Content uploaded by Anthony Beech
Author content
All content in this area was uploaded by Anthony Beech on Dec 30, 2014
Content may be subject to copyright.
Content uploaded by Anthony Beech
Author content
All content in this area was uploaded by Anthony Beech on Oct 01, 2014
Content may be subject to copyright.
219
Therapeutic
Climate
of
Sexual
Offender
Treatment
Programs
Anthony
Beech
1,2
and
Ann
Scott
Fordham
3
1
Oxford
Regional
Forensic
Service,
Department
of
Forensic
Psychology,
Fairmile
Hospital,
Wallingford,
Oxon
OX10
9HH,
U.K.,
and
The
University
of
Birmingham,
Birmingham,
U.K.
2
To
whom
correspondence
should
be
addressed.
3Merseyside
Regional
Forensic
Psychiatry,
36,
Rodney
Street,
Liverpool
L1
9AA,
U.K.
A
measure
of
group
atmosphere,
the
Group
Environment
Scale
(GES),
was
administered
to
members
and
leaders
of
12
sexual
offender
treatment
groups:
8
were
probation
programs;
4
were
conducted
at
a
long-term
residential
center.
The
GES
measured
the
following
aspects
of
group
processes:
relationships
within
the
group,
personal
growth
of
members,
and
structure
of
the
group.
Results
suggested
that
the
atmosphere
of
a
group
had
an
important
influence
on
treatment
change.
A
successful
group
was
highly
cohesive,
was
well
organized
and
led,
encouraged
the
open
expression
of
feelings,
produced
a
sense
of
group
responsibility,
and
instilled
a
sense
of
hope
in
its
members.
A
helpful
and
supportive
leadership
style
was
found
to
be
important
in
creating
an
atmosphere
in
which
effective
therapy
could
take
place.
Overcontrolling
leaders
were
seen
to
have
a
detrimental
effect
upon
group
climate.
It
is
suggested
that
the
employment
of
a
group
process
measure,
such
as
the
GES,
would
be
a
useful
inclusion
to
any
outcome
evaluation
of
treatment
programs.
KEY
WORDS:
group
process;
group
therapy;
sexual
offender
therapy;
sexual
offending.
INTRODUCTION
A
number
of
evaluation
studies
have
attempted
to
examine
the
effec-
tiveness
of
treatment.
One
such
study,
the
STEP
(Sex
Offender
Treatment
Evaluation
Project)
report,
has
recently
been
published
in
the
United
King-
dom
by
Beckett,
Beech,
Fisher,
and
Fordham
(1994).
This
research
had
a
number
of
objectives
including
(1)
describing
the
developmental
and
pre-
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
220
senting
characteristics
of
sexual
offenders
undergoing
therapy
in
a
number
of
representative
treatment
programs
conducted
by
probation
services
in
England;
(2)
evaluating
the
extent
to
which
these
treatment
programs
were
successful
in
treating
offense-specific
and
personality
problems
in
treat-
ment ;
and
(3)
providing
a
framework
for
the
long-term
examination
of
the
relationship
between
change
achieved
after
treatment
and
recidivism.
Therapy
for
producing
a
reduction
in
recidivism
in
sexual
offenders
in
the
United
Kingdom
is
delivered
mainly
via
cognitive/behavioral
group
work
(Barker
&
Morgan,
1993).
The
cognitive
component
targets
the
of-
fender’s
distorted
pattern
of
thinking,
while
the
behavioral
element
focuses
on
teaching
offenders
to
control
or
modify
deviant
arousal
and
fantasies.
Group
work
is
seen
as
the
treatment
of
choice
because
the
group
experi-
ence
can
reduce
levels
of
denial,
increase the
need
for
change,
and
help
clients
accept
and
develop
more
appropriate
ways
of
dealing
with
problems
(Clark
&
Erooga,
1994).
Other
men
in
the
same
position
in
group
provide
the
opportunity
for
promoting
change
through
mutual
challenges.
Here,
members
as
well
as
leaders
can
be
seen
as
being
involved
in
the
therapeutic
process
(Barker
&
Beech,
1993).
Behroozi
(1992)
suggests
that
with
invol-
untary
clients,
confrontation
that
addresses
denial
is
far
more
effective
when
undertaken
by
peers
than
by
those
perceived
to
be
authority
figures.
Group
work
also
provides
the
opportunity
for
coworking,
thus
enabling
therapists
to
sound
out
issues
with
colleagues,
and
avoids
potential
collu-
sion
with
the
distorted
thinking
patterns
of
perpetrators
that
may
occur
when
working
solely
on
a
one-to-one
basis.
As
Erooga,
Clark,
and
Bentley
(1990)
observe,
isolated
working
replicates
to
some
degree
the
very
secrecy
within
which
the
abuse
was
developed
and
sustained
and
makes
it
more
likely
for
the
worker
to
be
become
enmeshed
in
the
perpetrators’s
view
of
the
world
and
his
abuse.
There
has
not
been
a
great
deal
of
research
reported
about
the
proc-
esses
in
operation
within
sexual
offender
treatment
programs.
Such
research
has
tended
to
focus
on
the
type
of
treatment
approach
adopted
and
the
characteristics
of
sexual
offenders
who
benefit
from
treatment.
The
general
conclusions
derived
from
a
comparitively
recent
review
(Marshall,
Ward,
Jones,
Johnston,
&
Barbaree,
1991)
indicate
that
comprehensive
cognitive/behavioral
programs
worked
best,
that
treatment
was
most
effec-
tive
with
child
molesters
and
exhibitionist,
and
that
rapists
showed
little
or
no
improvement
during
treatment.
