Remaking Relapse Prevention

“Determinants of Relapse”
(Marlatt & Gordon, 1980)

New type of cognitive-behavioral intervention

Relapse prevention
 Relapse prevention
Maintaining change in addicts

Ceased

Through other interventions

Relapse Rates for Addictions
First 12 months after cessation

80%

First 3 months

66%
(Hunt et al., 1971)
 Negative emotional states
Interpersonal conflict
Social pressure

71% of all relapses

(drinkers, smokers, heroin addicts,

compulsive gamblers, and over eaters)
(Cummings et al, 1980)
 Deviant Cycle
Life Event
Remorse,
Guilt, or Fear Negative Affect

Seemingly
Offense Unimportant
Thinking Errors
Decisions (SUDS)

Grooming
or Force High Risk
Situations
Planning
Passive/Active Target Selection
 Developed for
 Offenders motivated to change

 Already ceased offending

 Offended through “seemingly unimportant

decisions”
 Not Developed For
 Psychopaths

 Child molesters who want to continue

“An important precondition for applying RP
interventions is that the offender be
motivated to stop offending.”
(George & Marlatt, 1980, p. 16)
 In the Beginning
 “the confidence and optimism we feel . . .
are quite strong . . .

 “our confidence . . . is without empirical

support”
(Gordon & Marlatt, p. 28)
 What is RP today?
“Relapse Prevention”
Has little meaning

“In the past 15 years, those words have served

as an umbrella under which a huge variety of
clinical interventions that had little or nothing to
do with the original notions of RP could be
found.”
(Laws, 2000, 0. 16)
 Nationwide Survey
RP Includes
Primary RP

 Community 18% 97.9%

 Residential 25% 93.4%

(McGrath et al., 2002)
Cognitive Behavioral Treatment
 Empathy
 Assertiveness

 Social skills

 Healthy sexuality

 Intimacy training

 Cognitive distortions

 Cognitive skills

 Relapse Prevention
Instilling Knowledge of RP
Satisfactory offense chains
Initial testing
39%

3 repetitions
100%
(Marques et al., 1989)
Test of Basic RP Concepts
Initial testing
34%

3rd testing
100%

(Marques et al., 1989)

 RP Too Complicated

 Abstinence violation effect

 Success expectancy

 Erroneous attributions

 Apparently irrelevant decisions

 Negative emotional state

 Problem of immediate gratification

 Adaptive coping response

 Increased probability of relapse

Updated Relapse Prevention
 Deviant Cycle
Life Event
Remorse,
Guilt, or Fear Negative Affect

Seemingly
Offense Unimportant
Thinking Errors
Decisions (SUDS)

Grooming
or Force High Risk
Situations
Planning
Passive/Active Target Selection
Self Regulation Model of Relapse Prevention

Life Event
Sometimes

Desire for
Offensive Sex

(Ward & Hudson, 1998)

Self Regulation Model of Relapse Prevention

Desire for
Offensive Sex

Avoidance Approach
Goals Goals

(Ward & Hudson, 1998)

Self Regulation Model of Relapse Prevention

Avoidant Approach

Passive Active Automatic Explicit

(Ward & Hudson, 1998)

Type of Offense Pathway: Roger
 Unemployed
 Bar from 12 to 3 pm
 Left drunk
 Boarded a train as “knew girls would be
there”
 Goals: get one to perform oral sex
Type of Offense Pathway: Roger
Sat behind two 13-year-olds
Touched their hair and masturbated
Tapped one on shoulder
They got up and left
Got off train, saw a 13-year-old
Began masturbating
Type of Offense Pathway: Roger
 Walked up to her with penis out of pants
 Wanted her to perform oral sex
 She called out and other girls joined her
 Bus arrived and they left
 They reported to bus driver
Type of Offense Pathway: Roger
“I just do things for no reason.”

“I wish I could put into words how I feel, and

understand what it is all about.”
Type of Offense Pathway: Roger
 Knew by heart the routes home of children
from local schools and holidays and breaks

 It was “familiar territory” so never had to plan

 Says “thousands” of victims

 Convicted 13 times
Type of Offense Pathway: Roger
 Says he felt children enjoyed the experience

 “I don’t hurt anyone and people quite like

what I do. I never carry out my fantasies
about rape and hurting people in real life.”
Roger: What Kind of Offender?

