Clinical and forensic psychology (year two) Flashcards

Question

Describe research findings of diversity and difference on diagnosis

Answer 1

- Some individuals have strange experiences (visions, auditory hallucinations, or profound spiritual experiences) but see them as spiritually enriching, not illness (Jackson & Fulford, 1997). - Huge diversity in what is considered an appropriate expression of distress in different cultures. o Cochrane & Sashidharan (1995) - diagnostic systems can label behaviours as problems because they differ from what is normal in white, western, male, middle-class culture. In some cultures behaviours and experiences are common which are considered very abnormal in others.

Answer 2

- Diagnosis does not predict the course or outcome of psychotic illnesses - .Diagnosis does not predict response to medication (Kendell, 1988).

Answer 3

- Avoidance – people want to create social distance (Mehta & farina, 1997) - Harsh treatment – Mehta & Farina (1997) people gave more electric shocks to those with problems understood as being due to mental illness compared to childhood events. - Unemployment & Social Disadvantage - Less likely to get jobs (Farina & Felner, 1983) Excluded from some professions & life insurance etc. - Loss of rights - Forced treatment Exclusion from driving / jury service

Answer 4

- Hopelessness and decreased confidence - Identifying with label of ‘mental patient’ (self fulfilling prophecy) - Disempowerment - Decreased ownership of experiences - Denial of the meaning of experiences and relevance to current environment - Denial of positive aspects of experiences

Answer 5

- Gives a misleading impression of certainty – syndromes and labels become real entities - Promotes ‘us’ and ‘them’ thinking - Narrow understanding of people’s problems - Does not see people as able to change - Places problem within individual rather than environment - Fosters dependency in patients - Narrows conceptualisations of treatment and treatment effectiveness - Narrows the focus of research (it is about diagnosis rather than need, vulnerability and risk)

Answer 6

- “The case formulation is a hypothesis about the nature of psychological difficulty underlying the problems on the patients’ problem list” (J. Persons 1989) - The way in which you understand the problem. - Application of the applied scientist approach o 1) Collect information that will help understand the client’s difficulties and highlight areas in which change may be possible (develop a hypothesis). o 2) Assess the level of severity of the problems in order to assess the impact of any interventions. This will allow you to test your hypotheses regarding the nature of the problem. i.e.. measure change o 3) To inform the client about the psychological approach(es) to be used in therapy.

Answer 7

Language from biomedical model means difficulties seen as problems within an individual o Pathologizes normal responses o Contributes to power imbalance between client and clinician - Labelling MH as illness is associated with predictions of dangerousness, unpredictability and fear and desire for social distance (Read et al., 2006)

Answer 8

Fernando 1991: Psychiatry is ethnocentric - Garb 1997: AA/Hispanic patients more likely to receive a diagnosis of schizophrenia than white patients - Neighbors et al 2003: white psychiatry inpatients are more likely than AA to be diagnosed with bipolar disorder - NHS Digital 2018: Black people four times more likely to be detained under the mental health act

Answer 9

DSM-5, 2000: 75% of people diagnosed with BPD are AFAB - Ball and Links, 2009: Evidence of causal relationship between childhood trauma and later diagnosis of BPD (particularly sexual trauma) - Some researchers have therefore argued that instead of seeing women’s distress as symptoms of a ‘borderline personality disorder’ we should understand their difficulties as a response to societal sexual violence and oppression (e.g. Shaw & Proctor, 2005)

Answer 10

Usual rather than unusual - more than 50% of people diagnosed with a mental disorder in a given year meet criteria for multiple disorders (Kessler et al., 2005) - 23% of sample of psychiatric patients have three or more diagnoses (National Comorbidity Survey) - Problem of comorbidity raises significant questions about the underlying structure & assumptions of classification (Hyman, 2010)

Answer 11

- Heterogeneity: consisting of lots of different parts or elements - Using specifiers and extra criteria increases heterogeneity - 80,000 symptom combinations for PTSD diagnosis in DSM-IV compared with 600,000 combinations in DSM-5 (Galatzer-Levy & Bryant, 2013) - Allsopp et al (2019): Explored the heterogeneity of mental health difficulties & experiences, and how diagnostic systems attempt to cope with this - Timescales – e.g. discrete episodes vs. minimum time requirements - Comparators – some experiences compared with ‘normal’ functioning (e.g. low mood) vs. others implicitly seen as inherently disordered (e.g. paranoia, hearing voices) - Role of trauma only acknowledged in specific categories e.g. PTSD

Answer 12

Heterogeneity: consisting of lots of different parts or elements - Using specifiers and extra criteria increases heterogeneity - 80,000 symptom combinations for PTSD diagnosis in DSM-IV compared with 600,000 combinations in DSM-5 (Galatzer-Levy & Bryant, 2013) - Allsopp et al (2019): Explored the heterogeneity of mental health difficulties & experiences, and how diagnostic systems attempt to cope with this - Timescales – e.g. discrete episodes vs. minimum time requirements - Comparators – some experiences compared with ‘normal’ functioning (e.g. low mood) vs. others implicitly seen as inherently disordered (e.g. paranoia, hearing voices) - Role of trauma only acknowledged in specific categories e.g. PTSD - Homogeneity: consisting of parts or elements that are all the same.

Answer 13

The majority of people using mental health services have been exposed to adverse or traumatic life experiences (Mauritz et al., 2013) - Multiple meta-analyses have demonstrated a robust association between traumatic experiences and mental health difficulties including: o Depression (Mandelli et al, 2015; Nelson et al., 2017) o Anxiety (Lindert et al., 2013) o Obsessive compulsive disorder (OCD) (Miller & Brock, 2017) o Suicidal behaviour (Zatti et al., 2017) o Self-harm (Liu et al., 2016) o Psychosis (Varese et al., 2012) o Bipolar disorder (Palmier-Claus et al., 2016) - Preventing childhood trauma would reduce cases of psychosis by a third (Varese et al, 2012) - Typical psychological therapies are not as effective for people who have had traumatic life experiences: o increased risk of recurrent and persistent depression (Nanni et al) o a lack of response/remission during depression treatment (Nanni et al) o twice as likely to develop chronic or treatment-resistant depression (Nelson et al., 2017)

Answer 14

Using ICD psychosocial codes (Allsopp & Kinderman, 2017) o neglect, abandonment, other maltreatment (Y06 and Y07) o homelessness, poverty, discrimination, and negative life events in childhood, including trauma (Z55-Z65) - ICD code analysis in mental health services (Kinderman et al., under review) o Diagnosis only used in 21.5% of patient records (N=21,701) o Codes for possible social determinants were used on only 43 occasions, \<1% of almost 5000 people who were given a diagnosis - GP records showed 1.8% of a sample of 11m had officially confirmed childhood maltreatment (Chandan et al., 2019) o Those who had been maltreated were over 2x more likely to develop a mental health problem - Organise services based on need & the severity/ complexity of distress - Use a ‘complaints- or problem-based approach’: Descriptions without implication of “a disorder” (e.g. ICD codes; Kinderman & Allsopp, 2018) - The Power Threat Meaning Framework - Trans-diagnostic approaches - Psychological formulation

Answer 15

- Borderline personality disorder: Characterised by impulsivity, unstable/intense relationships, suicidal/self-harm behaviour, marked reactivity of mood

Answer 16

- Three clusters of personality disorders: o A: Odd/eccentric (paranoid, schizoid, schizotypal) o B: Dramatic/erratic (Antisocial, borderline, histrionic, narcissistic) o C: Anxious/fearful (Avoidant, dependent, obsessive-compulsive)

Answer 17

- Personality disorders very closely associated with childhood abuse - Diagnosis is: disempowering, ignores trauma/blame, locates blame in a ‘disorder’ o Also misogynistic

Answer 18

In the DSM system- Narcissistic Personality Disorder (NPD); Anti-Social Personality Disorder (ASPD) Diagnostic systems rely on arbitrary cut-off points between “normal” and “abnormal” personality In personality literature, this variation is considered as normal From evolutionary perspective, different levels of these traits could be adaptive (e.g., fast life history; short-term mating strategy)

Answer 19

Superficial charm 2. Grandiose sense of self-worth 3. Easily bored 4. Pathological lying 5. Manipulative 6. Lack of remorse or guilt 7. No emotional depth 8. Callous 9. Parasitic lifestyle 10. Poor behavioural control 11. Early behaviour problems 12. No long-term planning 13. Impulsive 14. Irresponsible 15. External locus 16. Frequent marital failures 17. Delinquent as a juvenile 18. Re-offending criminal 19. Promiscuous sexual behaviour 20. Versatile as a criminal

Answer 20

monoamine hypothesis: norepinephrine, dopamine & serotonin disturbances are responsible for depression. These are important for sleep, appetite & emotion. Most antidepressants increase levels of these. Evidence is still equivocal after 20 years. More recently, an imbalance between monoamines & acetylcholine has been suggested as the cause (Janowski et al, 1983). Also, an increase in cholinergic activity due to stress is thought to effect the incentive function of the brain's reward system by reducing sensitivity (Willner, 1985).

