CHAPTER TWELVE

METHODS OF TREATMENT

LEARNING OBJECTIVES:

1.      To know about the many different treatment methods that are currently used with delinquents.

2.      To be familiar with how these methods are used and the skills that staff using each method must have.

3.      To be aware of the research showing that the various methods are or are not effective.

4.      To be familiar with programs that use a combination of methods.

CHAPTER OUTLINE:

·        Specific methods of treatment in handling the juvenile are used both in pure prevention and rehabilitation programs, as well as in diversion programs and in agencies that deal with troubled youths in the community.

·        The various treatment methods to be described are strategies that attempt to change those conditions thought to be causative factors in juvenile delinquency.

·        One category of treatment, punishment, is not a prevalent today as in the past; it will not be considered in this chapter as a viable technique of treatment.

·        Generally, there are two basic approaches of in dealing with youngsters: the individual and the group method of treatment.

·        The individual method is generally used by psychiatrists, psychologists, and social workers; the group method involves schoolteachers, recreation specialists, and social workers.

·        Knowledge of the various approaches for treatment and rehabilitating the delinquent or the predelinquent is important for the professional within the juvenile justice system.

·        Because of the many treatment methods, the professional soon learns that there is no “right way” to treat the youngster and that many approaches have merit.

Psychotherapy

·        Psychotherapy was defined as a method of treatment of emotional and personality problems by psychological means; the aim of this method is to remove or retard symptoms or behavior patterns that are contributing to the dysfunctional behavior.

·        A basic concept of psychotherapy is the phenomenon of transference, the redirecting of feelings from the client to the therapist.

·        Aichhorn, who was one of the first people to attempt psychotherapy with delinquents, felt that transference was one of the important elements in treating the juvenile delinquent.

·        The psychotherapeutic method is often ascribed an aura of mysticism; in very simple terms, psychotherapy is merely a method of conversation between the client and the therapist to allow them to get to know each other so that they can be comfortable in exchanging communication.

·        Studies of the effectiveness of psychotherapy in interrupting a pattern of delinquent behavior have rarely shown this method to be successful and, in some cases, youths in psychotherapy become more delinquent than others.  The exceptions involve programs that are used only for youths prejudged to be amenable to psychotherapy, and programs that use psychotherapy in combination with other treatment methods.

Social Casework

·        Traditionally, social work was primarily related to the correction component of the criminal justice system; over the past few decades, social work has extended its services to the entire continuum of the system.

·        Casework with delinquents can be viewed as a three-phase process: passive casework, aggressive casework, and intervention with and authoritative agency.

·        Another form of casework called “directed friendship” involves paid professionals to visit homes and schools for the express purpose of giving personal advice and guidance.

Reality Therapy

·        The major premise of reality therapy is that all persons have certain basic needs; when they are unable to fulfill these needs, they act in an irresponsible manner.

·        The object of reality therapy is to help the person act in a responsible manner- in the case of delinquents, to help them refrain from antisocial activity.

·        Reality therapy emphasizes the present behavior of the youngster and considers it the most important event; Glaser, its originator, noted that delving into the past is “a fruitless historical journal- which leads to excusing the offender’s past actions as an unfortunate culmination of his history.”

·        The therapist treats the youngster as a responsible rather than an unfortunate youngster; the youngster is expected to obey rules but is not rejected for breaking one; the therapist always gives the client a great deal of support for acting in a responsible manner.

·        Reality therapy has been criticized because many feel that it is an oversimplification of human behavior, and in some cases the transmitting of expectations to the youngster can have negative effects if the youngster came from a situation in which there was a great many expectations transmitted.

·        Regardless of the criticism, however, there is evidence that the method can be effective.

·        Reality therapy, like other therapies, is only as good as the individual counselor or therapist who is using it; a key factor is consistency.

Transactional Analysis

·        Transactional analysis, which can be utilized both individually and in groups, is mainly concerned with evaluating and interpreting interpersonal relations and dynamic transactions between the client and the environment.

·        The major purpose of therapy is to point our the various games that the client plays and attempt to strengthen the adult component of the personality, displace the immaturities of the child component, and reduce the subjective judgment of the parental component.

·        Even though this method has primarily been used with adults, some argue that this method has a special value for adolescents because of their typical resistance to psychotherapy.

