1.
Remaking Relapse Prevention

2.
Agenda <ul><ul><ul><li>Relapse Prevention Vs Good Lives </li></ul></ul></ul><ul><ul><ul><li>What to Include in Treatment? </li></ul></ul></ul><ul><ul><ul><li>Interviewing Children </li></ul></ul></ul><ul><ul><ul><li>Suggestibility </li></ul></ul></ul><ul><ul><ul><li>Violent Thinking </li></ul></ul></ul>

3.
<ul><li>“ Determinants of Relapse” </li></ul><ul><li>(Marlatt & Gordon, 1980) </li></ul><ul><li>New type of cognitive-behavioral intervention </li></ul><ul><li>Relapse prevention </li></ul>

4.
Relapse prevention <ul><li>Maintaining change in addicts </li></ul><ul><li>Ceased </li></ul><ul><li>Through other interventions </li></ul>

5.
Relapse Rates for Addictions <ul><li>First 12 months after cessation </li></ul><ul><li>80% </li></ul><ul><li>First 3 months </li></ul><ul><li>66% </li></ul><ul><li>(Hunt et al., 1971) </li></ul>

6.
<ul><li>Negative emotional states </li></ul><ul><li>Interpersonal conflict </li></ul><ul><li>Social pressure </li></ul><ul><li>71% of all relapses </li></ul><ul><li>(drinkers, smokers, heroin addicts, compulsive gamblers, and over eaters) </li></ul><ul><li>(Cummings et al, 1980) </li></ul>

7.
Deviant Cycle Negative Affect Seemingly Unimportant Decisions (SUDS) High Risk Situations Target Selection Planning Passive/Active Grooming or Force Offense Remorse, Guilt, or Fear Thinking Errors Life Event

8.
Developed for <ul><li>Offenders motivated to change </li></ul><ul><li>Already ceased offending </li></ul><ul><li>Offended through “seemingly unimportant decisions” </li></ul>

9.
Not Developed For <ul><li>Psychopaths </li></ul><ul><li>Child molesters who want to continue </li></ul>

10.
<ul><li>“ An important precondition for applying RP interventions is that the offender be motivated to stop offending.” </li></ul><ul><li>(George & Marlatt, 1980, p. 16) </li></ul>

11.
In the Beginning <ul><li>“ the confidence and optimism we feel . . . are quite strong . . . </li></ul><ul><li>“ our confidence . . . is without empirical support” </li></ul><ul><li>(Gordon & Marlatt, p. 28) </li></ul>

12.
Deviant Cycle Negative Affect Seemingly Unimportant Decisions (SUDS) High Risk Situations Target Selection Planning Passive/Active Grooming or Force Offense Remorse, Guilt, or Fear Thinking Errors Life Event

13.
Life Event Sometimes Desire for Offensive Sex Self Regulation Model of Relapse Prevention (Ward & Hudson, 1998)

14.
Self Regulation Model of Relapse Prevention Desire for Offensive Sex Avoidance Goals Approach Goals (Ward & Hudson, 1998)

15.
Self Regulation Model of Relapse Prevention Avoidant Passive Active Automatic Explicit (Ward & Hudson, 1998) Approach

16.
Type of Offense Pathway: Roger <ul><li>Unemployed </li></ul><ul><li>Bar from 12 to 3 pm </li></ul><ul><li>Left drunk </li></ul><ul><li>Boarded a train as “knew girls would be there” </li></ul><ul><li>Goals: get one to perform oral sex </li></ul>

17.
Type of Offense Pathway: Roger <ul><ul><ul><li>Sat behind two 13-year-olds </li></ul></ul></ul><ul><ul><ul><li>Touched their hair and masturbated </li></ul></ul></ul><ul><ul><ul><li>Tapped one on shoulder </li></ul></ul></ul><ul><ul><ul><li>They got up and left </li></ul></ul></ul><ul><ul><ul><li>Got off train, saw a 13-year-old </li></ul></ul></ul><ul><ul><ul><li>Began masturbating </li></ul></ul></ul>

18.
Type of Offense Pathway: Roger <ul><li>Walked up to her with penis out of pants </li></ul><ul><li>Wanted her to perform oral sex </li></ul><ul><li>She called out and other girls joined her </li></ul><ul><li>Bus arrived and they left </li></ul><ul><li>They reported to bus driver </li></ul>