Answer 21

Psychodynamic 'Frozen anger' directed at self following some real/imagined loss. Behavioural Lewinsohn (1974)~ a low rate of response contingent positive reinforcement is the causal & maintaining factor in depression. Also linked with inadequate social reinforcement. Evidence is mainly correlational. Seligman (1975)~ learned helplessness model developed to account for deficits in dogs exposed to uncontrollable shocks. Assumes that a person learns that outcomes are independent of their response and thus uncontrollable. 1. Inadequate or insufficient reinforcement Lazarus (1968) Depression can result from a lack of reinforcement Unclear whether reduced frequency or quality of reinforcement is the important factor 2. Reduced frequency of social reinforcement; Lewinsohn (1975) People drop reinforcing activities due to extinction by a low rate of response contingent positive reinforcement (they can’t make good things happen) 3. Loss of reinforcible behaviour (Ferster, 1973) Depressed person does not receive reinforcement because they do not have the responses which would elicit it. Loss of reinforcer effectiveness (Costello, 1972) Although same behaviours and consequences occur, they have lost their reinforcement potency. Could be due to changes in biochemical mechanism underlying motivation, or Breakdown in behavioural chain due to loss of 1 reinforcer (eg. Rewards are dependent upon one central component such as work).

Answer 22

It is not a situation in and of itself that determines what people feel but how they construe a situation (Beck, 1964; Ellis, 1962) Early life experiences ê Core beliefs ê Conditional assumptions/rules for living ê Activating event ê Negative Automatic Thought ê Symptoms of Depression (emotional, physical, behavioural) Suggests that vulnerability to depression arises from certain kinds of schemas/ beliefs that a person holds about themselves, the world or others, and the future (negative cognitive triad) When a core belief is activated we interpret situations through the lens of this belief even though the interpretation may not be valid Common core beliefs The self “I’m incompetent” “I’m worthless” Other people “No nobody loves/cares for me” “Others always let you down in the end” The world “The world is a cruel place, there is no point trying” “The world is full of pain, life is about suffering”

Answer 23

Identifying automatic thoughts allows you to evaluate their validity See Unhelpful Thinking Styles handout All or nothing Over-generalizations Mental filter disqualifying the positives Jumping to conclusions Magnifying & minimising Emotional reasoning Labeling Personalisation Should, must, ought to

Answer 24

Post-(European) enlightenment ideas (17-18th C) led to development of: Western Psychiatry focused on ‘abnormal’ mind  mental illness & medical therapies Western Psychology focused on ‘normal’ mind  ’scientific’ psychological therapies Non-western medical systems mainly holistic and often embedded in philosophy, religion etc. Examples: Ayurveda in Indian sub-continent Chinese traditional medicine Traditional healing Faith healing

Answer 25

Religious practices Traditional medicines Provision and resources– poverty – emigration Stigma Many more! i.e. Politics, human rights laws, science, etc

Answer 26

Understanding causation – withcraft, curses, spiritual influences i.e. Campbell et al. (2017): Looked at the content of delusions in a sample of South African Xhosa people with schizophrenia. 72.5% believed others had bewitched them 2. Acceptance of treatment - fasting, praying 3. Content of delusions or paranoia “Most are religious with much emphasis on prayer. Ethiopians are not serious about depression or sophisticated sickness. We believe in religion and holy water as a cure” (Palmer, 2007)

Answer 27

Describe the role of tradition medicines More accessible- location, language Cheaper Added spiritual influence on treatment- make treatment more effective and faster? More accepting of theory of causation

Answer 28

Evidence is varied Systematic review conducted by Posadzki et al (2012) showed: Most surveys were of poor methodological quality. The average prevalence of use of CAM was 20.6% (range 12.1–32%). The average referral rate to CAM was 39% (range 24.6–86%) CAM was recommended by 46% of physicians (range 38–55%). Self-report survey conducted by Sharp et al. (2018) showed: 16% of respondents had seen a CAM practitioner in the last 12 months

Answer 29

Impacts views towards mental illness Literate individuals are more likely to exhibit positive feelings towards individuals with mental disorders Can also impact help seeking behavior and treatment choice Formal vs. Informal education “the people from the developing countries… many people cannot realize it (…) for some people, they have very limited education or knowledge, they won’t see the seriousness of the mental illness.” (Donnelly et al., 2011)

Answer 30

1. Ostracised from community 2. Impacts employment/business 3. Impacts housing 4. Impacts ‘marriageability’ of patient and family members 5. Self-stigma?

Answer 31

Surveys and check-lists are practical and low-cost, but ‘the fatal error of community studies was to define all symptoms as pathological without considering the context in which they arose and persisted’ (Horwitz and Wakefield, 2007, p. 129). By shifting focus away from context, reported rates of disorders, such as depression, are inflated, meaning that ‘the extraordinarily high rates of untreated mental disorder reported by community studies are largely a product of survey methodologies that inherently overstate the number of people with a mental disorder’ (Horwitz and Wakefield, 2006). Such tools enable a “massive pathologization of normal sadness” that has made “depressive diagnosis less rather than more scientifically valid” (2007:103).

Answer 32

1. Category Fallacy “the reification of a nosological category developed for a particular cultural group that is applied to members of another culture for whom it lacks coherence” (Kleinman, 1987). 2. Potential biases 3. Others including traditional practices, communication, service provision, illness behavior, etc.

Answer 33

OVERVIEW OF SOURCES OF DISTRESS: Poverty and a ‘broken economy’ Housing and ‘homelessness’ ‘More important than exams, if you don’t have a place of your own to live in what good is school?’ Domestic violence and marginalisation Ill-health (physical and emotional) i.e. Jighar Khun (liver-blood; regret, depression) Educational provision Governance and social justice

Answer 34

Method of learning that occurs through rewards and punishments for behaviour. Through operant conditioning, an individual makes an association between a particular behaviour and a consequence (Skinner, 1938). Learned consequences modify the type and frequency of behaviour

Answer 35

Published Psychology from the Standpoint of a Behaviorist in 1919 Classical (Pavlovian) and instrumental conditioning can explain much, if not all, behavior. Inferring internal states is redundant and unnecessary Cognitive explanations are not scientific

Answer 36

POSITIVE REINFORCEMENT Increasing a behaviour through reward e.g. an extra 30 minutes TV for helping with clearing up NEGATIVE REINFORCEMENT increasing a behaviour by removing an aversive stimulus e.g. leaving for work early to avoid being stuck in traffic EXTINCTION decreases a behaviour slowly due to NOT experiencing an expected positive stimulus. e.g. Pavlov’s dog no longer salivates when hears bell as not provided with food

Answer 37

Obsessions Recurrent & persistent thoughts, images or urges that are experienced as intrusive and unwanted and cause marked anxiety or distress. Compulsions Repetitive behaviours (e.g. hand washing, checking) or mental acts (e.g. praying, counting) that the person feels driven to perform in response to an obsession to reduce distress or preventing some dreaded event or situation.

Answer 38

Two stage theory of the acquisition & maintenance of fear and avoidance behaviour (Mowrer, 1939; 1960). Stage 1 Acquisition – Thoughts, images, objects can acquire distressing properties through association e.g. an obsession is linked to distress e.g. thought of hurting an animal. Stage 2 Maintenance – Avoidant, escape responses i.e. RITUALS develop because they decrease anxiety/distress and are maintained through negative reinforcement.