Approach Automatic
What Kind of Treatment?
 Type of Offense Pathway: Dave
 40 year-old
 Confident and outgoing
 Worked abroad in a program to help teen
prostitutes
 Talked to pimps
 They made a “powerful case”
 Felt his values had “become contaminated”
 Type of Offense Pathway: Dave
“Some of the younger girls I was trying to
help said that things about the life were
good. Intellectually I knew that that was
about comparisons with the life they had
before, extreme poverty and so on, but at
another level I got interested – although I
never did anything wrong to them.”
 What Type of Offender: Dave
 In past had baby-sat for 11-year-old
 Went in bedroom aroused and watched
child sleep
 Told wife
 Agreed never to babysit again
 Type of Offense Pathway: Dave
 I talked to my wife about the babysitting
experience before we had the children.
That was good, but then I sort of laid the
responsibility for stopping it happening
again on her. I did that again after our
daughter told her what I’d been doing.”
 Type of Offense Pathway: Dave
 Family living in an open-plan home in hot
climate
 Kids often undressed
 Felt 10-year-old daughter was seductive
 Knew his arousal was wrong
 Tried to avoid situations where he might
abuse her
 Type of Offense Pathway: Dave
 Refused to share a tent with her on
camping trip
 Other times he fondled her genitals
 Once persuaded her to straddle him
 Told himself knew what was happening
and agreed
 Type of Offense Pathway: Dave
 When wife gone, got into daughter’s bed
to have intercourse
 Realized what he was doing and stopped
 Shaken that he almost raped her
 Type of Offense Pathway: Dave
 “I thought that carrying on with my work
would help me get my head straight –
instead it was just making it worse.”
 Type of Offense Pathway: Dave
“I kept away from my daughter – wouldn’t
take any interest in her. She wondered
what was wrong with me – my wife says
that made her more likely to want affection
from me. Then when she came to me I
misread what she wanted, because my
thinking was getting so messed up.”
Dave: What Kind of Offender?

Avoidant Active
What Kind of Treatment?
 Type of Offense Pathway: Joe
 40-year-old
 6 cts against one boy, now 19
 Over 8 years
 Fondling, oral sex, anal intercourse
 Working as handyman at boy’s house
 Boy began to hang around him
 Type of Offense Pathway: Joe
 Urinated in bushes and boy saw it
 Boy watching excited him
 Asked boy to touch his penis
 Boy compliant
 Escalated to anal intercourse
 Boy told him he didn’t want to do these things
 Type of Offense Pathway: Joe
 Told boy it was normal
 Told him no one would believe him
 Told boy, why had he done it if didn’t want
to
 Told boy if reported, they would blame him
 Told boy that he (the boy) was gay
“You’re just a little queer! Why don’t you
accept that?” a
 Type of Offense Pathway: Joe
 2 previous convictions
 Type of Offense Pathway: Joe
Previous Treatment

“You’re got to go along to get along. If I was ever going

to get out of there, I realized that I was going to have
to learn to say what they wanted to hear.”

Psychologist: Did well and was able to “freely share his

experiences and mistakes with other group members
and to take responsibility for his actions.”
 Type of Offense Pathway: Joe
“showing them what real life was like”

“You need to know how to get that feeling of

being in charge – the world is a frightening
place”

“Of course, I took my ‘fee’”

Joe: What Kind of Offender?

Approach Explicit
What Kind of Treatment?
 Type of Offense Pathway: Ben
 25-year-old
 Police called to residence – found father of
a 5-year-old holding Ben in custody
 Ben was babysitting
 Returned to find him in bed with son
 Boy crying; told parents Ben had “touched
my thing and sucked on it.”
 Type of Offense Pathway: Ben
 3 arrests at ages 15, 22 and 23: all
victims boys under 10

 No other criminal history

 Type of Offense Pathway: Ben
 1st offense: met 6-year-old when he was
coming home from school. Bought him ice
cream, took him to a park, pulled down his
pants and fellated him

 After graduating from university, picked up

a boy, took him for a ride, drove to a park,
fondled him and fellated him
 Type of Offense Pathway: Ben
 Uncomfortable around adults his age
“They seemed so much more grown up than
I was.” “I felt awkward, like I couldn’t get
one foot in front of the other.”

Children: “They weren’t trying to live up to

some social standard.” “I envied them
because they seemed so free, so at ease
in their world.”
 Type of Offense Pathway: Ben
“I will admit that I especially liked looking at
the boys. They were so cute, bright eyed,
smooth skin. It sounds silly, but I wished
that I could look like that, rather than a
hulky, almost adult male.”

