CoSA Funding Threatened (Again) in Canada

Last week, all Circles of Support and Accountability (CoSA) projects in Canada were informed by the Correctional Service of Canada (CSC) that their contracts would be terminated at the end of the current fiscal year, which in Canada means end of March 2014. The finality and implications of that decision are still being reviewed, but it is clear that CoSA funding in Canada is again under threat.

CoSA began in Southern Ontario in the summer of 1994, but it wasn’t called that then. Repeat child molester Charlie Taylor was being released from Warkworth Institution (a medium security federal penitentiary). Although most offenders receiving determinate sentences in Canada are eligible for conditional release (i.e., day parole, full parole, or statutory release at the two-thirds point) before the end of their sentences, it was not uncommon in those days for a high risk sexual offender to be detained by the National Parole Board. In such circumstances, the offender is held until the very end of his sentence (known in Canada as the Warrant Expiry Date, or WED). This is equivalent to the US experience of “maxing out”.

On the surface, the practice of detention appears to make sense. High risk sexual offenders who have refused treatment or have been otherwise problematic while incarcerated are held past their release eligibility dates, thereby delaying their release to the community until the last possible moment. But, when one looks a little deeper, the practice is fraught with potential pitfalls for the community. The Correctional Service of Canada provides an array of treatment and other reintegration services for sexual offenders on conditional release, including problem-solving skills training, substance abuse treatment, job search, and psychiatric services, among others. The key point in this, however, is the phrase “on conditional release”. Offenders released at the end of their sentences are not eligible for such reintegration assistance, on the basis that they are no longer under the umbrella of CSC or the federal government’s responsibilities for offender reintegration. This was the situation facing Charlie in 1994, and the many WED sexual offenders who have since followed.

Charlie’s release was an incident waiting to happen – a repeat sexual offender with dozens of prior victims released to the community with no formal aftercare or link to the community in any meaningful way. Understandably, the citizens of the city to which Charlie was released were incensed. However, prior to his release, efforts were undertaken to establish some aspect of social support for him, which was principally in the form of a group of volunteers from a local Mennonite church under the direction of the Rev. Harry Nigh. That small group of volunteers pioneered what we now know as Circles of Support and Accountability, a model of professionally supported volunteerism that has proliferated across Canada and into the United Kingdom, Europe, and the United States. There are presently over 30 individual CoSA projects worldwide, all based in part on the innovative model developed over the past 20 years in Canada. Indeed, US-based evaluability research has assessed projects in terms of how much fidelity they show to the original Canadian model.

Funding for CoSA projects in Canada has always been tenuous. When delegates from CSC and the Mennonite Central Committee of Ontario (MCCO) traveled to Ottawa to discuss funding with then-Solicitor General Herb Gray in 1996, they were initially turned down. Mr. Gray asserted that the Government of Canada had no legal responsibility for providing services to offenders no longer serving sentences. However, he was persuaded that while no legal responsibility existed, there was a moral responsibility to assist in protecting citizens from harm that might be committed by known at-risk offenders. On that basis, a funding structure was established that has seen CoSA projects receive federal government funding over the ensuing 18 years. Once again, this funding relationship is under threat.

To be fair, the government (via CSC) may maintain some funding for CoSA projects; however, reports are that this funding will be limited to work with only certain types of offenders. Since Charlie’s WED release in 1994, Canada has legislatively attempted to address the problem of WED releases with no aftercare. At the time of sentencing, sexual offenders with prior histories and who present particular challenges may now be declared Long Term Offenders and have post-sentence periods of community supervision appended to their regular sentences, known as a Long Term Supervision Order (LTSO). LTSOs are managed by CSC and offenders may be supervised in a parole/probation hybrid for up to 10 years post-sentence. It appears that CSC is, at least in principle, okay with CoSA projects working with LTSO offenders, who are still under CSC’s risk management umbrella. The offenders they no longer want to support are those who didn’t get an LTSO at sentencing and who are therefore released at WED. It’s déjà vu all over again. The public has been clear for decades that they expect their communities to be safe and that they want the government to provide protections; as such, the continued policy of WED release with no provisions for support or accountability raises ethical as well as moral questions.

CoSA was founded as a grass roots, community based response to what amounted to a failure of the government to protect the people. High risk sexual offenders were being knowingly released into the community with no aftercare, no supervision, and no attempts at linking them to social supports or other risk management frameworks. Courageous citizens like Rev. Nigh and more than 750 socially conscious Canadians have since stepped up to the plate to help cover that risk, often without much in the way of thanks or accolades. Despite its clear legal responsibility for managing sexual offenders on LTSO, CSC seems to be looking to outsource a substantial portion of this work back to the community to whom it is accountable. However, CSC doesn’t appear willing to assist the community in managing the risk of offenders for whom they (CSC) are trying to divest responsibility. There’s an issue of fairness here.