Answer 39

Expose people to obsessional stimuli Prevent compulsions used to lessen distress associated with the obsessional stimuli Repeated exposure to the obsessions while using strict response prevention leads to habituation 1. Generate a list of feared situations (external/internal) 2. Teach “subjective units of distress” (SUDS) and get a rating for each situation 3. Hierarchies typically need 10-20 steps 4. Refinement to hierarchy often required during treatment

Answer 40

Foundation for experimental investigation of OCD 2. Provided some support for Mowrer’s Model (at least for the maintenance phase) 3. Delineated between forms of compulsive behaviour 4. Development of an effective therapy (ERP)

Answer 41

1. Little evidence supporting acquisition stage 2. Does not adequately explain the cognitive aspects of OCD 3. Not all obsessions provoke anxiety/distress 4. Compulsions can elevate anxiety 5. Doesn’t differentiate between anxiety disorders

Answer 42

(Beck, 1967; 1976) Emotional disorders maintained by ‘distorted thinking’ Distorted thinking characterised by frequent negative automatic thoughts (NATs) NATs are a product of beliefs and assumptions stored in memory i.e. Schemas Beliefs & assumptions represent knowledge structures, which are relatively stable constructs termed schemas (Bartlett, 1932) Schemas guide behaviour and shape interpretation of events. Behaviour and thinking follows logically from the beliefs and assumptions. Early Experience Dysfunctional Schemas ↓ Critical Incident ↓ Schema Activation ↓ Negative Automatic Thoughts ↓ Symptoms ↓ Behavioural Motivational Affective Cognitive Somatic

Answer 43

Focus of therapy; based on the content of schemas Beliefs Unconditional in nature perceived as reflecting the truth about the self and world. Declarative statements; ‘I’m worthless, I’m a failure, I can’t cope’ 2. Assumptions Conditional in nature- guide behaviour ‘If I don’t achieve success in everything I am a failure’

Answer 44

Specific schemas/NATS are associated with specific disorders. ‘Content specificity hypothesis’ Schemas can arise from early experience, or develop subsequently to the development of the disorder. Negative Automatic Thoughts Reflect the activation of schemas Appraisals/interpretation of events Automatic, rapid, involuntary, plausible, thoughts/images, systematic errors

Answer 45

Selective abstraction: Draw conclusions based on limited evidence without considering wider evidence Catastrophizing: Overestimating the significance of events Dichotomous thinking: Black & white thinking /all bad or all good Overgeneralisation: Applying a belief based on one situation to all situations

Answer 46

Provided the impetus for disorder specific models Useful heuristic to explain anxiety/psychological difficulties. Notion that information stored in long term memory influences processing. Clinically relevant & effective treatments Question mark over the validity of the theory Clinical, rather than a scientific theory- developed from practical experience Negative thoughts might be a consequence not an antecedent of anxiety Focus is only on one level of cognition

Answer 47

Led to theories and therapies for clinical disorders. Provides more empirical evidence than can be obtained within therapy Casts light on the causal role of cognitive processes in the development of psychological disorders Research in cognitive psychology of direct relevance for treatment strategies

Answer 48

A. Marked & persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. B .Exposure to the situation almost always provokes anxiety, which can take the form of a panic attack C .Person recognises the fear is excessive/unreasonable D. Situation avoided or endured with intense anxiety/distress.

Answer 49

Panic attacks: surge of intense fear/intense discomfort that reaches a peak within minutes Symptoms: Nausea Heart pounding Sweating Sensations of choking Palpations/pounding heart Feeling dizzy/lightheaded Feel of losing control Chills/heat sensations Defined by 4 or more symptoms from list of 13 Often accompanies with hypervigilance about bodily sensations e.g counting heart rate, monitoring thoughts Overestimate extent to which symptoms are visible

Answer 50

Recurrent or multiple panic attacks 1 attack has been followed by 1 month or more than 1 or more of following Persistent concern about additional attacks Worry about implication of attack/consequences Significant change in behaviour related to the attack Symptoms not due to medical condition Not attributable to another psychiatric disorder

Answer 51

Marked fear/anxiety about 2 or more of following 5 situations Using public transport Being in open spaces Being in closed spaces Standing in a line/ in a crowd Being outside the home alone Situations are avoided or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion

Answer 52

Develop case formulation Walk through CF with patient Show that misinterpretation is false – where models/theories can help to design appropriate experiments Induce symptoms of when you’re anxious – e.g start hyperventilating, drink coffee If patient uncomfortable, psychologist does this first Inducing symptoms bans safety behaviours e.g standing up, not allowing water, not allowing something to prop up/crutch Disconfirmation maneuverer: make the symptoms worse e.g if dizzy, stand on one leg What does this tell you about belief you’ll faint? Proves belief is false Do experiment again not in a safe place e.g psychologist stands further and further away so they can’t help, etc 80% remission rate

Answer 53

CBT or ERP - recommended psychological approaches for OCD (NICE, 2006) Multiple meta-analyses conclude that CBT or ERP are effective interventions (Abramowitz et al., 2002; Eddy et al., 2004; Gava et al., 2007; Jónsson and Hougaard, 2009; Olatunji et al., 2013; Öst et al., 2015; Pearcy et al., 2016; Romanelli et al., 2014; Rosa-Alcázar et al., 2008; Schwartze et al., 2016; Skapinakis et al., 2016; Wootton, 2016).

Answer 54

To determine the efficacy treatment for OCD Applied Jacobson criteria to individual patient data on the “Gold Standard” outcome measure i.e. Yale Brown Obsessive Compulsive Scale (Y-BOCS) Two fold criterion for recovery on Y-BOCS Statistically significant improvement following Tx Post-treatment score closer to a functional rather than dysfunctional population Asymptomatic criterion: 7 points or less on Y-BOCS

Answer 55

Approximately 60% of people continue to experience symptoms following psychological interventions. However there are other issues to consider when interpreting results Therapist competency Inclusion/exclusion criteria of the RCTs Treatment Adherence 15% of eligible people refused psychological Tx 16% of treatment starters dropped out of psychological Tx (Leeuwerik, Cavanagh, & Strauss, 2019)

Answer 56

Mens rea: must be shown that the person acted with criminal intent, exercising free will = criminally responsible. R v. M’Naughten (1843) - Lead to the M’Naughten Rule (legal test of responsibility)– not criminally responsible if: At the time of committing the act, the party accused was labouring under such a defect of reason from a disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, he did not know he was doing wrong. “The Tories in my native city have compelled me to do this. They followed me to France, into Scotland and all over to England. In fact, they follow me wherever I go… They have accused me of crimes of which I am not guilty; they do everything in their power to harass and persecute me. In fact they wish to murder me.” M’Naughton, as cited in Asoken (2007)

Answer 57

↑ levels of offending among psychiatric populations (compared with general populations) ↑ levels of offending among patients with psychosis compared with the general population in Sweden (Fazel et al., 2009) ↑ prevalence of mental disorders amongst criminal populations Systematic review of 62 studies (23,000 prisoners) from 12 ‘western’ countries (Fazel & Danesh, 2002) 4828 offenders (given a community sentence) in Sweden who were assessed by a psychiatrist (Grann et al., 2008) diagnosis of substance abuse & personality disorders = risk of subsequent violent offending 90.8% of male juvenile detainees in South Korea had at least one psychiatric diagnosis (N = 173, Kim et al., 2017)

Answer 58

Lack of empathy/callousness, inappropriate responses to others’ emotions Antisocial personality disorder (Richard-Devantoy, Olie, & Gourevitch, 2009) Dark Triad Traits (Ali & Chamorro-Premuzic, 2009; Del Gaizo & Falkenbach, 2008; Jonason, et al., 2017; Lyons & Brockman, 2017; Wai & Tiliopoulos, 2012; Watson & Morris, 1991; Watts et al., 2017) Impulsivity Secondary psychopathy (Hughes et al., 2012) Aggression + cognitive bias Psychosis (Park et al., 2018) Emotional instability and aggression Borderline personality disorder (Herpertz et al., 2016) Cognitive disruption + lack of inhibition Substance abuse disorder (Richard-Devantoy et al., 2009)

Answer 59

Individual differences: Gender: Males & anger attacks in depression (Winkler et al., 2005) Age: Younger people more aggressive than older people Social differences Inadequate resources (Swanson et al., 2002) Dysfunctional families (Matejkowski & Solomon, 2008) Lack of social support (Silver & Teadale, 2005) Stressful life events (e.g. being unemployed, legal issues, sacked) (Silver & Teadale, 2005)

Answer 60

No link with violence (e.g. Quinsey et al., 2006) Negative association (e.g. Appelbaum et al., 2000) Offending in less than 1% of general population (Simeone, et al., 2015) 3.6% of male, 3.9% of female offenders (systematic review of 84 studies, 24 countries) (Fazel & Seewald, 2012) Various risk factors for violence & schizophrenia (e.g. age Andrew & Bonta, 1998)

Answer 61

Cause Paranoid ideas, command hallucinations, other delusions cause offending; ‘psychotic drive’ (Smith (2000) → offending (Persecutory delusions? Perceiving the world as threatening?) Disinhibiting effect of psychosis in sex offending (Phillips et al., 1998) Consequence Association with violent offending and self-harm/suicide in those with schizophrenia (e.g. Nicholls et al. 2006) Correlation Stressful life events can lead to both Co-morbidity of substance misuse (e.g Van Dorn et al., 2012)

Answer 62

8% of general population 10.2% of male, 14.1% of female offenders (systematic review of 84 studies, 24 countries) (Fazel & Seewald, 2012) Anger & depression (short-term) in imprisoned offenders (Kelly et al., 2019)

Answer 63

Causes Offend because they are depressed (e.g. anger attacks) Consequence Triggered by guilt Due to incarceration (in women – Fagan & Western, 2003) Correlation Precursors to depression Losing job or relationship

Answer 64

Stigma attached to those with mental health issues (e.g. China, Yin et al., 2020) Stigma attached to schizophrenia is often greater than for depression (e.g. Turkey; Utz et al., 2019) Unpredictable, uncontrollable, violent (e.g. Germany; Angermeyer & Matschinger, 1994)

Answer 65

Owen (2012) Portrayals of schizophrenia by entertainment media: a content analysis of contemporary movies. 1990-2010, 41 characters 83% displayed violent behaviour towards themselves or others 1/3 of violent characters committed a homicide

Answer 66

Moved to the US when 8 Didn’t know much English At 12, diagnosed with social anxiety disorder Not good relationship with his father Counselling for a number of years Strong support at school Ok for a couple of years at Virginia Tech Stopped writing home Arguing with classmates Harassing female students Statements that caused concern Killed 32 students then himself

Answer 67

Started in late 19th, early 20th centaury. Developed between 1930’s and 1970’s. Changed again in the 1990’s.