“It must have been then that I began to think

about them sexually.”
 Type of Offense Pathway: Ben
“When I jerked off, I tried to fantasize about
girls my age in my classes, but it didn’t
work. When I thought about kids, I felt
guilty, but I got really aroused and I could
ejaculate. Although I didn’t really want
them to be, the fantasies were about
feeling these kids up and sucking their
dicks. The more I did it, the easier it got.”
 Type of Offense Pathway: Ben
“When I saw that kid in 1989, I don’t know, I
guess I just felt that I had to do it. I
conned him and I took him to the park and
went down on him. I felt like shit after
that.”
 Type of Offense Pathway: Ben
 Cruised while at university, but didn’t pick
up any kids. Afraid of getting kicked out.

 “After I graduated from university and

couldn’t find a job, I felt worthless. So I
started cruising again.” “This time I was
afraid something would happen, and it
did.”
 Type of Offense Pathway: Ben
 Felt guilty. Boy couldn’t identify him.

 “I should have said, ‘Hey! I did it!’ but I

didn’t.”
 Type of Offense Pathway: Ben
Last offense, asked boy, “Do you want to
learn about sex?”

“It seemed to me that he was fine with it until

his old man burst into the room.”
 Type of Offense Pathway: Ben
 Still masturbating to fantasies. “I can’t
seem to stop it.”

 Response to first arrest: “I just wanted to

forget about it.”
Ben: What Kind of Offender?

Avoidant Passive
What Kind of Treatment?
Good Lives Model
 RP Avoidant

 Good lives model Approach

 Primary Goods

People seek primary goods

 Primary Goods
Experiences, states of mind, activities

Sought for their own sake

Increase psychological well-being

 Sexual Offending

Attempts to pursue primary human goods

Socially unacceptable

Personally frustrating
What Are Primary Goods
 Life

 Knowledge

 Excellence in play and work

 Excellence in agency

 Inner peace

 Friendship

 Community

 Spirituality
 Happiness

 Creativity
 Tender Minded Theory
People are good

Bad acts are an attempt to meet same

needs as everybody else
 Theoretical Position
“It is true that we did not cite any study
applying the ideas of Deci and Ryan
[human needs and self-determination] to
an offender population – to our knowledge
there are no such studies yet.”
(Ward & Stewart, 2003, p. 222)
 Theoretical Position
“. . .there is little or no evidence for the
assessment and treatment aspects of the
theory other than the rationally based
reasons outlined above. This weakness
reveals that the theory lacks empirical
adequacy.”
(Ward et al., 2006, p. 311)
 Deci & Ryan (2000)
Nonoffenders
Autonomy, competence & relatedness

Correlated with

Indices of well-being
(Negatively correlated with anxiety and
depression; positively correlated with self-
esteem)
 Innate needs

Correlated with

Noncriminogenic needs
( Bonta and Andrews, 2003)
“I plain and simple needed to get some
good, hot, kinky sex but resented having
to rely on the generosity of women to hit
on their pussies. . . My days of
begging . . . Were over.”
(Athens, 1997, p. 10)
Applying the Good Lives Model
What goods are associated with offending?

Pursuit of emotional equilibrium

Intimacy
Personal control
Grievance
Sexual pleasure (goods of health & body)
Play (to get a thrill)
What Prevents Meeting These
Appropriately?

Socially isolated
Lack skills for relationships
Overly aggressive when mood low
Identifying Overarching Primary
Goods
Mechanically Inclined

“In this example, he might enroll in a night

course on practical mechanics
(knowledge), join a car club (relatedness),
and eventually train as a car mechanic
(mastery at work).”
(Ward et al., 2006, p. 308)
Identify Environment Needed
 Info about opportunities for work
 Social supports

 Living arrangements

 Culture of the community

 People are What They Do

To forge a more adaptive personal identity

Must live a better life

 Rehabilitation Involves
 Looking at past life

 Developing a new good lives plan

 Must Take into Account
 Offenders’ strengths

 Primary Goods

 Relevant Environments

 What competencies & resources?

“The problem does not reside in the primary
human goods that underlie offending, but
in the way individuals seek these goods.”
(Ward et. Al, 2006, p. 307)
 Secondary Goods
Ways primary goods are translated into
action

Primary goods: work

Secondary goods: Training in computers

 At Its Best
 Loneliness: Risk factor

 How to build a life with social connection

 At Its Worse
 Takes sex out of sexual offending

 Exercise, eat well, get a job – you’ll be fine

 Assumptions
Lost Souls or Predators

Lost Souls Only Need Apply

Is All Offending from Frustration?
Psychopathic

Predators

Sadists