of post-test-follow-up change and length of programme and no interaction between
length of programme and post-follow-up change. However, planned comparison within the interaction using
univariate F-tests found a significant effect in the MSI: Justifications scale (F(1,54) = 5.1, p < .05). Further
comparisons, using t-tests, found that this significant effect was due there being a significant decrease in the level
of justifications in the longer sample but no change in the shorter group. These results are shown in Table A.23.
TABLE A.23:
PRO-OFFENDING ATTITUDES
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Cognitive Distortions
Victim Distortions
MSI: Justifications
16.2
38.8
6.2
(8.8)
(22.6)
(5.5)
9.8
14.9
4.6
(9.9)
(22.5)
(4.9)
10.3
16.1
3.7
(8.9)
(16.7)
(4.6)
0.1
0.1
0.1
NO
NO
NO
LONGER
Cognitive Distortions
Victim Distortions
MSI: Justifications
16.4
38.3
4.6
(12.2)
(24.2)
(3.7)
6.6
16.6
3.3
(7.9)
(16.9)
(4.0)
7.7
13.5
2.4
(8.9)
(14.8)
(2.7)
0.1
0.3
0.2
NO
NO
YES
(2.2)*
* p < .05
There differences between the long-and the short-term groups were that there was a significant change in MSI:
Justifications, MSI: Sexual Obsessions and the Emotional Identification measures in the longer treatment sample.
These results suggest that the longer treatment regime has a carry-over effect after the end of therapy, in terms
of showing less justifications for offending, showing less emotional identification with children and less general
level of sexual obsessions actually taking these men into the ‘fake good’ range.
Emotional Identification
A MANOVA carried out on the data with post-long-term follow-up change as a within-subjects factor, and type of
abuse (intra/extrafamilial) and length of treatment as a between-subjects factor, found no significant effects,
apart from overall change (as described in Section A.4). However, the results for the mean for the total group
and planned comparisons post-treatment to long-term fo l l ow-up, using t-tests, for both the intra- and
extrafamilial cases are shown in Table A.24.
113
TABLE A.24:
EMOTIONAL IDENTIFICATION
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Emotional Identification 14.9 (12.2)
Extrafamilial (N = 8)
14.2 (11.0)
Intrafamilial (N = 18)
10.61
(7.7)
11.8
12.5
11.6
(10.5)
(12.3)
(10.0)
10.4
10.9
10.2
(10.5)
(11.5)
(10.4)
0.1
0.2
0.1
NO
NO
NO
LONGER
Emotional Identification 18.6
Extrafamilial (N = 10) 21.0
Intrafamilial (N = 20)
13.7
13.1
12.9
12.3
(10.7)
(9.0)
(11.3)
9.7
8.4
10.6
(8.6)
(5.6)
(10.0)
0.3
0.5
0.1
YES
YES
NO
(17.1)
(12.3)
(12.2)
(1.9)*•
(1.9)*•
*• p < .05 {one-tail} * p < .05 *** p <.001
It can be seen from Table A.24 that overall there is a marginally significant decrease in the level of emotional
identification in the longer group sample, but it can further be seen that this was due mainly to the decrease in
the level of Emotional Identification with children in the extrafamilial abuser group.
Relapse-prevention skills
MANOVAs carried out on the awareness of Risk Situations, Generation of Strategies and Perception of Risk
Scales and found marginally significant differences between the longer and shorter groups (Awareness: F(1, 54)
= 3.9, p < .05; Strategies: F(1, 54) = 3.6, p = .06). It can be seen from Table A.25 that this is due to the higher
level of Awareness and Strategies in the longer group sample at both post-treatment and long-term follow-up.
TABLE A.25:
RELAPSE-PREVENTION SKILLS
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN(SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER (N = 23)
AWARENESS
STRATEGIES
RISK
5.6
5.6
0.5
(5.5)
(5.3)
(0.8)
11.4
10.8
0.7
(5.2)
(4.1)
(0.9)
11.0
9.3
0.6
(4.7)
(4.6)
(0.9)
0.1
0.3
0.1
NO
NO
NO
LONGER (N = 26)
AWARENESS
STRATEGIES
RISK
7.0
6.2
0.5
(5.2)
(4.3)
(0.9)
13.6
12.0
0.7
(3.3)
(3.9)
(0.9)
13.1
11.9
0.6
(4.1)
(3.2)
(0.9)
0.10
0.02
0.1
NO
NO
NO
Here, it should be noted that three men in the shorter group sample and four men in the longer group sample
failed to complete this questionnaire. It can be seen from the table above that there is no difference between
shorter and longer groups approximately nine months after the end of treatment. There is some indication,
however, that men’s strategies in the shorter groups are not as good at follow-up as immediately after treatment.
It should also be noted that these men’s level of Awareness of Risk Situations and RP strategies are lower
immediately after treatment, and at follow-up, compared with the men in longer treatment. However, these
differences were not found to be significant.
A.6.
PRISON AND COMMUNITY SAMPLES AT FOLLOW-UP
Comparisons were made at the follow-up period to see whether there was a difference between how treatment
held-up in the comparative long-Term between men who were still in prison (N = 32) and men who had been
released into the community (N = 24).
114
Factor 1
A MANOVA car ried out on the denial admittance factor, with situation at follow-up (prison/community) as an
independent factor, and post-follow-up change as a within-subjects factor, found no significant overall change
post-test to long-term follow-up (as described in Section A.4), and no significant differences between the prison
and community samples and no interaction between situation and post-follow-up change.
TABLE A.26:
DENIAL/ADMITTANCE
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN(SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
PRISON
MSI: Soc. & Sex. Des.
MSI: Lie
MSI: Sex Dev. Admit.
SOAQ
MSI: Sex. Obs.
19.7
8.6
46.0
95.3
1.8
(7.9)
(3.5)
(18.2)
(18.1)
(2.1)
21.9
6.3
56.3
77.0
2.1
(8.6)
(3.5)
(13.7)
(15.9)
(2.3)
21.2
7.2
51.9
78.7
1.7
(7.7)
(3.5)
(16.2)
(17.8)
(1.9)
0.1
0.2
0.2
0.1
0.1
NO
NO
NO
NO
NO
COMMUNITY
MSI: Soc. & Sex. Des.
MSI: Lie
MSI: Sex Dev. Admit.
SOAQ
MSI: Sex. Obs.
21.7
7.6
53.1
89.6
3.0
(8.9)
(3.9)
(12.0)
(14.9)
(3.6)
22.8
(9.2)
5.9
(3.4)
54.2 (16.7)
79.1 (20.1)
3.30 (3.8)
22.3
6.5
52.8
79.0
1.9
(9.2)
(3.6)
(15.6)
(21.0)
(2.7)
0.1
0.1
0.1
0.0
0.4
NO
NO
NO
NO
YES
(2.7)*
* p < .05
Planned comparisons within the MANOVA, using univariate F-tests, found only one marginally significant effect
in the MSI: Sexual Obsessions measure (F(1, 54) = 3.6, p = .06). It can be seen from Table A.2 that this was due
to men in the community sample significantly decreasing in their level of obsessions at long-term follow-up,
whereas there was no change in the prison sample. However, it should be noted that the change observed in
the community sample was due to the mean score on the Sexual Obsessions measure moving from the
‘expected deviant’ range into the ‘questionable-fake good’ range. These results perhaps suggest that the
community sample were trying to present themselves in a more favourable light than the prison sample. Table
A.26 also shows comparisons between the other measures in the prison and community samples fo r
completeness, where it can be seen that there were no noticeable differences between the samples on the
other measures.
Factor 2
A MANOVA carried out on the social competence/acceptance of accountability factor, with situation at followup (prison/community) as an independent factor, and post-follow-up change as a within-subjects factor, found a
significant overall change post-test to long-term follow-up (as described in Section A.4) but no significant
difference between the prison and community samples and no interaction between situation and post-follow-up
ch a n ge. Planned comparisons within the MANOVA, using univa riate F-tests, found only one margi n a l ly
significant effect in the Locus of Control measure (F(1, 54) = 4.4, p < .05). It can be seen from Table A.28 that
this interaction was due to men in the community becoming significantly more externally controlled at the
nine-month follow-up period compared with the post-treatment results, whereas no difference was found
between post-test and follow-up in the prison sample. Table A.27 shows post-treatment follow-up comparisons
for the other Factor 1 variables for completeness.
115
TABLE A.27:
SOCIAL COMPETENCE
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN(SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
PRISON
Self-Esteem
Emotional Loneliness
Under-assertiveness
Personal Distress
4.0
41.5
13.2
11.7
(2.2)
(9.9)
(8.1)
(6.7)
4.9
42.7
11.2
10.8
(2.2)
(12.3)
(7.4)
(7.0)
5.4
38.6
9.9
9.7
(2.0)
(14.1)
(7.8)
(6.0)
0.3
0.6
0.2
0.3
NO
NO
NO
NO
COMMUNITY
Self-Esteem
Emotional Loneliness
Under-assertiveness
Personal Distress
4.6
45.2
11.2
12.2
(2.8)
(10.3)
(7.4)
(5.0)
4.8
40.3
8.3
9.9
(2.8)
(8.2)
(7.0)
(5.0)
5.2
39.4
8.7
9.3
(2.6)
(9.1)
(5.8)
(4.6)
0.2
0.1
0.1
0.2
NO
NO
NO
NO
Even though it can be seen from Table A.27 that no differences were found between the men seen in the
community and men is prison, in terms of any statistical change from post-treatment levels of social adequacy, it
can be seen from the effect sizes that men still in prison are more likely to have shown some improvement on
social competence than men in the community.
TABLE A.28:
ACCEPTANCE OF ACCOUNTABILITY
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
PRISON
Locus of Control
MSI: Cog. Dis. & Imm.
14.8
5.8
(5.2)
(3.3)
14.1
5.19
(5.9)
(2.83)
13.7
4.6
(5.6)
(2.8)
0.1
0.1
NO
NO
COMMUNITY
Locus of Control
MSI: Cog. Dis. & Imm.
14.7
6.8
(5.0)
(3.3)
11.9
6.0
(5.7)
(3.6)
13.5
5.0
(6.0)
(3.9)
0.3
0.2
YES
NO
(2.3)*
* p < .05
As previously noted, it can be seen from Table A.28 that the community sample actually got significantly worse
in their general acceptance of accountability (as measured by the Locus of Control scale) at the seven-month
follow-up. There was no change in the prison sample. It should also be noted that in the community sample
(and to a lesser extent in the prison sample) the effects are going in the opposite direction for these measures
of accountability.
