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TREATMENT OF VIOLENT BEHAVIOR / PERSONALITY PSYCHODYNAMIC PSYCHOTHERAPY

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Forensic Psychology (PSY - 513)
VU
Lesson 29
TREATMENT OF VIOLENT BEHAVIOR / PERSONALITY
PSYCHODYNAMIC PSYCHOTHERAPY
OBJECTIVES:
To get an insight about the stages of change
To understand the use of violence reduction scale, integrating the risk assessment and
change measurement together for therapeutic purposes
To understand that while using VRS, How we actually measure change
To find the answer that how psychodynamic model works for the treatment of violent
criminals
Topics from previous lectures
Stages of Change
The Trans-theoretical Model of Change or the Stage of Change Model was developed by Prochaska et
al, 1992, it addresses the issue of treatment readiness, treatment change and the need to match treatment
delivery to client readiness. The model postulates that individuals who modify their problem behaviours
progress through a series of five stages:
1.
Pre-contemplation
2.
Contemplation
3.
Preparation
4.
Action
5.
Maintenance
Pre-contemplation
Is marked by absence of any desire to change.Criminals in the pre-contemplation stage have neither
insight nor intention to change in the foreseeable future. They are often in denial and blame external
factors. Do not consider crime as some thing bad. Like a chain smoker denying the adverse effects of
smoking on health.
Contemplation
Those in the contemplation stage are fence-sitters; they acknowledge their problems but have shown no
relevant behavioural change: `all talk, no walk'. But at least in this stage they have started thinking about
the change. Like a smoker has started thinking about quitting the smoking, although no behavioural step
is taken yet.
Preparation
Those in the preparation stage combine intentions to change with relevant behavioural changes to
address problems. However, changes tend to be recent and/or quite unstable.( e.g.cutting down the
number of cigarettes)
Action
Those in the action stage actively modify their behaviours, attitudes and environment to address their
problems; overt behavioural changes are made, commitments followed through and energies expended
to change.( a smoker has completely quitted the smoking but only three to six months have passed so
we can not say that he will maintain his behaviour)
Maintenance
In the maintenance stage, the desired behaviour is maintained over a long period of time like one year or
more. Relapse prevention techniques are used to consolidate, strengthen and generalize the gains made
in the action stage.
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Forensic Psychology (PSY - 513)
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Treatment is a process of change. The primary goal of correctional treatment is to bring about positive
changes in criminogenic needs leading to risk reduction. Treatment changes must be assessed
objectively and systematically to determine the amount of risk reduced. Assessment and treatment must
be closely integrated: assessments of the clients' risk, need and responsivity should inform treatment
providers of who to treat (risk principle), what to treat and how to deliver treatment, in particular to
treatment-resistant clients Clinicians who provide correctional treatment require the appropriate tools to
assess risk, needs, responsivity and treatment readiness, and to measure treatment change.
The VRS was developed by Wong & Gordon, 2006 and is designed to integrate the assessment of
risk, and treatment change into a single tool. It assesses the clients' level of violence risk, identifies
treatment targets linked to violence, assesses the clients' readiness for change and their post-treatment
improvements on the treatment targets. Treatment improvement or lack thereof is linked to quantitative
changes in violence risk.
Qualities of Violence reduction scale
The VRS allows the practitioner to exercise reasonable clinical discretion while maintaining structure
and scientific rigor. This scale is one of the best, as integrate the idea of risk assessment and change
measurement together for therapeutic purposes.
It provides a quantitative measure of the risk of violent recidivism of forensic clients, in
particular, those who are to be released from an institution to the community
It uses both static and dynamic variables that are empirically or theoretically linked to violence to
assess and predict violence.
Identifies treatment targets linked to violence; dynamic variables that receive high ratings (rated 2
or 3) are considered relevant treatment targets.
It uses the well established Transtheoretical Model of Change to assess change as a function of
treatment linking changes in treatment to changes in risk.
It identifies the client's stages of change (treatment readiness) which tells the service deliverer
what therapeutic approach to take that would maximize treatment efficacy.
It allows service deliverers to assess pre- and post-treatment risk levels.
How Do We Actually Measure Change?
Move from one stage to the other is measured as a decrease of one point
Total change in dynamic factor is added together.
Sum of the all change points is taken as measure of change.
In addition, according to the Transtheoretical Model of Change, the client's ideal behaviours at each
stage of change should be matched with appropriate intervention: the responsivity principle. As such,
assessment of the client's stage of change also identifies the most appropriate therapeutic approach to
take. A brief summary of therapist tasks that correspond to each stage of change follows:
Pre-contemplation
The therapist should: focus on developing a working alliance, enhancing motivation for change and
engagement in treatment; raise doubts and create dissonance regarding the client's current functioning
and his hopes of achieving future goals; use cost-benefit analyses to highlight the cost of criminal
behaviour.
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Forensic Psychology (PSY - 513)
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Contemplation
The therapist should: tip decisional balance; evoke reasons to change in order to reduce dissonance;
strengthen the client's confidence to effect change (i.e. increase self-efficacy).
