• Editor’s Comment
 • Jan Hindman
 • STABLE-2007 & ACUTE-2007: Improving the Assessment of Dynamic Risk Potential
 • ATSA and Public Policy: Many Steps Forward
 • Clinical and Theoretical Notes on the Change Process for Sexual Offenders
 • Juvenile sexual offenders: Comparison of victim age based subgroups and prediction of treatment outcome and recidivism
 • Board of Directors Election Results
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Vol. XIX, No. 4
Fall 2007
Clinical and Theoretical Notes on the Change Process for Sexual Offenders

 

Introduction   
     Change versus the management of sexual offenders has been a controversial issue for years. D.R. Laws occasionally reminds professionals that sexual offender treatment in not therapy, but merely management and, therefore, offenders do not change at a deeper level. Marshall, Ward, and associates (2005) have presented the philosophical difference in rehabilitation orientations. They compared a risk management approach—avoidance oriented and focused on reducing the risk by protecting the community—to the Good Lives Model approach, which focuses on enhancing the client’s quality of life in order to lower their propensity to reoffend. Assuming that management and treatment require a degree of change, the question emerges—what is change, and why is it so important?

     Earlier evidence supports the hypothesis that treatment does not assure relapse prevention (Furby, Weinrot, & Blackshaw, 1989; Rice Quinsey, & Harris, 1991). Recent studies indicate that not all treatments are effective (Hanson, Gordon, Harris, Marques, Quinsey, & Seto, 2002), yet skillfully implemented cognitive-behavioral approaches have been shown to decrease the likelihood of re-offending (Alexander, 1999; Marshall, 1999, 2006; Marshall, Marshall, Serran, & Fernandez, 2006; Hanson et al., 2002). Can we precisely identify what effective treatment actually changes in clients when attempting to lessen the possibility of them reoffending? The primary purpose of this article centers on conceptualizing the change process, including viewing change from different perspectives, within a Meta view.

Definition of Change   
     Change has been defined a number of ways, as indicated by the variety of theories and therapeutic models (Rychlak, 1981). A key aspect is summarized by Zeig & Munion (1990). They emphasize the projected realities of therapist upon client at both the conscious and subconscious level: “The model is not only a philosophy…. it becomes a lens. This lens tells the practitioner what to look for and respond to in the therapeutic encounter—but it is a double-edged sword in that it focuses and limits viewing simultaneously. The therapist then passes on the lens to the patients” (1990, p. 9).

     The same holds true for sexual offender treatment. The clinician’s view of both human nature and change is projected onto the offender. From a constructivist perspective, both the therapist and client (i.e., offender) co-create the therapeutic and treatment realities, in which the therapist tries to influence the offender to change (maintain abstinence or recovery). If the offender is operating out of a shame-based approach, the client is like to receive a message of shame. The therapist, consciously and unconsciously, sells a model of therapy. This is why it is important for clinicians to understand what they are selling and why, along with the expected outcomes and process. Prior to selling a treatment model, the therapist should clarify the parameters of the change process.

     On a generic level, change can be defined as creating a difference in functioning at some level (Bateson, 1979; Carich, Williamson, & Dobkowski, in press). Watalawick, Fisch, & Weakland (1974) observed two levels of change. First order change is superficial, non-systemic, and usually extrinsically motivated (Deci & Ryan, 2000), whereas second order change requires structural change of a client’s system. Based upon Carich’s (1999, 2003) concept of meta-causality, higher-level change or third level change was suggested (Carich, Williamson, & Dobkowski, in press), in which structural change is maintained over an extended period of time. At this level of change, concurrent with Prochaska and DiClemente’s (1982, 1986) maintenance stage (Ward & Stewart, 2003), the offender’s intrinsic motivation results in an acceptance of external interventions. These interventions, woven through the client’s system, provide a support for their own internal interventions. The resulting congruence of the client’s internal process and the image he presents is ultimately the key to maintaining change.

