Treatment Modules for Sexually Violent Offenders

Abstract

In this chapter, modules are described of a cognitive-behavior-oriented group treatment program for sexually violent offenders in so far as they differ from or are expanded upon the modules for violent offenders. The content and form of these modules are the results of the heuristic model as presented in Chap. 2, literature study, our research, and clinical experience. The modules are intended to reduce dynamic risk factors and to strengthen protective factors. There is a different Basic program with at least 15 sessions for rapists and child sexual abusers. For a Specific program with at least 45 sessions, three modules are described, namely Psychoeducation, Cognitive Distortions, and Management of Risk Situations. For the Prosocial Network, Contact with Women, and Work and Leisure modules, we refer to the Extended program for violent offenders. Two follow-up sessions are described for the evaluation of participants after the Basic or Specific program.

Appendix: Emotion Management

1.1 Introduction

Below we explain how emotions may lead to maladaptive but also to adaptive behavior. Emotion is a feeling. For instance, you are furious at someone because what you wanted to happen did not happen. You feel that you have been wronged or think that the other person has offended you. If you can control your emotion in such a way that you react appropriately, you will reach your goal more often and you will feel calmer. To clarify the connection between emotion and maladapted behavior, we use the following behavior chain: Behavior chain: Antecedent → Thoughts → Tension → Emotion → Behavior → Consequences.

1.1.1 1. Behavior

Aggressive behavior is an example of inappropriate behavior because the direct result is often positive, but in the long run, you get into difficulties. It is better to stand up for yourself in an assertive way. Assertive behavior means that you act according to your interests without affecting other people’s rights. Assertive behavior is an adaptive behavior. In our interaction with each other, we have to apply specific values and norms of our society. Standards and values are social rules that ensure that people are pleasant, polite, and respectful of each other. With assertive behavior, you take into account those values and norms, even if you stand up for yourself.

1.1.2 2. Antecedent

Emotions usually have to do with what someone else says or does. We speak of an antecedent event when the behavior of another person can give rise to an emotion. These emotions may lead you to behave emotionally, for instance by scolding, threatening, or beating. To be able to act appropriately, it is essential to realize what happens precisely: What does or says that other person exactly. In a situation, it is best to first carefully observe what you hear or what you see and what you feel yourself. We call those observations. Behavior chain: Antecedent → Behavior.

Example: Wesley has just made coffee but the coffee can is still on the counter. However, Nancy wants to do the dishes. Nancy says to Wesley in an angry voice: “Can’t you store that coffee in the closet right away? Then at least I can do the dishes.”

Behavior chain: Coffee can at the kitchen counter → Nancy scolds Wesley. Alternative behavior chain: Coffee can is at the kitchen counter → Nancy asks Wesley to store the coffee.

1.1.3 3. Thoughts

Observations are followed by thoughts (interpretations). It is important to make a distinction between what you observe (antecedent) and the interpretations you make (thoughts). Interpretations are thoughts that you have about the antecedent. A thought can be: “She has the pick on me” or “He is forgetful again.” Behavior chain: Antecedent → Thoughts → Behavior.

Example: Daphne is not home yet at 7 o’clock in the evening, while she always stops working at half past five. Dennis looks at the clock and thinks: “She’s cheating.” As soon as Daphne comes home, Dennis scolds her. Behavior chain: Daphne is not home yet at 7 o’clock → Dennis thinks: “She has an affair.” → Dennis scolds Daphne when she returns home. Alternative behavior chain: Daphne is not home yet at 7 o’clock. → Dennis thinks: “She can take care of herself.” → Dennis asks Daphne when she comes home why she is late and if she wants to call from now on when she has to work overtime.

1.1.4 4. Physical Tension

When people perceive someone’s behavior as unpleasant, they usually do not get emotional right away. It takes a while before they know exactly what is happening. They do notice that their physical tension immediately increases. This tension can occur in different ways: faster heartbeat, perspiration, stretching muscles, shaking, blushing, and the like. An increase in physical tension is entirely reasonable in social situations in which, in our opinion, something unpleasant happens. Behavior chain: Antecedent → Thoughts → Tension → Behavior.

Example: Patrick walks into the hall with a bag full of groceries. Marian is running ahead of him. Marian does not keep the door open for Patrick. Patrick thinks: “What a bitch” and gets completely riled up. The next time Patrick does not keep the door open for Marian. Behavior chain: Marian does not keep the door open for Patrick → Patrick thinks: “What a bitch” → Patrick gets worked up → Next time, Patrick bangs the door shut in front of Marian’s nose. Alternative behavior chain: Marian does not keep the door open for Patrick → Patrick thinks: “She is with her thoughts elsewhere.” → Patrick relaxes → Patrick says something about the fact that Marian did not keep the door open for him and asked her to show some consideration with him the next time.

1.1.5 5. Emotions

Behavior is partly determined by the feelings that precede it. Negative feelings may lead to maladaptive behavior: feeling down to depression, anger to aggression, suspicion to social isolation. Negative feelings are not always wrong. Death comes with grief, and deception comes with bitterness. These feelings are temporary. Behavior chain: Antecedent → Thoughts → Tension → Emotions → Behavior.

Example: Gerald is waiting in the bakery for his turn. Then arrives a woman who immediately addresses the saleswoman and asks for her order. The saleswoman does not dare to refuse because she and the woman are good acquaintances. Gerald thinks: “What a rude person, acquaintances have certain privileges here.” He gets it completely hot under the collar. Gerald feels completely ignored and walks angrily out of the shop. Behavior chain: Woman pushes forward in the bakery → Gerald thinks: “What a rude person, acquaintances are allowed to do this.” → Gerald gets it hot under the collar → Gerald feels ignored and angry → Gerald runs out of the store. Alternative behavior chain: A woman pushes forward → Gerald thinks: “She does not notice me.” → Gerald relaxes → Gerald feels fairly calm → Gerald says that it is his turn first.

1.1.6 6. Consequences

Behavior is mainly determined by the consequences it has. It is essential to make a distinction between (a) consequences immediately after the end and (b) consequences after some time. Some behaviors directly produce a positive result but have negative consequences in the longer term. For instance, good food can lead to getting too fat. In yet other cases, the result is negative in the short term but the effect is positive after months or years. Going to school means that you cannot spend all day with your friends but you obtain a diploma later on. Consideration is not always easy. This is partly because you can be more assured of a direct result than of a long-term consequence. Many people find it difficult to see beyond the end of their noses. Behavior chain: Antecedent → Thoughts → Tension → Emotions → Behavior → Consequences.

Example: Dwight is queuing at the supermarket. The woman for Dwight asks the cashier after the checkout how it goes with her children. Dwight thinks: “I’ll be here until tomorrow” and is getting tense. He is annoyed and says to the cashier and the woman: “Can’t you hurry up? I have something else to do than to listen to your chatting.” The cashier gets scared and says: “I will help you immediately.” Dwight is immediately helped but later feels uncomfortable because he was in no hurry. Behavior chain: A woman is talking with cashier → Dwight thinks: “I’ll be here until tomorrow” → Dwight gets tense → Dwight gets annoyed → He makes an angry remark to the cashier → Dwight is helped immediately but later feels uncomfortable. Alternative behavior chain: A woman is talking with cashier → Dwight thinks: “I have some time if it does not last too long.” → Dwight relaxes → He stays calm → Dwight says to the women: “Aren’t you chatting a bit too long?” → Dwight feels comfortable because the women look at him kindly and take him into account.