|The Importance of a Strengths-Based Approach in Sex Offense-Specific Services|
looking back on the history of mental health, criminal justice, and sex
offense-specific (SOS) services, the majority of clinical assessment,
treatment, theory, and research has focused on ‘risk factors’; that is, factors
that increase the likelihood of clients developing and maintaining problematic
symptoms and abusive behaviors. However,
focusing disproportionately on risks
and deficits can be stigmatizing to clients and impede treatment engagement
(Powell, 2017). There is growing support
for utilizing a strengths-based approach in mental health treatment, including SOS services (Collie, Ward, Ayland,
& West, 2007; Marshall &
Marshall, 2014; Powell, 2010a, 2011,
2016; Ward & Marshall, 2004). If we want clients (youth and adults) to learn
how not to be sexually abusive, we need to do more than just teach them
“what not to do”, we need to teach them “what to do”, which is
what the Strengths-Based Approach (SBA)
is all about.
Defining a Strengths-Based Approach
SBA is an approach that focuses on
the identification, creation, and reinforcement of strengths and resources
within individuals, their family, and their community. It places a strong emphasis on positive
relationships, therapeutic engagement and the promotion of hope and resiliency
(Powell, 2015). Any intervention that emphasizes strengths and
the exceptions to problems and deficits, can be classified as
“strengths-based”. SBA has evolved out of
many schools of thought and areas of study including Humanistic Psychology, the
Social Work profession, Resiliency research,
Solution-Focused Brief Therapy, Narrative Therapy, Developmental Assets
research, Positive Behavioral Intervention & Supports (PBIS), Character Education,
Motivational Interviewing, Positive Psychology, and the Good Lives Model.
SBA does Not Ignore Risk and Problems
strengths-based orientation does not mean providers are naive to or ignore
problems. Risk factors, problem behaviors, and accountability are addressed;
however, SOS providers first create an atmosphere in which clients are open to
addressing these sensitive topics. Initially focusing on strengths and
exceptions to problems helps create an atmosphere in which clients feel
psychologically safe and engaged in treatment.
The Risk-Need-Responsivity (RNR) model has identified the importance of
targeting dynamic risk factors linked to criminal behaviors (Bonta &
Andrews, 2017). An effective manner of targeting these risk factors is to
identify and reinforce the strengths-based alternatives. For example, a common risk factor is having procriminal/
delinquent associates (Bonta & Andrews, 2017, p. 45), which can be managed
and mitigated by helping clients develop the skills and opportunities to
establish connections with prosocial supports.
Over the past
decade there has been an informative debate between the RNR camp and the strengths-based
oriented Good Lives Model (Andrews, Bonta, & Wormith, 2011; Ward, Melser,
& Yates, 2007; Ward, Yates, & Willis, 2012; Wormith, Gendreau, &
Bonta, 2012). As we gain a greater
understanding of the complexity of human behavior and psychosocial development,
there is growing recognition for embracing a holistic perspective that targets
not only risk factors but also protective factors, strengths and resources (Leversee & Powell, 2017; Longo, 2002; Morrison, 2006; Wilson & Yates, 2009).
Key Attributes of Strengths-Based Providers: The Therapeutic
therapeutic alliance has
been identified as a common factor for
increasing client engagement and positive treatment outcomes in both adult and child psychotherapy research
(Norcross, 2011; Wampold & Imel, 2015). It
has also been recognized as a critical variable in sexual-offense-specific
services (Blanchard, 1995; Marshall
& Burton, 2010; Marshall, Serran, Moulden, et al., 2002; Powell,
2010b). Marshall (2005) identified specific
attributes of SOS therapists associated with positive treatment targets. These therapist attributes were: 1) Warmth
and Empathy regarding the
therapist’s ability to communicate acceptance and unconditional positive regard;
2) Rewardingness involving the verbal
encouragement given to clients for their small steps toward whatever goal is
being sought; and 3) Some Directiveness, which is defined
as providing some direction and guidance (e.g., “Have you thought of trying . . .”; “Have you
considered . . .”)
while still allowing clients opportunities to develop their own
solutions to problems. Marshall’s research also identified the antithesis of
these therapist characteristics- being harsh and confrontational, which were
negatively correlated with achieving treatment targets. SOS providers' humanistic
attributes play a key role in effective services.