Factor 3
A MANOVA carried out on the pro-offending factor, with situation at follow-up (prison/community) as an
independent factor, and post-follow-up change as a within-subjects factor, found no significant differences in
the main factors or the interaction of these factors. Table A.29 shows planned comparisons post-test to followup for completeness
116
TABLE A.29:
PRO-OFFENDING ATTITUDES
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
PRISON
Cognitive Distortions
Victim Distortions.
MSI: Justifications
16.6
40.0
5.6
(12.2)
(22.3)
(5.4)
7.8
13.8
4.2
(8.1)
(13.6)
(4.7)
7.9
12.9
2.8
(8.7)
(14.1)
(3.6)
0.0
0.0
0.3
NO
NO
YES
COMMUNITY
Cog. Distortions
Victim Distortions
MSI: Justifications
15.9
36.6
5.1
(8.3)
(17.6)
(3.3)
8.8
18.5
3.5
(10.1)
(20.6)
(4.0)
10.3
16.0
3.3
(9.1)
(17.6)
(4.0)
0.2
0.2
0.1
NO
NO
NO
(2.8)**
** p<.01
It can be seen from Table A.29 that men in the prison sample significantly improved on the MSI: Justifications
scale; however, as a group they still fell into the ‘justifies sexual deviance’ range.
TABLE A.30:
EMOTIONAL IDENTIFICATION
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
PRISON
Emotional Ident.
Extrafamilial (N = 6)
Intrafamilial (N = 26 )
16.0
13.2
12.6
(16.6)
(14.2)
(11.3)
12.8
10.2
13.0
(11.9)
(13.3)
(11.5)
10.6
12.8
10.3
(10.6)
(11.6)
(10.2)
0.2
0.3
0.2
NO
NO
YES
COMMUNITY
Emotional Ident.
Extrafamilial (N = 12)
Intrafamilial (N = 12)
17.8
17.2
11.6
(12.1)
(8.8)
(8.1)
12.1
14.0
9.7
(8.7)
(8.8)
(8.2)
9.4
7.8
10.7
(8.1)
(6.5)
(9.3)
0.2
0.7
0.1
NO
YES
NO
(2.0)*•
(2.5)*
*• p < .05 {one-tail} * p < .05
It can be seen from Table A.30 that the significant three-way interaction is due to a complicated set of results,
with ex t ra familial ab u s e rs in the community showing a significant ch a n ge in their levels of Emotional
Identification after a period in the community (reporting less Emotional Identification)5; while men in prison
s h ow no ch a n ge, intra familial ab u s e rs in prison show a significant ch a n ge in their level of Emotional
Identification after a period in prison, whereas men in the community do not.
Relapse-Prevention skills
It should be noted that three men who were still in prison and four men in the community declined to fill out
the RP questionnaires even though they completed the other measures.
MANOVAs carried out on the awareness of Risk Situations, Generation of Strategies scales and Perception of
Risk found no significant differences between the prison and community or between post-test and follow-up.
However, significant interactions were found between situation and post-test-follow-up change (Awareness: F(1,
47) = 5.8, p < .05; Strategies: F(1, 47) = 4.3, p < .05). Planned comparisons between the scales for both the
prison and community samples are reported in Table A.31.
5
The most proba ble explanation for this finding was that it may be a defensive reaction, i.e. faking good on this measure reporting no Emotional Identification
with children as a way as representing themselves at little risk of re-offending
117
TABLE A.31:
MEASURES
RELAPSE-PREVENTION SKILLS
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
PRISON
AWARENESS
STRATEGIES
RISK
5.8
5.8
0.4
(5.2)
(4.8)
(0.7)
12.4
11.4
0.7
(4.4)
(3.9)
(0.9)
13.2
11.7
0.6
(3.9)
(3.5)
(0.8)
0.1
0.1
0.1
NO
NO
NO
COMMUNITY
AWARENESS
STRATEGIES
RISK
7.0
6.0
0.6
(5.5)
(4.8)
(0.9)
12.8
11.4
0.8
(4.5)
(4.3)
(0.9)
10.7
9.3
0.7
(5.0)
(4.6)
(1.0)
0.4
0.5
0.1
YES
YES
NO
(2.4)*
(2.6)*
* p < 0.05
It can be seen from Table A.31 that the interactions found in both the awareness and strategy scales are due to
men in the community becoming significantly worse in terms of recognising risk situations and producing
sensible relapse-prevention strategies, while there was no change in these scales in men in the prison sample.
A.7.
EFFECTS OF FOLLOW-UP SITUATION AND TREATMENT LENGTH
In order to assess whether there were any combined effects of length of treatment (longer/shorter) and followup situation (prison/community), and in order to control for any pre-treatment differences between the groups,
MANCOVAs were carried out on all follow-scores (Factors 1 to 3, Emotional Identification and RelapsePrevention measures) with pre-treatment scores on the measures as covariates. The results of these analyses are
shown below.
Factor 1
No main effects or interactions between the main effects were found. Planned comparisons within the
interaction only found one significant effect in the MSI: Social and Sexual Desirability measure (F = 4.5, p <
.05).
Factor 2
No main effects or interactions between the main effects were found. Planned comparisons within the
interaction found no significant effects.
Factor 3
No main effects or interactions between the main effects were found. Planned comparisons within the
interaction only found one significant effect in the Victim Distortions measure (F = 9.0, p < .01). Further
comparisons, using t-tests, found no significant differences between longer or shorter groups in the prison;,
however, when the means were compared it could be seen that the men still in prison who had been on longer
groups had the lowest level of Victim Distortions (M = 10.95, SD = 12.3), with men in the community who had
been on shorter groups having the highest level of distortions (19.9, 20.2). Men in the community who had
been on longer groups (12.5, 15.0), had mar ginally less distortions than men in prison on shorter groups (14.3,
15.4).
Relapse-Prevention skills
A significant difference was found in the follow-up situation (prison/community) in both awareness of risk
situations and Generation of Strategies with men still in prison being better, and a significant difference in
Generation of Strategies between shorter and longer groups, with the latter being better, but no significant
interaction between the factors.
118
A.8.
COMMUNITY FOLLOW-UP: LONG VERSUS SHORT THERAPY
It was found in Section A.6. that men in the community at long-term follow-up had got significantly worse in
terms of awareness of risk situations and sensible production of RP strategies (Table A.31), significantly worse
in their acceptance of general accountability for their actions (Table A.28), and there was an indication that
their level of distorted thinking about children was increasing (Table A.29). This section compares the men in
the community by treatment delivery (shorter or longer therapy). The analyses reported below are on small
sample sizes: 12 men in the shorter groups and 12 men who were in the longer groups.
Factor 1
A MANOVA carried out on the denial admittance fa c t o r, with length of thera py (longe r / s h o rter) as an
independent factor and post-follow-up change as a within-subjects factor, found no significant overall change
post-test to long-term follow-up and no significant differences between longer and shorter treatment although
planned univariate F-tests within the Length of therapy factor found that Sex Deviance Admittance, MSI: Lie and
SOAQ scale scores were significantly different. It can be seen from Table A.32 that these results were due to
men in the shorter groups having much higher levels of denial both at post-treatment and long-term follow-up.
No significant overall interaction was found between the two main factors, although planned univa ri a t e
comparisons within the interaction found a significant ef fect in the MSI: Sexual Obsessions scale. It can be seen
from Table A.32 that this was due to the men in the longer groups reported level of sexual obsessions being
significantly less at long-term follow-up. However, this improvement is due to these men moving from the
‘expected deviant range’ into the ‘questionable-fake good’ range on this measure.
TABLE A.32:
DENIAL/ADMITTANCE
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
MSI: Soc. & Sex. Des.
MSI: Lie
MSI: Sex Dev. Admitt.
SOAQ
MSI: Sexual Obs.
20.4
9.6
49.6
97.6
2.1
(9.8)
(3.5)
(15.5)
(12.2)
(2.8)
20.1
7.5
47.0
88.0
2.1
(10.9)
(3.4)
(21.1)
(19.2)
(2.6)
20.5
8.6
45.4
89.5
1.7
(10.8)
(3.0)
(18.7)
(20.5)
(2.4)
0.0
0.3
0.09
0.06
0.09
NO
NO
NO
NO
NO
LONGER
MSI: Soc. & Sex. Des.
MSI: Lie
MSI: Sex Dev. Admitt.
SOAQ
MSI: Sex. Obs.
22.9
5.7
56.7
81.7
3.8
(8.2)
(3.2)
(5.7)
(13.3)
(4.2)
25.3
(8.0)
4.4
(2.7)
61.4
(5.5)
70.25 (17.4)
4.4
(4.5)
24.0
4.5
60.2
68.5
2.1
(8.0)
(2.9)
(6.7)
(16.2)
(2.9)
0.2
0.0
0.1
0.1
0.6
NO
NO
NO
NO
YES
(3.0)*
* p < .05
Factor 2
A MANOVA car ried out on the social/competence/acceptance of accountability factor, with length of therapy
(longer/shorter) as an independent factor and post-follow-up change as a within-subjects factor, found no
significant overall change post-test to long-term follow-up and no significant differences between longer and
shorter treatment. However a significant interaction was found between the two main factors (F(6/17) = 3.7, p
< .05). Univariate F-tests within the interaction found that significant differences in Emotional Loneliness
(F(3/22) = 6.2) and Personal Distress (F(1/22) = 4.6) were responsible for this interaction. Table A.33. shows
that these significant effects were due to significant changes in the shorter groups in terms of the men
becoming less emotionally lonely and reporting lower levels of personal distress at long-term follow-up,
although it should be noted that in the case of the Emotional Loneliness scales this change put the men in the
119
shorter groups at the same level as men in the longer groups. Comparisons in terms of the other social
competence measures and the acceptance of accountability measures are shown in Tables A.33 and A.34 for
completeness.
TABLE A.33:
SOCIAL COMPETENCE
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEANS (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Self-Esteem
Emotional Lone.
Under-assertion
Personal Distress
5.1
44.2
10.9
11.7
(2.9)
(11.5)
(8.1)
(5.2)
4.8
42.2
9.1
10.0
(2.9)
(9.7)
(8.0)
(5.2)
5.3
39.1
8.6
7.8
(2.7)
(10.0)
(5.5)
(4.4)
0.4
0.4
0.1
0.6
NO
YES
NO
YES
LONGER
Self-Esteem
Emotional Lone.
Under-assertion
Personal Distress
4.1
46.3
11.6
12.7
(2.8)
(9.2)
(7.0)
(5.1)
5.0
39.7
7.6
9.8
(2.6)
(8.5)
(6.0)
(5.1)
4.8
38.4
8.7
10.7
(2.9)
(6.0)
(6.4)
(4.5)
0.1
0.2
0.2
0.2
NO
NO
NO
NO
* p < .05
TABLE A.34:
(3.2)***
(2.8)*
*** p <.001
ACCEPTANCE OF ACCOUNTABILITY
MEASURES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEANS (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Locus of Control
MSI: Cog. Dis. & Imm.