     From a holistic perspective, the change process itself requires a change at multiple experiential domains (Zeig, 1987). Experiential domains include: biological, physiological, cognitive, affective, social or interpersonal, behavioral, spiritual, environmental, and contextual. That is, an interplay of multiple, dynamic, intrapersonal components affect and are affected by the dynamics of the interpersonal process. The authors suggest a holistic view in which each domain interacts with each other integrating a mind-body core perceptual information-processing unit. Therefore change occurs in all experiential dimensions, at varying degrees and levels, from superficial to deep.

Causality and Change   
     The topic of causality seems to underlie discussions of change (Rychlak, 1981). The various philosophies and theories of causality have been expressed a number of ways ranging from pattern, context, content, and processes. Typical forms (i.e., patterns) include the controversy of linear versus circular causality (mutual causality) and content, and Plato’s idealistic philosophy, cognitive views, constructivism or any form of post modernism versus Aristotle’s realism reductionism views. Kant is perceived to have bridged the gap with his critical realism, saying that at some level there an objective reality; however, reality is filtered with subjective perception (Carich, 1998; Durant & Durant, 1967; Rychlak, 1981). Other forms of debate include the mechanistic medical model versus the holistic view, including the Cartesian dualism between mind-body (Rossi, 1993; 2002). Applied to change, it implies that change occurs in a linear fashion versus within a system involving circular causality, or change occurs by changing beliefs versus behavior. That is, mental interventions dictate physical intervention. From a higher level, referred to a meta-recursive causality (Carich, 1998), all of these debates are complementary of each other, subsumed under a higher causality occurring on diverse levels. Each view is “true” at some level and “untrue” from higher level, or broader perspective.

Assumptions of Change   
     A brief exploration of assumptions concerning change will follow to aid our inquiry. These in clued self-determinism, postmodernism, teleology, holism, contextual parameters and dynamics, and the meta-recursive view.

     Self-determinism.    
     Self-determinism refers to choices one makes (Adler, 1941; Ansbacher & Ansbacher, 1956; Dreikurs, 1950, 1967). Changes and choices are made at conscious and unconscious levels of awareness. Change requires a series of decisions, and the offender will make choices to offend based on meeting perceived needs. Whether the choice is conscious or unconscious, the client is held accountable if the choice results in relapse. Unconscious decisions to offend are best represented by Ward and Hudson’s (1998, 2000) impulsive automatic offense pathway (Laws & Ward, 2006).

     Postmodernism.   
     The Postmodern views encompass constructivism and social constructivism (Hansen, 2004; Mahoney, 2003; Niemeyer & Bridges, 2003). In essence, people subjectively create or construct their own worlds based upon beliefs concerning external reality and their own past perception of experiences and current reality. Mahoney (2003) summarized these views, based upon idealism and Kant’s critical realism philosophy and, more currently, referred to as postmodern thinking (Adler, 1941; Ansbacher & Ansbacher, 1956; Kelly, 1955, Rychlak, 1981): “Like existential philosophy, constructivism says that we humans are active participants in our own lives. We chose and our choices make important differences in our lives and in the lives of all with whom we are connected. We are often reactive and constructivism does not deny our capacity for unreflective reflex and conditioning . . . we are moving in the midst of forces far greater than ourselves, yet we have a choice within those forces. The central point of this first theme is that humans are not passive pawns in the game of life” (Mahoney, 2003, p. 5). In constructivism, the individual is an active agent in the process of experiencing, organizing their world into meaningful patterns.