Cognitive Therapies

·        Counselors who use cognitive therapies actively and directly challenge and confront offenders’ irrational thoughts and irresponsible behaviors.

·        Cognitive skills development is a second major type of cognitive therapy; emphasis is placed on developing decision-making skills, moral education, and replacing aggressive behavior.

·        The cognitive therapy approach used with juvenile offenders focuses on teaching them to think through a situation before taking any action; participants are taught to think logically, objectively, and rationally; and they are taught not to over generalize, distort facts, or blame others for their actions or for what happens to them.

·        Once a child learns the basic skills of problem solving, the therapist must provide opportunities for role modeling and behavior rehearsal under supervision.

·        Although cognitive therapy for juvenile delinquents makes sense to many people as a treatment approach, there has been only limited evaluation evidence of its effectiveness in U.S. settings.

Vocational Counseling

·        Vocational counseling is different from the preceding therapeutic methods and does not address the interpersonal dynamics of human behavior or spend a great deal of time on diagnosis.

·        The main purpose of vocational counseling is to increase the client’s knowledge of career choices, job specifications, and qualifications and training needed for successful employment.

·        The positive attitudes, skills, and habits that youngsters develop and refine in the work situation can be carried over to the community and can positively affect their relationships with others.

·        Job placement and job-related programs which successfully reduce delinquency share on important element: they provide youths with jobs which are not “dead end,” but which allow for career advancement.

·        Vocational guidance programs that involve vocational counseling have often been effective in redirecting the energy of delinquent youngsters into positive challenges.

Behavior Therapy

·        Behavior therapy, or behavior modification, utilizes treatments based on principles of learning theory as well as experimental psychology.  These treatments focus on explicit specifications of procedures and goals as well as objective evaluation of therapeutic outcomes.

·        This type of therapy is closely linked with the social learning theory described previously.

·        Maladaptive behavior usually has to be modified through the development of new learning processes; behavior will change in direct proportion to the amount of rewards or punishments that exist as reinforcement.

·        A point system is often used as a part of behavior modification treatment; in general, behavior modification treatment has influenced youths to behave positively while they are in a program, but studies of long-term effects on recidivism show inconsistent effects.

·        Behavior modification has been used successfully to alter negative behavior and encourage positive achievements.  The family is the first “institution” that either directly or indirectly uses the behavior modification approach.

Behavioral Contracts

·        Behavioral contracting (also called contingency management) has become a very popular and useful method of working with delinquent adolescents.

·        The assumptions of behavior modification contracting have proven useful in graphically illustrating to the client the expectations of the counselor and the consequences of client behavior.

·        To enhance the usefulness of contracts between youth and correctional staff, contracts can also be developed between youth and parents.

·        A number of studies have shown the effectiveness of using behavior contracts in correctional programs; this treatment method also appears to be effective in community settings.

·        Essential steps to behavioral contracting include (a) an analysis of the client’s behavior to determine the antecedents and consequences of behavior; (b) the behavioral contract must not only be fair and formal, but it must also precisely state the conditions of the agreement; and (c) the contract should be stated in positive terms and implemented with positive rewards for positive behavior.

Crisis Intervention

·        The basis of crisis intervention is that when people experience a crisis, their psychological resources may become overtaxed, making them vulnerable to further breakdown.  The resolution of the current crisis may lead to the solution of older problems, as well, because of the reawakening of fears and repressed problems that recur during time of crisis.

·        The delinquent often expresses aggression by acting out in the community and coming in conflict with the law.

·        In some cases, crisis intervention involves the family as well as the youngster.

·        Handling problems when they are at the crisis stage and when there is a great deal of anxiety can contribute to problem solving.

·        Crisis intervention, as a technique for dealing with problems on the spot, can be effective in producing change and helping the delinquent deal with new methods for handling strain, frustration, and aggression in crisis situations.

Individual and Group Counseling

·        Counseling can be used with both groups and individuals.  Usually, the major goals of counseling are support and reeducation.

·        There are various types of individual treatment methods for delinquents.

·        The most prevalent group treatment approach in institutional settings and juvenile court programs is called group counseling, which involves the sharing of personal concerns, problems, and day-to-day experiences within the group.

·        In group counseling or group therapy, it is important to select those youngsters who can benefit from the group but who will not be scapegoated.

·        Role-playing may be a highly effective component of group counseling because it enables youngsters to view situations as others do.

