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Community-based Treatment for Sex Offenders: an Evaluation of Seven Treatment Programmes.Home Office Research Findings
Crime and Prejudice: Can social workers stay true to the values of anti-discriminatory practice when engaging sex offenders'?
1.1 There is little argument that those who chose to commit sex offences are unpopular, considered by many to be 'evil', but also undeserving of support despite the high level of need to support and rehabilitation (Ward et al, 2007). As a group, sex offenders occupy only a small percentage of criminals within the community and in custody; however the nature of their offence generates the greatest concern and public outrage. As such the group often find themselves on the front pages of tabloids and elicit little to no sympathy. The past twenty years has seen a number of deplorable sexual offences brought to justice but also the public attention, with offenders more or less dehumanised; referred to as 'subhuman', 'monsters' or 'animals' by popular and widely read newspapers in the UK (The Sun, 2011). Whether painting these offenders as less than human is a media strategy to try to help the public make sense of the crime, or a means of justifying their sensationalist language in order to move units is open to further debate. However, high profile cases such as Ian Huntley and the Soham murders and the murder of Sarah Payne generated significant social narrative resulting in political pressure and subsequent change to legislation witnessed through Sarah's Law which, as of this year, has been extended to the whole of the UK (Home Office, 2012).
Media and press are the most significant resource for information gathering and, to some extent people are inclined to accept the mainstream media's word on matters. Rawlinson (1998) argues that in areas such as crime, the media voice is the only insight the public have and as such stereotypes about sexual offenders as 'weirdos', 'loaners' and 'outsiders' have been allowed to manifest assisted by the need to allay moral panic. As such, sensationalism, compounded by the on-going tendency to focus only on the high-profile cases (which invariably involve young girls), have a direct and damaging impact on the practitioners who must work with these people and indeed how the work is undertaken (McCulloch and Kelly, 2007).
Sadly, social workers are sadly not immune from the influences of the media, society and their own personal values. Indeed, given the repellent nature of sexual offences, the gut reaction of many practitioners is to want to 'kick their teeth in' (Sheath, 1990. p 159). As such there is a difficult ethical tightrope in place for those who work with people who commit sexual offences; balancing both societal pressures and their own personal values and feelings alongside the professional values expected by the body they represent. Social work values differ from other practitioners who are called upon to work with sex offenders; most significantly due to the principles of anti-oppressive and anti-discriminatory practice which seek to empower the service user. These principles are the very essence of social work in both practice and training (Daltymple and Burke, 1995: Dominelli et al, 1995); however the equivalent does not exist within medical and psychological circles where there is much more emphasis placed on ethics of treatment. In fact, it is likely that most practitioners who come into contact with service users will represent different practice wisdom, personal values, knowledge base and professional values.
It was the politicization of social work in the 1970s that highlighted how social welfare individualized social problems. Thus, rather than being seen as due to the moral failings of the poor, poverty and marginalization were attributed to wider political and structural inequalities (McLaughlin, 2005). The agenda has since widened to include issues such as sexuality, disablism, ageism and gender amongst others. Anti-oppressive practice, like work with sex offenders has developed and evolved significantly over the past thirty years. The inherent 'values', while heavily debated (Beresford, 2008); still hold fast to principles of self-help, protection of the vulnerable, social inclusion and equality (Barnard et al, 2008). 'Radicalization' and protest in the 1960's and 1970's sought to re-address a power imbalance felt by minority groups and significant theory and models emerged which helped inform social work practice; with perhaps the most robust and reflected upon being that of anti-Discriminatory (ADP) and anti-oppressive practice (AOP). These are embodied as professional values held by social workers and, it is hoped that by adhering to them that discrimination and oppression can be restricted to a minimum within our own practice and challenged in others with view to emancipation of those we work with (Thompson, 2001). Today, ADP still holds true to its radical roots and value base and emphases 'user control', equality over equal rights and citizenship rather than respect (Preston Shoot, 1995).
A lot has been written on the subject of ADP by many of the discipline's most recognised academics (Thompson, 2001: Dominelli, 2002, Adams et al, 2009), and social work training includes training on how to recognise disadvantage and oppression (Wilson and Beresford, 2000). Indeed the social work code of ethics espouses doctrines such fairness, respect and equality (GSCC, 2012). However, the role also supports the importance of recognising individuals without consideration for wider personal or political ideologies (Leonard, 1976: Bolger et al, 1981: Simpkin, 1989). Social work values therefore assume that practitioners come from a position of being socially neutral (Smyth and Campbell, 1996). Thus, while the principles of ADP are theoretically sound and seemingly transparent, a lot is asked of the social worker given that, as human beings they are vulnerable to the same cynicism, objection and even repulsion as the rest of the populous.
My research aims to address how social workers are to apply the principles of ADP/AOP to engage those whose sexual offences would normally be subject to prejudice from society. I am to do this by completing a literature review of the relevant work; by looking at the research on writing around anti-discriminatory practice and its relationship with social work and then by looking at how the principles are, if at all, applied when working with sex offenders to better understand how they managed to overcome such moral dilemmas.
This critical literature review will commence with the methodology. This section will define the term secondary research along with providing a critical analysis of the varying methods used to conduct the review.
1.2 Research Question and objectives:
- Define the terms used; namely anti-oppressive, anti-discriminatory practice and sex offenders/offences.
- Provide historical, contextual and theoretical underpinnings of the work conducted with AOP/ADP and sex offenders
- Discuss the implications of Cognitive Behavioural Therapy with Sex offenders
- ADP in custody: Are convicted and remanded sex offenders in received from practice which is informed by ADP/AOP?
- ADP in the community: Are sex offenders who are managed in the community receiving practice which is informed by ADP/AOP?
- Models of intervention used
- Implications for social work
- Final conclusions
2. Methodology / Methods
2.1 Rationale for Literature review:
The research takes the format of a literature review using both quantitative and qualitative data collected from established researchers in the field of ADP, sexual offending and aggression, social work and probation (Bryman, 2008). Given the limited writing which refers to the specific area of my research it may be considered that the dissertation might be enhanced by the use of primary data research. However, significant and extensive searches found that there was a great deal of quality secondary data available which supports the two independent but also fundamentally linked areas of study which the research is situated; namely the difficulties of ADP in practice and engagement with both sex offenders and those who work with them. Thus, it was possible to locate sufficient information from relevant journal articles, books, social work based literature and Internet resources.