     In terms of changes, Mahoney (2003) states: “There are, of course, biological structures and processes that shape any individual’s experiencing in five themes, that is, that biochemically and neurologically humans are ever-active organizers whose biological patterns develop and change in ways that reflect an extensive network of dynamic relationships. When the many factors influencing any given life moments are taken into account … (genetic constraints and activations, cultural and developmental history, current health, skills development and life circumstances) each human being can be seen as doing and feeling what is natural for him or her. They are still responsible for their actions, and as an important part of that responsibility is engagement in the future development…” (Mahoney, 2003, p.9). He continues: “Human development rarely follows simple linear path. It is more often a zigzag course with frequent striking point, repetitive cycles, occasional regressions…. The particulars may seem dizzying in their diversity, yet these are patterns” (Mahoney, 2003, p.10). Mahoney’s point is that the individual interacts with external reality; however, the individual filters external reality through an internal lens.  

     In treating sexual offenders, the therapeutic context, at numerous levels, are constructed co-realities involving group members and the therapist? Therefore, the therapeutic process impacts the perceptual view of the offender in relation to the environment, to some degree. As the client engages in self-discovery and self-disclosure necessary for change, the initial efforts are likely to be a tentative and exploratory.

     Teleology.   
     The teleological perspective states behavior serves purposes within a given system (Adler, 1941; Ansbacher & Ansbacher, 1956; Dreikurs, 1950, 1967). That is, behavior is seen as goal-oriented in unique ways based upon the individuality of the given system. Ward (2002) proposes that the offender tries to obtain “goods” (i.e., physiological satisfaction, relatedness, competence, intimacy, meaning, and fulfillment) through sexual behavior (Marshall et al., 2005). Ward and Stewart (2003) connect criminogenic needs and human needs with “goods”, which can be translated into commonly found dynamic risk factors (DRFs) that are typically addressed in treatment (Carich & Calder, 2003; Carich & Adkerson, 1995, 2003; Hanson & Harris, 2001, Thornton, 2002; Marshall, 1996, 2006)

     Offenders attempt to obtain goods through offending by meeting perceived needs. Offenders report a sense of satisfying emotional needs during offending. For example, besides sexual gratification, offenders’ distorted beliefs may result in a sense of achieving acceptance or intimacy. Unfortunately, the result is the sexual victimization of the vulnerable.

     Holistic View.   
     Within the last few years, the holistic view has been applied to offenders (Carich & Calder, 2003; Longo, 2002). From the holistic view, one recognizes the interconnection between the various parts of the self, and how those parts are connected to the environment, from the micro through the macro levels (Dreikurs, 1950, 1967), resulting in a whole which is greater than the sum of its parts. Human experience involves mind-body connections (Rossi, 1993) and interconnected experiential domains with sensory modes. The mind-body forms a cybernetic complementarity, involving all experiential dimensions. Thus change, to some degree, involves both the mind and body together, in contexts or states, inside and outside of the therapeutic environment—intrapersonally and interpersonally.

     Interpersonal Context.   
     Therapy or sexual offender treatment occurs within the interpersonal context. This context consists of interactional processes based upon communication or exchange of information in the form of messages. Patterns of communication form the relationships, which are mutually feeding processes with all the individuals involved. Influence within the interpersonal context varies among participants or elements. The client influences the therapist in terms of the directions and the types of techniques used (the responsivity principle). All parties calibrate the interpersonal relationship. The point of the therapy is that the therapist influences (helps) the client to change through the use of interventions delivered by therapeutic techniques. Change occurs within the therapeutic context—in and out of group sessions.

     Learning Context.   
     Change involves a learning process at some level. The offender has learned or made a series of decisions involving sexual abuse. In treatment, the offender now learns a different set of coping behaviors to replace offending (Cortoni & Carich, 2007). This is a learning process typically involving different types of learning and multiple forms of intelligence (Gagne, 1983; Gardner, 1983). Life is too complex to simply indicate that learning means reassessment of a right or wrong, good or evil, philosophical dichotomy. A number of processes are acknowledged and plausible. From this view, learning and change encompass many elements, processes, levels, and relationships. As everything is connected at the highest level, there are multiple ways to facilitate change. Indeed, there are multiple expressions of change.