14.5
7.1
(5.6)
(3.1)
13.9
5.6
(5.8)
(4.0)
14.7
5.2
(6.3)
(4.3)
0.1
0.1
NO
NO
LONGER
Locus of Control
MSI: Cog. Dis. & Imm.
15.0
6.8
(4.6)
(3.5)
9.8
6.3
(5.0)
(3.4)
12.3
4.8
(5.8)
(3.8)
0.4
0.3
YES
NO
(2.4)*
* p < .05
It can be seen from Table A.34 that it was the men in the longer groups that actually got significantly worse in
their general acceptance of accountability (as measured by the Locus of Control scale) at the seven-month
follow-up, Although it should be noted that the level at which they ended up was still lower than that found in
the shorter term groups.
Factor 3
A MANOVA carried out on the social/competence/acceptance of accountability factor, with length of therapy
(longer/shorter) as an independent factor, and post-follow-up change as a within-subjects factor, found no
significant overall change post-test to long-term follow-up and no significant differences between longer and
shorter treatment and no significant interaction between the two main factors. However, planned comparisons
within the interaction, using univariate F-tests, found a significant interaction in the Victim Distortions measure.
It can be seen from Table A.35 that this was due to there being a big (in terms of effect size) reduction of level
of Victim Distortions in the longer-term groups compared with no change in the shorter-term groups.
120
TABLE A.35:
MEASURES
PRO-OFFENDING ATTITUDES
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Cog. Distortions
Victim Distortions
Emot. Identification
MSI: Justifications
16.1
38.9
13.7
4.8
(4.8)
(25.2)
(15.6)
(3.6)
10.0
17.1
10.9
3.6
(10.2)
(20.9)
(9.4)
(4.0)
11.33 (10.24)
19.86 (20.19)
8.17 (9.14)
4.2
(5.1)
0.1
0.3
0.3
0.1
NO
NO
NO
NO
LONGER
Cog. Distortions
Victim Distortions
Emot. Identification
MSI: Justifications
19.0
35.3
19.0
5.3
(7.1)
(25.4)
(7.0)
(3.2)
7.4
19.9
13.4
3.4
(10.4)
(21.1)
(8.2)
(4.1)
9.3
12.2
10.7
2.5
0.2
0.8
0.2
0.2
NO
NO
NO
NO
(7.9)
(14.3)
(7.0)
(2.6)
Emotional Identification
A MANOVA carried out on the data with change (post-term/long-term follow-up) as a within-subjects factor and
type of abuse (intra/extrafamilial) and programme length (shorter/longer) as a between-subjects factor, found
no significant main effects and only one marginally significant interaction: type of abuse by post-term follow-up
change (F(1/20) = 4.0, p = .06). It can be seen from Table A.36 that this result is due to the extrafamilial men in
both the longer- and shorter-term groups reporting a lot less emotional identification with children at the
fo l l ow-up period, perhaps, as commented prev i o u s ly, as a way of denying that they are at any risk of
committing further offences. In contrast, intrafamilial abusers who had undergone longer-term treatment
showed levels of Emotional Identification that are back to their pre-treatment levels.
TABLE A.36:
MEASURES
EMOTIONAL IDENTIFICATION
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
SHORTER
Emot. Identification
Extra. (N = 5)
Intra. (N = 7 )
13.7
9.6
9.3
(15.6)
(9.2)
(9.1)
10.9
12.6
9.7
(9.4)
(10.8)
(8.8)
8.2
6.8
9.1
(9.1)
(9.9)
(9.3)
0.3
0.6
0.0
NO
NO
NO
LONGER
Emot. Identification
Extra. (N = 7)
Intra. (N =5 )
19.0
22.4
12.8
(7.0)
(5.7)
(10.0)
13.4
15.0
9.6
(8.2)
(7.8)
(8.2)
10.7
8.6
12.8
(7.0)
(3.3)
(10.0)
0.2
0.7
0.3
NO
NO
NO
Relapse-Prevention skills
It should be noted that one man in the shorter sample and one who had undergone longer treatment declined
to fill out this measure. Therefore the data reported on consist of 11 men in the shorter groups and 11 men in
the longer groups.
MANOVAs were carried out on the awareness of risk situations and Generation of Strategies scales with length
of group (longer/shorter) as a between-subjects factor, and Post-term-Follow-up comparison as a within-subjects
factor. These analyses found: significant differences between the longer and shorter groups (Awareness: F(1,
20) = 5.3, p < .05; Strategies: F(1, 20) = 4.9, p < .05) it can be seen from Table A.37 that this is due to the
higher level of awareness of risk situations and Generations of Strategies in the longer group sample at both
post-treatment and long-term follow-up, and an overall significant difference between post-term and follow-up.
Although no significant interactions were found, it can be seen from Table A.37 that these results are probably
121
due to the shorter group’s sample scoring becoming significantly worse, whereas, scores for men in the longer
sample held up over the long-term follow-up period.
TABLE A.37:
MEASURES
RELAPSE-PREVENTION SKILLS
BASELINE
MEAN (SD)
POSTMEAN (SD)
FOLLOWUP MEAN (SD)
SHORTER
AWARENESS
STRATEGIES
RISK
4.8
4.3
0.5
(5.0)
(5.0)
(0.8)
10.8
10.4
0.7
(5.3)
(4.0)
(0.9)
8.2
6.6
0.6
(4.9)
(4.6)
(0.8)
0.5
0.9
0.0
YES
YES
NO
LONGER
AWARENESS
STRATEGIES
RISK
9.3
7.8
0.7
(5.3)
(4.7)
(1.0)
14.6
12.3
0.8
(2.6)
(4.5)
(0.9)
13.0
11.7
0.6
(4.1)
(3.0)
(1.0)
0.3
0.1
0.2
NO
NO
NO
* p <.05 **** p < .0001
122
EFFECT
SIZE
SIGNIFICANT
CHANGE (t)
(2.1)*
(5.3)****
APPENDIX B: PRE-TREATMENT ANALYSIS OF THE
CHILD ABUSER SAMPLE
B.1.
METHOD OF DERIVING MEANINGFUL GROUPS
By combining the data from the current sample with our previous sample (Beckett et al., 1994) a larger group
of child molesters can be used to generate a more meaningful way of looking at child abusers prior to treatment
on the basis of psychometric profiles. The pre-treatment data from the sample of child abusers prior to
t reatment (N = 82) we re combined with 59 sets of child-molester data from a group of men who had
undergone community-based treatment for sexual offending (from Beckett et al., 1994). One man had been
seen both in the present and in the Beckett et al. study, so he was dropped from the prison sample; this gave a
total sample size of 140 men1.
Adjustment for social desirability
In order to assess the level of dissembling, the data from the test battery were adjusted for social desirability
response bias (SRDB; Saunders, 1991). SRDB occurs when individuals give answers that are socially approved in
order to make a good impression. Saunders suggests that if SRDB is taken into account a truer level of the
endorsement of interpersonal violence attitudes in various samples can be measured. Saunders reports an
unpublished study that has already applied this method to the adjustment of scores in incest perpetrators,
where he reports that when perpetrators’ level of self-esteem was adjusted for social desirability response bias a
perpetrator’s self-esteem was lower than that originally endorsed. The adjustment was achieved as follows:
a. the unstandardized regression coef ficient in predicting the unadjusted score on a particular scale from the
subject’s score on the social desirability scale used in the study (Greenwald & Satow, 1970) was worked out
from the regression formula: Y = (a)(X) + b, where (a) is the regression coef ficient, X is social desirability
scale score (SDRB) and Y is the particular scale score;.
b. the unstandardized regression coefficient becomes the correction factor so that the derived score for a
particular scale can be derived as follows Y1= Y - (a)SDRB, where Y1 is the adjusted score and Y is the
original score.
Data analysis
The data for both the unadjusted and adjusted scores were converted into standardised scores. All the
standardised unadjusted and adjusted scores were analysed using Ward’s (1963) agglomerative method of
CLUSTER ANALYSIS. This is a way of forming hierarchical groups of mutually exclusive subsets using more than
one variable. This method was used as it maximises the differences between groups and has been reported as
being the most effective clustering methodology (Everitt, 1979). This method is similar to that used in studies
of the Minnesota Personality Inventory (MMPI) (Hathaway & McKinley. 1943) and sexual offenders (Knight,
1988; Nagayama-Hall et al, 1991). The ‘complete linkage’ parameter was used in the Statistical Package for
Social Scientists (SPSS) (1990) program. The method for calculating an optimal partition in the hierarchical
analyses was a stopping method defined by Mojena (1977) as the solution that satisfies the inequality:
zj+ 1 > z + ksz
where z is the fusion coefficient, zj+ 1 is the value of the coefficient at stage j + 1 of the clustering process and z
and sz are the mean and standard deviation of the fusion coefficients.
1
Comparison between the community and prison samples found significant differences in just three of the variables: MSI: Sexual Obsessions, mean prison sample
2.5 (2.9), mean community sample 4.1 (3.7), t = 2.7, p < .01; Victim Empathy Distortions, prison 40.1 (24.6), community 25.6 (19.1), t = 3.9, p < .0001; and
Children & Sex: Emotional Identification, prison 15.1 (12.4), community 19.9 (13.6), t = 2.1, p < .05. The result of the MSI: Sexual Obsessions scale indicated that
the prison sample o verall were more likely to be presenting themselves in the best light on this measure; the results of the Victim Distortions measure indicated
more distorted attitudes about victims in the prison sample. The significantly lower level on the Emotional Identification measure in the prison sample is
probably a reflection of the higher number of men who have committed intrafamilial offences in this sample compared to the community sample: 62 per cent
compared to 54 per cent.
123
TABLE B.1:
MEAN OF THE THREE CLUSTERS WITH NON-OFFENDER/TREATED
MEAN COMPARISONS
CLUSTER 1
(High
Deviance)
CLUSTER 3
(Low
Deviance)
NORMS/MEANS
OF TREATED
CHILD ABUSERS
NUMBER IN SAMPLE
40
45
55
81
SOCIAL DESIRABILITY
54.55
64.44
57.78
55.6
3.0
5.0
4.5
7.1
EMOTIONAL LONELINESS
52.5
43.8
40.7
33.8
UNDER-ASSERTIVENESS
18.4
11.8
8.0
8.8
PERSONAL DISTRESS
14.1
12.6
10.5
7.5
LOCUS OF CONTROL
18.3
16.5
12.0
11.0
VICTIM-EMPATHY DISTORTIONS
41.1
35.1
28.2
18.0
COGNITIVE DISTORTIONS
23.5
16.3
9.6
13.1
MSI: COG. DISTORTIONS & IMM.
