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Creating Treatment Curriculum for a Civil Commitment Program
Lessons Learned
Jannine Hébert MA, LPExecutive Clinical Director Minnesota Sex Offender Program (MSOP)
Elizabeth Griffin MA, LMFTGriffin Counseling and Consulting
www.internetbehavior.com/iatso2014
Outline
• Who is here?• Introductions• Presentation
– Introduce the challenges of creating a treatment curriculum for civilly committed sexual abusers
– Tour the curriculum– Provide specific treatment examples to assist in
the change process
Treatment completion reduces risk
What does treatment look like?
Goals of Curriculum Project • Engaged challenging clients• Reflective of research• Reflected program design• Meaningful curriculum-not a checklist• Consistent treatment language• Strengthen culture• Easily followed and centralized• Standardized while allowing for individual client
needs/abilities/pathology• Feedback from both clinicians and clients
Foundation of Creation Process• Researched current trends in sex offender treatment
– CBT/RP/RNR– Schema Therapy– Mindfulness
• Looked to adjunct fields– Art Therapy– Movement Therapy
• Relied heavily on responsivity principles
• Contacted and gained permission from authors/providers
Sex Offender Civil Commitment Minnesota
• Psychopathic Personality (PP) – 1939
• Sexual Dangerous Person (SDP) and Sexual Psychopathic Personality (SPP) - 1996
Minnesota Sex Offender ProgramCivil Commitment
Communities
DOC
Counties
Courts
MSOP
Statutes/Laws
19951996
19971998
19992000
20012002
200337956
20042005
20062007
20082009
20102011
20122013
19 20
5843
32 308 13 14
235
170
145
170150 151
114124
88 92
69
SPP/SDP Referrals from DOC to Counties
Challenges• 2 facilities• Census 700 +• High- risk, needs, resistance, pathology,
hopelessness and institutionalization• Large clinical staff- 100+ clinicians
– Program integrity, range of experience/education• Public and legal scrutiny
MSOP clients
• High risk as deemed by the courts• High on sexual deviance• Multiple previous treatment attempts• Personality disorders• Some high on psychopathic traits• Heterogeneous group• Range of cognitive functioning • Mental health needs/personality disorders
Program Design
• Primary Therapist• Core Group• Psycho-Educational Group
• Quarterly/Annual Treatment Review• Therapeutic environnment. Treatment 24/7
Program DesignMSOP Treatment Program
Phases/Matrix factors
Treatment phases
• Phase I-Orientation, engagement, self-management*(pre-contemplation, contemplation)
• Phase II-Disclosure, identification of abuse patterns and schemas, skill acquisition, awareness of self and others*(contemplation, preparation, action)
• Phase III -Skill application, transitions, consistent utilization of pro-social coping strategies*(maintenance)
• Escorted on campus• Escorted in the community• Unescorted on campus
Minnesota Sex Offender Program
• Group behavior• Attitude toward
change• Self-monitoring• Thinking errors• Pro-social problem
solving• Healthy Lifestyle
• Emotional regulation• Interpersonal skills• Sexuality• Cooperation with
rules/supervision• Productive use of time• Life Enrichment
Minnesota Sex Offender ProgramTreatment Progress/Matrix Factors
Matrix Factor Criminogenic Need/Dynamic Risk Factor
Group Behavior
Resistance to Rules/SupervisionNegative Social Influences
Poor Self-RegulationGeneral Hostility
Hostility toward Women
Attitude toward Change Offense-supportive AttitudesAntisocial attitudes and behavior
Self-Monitoring
Antisocial attitudes and behaviorImpulsivity
Sexual PreoccupationDeviant Sexual Interests
Sexualized Coping
Thinking Errors
Offense Supportive AttitudesGeneral Hostility
Hostility toward WomenAntisocial attitudes and behavior
Prosocial Problem Solving Negative Social Influences
Emotional Regulation Poor Self-RegulationImpulsivity
Interpersonal SkillsEmotional Congruence with Children