Meet Basic Human Needs
The fulfillment of
basic human needs is another SBA intervention. When basic needs are not met, a client’s capacity to fully
participate in SOS services can be impeded, which is the premise of Maslow’s Hierarchy of Needs Theory
(1970). While the order and potency of
basic human needs are not universal or fixed, they can influence behavior and
motivation. The most advanced
need is referred to as self-actualization,
which entails living up to your fullest potential. This full potential, as it
relates to SOS services, includes learning from past offenses, repairing harm,
and identifying ways to lead a productive, prosocial lifestyle. To be engaged
at this high level, basic needs must first be met, which include physiological needs (e.g., need for
food, water, sleep, comfortable body temperature); safety needs (e.g., need for stability, predictability,
protection); social needs (e.g., need to love and be loved, to be accepted,
and to belong to a group or family); and competency
needs/ esteem and achievement needs (e.g., need for self-esteem and mastery
of our environment, and be recognized and respected for personal achievements/
competencies). A client’s capacity to focus on SOS services will be impaired if
they arrive to sessions feeling hungry or sleepy (unmet physiological needs);
or are living in a physically or psychologically unsafe environment (unmet
safety need); or have no friends and/or feel alienated from family (unmet
social need); or are struggling academically in school and/or having trouble
getting a job (unmet competency need). Strengths-based providers must
frequently consider the question, “What needs are not being met for this client and how can I help meet those needs?
hope has been identified as an
important variable in the psychotherapy process and for treating many
psychological issues (Larsen & Stege, 2010a, 2010b; Snyder, 2000). When clients have hope that their
participation in treatment can lead to a better life, they are more likely to
be actively engaged. Although the
construct of hope has received limited attention in the SOS field thus far (Moulden
& Marshall, 2005; Powell, 2010a, 2011), it deserves
empirical and clinical attention due to the many areas of study that offer
evidence for hope. This evidence
includes, 1) the low sexual reoffending recidivism rate for both youth and adults who engage in SOS treatment
(Caldwell, 2016; Hanson, Harris, Helmus, & Thornton, 2014; Schmucker & Friedrich, 2015; Worling et al., 2010); 2) the maturation
of the brain’s Prefrontal Cortex that is occurring during
adolescence and early adulthood, which enhances executive functioning,
including the ability to anticipate consequences (think before acting) and regulate emotions (Casey, Giedd, & Thomas, 2000; Diamond, 2002; Sowell, Trauner,
Gamst, & Jernigan, 2002); 3) the influence
of neuroplasticity to wire the brain in positive ways
when repeatedly practicing healthy
alternatives to problem behaviors (Bryck & Fisher, 2012; Nelson, 2003; Winerman, 2012), and 4) the
newly coined term Life-Span Wisdom Model,
which highlights the positive
developmental outcomes that can occur as clients gain knowledge and wisdom
through their exploration and life experiences (Romer, Reyna, & Satterthwaite, 2017). All these areas of study help
promote hope, not only within clients but also within providers.
Promote Resiliency Protective Factors
Protective factors are conditions
that increase the likelihood of positive outcomes in response to life adversity
(resilient responses). Some protective
factors are internal characteristics within clients, while others are external,
in that they are obtained from clients' family and/or community supports and
resources (Powell, 2015, p. 179). There
is growing clinical interest and research investigating protective factors
associated with desistance from sexual offending (Bremer, 2006; Gilgun 2006; Langton & Worling, 2015; Powell,
2010a, 2011, 2016). Thus far, results
have been mixed with some studies identifying a link (direct and/or buffering
effects) between protective factors and reduced sexual reoffense recidivism
with adults (Miller, 2015; de Vries Robbe, de Vogel, Koster, & Bogaerts,
2015) and juveniles (Worling & Langton, 2015), while other studies have not
found a significant link (Klien, Rettenberger, Yoon, Kohler, & Briken,
2015; Spice, Viljoen, Latzman, Scalora,
& Ullman, 2013; Zeng, Chu, Lee, 2015).