Preparation
The therapist should assist the client in: determining the best course of action to change; setting and
achieving shorter-term behavioural goals that are planned, observable, measurable and relevant;
highlighting successes and emphasizing change potential.
Action
This is the main skill-teaching and skill-building phase of treatment. The therapist should assist the
client in strengthening skills through over practice and reinforce client's self-efficacy in problem-solving
and achieving treatment goals.
Maintenance
The therapist should: assist and encourage the client to practice and generalize learned skills to new and
challenging situations by providing access to such situations; identify strategies and interventions to
prevent lapses and relapses. Obviously, strengthening and reinforcing the client's self-efficacy is
important whenever the client takes steps to make changes, regardless of the stage of change.
How to treat a violent personality?
Gordon & Wong, 2000 developed a program with the Integration of assessment and treatment of
violence-prone offenders. A risk reduction focused correctional treatment program for violence prone
forensic clients.
We have discussed different psychological models of violence. Now we will discus s that how these
approaches can help in treating a violent, crimnogenic personality.
Psychodynamic model
Psychodynamics provides a unique opportunity for therapist and patient to discover and to explore the
violence, both conscious and unconscious. We have discussed in detail the basic concepts of this model;
now will view the application of those concepts into forensic psychology.
Freudian assessment
Using a psychodynamic approach, clinician may assess through HTP. As discussed earlier, individual
is asked to draw a house, tree and person and then those drawings are interpreted. No special equipment
is required for this test.
House drawing represents family
Tree drawing tells about the ego strength and growth potential.
While drawing of person depicts the self esteem and ego strength.
Two qualities /benefits of using this test are that:
1. It not only allows assessing the personality.
2. But also permit to begin communication in a meaningful way.
HTP is a very good test to start a therapeutic relationship, because it permits a window into the soul of
the person. On one hand therapist is communicating with criminal so working toward making a rapport
on the other hand by interpreting the drawings treatment targets are identified like if the ego is too much
strong are weak, steps are taken to balance them.
The primary use of the HTP, however, is related to the qualitative scoring scheme in which the test
administrator subjectively analyzes the drawings and the responses to questions in a way that assesses
the test taker's personality. For example, a very small house might indicate rejection of one's home life.
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Forensic Psychology (PSY - 513)
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A tree that has a slender trunk but has large expansive branches might indicate a need for satisfaction. A
drawing of a person that has a lot of detail in the face might indicate a need to present oneself in an
acceptable social light.
Other methods of interpretation focus on the function of various parts in each of the drawings. In the
house drawing, the roof might represent one's intellectual side, the walls might represent the test taker's
degree of ego strength, and the doors and windows might represent the individual's relation to the
outside world. In the tree drawing, the branches might indicate the test taker's relation to the outside
world and the trunk might indicate inner strength.
One crucial thing for consideration is the cultural differences in interpretation of HTP, a chimney on
roof with smoke may indicate warmth and satisfaction in England but the same drawing has totally
different indication in our culture, smoke can points to the aggressive and violent environment of
family.
Common sense is more important then the HTP manual in forensic settings.
While heeding a psychodynamic approach, a clinician will also explore the following phenomena and
will estimate the severity of problem. We are not going to dwell on description of these concepts as we
have already discussed in detail.
Psychosexual stages (how individual developed and what was the surrounding environment
and family attitude toward child)
Fixations at different stages
Oedipal conflict ( relationships with father , mother are analyzed)
The role of defense mechanisms (which defense mechanism is person using more frequently
like blaming others all the time, or rationalizing e.t.c)
Personality factors (presence of any personality disorder is identified as individuals with PD
are comparatively difficult to treat)
Starting therapy
In psychodynamic methods, focuses on the depth and breadth of the clinical experience itself: entering
into the inner world of patients and their object relationships, meeting and facing feelings as they
emerge within transference and the countertransference. No relationship starts with out transference and
counter transference. A therapist needs to be alert and attentive to resolve the transference counter
transference issues.
Transference
Transference is the client's unconscious redirection/projection of feelings for one significant to the
therapist. (Perceiving therapist as father or mother)
Counter Transference
From a psychodynamic perspective, countertransference is an inevitable part of all patient-therapist
contact. In its broadest sense it means the therapist's emotional response, which stems both from the
specific relationship with the particular patient and from the character and disposition of the therapists
personal life. Conscious countertransference can usually be controlled and may shed useful light on
aspects of the patient's personality and ways of relating. Clearly, it remains an essential task for the
clinician to meticulously observe the inner feelings after every session and discuss under supervision to
crystallize the vision.
Therapeutic relationships
Once the therapist has resolved the all transference and countertransference issue and fantasy
relationship evaporates, the real therapeutic relationship emerges.