Stephenson’s
study
(1991)
is
the
only
report
to
date
comparing
the
effectiveness
of
several
group
programs
for
sexual
offenders.
She
found
that,
of
eight
community-based
programs
in
the
Pacific
region
of
Canada,
only
one was
successful
in
reducing
recidivism.
This
group
was
better
man-
aged
than
the
other
programs;
those
involved
in
running
the
group
kept
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
221
accurate
records,
and
the
therapists
prepared
a
comprehensive
pretreat-
ment
plan,
did
not
tolerate
denial,
and
were
tough-minded
in
their
approach
but
were
respected
by
their
clients.
In
the
less
successful
pro-
grams,
clients’
behavior
was
often
disruptive
and
considerable
hostility
was
expressed
toward
some
therapists.
In
contrast
to
the
lack
of
research
on
group
processes
in
sexual
of-
fender
therapy,
there
has
been
a
great
deal
written
concerning
this
issue
in
the
general
literature
about
group
work. Belfer
and
Levendusky
(1985)
and
Yalom
(1975)
emphasize
the
following
as
being
of
particular
impor-
tance
in
running
effective
groups:
1.
Cohesiveness
has
been
considered
vital
in
keeping
group
members
involved
and
has
been
found
to
be
an
important
precondition
for
positive
change
(Braaten,
1989).
It
enhances
the
power
of the
group
to
change
the
attitudes
and
behaviors
of
its
members.
In
a
highly
cohesive
group,
participants
are
able
to
share
sensitive
information
about
current
fantasies,
to
question
their
own
behaviors
and
to
feel
able
to
deal
with
the
powerful
emotions
unleashed
in
therapy
(Clark
&
Erooga,
1994).
Cohesion
is
understood
to
be
influenced
by
the
leaders’
style,
particularly
in
the
early
sessions
of
the
program
(Yalom,
1975).
2.
Effective
group
leadership
is
crucial
in
establishing
the
purpose
of
the
group,
facilitating
the
achievement
of
goals,
and
ensuring
confidentiality.
Leaders
should
not
only
provide
interventions
that
are
informative
or
symptom-focused,
but
also
facilitate
and
model
effective
interpersonal
interactions.
Karterud
(1988),
in
a
study
of
six
therapeutic
community
groups
in
Norway,
found
that
in
the
highest-functioning
group,
leaders
were
more
supportive
and
less
aggressive.
In the
less
effective
groups
a
number
of
serious
problems
were
observed
in
leadership
style.
Therapists
practiced
extreme
turn-taking,
did
not
support
member-member
inter-
actions,
and
often
resorted
to
an
aggressive
confrontational
style.
Leadership
style
has
been
shown
to
influence
group
development.
In
early
sessions,
the
leaders’
most
productive
intervention
may
be
directed
to
facilitate
active
participation
by
all
members
(Nichols
&
Taylor,
1975).
3.
Group
norms
are
the
behavioral
rules
that
guide
the
interaction
of
the
group.
At
the
outset
of
the
group,
Clark
and
Erooga
(1994)
suggest
that
leaders
should
establish
an
environment
which
is
conducive
to
positive
change.
They
suggest
that
this
can
be
done
by
creating
an
antioffending
atmosphere
where
there
is
an
expectation
of
disclosure
rather
than
denial,
encouraging
clients
to
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
222
take
responsibility
for
their
actions,
and
getting
men
to
express
their
feelings.
Yalom
(1975)
argues
that
the
early
establishment
of
group
norms
is
an
important
task
of
group
leaders,
as
these
will
deter
behaviors
that
threaten
group
cohesiveness,
such
as
lateness,
nonattendance,
member-member
attacks,
and
extra
group
social-
izing.
4.
The
instillation
and
maintenance
of
hope
for
the
future
in
members
are
also
considered
to
be
important
therapeutic
agents
for
change
(Couch
&
Childers,
1987).
This
may
be
the
case
particularly
with
a
sexual
offender
group,
because
these
men
may
be
demoralized
and
could
easily
be
discouraged
from
engaging
in
group
work.
Couch
and
Childers
suggest
that
group
leaders
can
improve
therapeutic
outcomes
by
understanding
hope
as
a
curative
factor
and
by
employing
strategies
to
instill
it.
Such
strategies
should
include
repeated
encouragement
by
leaders
to
keep
clients
from
disengaging
from
the
group
and
help
the
client
to
appreciate
that
change
is
possible.
Because
of
the
emphasis
given
to
the
importance
of
group
climate
in
af-
fecting
the
success
of
therapy
it
is
essential
to
investigate
this
aspect
of
treatment.
It
was
hypothesized
that
sexual
offender
treatment
groups
that
were
seen
to
be
cohesive,
well
organized,
and
well
led,
with
encouragement
of
desirable
group
norms
by
leaders
and
the
instillation
of
hope,
would
be
more
effective
than
those
that
did
not
possess
these
characteristics.
METHOD
Groups
A
measure
of
group
atmosphere
was
administered
to
both
the
group
leaders
and
the
group
members
of
12
sexual
offender
treatment
groups
at
seven
centers
in
the
United
Kingdom.
Table
I
shows
number
of
clients
and
therapists
and
the
average
number
of
hours
of
therapy
in
each
group.
Center
A
was
the
only
residential
private
specialist
center
established
for
the
treatment
of
child
abusers
in
the
United
Kingdom.
Both
incest
per-
petrators
and
extrafamiliaI
offenders
were
admitted,
provided
they
had
no
history
of
abducting
children.
Four
groups
were
running
at
the
time
of
as-
sessment.
