JOURNAL 10.1177/0886260505278514 Marshall et OF al.

/INTERPERSON CONSTRUCTIVE AL VIOLENCE TREA TMENT / September 2005

Working Positively With Sexual Offenders

Maximizing the Effectiveness of Treatment
Rockwood Psychological Services University of Melbourne H. M. Prison Service University of Ottawa and Rockwood Psychological Services

WILLIAM L. MARSHALL TONY WARD

RUTH E. MANN

HEATHER MOULDEN

YOLANDA M. FERNANDEZ
Rockwood Psychological Services University of Ottawa and Rockwood Psychological Services Rockwood Psychological Services
In this article, the authors draw on literatures outside sexual offending and make suggestions for working more positively and constructively with these offenders. Although the management of risk is a necessary feature of treatment, it needs to occur in conjunction with a strength-based approach. An exclusive focus on risk can lead to overly confrontational therapeutic encounters, a lack of rapport between offenders and clinicians, and fragmented and mechanistic treatment delivery. The authors suggest that the goals of sexual offender treatment should be the attainment of good lives, which is achieved by enhancing hope, increasing self-esteem, developing approach goals, and working collaboratively with the offenders. Examples are provided of how these targets may be met. When this is done within a therapeutic context where the treatment providers display empathy and warmth and are rewarding and directive, the authors suggest that treatment effects will be maximized. Keywords: sexual offenders; good lives; hope; self-esteem; collaboration

GERIS SERRAN

LIAM E. MARSHALL

JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 9, September 2005 1096-1114 DOI: 10.1177/0886260505278514 2005 Sage Publications

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During the past several years, we have been concerned about certain aspects of treatment programs for sexual offenders. We have no doubt that treatment can be effective, as Hanson et al. (2002) have shown, but the sad fact is that this is not the case for all programs. In support of this observation, Hanson (2002) provided further detailed analysis of the data in his recent metaanalysis, demonstrating that several of the 42 programs were ineffective. There is no doubt that some of these variations in outcome are because of sample differences, and Hanson (2002) made it clear that those programs with predominately high risk offenders did tend to fail to produce positive benefits. These analyses, however, did not account for all the failures. In addition, even among programs that were dramatically effective, not all treated clients avoided relapsing. Although the issues we raise in this article may not explain all treatment failures, we believe that incorporating in treatment the suggestions we outline below will reduce the number of offenders who subsequently relapse. In a sense, our concern is with the issue of offender responsivity (Andrews & Bonta, 1998). The responsivity principle is concerned with a programs ability to match the clients learning style and respond to the particular features of the clients. Our general concerns about current treatment approaches can be summarized as follows: (a) there is an excessive emphasis on negative issues in both the targets of treatment and the language used by treatment providers, (b) there is a failure to explicitly encourage optimism in clients and encourage their belief in their capacity to change, (c) there is a general absence of an explicit attempt to work collaboratively with clients, (d) the role and influence of the therapist has been all but neglected, and (e) there have been few attempts to provide clients with goals that will result in them leading a more fulfilling and prosocial life. In the sections that follow, we will address these issues. It has been suggested (Marshall, 1989; Marshall, Anderson, & Fernandez, 1999) that sexual offenders seek much the same goals as other people, but they choose inappropriate pathways (i.e., sexual offending) to achieve these goals because they do not have the skills, attitudes, and self-confidence to achieve them by prosocial pathways. Treatment, therefore, should provide sexual offenders with the attitudes and self-confidence necessary for them to meet their needs in appropriate ways. To do this, we suggest that therapists assist their clients in identifying the needs the clients are inappropriately attempting to meet by offending, help the clients set goals that will allow them to lead a socially acceptable and satisfying life, and create a therapeutic climate conducive to generating optimism in the clients about their prospects of successfully achieving these goals.

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From this perspective, the approach to treating sexual offenders should involve enhancing many skills, instilling prosocial attitudes, and increasing the clients sense of self-worth. However, most programs outline their treatment strategies in rather negative terms. For example, the focus is often on the elimination of negative attitudes, the reduction of cognitive distortions, the extinction of deviant sexual interests, and the generation of a list of people, activities, and places to avoid (i.e., relapse prevention [RP]). In addition, as several authors (e.g., Kear-Colwell & Pollack, 1997; Marshall, 1996) have pointed out, too many sexual offender treatment providers appear to believe that it is necessary to be extremely confrontative when working with these clients. This latter notion is inconsistent with the demonstrated value of motivational interviewing (Miller & Rollnick, 1991, 2002), and there is evidence that confrontation reduces otherwise effective treatment with both sexual offenders (Beech & Fordham, 1997; Marshall, Serran, Fernandez, et al., in press) and addictive clients (Miller, Benefield, & Tonigan, 1993; Miller & Sovereign, 1989; Miller, Taylor, & West, 1980). We suggest that a more positive approach to all aspects of treatment with sexual offenders will maximize treatment benefits. In this article, we argue that making sexual offender treatment more positive and self-enhancing for our clients is likely to increase their responsivity to treatment. Examination of research and theory in various domains of psychology reveals the existence of several ways to work more positively with sexual offenders. In our view, the goals of sexual offender treatment should be the attainment of good lives, which is achieved by enhancing hope, increasing self-esteem, developing approach goals, and working collaboratively with the offenders. We will discuss each of these approaches in turn.
MODELS OF OFFENDER TREATMENT