There is significant data and information available to the researcher, however given the breath and variety it was necessary to narrow down the search in order to achieve the most significant and most relevant information. Approved websites were located through the University of Leicester portal to search for literature including ASSIA, Social Care Abstracts and the Leicester University Library databases using the search terms 'social care', 'engagement' and 'anti-discriminatory (and or) oppressive practice'. Additional searches were undertaken by augmenting the search by adding terms such as 'sex offender' and 'paedophiles' in order to achieve better and more varied results. Understandably these terms generated a high level of results requiring the need to include or exclude based on the details within the abstract. Exclusion due to age was given some consideration; however given the recent evolution of sex offender practice and that of anti-discriminatory practice having a 'cut off' date became frustrating and unrealistic when giving a background and context. However, within the main literature review of the research the majority of resources do not predate 1997. Furthermore, as there is significantly more writing from an international medical, psychological and criminological perspective I aim not to limit by country thus allowing the opportunity for longitudinal, subgroup and cross-cultural analysis (Bryman, 2004). However, due to my own comprehension will only be using English texts.
Furthermore, while academic texts contain wealth of information it must be considered that given the time it takes to write, expense of publishing and the need for many researchers to achieve published works there is often a strong lean from academics to publish their thoughts and works in journals. The upshot of this is a huge wealth of available information which is digestible, peer reviewed, freely available and above all else able to be very current. The research contains a significant amount of information obtained from articles from journals including: Critical Social Policy, Journal of Sexual Aggression, journal of Correctional Health Care, Probation Journal and the British journal of Social Work.
While the Internet is a valuable tool for accessing information (Noaks et al, 2004), it is very difficult to find balanced, researched and peer reviewed information and opinion on the topic of sex offenders which has not been affected by bias or indeed threatening and abusive language. Therefore Internet websites which are not secure have been avoided with the caveat of newspaper sites which proved useful for gauging the temperature of public opinion which has been instrumental in how sex offenders are treated and perceived.
2.3 Advantages of a literature review:
Secondary data became preferable for several reasons; foremost due to the limited time in which to complete the research, but also because the quality of the information which found was excellent as well as peer reviewed and reliable. Indeed, the benefits of secondary data will allow me to draw from top flight professionals who may have had access to resources which I could not conceivably match. And, while some practitioners recognise drawbacks due to missing data and reliability (Rubin and Babbie, 2011); my searches have already concluded significant relevant writing, including much on practitioner experiences as well as just those of the service user.
I consider that perhaps the most significant drawback is that, given the contentious nature of the material there may be some misrepresentation of statistics (Silverman, 2001). Indeed, victims of sexual offences are less likely to report incidents to the police and therefore the true scope and breath of the study is undermined by the validity. This is however manageable and preferable to undertaking individual research for which may have struggled to gain ethical approval given the often 'dangerous and manipulative' nature of sex offender (Prendergast, 1991). Indeed, any attempt to conduct a primary research piece would, at this stage only yield a small scale sample which would not be representative and challenging to generalise which may prompt some researcher bias (Sarantakos, 2005: Bryman, 2009). To evaluate the data collected I will be using 'grounded theory' (Glaser & Strauss, 1967) which describes a theory that has been achieved from the gathering and analysis of research information.
Notwithstanding the aforementioned advantages, secondary data analysis, like any methodological approach has its limitations. Secondary researchers have no control over the data they use which may be well out long out of date, disregarded and also not directly relevant. Indeed, the following research was the product of significant trawling of journal articles and texts referring to obsolete legislation and priorities.
3. Literature review
3.1 Background and theoretical underpinnings
A sexual offence is the 'act of a sexual nature against a person without that person's consent' (Hale, et al, 2005). It is an act which is universally un-tolerated and, as such any commission of it is met with seriousness. While there are significant differences in aetiological theories with regards sexual offenders and their treatment, there is some evidence that perpetrators consistently present with chronic and often habitual patterns of behaviour for which there is a potential for disruption (Knopp, 1984). The argument therefore is that all sex offenders are not inherently acting maliciously and, while their act is unforgivable and no attempt to justify their actions will be made within this paper; one must consider additional factors which may be contributory or perhaps self-enabling.
Working with sex offenders has been linked to increased stress and, in some cases 'burnout' amongst practitioners leading understandably to high rate of illness; thus the longstanding search for suitable and sustainable treatment of sex offenders has seen both curious and questionable methods used. Wood et al (2000) locate the beginnings of sex offender treatment in 1930's America where they were seen as 'deranged' and 'psychopathic' and therefore were routinely detained in asylums. This perception remained throughout the majority of the 20th Century until the 1970's when social work practice changed and ADP emerged and the rise of feminist practice stemming from radicalism saw significant 'progressions' with treatment.
Quinsey, Bergensen and Steinman looked beyond the 'psychopathic' view and considered that behaviour could be altered by changing cognitive patters, and in 1976 they used electric shock aversion therapy in an attempt to do this. They undertook further work in 1980 'capitalising' on the apparent successes of the previous application by treating 18 child sexual offenders using biofeedback and signalled-punishment aversion therapy with electric shock treatment. Again, this was reported to achieve positive results however there was no follow up following the intervention and it has not been revisited. While the idea of 'shock' therapy fills many people with horror, however the truth is that at the time this was widely considered to be effective treatment and is still routinely used in nearly every psychiatric hospital in the UK (DoH, 2008). Applying Electroconvulsive Therapy (ECT) to sex offenders was therefore significant as it showed recognition of sex offenders as people who were in need, albeit 'sick' ones.
Groth, Hobson and Gary (1982, p. 140) recognised that there were limitations within the electroconvulsive psychoanalytic approaches with sex offenders and worked on an assumption that these individuals had clinical or psychological problems. This thinking was later validated by the work of Saunders, McClure and Murphy (1986), who confirmed beliefs that only a very small percentage of non-incarcerated sexual offenders against children had definable psychiatric conditions. In 1984, Finkelhor's was the first to consider sociological and psychological variations in relation to sex offenders and crucially acknowledged that individual psychopathology linked a history of child sexual abuse was only be linked to some of cases; thereby nullifying the notion at all sex offenders were victims of sexual abuse themselves which is a perceived misconception.