10.6
6.2
4.4
3.0•
7.9
4.7
3.3
1.0$
28.1
10.4
14.6
6.4
1.5
2.2
1.8*
MSI: SOCIAL & SEXUAL DESIRABILITY
21.5
17.9
27.0
30.9*
MSI: SEX DEVIANCE ADMITTANCE
62.2
35.8
57.1
61**
SELF-ESTEEM
MSI: JUSTIFICATIONS
EMOTIONAL IDENTIFICATION
MSI: SEXUAL OBSESSIONS
•
$
*
**
CLUSTER 2
(High Social
Des./Denial)
NO REPORTED NORMS: SCORE <= SUGGESTS FEW COGNITIVE DISTORTIONS
NO REPORTED NORMS: SCORE <= SUGGESTS ACCEPTANCE OF ACCOUNTABILITY
NON-OFFENDER SAMPLE OF 40 MEN (NICHOLS & MOLINDER 1984)
MEAN OF TREATED CHILD ABUSER SAMPLE (NICHOLS & MOLINDER 1984)"
124
19.0
B.2.
RESULTS OF THE ANALYSES
Analysis of unadjusted data
Cluster analysis of the unadjusted data suggested that the optimal partitioning of the data was three clusters:
CLUSTER 1 comprising 40 men, CLUSTER 2 comprising 45 men; CLUSTER 3 containing 55 men. Table B.1;
shows the mean scores for the 13 variables for the three groups, with mean scores for non-offending or
acceptable range of scores for treated child molesters (for the MSI measures) included for comparison.
A MANOVA carried out on all the variables between the clusters found a significant difference between all three
groups (Hotelling’s F(26/248) = 16.3, p < .0001). Univariate F-tests within the MANOVA showed that there were
significant differences, between the groups, on all of the scales. These all reached the p < .001 level, except for
the Victim-Empathy Distortions scale which was significant at the p < .05 level. Further comparisons consisted
of comparing two clusters at a time, using MANOVAs, with univariate comparisons on each scale.
CLUSTER 1 was significantly different from CLUSTER 3 (F(13/81) = 23.0, p < .0001). This was due to significant
differences on 12 scales (Self-Esteem, F = 9.1, at p < .01; Emotional Loneliness, F = 38.8, p < .0001; Underassertiveness F =57.6, p < .0001; Personal Distress F = 10.2, p < 0.01; Locus of Control, F =36.7, p < .0001; MSI:
Cognitive Distortions & Immaturity, F = 103.5, p < .0001; Victim-Empathy Distortions, F = 8.0, p < .01; Children
and Sex Cognitive Distortions, F = 40.2, p < .0001; MSI: Justifications, F = 33.1, p < .0001; Children & Sex
Emotional Congruence, F = 29.0, p < .0001; MSI: Sexual Obsessions, F = 50.90, p < .0001; MSI: Social & Sexual
Desirability, F = 17.4, p < .0001). No difference was found between the two groups on the MSI: Sex Deviance
Admittance scale.
CLUSTER 1 was significantly different from CLUSTER 2 (F(13/71) = 15.9, p < .0001). This was due to significant
differences on 10 scales (Self-Esteem, F = 16.3, at p < .0001; Emotional Loneliness, F = 12.1, p < .001; Underassertiveness F = 18.5, p < .0001; MSI: Cognitive Distortions & Immaturity, F = 40.9, p < .0001; Children and
Sex Cognitive Distortions, F = 40.2, p < .0001; MSI: Justifications, F = 8.5, p < .005; Children & Sex Emotional
Congruence, F = 44.4, p < .0001; MSI: Sexual Obsessions, F = 67.2, p < .0001; MSI: Social & Sexual Desirability,
F = 5.4, p < .0001; and MSI: Sexual Deviance Admittance, F = 88.9, p < .0001). The measures where there was
no significant differences between these two clusters were Personal Distress, Locus of Control and VictimEmpathy Distortions.
CLUSTER 2 was significantly different from CLUSTER 3 (F(13/86) = 12.8, p < .0001) on seven scales (Underassertiveness F = 10.4, p < .01; Locus of Control, F = 19.8, p < .0001; MSI: Cognitive Distortions & Immaturity,
F = 12.2, p < . 001; Children and Sex Cognitive Distortions, F = 12.3, p < .001; MSI; Children & Sex Emotional
Congruence, F = 5.7, p < .05; MSI: Social & Sexual Desirability, F = 47.6, p < .0001 and MSI: Sexual Deviance
Admittance, F = 54.5, p < .0001). No significant differences were found in Self Esteem, Emotional Loneliness,
Personal Distress, Victim-Empathy Distortions, MSI: Justifications and MSI: Sexual Obsessions.
Unrelated ‘t’ tests between the three clusters on the Social Desirability scale found no difference between
CLUSTER 1 and CLUSTER 3. CLUSTER 2 scores were significantly higher on Social Desirability from CLUSTER 1
(t(83) = 3.7, p < .0001) and CLUSTER 3 (t(98) = 2.8, p < .005). CLUSTER 2 scores were also found to be
significantly different from a non-offender scores on Social Desirability (t(124) = 4.4, p <.0001). CLUSTER 1 and
CLUSTER 3 scores were not significantly different from non-offender scores on this measure.
Summary of the analysis of unadjusted data
CLUSTER 1 can be labelled as a high deviance group, as the results from this group are significantly more
deviant than the other two groups on most of the scales. It can be seen from Table B.1 that this cluster had the
most distorted attitudes on the offence measures, coupled with the highest levels of social inadequacy (i.e. low
self-esteem and high levels of emotional loneliness, under-assertiveness and personal distress).
CLUSTER 3 can be labelled as a low deviance group, having the lowest levels of social inadequacy and lowest
levels of distorted attitudes on the offence measures of the three groups. It can be seen from Table B.1 that the
means for this group on the different varia bles are closer to the reported scores for the non-offender sample
than the other two groups.
125
CLUSTER 2 may be considered a faking good group, because although scores on many of the measures fall
between CLUSTER 1 and CLUSTER 3, the low mean score on the MSI: Sex Deviance Admittance scale in the
‘frankly dishonest range’, the low mean scores on the MSI: Social and Sexual Desirability scale in the ‘present
asexual image–consider dissimulation range’, the low score on the MSI: Sexual Obsessions scale in the ‘High
Denial’ range, and the low mean score on the Emotional Congruence scale suggest that men in this group were
being dishonest in their responses and trying to present themselves in a more favourable light. Analyses of the
social desirability scores of the clusters confirmed this in that that men in this faking good group (CLUSTER 2),
had significantly higher scores than high deviance men (CLUSTER 1) and low deviance men (CLUSTER 3).
Significantly higher social desirability scores were found in the faking good compared with non-offenders.
Analysis of adjusted data
In order to adjust for the ‘faking good’ (high social desirability/ denial) effect identified in the first cluster
analysis the data from the measures were adjusted as described in B.1.
This adjusted data for the scales used were then transformed into standardised and analysed using clustering
techniques. Using the stopping method reported in B.2, the optimal partitioning of the data was two clusters:
CLUSTER A comprised 51 men, CLUSTER B comprised 89 men. Table B.2 shows the mean adjusted and
unadjusted scores for the 13 variables for these two groups.
A MANOVA carried out on the 13 adjusted variables between the two groups found a significant difference
between them (F(13/126) = 18.1, p < .0001). Univariate F-tests within the MANOVA showed that there were
significant differences on ten of the scales at p < .001 and the Self-Esteem scale at p < .05. The only scales
where no significant differences were found were Personal Distress and MSI: Social and Sexual Desirability.
Summary of results of the adjusted data analysis
From Table B.2 it can be seen that CLUSTER A’s results are more deviant than CLUSTER B, with CLUSTER A
s h owing higher deviance scores than CLUSTER B. Comparison between the adjusted cl u s t e rs and the
unadjusted clusters suggests that that the scores of CLUSTER A are similar to those found in the high deviance
group (CLUSTER 1 of the previous analysis) and CLUSTER B’s results are similar to the low deviance group
(CLUSTER 3 of the previous analysis).
Examination of the overlap between the two sets of results found that the structure from the first analysis
remained the same in terms of low and high deviancy categories. CLUSTER A comprised 38 of the 40 (95%)
high deviance men in CLUSTER 1, ten men from the faking good group (CLUSTER 2) and three men from the
low deviance group (CLUSTER 3). CLUSTER B comprised 52 of the 55 (95%) low deviance men originally in
CLUSTER 3, 35 men from the faking good group and two high deviance men originally in CLUSTER 1.
B.3. CATEGORIES OF CHILD ABUSER BY DEVIANCE AND DENIAL
These results show that when the data were adjusted for social desirability, four categories could be identified.
HIGH DEVIANCE/LOW DENIAL (N = 41).
As 95 per cent of the original high deviance group (CLUSTER 1) men fell into CLUSTER A, these men can be
seen as high deviance, but basically admitting to this level of deviance.
HIGH DEVIANCE/HIGH DENIAL (N = 10).
Ten of the 45 men in the original ‘faking good’ group (CLUSTER 2) were reclassified as CLUSTER A (high
deviancy) of the adjusted data analysis; therefore these men can be seen as high deviancy but fall into the
‘faking good’ category of the original analysis.
126
TABLE B 2:
MEANS OF DERIVED CLUSTERS FOR ADJUSTED AND UNADJUSTED
DATA
NUMBER IN SAMPLE
CLUSTER A
UNAJUSTED
CLUSTER B
UNAJUSTED
51
89
SELF-ESTEEM
CLUSTER A
UNAJUSTED
51
CLUSTER B
UNAJUSTED
89
3.5
(2.6)
4.6
(2.7)
-2.2
EMOTIONAL LONELINESS
50.3
(10.7)
42.1
(10.6)
61.8
54
UNDER-ASSERTIVENESS
16.2
(7.4)
9.9
(6.8)
22
15.9
PERSONAL DISTRESS
13.0
(6.2)
11.8
(5.6)
13
11.8
LOCUS OF CONTROL
17.6
(5.0)
13.9
(5.5)
17.6
13.9
VICTIM-EMPATHY DISTORTIONS
41.7
(25.5)
29.8
(21.3)
30.1
17.8
COGNITIVE DISTORTIONS
22.8
(12.8)
11.6
(9.6)
28.6
17.6
MSI:COG. DISTORTIONS & IMM.