     Meta-Recursive Causality/Reality.   
     Change and learning is often linked to philosophical notions of causality (Carich, 1998; Rychlak, 1981). Philosophical questions involve how and why people learn, change, or engage in particular behaviors. Therefore, numerous authors have articulated numerous theories explaining the different facets of self and human behavior. Ultimately, many theories are translated into therapeutic approaches aimed at change, addressing change in relation to 1) linear vs. circular causality, 2) Aristotle’s objective empiricist approach vs. Plato’s idealistic approach, and 3) Mind/body dualism vs. monism.

     The authors recognize the value and validity of each approach from a higher Meta level. Change involves multiple dimensions, elements, contextual forms, processes, levels, dynamics, and contents—the paradox being that views that could be the antithesis of holism can have value as a part of the holistic perspective recognized as valuable when working with sexual offenders (Longo, 2002).

Learning, Change and State Dependent Phenomena   
     Offending can also be viewed in terms of state behavior (Carich & Calder, 2003; Carich & Parwatakar, 1992, 1995). Thus, when the offender enters an offense process (i.e., pathway, cycle, relapse process, offense chain), he/she is entering an offending state. The state view stems from an awareness of dissociation that has been observed as a characteristic of sexual offenders, as well as other criminals, including serial killers (Carich, 1999; Carich & Calder, 2003; Carich, Fisher, & Kohut, 2006).

     Dissociation is the sense of detachment from a current contextual reality at one level while maintaining a connection at another level. Dissociation is not psychosis, as the individual remains in contact with current reality on some level. In fact, when an offender enters an offending modality, Marshall and colleagues (2006) described the internal cognitive process as a state of deconstruction as the offender’s mindset or cognitive framework changes from nonoffending intentions to offending. This is a description of the internal process of state dependent behavior, as the offender deconstructs into an offending mindset.

     Interestingly, Ernest Rossi (1993, 2002) proposes that the essence of dissociation and state dependent learning occurs through the mind-body connection known as the state dependent memory learning and behavioral system. It is emphasized that the experiential domains are part of the mind-body process known as SDML&B system (State Dependent Memory Learning and Behavioral System) located in the hypothalamic limbic system of the brain. Rossi traced the mind body connection to a molecular level (1993), and viewed this as basic blocks of learning through exchange messenger molecules. Rossi emphasized that behavior is thus encoded (learned) via the SDML&B system or state dependent process. Carich and Parwatakar (1992, 1995) applied this to sexual offenders, speculating on a metaphorical internal switchbox in which the offender activates, consciously or unconsciously, when in a deviant state and when engaged in an offense pattern. Offense patterns can be demarcated into patterns with specific interventions. Just as offending behaviors/states can be accessed at any time, interventions and change states/processes can be accessed. Therefore, change is reflected in SDML&B processes, in which offending behaviors are decoded and recoded. Change occurs at a mind-body level via the SDML&B system. New behaviors are encoded, defined by familiar terms such as cognitive restructuring (particularly of core schema), emotional regulation skills, arousal control, general regulation skills, and process changes. Although this describes possible processes, the content of the change varies.

Content versus Cybernetic Patterns Processes   
     Change involves both content and process. Aspects of the change process have been discussed in terms of multiple levels and experiential domains. The content refers to actual dynamic risk factors (DRFs) and treatment targets often translated into treatment elements. A sampling of these can be found in Table 1.