Concurrently, Marquis (1970) was experimenting with the idea of orgasmic reconditioning. This process requires the subject to masturbate whilst thinking about their deviance and then alter their thoughts to something more 'suitable' at point of climax. Marshall and Barbaree also took a different approach to their work with sex offenders concluding positive evidence of the effectiveness of the widely contentious 'satiation therapies' which include verbal and masturbatory techniques (1978, p. 303). The verbal process is intended to decrease the sex-offender's need for deviant sexual arousal and incorporates them simply describing scenarios which they find exciting over and over until these apparently deviant act become boring and pedestrian to them. The masturbatory element involves the client masturbating over non-deviant material and continuing past the point of ejaculation. This was considered to be highly successful and many researchers believed these methods should be used as common practice in rehabilitation. However, while there has been noted success in relation to the interventions, most studies accessed made reference to fetishism as opposed to the sort of sexual abuse which I would consider high on the public's agenda.
The 1980's became a significant time for the development of work with sex offenders; characterised mainly by the work of Salter (1988) and Finkelhor's (1984). Though it had been considered important to sex offender treatment with cautionary intervention up, both recognised the importance of cognitive distortion in tackling sex offender's perception of their offence. While today the term tends to be used quite broadly, Finkelhor's application was that if reservations about the offence were to be overcome and, the perpetrator must desist making excuses and justifying the act and acknowledge it as simply deviant (Beech et al, 1998). He emphasised the importance of the societal and cultural pervasive socialisation patters, difference in values and morality as well as biological factors. The model therefore provided a clear framework for practitioners to work within, targeting sexual arousal, emotional regulation and helping offenders to understand, identify and avoid situations which might put them or potential victims at risk (Ward, 2003). This represents a style of working which is clearly identifiable as social work; and this new holistic approach to working with sex offenders was progressive in acknowledging the needs and to an extent 'rights' to the offender.
Unsurprisingly other practitioners followed suit and Salter's thinking advised practitioners that, while some offenders may acknowledge their deviance, they may also lay blame on alcohol, stress and other factors and therefore minimise their culpability. Salter's work is further validated by more recent studies which indicate cognitive distortion is recognised as highly common in sexual offenders; Hudson et al (1993) conducted a study whereby 'child molesters' claimed that they thought that unresponsiveness was a sign that they were not bothered and alarmingly another study where rapists had apparently claimed that they perceived distress as a sign of enjoyment. This said, more usually the 'distortions' which are referred to are normally made by offenders to rationalise, justify or deny offence behaviours (Berliner and Conte, 1990, p. 34). The reduction and tackling of cognitive distortions is essential with effective CBT and is shown to aid recidivism rates (Marshall et al, 1999). As such CBT became central to work around sex offenders.
4.1 The rise of CBT
Cognitive behavioural therapies derived from relapse prevention therapy which had become popular following successes in areas such as self-esteem and substance use (McCulloch et al, 2007). Its use with sex offenders reflected some progression away from the previous methods as it recognised social and environmental influences upon sexual offending as opposed to simply deeming it a mental illness (Moster et al, 2008). Since the 1980's, the use of CBT has gained respect and usage from agencies making it the most common intervention used (Andrews & Bonta, 1998; 1998; Freeman-Longo & Knopp, 1992; Laws, 1989). Hanson (2002) found, after significant meta-analysis a recidivism rate of 9.9% compared to 17.4% for those who had not undergone CBT interventions. This evidence was reinforced by Lösel and Schmucker's (2005) whose meta-analytical study of sexual offender program espoused similar findings giving further kudos. The emergence of CBT as a means of sex offender treatment coincided with a new socio-political climate which sought to promote and publicise 'what works' with offenders. CBT is the most commonly used intervention with sex offenders, and widely considered to be the most effective (Andrews and Bonta, 1998; Becker and Murphy, 1998; Freeman-Longo & Knopp, 1992; Home Office, 2010), it does however still remain much less used than initially planned.
Authors such as Sparrow (2002) suggest that such a shortfall from initial expectations, is, at least in part, due to a prevailing negative media response, unhappy with anything seen than 'less than' the most draconian of interventions and punishments, alongside a centralized, managerialist government unwilling to work with agencies they felt to be 'untrustworthy' and preferring to focus on more punitive measures which sought to minimising risk rather than therapeutic intervention.
CBT with elements of Relapse Therapy (RT) are the most common interventions with sex offenders in both the UK, Canada and US and generally involve group and individual therapy, work on victim empathy, learning about abuse cycles, cognitive restructuring, anger management and assertiveness, interpersonal skills and changing deviant sexual arousal patterns (Moster et al, 2008).
4.2 Ethical conflicts within CBT
CBT is postulated on the idea that all our emotional responses and behaviours are determined by pre-existing attitudes and beliefs which we may have developed or 'picked up' along the way (Beck, 1995). Thus, if we are to change how we react to experiences and emotions then we must change both our thoughts and how we perceive the matter (Moster, 2008). Facilitating this requires the use a number of techniques and constructs to help the subject examine and understand their cognitive processes and the subsequent link between these thoughts and their behaviour. Beck (1995) suggests that some of the most effective techniques are cognitive restructure, reversal of behaviours and directive role play which aims to confront the individual with the consequences of their behaviour and engender a reflective stance to be developed. While motivational methods of treatment do exist, some practitioners prefer the well-established confrontative approach which can raise questions in relation of social work ethics (Sheath, 1990; Moster et al, 2008).
With some offender treatments for example, practitioners may be required to adopt a set of principles which may differ from the core values of their profession. This includes, but is not limited to mandatory participation in treatment which contradicts traditional mental health ethics and confrontative CBT intervention which has been criticised for its apparent manipulative nature (Sheath, 1990; Glaser, 2003). While this may present a dilemma for social work where values of empowerment and respect are fundamental; Holmes and Lindley (1991) contend that clinicians should feel 'no shame' and that even if some of the techniques used are perceived to be ethically dubious, if they result in individuals gaining better understanding and capacity to make rational and informed choices with the client group, then they should be encouraged. Indeed many writers share this notion and discuss the idea that the offender learning from their own 'internal management' rather than dependence of external control is key to the reduction of recidivism (Marshall et al, 1999).