One
of
these
was
a
4-week
assessment
group;
the
other
three
were
long-term
treatment
groups
delivering
an
average
of
15
hr
of
group
work
each
week.
Of
the
20
men
seen,
most
could
be
considered
to
be
at
high
risk
of
reoffending,
having
deeply
ingrained
prooffending
attitudes
and
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
223
Table
I.
Group
Descriptions
behaviors.
Fifteen
had
committed
extrafamilial
or
both
intra-
and
extrafa-
milial
offenses;
of
these,
11
had
been
convicted
or
had
disclosed
previous
contact
sexual
offenses
against
children.
Of
the
four
incest
offenders,
one
had
been
convicted
of
a
previous
contact
offense
against
a
child.
The
av-
erage
number
of
known
girl
victims
in
the
groups
studied
was
5.75
(range,
1
to
31),
and
the
average
number
of
boy
victims
was
16.9
(range,
1
to
50).
Center
B
conducted
an
ongoing
group
for
the
local
probation
service
consisting
of
2
hr
of
weekly
therapy.
Men
would
attend
these
sessions
for
the
duration
of
their
probation
order.
Of
the
eight
men
in
this
group,
six
were
child
abusers,
one
was
an
exhibitionist,
and
one
was
an
adult
rapist.
Of
the
child
abuser
sample,
three
had
committed
intrafamilial,
one
extrafamilial,
and
two
intra-
and
extrafamilial
offenses.
All
of
the
men
who
had
committed
extrafamilial
offenses
had
been
convicted
of
previous
sexual
offenses.
The
average
number
of
known
girl
victims
in
the
group
studied
was
2.0
(range,
1
to
4);
the
average
number
of
boy
victims
was
2.0
(range,
1
to
4).
Center
C
conducted
an
ongoing
group
for
the
local
probation
service
and
a
national
child
protection
agency,
consisting
of
2
hr
of
biweekly
ther-
apy.
Men
would
attend
these
sessions
for
the
duration
of
their
probation
order.
Of
the
nine
men
in
this
group,
all
were
child
abusers.
Four
had
committed
intrafamilial
and
four
extrafamilial
offenses;
one
had
committed
both
intrafamilial
and
extrafamilial
offenses.
Of
these,
two
had
been
con-
victed
of
previous
sexual
offenses.
The
average
number
of
known
female
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
224
victims
in
the
group
studied
was
1.5
(range,
1
to
3);
the
average
number
of
known
male
victims
was
4.7
(range,
4
to
6).
Center
D
conducted
a
number
of
short-term
groups
consisting
of
2
weeks
of
day-long
sessions.
Of
the
eight
men
in
the
group,
all
had
com-
mitted
offenses
against
children.
Six
had
committed
intrafamilial
offenses
and
two
extrafamilial
offenses;
of
these,
two
had
been
convicted
of
previous
sexual
offenses.
The
average
number
of
known
female
victims
in
the
group
studied
was
1.7
(range,
1
to
2);
the
average
number
of
known
male
victims
was
5.7
(range,
1
to
8).
Center
E
also
conducted
short-term
groups
consisting
of
2
weeks
of
day-
long
sessions.
Sixteen
men
in
two
groups
were
seen
here.
Each
group
had
seven
child
abusers
and
either
an
exhibitionist
(E:1)
or
a
rapist
(E:2).
Of
the
14
child
abusers,
7
had
committed
extrafamilial
and
7
intrafamilial
of-
fenses ;
of
these,
5
had
been
convicted
of
previous
sexual
offenses.
The
av-
erage
number
of
known
female
victims
in
the
group
studied
was
1.4
(range,
1
to
3);
the
average
number
of
known
male
victims
was
2.7
(range,
1
to
5).
Center
F
also
conducted
short-term
groups
consisting
of
2
weeks
of
day-long
sessions,
plus
three
follow-up
day
sessions.
Sixteen
men
in
2
groups
were
seen
here.
The
first
group
had
7
child
abusers
and
one
exhi-
bitionist
(F:1);
the
second
group
(F:2)
consisted
of
6
child
abusers,
an
exhibitionist,
and
a
man
who
had been
convicted
of
making
obscene
tele-
phone
calls.
Of
the
14
child
abusers,
8
had
committed
intrafamilial
offenses
and
6
extrafamilial
offenses;
of
these,
4
had
been
convicted
of
previous
sexual
offenses.
The
average
number
of
known
female
victims
in
the
groups
studied
was
1.1
(range,
1
to
2);
the
average
number
of
known
male
victims
was
11.5
(range,
1
to
41).
Center
G
conducted
a
treatment
program
consisting
of
short-term
groups
which
lasted
1
week.
This
was
followed
by
long-term
coworking:
a
group
leader
worked
with
the
client
and
the
client’s
probation
officer.
Seven
of
the
eight
men
in
the
group
were
child
abusers;
the
other
man
had
committed
adult
rape.
Of
the
seven
child
abusers,
four
were
extrafa-
milial
and
three
were
incest
offenders.
Six
of
these
men
of
had
committed
offenses
against
girls
(average
number
of
victims,
1.3;
range,
1
to
2).
The
other
child
abuser
had
committed
offenses
against
both
boys
and
girls
(total
of
four
victims).
He
was
the
only
member
of
the
group
who
had
been
con-
victed
of
a
previous
sexual
offense
(indecent
exposure).
Measures
The
measure
used
was
the
Group
Environment
Scale
(GES;
Moos,
1986).
This
instrument
contains
a
number
of
scales that
describe,
and
can
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
225
be
used
to
compare,
the
overall
climate
of
different
groups.
MacKenzie
and
Livesley
(1986)
suggest
that,
in
the
measurement
of
group
process,
it
is
helpful
to
use
measures
that
deal
with
the
group
as
an
entire
system.