9.8
(3.8)
5.0
(2.5)
9.8
5
MSI: JUSTIFICATIONS
7.9
(5.8)
3.4
(2.9)
7.9
3.4
26.4
(14.8)
11.8
(8.3)
43.7
29.7
5.6
(3.7)
1.8
(2.1)
11.4
7.7
MSI: SOCIAL & SEXUAL DES.
22.1
(7.1)
22.7
(8.0)
33.6
34.6
MSI: SEX DEVIANCE ADMITTANCE
57.8
(18.2)
48.3
(16.4)
86.7
78.1
EMOTIONAL INDENTIFICATION
MSI: SEXUAL OBSESSIONS
-1.3
LOW/DEVIANCE LOW DENIAL (N = 54).
95 per cent of the original low deviance men (CLUSTER 3) were also found in CLUSTER B of the adjusted
analysis; this suggests that these men are real low-deviancy men.
LOW DEVIANCE/HIGH DENIAL (N = 35).
Thirty five out of 45 men originally in the medium deviance/high denial group (CLUSTER 2) were reclassified as
CLUSTER B; therefore these men can be seen as low deviancy, but fell into the ‘faking good’ category of the
original analysis.
Analysis of the derived categories
In order to see whether these four categories were meaningful, a two-way MANOVA was carried out using the
original data between the four derived categories with Deviance (High/Low) as one independent factor and
Faking (Admittance/Faking) as the other independent fa c t o r. Here significant main effects of Dev i a n c e
(F(13/124) = 9.46, p < .0001), Faking (F(13/124) = 7.26, p < .0001) and a significant between Deviance and
Faking (F(13/124 = 5.17, p < .0001) were found. Table B.3 shows the results of F-tests effect the variables
making up these significant effects.
127
It can be seen from Table B.3 that their significant result in the Deviance factor was due to significant
differences on most of the scales. The only scales where no significant differences were found were Personal
Distress and Self-Esteem and two scales related to faking good, viz. MSI: Sex Deviance Admittance and MSI:
Social and Sexual Desirability. It can be seen that the significant difference in the Faking Good factor was due to
significant differences on five measures: Self-Esteem, Emotional Congruence and three scales specifically related
to denial (MSI: Sexual Obsessions, MSI: Social and Sexual Desirability, and MSI: Sex Deviance Admittance). The
significant interaction between Denial and Faking Good was produced by significant differences in ten scales
c ove ring: fixation (Emotional Congruence), acceptance of accountability for offending (MSI: Cognitive
Distortions and Immaturity, Locus of Control), social inadequacy (Personal Distress, Emotional Loneliness, SelfEsteem, Under-assertiveness) and denial (MSI: Sexual Obsessions, MSI: Social and Sexual Desirability, MSI: Sex
Deviance Admittance). The only scales where there were no significant interactions were the distortion scales:
Cognitive Distortions, MSI: Justifications and Victim-Empathy Distortions.
Table B.4 shows the mean scores for the four derived groups described on these two dimensions. Comparisons
between the HIGH DENIAL and LOW DENIAL in both the LOW and HIGH DEVIANCE groups are also reported
here.
Comparisons within the deviancy categories
It can be seen from Table B.4 that both of the HIGH DEVIANCE categories have high levels of victim-empathy
distortions in comparison with the two LOW DEVIANCE groups. Apart from that there are big differences
within the DEVIANCE categories on most of the measures; however, it should be borne in mind that a
significant overall difference was found between all HIGH DEVIANCE and all LOW DEVIANCE men previously
(see Section B.2). As this is quite a complicated pattern of results comparisons are reported below between the
ADMITTANCE and HIGH DENIAL groups within both the LOW and HIGH DEVIANCE categories.
Comparing the LOW DEVIANCE/LOW DENIAL and the LOW DEVIANCE/HIGH DENIAL groups
Here, as might be expected, there is a significant difference between the two low deviancy categories on all of
the denial/admittance measures, including those not used in the cluster analysis (i.e. MSI: Lie and the Sex
Offence Attitudes Questionnaire, SOAQ). Acceptance of Accountability was found to be significantly lower, on
both measures, in the HIGH DENIAL group.
There were no differences in the main social inadequacy variables (Self-Esteem and Emotional Loneliness) and
most of the pro-offending attitudes did not differ significantly. However, the Emotional Identification scale is
significantly lower in the HIGH DENIAL group (and is in fact the lowest of all four groups). This result perhaps
suggests that reporting a low level of emotional interest in children is part of a general pattern of denial in this
group. Scores in the HIGH DENIAL group were found to be significantly higher on the cognitive distortions
about ch i l d re n ’s sexuality scale, although the mean score is still ve ry mu ch lower than the two HIGH
DEVIANCE groups.
Comparing the HIGH/DEVIANCE LOW DENIAL and the HIGH DEVIANCE/HIGH DENIAL
groups.
All the denial/admittance measures apart from the MSI: Social and Sexual Desirability measures were found to
be significantly different in the two groups, with the HIGH DENIAL group being in high levels of denial on the
MSI: Sex Deviance Admittance scale, in the ‘frankly dishonest’ range and the MSI: Lie scale and in the
‘dishonest about deviant sexual interests’ range. This group’s average score fell into the HIGH DENIAL range of
the MSI: Sexual Obsessions scale. Again, this group tended to report a significantly lower level of emotional
identification with children than the LOW DENIAL group.
No difference was found in Cognitive Distortions, Victim-Empathy Distortions or MSI: Justifications (in the
‘justifies sexual deviance marked’ range), suggesting that these groups are indeed highly deviant in their
attitudes.
The interesting finding here was that the HIGH DEVIANCE/HIGH DENIAL group reported significantly higher
levels of social adequacy than the LOW DENIAL group. It was thought that this may have been due to the fact
128
129
130
131
that we had identified a more socially adequate deviancy group, however, inspection of the personal history
data of men in this sample suggested; that nine out ten men in this category were of low social competence.
Evidence for the validity of the categories
Data from official offence histories used to provide convergent criteria for the groups of offenders identified
above are shown in Table B.5.
Comparison of all LOW DEVIANCY (LD, N = 89) and all HIGH DEVIANCY men (HD, N = 51)
When these two groups are compared in terms of number of victims, the HIGH DEVIANCY men had:
significantly more victims than LOW DEVIANCY men (t(53.69) - 2.71. p < .01); were significantly more likely to
have committed offences outside or both inside and outside of the family using Goodman and Kruskal’s Tau =
1.55, p < 001; were significantly more likely to have committed offences against boys or both boys and girls
than girls (T = 2.43, p < .0001). The HIGH DEVIANCY men scored significantly higher on the algorithm for
predicting reoffending than the LOW DEVIANCY men (T = 1.63, p < .0001). Although the HIGH DEVIANCY
men had considerably more convictions for previous sexual offences, the difference between the two groups
just failed to reach significance. The percentage of men for each category described above are shown in
brackets for LOW DEVIANCY and HIGH DEVIANCY men in the first two columns of Table B.5.
Comparison of LOW DEVIANCY/LOW DENIAL and LOW/DEVIANCY HIGH DENIAL men
No difference was found between these groups in terms of number of victims and sex of victims, with both
groups having offended mainly against girls. A significant difference was found between these two groups in
terms of whether the offences were inside or outside of the family (T = 5.79, p < .05) with LOW DEVIANCY/
HIGH DENIAL men as a group having committed relatively more extrafamilial or extrafamilial plus intrafamilial
offences than the LOW DEVIANCY/LOW DENIAL men.
Comparison of HIGH DEVIANCY/LOW DENIAL and HIGH/DEVIANCY HIGH DENIAL men
Here it was found that there was a significant difference between the mean number of victims in the two
groups, with the HIGH DEVIANCY/LOW DENIAL men having a significantly higher number of victims (t(40.42)
= 2.60 p < .05). No differences were found between the two groups in terms of sex of victims or familiarity,
and whether they had been convicted of a previous sexual offence.
B.4.
A QUICK METHOD OF IDENTIFYING DEVIANCY LEVEL
Because of the unwieldy nature of identifying deviance levels using all the measures previously described, an
investigation was undertaken to see whether coding rules could be generated from a combination of a small
number of measures. This method was by Hanson (personal communication) who proposed that higher
deviance would be defined by scores that were at least half of standard deviation above the mean on one
measure of social inadequacy and one measure of deviant sexual attitudes, and lower deviance is any scores
that fall below these levels. Analysis found that the best combination of scales were the Emotional Loneliness
and the Cognitive Distortions about Children scales. The cut-off level to be classed as high deviance on the
Emotional Loneliness scale was 49 or above and for the Cognitive Distortions scale 21, or above. The results of
these analyses are shown in Table B.6.
132
TABLE B.6:
PROPORTION OF CORRECTLY IDENTIFIED HIGH/ LOW
DEVIANCE MEN
EMOTIONAL
LONELINESS
HIGH DEVIANCE (51)
LOW DEVIANCE (89)
29
69
COGNITIVE
DISTORTIONS
(57%)
(78%)
32
74
(63%)
(83%)
HIGH ON AT
LEAST ONE SCALE
47
86
(92%)
(97%)
It can be seen that there is good agreement with the major results reported in Section B.3 as regards deviancy
category (HIGH/LOW) when an individual is categorised as HIGH DEVIANCE if they have score of 49 or above
on the Emotional Loneliness scale or a score of 21 or above on the Cognitive Distortions scale. Interestingly,
this method effectively identifies level of deviance even in the 45 men who were ‘faking good’ in the sample.
133
134
APPENDIX C: RESPONSE TO TREATMENT
C.1.
INTRODUCTION
There has been some work on the development of assessing what constitutes clinically significant change in
psychotherapy outcome research (see Hanson & Lambert, 1996 for review). This has been used in the present
study to assess whether clients have shifted significantly in their attitudes in following sex offender treatment
programmes. The way of assessing clinical change is (a) to work out a cut-off point between normal and
dysfunctional responding on the measure of interest and (b) to assess, if an individual crosses the cut-off point,
whether that change is reliable.
C.2.
DERIVATION OF CLINICAL CUT-OFFS
The cut-off points were worked out in the following way:
(SD1)(MEAN2) + (SD2)(MEAN1)
SD1 + SD2
cut-off =
where SD 1 and MEAN 1 are from 81 non-offenders (Beckett et al. 1994) and MEAN2 and SD 2 from 106 untreated
child abusers1. This method was used for the social adequacy and pro-offending attitudes measures. Table C.1
shows the mean and standard deviations for the two samples (except where indicated) and the derived cut-off
points for the measures. Table C.2 shows the cut-off points for the Emotional Identification measure.