Answer 68

McNeill 2006 Desistance is the word for how people with a previous pattern of offending come to abstain from crime. Desistance is a journey. It is influenced by someone's circumstances, the way they think, and what is important to them (www.gov.uk, 2019) Used as a foundation in probation for working with all offenders. Criminogenic need Different types of desistance

Answer 69

1800: James Hadfield found not guilty by reason of insanity 1843: Daniel McNaughton found not guilty by reason of insanity 1876: Cesare Lombroso 1879: Francis Galton facial composites

Answer 70

James Hadfield – head injury in battle Attempted to murder King George III Tried for high treason Was acquitted on grounds of insanity

Answer 71

Lead to the McNaughten Rule (legal test of responsibility)– not criminally responsible if: At the time of committing the act, the party accused was labouring under such a defect of reason from a disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, he did not know he was doing wrong. “The Tories in my native city have compelled me to do this. They followed me to France, into Scotland and all over to England. In fact, they follow me wherever I go… They have accused me of crimes of which I am not guilty; they do everything in their power to harass and persecute me. In fact they wish to murder me.” McNaughton, as cited in Asoken (2007)

Answer 72

Lombroso (1876) – Biological Positivism Criminality is inherited, someone ‘born criminal’ can be anatomically identified by such items as a sloping forehead, ears of unusual size, asymmetry of the face, prognathism, excessive length of arms, asymmetry of the cranium and other ‘physical stigmata’ Underlying theoretical supposition that criminality is innate and that it is expressed in (or related to) physical characteristics. Painstaking measurements “The appearance of a single great is more than equivalent to the birth of a hundred mediocrities” (Lombroso)- Social Darwinism, application of ideas to support stereotypes, e.g. racial biases, eugenics movements Theories lack credibility, though should be remembered for developments in research methods Predominant view in both early clinical and criminal psychology through phrenology studies, work of Caesare Lombroso and Francis Galton

Answer 73

Sheldon (1942) - These were associated with three types of personality characteristics: Endomorph - Viscerotonia (pleasure loving, dependent) Mesomorph - Somatotonia (exercise loving, aggressive) Ectomorph - Cerebrotonia (withdrawing, unsociable) It was argued that (mesomorph) would be most likely to have traits related to delinquency; such as aggression, impulsivity, and risk taking.

Answer 74

Early to mid1800s Early legal precedents around ‘insanity’ Biological focus Late 1800s, early 1900s Emphasis on experimental methods Early to mid 1900s Further work on biological models Stunted growth of legal psychology 1950s to 1970s Shift to include social factors

Answer 75

Centre of Europe Slightly smaller than the UK, around a sixth of the population Landlocked 2004, member state of Europe Union 2005, 3,44060 criminal acts (police) (2005, England and Wales = 5,63511) Property crimes around 66.6% of all crimes; violent crimes around 6.3%

Answer 76

Since 1990s, increase in: Research and academic literature Roles for FPs in government and Czech police Courses forensic psychology at universities Psychologists being judiciary experts Tool for police officers (recruitment and dealing with trauma) or studies on crime prevention (societal level).

Answer 77

Culture is a social pattern that is heritage within a society. It determines what is important and unimportant, right and wrong, acceptable and unacceptable. Culture encompasses explicit and tacit values, norms, attitudes, beliefs, behaviours and assumptions. Cultural diversity (also known as multiculturalism) is a group of diverse individuals from different cultures or societies. Usually, cultural diversity takes into account language, religion, race, sexual orientation, gender, age and ethnicity.

Answer 78

Cultural bias occurs when people of one culture make assumptions about the behaviour of people from another culture based on their own cultural norms and practices. Unconscious Bias – For race and ethnicity we need to understand that we (rightly or wrongly) are representing structures where we are aware that there is a vulnerability to bias

Answer 79

A Canadian Federal court challenged the administering of 5 risk assessment instruments with Canadian Aboriginal prisoners. Fujii et al (2005) found some risk measures showing good cross cultural validity but it is important to recognise the unique ethnic differences in prediction of violence risk. Effectively, forensic clinicians and researchers can no longer overlook the role of culture in risk assessment (Shepherd et al, 2016) Multicultural groups are diverse not only in their beliefs and expectations, but also in their assumptions about what the clinician can do for them (Katz & Algeria, 2009)

Answer 80

Ethnic and racial minority families from the US may also differ in their explanations about mental illness and treatment (Novins et al., 1997). For example, African American and Native American families may have alternative explanations of mental illness such as supernatural or spiritual forces that lead youth to undesirable behaviors (Cheung & Snowden, 1990) In order for clinicians to work in culturally sensitive ways with offenders within the forensic treatment process, this may even include working collaboratively with cultural representatives in order to develop a more responsive treatment process (Andrews & Bonta, 2007). Consider own cultural competence (Weiss & Rosenfeld

Answer 81

Request to complete risk assessment for honour based violence (HBV) Need to use interpreter (consider working with intepreters, guidelines for psychologists, November 2017, BPS) Identify limitations to assessments Refer to the literature to guide formulation and understand culture of client Example “Given that issues concerning culture and religion form an important part of black, and minority ethnic women’s identities, those who are religiously observant can experience feelings of further distress, anxiety and shame if public agencies do not meet their need. This can lead some to feel that they are being treated with a lack of dignity and respect as well as feelings of lessened value and a sense of “double victimization” (Gill, 2004). Services must therefore be culturally sensitive and this would be relevant

Answer 82

Nigerian Prisoner undertakes the Prison Core Sex Offender Treatment Programme Western values did not apply to his – saw sex differently Issues related to cultural constraints in talking about sex and also how an individual’s identity and personal change are construed. The ways in which non-western cultures approach issues of gender and how sex is (or not) discussed may affect how willing a person may be to participate in groups where there is an expectation that the detail of sex offences is shared and discussed. Whilst the BME sex offender may successfully learn the language of Western cognitive-behavioural therapy, the question of how relevant this will be to his survival in a non-western community is yet to be asked.

Answer 83

Research samples should reflect the diversity of the population Consider language or literacy barriers and other practicalities such as avoiding running groups at prayer time and being sensitive to global events that may impact on individuals Research and those pursuing it should respect the diversity of human culture and conditions and take full account of ethnicity, gender, disability, age, and sexual orientation in its design, undertaking, and reporting. Researchers should take account of the multicultural nature of society. It is particularly important that the body of research evidence available to policy makers reflects the diversity of the population.( Research Governance Framework for Health and Social Care, 2001)

Answer 84

5. be aware of the impact of culture, equality and diversity on practice 5. 1 understand the impact of differences such as gender, sexuality, ethnicity, culture, religion and age on psychological wellbeing or behaviour 5. 2 understand the requirement to adapt practice to meet the needs of different groups and individuals

Answer 85

Criminals biologically different to non-criminals – either from birth or brain injury Biological differences lead to inability to learn and follow rules, which leads to criminal behaviour Growing body of evidence that suggests a link between predisposition to offend and genetic, hormonal or neurobiological factors (Beech et al., 2018)

Answer 86

Activation of brain areas associated with emotional regulation differ between criminals and non-criminals Reduced activity in left amygdalae of conduct disordered males shown negative pictures (Kleinschmidt & Poustka, 2005). Neuropsychological deficits Lower verbal IQ (Brennan et al., 2003) and executive dysfunction (Moffitt, 1993). Increased delinquent behaviour in youths with history of traumatic brain injury Executive functioning and impulse control (Carswell et al., 2004) Findings indicate that offenders are less sensitive to punishment and more sensitive to possible rewards. Less able to plan, act in a rationally self-interested manner, control impulses or respond flexibly to problems encountered in daily life. However…Participants mostly male, small sample sizes. Offender populations – possible neurological differences between offenders who are caught and those who evade detection?