There appear to be two broad models of offender rehabilitation, each committed to changing those characteristics of individuals that are associated with criminal acts, but each has a different orientation. These models are not typically differentiated and may even coexist to some degree. The first is concerned with risk management, where the primary aim of rehabilitating offenders is to avoid harm to the community rather than to improve the offenders quality of life. From the perspective of this model, the enhancement of offenders functioning may be viewed as desirable, but this should not be the primary objective of program developers and policy makers. Furthermore, the label risk management implies that psychological functioning

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deficits cannot be solved or overcome, but only managed. Essentially, this is a pessimistic model of the potential for change. In this model, the relationship between the level of functioning of offenders and recidivism rates is an instrumental one: It is a means to the end of reduced risk to the community. In contrast, the second model is concerned with the enhancement of offenders capabilities to improve the quality of their life and, by doing so, reduce their chances of committing further crimes. According to this model, focusing on providing offenders with the necessary conditions (e.g., skills, values, opportunities, social supports) for meeting their needs in more adaptive ways will reduce the likelihood that they will continue to harm themselves and others (Ward & Steward, in press). In this model, the primary end or goal is not the reduction of crime, but rather the enhancement of the offenders well-being, although it is argued that a reduced risk to reoffend will reliably follow. The risk management model has, in recent years, dominated correctional psychology and offender rehabilitation policy (see Andrews & Bonta, 1998; Ashford, Sales, & Reid, 2001). Even when the focus of this approach has been on offenders needs, policy makers tend to be concerned with reducing further crimes or the incidence of disruptive behavior within prisons, and they pay little attention to the offenders well-being and capabilities. For example, Ashford et al. (2001) have distinguished between the subjective needs of the offender and the objective needs of the justice and correctional systems and society at large. They point out that offender needs not linked to reduced recidivism are typically considered relatively unimportant. Ashford et al. also argue that such decisions reflect the overarching values of the institutions in question. Another aspect of the risk management model is the notion of criminogenic needs (Andrews & Bonta, 1998), which suggests that only those offender characteristics associated with a reduction in recidivism should be directly targeted in rehabilitation programs. We are not suggesting that reducing crime is an inappropriate goal for sexual offender treatment. Clearly, it is paramount. Having this as the sole aim of treatment, however, leads to the development of programs that the offenders may find unengaging, personally irrelevant, and even disempowering. By failing to focus on the offenders perspective of what is important, we may reduce the effectiveness of our programs. In a recent article, Ward and Steward (in press) have developed a needsbased framework to further the understanding of the causes of crime and to guide the assessment and rehabilitation of offenders. In their theory, the goals and desires of individuals are partially determined by their fundamental interests and concerns (i.e., their basic needs). These basic needs are usefully construed as innate propensities to engage in certain activities that if not met,

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result in harm or increased risk of harm in the future. Examples of basic needs are relatedness, autonomy, and competency. Whether basic needs can be met in a manner that will promote an individuals well-being depends crucially on the existence of specific internal and external conditions. Internal conditions refer to psychological characteristics such as skills, beliefs, attitudes, and values. External conditions refer to social, cultural, and interpersonal factors that facilitate the development of the necessary internal conditions and include effective parenting, education, vocational training, social supports, and the opportunity to pursue valued goals. The criminogenic needs identified in the risk management model are associated with the distortion of these conditions and can be viewed as the product of internal or external obstacles that prevent basic needs from being met in an optimal and prosocial manner. Human goods (see Emmons, 1996, for a comprehensive discussion of these goods) reflective of a fulfilling lifestyle are derived from, or made possible by, the meeting of basic psychological needs and the possession of the necessary internal and external conditions. These goods include friendship, enjoyable work, loving relationships, creative pursuits, sexual satisfaction, positive self-regard, and a reasonably challenging environment. The presence of internal and external obstacles results in impaired social and psychological functioning and, therefore, a less fulfilling life. Rehabilitation, according to this view, should focus on identifying the various obstacles preventing offenders from living a balanced and fulfilling life and then equip them with the skills, beliefs, values, and supports needed to counteract the pernicious influence of these obstacles. In a sense, when offenders agree to enter a rehabilitation program, they are implicitly asking therapists the following question: How can I live my life differently? This requires clinicians to offer concrete possibilities for living good or worthwhile lives that take into account each individuals abilities, circumstances, interests, and opportunities. Ethical questions involve clinicians in the consideration of what constitutes a worthwhile life and are not exhausted by issues related to their conduct. There is no discretion here; every therapeutic intervention is buttressed by assumptions about what constitutes a desirable outcome and, therefore, points to a vision of human wellbeing and fulfillment. Of course, we cannot choose or live offenderslives for them, but we should be clear about what are reasonable possibilities and help them acquire the requisite skills and capabilities to increase their chances of living such lives. This does not entail ignoring the needs of the community for security and safety; it simply reminds us that all human lives should reflect the best possible outcomes rather the least worst possibilities.