The
GES
grew
out
of
extensive
work
on
the
measurement
of
social
envi-
ronments,
such
as
task-oriented
groups,
social
and
recreational
groups,
and
psychotherapy
and
mutual
support
groups.
Because
of
the
large
number
of
groups
examined
by
Moos
and
his
colleagues,
each
of
the
10
GES
subscales
has
been
standardized,
enabling
interpretation
of
group
profiles.
1.
Cohesion
measures
the
members’
group
involvement,
commitment
to
the
group,
and
concern
and
friendship
they
show
for
each
other.
2.
Leader
Support
measures
the
help
and
friendship
shown
by
group
leaders.
3.
Expressiveness
measures
the
extent
to
which
freedom
of
action
and
expression
of
feelings
are
encouraged
in
the
group.
4.
Independence
measures
the
encouragement
of
independent
action
and
expression.
5.
Task
Orientation
assesses
the
emphasis
placed
on
practical
tasks
and
decision
making
in
the
group.
6.
Self
Discovery
assesses
the
extent
to
which
the
group
encourages
members’
revelations
and
discussions
of
personal
information.
7.
Anger
and
Aggression
measures
the
tolerance
of
open
expression
of
negative
feelings
and
intermember
disagreement.
8.
Order
and
Organization
measures
the
structure
of
the
group
and
explicitness
of
its
rules.
9.
Leader
Control
measures
leader
direction
and
enforcement
of
the
group’s
rules.
10.
Innovation
measures
leaders’
encouragement
of
change
in
group
activities.
These
scales
assess
the
following
dimensions
of
group
atmosphere:
rela-
tionships
within
the
group
(Scales
1
to
3),
personal
growth
of
group
mem-
bers
(Scales
4
to
7),
and
system
maintenance
and
system
change
(Scales
8
to
10).
The
GES
was
administered
to
the
long-term
residential
groups
(A:l,
A:2,
A:3)
and
groups
B and
C
when
members
had
been
in
therapy
for
6
months.
It
was
administered
to
the
short-term
intensive
groups
(A :Assess-
ment,
D,
E:l,
E:2,
F:l,
F:2)
2
days
prior
to
the
end
of
treatment
and
to
the
short-term
intensive
plus
coworking
group
(G)
1
day
prior
to
the
end
of
the
group
treatment
period.
These
time
periods
were
chosen
in
order
to
assess
the
atmosphere
of
a
mature
group.
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
226
Data
Analysis
Analysis
of
the
data
was
concerned
with
comparing
how
members’
and
leaders’
perceptions
of
the
groups
differed,
what
differences
there
might
be
between
groups,
and
how
that
might
relate
to
treatment
outcome
and
investigating
how
leadership
style
affects
group
processes
and
what
might
constitute
a
successful
group.
From
the
previous
discussion
it
was
expected
that
the
more
successful
groups
would
be
cohesive,
as
measured
by
the
Cohesion
scale
(1);
be
well
organized,
as
measured
by
the
Order
and
Or-
ganization
(8)
and
Innovation
(10)
scales;
have
a
good
level
of
leader
control,
without
being
aggressive
and
confrontational,
as
measured
by
the
Leader
Control
scale
(9);
be
well
led
and
encourage
personal
growth
of
members,
as
measured
by
the
Independence
(4)
and
Task
Orientation
(5)
scales;
be
supportive
of
members,
as
measured
by
the
Leader
Support
scale
(2);
and
encourage
desirable
group
norms,
as
partly
measured
by
the
Ex-
pressiveness
(3)
and
Self
Discovery
(6)
scales.
A
method
of
identifying
short-term
treatment
effectiveness
is
described
in
the
STEP
Report
(Beckett
et
at,
1994;
Beech,
Beckett,
&
Fisher,
199&dquo;7).
This
method
employed
a
range
of
scales
measuring
level
of
cognitive
dis-
tortions
about
children,
fixation
on
children,
level
of
denial,
admission
of
offense
behaviors,
and
level
of
social
inadequacy.
It
was
found
that
54%
of
the
sample
(28
of
52)
seen
at
posttreatment
had
scores
on
most
of the
measures
which
fell
within
the
limits
of
nonoffenders.
There
were
also
sig-
nificant
pre-post
changes
on
all
measures
employed.
These
findings
suggest
that
this
group
of
men
benefitted
from
treatment.
In
comparison,
the
rest
of
the
sample
(N
=
24)
had
scores
that
were
still
outside
the
normal
range
of
scores
at
posttest
and
no
change
was
found
on
their
scores
on
the
ques-
tionnaires
given
before
and
after
treatment
(except
for
an
improvement
in
the
level
of
denial
of
offense
behaviors).
RESULTS
Overall
Analyses
A
MAN4VA
was
initially
carried
out
on
the
data.
This
consisted
of
using
two
grouping
variables
(Member/
Leader
and
Treatment
Group)
and
the
10
GES
scales
as
multiple
dependent
variables.
Significant
main
effects
were
found
in
both
the
Member/Leader
and
the
Treatment
Group
vari-
ables.
(No
significant
interaction
was
found
between
these
two
variables.)
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
227
Participants
A
highly
significant
difference
was
found
in
the
Member/Leader
vari-
able
[F(10,72)
=
5.35,
p
<
.001],
indicating
that
members
and
leaders
perceived
the
group
differently.