Answer 87

Meta-analysis of 100+ behavioural genetic studies - 40-50% of variance in antisocial behaviour due to genetic inheritance (Rhee & Waldman, 2002). Study of 862 Swedish male adoptees - genetic influences are the most significant contributor to later criminal behaviour (Cloninger et al., 1982). However…Growing evidence to suggest gene/environment interaction, e.g. ‘warrior gene’ (MAO-A) has no overall effect on antisocial behaviour but low MAO-A activity + childhood abuse = increased adult aggression (Frazzetto et al., 2007). Also, similar biological predispositions can be associated with very different behavioural outcomes. E.g. Both bomb disposal experts and those with a capacity to violence (males and females) have lower resting heart rates – suggesting physiological under arousal (Raine, 2013) ISSUES WITH GENETICS Determinism Do we lock people with criminal genes up before they commit a criminal act?

Answer 88

Links with biological explanations in terms of underlying mechanisms that contribute toward personality are believed to be biological – impulse control According to Eysenck (1996), offending is natural and rational as human beings are hedonistic, seek pleasure and avoid pain Delinquent acts essentially pleasurable and beneficial for the offender - e.g. theft, violence, vandalism Most people do not offend because of their conscience – a conditioned fear response, which opposes hedonistic tendencies Conscience built up in childhood through punishment for disapproved acts – classical conditioning links the fear of punishment to the act Offenders are people who have not developed strong consciences due to poor conditionality. More likely in people: High on extraversion due to low cortical arousal (stops punishment from having as big an impact as rewards) High on neuroticism as high resting levels of anxiety interfere with conditioning, and reinforce existing behavioural tendencies High on psychoticism (low empathy, impulsive, emotionally cold, hostile, egocentric) - more likely to offend because these traits are typical of criminals

Answer 89

Increased prevalence of mental disorders amongst criminal populations compared to general population, and higher levels of offending (Steadman et al., 2009). Mental disorders can include: Illnesses such as schizophrenia and depression Intellectual disabilities Personality disorders However… Questions raised as to whether disorders cause offending or association caused by other factors (Van Dorn et al., 2012). Studies conducted with convicted offenders – difference between convicted and non-convicted?

Answer 90

A severe personality disorder strongly linked with antisocial behaviour - callous disregard for others, lack of behavioural controls. Suggestion that psychopathy be viewed as a dimension rather than taxonomy as psychopathic traits can be observed in the general population (Hare & Neumann, 2008). CU (callous unemotional) traits in children are stable through to adolescence, and predictive of psychopathy in adulthood (Burke et al., 2007). Argument - limited ability to learn when one’s actions are causing distress in childhood compromises early moral socialisation, resulting in greater aggressive behaviour and crime in later life (Gao et al., 2010). Inability to detect facial expressions that signal distress in others leaves psychopaths open to repeatedly behaving in fear inducing ways (Blair, 2001). Evidence that psychopaths have compromised ability to make aversive conditioned associations, related to abnormal amygdala functioning (Birbaumer et al., 2005). Estimated prevalence of psychopathy in the UK is 0.6% but approx. 7-8% in UK prison populations (Coid et al., 2009). Psychopathy associated with high levels of general, violent and sexual recidivism (Hemphill et al., 1998). Psychopathy in adults (Blair, 2001) and CU in children (Frick et al., 2003) are particularly associated with instrumental aggression to achieve a goal (rather than reactive) Majority of murders committed by psychopaths were for instrumental reasons (Woodworth et al., 2003). Aggression committed to achieve a goal However… Debate regarding whether antisocial behaviour represents a core psychopathic personality trait or is a behavioural consequence of a collection of traits (Skeem & Cooke, 2010). Most crimes are not committed by psychopaths and not all psychopaths are criminals (Mahmut et al., 2008). Causes of psychopathy are not yet fully understood but… Evidence suggests biological differences in areas of brain associated with empathy/morality (Gregory et al., 2012). Environmental factors such as parental separation, lack of parental supervision, and parental conviction also linked to amoral characteristics of psychopathy (Raine, 2013).

Answer 91

ATTACHMENT Primary attachment figure acts as a secure base for exploring the world (mother viewed to be key) (Bowlby, 1969). Attachment relationship leads to development of an internal working model – cognitive framework of mental representations to understand the world, self, others. This internal working model influences contact with others and evaluation of these interactions. Model of others as being trustworthy Model of the self as valuable Model of the self as effective when interacting with others Disrupting primary attachment relationship for a prolonged period is likely to have irreversible negative effects on cognition, social interactions and emotions. Long-term consequences could include: Delinquency Reduced intelligence Increased aggression Depression Affectionless psychopathy - acting on impulse with little regard for others, lack of guilt, inability to form meaningful and lasting relationships Comparison of 44 juvenile thieves / 44 controls (Bowlby, 1951) Almost 40% of juvenile thieves separated from mothers for 6+ months during first 5 years compared with 4.5% of control 1/3 had affectionless character compared to 0 controls However… Recall data – memories may not be accurate Potential experimenter bias Bowlby concluded that maternal deprivation caused affectionless psychopathy – correlational data Other external variables not measured may have affected behaviour, e.g. family conflict, income, education etc. Loss of mother a stronger predictor of delinquency than loss of father (Juby & Farrington, 2001). History of abuse and disturbed attachment associated with lack of empathy and violent criminality (Saltaris, 2002). However… Separation from either biological parent during first 5 years linked to higher levels of offending (Kolvin et al., 1988). Not just a broken home, parental conflict also a factor Offending higher for boys from broken homes with affectionless mothers (62%) and unbroken homes with conflict (52%). Lower for unbroken homes without conflict (26%) and broken homes with affectionate mothers (22%) (McCord, 1982).

Answer 92

Criminal behaviour is learned. Attitudes that support offending and behaviours for committing crimes learned within the family or peer group. 40% of sons with criminal fathers also had criminal conviction by age 18 compared to 13% of sons with non-criminal fathers (Osborne & West, 1979). Juvenile delinquents more likely to report having peers who engage in criminal activity than non-delinquents.

Answer 93

Parents of antisocial children demonstrate deficiencies in child rearing practices (Patterson et al., 1992). Fail to tell children how they are expected to behave, monitor behaviour, or enforce rules at appropriate time and unambiguously with appropriate rewards and sanctions. Parents use more punishment but inconsistently and do not make it contingent on child’s behaviour. Children raised in coercive families learn to use coercive behaviour Parent shouts at/threatens child, child shouts back, parent stops being coercive. Child learns to use hostile reactions to end hostile situations. Skilful parents use rewards for positive behaviours and ignore or use time out for undesirable behaviours. Consistent and contingent parental reactions + careful monitoring of children’s behaviour prevent delinquency (Snyder et al., 2003). Poor parental supervision a strong predictor of offending (Smith & Stern, 1997). Parental reinforcement also a predictor. Physical punishment at age 7 and 11 predicted later convictions – 40% offenders smacked/beaten at age 11 vs. 14% non-offenders (Newson & Newson, 1989). Harsh or erratic parental discipline and cruel, passive or neglecting attitudes predicted convictions for original sample and their sons – 2 successive generations of males (Farrington et al., 2015). However… Much of the supporting evidence is based on self-reflections of childhood – accuracy of memory? Not all offenders recall parental upbringing as problematic and not all children raised with poorer parental practices end up committing offences. For SLT in general, patterns linking parent and peer influences to offending tend to be for petty acts (e.g. vandalism). Data tends to be correlational – problems inferring causality.

Answer 94

Farrington’s Cambridge Study 411 South London boys Prospective longitudinal methods Personal interviews from age 8-46 Tests of individual characteristics, intelligence, attainment, personality and impulsivity Parental details of background, child rearing practices Teachers and CRB checks By age 40, 40% convicted – commonly for theft, burglary, vehicle theft. Peak age of offending 17; peak age for prevalence of offending 14; peak age for decreased offending 23. ICAP theory influenced by results of Cambridge study – looking at risk factors for crime. Designed to explain offending by lower class males. Integrates aspects of several theories – strain, control, learning, labelling and rational choice (Cote, 2002). Key construct is antisocial potential (AP) – potential to commit anti-social acts. Transferring from antisocial potential to behaviour depends on cognitive processes that consider opportunities and victims – decisions to turn the potential into reality. People can be placed on a continuum from low to high AP. Few people have high AP, but those that do are more likely to commit crimes. Primary factors that influence high AP are desire for material gain, peer status, excitement and sexual satisfaction. Whether factors influence behaviour depends on if the person can use legitimate means to satisfy them. Males from low-income families with low academic attainment who are unemployed are more likely to engage in antisocial behaviour and crime. Long-term (LT) between-individual and short-term (ST) within-individual variations in AP. LT –poorer families, socially impulsive and sensation seeking, poorly socialised and have a low IQ. Ordering of people tends to be consistent over time but levels vary with age – peak in teenage years due to changes in factors that influence LT AP (e.g. increased importance of peers, decreased importance of parents). ST – situational factors such as frustration, anger, boredom or alcohol. Whether a crime is committed depends on cognitive processes - considering subjective benefits, costs and probabilities of different outcomes. Immediate situational factors – material goods that could be stolen, likelihood and consequences of being caught. Social factors – disapproval by parents or partner, encouragement and reinforcement from peers. Stored behavioural repertoires/scripts (Huesmann, 1997). Consequences of offending may lead to changes in LT AP and future decision-making processes Reinforcing consequences, e.g. gaining material goods and peer approval. Punishing consequences, e.g. legal sanctions, parental approval. If consequences involve labelling, ability to achieve aims legally may be reduced, leading to increased AP (Farrington & Murray, 2014). Also focuses on preventative factors – individual and social. People get less impulsive and frustrated with age Life events such as marriage, steady employment, moving home – shifts in interactions from peers to partner and children Decreased offending opportunities (e.g. less drinking with male peers). Increased informal controls (e.g. family and work responsibilities). Changes decision making by reducing subjective rewards of offending – risk of getting caught higher (e.g. disapproval from partner, incarceration and losing family). Identifies different factors that could influence future offending and antisocial behaviour, both in the short and long term. Findings of Cambridge study have been very influential in the development of programmes to try to reduce offending. However… Research also shows that many people with these risk factors do not go on to offend (Webster et al., 2006). Focuses on risk factors related to family, parenting and peer groups – ignores wider issues such as the neighbourhood (Webster et al., 2006). Most of research focuses on males from working-class backgrounds – explanations for females, those from middle and upper classes, rural areas who offend?

