The importance of group processes in offender treatment
Introduction
An interest in, and an examination of, process issues in psychological treatment has a long history. Indeed early psychoanalytic practitioners accepted without question that it was the interactive processes between the therapist and the client that was the vehicle of change (Sterba, 1934, Zetzel, 1956). These processes were framed in terms of transference and countertransference (Greenson, 1967). In other forms of psychotherapy the processes of therapy have also been seen as the effective components of treatment with procedures or techniques being assigned, at best, a marginal role (Frank, 1971, Frankl, 1978, Kohut, 1990, Rogers, 1961, Strupp and Hadley, 1979, Yalom, 1980). It is only recently that behavior therapists and cognitive behavior therapists have shown an interest in these features of treatment (see Schaap, Bennun, Schindler, & Hoogduin, 1993, for a summary of this literature up to the early 1990s). Early behavior therapists were concerned to develop techniques to change problematic behaviors and seemed to imply that the way these techniques were presented to the clients was largely irrelevant (see Kazdin, 1978, for an early history of behavior therapy). Behavior therapists took this position, at least in part, because techniques could be described in terms that allowed replication whereas the processes of treatment were not so easy to detail to the same level of precision.
Process issues in therapy have been identified as involving four aspects: (1) features of the therapist; (2) clients' perceptions of the therapist's features; (3) the therapeutic alliance; and (4) the therapeutic climate in group treatment. In our review of process variables (Marshall, Fernandez, et al., 2003) we identified 34 features of the style of therapists that had been either demonstrated to influence or block treatment, or had been repeatedly claimed to be influential. Some of these features appeared to be more influential than others, and some subsumed others; for example, it may be impossible to be warm and empathic and to not be genuine, supportive, and respectful (Safran & Segal, 1990). The features or style of effective therapists have been the primary foci of process research over the years. Relatively little attention has been paid to the clients' perceptions of the therapist but what has been done indicates that clients often do not see the therapist in the same way the therapist sees him/herself (Free, Green, Grace, Chernus, & Whitman, 1985) and yet the clients' perceptions accurately predict treatment gains (Orlinsky, Grawe, & Parks, 1994). The therapeutic alliance refers to the degree to which the therapist and client work together, which, to a large extent, is a function of the style of the therapist. This therapeutic alliance has been given considerable research attention, and has consistently been shown to strongly predict the benefits derived from treatment (Martin, Garske, & Davis, 2000). Finally, in group therapy the so-called “climate” of the group on various dimensions has been shown to influence outcome (Yalom, 1995).
This paper, then, will address the issues involved in the delivery of treatment programs for offenders. Descriptions of treatment, particularly when these descriptions are embedded within a detailed treatment manual, typically have little to say about therapeutic or group processes (see Marshall, 2009 for a discussion). Clearly it is easier to identify treatment targets and to describe procedures to modify these targets, than it is to outline essential therapist features, the ideal therapist–client relationship, and the optimal group climate. In addition, even if these process issues could be described, it would be even more difficult to specify how these features are to be enacted. As a result, few descriptions of treatment for offenders have included these issues.
An ideal evaluation of the influence of process issues would require comparisons of beneficial changes across several programs each run by a different but equally trained and experienced therapist, where each group of clients was approximately matched on their histories of problems, and where all the programs were required to follow the same guide or manual, and be monitored to ensure compliance with the manual. Not only would this be a rare circumstance, but the requirements for therapists to follow a manual and be closely monitored for compliance would necessarily reduce the flexibility essential to maximize the advantages of the process issues (Marshall, 2009). In those circumstances any effects derived from therapeutic processes would be diminished, so if any were evident we could assume that they would be of greater magnitude under more flexible conditions.
Despite these concerns there is clear evidence of a significant influence of the various aspects of therapeutic processes on the attainment of treatment goals. We will deal with these issues in three parts: (1) evidence from the general clinical literature; (2) observed effects for adult offenders; and (3) the influence of these factors in the treatment of juvenile offenders.
Section snippets
General clinical literature
In the treatment of various Axis 1 and Axis 2 disorders, researchers have isolated the influence of various aspects of therapeutic processes on treatment-induced changes. These processes include: therapist characteristics, therapeutic alliance, and features of the group climate. Much of the research on the first two processes has been derived from individual (on-on-one) therapy although recent motivationally-based treatment has provided the opportunity to evaluate therapeutic processes within
Nonsexual offenders
As a result of their meta-analyses of offender treatment outcomes, Andrews, Bonta, and Hoge (1990) generated a set of principles of effective offender treatment. Among these the most important for the present issues is what they called the “responsivity” principle. This principle addresses the need to employ demonstrably powerful change strategies (general responsivity principle) and to adjust the delivery of treatment to each client's unique features (e.g., personality and cognitive style);
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