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THE GOOD LIVES MODEL OF OFFENDER REHABILITATION

Human beings naturally seek primary goods, so called because they are viewed as desirable or good ends in themselves (Deci & Ryan, 2000; Emmons, 1996). There are three classes of primary goods derived from the facts of the body, self, and social life and the basic human needs associated with such facts (Kekes, 1989). The primary goods of the body include basic physiological needs for sex, food, warmth, water, sleep, and the healthy functioning of the body as a whole. The primary goods of the self are derived from the basic needs of autonomy, relatedness, and competence. Each of these needs is associated with a cluster of related primary goods. For example, relatedness can be further broken down into goods of intimacy, understanding, empathy, support, sexual pleasure, and sharing. The primary goods of social life include social support, family life, meaningful work opportunities, and access to recreational activities. A conception of good lives should be based on these three classes of primary goods and should specify the forms they will take in each individuals life plan. The term good lives is preferred to the singular good life, as there is no one ideal or preferred lifestyle for any given individual (Rasmussen, 1999). Once a conception of a good life has been determined for an individual offender, a general plan can then be adapted for him or her taking account of his or her specific capabilities (i.e., his or her particular internal and external conditions). The specific form that a plan will take depends on the actual abilities, interests, and opportunities of each individual and the weightings he or she gives to specific primary goods. The weightings allocated to specific primary goods are constitutive of an offenders personal identity and spell out the kind of life sought and, relatedly, the kind of person he or she would like to be. However, because human beings naturally seek a range of primary goods, it is important that all the classes of primary goods are addressed in a conception of good lives; they should be ordered and coherently related to each other. For example, if an offender decides to pursue a life characterized by service to the community, a core aspect of his or her identity will revolve around the primary goods of relatedness and social life. The offenders sense of mastery, self-esteem, and his or her perception of autonomy and control will all reflect this overarching good and its associated subclusters of goods (e.g., intimacy, caring, honesty). The plan should be organized in ways that ensures each primary good can be secured by the individual. A plan that is fragmented and lacks coherency is likely to lead to frustration and harm to the individual concerned, as well as to a life lacking an overall sense of purpose and meaning.

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Goods and the Treatment of Offenders To illustrate that rehabilitation programs for sexual offenders, as a matter of fact, do allude to goods or values, we provide two examples. Core components that typically underlie the cognitive-behavioral treatment of sexual offenders include the following: modification of attitudes and perceptions, improving relationship skills, arousal reconditioning, enhancement of coping skills, increasing victim empathy, mood regulation, and the identification of offense pathways (Marshall, 1999). Each of these modules sets out to provide offenders with the necessary skills and knowledge to modify the particular problems that are targeted. Alongside this technical task is also an indirect attempt to highlight certain primary goods or values, although this is rarely explicitly acknowledged (Ward, 2002). For example, in the module, victim empathy, the evident primary goods concern the need to take the well-being and perspective of other people into account when interacting with them. The putative mental states and needs of the victim become a focus and remind the offender to value equally the wellbeing of others alongside his own. In addition, there is an appreciation of the nature of harms (related to deprivation of goods such as self-autonomy and choice) that can be inflicted on victims of sexual offenses. Additionally, in the module, relationship skills, the goods associated with different types of relationships are canvassed with the focus being on establishing a link between each individuals need for safety and their habitual interpersonal strategies. The aim is to provide offenders with the capacity to form deeply satisfying intimate and supportive relationships and thus to cease using deviant sex as a substitute for such relationships. Our second example comes from the treatment of developmentally disabled sexual offenders; more specifically the model developed by Haaven and Coleman (2000). In this model, treatment is based roughly on the distinction between a new me and an old me. The old me constitutes the individual who committed sexual offenses and encompasses values, goals, beliefs, and ways of living that directly generate offending behavior. The construction of a new me involves the endorsement of a new set of goals that specify a good life for the individual (i.e., a life in which important primary goods are achieved in ways that are socially acceptable and personally fulfilling). The setting of new goals and ways of living highlights the internal (i.e., skills, beliefs, attitudes) and the external (i.e., access to resources, opportunities, social supports) conditions necessary to achieve them. Therapy, then, is based on instilling the competencies required to meet the goals, instituting the conditions, and structuring the environment in ways consistent with living a more fulfilling life.

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We believe clinicians ought to explicitly construct a conception of good lives to guide the rehabilitation of each offender. The identification of individuals psychological dispositions or vulnerability factors causally related to their offending is a first step in the assessment process. This provides information on the internal and external obstacles that are frustrating the meeting of basic human needs and, therefore, preventing the achievement of primary human goods. Once this is done, it is necessary to construct a conception of good lives that is tailored to each offenders overarching good and to inquire about the necessary conditions required to live a different kind of life. A conception of human well-being should outline the primary goods to be instantiated in good lives and the range of specific forms they can take. The ordering or relationship between the various goods should also be described and the internal and external conditions necessary for their attainment explicitly noted. The conception of a possible good life for an offender should also include a concrete understanding of the possible ways of living that are realistic for him or her. It should take note of each offenders capabilities, temperament, interests, skills, deep commitments (i.e., basic value system and preferred ways of living in the world, for example, as a teacher or provider), and support networks. Thus, psychological, social, vocational, and environmental factors are all explicitly incorporated within a model of human well-being in a rehabilitation context. The emphasis of rehabilitation should be on goals that are associated with basic human goods and that lead to valued outcomes. This necessarily involves the instillation in the offender of knowledge, competencies, strategies, and skills and the creation of opportunities to live better kinds of lives. A significant overarching feature of this approach to offender treatment is the instilling of optimism and hope for the future among the participants.
INSTILLING HOPE

Snyder (2000) has described research on hope theory that has relevance for working more positively with sexual offenders (Moulden & Marshall, 2002). Frank (e.g., Frank, 1989; Frank & Frank, 1991), in fact, has suggested that the enhancement of hope is the underlying factor that produces treatment gains for all types of therapy and with all types of clients. Hope theory identifies three crucial components to successful functioning: the establishment of goals (in the present context, this would be the definition of a personalized good life), the development of pathways to achieve those goals (i.e., the establishment of the internal and external conditions necessary to achieve