TABLE C.1:
MEAN AND STANDARD DEVIATIONS
MEASURE
Self-Esteem
Emotional Loneliness
Under-assertiveness
Personal Distress
Locus of Control
Cognitive Distortions
Victim Distortions
NON-OFFENDERS (SD)
7.1
33.8
8.8
7.5
11.0
13.1
18.0
CHILD ABUSERS (SD)
(1.4)
(7.0)
(5.4)
(3.8)
(5.6)
(8.8)
(9.6)
4.4
46.8
12.7
12.9
15.8
17.8
33.3
(2.7)
(11.9)*
(7.9)
(6.1)*
(6.1)*
(13.6)
(24.3)
CUT-OFF
6.2
38.6
10.4
9.6
13.3
14.9
22.3
* Number in sample = 59
As for the Emotional Identification measure, the scale used here measures the extent to which an individual can
understand, relate to and identify with what they believe are the thoughts, feelings and concerns of children.
Moderate levels can be viewed as normal, especially for parents, since it confers a sensitivity to children’s
needs. We have pr eviously found (Beckett et al. 1994) that some child abusers appear emotionally as well as
sexually fixated on children; these men (usually with no children of their own) had significantly higher levels of
emotional identification with children than non-offending men who were not parents. In comparison, it was
found that men who had abused their own children had significantly lower le vels of emotional identification
with children compared with non-offending parents. This latter finding perhaps suggests that emotional
withdrawal from children made it either easier to abuse or deal with the effects that their abuse had on their
children. Therefore, a priori predictions of a treatment effect in the present study were that: extrafamilial men
should decrease in the level of emotional identification in order to show a treatment change; and that
intrafamilial men would increase in their level of emotional identification through treatment.
1
This group consisted of 59 child abusers from the first STEP study and 47 child abusers seen in prison as part of the study in order to gather test-retest reliabilitys
on the measures used.
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TABLE C.2:
MEAN AND SD OF THE EMOTIONAL IDENTIFICATION MEASURE
NONOFFENDERS
N
MEAN (SD)
CHILD ABUSERS
N
ALL
PARENTS
NON-PARENTS
81
32
49
18.9
(10.7)
23.44 (11.4)
16.1
(9.3)
ALL
INTRAFAMILIAL
EXTRAFAMILIAL
INTRA & EXTRA
107
60
41
6
MEAN (SD)
20.2
15.5
26.1
27.0
CUT-OFF
(13.7)
(11.7)
(14.3)
(21.1)
19.5
20.1
These results suggest that for men who have committed extrafamilial offences to improve they should show a
decreased level of emotional identification; and for intrafamilial offenders to improve they should show an
increased level of emotional identification.
C.3.
CALCULATION OF RELIABLE CHANGE
Here any pre/-post change is significant if the reliability change index (RC) is greater than 1.64 2 for a one-tailed
test. The method of calculating RC is as follows:
RC = (post-treatment) - (pre-treatment)
SE
SE = SD √(1 - rxx)
{where rxx = the test retest reliability of the measure}
Table C.3. shows the test-retest reliabilities, sample size and RC for all of the measures.
TABLE C.3:
TEST-RETEST RELIABILITIES
MEASURE (SD)
Self-Esteem (2.71)
Emotional Loneliness (11.90)
Under-assertiveness (7.86)
Personal Distress (6.08)
Locus of Control (6.07)
Cognitive Distortions (13.56)
Victim-Empathy Distortions (24.29)
Emotional Ident: Intrafamilial (11.72)
Emotional Ident: Extrafamilial (14.31)
C.4.
SAMPLE
SIZE
RELIABILITY
CO-EFFICIENT
RELIABLE
CHANGE
40
237
44
56
158
45
46
45
45
0.75
0.91
0.80
0.78
0.83
0.77
0.95
0.63
0.63
> 2.2
> 5.8
> 5.8
> 4.7
> 4.1
> 10.7
> 8.9
> 11.7
> 14.3
CLINICALLY SIGNIFICANT CHANGES
The methodology described above allows for comparison across the different groups on the eight measures
that have derived clinical cut-offs and RC indices. These measures fall into two main categories:
a. social competence, i.e. Self-Esteem, Emotional Loneliness, Under-assertiveness and Personal Distress;
Locus of Control is also included under this heading to aid comprehensibility of the findings.
b. p ro - o ffending attitudes, i.e. Cognitive Distortions, Vi c t i m - E m p a t hy Distortions and Emotional
Identification (with children).
2
RC is quoted as 1.96 SD in the literature or 0.025 probability in each tail. In this case a one-tailed test is used (i.e. 0.05 probability in one-tail because the direction
of change is predicted).
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Table C.4 shows the results of the eight measures across the different groups. The scoring for each measure is
as follows.
YES – indicates clinically significant change pre- to post-test on the measure concerned. A score of one was
given on a measure if there was clinically significant change.
WITHIN PRE – indicates that the subject’s score prior to treatment was already within the cut-off point for
functional responding. A score of one was given if the score on a particular measure was within the cut-off for
the measure prior to treatment
NO – means that no clinically significant change had occurred. A score of zero was given if no clinically
significant change occurred.
WORSE – indicates that an individual has become significantly worse by having a score that is greater than the
RC amount for the particular measure pre- to post-treatment. A score of minus one was given if this occurred
on any measures.
HIGH – this just refers to the Emotional Identification measure. A score of minus one was given if emotional
identification levels remained high after treatment, i.e. outside the clinical cut-off.
The total score for the pro-offending attitudes measures (i.e., Cognitive Distortions, Victim-Empathy Distortions
and Emotional Identification) was out of three. By giving a minus rating to somebody who had high levels of
emotional identification after treatment this made sure that somebody was not classified as treated, even if they
had changed significantly on the other two measures.
The total score for the social competence measures was out of five.
An overall treatment effect was defined as a score of least two on the pro-offending attitudes measures and a
score of at least three on the social competence measures.
An offence-specific treatment effect was judged to have taken place if there was a score of at least two on the
pro-offending attitudes measures.
No treatment effect was judged to have taken place if there was score of three or more on the social
competence measures accompanied by a score of less than two on the pro-offending attitudes measures.
Table C.4 shows, by treatment group, whether individuals had shown an overall change or whether there had
been an offence-specific effect of treatment.
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138
139
140
APPENDIX D: GROUP ENVIRONMENT
D.1.
BACKGROUND
There has not been a great deal of research reported about the processes in operation within sexual offender
treatment programmes. Such research has tended to focus on the type of treatment approach adopted and the
characteristics of sex offenders who benefit from treatment. Stephenson’s (1991) is one of the few studies
comparing the effectiveness of several group programmes for sexual of fenders on process variables. She found
that of eight community-based programmes in the Pacific region of Canada, only one was successful in reducing
recidivism. This group was one that was better mana ged than the other programmes; those involved in running
the group kept accurate records; and the therapists prepared a comprehensive pre-treatment plan, did not
tolerate denial and were ‘tough-minded’ in their approach, but were respected by their clients. In the less
successful programmes, clients’ behaviour was often disruptive and considerable hostility was expressed
towards some therapists.
In contrast to the lack of research on group processes in sexual offender therapy, there has been a great deal
written concerning this issue in the general literature about group work. Belfer and Levendusky (1985) and
Yalom (1975) emphasise the following as being of particular importance in running effective groups:
1. Cohesiveness is considered vital in keeping group members involved and has been found to be an important
precondition for positive change (Braaten, 1989). It enhances the power of the group to change the
attitudes and behaviours of its members. In a highly cohesive group, participants are able to share sensitive
information about current fantasies, to question their own behaviours and to feel able to deal with the
powerful emotions unleashed in therapy (Clark & Erooga, 1994). Cohesion is understood to be influenced
by the leaders’ style, particularly in the early sessions of the programme (Yalom, 1975).
2. Effective group leadership is crucial in establishing the purpose of the group, facilitating the achievement of
goals and ensuring confidentiality. Leaders should not only provide interventions that are informative or
symptom-focused, but also facilitate and model effective interpersonal interactions. Karterud (1988), in a
study of six therapeutic community groups in Norway, found that in the highest functioning group, leaders
were more supportive and less aggressive. In the less effective groups a number of serious problems were
observed in leadership style. Therapists practised extreme turn-taking, did not support member/member
interaction, and often resorted to an aggressive confrontational style. Leadership style has been shown to
influence group development. In early sessions, the leaders’ most productive intervention may be directed
to facilitate active participation by all members (Nichols & Taylor, 1975).
3. Group norms are the behavioural rules that guide the interaction of the group. At the outset of the group
Clark and Erooga (1994) suggest that leaders should establish an environment which is conducive to
positive change. They suggest that this can be done by creating an anti-offending atmosphere where there is
an expectation of disclosure rather than denial, encouraging clients to take responsibility for their actions
and getting men to express their feelings. Yalom (1975) argues that the early establishment of group norms
is an important task of group leaders, as these will deter behaviours that threaten group cohesiveness, such
as: lateness, non-attendance, member/member attacks and extra-group socialising.
4. The instillation and maintenance of hope for the future in members is also considered to be an important
therapeutic agent for change (Couch & Childers, 1987). This may be particularly the case with a sexual
offender group, because these men may be demoralised and could easily be discouraged from engaging in
the group work. Couch and Childers suggest that group leaders can improve therapeutic outcomes by
understanding hope as a curative factor and by employing strategies to instill it. Such strategies should
include repeated encouragement by leaders to keep clients from disengaging from the group and help the
clients to appreciate that change is possible.
Because of the emphasis given to the importance of group climate in affecting the success of therapy it is
essential to investigate this aspect of treatment. It has been found previously (Beech & Fordham, 1997) that
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treatment groups that were cohesive, well-organised and well-led, with encouragement of desirable group
norms by leaders and the instillation of hope, are more effective than those that did not possess these
characteristics.
D.2.
MEASUREMENT OF GROUP PROCESSES
The measure used was the Group Environment Scale (GES; Moos, 1986). This instrument contains a number of
scales that describe, and can be used to compare, the overall climate of different groups. MacKenzie and
Livesley (1986) suggest that, in the measurement of group process, it is helpful to use measures that deal with
the group as an entire system. The GES grew out of ex t e n s i ve wo rk on the measurement of social
environments, such as task-oriented groups, social and recreational groups, psychotherapy and mutual support
groups. Because of the large number of groups examined by Moos and his colleagues, each of the ten GES
subscales have been standardised, enabling interpretation of group profiles:
1. Cohesion measures the members' group involvement and commitment to the group and concern and
friendship they show for each other;
2. Leader Support measures the help and friendship shown by group leaders;
3. Expressiveness measures the extent to which freedom of action and expression of feelings are encouraged
in the group;
4. Independence measures the encouragement of independent action and expression;
5. Task-Orientation assesses the emphasis placed on practical tasks and decision-making in the group;
6. Self-Discovery assesses the extent to which the group encourages members’ revelations and discussions of
personal information;
7. Anger and Aggression measures the tolerance of open expression of negative feelings and inter-member
disagreement;
8. Order and Organisation measures the structure of the group and explicitness of its rules;
9. Leader-Control measures leader-direction and enforcement of the group’s rules;
10. Innovation measures leaders’ encouragement of change in group activities.
These scales assess the following dimensions of group atmosphere: relationships within the group (Scales 1 to
3); personal growth of group members (Scales 4 to 7); and system maintenance and system change (Scales 8 to
10).