However, regardless of the direct influence of protective factors on
desistance from sexual offending, there is decades of evidence linking
protective factors to general resiliency
(Hawkins, Graham, Williams, & Zahn, 2009;
Coatsworth, 1998; Masten, Cutuli, Herbers,
& Reed, 2009; Trickett, Kurtz, & Pizzigati, 2004).
Educating clients about their capacity to be resilient and introducing them to protective
factors commonly linked to resiliency can lead to positive outcomes.
Utilize Solution-Focused Questions
providers also focus on the identification of solutions and exceptions to
problems (Berg & Steiner, 2003; Lethem, 2002; de Shazer et al., 1986; Franklin,
Zhang, Froerer, & Johnson, 2016). Rather than focus only on problem
behaviors including sexually abusive acts, providers ask clients about their interpersonal
interactions (both sexual and non-sexual) that have been prosocial and
respectful (e.g., “Tell
me about times when you have interacted with others in a respectful manner with
good boundaries”; “Tell me about a situation when you felt like acting out
sexually/ sexually offending but you did not do it. How did you stop yourself? What thoughts, feelings, behaviors, and/or
situations helped you stop and make a healthy choice?”; “Tell me about times
when you have managed your sexual arousal well.
How did you do it?”; “Tell me about times when you were kind and
respectful towards a friend, romantic partner, and family members”; “Think about
a time when you have been sexual with another person in a respectful, prosocial
manner. What was it about your interactions that made it respectful and
in the Exploration of Life Goals (Approach Goals)
and ‘goal consensus’ between the client and provider has been found to enhance
the effectiveness of treatment (Defife & Hilsenroth, 2011; Shirk &
Karver, 2011; Tryon & Winograd, 2011). Rather than providers taking on a
one-sided expert role while clients are passive recipients, there is a mutual
exploration about what will help clients develop into healthy successful
adults. One of the
keys to this collaborative exploration is placing an emphasis on ‘approach
goals’, which focus attention on what clients want to achieve in life, now and
in the future. Motivation to manage abusive behaviors and engage in treatment
can be enhanced when it leads to things clients want (e.g., making and keeping
friendships and romantic relationships; being free in the community to pursue
extracurricular activities, education, and other life goals). The
Good Lives Model has illuminated the importance of approach
goals (Netto, Carter, & Bonell, 2014; Ward, Mann, & Gannon, 2007), which have
been linked to greater engagement in treatment (as measured by homework
compliance and willingness to disclose lapses) compared with programs that
primarily focus on avoidance goals (Mann, Webster, Schofield, & Marshall,
to help identify a client’s individualized approach goals include, “What
do you like to do in your free time?”; “When
have you felt most happy in your life?”; “What would others say are your
biggest talents/ things you do well?”; “What
do you want your life to look like in the future?”; and
“What do you hope to be doing in one year/ two years/ five years/ ten
years from now?”
Emphasis on the Responsivity Principle
A primary goal of strengths-based services is to create an
atmosphere in which clients feel psychologically safe and engaged. Responsivity (specific type), the second R
in the RNR Model (Bonta & Andrews, 2017), highlights the importance of
matching the style and mode of services to the individualized needs of the
client. Individualized needs include
clients’ strengths, abilities, motivations, readiness to change, mental status,
learning ability, learning style, circumstances, developmental maturation,
personality, psychosocial functioning, cultural factors, religious beliefs, and
other variables. Considering
responsivity is especially important when making decisions about what treatment
modalities (individual therapy, family therapy, and/or group therapy) to
utilize. The SOS field has traditionally placed
a strong emphasis on group therapy; however, there are many reasons to be
vigilant about responsivity when considering group services. Group dynamics
can interfere with treatment responsivity in a variety of ways including, 1) clients with lower cognitive functioning and
slower processing speed, which can impair their ability to benefit from
group services due to the faster-paced communication coming from multiple group
members; 2) clients struggling with major mental
illness, which is not a good fit for group interventions; 3) clients struggling
with a high degree of social
anxiety and interpersonal mistrust, which is heightened in group settings;
4) groups with a high number of
members with psychosocial deficits that impairs their ability to respond to
other group members in prosocial, empathetic ways; 5) groups with a high number of members with delinquent, antisocial
tendencies, which under some circumstances can lead to ‘deviancy training’ (Dodge, Dishion, & Lansford, 2006; Gottfredson, 2010; Leve
& Chamberlain, 2005; Poulin, Dishion, & Burraston, 2001) and/or ineffective
or detrimental treatment for low-risk clients (Andrews & Dowden, 2006;
Lowenkamp, Latessa, & Holsinger, 2006); and 6) higher risk of trust and confidentiality violations in group therapy settings.