While the main goal of CBT with sex offenders is recidivism there are other goals for social workers to be mindful of; essential to CBT is that offenders are able to retain (or perhaps regain) self-worth. This requires intervention which both serves to protect the public and, at the same time, helps nurture the offender (Moster et al, 2008). While areas of CBT do encourage the client to create 'false realities' and pasts, the client is actively encouraged to think positively about their lives post-therapy; be this in the near future or following release from custody (Marshall, Anderson and Fernandez, 1999).
Another potentially contentious issue arises from the fact that CBT with Sex Offenders has to date unapologetically focused on directly challenging and changing opinions, actions and attitudes focusing on reactionary intervention which aims to modify existing behaviours but also questions the underlying conflicts that facilitate. Sheath (1990) refers to this form of intensely confrontative treatment as being nothing short of a 'legitimate form of nonce bashing' and discusses his own feelings of prejudice and repulsion which no doubt blur the quality of intervention being delivered. This is one of the fundamental conflicts of intervention with sex offenders and an area which requires practitioners to be open, honest and reflective about their abilities to put their feelings aside. Whilst social work is built around the principles of non-discrimination, managers and teams must also be realistic about the expectations of their staff.
Sheath is not the only practitioner to recognise the shortcomings of CBT; Payne discusses some of the problems of the intervention from another ethical position, critiquing the process as simply a manipulation of offenders' behaviour rather than progress achieved as a result of the client rather than the professional retaining control (1997). Payne does not however clarify his position as to whether he feels the right maintain to self-determination can be incorporated within CBT, or indeed if it's incompatible, stating only that it is only achieved when the client's one aim is to 'free themselves from behaviour' (1997: p. 123). Such tension might reasonably be held to present social workers, for whom issues of self-determination are central to the value base of the profession, with a very difficult 'circle to square' when attempting to justify the use of CBT in this manner.
Hackett (2008) suggests that the predominance of CBT in this area has also contributed to the homogenisation of sex offenders, as many of the key interventions, such as the cycle of abuse (Ryan et al, 1987) and Finkelhor's four preconditions model, have a tendency to focus on the offence, rather than the offender. Thus a fundamental flaw in the approach would seem to be that a series of highly contentious and questionable assumptions are required about offenders as a group and how they operate, which fundamentally fail to recognise that every single sexual offender is a different person with their own issues, but also an offender with their own issues, agenda, perception of their offence and perception of their victims (Sheath, 1990). Indeed, it might plausibly be argued that a reactive, 'one size fits all', application of CBT side-steps what is often the crux of the client's problems; sexual orientation, self-perception, sexually deviant and unfulfilled fantasy. Attempting to 'decode' a sexual offender while they are still in a state of defensiveness may as a result be, as Sheath puts it, a 'nihilistic exercise and at worst counter-productive' (p. 161).
Given the ethical issues raised above, whose overall implication would appear to be that the 'ends justify the means', with regard to the use of CBT, it would seem reasonable to question the extent to which such a positive duality of outcome can in reality ever be more than 'wishful thinking', as it would seem that public protection will inevitably be given higher priority.
4.3 Beyond CBT
Research by Marshall (2002) and Craissati et al (2002) adds to the discourse thatin suggestsing that it is an inability to form adult relationships which sometimes results in the pursuit of intimacy in other, maladaptive ways. Marshall (1989; 1993; 1996; 2002) uses the insights offered through the application of attachment theory to explain how sexual offenders are frequently emotionally distant and 'superficial' in intimate relationships. Going on to suggest a link between early attachment experiences and the development of internal working models which support the forming and maintenance of relationships in adolescence and adulthood (Bowlby, 1969). Such working models contribute not only to our own attitudes and beliefs, but also to how we recognise and respect the roles of others. Popular attachment debate discusses three main 'styles' of attachment; the secure which is thought to stem from warm and consistent parenting and then two types of insecure attachments, namely anxious which is thought to be rooted in inconsistent parenting and the avoidant which is linked to unresponsively in parenting (Ainsworth, 1979; Alexander, 1992).
Insecure attachments are considered to be a vulnerability factor with offending in general (Alexander, 1992) and Marshall suggests this can pose challenges in adolescence and can make children ill-equipped for the challenges of puberty, and thus less likely to achieve a satisfactory level of understanding of relationships and intimacy amongst peers and other relationships. He suggest that can result in confusing sex with intimacy which, combined with pre-existing loneliness, frustration and natural sexual urges may lead to inappropriate sexual promiscuity and violence (Marshall, 1989). Indeed, the pioneering practitioner on attachment, Bowlby (1944) published research based on a cohort of 47 young offenders, proposing that the absence of a secure attachment figure can ostensibly result in an 'affectionless psychopathy'. A condition characterised by a lack of empathy and an inability to form relationships.
Considering sexual offenders within a frame of attachment may enable practitioners who struggle to separate the offence and the offender to work more effectively with them. Indeed, there significant evidence which links insecure and disorganised attachment anti-social behaviour and aggression in adulthood. Using Attachment Theory in which a way with sex offenders does not serve to justify their actions or behaviour, however when considered amongst the myriad of other social and psychological factors, some understanding of cognition and behaviour may be observed which is something that practitioners struggle with (Sheath, 1990; Hudson, 2005). As such, attachment theory does not give us a set of rules for dealing with sex offenders but is does support better understanding as well as support a better understanding on their own behaviour.
5.1 Working with sex offenders in custody
Whether it be increased awareness, less tolerance, changes in attitudes or the rise of DNA testing - there has been a gradual increase since the 1980's of incarcerated sex offenders, putting increased pressure on prison structures, agencies who work with the client group and the need to find suitable, sustainable and effective treatment for sexual offenders (Greenfield, 1997). We also live in a world where public opinion wishes sexual offenders to be as socially excluded as possible and therefore prison presents as the perfect place for them to remain. Though seemingly straightforward, this does however present with an increasing number of issues; there is of course the spiralling cost of custody and remand places, the likelihood of meeting 'like-minded' and collusive people but also the fact that social exclusion has a tendency to increase risk, rather than reduce it (Sommerville, 2000).