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this good life), and the persons belief that he or she is capable of achieving these goals. The latter is called agentic thinking and is akin to Banduras (1977) notion of self-efficacy. When a pathway to a goal is blocked for whatever reason, clients may feel frustrated or defeated. Hopeful individuals, on the other hand, can overcome these blocks because they typically recognize multiple routes to any given goal, and they believe they will succeed. Clients who are low in hope readily feel discouraged when an obstacle blocks their chosen pathway to a goal, and they simply give up. It is necessary, therefore, to enhance clients sense of hope in order for them to succeed in achieving their goals and thereby benefit from treatment. A significant aspect of enhancing hope in dysfunctional clients is not only to provide them with the skills (behavioral and cognitive), beliefs, attitudes and values appropriate to achieving their good life, but also to help them identify the multiple potential pathways to each of their goals so that obstacles will not seem so insurmountable. The task of therapists adopting a hope theory approach is to assist the client in identifying a set of goals (optimally, those that will produce a good life) and then breaking these down into a set of achievable subgoals. A set of multiple pathways to each of these subgoals is mutually identified, and training in the skills necessary to enact the pathways should then be undertaken. The skills essential to achieving the subgoals may be rehearsed in role plays (Mann, Daniels, & Marshall, 2002) and then put into practice under conditions that optimize the chances of success. Encouragement by the therapist for each effort is essential to increase the clients agentic thinking (i.e., selfefficacy). As we noted earlier, it is helpful to assist offenders to identify the goods or goals they were attempting to achieve by offending. In doing so, it is important for clinicians to find a language for discussing goals that is accessible to clients. Haavens (1990) Old me, New me approach exemplifies the value of finding appropriate terms. The typical responses to questions concerning these goals (other than the all-too-common I dont know) identify sexual gratification, striking back at someone or some group (e.g., women), securing feelings of comfort, feeling in control, or exercising power over another person. Each of these goals can be reinterpreted to reflect normative needs. According to research on good lives, all people seek sexual satisfaction, feelings of comfort, and some degree of power and control in their lives. Nonaggressive people may not want to strike back at someone who has offended them, but they will certainly want some form of redress even if just an apology. Thus, each of the goals that sexual offenders seek in their abusive behaviors is a goal they share in common with other people; it is simply the

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pathways they choose to obtain these goals that are dysfunctional and hurtful to others. Reframing offending behavior as the selection of inappropriate pathways helps offenders to see themselves as distinct from their specific abusive acts, which shifts their feelings of shame (i.e., I am a bad person) to feelings of guilt regarding these specific behaviors (i.e., I have done bad things). Tangney and Dearing (2002) have shown that feelings of shame block attempts at behavior change (I am a bad person and therefore unchangeable), whereas guilt motivates change (I did a bad thing, but I can stop doing it). Reframing offending behavior in this way encourages agentic thinking, which is essential to the generation of hope and to the achievement of treatment-defined goals. Another way of looking at this issue is in terms of attribution theory. There is considerable evidence (for a review, see Snyder & Higgins, 1988) that internal, stable, global attributions (e.g., I am a pervert) are less likely to lead to successful behavior change than are external, variable, specific attributions (e.g., I was drunk and angry). Traditionally, sexual offender treatment providers have encouraged offenders to see themselves as motivated in their offending behavior by internal, stable, psychological drives. This may not be the best way to facilitate behavior change.
ENHANCEMENT OF SELF-ESTEEM

Related to enhancing agentic thinking, and thereby instilling hope, is the need to improve the clients self-esteem. Agentic thinking, self-efficacy, and self-esteem are psychologically related, although distinct, states. Because they are related, however, we would expect that enhancing one would facilitate the enhancement of the others. In a series of studies, Marshall and his colleagues (Marshall & Christie, 1982; Marshall, Christie, Lanthier, & Cruchley, 1982) developed a set of procedures for enhancing self-esteem. These procedures include increasing the clients frequency and range of both social and pleasurable activities, and having them generate, and then repeatedly rehearse, a list of positive qualities about themselves. In these early studies, nonoffending volunteers were recruited from the community who complained of very low self-esteem. Each of the procedures, both individually and collectively, produced dramatic increases in self-esteem after a brief 6-week period of practice. When these procedures were collectively applied to a group of 81 child molesters, whose self-esteem scores were over one standard deviation below the norma-

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tive mean, clear benefits were evident (Marshall, Champagne, Sturgeon, & Bryce, 1997). As a result of these interventions, the self-esteem scores of these child molesters approached the normative mean. In addition, it was found that these improvements in self-esteem were significantly correlated with reductions in deviant sexual interests as assessed by phallometry (Marshall, 1997), greater empathy, enhanced intimacy, and lowered feelings of loneliness (Marshall, Champagne, Brown, & Miller, 1997), as well as improvements in the ability to cope with stress (Marshall, Cripps, Anderson, & Cortoni, 1999). Clearly, increasing sexual offenders self-esteem has a facilitating effect on most of the primary targets of sexual offender therapy.
AN EMPHASIS ON APPROACH GOALS