Realistically, the only pats on the back CoSA volunteers ever get are from the offenders they help or via research published showing the successes of their efforts and the model. To date, four controlled studies demonstrating the effectiveness of the model have been published in prestigious peer-reviewed journals (one of which was founded in Canada). Two of these studies are from Canada (1 and 2), the others coming from the UK and the USA. All four studies show the same outcome – dramatically different rates of sexual and other reoffending in groups of CoSA participants when compared to matched or randomly assigned samples who did not participate in a CoSA. These findings have been encouraging enough for the US federal government to support CoSA project development in various places in the US; the same being the case in the UK and ever more so in other international jurisdictions. Even behind the scenes, the most skeptical researchers have been impressed by CoSA findings.

Yet, in defending their decision to defund CoSA in Canada, CSC officials have declared CoSA research to be seriously flawed (surprisingly, two of these studies were originally published by CSC’s own Research Branch). To be truthful, there is something to this assessment. Four studies with small sample sizes and relatively short follow-up times – there is clearly a need for more research before we can definitively declare CoSA to be a truly evidence based initiative. Of course, virtually all scientific studies have flaws. But, really, the evidence comes from researchers in three different countries, all of whom found the same thing. Further, the decision to defund CoSA comes as Canada wraps up its participation in a 5-year national demonstration project funded by the National Crime Prevention Center, a federal agency affiliated with Public Safety Canada, ostensibly the same government ministry that wants to cut the funding. What’s the rush? Why not wait and see what the ongoing national research project finds?

In many ways, attacking the CoSA research base is disingenuous. This can be seen as a standard governmental and corporate tactic employed when one wants to close down something that touts empirical research as a basis for its existence. The great Canadian criminologist Paul Gendreau warns us of this sort of thing in his many publications regarding correctional quackery and “fart-catching”. Such attempts to selectively dismiss or promote research findings can also be seen as “ideologically and professionally convenient” (Andrews & Wormith, 1989):

"Knowledge destruction" refers to the uncritical acceptance of null findings, while findings of covariation are contaminated or dismissed through the mere suggestion of errors of conceptualization or measurement (Gottfredson 1979). "Knowledge construction" involves exploring the implications of identified threats to the validity of research-based conclusions and recognizing that the effect of threats is not always the production of inflated estimates of validity. Rather, "threats to validity" sometimes may have the effect of masking covariation or producing underestimates of the magnitude of covariation. In summary, an objective of the psychology of crime is to understand personal covariates of criminal activity, whereas an objective of major portions of mainstream criminology is to discredit such an understanding.

The current government in Canada remains convinced that it must implement criminal justice reforms that are, as a group, poorly supported by research. Mandatory minimum sentences, efforts to limit or deny conditional release, longer sentences for sexual offenders, and other get-tough-on-crime measures, which the government calls their “Safer Streets and Communities Act,” have been or are about to be implemented in Canada in the near future. Some of these changes are already being challenged – some successfully – in the courts. It is disquieting that the current government agenda is at times diametrically opposed to findings in decades of peer-reviewed research, most of it published by Canadians funded or working directly for the same government agencies that now seek to ignore those findings. As one volunteer observer commented after hearing of the impending defunding of CoSA, “My first reaction to this news is that communities are less safe this week than they were last week.”

To summarize, the Correctional Service of Canada (on the recommendations of the National Parole Board) used to release high risk sexual offenders into the community without aftercare or other follow-up services. This forced community members to take matters into their own hands through development of grass roots projects intended to provide support for offenders while ensuring a means by which offenders can be accountable for their behavior once released. Convinced that a moral responsibility existed to assist these community volunteers in their efforts, government funding has been provided to established CoSA projects coast to coast in Canada for nearly 20 years. This partnership in risk management between the correctional service and the community has become a best practice model for jurisdictions worldwide. Now, the Government of Canada seeks to cease that partnership in risk management with the community, one end result being that vulnerable citizens will be at increased risk for harm from offenders the government was so concerned about that those offenders were detained until the very last day of their sentences. This situation will no doubt be exacerbated by the fact that the government plans to spend millions of dollars on get-tough-on-crime measures that a quick review of the science will reveal are unlikely to work, while defunding an initiative that many people internationally are convinced is exactly the sort of approach most likely to work. Ultimately, the Government of Canada’s plan amounts to bad policy based on ignoring good science. And, given Canada's prominence in the "what works with offenders" world – including sexual offenders – that’s a shame.