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Forensic Psychology (PSY - 513)
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Techniques
Following techniques are used:
Free association (client is asked to express what ever comes in mind with out any censor)
Dream interpretation (earlier dreams are considered as current sate of mind and later dreams in
therapeutic process are considered as a change that has occurred as a result of therapy)
Re-parenting
Is the emotional support from therapist (will discuss in detail in next lesson)
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Table of Contents:
  1. INTRODUCTION TO FORENSIC PSYCHOLOGY:Future of Forensic Psychology
  2. INTRODUCTION TO FORENSIC PSYCHOOGY:Way of police investigation
  3. FORENSIC PSYCHOLOGY AND POLICE:Violent Criminals
  4. POLICE PSYCHOLOGY:Use of excessive force, Corruption, Personnel Selection
  5. POLICE PSYCHOLOGY:Fitness-for-Duty Evaluation (FFDE), False Confessions
  6. INVESTIGATIVE PSYCHOLOGY:For instance, Empirical and logical approach
  7. INVESTIGATIVE PSYCHOLOGY:Crime Scene Investigation, Staging
  8. PSYCHOLOGY OF VIOLENCE:Law of Conservation of Energy, Super ego
  9. PSYCHOANALYTIC MODEL AND VIOLENCE:Fixation at Oral Stage
  10. PSYCHOANALYTIC MODEL AND VIOLENCE:Defense Mechanism, Rationalization
  11. JUNGIAN PSYCHOLOGY AND VIOLENCE:Freudian Methods, JUNGIAN PSYCHOLOGY
  12. JUNGIAN PSYCHOLOGY AND VIOLENCE:Religion and mental illnesses
  13. BEHAVIORIST PERSPECTIVE AND VIOLENCE:Shadow’s violence, Child’s violence
  14. BEHAVIORIST PERSPECTIVE AND VIOLENCE:Operant Conditioning
  15. BEHAVIORIST PERSPECTIVE AND VIOLENCE:Schedules of Punishment
  16. SOCIAL LEARNING MODEL AND VIOLENCE:Observational learning, Vicarious punishment
  17. MORAL DEVELOPMENT AND VIOLENCE:Symbolic functioning, Formal operational stage
  18. BIO-PSYCHO-SOCIAL MODEL:Mental hospitals are factories of abuse
  19. ISLAMIC PERSPECTIVE ABOUT VIOLENCE:Morality is essential
  20. ISLAMIC MODEL:Nafs al-Ammara, Nafs al-Lawwama, Nafs ul Naatiqa
  21. TREATMENTS FOR THE SOUL:Tawba, Sabr o Shukr, Niyyat o Ikhlaas, Taffakkur
  22. CRIMINOGENIC PERSONALITY:Personality Disorders, Common Crimes
  23. CRIMINOGENIC PERSONALITY AND VIOLENCE:Mnemonic, Similarities
  24. CRIMINOGENIC PERSONALITY AND VIOLENCE:Terrorism and Psychopaths
  25. LEARNING DISABILITIES/MENTAL RETARDATION AND VIOLENCE
  26. ASSESSMENT OF PERSONALITY DISORDERS:Reasons for referral, Personality Inventories
  27. ASSESSMENT OF PERSONALITY DISORDERS:Different cutoff scores
  28. RISK ASSESSMENT:Violence reduction scale, Stability of Family upbringing
  29. TREATMENT OF VIOLENT BEHAVIOR / PERSONALITY PSYCHODYNAMIC PSYCHOTHERAPY
  30. JUNGINA THERAPEUTIC MODEL:Limits of re-parenting, Personality Typologies
  31. GROUP THERAPY FOR OFFENDERS:Learning in Groups, Humanistic Groups
  32. PSYCHOTHERAPIES IN FORENSIC SETTINGS:Narrative Therapy
  33. PSYCHOTHERAPIES IN FORENSIC SETTINGS:Solution Focused Therapy
  34. PSYCHOTHERAPIES IN FORENSIC SETTINGS:Avoiding reactance, Externalization
  35. PSYCHOTHERAPY IN FORENSIC SETTINGS AND SPECIAL CHALLENGES
  36. FORENSIC PSYCHOTHERAPY:Exploring therapeutic alliance, Music Therapy
  37. VIOLENCE REDUCTION PROGRAM:Target Population, Lack of motivation
  38. VIOLENCE REDUCTION PROGRAM:Criminal attitude, Interpersonal Aggression
  39. VICTIM SUPPORT:Main features of PTSD, Emotional Support
  40. VICTIM SUPPORT:Debriefing, Desensitization, Eidetic Therapy, Narrative Therapy
  41. SUBSTANCE MISUSE TREATMENT PROGRAM:Marijuana, Unconventional drugs
  42. SUBSTANCE MISUSE TREATMENT PROGRAM:Stages of Change, Homosexuality
  43. EXPERT WITNESS:Insanity Pleas, Sexual Offence Risk, Instructions
  44. COUNTER TERRORISM:Misconceptions, Psychologists & Propaganda war
  45. SUMMING UP FORENSIC PSYCHOLOGY:Problems with Risk Assessment, Expert Witness