Table 1: Content Factors Involved in Change Process

Carich/Calder       8 Elements Hanson/Harris SONAR (DRF) Thornton’s SRA/DRFs Marshall’s targeted DRFs Recovery Factors (Carich)
1. Offense disclosure/ responsibility Cooperation Attitude Distorted attitudes Denial l/ minimization 1. Implied throughout motivation/ commitment           2. Responsibility vs. disowning
2. Offense specific cognitive restructuring  Attitude Distorted attitudes Denial/minimization Pro-offending attitude Distorted perception Responsibility vs. disowning behaviors
3. Cycle & RP (regulation skills) Sexual regulation General regulation Self-management Relapse prevention Assault cycle and intervention
4. Victim empathy   Implied socio-affective Victim empathy Social interest
5. Arousal control Sexual regulation Sexual interest Self-management Deviant fantasies Arousal control
6. Clinical issue resolution   Underlying dynamics Offense related Clinical issue resolution
7. Social skills, interpersonal restructuring and affective management Social influences Intimacy skills Socio-affective  Attachment style Socio-affective
8. Lifestyle restructuring and management General regulation Criminogenic needs   Lifestyle behavior management

 

     Within the therapeutic context, the DRFs and treatment targets are the substance of the treatment plan. Typical treatment plans have goals, objectives, and expected outcome criteria (Carich & Adkerson, 2003; Carich & Calder, 2003; Metzger & Carich, 1999). DRFs are the actual dynamics, issues, deficits, or problems targeted in treatment. The process of treatment and change involves dynamics and patterns. Thus, the substance of change—the actual change process—can perhaps best be viewed from a cybernetic perspective of complementary patterns. Process and content cannot be separated. Both form a cybernetic complementarity.

         The change process combines as a pattern of stability and change within a system. Each is an inherent part of the other—a connection formed in mutual reliance (Keeney, 1983; Keeney & Ross, 1983; Carich, 2004), involving patterns of stability (patterns of sameness) and change (patterns of differentness). By looking at the therapeutic process as a cybernetic system, the offender’s patterns of stability and change are calibrated to form a cybernetic complementarity as indicated in Figure 1.

Figure 1: Cybernetic Complementarity of Process/Content

------>
Process / Content
<------

…Process <--> Content <--> Process <--> Content <--> Process <--> Content…

     Each is an inherent part of the other. The connection is both complementary and interconnecting. Likewise, change can be viewed in terms of cybernetic patterns forming complementarities (Keeney, 1983; Keeney & Ross, 1983; Carich, 2004). More specifically, patterns of stability (patterns of sameness) vie with change (patterns of differentness). Therefore, by looking at the therapeutic process as a cybernetic system (Keeney, 1983), the offender’s patterns of stability and change are calibrated to form a cybernetic complementarity. Defenses and cognitive distortions, including core schemas and IT’s (implicit theories or worldviews), form the basis of patterns of stability. Patterns of stability reflect the offender holding onto familiar patterns, while the therapist introduces something different in the patterns of change. This entire process is calibrated at various levels, through the process of socio-feedback. Applied to sexual offender systems, treatment cannot separate the patterns of content and the process. Through treatment, content and process, the sexual offender pattern of stability, system, and process must be addressed simultaneously.

     At a deeper level, the profound changes the sexual offender will hopefully experience must be integrated into a stable system that will constantly maintain resistance to the dynamics of healthy change at varying degrees and levels. When new patterns of change, or interventions, are introduced into the client’s system, the cybernetic view states that the client system calibrates itself to incorporate new patterns. Treatment becomes interactional, as different responses from the therapist are calibrated while, at the same time, the client calibrates new patterns of information. Nonoffending states are introduced, often in conflict with the client’s old stability. The degree to which the offender protects the stability will determine the effectiveness of treatment and the resistance to change. This process is reflected in a figure adopted from Keeney (1983; Keeney and Ross, 1983—see Figure 2):

Figure 2: Cybernetic Complementarity of Change

<------
Stability / Change
------>

------>
Stability / Change
<------

     As indicated, when new patterns of change or interventions are introduced into the client’s system, the system calibrates to incorporate the new patterns. Treatment could be viewed as an interpersonal dance. The therapist's responses are interpreted by the client (offender) who behaves (responds) to direct further interaction. Likewise, a dance occurs intrapersonally as the client (offender) interprets new patterns of information as new non-offending oriented states are created.