Robin J. Wilson, Ph.D., ABPP

Wilson Psychological Services LLC, Sarasota, FL

McMaster University, Hamilton, ON

References:

Andrews, D.A. & Wormith, J.S. (1989). Personality and crime: Knowledge destruction and construction in criminology. Justice Quarterly, 6, 289-309.

Bates, A., Williams, D., Wilson, C., & Wilson, R.J. (2013). Circles South-East: The first ten years 2002-2012. Published online first April 24, 2013, International Journal of Offender Therapy and Comparative Criminology. doi:10.1177/0306624X13485362

Duwe, G. (2012). Can Circles of Support and Accountability work in the United States? Preliminary results from a randomized experiment in Minnesota. Sexual Abuse: A Journal of Research and Treatment. 24, 1-23.

Elliott, I.A., Zajac, G., & Meyer, C.A. (2013). Evaluability assessments of the Circles of Support and Accountability (COSA) model: Cross-site report. Washington, DC: Department of Justice.

Gendreau, P. (2009). Chaos theory and correctional treatment: Common sense, correctional quackery, and the law of fartcatchers. Journal of Contemporary Criminal Justice, 25, 384-396.

Wilson, R.J., Cortoni, F., & McWhinnie, A.J. (2009). Circles of Support & Accountability: A Canadian national replication of outcome findings. Sexual Abuse: A Journal of Research & Treatment, 21, 412-430.

Wilson, R.J., Cortoni, F., Picheca, J.E., Stirpe, T.S., & Nunes, K. (2009). Community-based sexual offender maintenance treatment programming: An evaluation. [Research Report R-188] Ottawa, ON: Correctional Service of Canada.

Wilson, R.J., Cortoni, F., & Vermani, M. (2007). Circles of Support & Accountability: A national replication of outcome findings. [Research Report R-185] Ottawa, ON: Correctional Service of Canada.

Wilson, R.J., Picheca, J.E., & Prinzo, M. (2005). Circles of Support & Accountability: An evaluation of the pilot project in South-Central Ontario. [Research Report R-168] Ottawa, ON: Correctional Service of Canada.

Wilson, R.J., Picheca, J.E., & Prinzo, M. (2007). Evaluating the effectiveness of professionally-facilitated volunteerism in the community-based management of high risk sexual offenders: Part two—A comparison of recidivism rates. Howard Journal of Criminal Justice, 46, 327-337.

The Promise and Peril of Role-Play in Experiential Treatment

A member of the Association for the Treatment of Sexual Abusers (ATSA) recently asked for others’ thoughts on having adolescents re-enact their sexual offenses as a part of group treatment. Of course, there is some question as to whether group treatment is the preferred modality for work with juveniles, but that is another matter for another post.

For those who may be unfamiliar, some adult programs have indeed used role-play re-enactments of sexual crimes as a means to explore the issues and harm of sexual abuse, although this practice has diminished. At the time, it certainly seemed like a good idea to many professionals.  There are probably many reasons for its decreased use, including research attention turned toward cognitive-behavioral therapy.

Experiential work in treatment can certainly deepen its impact. In an era when so much focus is on building clients’ responsiveness to treatment, experiential work seems a natural part a larger program that adheres to the principles of effective treatment. Among the helpful resources, John Bergman and Saul Hewish’s book, Challenging Experience (2004), offers many excellent ideas, and Bergman has recently summarized the fascinating history of experiential techniques in a 2012 book chapter. I incorporate many of these techniques into my own work. Of course, none of these resources advocates real re-enacting of the client’s own crime. Still, experiential techniques can be very powerful tools that only skilled therapists should use.

That said, there are many reasons not to have young people re-enact offense scenes in treatment. In fact, I would be extremely careful about going anywhere near it. Here are a few perspectives:

The first is a clinician’s perspective: Young people in trouble with the law often have far more complex/developmental trauma in their backgrounds than we realize. No matter how one looks at it, acting out offense scenes is a high-dose/high-intensity activity that is rife with opportunities for increasing shame instead of understanding. There is no doubt that some kids will gain some genuine understanding from it; however, my concern is that many more will simply acquiesce to it and say that it was an important experience for them while never sharing what they really went through doing it. Many is the young person victimized by an adult who came away saying it was not so bad or that they deserved it. To what extent are these kids truly consenting to experiential treatment activities that may a very public expectation of the provider or the program? When treatment completion is largely dependent on participation – and the adolescent knows that their peers are participating – how easily can they (and their families) weigh the risks against the benefits? Where does pressure offset consent? To what extent are we replicating abuse and abusive environments?

