The “art” of treatment in forensic settings with complex client histories and unique public scrutiny through the courts and probation leaves us at times scrambling to meet the demands of how to balance our core essential role of treating our clients and our quasi-public role with the courts.  For me this is what makes this work most challenging and interesting! 

Many years ago, in the early 2000’s, I was a manager and clinician in a community-based adult outpatient treatment program.  During that time, I conducted a treatment intake of a young man who was court ordered to treatment and needed a group therapy placement.  The intake was the beginning of his treatment experience.  The young man was employed and lived with his parents who were well educated and very supportive.  He had been convicted of possession of illegal images of minors. He had no prior legal history and a diagnosis of autism spectrum disorder.  He understood the legal issues, what he had done wrong, and the court order for treatment.  The entire arrest and prosecution was traumatic for him and his parents.  He needed a clinician and therapy group that could work with him, and a time and day that he could coordinate with his work and transportation needs.  I presented the intake summary to the treatment teams and during the intake presentation one of the newer psychologists said, in part, ”…all I know is that he is a sex offender….”  

I was flabbergasted.  This psychologist had finished an internship with our agency and was recently granted a license.  The label she used so casually said nothing about the young man, his social and treatment needs, and how we should plan his care and treatment.  As a program, we prided ourselves on having a reputation for treating all clients with equal respect and made every effort to make group and clinician placements that best accommodated client needs.   Well before RNR became well known and was a common treatment paradigm we worked to balance the art of providing competent and comprehensive treatment within a system of care coordination and accountability. 

During the intake I established a very positive relationship with this young man.  I included his parents in the intake and worked closely with his county probation officer to ensure thoughtful and professional care coordination.  It was my role to begin the treatment alliance, not with a “sex offender”, but with a scared young man and his parents who cared deeply about their son and wanted to understand what happened and what they could do to help their him. From the very beginning he struggled to figure out what he needed to do to manage the demands of probation and treatment with his limited transportation options and work schedule as he knew that finding meaningful employment was always a challenge for him.  We eventually found a clinician and a treatment group he could attend on a schedule that did not threaten his job.  To ensure that this arrangement would work for our client required us to have compassion for him and his family while also meeting the core requirements of the treatment program and meeting probation conditions. 

We know the significant contribution of therapeutic alliance (Barber et al., 2009) and the numerous issues and consequences of labeling clients (Schultz, 2014, Lowe & Willis, 2020).  There are also unique issues involved in forming the therapy alliance with clients in correctional settings (Ross, et al, 2008).  As treatment providers our attitude about our clients drives our philosophy about the need (or not) for a strong therapeutic alliance, and how we treat clients as they start and progress through treatment.  When we view our clients as unique human beings with their own social, emotional, sexual, and relationship histories and needs, we can conceptualize them in terms of not just dynamic risk factors and RNR but also in a wholistic manner that allows us to always consider the importance of the therapy process and therapeutic alliance.

References

Barber, J. P., Connolly, M. B., Crits-Christoph, P., Gladis, L., & Siqueland, L. (2009). Alliance predicts patients’ outcome beyond in-treatment change in symptoms. Personality Disorders: Theory, Research, and Treatment, S(1), 80–89.

Ross, E., Polashek, D., and Ward. T. (2008). The therapeutic alliance: A theoretical revision for offender rehabilitation.  Aggression and Violent Behavior.  Volume 13, Issue 6, November–December 2008, Pages 462-480

Schultz, C  (2014).  The Stigmatization of Individuals Convicted of Sex Offenses: Labeling Theory and The Sex Offense Registry.  Themis: Research Journal of Justice Studies and Forensic Science. Volume 2, Spring 2014

Lowe, G. & Willis, G. (2020). “Sex Offender” Versus “Person”: The Influence of Labels on Willingness to Volunteer with People Who Have Sexually Abused.  Sexual Abuse, Volume 32, Issue 5, Sage. https://doi.org/10.1177/1079063219841904