Therapeutic Change and Process Variables   
     The therapeutic process consists of the actual interpersonal context between the therapist and client as mentioned earlier. Contemporary sexual offender treatment typically encompasses some form of cognitive-behavioral dynamic group approach (Carich & Calder, 2003: Marshall, Anderson, & Fernandez, 1999; Schwartz & Cellini, 1995, 1997). The term “dynamic” reflects a broader holistic approach addressing a variety of DRFs at different levels, incorporating a variety of experiential dimensions. Treatment provides an interactional relationship process between the therapist and the group, including the relationship between group members. Each member of the therapeutic context navigates through a sociofeedback process, calibrating the system through each other’s responses. For example, the therapist makes a response (e.g., introducing or implementing group rules, delivering an intervention, developing rapport) and the client responds by gauging the meaning intrapersonally. If the therapist delivers shame-oriented responses mixed with an underlying message that the offender is permanently bound to a deviant offense pattern, the offender will most likely respond by further entrenching offense-related patterns of stability. A change-oriented response set, without shame, as indicated by Marshall and colleagues (2005, 2006) will, with repetition in diverse therapeutic contexts, facilitate change (Marshall & Marshall, 2005; Fernandez, Shingler, & Marshall, 2006; Fernandez, 2006).

     The therapeutic context is created through patterns of communication defined through interactions. Therefore, the clinician influences the offender to change by the type of therapeutic environment provided. As influence is inevitable, it is incumbent upon the clinician to develop and transmit change-oriented communications, while also transposing or projecting a particular therapy or treatment model onto the client. The therapeutic context is co-created by the therapist and group members at multiple levels, results in the creation of a therapeutic reality. All parties are participants at some level. Part of the therapist’s responsibilities involves creating a context to help the client enter a state of receptivity, although it is the client’s responsibility to change.

     There has been much recent focus on characteristics and process variables or the elements and dynamics within the clinician’s therapeutic context. The results indicate that certain therapist characteristics enhance the process, while others appear to create barriers. Table 2 identifies a number of process variables, as noted by Marshall and colleagues (2003a):

Table 2: Process Variables

Therapist behaviors that enhance treatment effectiveness
Empathic  Warm  Asks open-ended questions
Directive Genuine  Asks open-minded questions
Confident Attentive  Encourages participation
Rewarding  Trustworthy  Self-disclosing
Supportive  Flexible  Use of humor
Self-disclosing  Respectful  Emotionally responsive 
Instills positive expectations    
Therapist behaviors that reduce treatment effectiveness
Aggressive confrontation  Judgmental  Authoritarian
Rejection  Defensive  Nervous
Manipulation of patient  Rigidity  Coldness
Low interest  Dishonest  Unresponsive
Critical  Sarcastic  Hostile/Angry
Discomfort with silences  Need to be liked  Does not wait for answers
Boundary problems    
(Marshall, Fernandez, Serran, Mulloy, Thorton, Mann, & Anderson, 2003a)

     Current research demonstrates that meaningful change in offenders is dependent on both the content of treatment and the process variables or therapist characteristics (Marshall et al., 2003a; Marshall et al., 2002; Marshall, 2005; Marshall, Serran, Fernandez, Mulloy, Mann, & Thorton, 2003b). The therapeutic context involves multi-constructed co-realities involving group members and the therapist at multiple levels. Therefore, the therapeutic process impacts the offender’s perceptual view of himself in relation to the environment, to some degree. The initial efforts are likely to be a tentative and exploratory as the client engages in self-discovery and self-disclosure, both considered important factors (in accordance with western therapeutic culture) necessary for change (Sue & Sue, 2003)

     A therapeutic environment that is safe and yet challenging will facilitate increased meaningful interaction within that environment. Clients observe not only their own personal interactions with the therapist, but also the interactions between therapist and other group members, as well as among the group members themselves. Conversely, a lack of safety within the process could encourage—consciously and unconsciously—pseudo-compliance to program goals and an attempt integrate old patterns of deceit and manipulation into the therapeutic context. The overall goal in any sexual offender treatment is to effect change. In basic terms, this change is identified as abstinence from offending. Minimally, there is an expectation of harm reduction, as the offender makes decisions that decrease his exposure to relapse risk and offending states, while fulfilling needs appropriately.