Univariate
F
tests
within
the
MANOVA
showed
that
significant
differences
between
member
and
leader
scores
on
the
following
scales
were
responsible
for
this
result:
Leader
Control
[F(1,81)
=
14.79,
p
<
.001],
Leader
Support
[F(1,81)
=
8.17,
p
<
.01],
Anger
and
Aggression
[F(1,81)
=
6.11, p
<
.05],
and
Innovation
[F(1,81)
= 5.68, p
<
.05].
Examination
of
the
mean
scores
of
members
and
leaders
on
these
scales
suggests
that
the
leaders
saw
themselves
as
more
in
control
of
di-
recting
the
group,
that
they
viewed
themselves
as
making
decisions
and
enforcing
rules
and
offering
a
greater
degree
of
help,
concern,
and
friend-
ship,
considered
themselves
as
better
able
to
handle
anger
and
aggression
in
the
group,
and
perceived
the
group
as
more
innovative
than
did
the
members.4
Treatment
Groups
There
was
a
significant
effect
in
the
Treatment
Group
variable
[F(110,702)
=
3.70, p
<
.0001],
indicating
that
the
climate
was
different
across
groups.
Univariate
F
tests
within
the
MANOVA
showed
that
this
effect
was
due
to
significant
differences
on
six
scales:
Cohesion
[F(11,81)
=
3.08, p
<
.01],
Expressiveness
[F(11,81)
=
2.12,
p
<
.05],
Independence
[F(11,81)
=
2.96,
p
<
.01],
Task
Orientation
[F(11,81)
=
2.92,
p
<
.01],
Anger
and
Aggression
[F(11,81)
=
4.96,
p
<
.0001],
and
Order
and
Or-
ganization
[F(11,81)
=
6.51,
p
<
.0001].
There
were
differences
in
group
climate
between
the
long-term
resi-
dential
groups
(providing
over
450
hr
of
therapy)
and
the
short-term
groups
(providing
between
36
and
64
hr
of
therapy).
Contrast
analyses
using
one-
way
ANOVAs
found
significant
differences
between
the
short-
and
the
long-term
groups
on
Task
Orientation
[t(93)
=
2.41,
p
<
.018],
Anger
and
Aggression
[t(93)
=
5.25, p
<
.0001],
and
Order
and
Organization
[t(93)
= 6.8, p
<
.0001].
In
order
to
assist
in
the
interpretation
of
these
data,
Table
II
shows
whether
each
combined
group
score
was
low,
medium,
or
high
on
each
of
4A
MANOVA
carried
out
only
on
the
Leader
data
on
all
10
GES
scales
across
the
12
groups
found
no
overall
significant
difference
in
how
leaders
perceived
the
group
climate
across
programs,
although
it
should
be
noted
that
this
analysis
was
carried
out
on
a
small
data
set
(N
=
30).
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
229
the
significant
GES
scales.
In
order
to
do
this,
data
from
the
groups
were
converted
into
standardized
t
scores
(mean
=
50,
SD
=
10)
on
the
basis
of
group
norms
provided
in
the
GES
manual
(Moos,
1986,
Appendix
A).
A
low
score
indicates
that
the
mean
score
on
the
variable
of
interest
is
at
least
half
a
standard
deviation
below
the
mean
(i.e.,
below
45),
a
medium
score
indicates
that
the
score
is
between
46 and
55,
and
a
high
score
in-
dicates
that
the
score
is
at
least
half
a
standard
deviation
above
the
mean
(i.e.,
above
55).
It
can
be
seen
from
Table
II
that
Anger
and
Aggression
was
generally
perceived
as
managed
better
in
the
long-term
groups.
The
high
and
me-
dium
scores
on
the
Task
Orientation
and
Order
and
Organization
scales
in
the
short-term
groups
suggests
that
these
were
generally
perceived
as
better
led
than
the
long-term
groups
(where
Task
Orientation
ranged
from
low
to
high
and
Order
and
Organization
was
perceived
to
be
low
in
two
of
these
groups).
Examination
of
the
differences
within the
short-term
groups
suggests
that
Cohesion
was
judged
to
be
generally
high
in
all
groups
except
Group
C,
where
it
was
at
a
medium
level;
and
Expressiveness
was
medium
or
high,
except
in
Group
C,
where
it
was
low.
Independence
was
at
a
medium
level,
except
in
Group
D,
where
it
was
high,
and
Group
C,
where
it
was
low.
Identifying
a
Successful
Group
Profile
As
there
were
significant
overall
differences
between
members’
and
leaders’
data,
further
analyses
were
carried
out
on
all
members’
data
(n
=
75)
in
both
the
short-term
groups
and
the
three
long-term
groups.
Because
of
the
small
numbers
in
each
of
the
long-term
groups,
the
data
were
pooled
to
comprise
one
long-term
group.
Initial
analysis
consisted
of
employing
a
MANOVA
with
one
grouping
variable
(Treatment
Group)
and
using
the
10
GES
scales
as
multiple
dependent
variables.
A
significant
main
effect
was
found
in
the
Treatment
Group
variable
[F(90,488)
=
1.94, p
<
.0001],
indicating
that
members’
ratings
of
climate
varied
across
the
groups.
Uni-
variate
F
tests,
within
the
MANOVA,
found
significant
differences
in
six
of
the
scales:
Cohesion
[F(9,65)
=
2.26, p
<
.05],
Leader
Support
[F(9,65)
=
3.01,
p
<
.001],
Independence
[F(9,65)
=
2.91, p
<
.01],
Anger
and
Aggression
[F(9,65)
=
3.76, p
<
.001],
Order
and
Organization
[F(9,65) =
3.65,
p
<
.0001],
and
Leader
Control
[F(9,65)
=
2.52, p
<
.05].
Multiple
classification
analysis
(i.e.,
adjusted
deviation
from
the
grand
mean)
of
these
data
was
used
to
derive
a
rating
for
each
group
on
the
significant
GES
scales.