19.
Type of Offense Pathway: Roger <ul><li>“ I just do things for no reason.” </li></ul><ul><li>“ I wish I could put into words how I feel, and understand what it is all about.” </li></ul>

20.
Type of Offense Pathway: Roger <ul><li>Knew by heart the routes home of children from local schools and holidays and breaks </li></ul><ul><li>It was “familiar territory” so never had to plan </li></ul><ul><li>Says “thousands” of victims </li></ul><ul><li>Convicted 13 times </li></ul>

21.
Type of Offense Pathway: Roger <ul><li>Says he felt children enjoyed the experience </li></ul><ul><li>“ I don’t hurt anyone and people quite like what I do. I never carry out my fantasies about rape and hurting people in real life.” </li></ul>

22.
Roger: What Kind of Offender? <ul><li>Approach Automatic </li></ul>

23.
Type of Offense Pathway: Dave <ul><li>40 year-old </li></ul><ul><li>Confident and outgoing </li></ul><ul><li>Worked abroad in a program to help teen prostitutes </li></ul><ul><li>Talked to pimps </li></ul><ul><li>They made a “powerful case” </li></ul><ul><li>Felt his values had “become contaminated” </li></ul>

24.
Type of Offense Pathway: Dave <ul><li>“ Some of the younger girls I was trying to help said that things about the life were good. Intellectually I knew that that was about comparisons with the life they had before, extreme poverty and so on, but at another level I got interested – although I never did anything wrong to them.” </li></ul>

25.
What Type of Offender: Dave <ul><li>In past had baby-sat for 11-year-old </li></ul><ul><li>Went in bedroom aroused and watched child sleep </li></ul><ul><li>Told wife </li></ul><ul><li>Agreed never to babysit again </li></ul>

26.
Type of Offense Pathway: Dave <ul><li>I talked to my wife about the babysitting experience before we had the children. That was good, but then I sort of laid the responsibility for stopping it happening again on her. I did that again after our daughter told her what I’d been doing.” </li></ul>

27.
Type of Offense Pathway: Dave <ul><li>Family living in an open-plan home in hot climate </li></ul><ul><li>Kids often undressed </li></ul><ul><li>Felt 10-year-old daughter was seductive </li></ul><ul><li>Knew his arousal was wrong </li></ul><ul><li>Tried to avoid situations where he might abuse her </li></ul>

28.
Type of Offense Pathway: Dave <ul><li>Refused to share a tent with her on camping trip </li></ul><ul><li>Other times he fondled her genitals </li></ul><ul><li>Once persuaded her to straddle him </li></ul><ul><li>Told himself knew what was happening and agreed </li></ul>

29.
Type of Offense Pathway: Dave <ul><li>When wife gone, got into daughter’s bed to have intercourse </li></ul><ul><li>Realized what he was doing and stopped </li></ul><ul><li>Shaken that he almost raped her </li></ul>

30.
Type of Offense Pathway: Dave <ul><li>“ I thought that carrying on with my work would help me get my head straight – instead it was just making it worse.” </li></ul>

31.
Type of Offense Pathway: Dave <ul><li>“ I kept away from my daughter – wouldn’t take any interest in her. She wondered what was wrong with me – my wife says that made her more likely to want affection from me. Then when she came to me I misread what she wanted, because my thinking was getting so messed up.” </li></ul>

32.
Dave: What Kind of Offender? <ul><li>Avoidant Active </li></ul>

33.
Type of Offense Pathway: Joe <ul><li>40-year-old </li></ul><ul><li>6 cts against one boy, now 19 </li></ul><ul><li>Over 8 years </li></ul><ul><li>Fondling, oral sex, anal intercourse </li></ul><ul><li>Working as handyman at boy’s house </li></ul><ul><li>Boy began to hang around him </li></ul>

34.
Type of Offense Pathway: Joe <ul><li>Urinated in bushes and boy saw it </li></ul><ul><li>Boy watching excited him </li></ul><ul><li>Asked boy to touch his penis </li></ul><ul><li>Boy compliant </li></ul><ul><li>Escalated to anal intercourse </li></ul><ul><li>Boy told him he didn’t want to do these things </li></ul>