Answer 95

Researchers find the evidence Academics shape the theory and the practitioners’ tools ASSET and ASSET Plus = YOS assessment tools, based on latest research evidence ASSET – originally looked at criminogenic and protective factors ASSET Plus assesses desistance factors

Answer 96

2016 Context – move away from criminogenic to desistance In preparation, HMIP in 2016 Inspection “to assess effectiveness of practice in YOS across eight domains which desistance research has highlighted as being significant in supporting children and young people’s journeys away from offending” (2016, p.7)

Answer 97

Eyre, Jamieson & Yates (2016) Three YOS in North England Questionnaires to YOS staff Focus groups on incoming Asset Plus Asked on challenges of new system and changes required Asked to provide a young offender ‘success story’ Narrative analysis of the success stories conducted

Answer 98

Ministry of Justice (2018) October-December 2016, adults and juveniles Overall reoffending rate = 29.4% Adults = 28.6% Juveniles = 40.4% Reoffending rates for violent offenders higher than non-violent offenders (Motiuk & Belcourt, 1997); Reoffending rates for sexual offenders ranges from 11-14% (Hanson & Morton-Bourgon, 2005, 2009)

Answer 99

Different treatment needs? Offenders often have a history of a violent offence (general offending: Bourgon & Armstrong, 2005; Sex offenders: Newman, 2011) Heterogeneous nature of violent offenders Same treatment rules may not apply Responsivity to treatment (Howells & Day, 2000)

Answer 100

Anger  violence Limitations But some studies show no relationship Mills and Kroner (2003) Might be exhibited under certain conditions Some violence exists without anger (e.g. sadism) Need for other aspects to be addressed too (multi-faceted)

Answer 101

Think First (McGuire, 2005) Violent offending = anti-social cognitions Anti-social cognitions  pro-social thinking and problem-solving Groups, 3 months  3 years Limitations: might not work for serious high-risk offenders – cognitions too engrained (Ward & Nee, 2009)

Answer 102

Range of different interventions Typically differentiate this type of behaviour from other types of violent offender – some can be violent towards partners but not others Usually focus on power, control, coercion – based on feminist viewpoints on IPV Limitations IPV offenders found to have some of the same characteristics, including anti-social cognitions, as other violent offenders. Women also perpetrate IPV against men, same sex partnerships, feminist approaches not relevant? (e.g. Dixon, Archer, & Graham-Kevan, 2012) The role of alcohol abuse needs to be examined (Norlander & Eckhardt, 2005)

Answer 103

High-risk, serious violent offenders More intense, examine an array of issues More individualised, responsive to the needs of the person Violence may be caused by multiple issues. Multi-disciplinary teams (psychologists, custodial staff, educational and programme staff) At least 12 months, treatment usually in a group (individually if needed)

Answer 104

Rimutaka Prison, near Wellington, NZ Intervention programme for violent offenders (voluntary, length of sentence not effected) High risk offenders Targets ‘hypothesised criminogenic needs of violent offenders’ (p.1616) VPU – 30 medium security beds Programme – closed groups of 10 men Therapist team = a psychologist and rehabilitation worker On arrival, 4 week assessment period to gain comprehensive understanding of Social history, background, family and support systems How each may function in a group (including motivation to change) Offending history, risk factors, current offence Reintegration needs on release Assessment data collected by Interviews Questionnaires Psychometric tests Three programmes running at a time Approx. 330 hours of treatment Four, 3 hour group meetings Weekly, for 28 weeks Individual intervention for psychological issues To plan for release – meetings with family members Post-release follow-up – routine support from probation officers

Answer 105

Most common treatment for sex offenders (for a review, see Moster, Dorota, Wnuk & Jeglic, 2008) Cognitive aspects Cognitive distortions (e.g. blaming the victim, denial and minimisation, rape myth acceptance) Other thinking patterns that might effect mood and behaviour Coping with negative emotions Empathy for others Therapy aims to encourage offenders to Identify their own thinking patterns Tools to re-evaluate these beliefs/thinking patterns Behavioural aspects Overt and covert behaviour Procedures to alter behaviour through reward and punishment Modelling (demonstrating a particular behaviour) Skills training (through rehearsal) (e.g. interpersonal skills such as assertiveness and communication)

Answer 106

Adapted from the addiction field (e.g. Marshall & Laws, 2003) Addition to CBT approaches Self-management approach How to anticipate and cope with relapsing (having thoughts about offending, and re-offending) Control over time across high-risk situations in the community Limitations Presumes all offenders have the same pathway to offending (Laws & Ward, 2006) Negative focus on treatment, must avoid certain situations (avoidant v. approach strategy)

Answer 107

Andrews & Bonta, 1998 Four principles (as outlined in Ward & Stewart, 2003) Risk principle Match level of risk with level of treatment High risk = more treatment (at least 100 hours of CBT over 3-4 month period) Need principle Target criminogenic needs Responsivity principle Is the treatment appropriate for that person? May impede learning? Gender, learning styles, culture, diversity, motivation The principle of professional discretion Clinical judgement should override the above principles if needed (flexibility, innovation)

Answer 108

Risk level – using assessment tool (Lecture 11) Criminogenic needs 4 domains (Thornton, 2002, 2003) relate to recidivism Deviant sexual interests Distorted attitude Low levels of socio-affective functioning (e.g. intimacy issues) Problems in self-management (lack of control over emotions and behaviour) Responsivity Internal factors Motivation External factors Therapeutic characteristics Therapeutic context

Answer 109

Failure to motivate and engage offenders in the process (e.g. Ward & Beech, 2015) External motivators such as parole might make people more likely to follow a treatment programme (Jones, Pelissier & Klien-Saffran, 2006) Attrition rates high (30-50% e.g. Ware & Bright, 2008) People who drop out, more likely to reoffend than completers (e.g. Hanson et al., 2002) People who most need the treatment might be more likely to drop out? Differs from other therapeutic models Orientation of treatment goals Rely on avoidant goals, rather than approach goals Limited collaboration between therapist and client Treatment goals enforced by therapist Limited attention to non-criminogenic needs (e.g. personal distress) Focussing on these might improve treatment outcomes Minimal focus on reintegration into society Crucial to have environmental systems such as relationships and employment

Answer 110

General assumptions Grounded in the ethical concept of human dignity and universal human rights; strong emphasis on agency Rehabilitation needs to 1) reuse risk but also 2) promote human needs and values through approach goals 11 classes of ‘primary goods’ (offenders have value certain states of mind, personal characteristics and experiences) (Ward & Gannon, 2006; Ward et al., 2007)

Answer 111

Two routes to offending Direct Attempts to achieve primary goods through offending (e.g. establishing a relationship) Indirect Something goes wrong whilst trying to achieve primary goods and a ripple effect means that offending occurs (e.g. trying to have friendship and agency leads to distress, which is alleviated by drinking, which leads to offending) Criminogenic needs Internal and external obstacles to acquiring primary goods Impulsivity might impact on agency Substance abuse might impact on living a healthy life Treatment aimed at working on knowledge, skills and competence to have a successful, non-criminal life. Working out individual’s priorities/weightings and how to get secondary goods Good Lives Treatment plan devised, individual to the person, identifies criminogenic needs that might be blocking achievement of the goods. Also may include developing internal and external skills, maximising external resources and social supports

