Vol. XXX, No. 3
Summer 2018
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In This Issue
Regular Features
Editor's Note
President's Message
FAQ
Should I Use Risk Assessment Scales with Indigenous Offenders?
Featured Articles
Sex Offending and Intimate Partner Violence: A brief look at two fields
The Importance of a Strengths-Based Approach in Sex Offense-Specific Services
Students' Voice
Problematic Sexual Interests in Individuals with Schizophrenia: A Pilot Study of Prevalence & Characteristics
Book Review
Motivational Interviewing with Offenders: Engagement, Rehabilitation, and Reentry
ATSA News
2018 Election
ATSA Grows Up!
Fund Development for the 21st Century
Legislative Update
2018 ATSA Conference: Exhibit and Support Opportunities
Apply for the ATSA Fellow for 2018
New Chapter Resources Now Available Online
New ATSA Members
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Forum Team
David Prescott
Book Review Editor

Sarah Gorter
Production Editor

Forum Editor
Contact the editor or submit articles to:

Heather M. Moulden, Ph.D.
Forensic Program
St. Joseph's Healthcare
Hamilton, Ontario, Canada
E: hmoulden@stjoes.ca
P: (905) 522-1155 ext. 35539
The Importance of a Strengths-Based Approach in Sex Offense-Specific Services
Kevin M. Powell, Ph.D

When 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  

Having a 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 Alliance  

The 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?

Promote Hope    

Instilling 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; Masten & 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   

Strengths-based 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 prosocial?”).

Collaboration in the Exploration of Life Goals (Approach Goals)

‘Collaboration’ 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, 2004).  Questions 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.

ACE-Responsive    

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). 

Conclusion  

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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