35.
Type of Offense Pathway: Joe <ul><li>Told boy it was normal </li></ul><ul><li>Told him no one would believe him </li></ul><ul><li>Told boy, why had he done it if didn’t want to </li></ul><ul><li>Told boy if reported, they would blame him </li></ul><ul><li>Told boy that he (the boy) was gay </li></ul><ul><li>“ You’re just a little queer! Why don’t you accept that?” a </li></ul>

36.
Type of Offense Pathway: Joe <ul><li>2 previous convictions </li></ul>

37.
Type of Offense Pathway: Joe <ul><li>Previous Treatment </li></ul><ul><li>“ You’re got to go along to get along. If I was ever going to get out of there, I realized that I was going to have to learn to say what they wanted to hear.” </li></ul><ul><li>Psychologist: Did well and was able to “freely share his experiences and mistakes with other group members and to take responsibility for his actions.” </li></ul>

38.
Type of Offense Pathway: Joe <ul><li>“ showing them what real life was like” </li></ul><ul><li>“ You need to know how to get that feeling of being in charge – the world is a frightening place” </li></ul><ul><li>“ Of course, I took my ‘fee’” </li></ul>

39.
Joe: What Kind of Offender? <ul><li>Approach Explicit </li></ul>

40.
Type of Offense Pathway: Ben <ul><li>25-year-old </li></ul><ul><li>Police called to residence – found father of a 5-year-old holding Ben in custody </li></ul><ul><li>Ben was babysitting </li></ul><ul><li>Returned to find him in bed with son </li></ul><ul><li>Boy crying; told parents Ben had “touched my thing and sucked on it.” </li></ul>

41.
Type of Offense Pathway: Ben <ul><li>3 arrests at ages 15, 22 and 23: all victims boys under 10 </li></ul><ul><li>No other criminal history </li></ul>

42.
Type of Offense Pathway: Ben <ul><li>1 st offense: met 6-year-old when he was coming home from school. Bought him ice cream, took him to a park, pulled down his pants and fellated him </li></ul><ul><li>After graduating from university, picked up a boy, took him for a ride, drove to a park, fondled him and fellated him </li></ul>

43.
Type of Offense Pathway: Ben <ul><li>Uncomfortable around adults his age </li></ul><ul><li>“ They seemed so much more grown up than I was.” “I felt awkward, like I couldn’t get one foot in front of the other.” </li></ul><ul><li>Children: “They weren’t trying to live up to some social standard.” “I envied them because they seemed so free, so at ease in their world.” </li></ul>

44.
Type of Offense Pathway: Ben <ul><li>“ I will admit that I especially liked looking at the boys. They were so cute, bright eyed, smooth skin. It sounds silly, but I wished that I could look like that, rather than a hulky, almost adult male.” </li></ul><ul><li>“ It must have been then that I began to think about them sexually.” </li></ul>

45.
Type of Offense Pathway: Ben <ul><li>“ When I jerked off, I tried to fantasize about girls my age in my classes, but it didn’t work. When I thought about kids, I felt guilty, but I got really aroused and I could ejaculate. Although I didn’t really want them to be, the fantasies were about feeling these kids up and sucking their dicks. The more I did it, the easier it got.” </li></ul>

46.
Type of Offense Pathway: Ben <ul><li>“ When I saw that kid in 1989, I don’t know, I guess I just felt that I had to do it. I conned him and I took him to the park and went down on him. I felt like shit after that.” </li></ul>

47.
Type of Offense Pathway: Ben <ul><li>Cruised while at university, but didn’t pick up any kids. Afraid of getting kicked out. </li></ul><ul><li>“ After I graduated from university and couldn’t find a job, I felt worthless. So I started cruising again.” “This time I was afraid something would happen, and it did.” </li></ul>

48.
Type of Offense Pathway: Ben <ul><li>Felt guilty. Boy couldn’t identify him. </li></ul><ul><li>“ I should have said, ‘Hey! I did it!’ but I didn’t.” </li></ul>

49.
Type of Offense Pathway: Ben <ul><li>Last offense, asked boy, “Do you want to learn about sex?” </li></ul><ul><li>“ It seemed to me that he was fine with it until his old man burst into the room.” </li></ul>

50.
Type of Offense Pathway: Ben <ul><li>Still masturbating to fantasies. “I can’t seem to stop it.” </li></ul><ul><li>Response to first arrest: “I just wanted to forget about it.” </li></ul>