Consistent with the literature on hope theory is the idea that future plans for sexual offenders should be specified in terms of approach goals. Traditional relapse prevention has taken the form of specifying a list of donts. Typically, relapse prevention plans consist of a list of people, places, and activities to be avoided. Although it makes intuitive sense to direct child molesters to avoid places where access to children is likely and to proscribe alcohol use for a rapist whose offending was facilitated by intoxication, it might be more effective to assist these offenders in designing an enjoyable and productive lifestyle that is exclusive of drunkenness or contacts with children. If child molesters are simply required to avoid children, then all we have done is take away their only pathway to the goals they were achieving by sexual offending without providing them with alternative prosocial pathways for meeting their needs. Mann (2000) has described her concern with traditional applications of RP strategies. She noted that they fail to appeal to many sexual offenders (and even produce resistance, in some cases) because of the apparently exclusive focus on avoiding relapse. The assumption in many programs is that for offenders, avoiding relapse is the most important goal. In fact, although reducing reoffending rates is always the primary goal for the treatment provider, offenders themselves often have other priorities (Jones, 2002). Traditional RP programs can fail to engage offenders because they impose a primary goal on them rather than negotiating and agreeing on the goal of the intervention. The psychology of goal-directed behavior (Emmons, 1996; Higgins, 1996) stresses that for a person to have maximal chances of achieving their goals, certain conditions must be met. First, goals are easier to achieve if they are ideal rather than ought goals (Higgins, 1996). Ideal goals are intrinsic

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aspirations linked to the individuals personal value base, whereas ought goals are typically imposed from without and adopted by an individual in an attempt to avoid criticism or disapproval. Second, approach goals are easier to achieve than are avoidance goals (Emmons, 1996). Approach goals are positive aims people strive to achieve, whereas avoidance goals involve strategies of denial. For example, not putting on weight would be an avoidance goal, whereas eating healthily would be an approach goal. Persons with a mainly approach goal orientation to life tend to be psychologically healthier than are persons with a mainly avoidance orientation (Emmons, 1996). Goals are also easier to achieve if the person believes they have what it takes to be successful (Carver & Scheier, 1990). When obstacles are encountered on the path to goal achievement, the process is interrupted and the person must reevaluate their chances of success if they continue working toward the goal. Confidence or hopefulness is necessary for the effort toward the goal to be sustained (Snyder, 2000). Such confidence is instilled when initial attempts at goal achievement are structured so that the likelihood of success is maximized. A positive success expectancy is linked to positive affect, such as optimism, happiness, or hope; whereas a negative success expectancy is likely to lead to negative affect, such as frustration or depression (Carver & Scheier, 1990). In addition, goals are easier to achieve if the person sees the learning process as part of the goal, rather than equating success only with the final achievement of a goal (Dweck & Leggatt, 1988). Thus, if a person attempting to climb a mountain is thwarted by bad weather, they might be more likely to make a second attempt if they consider the first to have been useful experience in their mountain-climbing career. The person who considers a thwarted day to have been a pointless day, because they did not make it to the top, is perhaps less likely to make a second attempt. Bearing these considerations in mind, Mann (2000) suggested several ways in which RP interventions could be reformulated in practice. The first reformulation should be to change the term relapse prevention, which in itself implies an avoidance goal. More approach-focused terminology would be to emphasize what it is being achieved, such as self-management or respectful living. Another example of how this principle can be applied is to rename the modification of deviant arousal component of treatment to the healthy sexual functioning component. Other changes to RP should involve encouraging clients to select their own, personally meaningful goals, in line with our earlier remarks concerning personal goods and good lives. We have found that even the most treatment-resistant sexual offenders will align themselves with goals such as

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developing more successful intimate relationships. Personal goods (as earlier defined) are incompatible with offending, so that striving toward them will inevitably mean striving away from offending. However, some offenders (particularly adolescents) may need to be steered away from simply selecting material goods as their primary goals. As we noted earlier, the definition of primary goods needs to be comprehensive or the achievement of a personalized good life will not occur. Again, Haavens New me, Old me approach with developmentally delayed sexual offenders is an excellent example of an approach-focused program (Haaven & Coleman, 2000; Haaven, Little, & Petre-Miller, 1990). A positive approach to RP also involves helping clients set subgoals and celebrate their achievement. In addition, therapists must convey a sense of hope and optimism for all their clients to encourage the development of selfefficacy (agentic thinking) and a positive success expectancy about change.
COLLABORATIVE APPROACHES

Collaboration has not traditionally been seen as an effective way to work with sexual offenders. Indeed, one influential clinical text has expressly rejected such a notion, recommending that the therapist must impose the goals of treatment (Salter, 1988). Although we agree that sexual offenders often start treatment with goals quite different from those of the treatment provider, we see collaboration as such an important element of a positive approach to working with sexual offenders that we recommend it be adopted at every stage of the assessment and treatment process. It should be clear that defining the overall goal of a good life for each offender cannot be achieved by the imposition of the therapists notion of what constitutes the good life. Only by the collaborative effort of the client and therapist can such a personalized good life, as the goal of the therapy, be achieved. Mann and Shingler (2001) have reviewed three relevant clinical literatures (relapse prevention, cognitive therapy, and motivational interviewing) and concluded that collaboration is, or should be, an essential component of each approach. The term collaboration is defined as a practice in which the therapist works with the client to define together the nature of the clients problems and to agree on a process for working toward solutions to the problems. It is our recommendation that the collaborative approach be adopted right from the initial contact with the client. We will illustrate this in the unlikely context of risk assessment. We say unlikely context because most risk assessments are completed without the clients participation except as a potential source of information. It is only the