Poor Adult AttachmentNegative Social Influences
Cooperation with Rules Resistance to Rules/SupervisionAntisocial attitudes and behavior
Sexual FunctioningSexual Preoccupation
Deviant Sexual InterestsSexualized Coping
Webpage Tour
Therapeutic Tools
• Develops a common language
• Lowers resistance and denial, increases compliance– Away from hard confrontational style
• Provides therapeutic/visual images to anchor concepts
• Useful for Clients• Learning Disabilities• Learning styles that are more suited to visual, tactile or
kinesthetic• More success in treatment
• More Active and Engaging– Hoop Therapy (Narrated PowerPoint)
Phase I
To Motivate ChangeTo Invite Into Treatment
Phase I• Connecting to Change
– Hermes’ Web– The Lawyer
• Perpetrator Profile– Lay out style of offending in a non threatening way– Allows clients to see that sexual offending is one part of self
• Your Story Module– Life Egg – Life Map (Client Example)
21
HERMES’ WEB Fundamental Concepts
A psychological communication toolThe egoThe coreThe barrierThe flipThe Truthful Lie
22
The Ego
The EgoWho we think we areWhat we identify withWhat we prefer to show
others
Chronological age
Ego
23
The Core
The soul, where all parts of the human personality meet
Psychological age
The hidden world
Core
24
The Barrier
The dividing line
The power of the barrier Stops output, unless compromised
via stress, drugs, alcohol, sex Cannot stop input or protect the
core from life events
Barrier
25
The Flip: Revolution
What has been ignored
Takes center stageRebelsActs out and offendsWith no interference
Phase I• Connecting to Change
– Hermes’ Web– The Lawyer
• Perpetrator Profile– Lay out style of offending in a non threatening way– Allows clients to see that sexual offending is one part of self
• Your Story Module– Life Egg – Life Map (Client Example)
Phase I• Connecting to Change
– Hermes’ Web– The Lawyer
• Perpetrator Profile– Lay out style of offending in a non threatening way– Allows clients to see that sexual offending is one part of self
• Your Story Module– Life Egg – Life Map (Client Example)
Phase I• Connecting to Change
– Hermes’ Web– The Lawyer
• Perpetrator Profile– Lay out style of offending in a non threatening way– Allows clients to see that sexual offending is one part of self
• Your Story Module– Life Egg – Life Map (Client Example)
Family Roles
Family Rules
LIFEEGG
Phase I• Connecting to Change
– Hermes’ Web– The Lawyer
• Perpetrator Profile– Lay out style of offending in a non threatening way– Allows clients to see that sexual offending is one part of self
• Your Story Module– Life Egg – Life Map (Client Example)
Phase II
Explore and Resolve Underlying Issues in Sexual Offending Behavior
(“What”, “Why”)
Phase II
• Roots of Offending– Hermes’ Web– Dandelion (Client Example)
• Schemas– Different Ways of Viewing the Word
• Chicken Little
– Introduce concept of “Perspective Taking”– More than one “truth”
• Hoodwinked Video
Phase III
Reintegration and Maintenance
Phase III
• Different format– Moving from external to internal– Clients take more responsibility for treatment
• Privileges – Exposure to the World
• Topic Format– Relationships Module– Relapse Prevention Module
• Maintenance Plan – Good Lives
Lessons Learned• The Marshalls were right
– WERD (Warm, Empathic, Rewarding, Directive)
• Behavior isn’t the problem it is the solution to the problem
• They will be there tomorrow
• Don’t ask your clients to do anything you are not willing to do
• Every conversation has the potential to shift or entrench a psychological state
Thoughts/Comments/Questions/Reactions?
Creating Treatment Curriculum for a Civil Commitment Program
Lessons Learned
Jannine Hébert MA, LPExecutive Clinical Director Minnesota Sex Offender Program (MSOP)
Elizabeth Griffin MA, LMFTGriffin Counseling and Consulting
www.internetbehavior.com/iatso2014