51.
Ben: What Kind of Offender? <ul><li>Avoidant Passive </li></ul>

52.
Implications for Treatment

53.
Good Lives Model

54.
<ul><li>RP Avoidant </li></ul><ul><li>Good lives model Approach </li></ul>

55.
Primary Goods <ul><li>People seek primary goods </li></ul>

56.
Primary Goods <ul><li>Experiences, states of mind, activities </li></ul><ul><li>Sought for their own sake </li></ul><ul><li>Increase psychological well-being </li></ul>

57.
Sexual Offending <ul><li>Attempts to pursue primary human goods </li></ul><ul><li>Socially unacceptable </li></ul><ul><li>Personally frustrating </li></ul>

58.
What Are Primary Goods <ul><ul><ul><ul><li>Relatedness </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Health </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Autonomy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Creativity </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Knowledge </li></ul></ul></ul></ul>

59.
Tender Minded Theory <ul><li>People are good </li></ul><ul><li>Bad acts are an attempt to meet same needs as everybody else </li></ul>

60.
Theoretical Position <ul><li>“ It is true that we did not cite any study applying the ideas of Deci and Ryan [human needs and self-determination] to an offender population – to our knowledge there are no such studies yet.” </li></ul><ul><li>(Ward & Stewart, 2003, p. 222) </li></ul>

61.
Theoretical Position <ul><li>“ . . .there is little or no evidence for the assessment and treatment aspects of the theory other than the rationally based reasons outlined above. This weakness reveals that the theory lacks empirical adequacy.” </li></ul><ul><li>(Ward et al., 2006, p. 311) </li></ul>

62.
Deci & Ryan (2000) <ul><li>Nonoffenders </li></ul><ul><li>Autonomy, competence & relatedness </li></ul><ul><li>Correlated with </li></ul><ul><li>Indices of well-being </li></ul><ul><li>(Negatively correlated with anxiety and depression; positively correlated with self-esteem) </li></ul>

63.
<ul><li>Innate needs </li></ul><ul><li>Correlated with </li></ul><ul><li>Noncriminogenic needs </li></ul><ul><li>( Bonta and Andrews, 2003) </li></ul>

64.
Applying the Good Lives Model <ul><li>What goods are associated with offending? </li></ul><ul><li>Pursuit of emotional equilibrium </li></ul><ul><li>Intimacy </li></ul><ul><li>Personal control </li></ul><ul><li>Grievance </li></ul><ul><li>Sexual pleasure (goods of health & body) </li></ul><ul><li>Play (to get a thrill) </li></ul>

65.
What Prevents Meeting These Appropriately? <ul><li>Socially isolated </li></ul><ul><li>Lack skills for relationships </li></ul><ul><li>Overly aggressive when mood low </li></ul>

66.
Identifying Overarching Primary Goods <ul><li>Mechanically Inclined </li></ul><ul><li>“ In this example, he might enroll in a night course on practical mechanics (knowledge), join a car club (relatedness), and eventually train as a car mechanic (mastery at work).” </li></ul><ul><li>(Ward et al., 2006, p. 308) </li></ul>

67.
Identify Environment Needed <ul><ul><ul><li>Info about opportunities for work </li></ul></ul></ul><ul><ul><ul><li>Social supports </li></ul></ul></ul><ul><ul><ul><li>Living arrangements </li></ul></ul></ul><ul><ul><ul><li>Culture of the community </li></ul></ul></ul>

68.
People are What They Do <ul><li>To forge a more adaptive personal identity </li></ul><ul><li>Must live a better life </li></ul>

69.
Rehabilitation Involves <ul><li>Looking at past life </li></ul><ul><li>Developing a new good lives plan </li></ul>

70.
Must Take into Account <ul><ul><ul><li>Offenders’ strengths </li></ul></ul></ul><ul><ul><ul><li>Primary Goods </li></ul></ul></ul><ul><ul><ul><li>Relevant Environments </li></ul></ul></ul><ul><ul><ul><li>What competencies & resources? </li></ul></ul></ul>

71.
<ul><li>“ The problem does not reside in the primary human goods that underlie offending, but in the way individuals seek these goods.” </li></ul><ul><li>(Ward et. Al, 2006, p. 307) </li></ul>