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assessor who makes all the decisions and who comes to the conclusions regarding risk. Mann and Shingler (2001) offered a set of principles for applying the collaborative approach to risk assessment. These involve explaining the purpose and methodology of risk assessment clearly, explaining and discussing how the assessment could be beneficial to the client, explicitly stressing the assessors commitment to working collaboratively, addressing negative reactions openly, and asking the client to assess himself or herself. It is, of course, important for assessors adopting this approach to be prepared to be transparent about their methods and nondefensive about their motives. Finally, in carrying out risk assessments and reporting on risk, assessors often forget to describe the offenders strengths and admirable qualities, or they are only mentioned in a cursory way, while emphasizing risk factors and deficits. Related to this is the need for assessors to be considerate in the language they use to describe an offender. Referring to deficits, deviance, or dysfunctions will alienate offenders, and such terms can be easily replaced with more neutral alternatives, such as behavioral descriptors (e.g., fantasies about sex with children rather than deviant sexual fantasies). Clinicians who have followed Mann and Shinglers principles have commented (sometimes with surprise!) that these approaches revolutionized their relationships with clients, including some of the most difficult or litigious men.
ROLE OF THE THERAPIST

In putting all the above principles into practice, and for the effective implementation of all facets of treatment, it is essential that the therapist embodies those personal features or styles shown to maximize treatment effectiveness. Although there is an extensive body of literature detailing the features of effective therapists across all therapeutic orientations and for all problem behaviors (Marshall, Fernandez, et al., in press), very little research on these issues has been done within the context of sexual offender treatment. Recently, however, attempts have been made to determine the influence of therapist characteristics on treatment changes with sexual offenders. Beech and Fordham (1997), for example, have shown that therapists adopting a nonconfrontational, but nevertheless, challenging style, produce greater benefits in their sexual offender clients than do those who are aggressively confrontative. In a series of studies, Marshall and colleagues (Marshall, Serran, Fernandez, et al., in press; Marshall, Serran, Moulden, et al., in press; Serran, Fernandez, Marshall, & Mann, in press) examined the relationship between

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various features of the style of sexual offender therapists and also the behavior and attitude changes induced by treatment. These researchers were fortunate to have access to videotapes of all treatment sessions conducted in various English prisons during the past several years. Each program in each prison followed the same detailed treatment manual, and the delivery of each program was rigorously monitored by both in-house staff and an international accreditation panel. In addition, each program employed the same set of pre- and posttreatment measures that assessed a variety of relevant features of the clients, such as attitudes, cognitive distortions, relationship styles, loneliness, self-esteem, denial and minimizations, and other important characteristics. Thus, the only feature of these programs that could vary was the way the therapists delivered the program, although even this was constrained in the degree to which it could vary by the monitoring processes. Nevertheless, sufficient variability was evident in the therapists behavior to allow an examination of the influence of various features of the therapists on the treatment-induced changes. From Marshall et al.s (as cited above) studies, clear evidence that confrontational styles had a negative impact emerged. The therapist features that clearly facilitated change on the measures were displays of empathy and warmth by the therapist, encouragement and rewards for progress, and some degree of directiveness. Of course, these are just the features we would expect to facilitate the enhancement of the clients self-esteem, hope, selfefficacy, and the identification of a positive future lifestyle that includes pathways to the good life.
CONCLUSION

We believe that if sexual-offender therapists adopt a positive therapeutic style (empathic, warm, rewarding, and directive) within the context of collaboratively developing a good-lives plan with their client, treatment benefits will be maximized. We propose that within such a program, instilling hope in the clients, enhancing their self-efficacy (or agentic thinking) and their selfesteem, and developing approach goals will further facilitate treatment benefits and thereby reduce the future likelihood of reoffending.
REFERENCES
Andrews, D. A., & Bonta, J. (1998). The psychology of criminal conduct (2nd ed.). Cincinnati, OH: Anderson.

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Ashford, J. B., Sales, B. D., & Reid, W. H. (2001). Political, legal, and professional challenges to treating offenders with special needs. In J. B. Ashford, B. D. Sales, & W. H. Reid (Eds.), Treating adult and juvenile offenders with special needs (pp. 31-49). Washington, DC: American Psychological Association. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Review, 84, 191-215. Beech, A., & Fordham, A. S. (1997). Therapeutic climate of sexual offender treatment programs. Sexual Abuse: A Journal of Research and Treatment, 9, 219-237. Carver, C. S., & Scheier, M. F. (1990). Principles of self-regulation: Action and emotion. In E. T. Higgins & R. M. Sorrentino (Eds.), Handbook of motivation and cognition: Volume 2 (pp. 352). New York: Guilford. Deci, E. L., & Ryan, R. M. (2000). The what and why of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227-268. Dweck, C. S., & Leggatt, E. L. (1988). A social cognitive approach to motivation and personality. Psychological Review, 95, 256-273. Emmons, R. A. (1996). Striving and feeling: Personal goals and subjective well-being. In P. M. Gollwitzer & J. A. Bargh (Eds.), The psychology of action: Linking cognition and motivation to behavior (pp. 313-337). New York: Guilford. Frank, J. D. (1989). Non-specific aspects of treatment: The view of the psychotherapist. In M. Sheppherd & N. Satorius (Eds.), Non-specific aspects of treatment (pp. 95-114). Toronto, Canada: Hans Huber. Frank, J. D., & Frank, J. B. (1991). Persuasion and healing. Baltimore, MD: Johns Hopkins University Press. Haaven, J. L., & Coleman, E. M. (2000). Treatment of the developmentally disabled sex offender. In D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking relapse prevention with sex offenders: A sourcebook (pp. 369-388). Thousand Oaks, CA: Sage. Haaven J. L., Little, R., & Petre-Miller, D. (1990). Treating intellectually disabled sex offenders: A model residential program. Orwell, VT: Safer Society. Hanson, R. K. (2002, September). Empirical evidence of sex offender treatment efficacy. Paper presented at 7th Biennual Conference of the International Association for the Treatment of Sexual Offenders, Vienna, Austria. Hanson, R. K., Gordon, A., Harris, A. J. R., Marquis, J. K., Murphy, W. D., Quinsey, V. L., et al. (2002). First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders. Sexual Abuse: A Journal of Research and Treatment, 14, 167-192. Higgins, E. T. (1996). Ideals, oughts and regulatory focus: Affect and motivation from distinct pains and pleasures. In P. M. Gollwitzer & J. A. Bargh (Eds.), The psychology of action: Linking cognition and motivation to behavior (pp. 91-114). New York: Guilford. Jones, L. (2002). An individual case formulation approach to the assessment of motivation. In M. McMurran (Ed.), Motivating offenders to change: A guide to enhancing engagement in therapy (pp. 31-54). Chichester, UK: Wiley. Kear-Colwell, J., & Pollack, P. (1997). Motivation and confrontation: Which approach to the child sex offender? Criminal Justice and Behavior, 24, 20-33. Kekes, J. (1989). Moral tradition and individuality. Princeton, NJ: Princeton University Press. Mann, R. E. (2000). Managing resistance and rebellion in relapse prevention intervention. In D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking relapse prevention with sex offenders (pp. 187-200). Thousand Oaks, CA: Sage.