     Current research supports the responsivity principle of matching the client’s needs. As mentioned earlier, the therapist projects—at the conscious and unconscious levels—his or her own model and worldview onto the client. Laws and Ward (2006) summarize this best:

     “While theories and ideas matter and provide clinicians with roadmaps for their day-to-day encounters with offenders, a poor map can derail treatment efforts and even result in extremely negative outcomes. We owe it to the community; our colleagues and the offenders themselves to think more critically about the practical and theoretical components of treatment.” (p. 253)

     Therefore, the therapist needs to first understand his or her own views and perhaps carefully develop an approach that will help reach the offender (Carich, Williamson, & Dobkowski, in press; Listiak, Carich, & Graham, 2006). This process also consists of patterns of communication or exchange of information. Therefore, any therapeutic session can be demarcated in terms of interventions housing therapeutic messages along with client responses.

     With the aid of exhaustive research (Marshall et. al. 2003a), greater numbers of the sexual offender treatment community are joining some pioneers (Blanchard, 1995) to understand the value of the Miller and Rollnick (1991, 2002) approach, that emphasizes paying attention to process variables and developing a positive challenging approach (Carich & Dobkowski, 2007; Fernandez, Shingler, & Marshall, 2006; Marshall 2005) based on therapeutic rapport and skills, thus avoiding shame-based confrontations.

Conclusion   
     There are numerous views of change and causality. The clinical part of the field is in the business of facilitating change within the client. Even if the format is simple education, the goal remains “No more victims”, with a minimum expectation of harm reduction. In terms of management, gaining and maintaining compliance requires a degree of change. Change can be viewed in logical levels ranging from first order superficial to second order structural change and third order long lasting, stress resistant, permanent structural change. Most change seems to occur at a superficial level; therefore, some offenders are more prone to relapse. Long-term change involves addressing deficits at multiple levels and developing consistent patterns. For long-term change, the structural frame of reference needs change including implicit theories (ITs) or core belief systems. From a holistic view, a variety of connected elements, experiential domains, and dimensions are involved in the change process (Longo, 2002).

     The change process can also be viewed as cybernetic, based on calibrated patterns of stability and change, through the process of sociofeedback. By definition, the therapist and client form a therapeutic system based on their relationship. The therapeutic relationship process can be broken down into patterns of communication. At one level, the therapeutic process is based upon the therapist influencing the client into a state of change by providing an effective treatment context. Any given session can be demarcated into a series of interventions and client responses.

     That said, the change process is complex. Change occurs on multiple levels—through dimensions, experiential domains, and mind-body processes. Though content (treatment targets) is relatively stable, multiple types of learning and unique client deficits and pathologies, as well as differences in therapist approaches and skill levels all provide variable within the widely accepted cognitive-behavioral approach. Change involves helping the offender transfer from an offending state to a nonoffending state. Generalization of nonoffending states corresponds to the long-range goal of helping the offender manage and maintain a long-term nonoffending state. This would involve helping the offender meaningfully address clinical issues, develop entrenched coping skills, and learn to address needs (goals) appropriately. Ultimately, it is up to the offender to make choices to maintain change states by utilizing appropriate coping skill strategies.

     Although some offenders may only require basic, short-term treatment, for offenders with more chronic patterns and pathological deficits, long-term treatment is necessary to effect long-term change and effective management. Effective treatment for most offenders must be meaningful and offer hope, while remaining vigilant to the powerful lure of their old offending system. The therapist must be aware of the complexity and uniqueness of the client and the client’s system, and contextualize treatment to address client needs throughout that complex process of change.

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