While benefits of group
therapy have been identified within the SOS field and in general treatment
(Jennings & Deming, 2017; Looman, Abracen, & DiFazio, 2014; Yalom &
Leszcz, 2008), providers must use caution about when, how,
and with whom group therapy is implemented and always be mindful
of the individual needs of clients to ensure that responsivity is a top
priority. It is important to note that there is also evidence
for the positive effects of individual and family therapy (Schmucker & Lösel, 2015) and the SOS field would benefit
from more clinical and empirical attention exploring these modalities.
The prevalence of adverse
childhood experiences (ACE) in SOS clients is quite pronounced (Levenson,
Willis, & Prescott, 2016; Reavis, Looman, Franco, & Rojas, 2013). ACEs can
heighten clients’ interpersonal mistrust, which necessitates that strengths-based
providers be patient, understanding, and vigilant to creating a therapeutic
space in which life adversity can be safely addressed. The term
‘ACE-Responsive’ is being used, rather than Trauma-Responsive or
Trauma-Informed, in order to highlight the importance of not assuming that
clients exposed to ACEs are “traumatized” (Clancy, 2009). We do not want to dictate how a client should
think or feel about their life adversity, but rather meet them where they are
at with it. Everything we know about resiliency, post-traumatic growth, and
similar constructs indicates that exposure to ACE’s does not mandate a lifetime
of negative outcomes.
Proactive and Prevention-Oriented
SBA is proactive and
prevention-oriented in that it focuses attention on healthy development
including interpersonal relationships and sexuality. Proactively educating clients about
characteristics associated with healthy relationships (e.g., listening,
kindness, trust, mutual respect and support, etc.) assists them in learning to
be prosocial friends, boyfriends, girlfriends,
husbands, wives, and parents. The
SOS field will benefit from ongoing clinical and empirical attention focused on
strategies for stopping the intergenerational transmission of abuse and
preventing abuse from occurring in the first place (Letourneau, Schaeffer,
Bradshaw, & Feder, 2017; Tabachnick & Klein, 2011). Examples of primary prevention include
educating parents about ‘safe, stable, and nurturing relationships’ and enhancing
knowledge and open communication within families (CDC,
2014; Powell, 2014; Rudolph, Zimmer-Gembeck, Shanley, & Hawkins, 2018;
Thornberry, et al., 2013).
Establishing a strengths-based
foundation helps create an environment in which clients feel psychologically
safe to engage in SOS services, including openly
addressing their sexually abusive actions. A strengths-based approach (SBA)
focuses on the identification, creation, and reinforcement of strengths and
resources within individuals, their family, and their community. It is an
approach that places an emphasis on positive relationships, targeting the
strengths-based alternative to risk factors, meeting basic human needs,
promoting hope and resiliency, exploring solutions and exceptions to problems, collaborating
on the identification of approach goals, enhancing treatment responsivity, being
responsive and sensitive to the impact of adverse childhood experiences, and
proactively intervening in ways to prevent future sexual victimization. As the field of SOS services (youth and adult
services) continues to learn from both empirical and clinical data,
incorporating a strengths-based orientation will be increasingly important in
order to address both risk management and health promotion. It directs services toward helping clients to
be healthy, prosocial members of our community, which is the ultimate goal.
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