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Mann, R. E., Daniels, M., & Marshall, W. L. (2002). The use of roleplays in developing empathy. In Y. M. Fernandez (Ed.), In their shoes: Empathy training. (pp. 132-148). Oklahoma City, OK: Wood and Barnes. Mann, R. E., & Shingler, J. (2001, September). Collaborative risk assessment with sexual offenders. Paper presented at the National Organisation for the Treatment of Abusers, Cardiff, Wales. Marshall, W. L. (1989). Invited essay: Intimacy, loneliness and sexual offenders. Behaviour Research and Therapy, 27, 491-503. Marshall, W. L. (1996). The sexual offender: Monster, victim, or everyman? Sexual Abuse: A Journal of Research and Treatment, 8, 317-335. Marshall, W. L. (1997). The relationship between self-esteem and deviant sexual arousal in nonfamilial child molesters. Behavior Modification, 21, 86-96. Marshall, W. L. (1999). Current status of North American assessment and treatment programs for sexual offenders. Journal of Interpersonal Violence, 14, 221-239. Marshall, W. L., Anderson D., & Fernandez, Y. M. (1999). Cognitive behavioral treatment of sexual offenders. Chichester, UK: Wiley. Marshall, W. L., Champagne, F., Brown, C., & Miller, S. (1997). Empathy, intimacy, loneliness, and self-esteem in nonfamilial child molesters. Journal of Child Sexual Abuse, 6, 87-97. Marshall, W. L., Champagne, F., Sturgeon, C., & Bryce, P. (1997). Increasing the self-esteem of child molesters. Sexual Abuse: A Journal of Research and Treatment, 9, 321-333. Marshall, W. L., & Christie, M. M. (1982). The enhancement of self-esteem. Canadian Counsellor, 16, 82-89. Marshall, W. L., Christie, M. M., Lanthier, R. D., & Cruchley, J. (1982). The nature of the reinforcer in the enhancement of social self-esteem. Canadian Counsellor, 16, 90-96. Marshall, W. L., Cripps, E., Anderson, D., & Cortoni, F. A. (1999). Self-esteem and coping strategies in child molesters. Journal of Interpersonal Violence, 14, 955-962. Marshall, W. L., Fernandez, Y. M., Serran, G. A., Mulloy, R., Thornton, D., Mann, R. E., et al. (in press). Process variables in the treatment of sexual offenders. Aggression and Violent Behavior: A Review Journal. Marshall, W. L., Serran, G. A., Fernandez, Y. M., Mulloy, R., Mann, R. E., & Thornton, D. (in press). Therapist characteristics in the treatment of sexual offenders: Tentative data on their relationship with indices of behavior change. Journal of Sexual Aggression. Marshall, W. L., Serran, G. A., Moulden, H., Mulloy, R., Fernandez, Y. M., Mann, R.E., et al. (in press). Therapist features in sexual offender treatment: Their reliable identification and influence on behavior change. Clinical Psychology and Psychotherapy. Miller, W. R., Benefield, R. G., & Tonigan, J. S. (1993). Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Journal of Consulting and Clinical Psychology, 61, 445-461. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behaviors. New York: Guilford. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change addictive behavior (2nd ed.). New York: Guilford. Miller, W. R., & Sovereign, R. G. (1989). The check-up: A model for early intervention in addictive behaviors. In T. Lberg et al. (Eds.), Addictive behaviors: Prevention and early intervention (pp. 219-331). Amsterdam: Swets & Zeitlinger. Miller, W. R., Taylor, C. A., & West, J. C. (1980). Focused versus broad-spectrum behavior therapy for problem-drinkers. Journal of Consulting and Clinical Psychology, 48, 590-601. Moulden, H., & Marshall, W. L. (2002). Hope in the treatment of sexual offenders: The potential application of hope theory. Manuscript submitted for publication.