Answer 112

Dynamic risk factors Andrews & Bonta, 2006 “Features of individuals associated with the risk of involvement in crime that change over time and are susceptible to change by direct effort, thereby reducing risks of criminal activity.” (Davies & Beech, 2018, p692) Anger Negative/antisocial attitudes Hostility Substance abuse Impulsivity Active symptoms of major mental illness Interpersonal and problem-solving skill deficits Antisocial personality Social-information deficits Education/employment Antisocial companions Need for more research into this for serious, violent offenders (Polaschek, 2006)

Answer 113

Dynamic risk factors Andrews & Bonta, 2006 “Features of individuals associated with the risk of involvement in crime that change over time and are susceptible to change by direct effort, thereby reducing risks of criminal activity.” (Davies & Beech, 2018, p692) Anger Negative/antisocial attitudes Hostility Substance abuse Impulsivity Active symptoms of major mental illness Interpersonal and problem-solving skill deficits Antisocial personality Social-information deficits Education/employment Antisocial companions Need for more research into this for serious, violent offenders (Polaschek, 2006)

Answer 114

Recognised as an international public health problem by World Health Organisation Costs of sexual abuse to victim physical and psychological harm teenage pregnancy problematic parenting behaviours adjustment problems in the victim’s later offspring Other costs include to public health and criminal justice services, loss of work days, reduced productivity Rehabilitation is important, aim to reduce risk and protect society

Answer 115

Recognised as an international public health problem by World Health Organisation Costs of sexual abuse to victim physical and psychological harm teenage pregnancy problematic parenting behaviours adjustment problems in the victim’s later offspring Other costs include to public health and criminal justice services, loss of work days, reduced productivity Rehabilitation is important, aim to reduce risk and protect society

Answer 116

Risk factors: factors that help to predict recidivism, that is, whether a person convicted of a sexual offence will commit another offence in the future Four domains of risk factors that predict sexual offence recidivism: Socio-affective function (e.g., intimacy deficits, emotion-regulation) Self-management (e.g., impulsivity, recklessness) Offence supportive attitudes (e.g., children enjoy sex) Deviant sexual interests (e.g., sexually attracted to minors) Risk, Need, Responsivity Treatment should be proportionate to risk, treatment should target needs related to offending, consider how responsive people are to diff. treatment

Answer 117

Aim: to reduce the risk that an individual will commit another offence again in the future Sex Offender Treatment Program (SOTP) Delivered to sexual offenders in England and Wales Other similar programs delivered in other countries Typically cognitive behavioural in approach Focus on reducing ‘risk factors’ related to sexual offence

Answer 118

Unclear! Meta-analyses suggest that sex offender treatment does reduce sexual recidivism 10.1 % in treated vs. 13.7 % in untreated offenders (Schmucker & Lösel, 2015) A recent report for the Ministry of Justice suggests that sex offender treatment may increase sexual recidivism (10.0% compared with 8.0%) h

Answer 119

Ability to implement intentional cognitive control over emotions Known risk factor for sexual offence recidivism Theory and research suggests a causal role of emotion regulation in sex offending What are emotions? Spontaneous, not consciously provoked Provide positive and negative valence Goal directed Involve multi-system changes (behavioural, autonomic, physiological)

Answer 120

Reappraisal Form of cognitive change, think in different way about same situation Dependent on higher order brain processes e.g., an interview = an opportunity, not a test Emotion Suppression Form of response modulation, inhibit emotionally expressive behaviours Effects on expressive behaviour and physiology e.g., poker face

Answer 121

Recommended for inclusion in sex offender treatment (Gillespie et al., 2012) Origins in Buddhism and Eastern traditions Paying attention in the present moment, non- judgementally (Jon Kabat-Zinn, 1994) Three interacting components contribute toward enhanced self-regulation

Answer 122

Sex offenders showed specific impairment in acceptance of emotional states More pervasive difficulties in the violent group Higher levels of anger Greater emotional non-acceptance Evidence of alexithymia, difficulties identifying emotions Some mindfulness problems, non-judgement, acting with awareness Homicide group may be relatively in charge of emotions

Answer 123

Fix and Fix (2013) Review reported benefits of meditation but noted methodological limitations Samuelson et al. (2007) 2000 offenders took part in mindfulness based stress reduction Exercises include body scan, stretching exercises, sitting meditation Reported benefits across hostility, self-esteem and mood Verheul et al. (2003) Benefits of Dialectical Behavior Therapy in borderline personality disorder Mindfulness represents important component of DBT Development of acceptance based techniques for regulating emotions

Answer 124

Potential difficulties introducing meditative practices Unfamiliarity with meditation Discomfort meditating in groups People may be differentially sensitive to mindfulness Serotonin genes differentiate those who benefit most Definition, measurement and operationalisation Only clear measurement technique = self-report Limited by understanding, measurement validity Difficult to evaluate change

Answer 125

Biggest barrier = lack of evidence, need for rigorous evaluation Meta-analyses show support for mindfulness in treating various forms of psychological distress but few studies in forensic samples Best evidence: change in recidivism rates following mindfulness interventions

Answer 126

In general terms the criminal justice system has defined risk as: the risk of future re-offending & reconviction - the probability that an offender / prisoner will offend, be arrested, and be reconvicted within two years; and the risk of serious harm - if reconvicted, the probability that the offence will be one of “serious harm” Section 224 of the Criminal Justice Act 2003 defines serious harm (in the sentencing context, when determining whether an offender presents a significant risk to the public of serious harm by the commission of further offences) as “death or serious personal injury, whether physical or psychological”.

Answer 127

What is a risk assessment? Systematic effort to estimate and evaluate adverse outcomes Try to make predictions about future behaviours Forensic risk assessments draw on information about the offender and their circumstances in order to reach judgements about their future behaviour Concept of risk encompasses “the nature, severity, imminence, and frequency or duration of harm – as well as its likelihood” (Litwack et al., 2006, pp.493) What is likelihood? Probability of the occurrence of an event What is seriousness? Predicted future behaviours can differ in their level of seriousness What is dangerousness? Adverse outcomes How undesirable these would be Offender may be labelled as dangerous: on the basis of a high probability of committing many offences OR because of the potential to perpetrate a small number of very serious offences OR more commonly an unknown mix of the two The risk of harm posed by offenders to others can be seen as having two key dimensions: 1. the relative likelihood that an offence will occur; and 2. the relative impact or harm of the offence - what exactly might happen, to what or whom, under what circumstances, and why. It is important to understand these two dimensions of risk. Some crimes (eg shoplifting) have relatively little impact or harm but, statistically, are the most common. Others (eg homicide) are rare but cause maximum damage. It is important to identify the person or groups of people who are specifically at risk; this allows resources and protective measures to be applied effectively. Risk is categorised as risk to: the public: either generally or a specific group such as the elderly, vulnerable adults (for example, those with a learning disability), women or an ethnic minority group; a known adult: such as a previous victim or partner; prisoners: within a custodial setting; children: either specific children or children in general staff: anyone working with the individual whether from Probation, the Prison Service, police or other agency (eg. health); self: the possibility that the individual will commit suicide or self-harm.

Answer 128

LOW: current evidence does not indicate a likelihood of causing serious harm; MEDIUM: there are identifiable indicators of serious harm. The offender has the potential to cause such harm, but is unlikely to do so unless there is a change in circumstances - for example, failure to take medication, loss of accommodation, relationship breakdown, drug or alcohol misuse; HIGH: there are identifiable indicators of serious harm. The potential event could happen at any time and the impact would be serious; VERY HIGH: there is an imminent risk of serious harm. The potential event is more likely than not to happen as soon as the opportunity arises and the impact would be serious.

Answer 129

make a prediction of risk along both dimensions - likelihood and impact of harm; identify the likelihood of re-offending; identify the risk of harm (what harm and to whom?); and identify the key risk factors that led to the offence under consideration and that should be addressed to reduce the likelihood of further offending.

