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Published on August 2, 2007

Author: Shariyar

Source: authorstream.com

Working with Young People who Sexually Abuse:  Working with Young People who Sexually Abuse Dr James Bickley The Lucy Faithfull Foundation Assessment Process:  Assessment Process REFERRAL INITIAL ASSESSMENT MEETING EXTENDED ASSESSMENT INITIAL FORMULATION Meeting with referrer PSYCHOMETRICS EXIT EXIT EXIT Programme outline:  Programme outline Pre-intervention Sexually Abusive Behaviours Element Needs Review Sexuality andamp; Sexual Knowledge Impact of sexually abusive behaviour Managing my feelings andamp; behaviours My view of myself, others andamp; the world My relationships with others Management of Programme Pitfalls in Juvenile Sex Offender Treatment:  Management of Programme Pitfalls in Juvenile Sex Offender Treatment Wieckowski, E., Grant, C.R. andamp; Hodges, C.E. (2002) The Conceptual Problem-Solving Model:  The Conceptual Problem-Solving Model 'a systematic approach for helping professionals identify and manage pitfalls that occur in treating juvenile sex offenders' The 4 steps of the conceptual problem-solving model:  The 4 steps of the conceptual problem-solving model Monitoring with awareness Identification of the pitfall Application of the intervention strategies Modification of the intervention strategies Programme Pitfalls in Juvenile Sex Offender Treatment:  Programme Pitfalls in Juvenile Sex Offender Treatment One-size-fits-all treatment approach ‘It worked for one, it’ll work for all’ Compartmentalisation ‘Each treatment piece is a separate unit, no reason for the juvenile to know how it all fits together’ Sexualising all juvenile offender behaviours, thoughts and feelings ‘Sometimes a cigar is just s cigar’ Programme Pitfalls in Juvenile Sex Offender Treatment (contd.):  Inadequate screening and selection of juveniles ‘sure, we’ll take him into the programme’ Insufficient measurement ‘Who needs data anyway’ External controls at the expense of self-management ‘We gotta keep him in handcuffs all the time!’ Programme Pitfalls in Juvenile Sex Offender Treatment (contd.) Programme Pitfalls in Juvenile Sex Offender Treatment (contd.):  Programme Pitfalls in Juvenile Sex Offender Treatment (contd.) Complacency among staff ‘we’re pretty good, no reason to change anything’ Countertransference ‘I hate that kid’ Under-utilisation of front line staff ‘Who needs them anyway’ Staff burnout ‘I’m fine, no really I’m fine!’ Pitfall 1: One-size-fits all treatment approach:  Pitfall 1: One-size-fits all treatment approach Warning signs of a ‘one-size-fits all’ approach Treatment plans for all offenders look very similar Juveniles address issues that are not significant to their offence dynamics Professionals superficially address certain treatment issues as part of a standard treatment protocol Professionals unable to employ clinical judgement and creativity in developing treatment plans Professionals adopt treatment techniques that they are not comfortable with, or are not in their area of expertise SCHEMATIC OF CBT APPROACH:  Minimisation Denial of seriousness Justifications Denial of responsibility Patterns of dysfunctional thinking Lack of victim empathy Emotional over/ under identification Self esteem problems Intimacy deficits Attachment problems Assertiveness difficulties Poor management of emotions Problems solving deficits Recognising risky situations Development of strategies to deal with risk SCHEMATIC OF CBT APPROACH But is this approach suitable for all offenders?:  In terms of the implicit assumptions it has about the offence process taken from the classic RP model of offending And what should be undertaken in treatment How well does it fit with what we know about some offenders But is this approach suitable for all offenders? RP model that has influenced sex offender treatment suggests that:  RP model that has influenced sex offender treatment suggests that There is a single process of relapse which is that negative events or mood states are the major precursors of relapse , i.e. in Wolf’s description of the offence process In treatment offenders should identify potential ‘high-risk situations’ or other possible threats to abstinence, and then develop the appropriate skills to prevent ‘relapse’ This approach also emphasises that problems are in part due to skills deficits Therefore in treatment it is necessary to deal with such skills deficits However therapists know that this is not always the case:  However therapists know that this is not always the case although some sexual offences are associated with ‘self-regulatory failure’ Others involve careful and systematic planning, accompanied by positive emotional states And offenders do not have to overcome any ‘internal inhibitions’ Pitfall 1: One-size-fits all treatment approach:  Pitfall 1: One-size-fits all treatment approach Intervention Strategies Assess the strengths and weaknesses of the young person Develop a good understanding of the young person’s individual offence dynamics Examine the young person’s relevant cultural/ environmental context Be creative in determining methods that can be used to help attain treatment goals Use supervision to support clinical judgment that certain treatment issues may not be applicable Assessment Process:  Assessment Process A framework for individual conceptualisation Assessment Process:  Assessment Process Information Gathering Details andamp; circumstances of offending behaviour Formulation Understanding of how behaviour occurred andamp; how it developed over time Statement of risk The likelihood that behaviour