These
are
given
in
Table
III.
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
231
Group
D
had
the
most
positive
ratings
on
Cohesion,
Leader
Support,
Independence,
and
Order
and
Organization
and
a
negative
rating
on
Leader
Control.
Contrast
analyses,
using
one-way
ANOVAs,
found
that
Group
D
scores
were
significantly
higher
than
all
of
the
other
groups’
on
Cohesion
[t(65)
=
3.94, p
<
.001],
Leader
Support
[t(65)
=
1.95, p
<
.05],
Independence
[t(54)
=
3.44,
p
<
.001],
and
Order
and
Organization
[t(54)
= 5.74, p
<
.0001].
In
comparison,
Group
C
had
the
most
negative
ratings
on
Cohesion
and
Independence,
a
negative
rating
on
Leader
Support,
and
a
positive
rating
on
Leader
Control.
Contrast
analyses,
using
one-way
ANOVAs,
found
that
Group
C
scores
were
significantly
lower
than
all
of
the
other
groups
on
Cohesion
[t(65)
=
5.03,
p
<
.0001],
and
Independence
[t(65) =
4.60,
p
<
.0001].
In
order
to
illustrate
the
differences
between
Group
C
and
Group
D,
GES
data
from
these
two
groups
were
converted
into
standardized
t
scores
(mean
=
50,
SD
=
10)
on
the
basis
of
group
norms
provided
in
the
GES
manual
(Moos,
1986).
Figure
1
shows
the
standardized
profiles
of
these
two
groups.
From
Fig.
1
it
can
be
seen
that
Group
D
members
rated
the
group
1
SD
higher
than
Group
C
members
on
six
of
the
GES
scales
(Co-
hesion,
Leader
Support,
Expressiveness,
Independence,
Task
Orientation,
and
Innovation).
The
only
scale
with
a
higher
rating
in
Group
C
compared
to
Group
D
was
Leader
Control.
A
comparison
of
the
successful
treatment
on
a
number
of
outcome
measures
(Beckett et
al.,
1994;
Beech et
aL,
1997)
at
posttest
found
that
57%
of
the
men
in
Group
D
met
this
criterion,
compared
to
only
25%
of
the
men
in
Group
C.
It
should
be
noted,
however,
that
these
were
small
sample
sizes,
and
Group
C
was
an
ongoing
program
and
thus
some
of-
fenders
had
not
necessarily
completed
treatment
at
the
time
of
assessment.
Effect
of
Leadership
Style
on
Group
Process
Investigation
of
leadership
style
across
the
groups
was
conducted
by
examining
the
relationships
among
Leader
Control,
Leader
Support,
and
other
GES
scales
using
correlational
analyses
(Pearson’s
product-moment).
This
analysis
was
conducted
solely
on
members’
responses
in
all
programs
(n
=
75).
Table
IV
shows
the
correlation
matrix
of
the
GES
scales.
As
a
large
number
of
comparisons
were
made,
the
significance
level
was
set
at
p
<
.001.
Table
IV
shows
that
the
Leader
Support
scale
was
significantly
related
to
the
Cohesion,
Task
Orientation,
and
Order
and
Organization
scales.
No
significant
relationships
were
found
between
Leader
Control
and
any
of
the
other
scales.
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
232
Fig.
1.
Standardized
profiles
of
groups
C
and
D.
DISCUSSION
Although
it
is
difficult
to
make
definitive
statements
on
what
may
con-
stitute
the
right
climate
for
sexual
offender
group
treatment
programs,
the
literature
on
groups
in
general
suggests
that,
to
be
effective,
a
group
should
be
highly
cohesive,
well
organized,
and
well
led,
have
desirable
group
norms,
and
instill
a
sense
of
hope
in
members.
Comparing
the
probation
programs,
in
which
a
similar
amount
of
therapy
had
taken
place
prior
to
the
administration
of
the
GES,
it
was
found
that
Group
D’s
ratings
on
six
of
the
scales
(Cohesion,
Leader
Support,
Expressiveness,
Independence,
Task
Orientation,
and
Innovation)
were
1
SD
above
Group
C’s.
Leader
Control
was
the
only
scale
where
Group
C
had
a
higher
rating.
These
re-
sults
indicate
that
Group
D
had
a
better
group
climate.
It
has
been
reported
elsewhere
that
Group
D
was
more
successful
in
producing
short-
term
treatment
change
than
Group
C
(Beckett
et
aL,
1994;
Beech
et
al.,
1997).
Taken
together,
these
findings
indicate
that
having
the
right
atmos-
phere
is
an
important
component
in
the
therapeutic
process.
Other
findings
suggest
that
leaders
tend
to
overestimate
the
help
they
provide
in
groups,
perceive
that
they
are
more
in
control
than
members
do,
and
see
the
group
as
facilitating
diversity
and
change
much
more
than
do
the
members.
It
is
not
unusual
for
there
to
be
differences
between
per-
ceptions
of
members
and
leaders,
but
it
has
been
suggested
that
marked
differences
between
client
and
therapist
treatment
expectations
have
been
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
234
related
to
client
dropout
from
therapy
(Pekarik
&
Finney-Owen,
1987).
Those
who
have
responsibility
for
running
groups
tend
to
perceive
the
so-
cial
climate
more
positively
than
do
members
(Moos,
1986).
However,
the
significant
differences
between
leaders
and
members
in
perception
of
the
leaders’
role
(Leader
Control
and
Leader
Support)
and
the
innovation
in
the
group
suggest
that
some
group
leaders
had
an
overly
optimistic
view
of
the
work
they
were
accomplishing.