Answer 130

Assess likelihood that someone will: Reoffend and for what type of offence Cause harm to themselves Cause harm to others Treatment needs of that person Individuals treatability and treatment readiness Identify the particular conditions in which a specific individual will behave violently or criminally. Risk assessments are used by: Police Courts Prisons Treatment providers Risk assessments are carried out at various stages of an offender pathway During investigation (Research focused lecture with Prof Laurence Alison) Pre-sentence at admissions Pre treatment Post treatment Pre-release Post-release

Answer 131

Non-custodial sentence or released from prison early Leads to more victims Additional costs to society

Answer 132

Parole is rejected, in prison for longer than necessary Infringement of human rights Damage to the individual Waste of public resources

Answer 133

STATIC FACTORS Static factors cannot be changed or influenced and are based on historical events or characteristics such as the offender’s gender, age, offending history, and previous convictions. Family background Previous offending behaviours Offence history Victim characteristics DYNAMIC RISK FACTORS Dynamic risk factors relate to the attitudes, circumstances and behaviours that underpin or support offending. Can change through interventions (theoretically!) Psychological Cognitive distortions, empathy, problem solving, decision making Social Peer groups, employment status, relationship status Behavioural Impulsivity, anger issues, risk taking, drug taking

Answer 134

CLINICAL RISK ASSESSMENTS Clinicians use their own experience and intuition Collect background information Observations of the offender by professionals Interviews with the offender Comes from medical field and seen as diagnostic method of assessment STRENGTHS/WEAKNESSES the debate centres on the accuracy of the clinician’s ability to predict violence. the clinician can assess emotional state throughout the interview. For example, emotional traits such as lack of empathy and anger (Menzies, Webster, & Sepejak, 1985) and physiological and behavioural traits such as chanting, flared nostrils, flushed face and clenching of the jaw/hands (Berg, Bell, & Tupin, 2000 Thornberry and Jacoby (1979) 65% who were subsequently released into the community, only 11% were re-arrested for violent offences. Monahan’s (1984) claim that two thirds of all clinical predictions of violence are incorrect Susceptible to decision-making heuristics and biases

Answer 135

Uniform rules and strict decision making criteria are applied Based on longitudinal studies which assess associations between risk factors at the outcome being measured These require analysis of substantial samples from which generalisations are to be drawn. Use algorithms or statistical equations Give risk score or risk level STRENGTHS/WEAKNESSES Eliminate the subjective errors present in clinical judgement Douglas, Ogloff, and Hart (2003) have criticised actuarial tools for being rigid, lacking sensitivity to change and failing to aid risk management and the prevention of violence. Difficulty in generalising from a group to an individual (Scott & Resnick, 2006), Oversimplify the complexity of factors involved because cases are diverse in nature rely solely on an actuarial tool could cause potentially important indicators of violent behaviour to be missed.

Answer 136

Hanson and Thornton (1999), the predictive accuracy of professional risk assessments (both actuarial and clinical) is only slightly better than chance. Combining empirically established risk factors with clinical judgement The use of both actuarial tools and of structured risk assessment instruments in conjunction with clinical interviews has therefore been judged to be most effective (Scott & Resnick, 2006). This recommendation harvests the benefits of both actuarial tools and clinical judgement (structured or unaided) while minimizing their limitations in practice. clinician is given some level of flexibility and discretion for when cases contain idiosyncrasies but yet they can still provide an empirically based individual risk assessment Completing risk assessments with a person results in a far more meaningful and better adhered to plan of action Popular measures: Offender Assessment System (OASys) Level of Service Inventory - Revised (LSI-R) Primary actuarial measure for non-mentally ill offenders (usually used for sentencing and parole decisions) Psychopathy Checklist - Revised (PCL-R) Primary measure for psychopathy, which is highly correlated with recidivism and risk of violence Structured Assessment of Violence Risk in Youth (SAVRY) For adolescents 12-18 years old HCR-20 (Historical, Clinical, and Risk Management) Primary risk assessment measure for mentally ill offenders Pros: Grounded in actuarial variables Good validity Combination of static and dynamic factors increases power More useful than purely actuarial as can help define strategies to manage risk Useful in identifying specific factors that increase or decrease risk Does have a ‘clinical override’ component Risk assessment informs risk management How to keep this person and other people safe? Cons: Need more research outcome studies Problems trying to combine actuarial & clinical measures, particularly if they contradict each other (Dawes et al, 1989) HCR-20 good at predicting risk in ‘high scorers’ but less good in the ‘middle or low’ range scorers (Strand et al, 1999)

Answer 137

The Psychopathy Checklist – Revised (PCL-R) was published by Robert Hare in 1991. This is a 20-item checklist that purports to measure Psychopathy It requires the administration of a semi-structured interview that can last between 90 and 120 minutes. Assesses a range of demographic, criminological, social and psychological information in a systematic manner. The PCL-R has been shown to be a strong predictor of recidivism and violence in offenders and psychiatric individuals, even though it is not a risk assessment device. However, it is heavily oriented towards the forensic context and tells us nothing about risk to self, mental instability or vulnerability

Answer 138

The assessment of risk is different from the assessment of dangerousness Can be high risk but low dangerousness or low risk but high dangerousness Risk and dangerousness are not fixed parameters but will change with context and over time Different risk factors have different levels of influence The rate of reoffending is determined by the criteria employed Grentekord (2003) sample of mentally disordered violent/sexual offenders Over 8 year period from release; 44% committed an offence, 30% returned to prison or forensic hospital, 13% committed a violent of sexual offence.

Answer 139

What are the key features of internet offending and IIOC? There is no regulatory body to ‘police’ the internet (Bainbridge & Berry, 2011). Control of the enormous amount of available content is limited (Beech et al., 2008). Global usage of the internet recently topped 4 billion users in 2017, which is over 50% of the worlds population (Internet World Stats, 2017). The Internet… Provides Accessibility, Affordability & Anonymity – ‘Triple A Engine’ (Cooper 2002). Allows individuals to engage with others who share the same pro-offending attitudes and enables easy access to IIOC (Quayle & Taylor, 2002).

Answer 140

Three prevailing ideas regarding the use of IIOC: Diverts from contact abuse: ‘compensatory’ model Use of IIOC acts as a diversion to contact offending (Riegel, 2004). This model suggests that viewing and reaching arousal to IIOC enables offenders to use this as a means to inhibit the urge to act upon fantasies (Babchishin et al., 2011). However, this model has little empirical support. Encourages contact abuse: ‘facilitation’ model IIOC facilitates the ‘spiral of sexual abuse’. Offenders begin with lower level images and progress through the levels from grooming/inciting/producing to the contact sexual abuse of a child (Sullivan, 2002). In occurrence alongside contact abuse: ‘concurrent’ model IIOC is used as part of an already established paraphilic lifestyle (Bourke & Hernandez, 2009). Individuals use IIOC to justify their paedophilic interests (i.e. if it exists it must be ok to view) rather than them becoming a paedophile because they have viewed IIOC (Sheenan & Sullivan, 2010).

Answer 141

Key question: What proportion of IIOC offenders are also committing contact sexual offences (or have previously)? A meta-analysis that considers a wide range of research suggests that contact sexual offending against children among IIOC offenders ranges from: As low as 5% (Seto & Eke, 2008); 55% when using self-report data; To as high as 84.5% - but this is considered a statistical outlier (Bourke & Hernandez, 2009); Research conducted as part of the FIIP & FIIP 2 projects suggests a best guess of 1 in 6. Source: (Seto, Hanson & Babchishin, 2011).

Answer 142

There are number of factors found to differentiate between offenders according to risk (IIOC vs. dual): 1) Previous behaviour - is an indicator of future behaviour; - anti-social tendencies; - previous criminal history (not just sexual offences). 2) Access to children - greater opportunity for contact offending. 3) Behavioural facilitators - engaging in risky behaviours.

Answer 143

Operation Ore Commenced in 1999 and was the UK’s biggest ever computer crime investigation of its time. Referrals sent to the UK from the US containing details of individuals who had paid for access to IIOC online using credit cards. Leading to 7,250 suspects identified, 4,283 homes searched, 3,744 arrests, 1,848 charged, 1,451 convictions, 493 cautioned and 140 children safeguarded. Following Operation Ore Continually growing number of IIOC investigations and access to the internet. Inconsistencies in workload prioritisation and risk assessment. Absence of an academically validated way to prioritise the most dangerous offenders (i.e. those most likely to also commit contact sexual abuse against a child). Lead to the idea to develop a risk prioritisation tool. The Kent Internet Risk Assessment Tool (KIRAT) was developed. KIRAT KIRAT applies to… Individuals suspected of possessing, making, taking and/or distributing indecent images of children (IIOC). Only applies in investigations involving IIOC. What does it do? Prioritises the most dangerous offenders (i.e. those most likely to also commit hands-on sexual offences against children). Uses known intelligence to assess risk. Allows police to take action to protect children. Assists with resource/workload management KIRAT contains four steps, each step contains a series of questions related to: Previous Offending Behaviour Access to Children Behavioural Facilitators Other Factors Responses to these questions will result in a final risk score for the suspect. Four risk scores; Low, Medium, High, Very High. Risk scores indicate risk the suspect poses of committing/have committed hands-on sexual offences against children (as well as IIOC offences). Risk scores linked to police action response times. KIRAT contains four steps, each step contains a series of questions related to: Previous Offending Behaviour Access to Children Behavioural Facilitators Other Factors Responses to these questions will result in a final risk score for the suspect. Four risk scores; Low, Medium, High, Very High. Risk scores indicate risk the suspect poses of committing/have committed hands-on sexual offences against children (as well as IIOC offences). Risk scores linked to police action response times.

Clinical and forensic psychology (year two) Flashcards

(174 cards)