the therapeutic alliance and criminogenic change michael mitchell, lcsw treating criminogenic risk,...

Treatment Criminogenic Risk, 2009 1

HOLDING BOTH SIDES OF THE MIRROR: The Therapeutic Alliance and Criminogenic Change

Michael Mitchell, LCSWTreating Criminogenic Risk , 2009


treatment components

criminogenic treatment

therapeutic relationship in criminogenic treatment

treatment guidelines

Treatment Criminogenic Risk, 2009 3Treatment Criminogenic Risk, 2009 3Treatment Criminogenic Risk, 2009 3

Therapeutic allianceCriminogenic treatmentTreatment factorsTreatment guidelines

Definitions

• Criminogenic• Stage of Change• Behavioral Health• Clinician/therapist

Treatment Criminogenic Risk, 2009 4Treatment Criminogenic Risk, 2009 4

Treatment Components Criminogenic treatmentTreatment factorsTreatment guidelines

TREATMENT COMPONENTS

Behavioral Health Treatment occurs in:

a) Emotionally charged and confiding relationship with a “helping person”

b) Healing setting with that fits with the expectation of being helped

c) Plausible explanation of presenting issue

d) Mutually agreed upon procedure that is intended to address the concern

Frank &Frank, 1991

The Genus of Psychotherapy• Therapeutic contract• Therapeutic operations• Therapeutic bond• Self relatedness• In session impacts• Sequential flow

Orlinsky, et al 1994


Treatment components Criminogenic treatmentTreatment factorsTreatment guidelines

Behavioral Health Treatment• research• common factors• client factors• therapist factors

Behavioral health treatment works!Changes are sustainedNo overall differences in approaches

40%

30%

15%

15%

Common Factors

Extra-thera-peutic Change

Therapeutic Relationship

Hope and Expectancy

Technique

Static factors Dynamic factors Length of stay Locus of change

Static factorsDynamic factors“Necessary and Sufficient Conditions”


Treatment ComponentsCriminogenic treatmentTreatment factorsTreatment guidelines

The Therapeutic Alliance

• “…the quintessential integrative variable" (Wolfe & Goldfried, 1988)• Necessary but not sufficient• Can be measured and it predicts outcome

Four Core Components client’s emotional relationship with the clinician client’s ability to work in therapy the clinician’s empathic understanding and involvementThe client-therapist agreement on the goals and task of therapy

Gaston, 1990

“The working environment that embodies mutual trust, respect and efforts for healing and change”



Criminogenic Treatment and

Anti-social Process

8888


Treatment Criminogenic Risk, 2009

Anti-Social Process

• Definition:– Anti-social behavior is a

pervasive pattern of behavior that intentionally or carelessly creates immediate and/or eventual harm to individuals or the social fabric through actions that defy social norms, mores, morals and laws.


Social Bond

Pro- Social Bond Development

Attachment Commitment

Involvement Belief

Family Effect

Individual Effect Contextual

Effect

9Criminogenic Change

Treatment Criminogenic Risk, 2009 10Treatment Criminogenic Risk, 2009 10Treatment Criminogenic Risk, 2009 10Treatment Criminogenic Risk, 2009 10


Need Invalidation

Narcissistic Wounding

Entitlement

Inadequacy

Pro-social Disengagement

Neutralizations

Anti-social entrenchment

Entrenched Anti-social

Self



Criminogenic Treatment

“The intentional use of behavioral health interventions to identify

and collaboratively change entrenched

anti-social behavior patterns to maximize pro-self identity and

participation.”

Facility based

Re-entry based

Community Based

Diversion



Criminogenic Treatment

It works! Community more effective than institutional based Tangible, structured, skill based programs more effective Must be criminogenically informed

RiskNeedResponsivityProfessional discretion

Best Practice Characteristics Behavioral/experiential in nature Intensity based on risk and need of offender Occupy 40-70% of the offender’s time Duration: 3 and 9 months Disrupt anti-social processes Family/significant other involvement Aftercare



Recidivistic Risk FactorsAndrews and Bonta,

Big Five• Criminal History• Anti-social Attitudes• Anti-social Associates• Anti-social Behaviors• Anti-social personality traits

Central Eight

• Substance Abuse• Family/Relationship• Recreation/Leisure

13Criminogenic Change

Static

Dynamic

Entrenched Anti-social

Culture


Traditional:Symptom reduction

Criminogenic:Pro-social

engagement

Primary Treatment Focus



Pro-social need

satisfaction

Narcissistic Healing

Pro-social Self

Social capital &

belonging

Pro-social supports

Increase pro-social

engagement

Pro-social treatment focus




The RealitiesCriminogenic Treatment Factors



Criminogenic Treatment Factors

• Substance abuse• Trauma• Mental Health• Cognitive• Gender Differences• Treatment disruptions• “Convert in the fox hole”

• “Captive audience”• Therapeutic leverage• Heightened stage of change• Non-behavioral health systems



You are from the Pro-social Club!

Criminogenic process is more powerful than a vague desire to change

Pro-social consequences

Sustainable change is relationship based

Things to keep in mind



Stages of treatmentEngagement Intervention Termination Aftercare

• Clear therapeutic contract• Reason for involvement• Stage of change• Pro-social priority• Gender differences

• Enactment• Compassionate dispassion• Cost of success• Counter-transference

• Planned/unplanned• Attachment/loss issues• “Welcoming” for future work

• Team approach• Extra-therapeutic demands• Stages of change



Treatment Guidelines

1. Individualized criminogenic process themes

2. Cultivate/enhance pro-social self image

3. Maintaining perspective4. Communicate/collaborate5. Responding to “anti-social

pull”6. Model pro-social inclusion



40%

30%

15%

15%

Common Factors

Extra-thera-peutic Change

Therapeutic Relationship

Hope and Expectancy

Technique

Extra-therapeutic factors Pro-social therapeutic

alliance Hope, Expectancy and

inclusion Technique

Criminogenic Common Factors


Conclusion

THANKS!!

the therapeutic alliance and criminogenic change michael mitchell, lcsw treating criminogenic risk,...

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