These
results
bear
out
observations
made
on
the
basis
of
interviews
with
the
group
leaders
of
the
programs
(Beckett et
aL,
1994,
Chap.
2).
Some
group
leaders
seemed
unaware
of
the
power
of
the
group
process
itself
in
instilling
change,
and
perhaps
more
importantly,
they
failed
to
recognize
their
own
role
in
setting
group
norms.
A
better
knowledge
of
group
dynamics
may
help
some
leaders
to
use
the
group
process
to
facilitate
change.
More
training
in
this
area
for
those
en-
gaged
in
sexual
offender
treatment
programs
seems
appropriate.
This
should
focus
not
only
on
the
content
of
treatment
but
also
on
the
leader-
ship
style.
As
discussed
previously,
leaders
should
set
a
clear
structure
and
set
of
rules
for
the
group,
they
should
not
be
aggressively
confrontational,
but
be
supportive
and
model
effective
interpersonal
interactions.
Leaders
should
facilitate
active
participation
by
all
members
and
take
care
to
find
out
whether
members
have
understood
key
therapeutic
messages.
Clear
communication
is
an
essential
skill
to
run
an
effective
group
and
leaders
should
ensure
that
they
are
presenting
information
in
a
comprehensible
way.
Comprehension
can
also
be
affected
by
level
of
anxiety.
Leaders
should
be
aware
that
if
the
group
experience
is
too
confrontational,
mem-
bers’
ability
to
benefit
will
be
impaired.
Members’
data
show
that
the
Leader
Support
scale
was
significantly
related
to
the
Cohesion,
Task
Orientation,
and
Order
and
Organization
scales.
This
suggests
that
friendly,
supportive
leaders
are
more
likely
to
be
conducting
cohesive,
well-organized
groups
with
an
emphasis
on
practical
tasks
and
decision
making.
As
Couch
and
Childers
(1987)
observe,
leader
support
can
be
an
important
part
of
the
therapeutic
process
by
encouraging
new
more
appropriate
behaviors,
by
calling
attention
to
such
improvements,
by
helping
members
to
assume
responsibility
for
their
progress,
and
by
en-
couraging
group
members
to
acknowledge
each
other’s
progress.
Comparing
climate
across
the
different
programs,
Group
D,
with
a
much
more
supportive
style
of
leadership
than
Group
C,
produced
more
short-
term
therapeutic
change.
Although
we
are
not
suggesting
that
having
good
leader
support
is
all
that
is
needed
for
effective
therapy,
it
appears
to
be
an
important
aspect
in
producing
the
right
environment.
In
contrast,
it
is
interesting
to
note
that
there
were
no
correlations
between
Leader
Control
and
any
of
the
other
GES
scales.
The
latter
find-
ing
suggests
that
overt
leader
direction
and
the
strict
enforcement
of
rules
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
235
appear
to
have
little
influence
on
overall
group
climate.
Although
when
comparing
Group
C
with
Group
D,
the
former
was
seen
by
members
to
have
a
higher
level
of
Leader
Control,
it
had
scores
on
Cohesion,
Leader
Support,
Expressiveness,
Independence,
Task
Orientation,
and
Innovation
that
were
1
SD
lower
than
those
found
in
Group
D.
This
result
lends
some
support
to
the
idea
that
being
very
controlling
as
a
leader
may
lead
to
negative
outcomes
in
group
practice
(Korda
&
Pancrazio,
1989).
The
high
level
of
Leader
Control
in
Group
C
appeared
to
have
a
detrimental
effect
upon
cohesiveness
and
the
level
of
support,
expression
of
feelings,
and
de-
gree
of
autonomy
felt
by
members
in
the
group.
Striking
differences
were
found
between
the
long-term
groups
and
the
short-term
programs
on
the
Anger
and
Aggression
and
Order
and
Organi-
zation
scales.
The
long-term
programs
were
seen
by
members
and
leaders
as
having
less
formality,
structure,
and
explicit
rules,
and
being
more
able
to
tolerate
and
encourage
the
open
expression
of
negative
feelings
and
in-
termember
disagreement
than
the
short-term
groups.
These
findings
may
reflect
the
amount
of
experience
the
therapists
had
running
these
groups
or
the
maturity
of
the
group
itself,
with
members
feeling
more
able
to
ex-
press
their
negative
feelings
and
the
leaders
feeling
less
need
to
make
explicit
the
norms
of
the
group.
Many
factors
influence
treatment
outcome,
such
as
the
amount
of
ther-
apy,
the
level
of
posttreatment
support,
the
level
of
social
and
sexual
problems
prior
to
treatment,
and
the
acquisition
and
employment
of
an
effective
relapse
prevention
plan.
However,
although
the
present
study
is
limited
in
scope,
initial
analysis
suggests
that
group
climate
had
an
impor-
tant
influence
on
the
quality
and
impact
of
therapy
for
sexual
offenders.
A
more
in-depth
study
of
how
therapeutic
climate
influences
treatment
can
be
investigated
only
looking
at
long-term
recidivism
and/or
reoffense
rates.
As
the
GES
deals
with
the
group
as
a
whole
system,
in
any
future
research
measures
to
look
at
therapists’
characteristics
and
attitudes
could
also
be
usefully
employed.
It
has
been
noted
in
the
psychotherapy
literature
that
these
can
have
strong
influences
on
therapeutic
outcome
(Karterud,
1988;
Korda
&
Pancrazio,
1989;
Pekarik
&
Finney-Owen,
1987).
Research
is
cur-
rently
under
way
investigating
the
therapeutic
climate
of
a
number
of
groups
for
incarcerated
sexual
offenders
in
the
U.K.
penal
system.