will continue Recommendations for treatment Outline of treatment needs Assessment Framework:  Assessment Framework Part I: Details of offence andamp; background information Part II: Current presentation Part III: Environmental conditions Details of offence & background information:  Details of offence andamp; background information Details of index offence/alleged abuse Family composition, history andamp; functioning Developmental, medical andamp; educational history Psychosexual, relationship andamp; social behaviour history Criminal andamp; forensic history Current presentation:  Current presentation Presentation Mental state Cognitive functioning Motivation to address offending behaviour Environmental conditions:  Environmental conditions Supervision andamp; monitoring Accommodation Support/information network Assessment Framework:  Assessment Framework Personal maintaining factors Biological Psychological Interpersonal Contextual maintaining factors Family system Parental/carer Environmental Treatment system maintaining factors Individual/family Professional Environmental Personal protective factors Biological Psychological Interpersonal Contextual protective factors Family system Parental/carer Environmental Treatment system protective factors Individual/family Professional Environmental Personal predisposing factors Biological Psychological Interpersonal Contextual predisposing factors Parent-child factors Exposure to family problems Stresses in early life Precipitating Factors Sexually Abusive Behaviour Clinical Formulation:  Clinical Formulation A brief statement of the central problem(s) Explanation of how they developed based on salient points from previous sections of the report Reference made to predisposing, precipitating and maintaining factors Protective factors and family strengths that have a bearing on prognosis should be mentioned Recursive Formulation:  Recursive Formulation Make or modify formulation Plan interview agenda andamp; select tests to check accuracy of formulation Conduct interview andamp; administer tests Pitfall 2: Compartmentalising Treatment:  Warning signs of compartmentalisation Young person has a limited understanding of how to apply the information they learned in treatment to interrupt their offence cycle Young person and professionals have difficulty seeing how treatment issues relate to, and impact one another Young person has difficulty generalising the information to other sexual and non-sexual situations Young person recites back information, but has difficulty conceptualising how it fits into a comprehensive relapse prevention strategy Pitfall 2: Compartmentalising Treatment Therapeutic Contracting:  Therapeutic Contracting A shared understanding! Pre-intervention:  Pre-intervention Boundaries andamp; expectations Gains andamp; Losses The change process: Managing Uncertainty Managing difficult feelings Therapeutic contracting: A shared understanding Thoughts, feelings and what we do: Introduction to the CBT approach The cost-benefit analysis:  The cost-benefit analysis Costs of change Benefits of staying the same Benefits of change Costs of staying the same The “Cycle Of Change”(Prochaska and DiClemente):  The 'Cycle Of Change' (Prochaska and DiClemente) Action Determination Contemplation Relapse Maintenance Exit 1: Choosing not to change Exit 2: Giving up trying Exit 3: Stable, successful change Entry point About Me:  About Me About Me: I tend to keep my problems to myself About my Interests andamp; Hobbies: I am interested in cars About things that have happened in my life: I fell out a tree when I was 8 and was knocked out About my Offences: I was found guilty of attempting to rape my cousin Ryan (aged 6) Slide31:  About My World About My Family: Dad left when I was 7 I’ve not seen him since About My Friends andamp; Relationships: I get on better with adults than people my age About School or Work: I was always in trouble at school About where I live: The neighbours don’t talk to us anymore What might we want to change?:  What might we want to change? About Me: Finding it difficult to talk about what I’ve done Not thinking before I do things Not keeping my feelings bottled up About My World: Having few friends my own age Arguments with mum What might we use to help?:  What might we use to help? About Me: Regretting what I have done and not wanting to offend again I am good woodwork and fixing things About My World: Mum wants me to get help and will support me I get on well with my Nan, I can talk to her about my problems Chance of a work-based training placement What does the programme involve & how will it meet my needs?:  What does the programme involve andamp; how will it meet my needs? Sexually Abusive Behaviour Element Aim: To help challenge the attitudes, beliefs and behaviours which led to and maintained your offending Which of my needs will it address: To learn why what I did was sexually abusive To help me take responsibility for my behaviour To spot and argue against thinking that helped me to believe it was ok, or not my fault To help me become more aware of the steps that led up to my offending Introducing the CBT approach:  Introducing the CBT approach What we do How we feel               What we think Behaviour is just the tip of the iceberg! Pitfall 2: Compartmentalising Treatment:  Intervention Strategies Relate the treatment objectives to each other Have the young person apply each treatment issue to both sexual and non-sexual situations Have the young person find similarities among objectives Instruct the young person to identify ways each treatment issue impacts the