The GES was administered to all groups about one-month before the end of treatment in order that a mature
group could be measured.
D.3.
DATA ANALYSIS
Eighty-eight GES forms were filled in by members and 35 forms were filled in by leaders. Analysis of the data
was concerned with comparing how members’ and leaders’ perceptions of the groups diffe red; what
differences there might be between groups, and how that might relate to treatment outcome; in investigating
how leadership style affects group processes; and what might constitute a successful group. From Beech and
Fordham (1997) it was expected that the more successful groups would be:
• cohesive, as measured by the Cohesion scale (1);
• well-organised, as measured by the Order and Organisation (8) and Innovation (10) scales;
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• shown to ha ve a good le vel of leader-control, without being aggressive and confrontational, as measured by
the Leader-Control scale (9);
• well-led, encouraging personal growth of members, as measured by the Independence (4) and Task
Orientation (5) scales;
• supportive of members, as measured by the Leader-Support (2)t scale;
• able to encourage desirable group norms, as partly measured by the Expressiveness (3) and Self Discovery
(4) scales.
D.4.
RESULTS
Overall analyses
An overall MANOVA was initially carried out on the data. This consisted of using two grouping va ri ables
(Member/Leader and Group) and the ten GES scales as multiple dependent variables. Significant main effects
were found in the Member/Leader factor and the Group factor. No significant interaction was found between
these factors.
Comparison between members and leaders
A highly significant difference was found in the Member/Leader variable (F(10,90) = 3.6, p < .001) indicating
that members and leaders perceived the group differently. Univariate F-tests within the MANOVA showed that
significant differences between three scales: Independence (F(1,99) = 5.7, p < .05); Leader Control (F(1,99) =
8.7, p < .01); and Order (F(1,99) = 7.4, p < .01). Examination of the mean scores of members and leaders on
these scales suggests that the leaders saw themselves as more controlling than members (leaders: 6.8 (1.6),
members: 5.9 (2.0)), saw the groups as better organised than did members (leaders: 6.77 (1.57), members: 5.9
(2.0)), and saw themselves as promoting more independent activity in members than members did (leaders: 6.6
(1.4), members: 5.9 (1.6)).
Differences between treatment groups
There was a significant effect in the Group variable (F(110/990) = 2.0, p < .0001), indicating that the climate
was different across groups. Univariate F-tests within the MANOVA showed that this effect was due to
significant differences on eight scales: Anger and Aggression, F(dF 11/99) = 3.4, p < .001; Cohesion, F(dF
11/99) = 2.5, p < .01; Expressiveness, F(dF 11/99) = 2.7, p < .01; Innovation, F(dF 11/99) = 2.1, p < .05; LeaderControl, F(dF 11/99) = 4.1, p < .0001; Leader-Support (F(11/99) = 3.3, p <.01; Self-Discovery (F(11/99) = 3.0, p
< .01; and Task-Orientation, F(dF 11/99) = 2.2, p < .05. The only scales where no significant differences were
found we re: Independence; and Orde r and Organisation. In te re s t i n g ly th ese are bot h system
maintenance/system change dimensions, suggesting that these are very tightly structured groups that do not
generally differ on this dimension.
The figures at the end of this Appendix show members’ and leaders’ data for all the groups. In order to assist in
the interpretation of these data, Table D.1. shows whether each combined group score was low, medium or
high on each of the eight significant GES scales. In order to do this, data from the groups were converted into
standardised t scores (mean = 50, SD = 10) on the basis of group norms provided in the GES manual (Moos,
1986, Appendix A). A low score indicates that the mean score on the variable of interest is at least half a
standard deviation below the mean (i.e. below 45), a medium score indicates that the score is between 46 and
55, a high score indicates that the score is at least half a standard deviation above the mean (i.e. above 55).
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144
It can be seen from Table D.1 that:
Leader-Support, Task-Orientation and Self-Discovery are medium or high in all groups;
Cohesion is generally high in all groups except Usk 1 and Whatton 2, where it is low;
Expressiveness is medium or high in all groups except Risley 2, Usk 1,, and Whatton 1, where it is low;
Independence and Innovation are medium or high in all groups except Littlehey 1, Usk 1, Whatton 1 and
Whatton 2, where it is low;
Leader-Control is seen as medium or high in all groups except Risley 2;
Anger and Aggression is low in most groups, only reaching a medium level in four groups: Channings Wood 1,
Littlehey 1, Usk 1 and Whatton 2.
O ve rall, these results suggest that most of the groups were perceived to be highly cohesive, very taskorientated, encouraged group members to disclose (high scores on self-discovery) and leaders were perceived
to be usually highly supportive of group members. However, most groups were seen to have a high level of
leader-control. This is in contrast to our previous findings (Beech & Fordham, 1997), with probation groups,
where a medium level was found in the more successful groups. The main exceptions to this pattern were Usk
1 and Whatton 2, where low scores were found on a number of the dimensions, suggesting some difficulties
within these groups.
Members’ perceptions of groups
As there were significant overall differences between members’ and leaders’ data, further analyses were carried
out using all the members’ data (N = 88). Initial analysis consisted of employing a MANOVA with one grouping
variable (Treatment Group) and using the ten GES scales as multiple dependent variables. A significant main
effect was found in the Treatment Group variable, F(110/760) = 2.03, p < .0001), indicating that members’
ratings of climate varied across the groups. Univariate F-tests, within the MANOVA, found significant differences
in eight of the scales: Cohesion, F(11,76) = 3.7, p < .0001); Leader Support, F(11,76) = 3.0, p < .001;
Expressiveness, F(11,76) = 3.2, p < .001; Task-Orientation F(11,76) = 2.0, p < .05; Self-Discovery F(11,76) = 3.8,
p < .0001; Anger and Aggression, F(11,76) = 5.8, p < .0001; Order and Organisation, F(11,76) = 2.4, p < .0001;
Leader-Control, F(11,76) = 6.5, p < .0001; and Innovation, F(11,76) = 3.2, p < .001. Multiple classification
analysis (i.e. adjusted deviation from the grand mean) of these data was used to derive a rating for each group
on the significant GES scales. These are shown in Table D.2.
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146
147
148
149
150
151
152
APPENDIX E. MULTIPHASIC SEX INVENTORY
The Multiphasic Sex Inventory (MSI) is a self-report questionnaire designed to measure a wide range of
psychosexual characteristics of sex offenders. There are 20 scales and a sexual history. The scales comprise.
a. A treatment Attitudes scale.
b. Three scales of sexual deviance;
i.
Child Molest;
ii. Rape scale;
iii. Exhibitionism;
c. Six validity scales:
i.
Social and Sexual Desirability
ii. Sexual Obsessions;
iii. Lie scale;
iv. Cognitive Distortions and Immaturity;
v. Justifications.
vi. Parallel items (not administered in this form).
d. Five scales related to atypical sexual behaviour.
e. Four scales of sexual dysfunction.
f. A sex knowledge scale.
A.
TREATMENT ATTITUDES SCALE (8 ITEMS)
Assesses an offender’s openness to treatment. From ‘not motivated’ (score 0–8), through ‘may not be’ (2),
‘motivated’ (3–5), to ‘highly motivated’ (6–8)*.
* It is obviously expected that clients having high scores on this measure will show the most motivation to
change.
B.
SCALES OF SEXUAL DEVIANCE
The core of the MSI are the Child Molest, Rape and Exhibitionism scales. These assess the style, magnitude and
duration of the sexually deviant behaviour. The total score on these scales can be converted into standardised T
scores where the mean score is 50 and the standard deviation = 10. A T-score of between 51 and 60 indicates
an expected minimum range of acknowledgement of offending patterns; 61–70 probably is a true indication of
the pattern; 71–80 indicates that the offender is highly open about his sexual outlet. T-scores of 40–50 indicate
minimisation of the pattern; a score of 0–39 indicates that the offender is being ‘frankly dishonest’.
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i. Child Molest scale (39 items; five subscales)
This is of most interest to the research reported here as the great majority of the clients seen have been child
molesters. The scale identifies four progressive stages in the sexual deviance pattern of a child molester.
Fantasy (10 items) measuring antecedent thoughts. If an offender has a high score on this scale it suggests that
he is being honest about his deviance.
Cruising and Grooming (10 items) is a measure of the stage as the of fender moves from fantasy to assault. He
may be reluctant to admit this part of his pattern at first. High scores indicate the owning of responsibility for
his actions.
Sexual Assault (10 items) It is often the case that offenders have high scores on this subscale, as the offender
would find it difficult to deny items on this scale when he has probably been discovered, convicted and
confessed to a proportion of his offending.
Aggravated Assault (6 items) is included in the MSI to differentiate the intensity of offending behaviour.
Incest type (4 items) Although not necessarily part of the pattern of assault, is included to look at the pattern of
incest offending in child molestation.
ii. Rape scale (38 items; five subscales)
This is of less interest to the study because of the small number of rapists (3) in this study. But a brief thumbnail
sketch of the scales is as follows:
Fantasy (8 items) measuring antecedent thoughts. Untreated offenders are likely to have a low score on this scale.
Cruising and Grooming (8 items) is a measure of the stage as the offender moves from fantasy to assault. An
offender who has a low score on this scale after treatment has not taken accountability for his actions.
Sexual Assault (7 items) Most rapists – even untreated ones – will endorse several items here. This is because
they are able to admit this behaviour much easier than fantasy and cruising behaviour.
Aggravated Assault (5 items) which measure the aggravated extent of the assault(s).
Sado-masochism (10 items) Included to differentiate dangerous sadistic rapists.
iii. Exhibitionism scale (19 items; four subscales)
Again this is of less interest to the study because of the small number of exhibitionists (3) in this study. These
scales are similar to those outlined above: Fantasy (3 items); Cruising (4 items); Sexual Assault (9 items);
Advanced Assault (3 items).
C.