Over the past 30 years the focus of treatment in relation to sex offending has been almost exclusively around the management of risk and protection of the public demonstrated by highly reactive and confrontatitive interventions (Sheath, 1990). While there is a clear rationale for this approach, given the media and political pressures as well as the public fear of victimization; it has left a fundamental gap in relation to rehabilitation and led to an overuse of custody (Garland, 2001). This sort of 'out of sight' punishment further exacerbates the idea of sex-offenders as sub-human beings and provides justification to treat them less favourably. While it can be understood that this view is held by the public, it is sadly often replicated by prison staff and other male in-mates who revel in 'giving them a hard time' by ritual beatings, ostracization and often rape (Sheath, 1990).
5.2 Ethical conflicts
Sex offenders in custody occupy very low status, and in many UK prisons are routinely segregated on separate wings often referred to as the vulnerable prisoner's wing or, more commonly the 'nonce' wing. Separation from the main populous can lead to offenders denying their offence in order to maintain safety from retribution seeking inmates. The upshot of this is sex-offenders are immediately disadvantaged, socialising less and with less opportunity to show that they have 'changed'. In essence, this equals to a situation where, before prisons have even had the opportunity for rehabilitation or treatment, they are excluded, dehumanized, victimized and subject to more discrimination and oppression that offenders who may be serving back to back life sentences.
Glaser (1969) found that a positive attitude by custodial officers critical to facilitating change in sexual offenders prior to their release. Hogue (1995), for example, found that prison officers who were not involved in the treatment of sexual offenders were significantly more negative in their attitudes towards sexual offenders than prison officers involved in treatment. Weekes, Pelletier, and Beaudette (1995) further found that only 20.7% of custodial officers viewed sex offenders as even treatable, rating them as more unchangeable, dangerous, irrational, mysterious, than non-sexual offenders. Of particular note, 68% of this sample of custodial officers indicated that they wanted more training in how to deal with sexual offenders and only 12.3% reported that their training had prepared them adequately enough.
While prison exists to restrict the liberty of offenders, it also has a fundamental function to observe basic human rights of its inmates as per the Human Rights Act. The Howard League for Penal Reform found that sex offenders (and indeed many other prisoners) were routinely having basic rights abused or unmet, specifically with relevance to sex offenders is including Article 3: - the right to freedom from torture or inhuman and degrading treatment and Article 14: freedom from discrimination. The status quo is therefore damaging; as Ward and Brigden discuss, when the sex-offender has their dignity and rights observed they are more likely to comply with treatment and to behave. Indeed, further deprivation of human rights simply perpetuates stigmas and breeds resentment (Matravers, 2000). In fact, by continuing to oppress the basic needs and rights of a sex-offender, one could argue that you are simply reinforcing their existing attitude which vindicates their offending and compliments and confirms cognitive distortions (Hudson, 1998; Thomas and Tuddenham, 2002; McAlinden, 2005; Ward et al, 2007).
Hudson (2005) looks at sex offenders' perspectives of their treatment and management and concludes that the majority of sex offenders do indeed see themselves as victims; both in relation to how they are treated by fellow inmates and prison staff alike. Following the prison riots across England and Wales in 1990, Lord Justice Woolf conducted an inquiry which found that; the abuse that sex offenders suffer, together with the restricted regimes that they endure, produce, in sex offenders a sense that they are somehow victims themselves, rather than perpetrators of crime. Therefore if a reduction in re-offending is the aim, attention needs to be focused on what they themselves have done, rather than what they are having to suffer (Sampson, 1994).
5.3 Sexual Offender Treatment Programme (SOTP)
Whilst in custody is perhaps the best place to rehabilitate sexual offenders given that there is opportunity offend, however the attitude of the main prison populous and custodial officers meant that meaningful engagement with the client group was uncommon, resulting in engagement in intervention which was often incentive based, mandatory or coercive. SOTP is however regarded as the most ethical way of rehabilitating sexual offenders and is offered on a voluntary basis to male prisoners convicted of a sexual offence or a violent offence with a sexual element (HMPrison). Introduced in 1991, SOTP is based on the apparent 'effectiveness of cognitive behavioural therapy' (Beech, et al, 2003: 2), compromising Finkehorn's thinking that sex offenders lack social skills, empathy and awareness and a problem solving focus including socialisation and moral reasoning elements (Falshaw et al, 2003).
The programme can be lengthy and will only be offered to offenders who have both the capability and indeed the time to complete it (Cobley, 2005). This presents another ethical dilemma around the motivation as some sex offenders in custody may perceive inclusion in treatment as a vehicle to early release as opposed to an intervention to effect personal change (Ellerby, 1997). Consequently, many participants appear resistant, deceptive and unwilling to fully participate (Clarke, 2011).
While public opinion will favour custodial measures, the eventual goal for any prisoner must be re-ablement and release. While a punishment first, engagement in therapeutic process whilst in custody is fundamental to ensuring that sexual offenders receive the treatment they both require to better understand why they offend and help them desist and allay society's unrelenting distain towards them. This is by no means an easy process, and from the literature observed, practitioners must themselves be mindful about their health and well-being, but also the attitudes they hold towards this client group. It goes without saying that it is hard to be effective when working with difficult service users, however this can understandably become significantly more challenging when colleagues are unsympathetic and undertaken in physical surroundings which are themselves' unlikely to be relaxing or restorative. Although not studied directly in the context of sex offender treatment provision, the importance of physical surroundings on psychological health (e.g. lighting, noise, indoor air quality) is an important area for consideration and has a recognised impact on mental health and well-being (Evans, 2003).
