FRI, Oct 8 \ 11.30-13.30 \ Treatment Techniques, IV

090
TREATMENT OF SEXUAL OFFENDERS IN DUTCH PRISON

Andre Rijk, PI Breda, The Netherlands
a.rijk@breda.dji.minjus.nl

PI Breda – located in the south of Holland – is a remandcentre in which inmates stay who are charged with a crime, but who are not convicted yet. This prison is the only prison in Holland with an special ward for sexoffenders. Almost every convicted offender will receive treatment aimed at relapseprevention, on a voluntairy or nonvoluntairy basis
Currently there is al lack of treatmentcapacity, as a result of which a lot of inmates who have to undergo treatment have to wait in our remandcentre.
Partly on the request of inmates we started 1999 a treatmentprogram in this remandcentre. This treatmentprogram is a coproduction of PI Breda and Forensic Clinik “De Grote Beek” Eindhoven.
The treatmentmethod was based on the state of the art-methods of treatmentprograms used in the Dutch clinics for sexoffenders, adapted to the prisonsituation.
The Dutch authorities were initial very reluctant and critical about this initiative, since treatment is not a goal of the Dutch prisonsystem and the system shouldn't be suited for treatment.
The program however is a success, according to inmates, therapists and clinic to which inmates are transferred. Partly as a result of this success the Dutch policy in relation to treatment in prison has been changed. New initiatives for treatment in prison have to be developed.
At the same time these initiatives are requested to meet a lot of requirements in order to be accepted and financial supported.
The next year we make effort to meet these requirements and at the same time to develop the program further in order to offer the inmates a broader preparation to the coming treatment in the clinics.

091
HOW TO MOTIVATE SEXUAL OFFENDERS? SCHEMA FOCUSED THERAPY: THE PROGRAM AND THE THERAPIST

Jacqueline Janssen
Pompestichting / Kairos, The Netherlands
jacquelinejanssen@kabelfoon.nl

The lack of motivation to change their (offence) behavior is a common problem according to many therapists treating sexual offenders. Often the cognitive distortions about their behavior and their victims are labeled as negations of what they have done and as a resistance to change..
Instead of only attributing these factors to the client and label him as unmotivated, we surely will make more progress in reducing recidivism by linking in our treatment programs to the client's self-appraisal of low efficacy.
Important cognitive variables in treatment outcome research are client expectations and the client's perception on the therapist (Marshall et all, 2003). The perceived self-efficacy is related to both enhanced motivation and performance (Bandura & Locke, 2003).
Schema focused therapy is a cognitive behavioral program. A positive attitude towards changing the self-efficacy and agency of these men, next to distinguishing the risk factors for relapsing, are the most important “healing” factors in treatment.
A short explanation of schema focused therapy will be given as also the way to make change possible.

Bandura A & Locke EA (2003). Negative self-efficacy and goal effects revisited. Journal of Applied Psychology, 88, 87-99
Marshall WL, Fernandez YM, Serran GA, Mulloy R, Thornton D, Mann RE, Anderson D (2003). Process variables in the treatment of sexual offenders: A review of the literature. Aggression and Violent Behavior, 8, 205-234.

092
SEX OFFENDER SITUATIONAL COMPETENCY TEST: A TREATMENT EVALUATION

Stephen Hogan, RPN, John R. Reddon, Ph.D., Lea H. Studer, M.D., Shelly L. Takacs, B.A., Todd E. Storme, B.A., & David Lake, B.Sc.N.,
Phoenix Program, Alberta Hospital Edmonton, Canada
stephen.hogan@amhb.ab.ca

There is widely held public perception that sexual crimes are on the increase, that the problem is growing ever more prevalent and that sexual offences have a high personal and societal cost. Some research and recent articles have questioned the value of sexual offender treatment programs. Treatment providers generally agree that relapse prevention is a key therapeutic component in the management of deviant sexual behavior. The dilemma remains how does one gauge whether the offender has acquired the skills we are trying to impart and whether the acquisition of these skills has an impact on re-offence. 164 convicted male sex offenders were treated in an inpatient psychotherapy program for six months to two years. In an attempt to measure some of the relapse prevention variables, the Sex Offender Situational Competency Test (SOSCT) was administered pre and post treatment. The test measures the offender's ability to recognize high-risk situations and assesses the effectiveness of the coping skills generated. Results have shown that post treatment scores improved significantly. Further the patient responses highlight the importance of a multi-modal treatment approach. This indicates that the SOSCT is a useful tool in measuring the efficacy of the relapse prevention components of sex offender treatment. There is also some indication that improved SOSCT scores are indicative of lower recidivism rates.

093
HATE IN THE COUNTER-TRANSFERENCE: THE VICISSITUDES OF WORKING WITH SEXUAL OFFENDERS

J David Millar
North Essex Mental Health Partnership Trust, CFCS, Essex, England
david.millar@nemhpt.nhs.uk

We might reasonably expect a wide range of intellectual, clinical, social, moral, or even “visceral” responses in the therapist whilst working with sexual offenders. These reactions could range from repulsion to reproach or from reparation to revenge. Along the way, I would suggest, lies the singular possibility of that all-too-human response, “hate”. How we deal with our hate within the general landscape of living is contentious enough but how we deal with it in the consulting room in the presence of a sexual offender is, perhaps, another matter.
Donald Winnicott, a British Psychoanalyst, wrote a classic paper, in 1948, called: Hate in the Counter-transference and here I am borrowing his title but elaborating his concept to specify a particular type of reaction evoked in the therapist by the sexual offender. The reaction is not, as I have outlined above, exclusively one of hatred but I would like to explore this reaction in particular to show the mutability of the emotional reactions in both offender and therapist.
I intend to illustrate this phenomenon with reference to two clinical vignettes illustrating the reaction: (1) between patient and analyst, and (2) between the victim, the victim's family, the therapist and the professional network.
My contention is that we must “own” our hatred in the countertransference and attempt to understand its complexities before we can even begin to help the offender discover his/her own complex moral, emotional and criminal tendencies.