The net result for adolescents is more likely to be “I’m a bad person” than “I’ve done something harmful.” Further, the highly fragmented experience that results from past trauma makes it far more likely that kids will see this as one more bad experience brought down on them by adults. Many readers might look at this as a challenging experience brought about by caring people who have their best interests at heart. Not so in the world of traumatized teens. Professionals must build, re-build, and maintain must a positive alliance with them every day.

Obviously, it’s not helpful to criticize without offering an alternative. Instead of thinking “let’s give them an experience, so that they will understand the harm of their actions”, why not think in terms of “this is a young man capable of understanding the harm of his actions, and that understanding is in there somewhere. How can I elicit, invoke, or invite that part of this kid to talk to me, thereby having him provide his own experience of understanding? This way, any epiphany is more likely to occur in the way that works for him and on his timetable, rather than through my methods or in accordance with my schedule.

The second is a clinical supervisor’s perspective: Supervisors should ask themselves how confident they are that their clinicians can manage this kind of activity without difficulty? For inpatient settings (which is where these activities typically take place), how will they manage it when their young clients return to their units shaken and upset, experiencing shame and at greater risk for self-harm? It might not happen today or tomorrow, but something will happen eventually. Then there is the “Lord of the Flies” problem, in that many of the kids might feel shame, anxiety, or even gratification from acting out others’ experiences. How certain is the supervisor that he or she knows what the clinician is doing with this high-stakes activity? How will the supervisor respond to complaints by families? After all, in their minds, they signed consent for their child to enter treatment, not another world.

The third perspective is that of an administrator: This is a media event waiting to happen. Eventually, there will be a bad experience and it will make the newspapers. In fact, this has happened in at least one adult treatment program some years ago. Inmates complained that they were being told to re-enact abuse situations. The complaints received all sorts of coverage and there were complaints about tax dollars supporting this, etc. More recently, there was a juvenile program’s use of the penile plethysmograph that led to complaints that appeared in the newspapers across Canada (Turpel-Lafond, 2011). There are many ways to use experiential exercises, but re-enacting offenses is generally not such a great idea.

Humanitarian perspective: We often have no idea how much power we hold over our clients of all ages. It may be the easiest element to forget when working with people who have sexually abused. We need to be extremely careful how we use it.

David S. Prescott

References

Bergman, J. (2012). The theatre of meeting: The history of drama and other experiential therapies as neurological analogs. In R.E. Longo, D.S. Prescott, J. Bergman, & K. Creeden (Eds.), Current perspectives and applications in neurobiology: Working with people who are victims and perpetrators of sexual abuse (pp. 317-344). Holyoke, MA: NEARI Press).

Bergman, J. & Hewish, S. (2003) Challenging experience: An experiential approach to the treatment of serious offenders. Oklahoma City, OK: Wood’N’Barnes.

Turpel-Lafond, M.E. (2011). Phallometric testing and B.C.’s Youth Justice system. Report to the Legislative Assembly. Retrieved February 18, 2014 from http://www.rcybc.ca/Images/PDFs/Reports/PPG%20Report%20FINAL%20Updated%20April%2014.pdf.  

Treatment Providers: Born or Made?

On the listserv of the Association for the Treatment of Sexual Abusers (ATSA), a member recently observed that, in his experience, great therapists are born more than made. Indeed, many professionals who have worked in larger agencies have had the experience of working with someone who just didn’t seem to “get it.” The underlying assumption is that some of us are simply better than others. Is that true?

The stakes are high for professionals treating people who have sexually abused; don’t we all want to be the most effective we can be? Early pioneers stated that treatment must be confrontational (e.g., Salter, 1988, p. 93). More recently, Marshall (2005) summarized a number of studies showing that the most effective therapists are those who are warm, empathic, and rewarding, while providing clear direction. What seems to be the case is that no matter the therapy, agreement between therapist and client on the goals and tasks of treatment, as well as on the nature of the relationship itself (these factors being referred to as the therapeutic alliance), is vital (Wampold, 2001).