other treatment issues Pitfall 2: Compartmentalising Treatment Pitfall 3: Sexualising all juvenile offender behaviours, thoughts and feelings:  Pitfall 3: Sexualising all juvenile offender behaviours, thoughts and feelings Warning signs Staff focus only on the ‘sex offender’ role of the young person Young person decreases his disclosure of personal information adopting a defensive stance Young person has difficulty explaining ‘normal’ sexual behaviour Presents himself as asexual, reporting little or no sexual thoughts or urges Pitfall 3: Sexualising all juvenile offender behaviours, thoughts and feelings:  Intervention Strategies Look at evidence that the young person’s behaviour is offence orientated How might other treating professionals view the same actions, thoughts and feelings Determine the similarity between the young person’s questionable behaviour, thoughts, or feelings, and his offending pattern and known distorted world-view Determining whether this is a high-risk situation for the young person Pitfall 3: Sexualising all juvenile offender behaviours, thoughts and feelings Offence-Specific Interventions:  Offence-Specific Interventions The role of the offence account Offence-Specific Components:  Offence-Specific Components Module I: Sexually abusive behaviour Module II: My sexually abusive behaviour Module III: Changing my sexually abusive behaviour (developing a ‘new life’ plan) Sexually Abusive Behaviour:  Sexually Abusive Behaviour What is sexual abuse? Distinguishing between appropriate and inappropriate sexual behaviour The role of sexual thoughts (‘fantasies’) Identifying thinking that supports sexual offending My Sexually Abusive Behaviour:  My Sexually Abusive Behaviour Offence account (revisited) Offending sequence (‘storyboards’ andamp; ‘footsteps’) Life context of offending pattern Responsibility for offending (Finklehor’s pre-conditions) Consequences of offending Finkelhor’s Four Pre-conditions:  Finkelhor’s Four Pre-conditions Internal Inhibitors External Inhibitors Victim’s Resistance Motivation Changing My Sexually Abusive Behaviour:  Changing My Sexually Abusive Behaviour Challenging offending linked thinking Taking control of my inappropriate sexual thoughts Recognising offending-linked behaviours ‘Footsteps’ out Pitfall 4: Inadequate screening and selection of juveniles:  Pitfall 4: Inadequate screening and selection of juveniles Warning signs The range of young people is too broad (i.e. age, offence type, IQ etc.) The treatment services do not match the existent population Excessive acting out and decreased trust toward staff or peers Selection of young people only guided by monetary considerations Programme staff giving in to outside pressure to admit inappropriate candidates 3-step system of screening:  3-step system of screening Screening criteria Identify good referral candidates (e.g. age, gender, mental health status, intelligence) Selection criteria Identify which young people should enter the programme (this process tends to be more subjective, e.g. personality, motivation) Maintenance criteria Minimal requirements the young person needs to attain to remain on the programme Pitfall 4: Inadequate screening and selection of juveniles:  Intervention strategies Consistently examine and refine criteria to match the changing needs of the programme, juveniles and community Clearly state programme criteria to referring agencies, court officials and community professionals Do not be afraid to say ‘no’ to inappropriate referrals Examine what is guiding selection procedure. Focus on ensuring a good fit rather than conceding to community, political or monetary pressures Pitfall 4: Inadequate screening and selection of juveniles Pitfall 5: Insufficient measurement:  Pitfall 5: Insufficient measurement Warning Signs Basic data is not available upon request Staff do not engage in research efforts Data stored on hard copies, but not entered into a computer Measurement system is too complicated to be used effectively, which encumbers data entry, access, and interpretation 4 components of measurement:  4 components of measurement Demographics Basic information about the young person, family, school, medical history etc. Testing Psychometrics (general andamp; offence-specific) Treatment Offence details/disclosures Progress through treatment Follow-up Adjustment to the community Recidivism Pitfall 5: Insufficient measurement:  Pitfall 5: Insufficient measurement Intervention strategies Block out time in staff members’ schedule to collect, enter, and analyse data Train staff to use testing materials that produce useful data Train staff to accurately interpret and analyse data Employ college interns (students) to assist in objective periodic analysis Pitfall 6: External controls at the expense of self-management:  Pitfall 6: External controls at the expense of self-management Warning signs Young person only parrots treatment information, but have difficulty explaining in their own words Their behaviours regress when they believe no one is monitoring them They become overly dependent on staff, lacking confidence when not constantly encouraged They become ‘institutionalised’ and find it difficult to function without a high level of supervision and structure They have difficulty making decisions Pitfall 6: External controls at the expense of self-management:  Intervention strategies Create a treatment environment whereby the real world is safely approximated in daily living Increase the young person’s self-confidence in their application of material learned in treatment Avoid chasing behaviours that unrealistically exaggerate