6.1 Practice in the Community
Until relatively recently, offences of a sexual nature were for want of a better word, 'bundled' in with violent offences. Legislation referring specifically to 'sex offenders' appeared in 1991 as the Criminal Justice Act offered longer 'protective' sentences for sex acts. This was followed in 1997 by the Criminal Evidence Act which gave police power to obtain DNA from sexual offenders. In the same year the Sexual Offences Act, Crime Act and Sexual Offenders Act were also introduced. The latter famously required all sexual offenders to be registered with the Police. The Crime and Disorder Act (1998) and Management of Sexual Offenders and Sentencing Bill (2005) added 'extended' sentences for sex offender post-release including polygraph testing and electronic curfews as a means of providing extended surveillance and protection for the public.
This raft of new legislation, whilst indicating the government's commitment to public protection, is also thought to be directly related to the media coverage which had adopted a 'name and shame' position. A mixed picture is certainly painted for practitioners; on one hand encouraged to work therapeutically with offenders in their community while on the other the government produces increasingly defensive risk models and surveillance measures (Thomas and Tuddenham, 2002). While as social workers we must acknowledge the difficult tension between protection of the public and that of the rights of the service user, the defensive position of the government is arguably understandable; as such, the 'Risk-need' model (Hudson, 2005) has become very popular in Great Britain, but also in North America, Australia, and New Zealand.
The risk-need model primary aims are to reduce potential of harm to the community rather and improving the quality of their life (Andrews & Bonta, 1998; Gendreau, 1996). Given its penal undertones it has unsurprisingly the preferred model and more likely to curry favour with the voting public, government and the media. While it has its place crudely speaking, from a social work position there is a clear need for the views of the client to be taken into consideration, whatever the public opinion on them may be (Garland, 2001). Indeed, evidence suggests that exclusion increases risk of offending and therefore attending to human needs, increasing confidence and improvement of one's overall quality of life by promoting social inclusion and focusing on rehabilitation is more likely to reduce the risk of re-offending (Ward and Stewart, 2003).
6.2 Ethical conflicts
Any prisoner serving a sentence of over four years in prison will be allocated a social worker, thus as the average length of sentence for a sexual offence is five years is likely that most sexual offenders will have social work involvement. The social worker is responsible for information sharing, working with the prisoner and their family in conjunction with the prison social care unit but also to assess risk; both in relation to what activities can be conducted and for the completion of a risk management plan. This contact will remain while the offender is managed in the community and in many cases beyond the end of the license.
There are complicated guidelines when working with sex offenders in the community and given the seriousness of their crime, intervention will normally be in conjunction with Multi Agency Public Protection arrangement which, as their names suggests will see 'public protection' as their priority. As such, it is crucial that social workers are involved with the process to ensure both protection of the public, but also protection of the rights of their service user. Sex offenders occupy with largest percentage of MAPPA cases, however 71% of said are currently assessed posing no significant risk to the community and categorised level 1; meaning they are managed with local supervision i.e. probation teams. While MAPPA categorisation marks another label which sex offenders are made subject to and adds further stigma and restriction to liberty, this is little compared to that of the 'sex offenders register'.
This 'register' represents significant curtaining of human rights, presenting difficulty when considering the 'core' fundamentals of social work which must include respect, valuing integrity and preservation of dignity (BASW, 2002). Indeed, while there must be balance between human rights public protection, prominent practitioner and academic in the field, Erooga argues in defence of such means stating 'interests of the community should always eclipse the interests and rights of sex offenders' (Erooga, 2007 p.181).
Initially, the register appeared to be a useful tool with compliance calculated at 94.7% in its first evaluation in 1997 (Plotnikoff and Woolfson, 2000). Indeed, compliance continued to rise, reaching 97% in 2001 following the Criminal Justice and Court Services Act 2000 which increased possible imprisonment for non-compliance with the register from six months to five years. Since its inception various additions have been made including photos, fingerprints, travelling restriction and police reporting; all were integrated into the Sex Offenders Act 2003.
'Compliance' with the register however requires nothing more than adhering to its restrictions; thus while having a register offers a certain safety through baseline accountability, there is little evidence that being part of a register serves to reduce one's likelihood of re-offending. Rather, the 'sex offenders register' has been significantly misused by the nation's media by exploiting the freedom of information by printing the names and addresses of sex offenders. Paradoxically, the stigmatisation, shame and social exclusion brought from being included on a modern day 'most-wanted' list is far more likely to lead to increased chances of risk (Ward, 2007).
Opposition to the Sex Offenders Act 2003 on the grounds of human rights' infringement has been largely unsuccessful and often vehemently opposed by political figures hoping to point score with the public. A recent ruling from the Supreme Court which called for convicted sex offenders who were registered 'for life' to appeal fifteen years after release from custody caused significant commotion amongst politicians and, speaking to the Telegraph in 2011, Prime Minister David Cameron stated such a ruling was both 'offensive' and flied in 'the face of common sense'. Indeed, the conservative party have been long time critics of the human rights act and this ruling has supported the party's commitment to review current legislation with view to making it a key element of their next election manifesto (BBC, 2011). In addition to privacy, legislation further restricts the most basic human rights including crucially, freedom as most criminals who complete their sentences have their liberty reinstated. Sex offenders however continue to suffer restrictions often years beyond their sentence.
The past twenty years has, as discussed, seen significant discourse between rights risk management and as I write, Ministers in the UK have begun plans to roll out mandatory polyphonic testing for the 3,000 convicted sex offenders who are living in the community following successful pilots between 2009 and 2011 in the East and West Midlands.
Though contentious, research found that when anticipating the so called 'lie detectors', sex offenders tended to be more likely to disclose information, while on the other hand continuing to perpetuate the stereotype of sex offenders as well-practiced lairs (Grubin, 2004).
While there are various arguments in relation to the use of polyphonic testing, the two most distinct tend to be in relation to accuracy and ethical justification for mandatory use as, again while polyphonic testing may be able to support decisions around risk, at present there is no evidence that the use of the test reduces post-treatment recidivism and critics argue that including the test amongst professional practice standards merely enhances what is the illusion of scientific credibility (Kokish, 2003; BBC, 2012).
While significant literature on sex offenders focuses on recidivism rates, it remains one of the most widely misunderstood and overestimated areas of the subject and public perception has been found to be over three times greater than those found in empirical research (Fortney et al., 2007). As sexual offences often go unreported offending rates are difficult to judge, however given the intrusive nature of the treatment and the unparalleled surveillance to which clients are made subject, rates of recidivism should be acknowledged.
