1. Creating Treatment Curriculum for a Civil Commitment Program Lessons Learned Jannine Hébert MA, LP Executive Clinical Director Minnesota Sex Offender Program (MSOP) jannine.hebert@state.mn.us Elizabeth Griffin MA, LMFT Griffin Counseling and Consulting elizgrif@gmail.com www.internetbehavior.com/iatso2014

2. Outline Who is here? Introductions Presentation – Introduce the challenges of creating a treatment curriculum for civilly committed sexual abusers – Tour the curriculum – Provide specific treatment examples to assist in the change process

3. Treatment completion reduces risk What does treatment look like?

4. Goals of Curriculum Project Engaged challenging clients Reflective of research Reflected program design Meaningful curriculum-not a checklist Consistent treatment language Strengthen culture Easily followed and centralized Standardized while allowing for individual client needs/abilities/pathology Feedback from both clinicians and clients

6. Foundation of Creation Process Researched current trends in sex offender treatment – CBT/RP/RNR – Schema Therapy – Mindfulness Looked to adjunct fields – Art Therapy – Movement Therapy Relied heavily on responsivity principles Contacted and gained permission from authors/providers

7. Sex Offender Civil Commitment Minnesota Psychopathic Personality (PP) – 1939 Sexual Dangerous Person (SDP) and Sexual Psychopathic Personality (SPP) - 1996

8. Minnesota Sex Offender Program Civil Commitment

9. SPP/SDP Referrals from DOC to Counties

10. Challenges 2 facilities Census 700 + High- risk, needs, resistance, pathology, hopelessness and institutionalization Large clinical staff- 100+ clinicians – Program integrity, range of experience/education Public and legal scrutiny

11. MSOP clients High risk as deemed by the courts High on sexual deviance Multiple previous treatment attempts Personality disorders Some high on psychopathic traits Heterogeneous group Range of cognitive functioning Mental health needs/personality disorders

12. Program Design Primary Therapist Core Group Psycho-Educational Group Quarterly/Annual Treatment Review Therapeutic environnment. Treatment 24/7

13. Program Design MSOP Treatment Program Phases/Matrix factors

14. Treatment phases Phase I-Orientation, engagement, self-management *(pre-contemplation, contemplation) Phase II-Disclosure, identification of abuse patterns and schemas, skill acquisition, awareness of self and others *(contemplation, preparation, action) Phase III -Skill application, transitions, consistent utilization of pro-social coping strategies *(maintenance) Escorted on campus Escorted in the community Unescorted on campus Minnesota Sex Offender Program

15. Group behavior Attitude toward change Self-monitoring Thinking errors Pro-social problem solving Healthy Lifestyle Emotional regulation Interpersonal skills Sexuality Cooperation with rules/supervision Productive use of time Life Enrichment Minnesota Sex Offender Program Treatment Progress/Matrix Factors

16. Matrix FactorCriminogenic Need/Dynamic Risk Factor Group Behavior Resistance to Rules/Supervision Negative Social Influences Poor Self-Regulation General Hostility Hostility toward Women Attitude toward Change Offense-supportive Attitudes Antisocial attitudes and behavior Self-Monitoring Antisocial attitudes and behavior Impulsivity Sexual Preoccupation Deviant Sexual Interests Sexualized Coping Thinking Errors Offense Supportive Attitudes General Hostility Hostility toward Women Antisocial attitudes and behavior Prosocial Problem SolvingNegative Social Influences Emotional Regulation Poor Self-Regulation Impulsivity Interpersonal Skills Emotional Congruence with Children Poor Adult Attachment Negative Social Influences Cooperation with Rules Resistance to Rules/Supervision Antisocial attitudes and behavior Sexual Functioning Sexual Preoccupation Deviant Sexual Interests Sexualized Coping

17. Webpage Tour

18. Therapeutic Tools Develops a common language Lowers resistance and denial, increases compliance – Away from hard confrontational style Provides therapeutic/visual images to anchor concepts Useful for Clients Learning Disabilities Learning styles that are more suited to visual, tactile or kinesthetic More success in treatment More Active and Engaging – Hoop Therapy (Narrated PowerPoint)

19. Phase I To Motivate Change To Invite Into Treatment

20. Phase I Connecting to Change – Hermes’ Web – The Lawyer Perpetrator Profile – Lay out style of offending in a non threatening way – Allows clients to see that sexual offending is one part of self Your Story Module – Life Egg – Life Map (Client Example)

21. 21 HERMES’ WEB Fundamental Concepts  A psychological communication tool  The ego  The core  The barrier  The flip  The Truthful Lie

22. 22 The Ego  The Ego  Who we think we are  What we identify with  What we prefer to show others  Chronological age Ego

23. 23 The Core  The soul, where all parts of the human personality meet  Psychological age  The hidden world Core

24. 24 The Barrier  The dividing line  The power of the barrier  Stops output, unless compromised via stress, drugs, alcohol, sex  Cannot stop input or protect the core from life events Barrier

25. 25 The Flip: Revolution What has been ignored  Takes center stage  Rebels  Acts out and offends  With no interference

26. Phase I Connecting to Change – Hermes’ Web – The Lawyer Perpetrator Profile – Lay out style of offending in a non threatening way – Allows clients to see that sexual offending is one part of self Your Story Module – Life Egg – Life Map (Client Example)

28. Phase I Connecting to Change – Hermes’ Web – The Lawyer Perpetrator Profile – Lay out style of offending in a non threatening way – Allows clients to see that sexual offending is one part of self Your Story Module – Life Egg – Life Map (Client Example)

30. Phase I Connecting to Change – Hermes’ Web – The Lawyer Perpetrator Profile – Lay out style of offending in a non threatening way – Allows clients to see that sexual offending is one part of self Your Story Module – Life Egg – Life Map (Client Example)

31. Family Roles Family Rules LIFE EGG

32. Phase I Connecting to Change – Hermes’ Web – The Lawyer Perpetrator Profile – Lay out style of offending in a non threatening way – Allows clients to see that sexual offending is one part of self Your Story Module – Life Egg – Life Map (Client Example)

33. Phase II Explore and Resolve Underlying Issues in Sexual Offending Behavior (“What”, “Why”)

34. Phase II Roots of Offending – Hermes’ Web – Dandelion (Client Example) Schemas – Different Ways of Viewing the Word Chicken Little – Introduce concept of “Perspective Taking” – More than one “truth” Hoodwinked Video

35. Phase III Reintegration and Maintenance

36. Phase III Different format – Moving from external to internal – Clients take more responsibility for treatment Privileges – Exposure to the World Topic Format – Relationships Module – Relapse Prevention Module Maintenance Plan – Good Lives

37. Lessons Learned The Marshalls were right – WERD (Warm, Empathic, Rewarding, Directive) Behavior isn’t the problem it is the solution to the problem They will be there tomorrow Don’t ask your clients to do anything you are not willing to do Every conversation has the potential to shift or entrench a psychological state

38. Thoughts/Comments/Questions/Reactions?

39. Creating Treatment Curriculum for a Civil Commitment Program Lessons Learned Jannine Hébert MA, LP Executive Clinical Director Minnesota Sex Offender Program (MSOP) jannine.hebert@state.mn.us Elizabeth Griffin MA, LMFT Griffin Counseling and Consulting elizgrif@gmail.com www.internetbehavior.com/iatso2014