Here
all
groups
deliver
the
same
program,
therefore
group
climate
and
its
in-
fluence
on
short-term
treatment
change
and
long-term
recidivism
may
be
more
easily
measured
without
the
confounding
effects
of
the
content,
mode
of
delivery,
and
differing
treatment
length
present
in
the
current
study.
The
routine
employment
of
some
measure
of
group
environment
would
seem
a
sensible
adjunct
to
any
evaluation
of
work
in
this
area.
As
Hollin
(1995)
points
out,
any
effective
program
working
with
offenders
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
236
should
employ
performance
indicators
that
include
both
outcome
and
proc-
ess
measures.
ACKNOWLEDGMENTS
The
STEP
evaluation
was
funded
by
the
Research
and
Planning
De-
partment
of
the
United
Kingdom
Home
Office.
We
would
like
to
thank
Dr.
William
Marshall
and
two
anonymous
referees
for
their
comments
on
an
early
draft
of
this
paper.
REFERENCES
Barker,
M.,
&
Beech,
A.
R.
(1993).
Sex
offender
treatment
programs:
A
critical
look
at
the
cognitive-behavioral
approach.
Issues
in
Criminological
and
Legal
Psychology,
19,
37-42.
Barker,
M.,
&
Morgan,
R.
(1993).
Sex
offenders:
A
framework
of
community-based
treatment.
London:
Home
Office
Publications
Unit.
Beckett,
R.
C.,
Beech,
A.
R.,
Fisher,
D.,
&
Fordham,
A.
S.
(1994).
Coinmunity-based
treatment
for
sex
offenders.
An
evaluation
of
seven
treatment
programs.
London:
Home
Office
Publications
Unit.
Beech,
A.
R.,
Beckett,
R.
C.,
&
Fisher,
D.
(1997).
Assessing
treatment
effectiveness
in
a
child
molester
sample.
Psychology,
Crime
and
the
Law
(in
press).
Behroozi,
C.
S.
(1992).
Groupwork
with
involuntary
clients:
Remotivating
strategies.
Groupwork,
5,
31-41.
Belfer,
P.
L.,
&
Levendusky,
L.
(1985).
Long-term
behavioral
group
psychotherapy.
An
integrative
model.
In
D.
Upper
&
S.
Ross
(Eds.),
Handbook
of
behavioral
group
therapy.
New
York:
Plenum
Press.
Braaten,
L.
J.
(1989).
Predicting
positive
goal
attainment
and
symptom
reduction
from
early
group
climate
dimensions.
Intemational
Journal
of
Group
Psychotherapy,
39,
377-387.
Clark,
P.,
&
Erooga,
M.
(1994).
Groupwork
with
men
who
sexually
abuse
children.
In
T.
Morrison,
M.
Erooga,
&
R.
C.
Beckett
(Eds.),
Sexual
Offenders
Against
Children:
Practice,
Management
and
Policy.
London:
Routledge.
Couch,
D.
R.,
&
Childers,
J.
H.
(1987).
Leadership
strategies
for
instilling
and
maintaining
hope
in
group
counselling.
Joumal
for
Specialists
in
Group
Work,
12,
139-143.
Erooga,
M.,
Clark,
P.,
&
Bentley,
M.
(1990).
Protection,
control
and
treatment:
Groupwork
with
child
sexual
abuse
perpetrators.
Groupwork,
3,
172-190.
Hollin,
C.
R.
(1995).
The
meaning
and
implications
of
"programme
integrity."
In
J.
McGuire
(Ed.),
What
works:
Reducing
reoffending.
Chichester:
Wiley.
Karterud,
S.
(1988).
The
influence
of
task
definition,
leadership
and
therapeutic
style
on
inpatient
group
cultures.
Interriational
Journal
of
Therapeutic
Communities,
9,
231-247.
Korda,
L.
J.,
&
Pancrazio,
J.
J.
(1989).
Limiting
negative
outcome
on
group
practice.
Journal
for
Specialists
in
Group
Work,
14,
112-120.
MacKenzie,
H.
R.,
&
Livesley,
W.
J.
(1986).
Outcome
and
process
measures
in
brief
group
psychotherapy.
Psychiatric
Annals,
16,
715-720.
Marshall,
W.
L.,
Ward,
T.,
Jones,
R.,
Johnston,
P.,
&
Barbaree,
H.
E.
(1991).
An
optimistic
evaluation
of
treatment
outcome
with
sex
offenders.
Violence
Update,
1,
8-11.
Moos,
R.
H.
(1986).
Group
environment
scale
manual
(2nd
ed.).
Palo
Alto,
CA:
Consulting
Psychologists
Press.
Nichols,
M.
P.,
&
Taylor,
T.
Y.
(1975).
Impact
of
therapist
interventions
on
early
sessions
of
group
therapy.
Joumal
of
Consulting
and
Clinical
Psychology,
31,
726-729.
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
237
Pekarik,
G.
P.,
&
Finney-Owen,
K.
(1987).
Outpatient
clinic
therapist
attitudes
and
beliefs
relevant
to
client
dropout.
Community
Mental
Health
Joumal,
23,
120-130.
Stephenson,
M.
(1991).
A
summary
of
an
evaluation
of
the
community
sex
offender
program
in
the
pacific
region.
Forum
on
Corrections
Research,
3,
25-30
(Correctional
Service,
Canada).
Yalom,
I.
(1975).
The
theory
and
practice
of
group
psychotherapy
(2nd
ed.).
New
York:
Basic
Books.
at ATSA on December 30, 2014sax.sagepub.comDownloaded from