Despite public opinion and media reaction to 'high profile' offenders releases from custody, recidivism rates amongst sexual offenders are actually relatively low with most estimates under 20%. Hanson and Bussiere's (1998) meta-analysis indicates that sex offenders' five-year re-offense rate is on average only 13.4%, making it significantly less than the re-offending rate for criminals of non-sexual offending. In a longitudinal study of 477 adult sex offenders, Barbaree's research over a period of 5.9 years yielded an overall recidivism rate of 11.3% (1997). It is unsurprising that sexual offenders who complete treatment are at a lower risk of re-offending that those who do not and therefore more should be done to encourage engagement in therapeutic processes amongst the group (Hanson et al, 1998).
As there is a need for supervision in public, the role of practitioners must move beyond that of simply management of risk and look to reintegrate back into society. As discussed, the emerging body of research suggests that overly punitive measures which are offence focused and victim specific can promote exclusion and shame and thus, may increase risk of re-offending making their effectiveness something which must be considered (Hudson, 1998; McAlinden, 2005; Thomas and Tuddenham, 2002). The above evidence supports a position that the measures in place to protect the public are in fact working effectively and therefore the treatment is effective. Therefore, as practitioners we must begin to look inwardly at our own practice and reflect upon the conflicting messages that different agencies and bodies espouse and promote treatment which is inclusive and promotes respect, dignity and empowerment. I say empowerment with some caution, as many practitioners believe that achieving 'power' over their victim is at the core of sex offender's agenda far more a goal than sexual gratification, however the recent influx of Internet child pornography contradicts this and raises an argument that additional resources and a return to modifying deviant interests may be necessary (Marshall et al, 2008). This said, given there is so little research on 'what works' with this specific group, McAlinden (2005) proposes that in the absence of a tangible or suitable alternative, there is perhaps a need for progressive thinking and 'careful experimentation' (2005 p.388).
7. Anti-Oppressive and Anti-Discriminatory Practice
7.1 Social work emerged in the 19th century incorporating three positions of social action; through professionalism, direct involvement based on social pacifism and the charity movement (Seed, 1973). The latter was to become the most successful and effectively social work as we know it today and it is within the stand of social work where ethics and values have emerged with the most influential being that of Anti-oppressive and anti-discriminatory practice (Hugman and Smith, 1995). Anti-oppressive practice is now a guiding force within social work; inherent in training and in practice and serves to promote awareness of social divisions and hierarchies, challenge norms and assumption and to offer emancipation (McLaughlin, 2005). The International Federation of social workers furthermore state that the 'main role' of the profession is to liberate the vulnerable and oppressed to promote social inclusion (Horner, 2003).
While in current practice this seems like a wholly reasonable for a professional body such as social workers, many believe that sex offenders forfeit their human rights due to the nature of the offence committed and thus they are placed outside the realms of protection (Ward, 2007). As discussed previously in the paper, the media has tirelessly worked to change the public view of the sex offender by dehumanizing them and referring to them animals and monsters. Many will agree that this notion is completely rational and justified, however from an ethical, social work and rehabilitative position this view is oversimplified and represents short-sighted thinking. As social worker we must be remain committed to ensuring that the rights of all our clients are recognised and adhered to, even if on a personal note their values are not aligned with our own.
Hackett argues that one of the main challenges for anti-oppressive practice comes in the need to locate the sex offender with the oppressor/oppressed continuum. This, he suggests has become the standardised approaches to ADP have routinely acknowledged the client as oppressed with the intervention task from social workers to empower to overcome the oppressive forces and factors with which they are dealing. While considering the offender as oppressed with acknowledgement of the significant and lasting harm they have caused would be untenable and collusive; work with sex offenders has a tendency to see the sex offender solely as an oppressor and, as many authors have note that sexual offenders themselves have been victims of abuse and/or oppression (Fisher, 1994; Featherstone et al, 1997). Hackett goes on to suggest that there is an issue of focus in relation to social work and AOP with sex offenders, who he asks, is the actual client? The sex offender? The community at large or the victim? Intervention with sex offenders will normally focus on the two latter which essentially allows practitioners to side-stop AOP with the abuser (Gocke, 1995). Lastly, Hackett raises the question of being deserving of non-oppressive practice acknowledging that the offence committed can frequently eliminate sex offenders from discussions about 'rights'. Every person is born with inherent human rights, and this includes those who offend - sexually or otherwise. Human Rights Legislation is committed to protection of rights 'without qualification or exception' and presents an ethical ideology, an equilibriutive means of 'bridging and transcending countries' boarders, ethnicity matters, gender issues, classes to provide equality, fairness and protection to all (Churchill, 2006). So, while we may recognise that sex offenders are rights violators, they are also holders and therefore, while they should no doubt be subject to restrictions, the idea of stripping them of identity is dangerous (Ward & Birgden, 2007).
Because sex offenders have broken the law as well as violated the rights of their victims, the state has a duty to punish them as well as protect the community; there is however crucially an obligation to respect them as people, protect them against violations, and uphold a human rights framework (Gostin, 2000). There are literally thousands of books on the subject of human rights, with hundreds more being published every year, however there has been little observed regarding the rights of the sex-offender and in 2004 Brigden conducted a review which found that there were only three journals which discussed the contentious topic; suggesting it is an area which is under researched and represented (Freeman-Longo, 1996; Laws, 1999; Marshall, 1996). Specific Indeed, while human rights and improved equality in practice and recognition has been observed in the fields of social work and probation, there has been less progression in fields of corrections and forensic psychology; both of whom work closely with sex offenders whilst in custody.