VALIDITY SCALES
i. Social and Sexual Desirability
ii. Sexual Obsessions
iii. Lie scale
iv. Cognitive distortions and Immaturity
v. Justifications
vi. Parallel items
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i. Social and Sexual Desirability (35 items)
This scale is designed to measure ‘normal’ sex drives and interests and to help identify whether clients are
responding in a socially desirable manner. Some subjects may respond in a manner that is ‘sex u a l ly
hypernormal’ which may suggest dissimulation in that he is trying to present himself as someone who is not
interested in sex. This is particularly the case with untreated paedophiles’*. The range of this scale goes from
‘normal sex drives and interests (28–35) through ‘questionable range, (24–27), ‘denial of sex drives and
interests’ (20–23) to ‘denial of sex drives and interests’ (0–19).
*
It would be expected that the profile of a treated paedophile if he is presenting an asexual image pretreatment would be a tendency to move towards the normal sex drives and interests category posttreatment.
ii. Sexual Obsessions (20 items)
This scale has two purposes: to measure an offender’s obsession with sex; and any tendency to exaggerate his
problem. It consists of a range of responses from no obsessions or ‘fake good’ (score 0–2), where the client
denies that he has any interest in sex, to a malingering or ‘fake bad’ response set (17–20). Sex offenders who
are honest about their high interest in sex are expected to score in the expected deviant range (9–16). Clients
scoring in the 10–16 range are seen as being sexually obsessed – having difficulty problems controlling sexual
thoughts and impulses.
iii. Lie Scale: Child Molesters and Rapists (13 items); Lie Scale: Exhibitionists (6 items)
The L(CM) and L(R) have been standardised and measure the openness to versus dishonesty regarding the
offender’s sexually deviant thoughts and behaviours. A low score (approaching zero) suggests that the offender
is openly admitting his sexual deviance and finds such behaviour pleasurable. At the other end of the scale (a
score of 8 or more) the offender is being dishonest about his interest in deviant sex.
iv. Cognitive Distortions and Immaturity (21 items)
This scale is intended to assess early childhood cognitive distortions which stay with the offender and map out
the potential to act out sex u a l ly deviant behav i o u r. A score of 0 to 3 suggests an acceptable ra n ge of
accountability for the client’s actions. A score of 4 to 9 suggests cognitive distortions and immaturity. A score
of 10 or more suggests character disturbance in that the offender feels more like a victim than a criminal. A
score of 15 or over suggests that the offender demonstrates severe lack of accountability for his actions.
v. Justifications (24 items)
This scale has 24 items and measures the extent to which an offender* tries to justify his sexual deviance. The
scale ranges from ‘accepting accountability’ (0–1), through ‘justifying sexual deviance’ (2–6), ‘justifying sexual
deviance marked’ (7–10) to ‘severe lack of accountability for his actions’ (11–24).
*
It would be expected that a successfully treated offender would have less justifications for his behaviour
post- compared with pre-treatment.
vi. Parallel items
The idea here is that there is cross-checking of clients responding in the MSI and the MMPI personality
inventories.. We did not administer the MMPI to our clients. However, parallel items were administered to
check the integrity of clients’ responses.
D.
FIVE SCALES RELATED TO ATYPICAL SEXUAL BEHAVIOUR
These scales comprise the Fetish scale (9 items); Voyeurism (9 items); Obscene calls (4 items); Bondage and
Discipline (6 items); Sado-Masochism (10 items). No strong predictions can be made about these scales
except to say that there may be more disclosure of atypical sexual behaviours post treatment.
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E.
FOUR SCALES OF SEXUAL DYSFUNCTION
These scales comprise Sexual inadequacies (8 items); Premature ejaculation (4 items); Physical disabilities
(8 items); Impotence (12 items). Again no strong predictions can be made about these scales except to say that
there may be more disclosure of sexual dysfunction post-treatment.
F.
SEX KNOWLEDGE AND BELIEFS SCALE (24 ITEMS)
A score on this scale of 17 or below indicates a need for more accurate information to be given to the offender.
Where courses include such information it would be expected that if an offender has a low score on this scale
pretreatment this would improve dramatically post-treatment.
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APPENDIX F: RISK OF RECONVICTION ALGORITHM
A version of Thornton’s algorithm (Fisher and Thornton, 1993) was used in this study. This algorithm was used
to work out ‘risk of reoffence’ levels for the clients in our sample. Subjects were categorised on the following
basis, where one point is given to any of the categories.
•
Any sex preconvictions
•
4+ preconvictions of any kind
•
Any current or previous conviction for non-sexual violence
•
Has been convicted of sexual offences against three or more distinct victims.
Risk of reconviction category is:
None of the above:
LOW RISK
One of the above:
LOW-MEDIUM RISK
Two of the above:
MEDIUM-HIGH RISK
Three or four of the above:
HIGH RISK
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158
APPENDIX G: BRIEF REPORT ON THE WOLVERCOTE UNIT1
G.1. HOW MEN GET REFERRED TO THE CLINIC
Prior to the clinic opening, in August 1995, there was advertising in such journals as the Probation Bulletin
and Community Care to get the attention of various probation and social services. Also, public relations
activity was conducted with judges, guardians ad litum etc. Plus, information from the Home Office and the
Department of Health was circulated. The Wolvercote Clinic Manager is also involved with NOTA (the National
Organisation for the Treatment of Sexual Abusers) and is hence able to network with those working with the
perpetrators of sexual abuse, while other members of staff have given talks to staff involved in running the
prison sex offender treatment programmes.
The majority of referrals are from the probation service enter long-term treatment with the Home Office paying
82 per cent of the fees. The Clinic Manager reckons that they say ‘yes’ to roughly 80 per cent of the men who
are suggested for referral.
The mechanics of referral
When there are requests for a potential referral to the Wolvercote Clinic a referral pack is sent out. A decision is
made by the therapy staff on the basis of the referral pack as to whether somebody is accepted or rejected.
Other reasons why clients may not end up at the Wolvercote Clinic; even though being recommended for
treatment, are that a client refuses or a parole board referral is not granted, or if a client is given a custodial
sentence.
Selection criteria2
Conviction or allegation of sexual harm to a child.
Exclusion criteria
• High level of mental illness.
• Chemical dependence – drug or alcohol.
• If someone is a child abductor
• If someone has learning difficulties.
• Previous history of high levels of gratuitous violence.
Referrals by agency
Referral requests, as of March 1998, are shown in Table G.1.
1
2
A residential unit for the treatment of child sexual abusers
Although it should be noted that the Clinic Manager occasionally sets less rigorous criteria for those men who are there for a four-week assessment to keep the
clinic operational
.
159
TABLE G.1:
REFERRAL PATTERNS
NUMBER OF
REQUESTS
PROBATION
SOCIAL SERVICES
SOLICITOR
CHURCH
HEALTH
OTHER
TOTALS
245
209
110
21
41
43
669
NUMBER
COMPLETED
119
53
23
14
1
5
215
REJECTED
WITHDRAWN
14
3
1
0
0
0
18
29
10
6
5
0
1
51
ADMISSIONS
OR ACCEPTED
74
39
16
9
1
5
144
Table G.2 below indicates where actual clinical admissions received long- or short-term treatment and the
average length of stay of those who have left long-term treatment.
TABLE G.2:
LONG-TERM TREATMENT BY REFERRAL3
REFERRER
PROBATION
PAROLE BOARD
CATHOLIC CHURCH
SOCIAL SERVICES
SOLICITOR
EMPLOYER
SELF-FUNDED
TOTAL
NUMBER NUMBER CURRENTLY
IN LONG-TERM
TREATMENT
55
4
7
39
3
1
1
110
8
1
2
3
14
NUMBER LEFT
LONG-TERM
TREATMENT
15
3
4
2
24
AVERAGE
LENGTH OF
STAY (WEEKS.)
51.9
53.3
43.7
31.5
45.13
It can be seen from Table G.2 that the average length of stay for the men who have left is about nine and a half
months. Just over half the men referred by probation services entered long-term treatment. It has been rare for
men referred by social services referral to enter long-term treatment. Nearly all the men referred by parole
boards and the church entered long-term treatment.
G.2 PROFILES OF MEN ENTERING LONG-TERM TREATMENT
Risk of reconviction
When the sample was looked at in terms of reconviction for sexual offenceS using a simpler method of
m e a s u ring risk of re c o nviction (described in Fisher & Thornton, 1993) it was found that the risk of
reconviction of the total sample of men entering long-term treatment (N = 38) was LOW-MEDIUM to MEDIUMHIGH (1.4).
Level of deviancy
Because the method outlined above is based on previous reconviction data and does noT include offences for
which these men may not have been charged, it may not accurately reflect the deviance levels of the sample. A
description of the men who have had previous therapy is described in Table G.3.
3
As of 23rd February 1998.
160
TABLE G.3:
NUMBER WHO HAVE HAD PREVIOUS THERAPY
TOTAL
PROBATION (51)
PAROLE (7)
CHURCH (7)
SOC. SERVICES (39)
OTHER (16)
TOTAL (110)
CORE SOTP
PROBATION
OTHER
6
3
1
7
1
3
12
3
4
4
6
8
6
24 $
6 *
4
8
2
44
$ Total is larger as one man has completed the Core SOTP and a probation course
* Total is larger as one man has had therapy at both the Gracewell Institute and the Core SOTP
Response to treatment in long-term therapy men
The treatment approach used at the Wolvercote Unit targets a number of areas considered important in the
treatment of sex offenders, including: increasing social competence; promoting awareness in offenders of the
damage done to their victims by their abuse (victim-empathy work); reducing distorted thinking which the
o ffender uses to gi ve himself permission to have unwanted sexual contact with his victims (cognitive
distortions); reducing denial and minimisation about their offences; developing an awareness of their pattern of
offending, developing strategies to deal with their deviant sexual arousal; developing alternatives to offending;
and developing the skills to cope appropriately with situations in which an offence is more likely to occur
(relapse-prevention techniques). The outcome data were analysed from this sample in the same way as reported
in Section 4.8. on 25 men who have left long-term treatment. Table G.4 shows treatment effectiveness by
deviancy level (Low/High).
TABLE G.4.
TREATMENT EFFECTS BY PRE-TREATMENT DEVIANCY LEVELS
N
LOW DEVIANCY
HIGH DEVIANCY
TOTAL
12
13
25
REDUCTION IN
PRO-OFFENDING
ATTITUDES
9
6
15
(75%)
(46%)
(60%)
OVERALL
TREATMENT
EFFECT
9
3
12
(75%)
(23%)
(47%)
NO TREATMENT
EFFECT
3
7
10
(25%)
(54%)
(40%)
It can be seen from Table G.4 that, in terms of producing overall change, this was successful in three-quarters of
Low Deviancy men and just over one-quarter of High Deviancy men which, in comparison with the Core
Programme is over twice as successful.
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178