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Rasmussen, D. B. (1999). Human flourishing and the appeal to human nature. In E. F. Paul, F. D. Miller, & J. Paul, (Eds.), Human flourishing (pp. 1-43). New York: Cambridge University Press. Salter, A. C. (1988). Treating child sex offenders and victims: A practical guide. Newbury Park, CA: Sage. Serran, G. A., Fernandez, Y. M., Marshall, W. L., & Mann, R. E. (in press). Process issues in treatment: Application to sexual offender programs. Professional Psychology: Research and Practice. Snyder, C. R. (2000). Handbook of hope: Theory, measures, and applications. New York: Academic Press. Snyder, C. R., & Higgins, R. L. (1988). Excuses: Their effective role in the negotiation of reality. Psychological Bulletin, 104, 23-35. Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. New York: Guilford. Ward, T. (2002). Good lives and the rehabilitation of offenders: Promises and problems. Aggression and Violent Behavior: A Review Journal, 7, 513-528. Ward, T., & Steward, C. A. (in press). Criminogenic needs and human needs: A theoretical model. Psychology, Crime, & Law.

William L. Marshall is a professor emeritus of psychology and psychiatry at Queens University, Canada, and the director of Rockwood Psychological Services, Kingston, Ontario, which provides sexual offender treatment in two Canadian federal penitentiaries. He has 35 years experience in assessment, treatment, and research with sexual offenders. He has more than 300 publications, including 16 books. He was president of the Association for the Treatment of Sexual Abusers from 2000 to 2001, and he was granted the Significant Achievement Award of that association in 1993. In 1999, he received the Santiago Grisolia Prize from the Queen Sophia Centre in Spain for his worldwide contributions to the reduction of violence, and in 2000, he was elected a Fellow of the Royal Society of Canada. In 2003, he was one of six invited experts who were asked to advise the Vatican on how best to deal with sexual abuse within the Catholic church. Tony Ward, Ph.D., M.A. (Hons), DipClinPsyc, is a clinical psychologist by training and has been working in the clinical and forensic field since 1987. He was formerly the director of the Kia Marama Sexual Offenders Unit at Rolleston Prison in New Zealand and has taught both clinical and forensic psychology at Victoria, Canterbury, and Melbourne Universities. He is currently the Director of Clinical Training at Victoria University of Wellington. His research interests fall into five main areas: rehabilitation models and issues, cognition and sex offenders, the problem behavior process in offenders, the implications of naturalism for theory construction and clinical practice, and assessment and case formulation in clinical psychology. He has published more than 150 journal articles, books, and book chapters. Ruth E. Mann leads the sex offender assessment and treatment strategy for H.M. Prison Service. She is responsible for program design, implementation, monitoring, and research. She has 18 years experience of developing treatment services for sexual offenders. Her research interests include dynamic risk assessment, cognitive factors in sexual offending, and positive and motivational approaches to treatment.

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Heather Moulden is currently completing her doctoral degree in clinical psychology at the University of Ottawa in Ontario, Canada. She is also employed at Rockwood Psychological Services where she provides treatment to sexual offenders. Her research interests include social competence and sexual offending, the impact of preparatory programs for sexual offenders, and effective treatment intervention. Yolanda M. Fernandez graduated with a Ph.D. in clinical and forensic psychology in 2001 from Queens University in Kingston, Ontario. As a registered psychologist, she currently holds the position of regional coordinator of Sexual Offender Treatment Programs within Correctional Services of Canada at the Millhaven Assessment Unit. Previously, she spent a year working as a psychologist in the maximum-security unit at Millhaven Institution. She has also worked as the clinical director of Rockwood Psychological Services and the clinical director of the Sexual Offender Treatment Program located at Bath Institution (a medium-security federal penitentiary). In 1999, she designed a training package to teach effective therapist skills to clinicians working with sexual offenders. She has provided this training within Canada, the United States, and several European countries. In addition to her clinical work, Yolanda is an active researcher who currently has several presentations at international conferences and has more than 20 publications. Her publications include an edited book, two coauthored books, and three coedited books. Her research interests include therapeutic process in sexual offender treatment, empathy deficits in sexual offenders, and phallometric testing with sexual offenders. She has been an active member of the Association for the Treatment of Sexual Abusers since 1996, including 2 years as the student representative to the Board of Directors. Geris Serran, Ph.D., graduated with a doctoral degree in clinical psychology from the University of Ottawa in 2003. She is currently employed at Rockwood Psychological Services where she works as the senior therapist of the Bath Institution Sexual Offenders Program. In addition to her clinical work, her research interests include therapeutic process, coping strategies, and treatment of sexual offenders. She has authored several book chapters, journal articles, and presentations at international conferences in these domains. Liam E. Marshall received his masters degree in psychology from Queens University in Kingston, Canada. He is currently enrolled in the doctoral program in the Department of Psychology at Queens University. He has been the graduate student representative on the Queens University Psychology Department Ethics, Headship, and Departmental committees. He has worked directly with sexual offenders in correctional settings for more than 9 years. He is the lead therapist for the Millhaven Institution Sexual Offenders Preparatory Program and is also a therapist for the Bath Institution Sexual Offenders Moderate-Intensity, Deniers, and Maintenance programs. He has trained therapists in the delivery of sexual offender programming for the British, Scottish, Australian, New Zealand, and Canadian prison services. He is currently on the editorial board of the Journal of Sexual Addiction and Compulsivity. He has a number of publications, including an in-press book and an edited book, on a variety of issues relevant to sexual offenders.