Ensuring that human rights are met and acknowledged is the cornerstone of Anti-oppressive practice. Generally speaking, AOP is considered to be an unquestionably good thing (Dominelli, 1998), as such criticism or comment on its tenants often places the critic on the side of the oppressor (Beresford and Wilson, 2000). Oppression is at its very core when individuals or groups who are regarded as different are devalued and dehumanized and this difference being used in order to justify action (Preston-Shoot, 1995. p 15). Thus, when ensuring that practice is anti-oppressive it is important to ensure that we are careful not to stigmatise or pathologise those whom we work with (Hackett, 2008). ADP is associated with a radical value base which highlights the importance of 'user control' and equality rather than equal opportunities and rights not needs as well as citizenship over respect (Preston-Shoot, 2005). It is however hard to see how user control, quality and rights are to be directly applied to work with sex offenders as regardless of what life experiences they may have had; sexual offenders have abused their power in order to oppress others (Morrison et al, 1994). The notion of empowerment therefore becomes highly contentious as the need for power and control is proven to be one of the main motivators for sexual aggression (Jones et al, 1999).
Perhaps the most difficult aspect of working with sex offenders is seeing them as simply 'service users' and acknowledging their needs to be as valid as someone who needs support such as a child in need or a client with mental ill-health. However, practitioners should consider that like issues with other client groups, there are developmental, social, biological and situational factors which are thought to be contributory to the onset of sexual deviance (Ward et al, 2006). Contemporary meta-analytic studies have reported that static variables relevant to sexual offending recidivism include vulnerability factors such as a dysfunctional childhood, conduct disorders, minority status, cognition and attitudes tolerant to anti-social behaviour and/or sexual offender, psychopathy and substance use (Ward, et al, 2006: Geaudreau, Little, & Goggin, 1996; Hanson & Bussiere, 1998; Quinsey, 1995). In light of this, the view of a service user as a 'sex offender' seems to habitually override any other rights they may have and the fact they may be gay, female, a child, disabled, black or ethnic minority is generally overlooked which in turn appears to excludes them from anti-oppressive discourses. Ward (2007) argues that for effective treatment to take effect both the offender's rights, and those of others, should be acknowledged and incorporated into treatment. This dual focus, he states, has the capacity to uniquely motivate offenders to acquire the skills and values required to live offence-free lives.
While there are many stigmas which sex offenders find themselves subject to; such as lacking empathy or moniker of a peculiar dark 'stranger' (when in fact most victims of sexual offending state that the abuser has been a family member), there has been a longstanding clinical assumption that the clients lack certain social skills such as confidence and communication skills (Hudson and Ward, 2000). More recent surveys have however found that the client group are more likely to suffer much more 'human' issues including issues with intimacy, loneliness, self-esteem, relationships and attachment deficits (Keenan & Ward, 2000; Marshall, 1996; Marshall & Barbaree, 1990; Marshall et al, 1996; Marshall et al, 2000; Smallbone & Dadds, 2000; Ward et al, 1995; 1999). This offers crucial and insight into sexualised behaviours and Marshall and colleagues (1999) hypothesise that insecure childhood attachment may be a root cause of intimacy issues and difficulties interacting with and understanding others.
Anti-oppressive practice is not a means to an end and something which, as practitioners we must strive for, challenging oppression and discrimination as and when we encounter it. Fortunately for students today the struggle to have such principles acknowledged has existed in the three decades which have preceded us. For these pioneering practitioners, taking an anti-oppressive stance placed them at odds with the state and subjected accusations of being overly 'politically correct' were used to undermine and denigrate those who were seeking change within the social and (conservative) political structures (Wise, 1995).
Throughout this paper I have discussed the various challenges and conflicts which arise from applying the principles of anti-oppressive and discriminatory practice to work with sexual offenders through considering different ethical positions in relation to the current ways in which this client group is worked with. This is not to suggest that practitioners and services are not already making efforts to apply these core social work principles and over the following chapter I will discuss interventions which have sought to facilitate the difficult balance.
8.1 Models of intervention with sex offenders
Morrison discussed how intervention in the field of sexual offenders cannot be value free (1994), and continuing the work of Salter (1988) proposed that an acceptable value base for practitioners should reflect acknowledgement of a prosecutable criminal offence which is fundamentally unacceptable. Indeed, while the overarching aim of sex offender treatment must be protection of the public, the apparent success with treatment over that of purely punitive measures certainly suggests a need to adopt therapeutic means of dealing with the sex offender problem.
Naturally tensions arise when combining social work's core values including warmth, value and respect with the confrontational and ethically questionable methods of treatment which have been permitted with sex offenders due to the media and political pressure. As a result risk, penal and correctional interventions have dominated. Sheath (1990) was amongst the first to recognise the short-comings of confrontatitive interventions and began to deconstruct the formulaic methods used in sex offender treatment, looking most specifically at CBT, and suggested alternatives approaches characterised by respect (for the offender, not the offence itself) and the need to understand the experiences of the offender contextually thus recognising potential developmental and environmental factors which may have been contributory. He argued for a balance between risk and need and his influence is reflected in some facets of work with sex offenders. Personal Construct Theory (PCT), for example requires practitioners so see the 'client' as an individual with their own unique and valid takes and interpretations and perspectives. Unlike in CBT where the sex offender is informed from the offset that their view is wrong and shameful (and so ultimately further damaging to self-esteem and professional/client relationship); PCT challenges us to observe the world from their position. By doing so we can hopefully begin to empathise, considering that perhaps their behaviour, though not justified, may be understandable given the circumstances which may have disaffected them.
The Thematic Inspection of Probation Service work with Sex Offenders (HM Inspectorate of Probation, 1998) supported these ideals, stating that treatment should apply "What Works" principles to work with sex offenders (McGuire, 1995) thus targeting those most at risk of re-offending by concentrating on areas related directly to offending and acknowledging risk and need. Such needs are important to consider, especially when considering the high amount of sex offenders who are themselves survivors of abuse. Dependent on studies, this number can be as high as 80% (Erroga, 2002). Indeed, while a small number of offenders are responsible for many offences, the victims are seldom children (Grubin, 1998). Beckett suggest that abuse surviroes tend to have difficulties forming appropriate adult relationships experience other problems (which include cognitive distortions) which link to their childhood (1994). Given the high number of offenders who are themselves victims, Maletzky and McGovern (1990) recommend the use of theSexual Assault Cycle which plots the offender's own pattern of abuse alongside a timeline of their changing patterns of sexual arousal including how the felt, what they were doing and feeling at the time in order to identify triggers.
Other practitioners have sought to plug the gap in interventions and amongst the most viable suggestions were raised by Brig