the young person’s lapses Avoid doing the treatment work for the young person Assist the young person to develop a support network to act as a safety-net and a resource as he practices his newly learned skills Pitfall 6: External controls at the expense of self-management Pitfall 7: Under-utilisation of front line staff:  Pitfall 7: Under-utilisation of front line staff Warning signs Front line staff do not feel they are part of the programme, they are not involved in decisions making Communication between clinical an front line staff is minimal The young person is able to ‘split’ clinical and front line staff Evidence of passive aggression between front line staff and other professionals in the programme Front line staff become apathetic and believe they cannot make a difference Pitfall 7: Under-utilisation of front line staff:  Intervention strategies Remind front line staff they are an integral component of the treatment programme Ask them for feedback and input on a regular basis and involve them in the decision making processes Train them about each treatment component so they can help monitor the young person’s progress in treatment Share general information about each young person’s offence dynamics, so they can help identify lapses Pitfall 7: Under-utilisation of front line staff Pitfall 8: Complacency among staff:  Pitfall 8: Complacency among staff Warning signs An escalation in significant programmatic problems Lack of enthusiasm for the work Sessions are missed or shortened Professionals are not aware of current trends in research and practice The programme structure has not significantly changed to keep up with research and literature Pitfall 8: Complacency among staff:  Intervention strategies Develop a programme review committee composed of internal and external professionals Attend conferences and regularly talk to other professionals in the field Address minor problems as they develop within the treatment programme Increase morale, motivation, and enthusiasm among staff, so they are mentally ready and eager to look for potential pitfalls Pitfall 8: Complacency among staff Pitfall 9: Countertransference:  Pitfall 9: Countertransference Warning signs Difficulty remaining objective toward the young person Evidence of a strong attraction or dislike for the young person The professional spends less or more time with the young person compared to others Difficulty engaging or disengaging in a therapeutic relationship with the young person The young person is able to ‘push your buttons’ Unconscious Processes: Working with Young People who Sexually Abuse (Bankes, 2002):  Unconscious Processes: Working with Young People who Sexually Abuse (Bankes, 2002) ‘Victimised’ reactions I think you can get shocked sometimes, like a real kick in the stomach ‘Persecutory’ reactions Over-controlling: In order to not let myself get too vulnerable I have to take charge and be directive Blaming I just thought how could you do this? …to a 7 year-old girl? She trusted you and you knew, you must’ve know what you were doing. There is no way you can blame the child for it, you are older and much wiser Unconscious Processes: Working with Young People who Sexually Abuse (contd.):  Or confrontational I was completely pissed off with the young person and I’d had enough and I thought ‘I’m doing all the work here’. So I behaved like mum or a teacher or any of these other people who have given him a negative response ‘Rescuing’ reactions Collusion I think maybe I was anxious that he might end being upset and I don’t want to hear him being upset Unconscious Processes: Working with Young People who Sexually Abuse (contd.) Unconscious Processes: Working with Young People who Sexually Abuse (contd.):  Overidentification Yes, I guess probably there is a bit of, you know, I could be John sitting there sometimes and getting quite angry (in professionals meetings). Perhaps I take some of his feelings with me Or by trying harder You become practically involved in their lives as well as emotionally, it’s extra to the therapeutic relationship Unconscious Processes: Working with Young People who Sexually Abuse (contd.) Pitfall 9: Countertransference:  Intervention strategies Assess your own emotions, and what they are telling you. If he elicits certain feelings or reactions from you, he likely did this to other individuals in the past In some cases, share feelings and thoughts that were elicited by the young person, and examine them with him Discuss your thoughts and feelings with colleagues as a way of addressing countertransference objectively Refer the young person to another professional if the countertransference interferes with the therapeutic relationship Pitfall 9: Countertransference Pitfall 10: Staff burnout:  Pitfall 10: Staff burnout Warning signs Expectations are too high, including the need to ‘cure’ offenders and blaming self for recidivism Avoid meeting with offenders or doing the work Decrease in enthusiasm and motivation at work Work interfering with home life Obsessively question own sexual behaviours, thoughts and feelings Unrealistically hyper-vigilant about sexual abuse Pitfall 10: Staff burnout:  Intervention strategies Set realistic expectations for treatment outcome Place responsibility for treatment progress onto the juvenile Limit number of sex offender clients Talk with colleagues who work with sexual offenders Participate in conferences to revitalise self with new treatment methodology Use relaxation and stress management techniques Use humour with self and colleagues Pitfall 10: Staff burnout

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