At first, Marshall’s findings seem encouraging. Warm, empathic, rewarding – that’s me, right? Until we ask others, including our clients. A major problem is that almost everyone considers themselves warm, empathic, and directive in one way or another. Do you know anyone who says they are cold and not particularly empathic? It’s now been 16 years since Beech and Fordham (1997) found that people treating men who had sexually abused believed themselves to be more helpful than their clients do. Have we gotten more effective since then? Or, does our faith in ourselves actually prevent us from becoming the best therapist we can be?

Research by Scott Baldwin and his colleagues (Baldwin, Imel, & Wampold, 2007) and by Bruce Wampold (2001) has found that there may be fewer differences between therapeutic approaches in psychotherapy, overall, than there are between therapists. Does this mean that who professionals are is more important than what we actually do?

A couple of recent publications should give us pause to consider our practice. The first is by Helene Nissen-Lie and her colleagues in Norway. The second is a review of research by Theresa Moyers and Bill Miller.

Helene Nissen-Lie and her colleagues (Nissen-Lie, Havik, Høglend, Monsen, & Rønnestad, 2013) examined an international sample of 70 therapists and 227 clients. The authors used measures that explored the personal satisfaction and personal burdens of each therapist. They next examined the therapist’s and the client’s experience of the alliance. They found that therapists with high levels of personal satisfaction rated their alliance to be higher than their clients did. The therapists’ self-reported level of personal burdens was strongly and inversely correlated with the client’s rating of the alliance. In other words, therapist’s experiences of their own problems seemed to have a greater effect on their alliance than their experiences of satisfaction. Important to recall is that it is the client’s experience of the alliance that predicts the success of treatment, and not the therapist’s.

Clearly, this was not a study of recidivism rates of sexual offenders, but instead yields important clues as to how therapists can build alliances that will help their methods become most effective. In this writer’s experience, many people who have sexually abused have described a sense of knowing when the time or situation was right to commit a crime. Why shouldn’t they also know when their therapist is on their game… and not?

In his early years, Bill Miller, then only beginning to develop motivational interviewing, decided to run a simple experiment. He looked at therapists providing substance abuse treatment, expecting to find that their clients relapsed less than people with addictions who read self-help books. He was wrong; there was no difference. Perplexed, he repeated the study and realized that those therapists who were judged by their peers to be more empathic did indeed produce clients who abused substances less. Therapists who demonstrated less empathy produced clients who would have done better with a good book. These findings are deeply frightening, but necessary to address if our field is ever to improve.

Since then, Theresa Moyers and Bill Miller (2013) have come to believe that although empathy levels differ between therapists, an important element of treatment provision is to screen for it during employment interviews and teach it to clinicians wherever possible. They also remind us of the body of research showing that it is the client’s perception of empathy that is more important than the therapist’s self-assessment. Further, they clarify that what is important is the actual demonstration and expression of “accurate empathy,” which they define as a:

… commitment to understanding the client's personal frame of reference and the ability to convey this heard meaning back to the client via reflective listening … the process encompasses the accurate understanding of both cognitive and emotional aspects of the client's experience as well as attunement to the unfolding experience of a client during a treatment session.

It can be a common refrain among treatment providers to say that people who have sexually abused are different or more challenging than other clients. Of course, Moyers and Miller are describing work with people who suffer from addictions – another population with a reputation for being deceptive and manipulative over time before entering treatment.

So where does this leave us?

Certainly, some therapists enter the field with higher levels of demonstrated empathy than others. Those of us committed to becoming better therapists can likely become more effective by deliberately practicing our skills in accurate empathy. However, our own self-assessment of our empathy – and for that matter our satisfaction with our lives – will probably predict very little of our actual effectiveness. Nissen-Lie and her colleagues have also shown that our personal burdens may have more of an effect on our clients than we realize. In the end, even if some of us have greater advantages in some areas, the best therapists may well be the ones who make themselves better… with the help of their clients.

David S. Prescott, LICSW

References

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842.

Marshall , W. L. (2005). Therapist style in sexual offender treatment: Influence on indices of change. Sexual Abuse:  A Journal of Research & Treatment, 17(2), 109-116.

Moyers, T.B., & Miller, W.R., (2012). Is low therapist empathy toxic? Psychology of Addictive Behaviors, 27, 878-884.

Nissen-Lie H.A., Havik, O.E, Høglend, P.A., Monsen, J.T., & Rønnestad, M.H. (2013). The contribution of the quality of therapists' personal lives to the development of the working alliance. Journal of Counseling Psychology, 60, 483-95.

Salter, A. (1988). Treating child sex offenders and their victims. Thousand Oaks, CA: Sage.

Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings.  Routledge.