·        The basic concept of role-playing is that because behavior is mainly the result of a reaction to what other people think of a person or what a person believes they think, the assuming of different roles will allow the youngster to test out perceptions in a nonthreatening situation.

·        Many formats can be followed when utilizing the role-playing method.

·        Although some group counseling programs have been effective in reducing recidivism and in improving other behaviors, many have not.

Group Therapy

·        Differentiating between group therapy, group counseling, group psychotherapy, guided group interaction, and social group work can be confusing.

·        Sarri and Vinter included psychotherapy, guided group interaction, and social group work under group therapy; they maintain these various methods are distinguished only by the type of worker who performs the service.

·        Some maintain that group therapy is a more intense process than social group work; the emphasis is still on the individual while the group is used as a mechanism to better understand the individual and that individual’s behavior.

·        The group process does not in itself solve all the problems of resistance to treatment.

·        Groups generally pass through various phases with distinguishable characteristics and processes.

·        Like most other methods discussed, the specific orientation that the group leader takes toward the goal of helping youngsters will vary depending on the group leader’s training, personality, and client group.

Social Group Work

·        Ferguson defines social group work as social work “focused on the individual in a group setting,” which attempts to help each group member function more effectively in groups and derive greater satisfaction from this participation.

·        The social group work method operates under many of the same assumptions as social casework, although it is more complex because of the number of group members and the increased interpersonal dynamics.

·        The worker has to be able not only to empathize and understand individual problems, but also to visualize and conceptualize how the group processes can contribute to problem solving.

·        One particular variation of group work and work therapy is called the “detached” group work method.

·        Although there is no doubt that the “detached” group work method involves the social worker with youths who would often not come to a program in an agency setting, there have been some serious problems in using this method; some studies of the effects of this method have been negative.

·        In addition to the various direct services offered to juveniles, social workers also provide services to the juveniles’ families and indirect services pertaining to the operation of the group home.

Group Psychotherapy

·        Group psychotherapy, when compared with other group methods, is usually thought of as having more ambitious goals, such as deep insight development and personality restructuring.

·        Schulman noted that the components necessary for an effective group psychotherapy situation, such as personal interaction, cooperation, and tolerance, are in direct conflict with the dissocial antagonistic, and exploitive orientation of delinquents.

·        A basic assumption of group therapy is that one of the major problems that delinquents have in their communities is that their behavior and demands are not realistic.

·        Through family therapy, patients are made aware of the often hidden and distorted negative aspects of their relationship with their youngster.

·        Regardless of whether the therapy involves a group of family members or a group of delinquent youngsters, the techniques are similar.

·        There is no clear research evidence that group psychotherapy is effective.

Activity Therapy

·        Very young children and resistant subjects such as delinquents and predelinquents are especially suited to the activity therapy method.

·        A group of six to eight children are gathered or invited to meet at a specific time and place to engage in play, such as group games or some artistic endeavor like modeling clay.

·        Not only is it important to select youths for activity therapy carefully, but it is also essential to take care in choosing appropriate activities.

·        The use of games in therapy is based on the idea that play is of considerable importance in socializing delinquents.

·        Regardless of the therapeutic technique utilized, a careful evaluation has to be made regarding its appropriateness for the particular client.

Guided Group Interaction

·        Guided group interaction is basically similar to group therapy or group psychotherapy in that it is also based on the assumption that through the group and its processes delinquents can solve their problems; the group is a major vehicle for change.

·        The group can exert a great deal of pressure on its individual members after the group has been stabilized and the leader trusted, and meaningful dialogue has taken place.

·        The process described for guided group interaction in regard to the structure of the group and the means it takes to achieve meaningful dialogue, communication, and expression of feelings is similar to the group processes discussed earlier.

·        Gottfredson concluded that, in the community, guided group interaction provides a cost-saving alternative to institutional placement.

Milieu Therapy

·        Whether the youngster is in an institution, a halfway house, or some other controlled or semicontrolled setting, milieu therapy attempts to produce an environment that will facilitate meaningful change, increased growth, and satisfactory adjustment.

·        Because the environment is, in fact, the therapeutic setting, daily activities, including both failures and successes, are the topics of discussion between clients and those persons who are a part of their milieu.

·        Milieu therapy takes a more general orientation to treatment than guided group interaction, group therapy, social casework, and other methods because it focuses on the total environment of the individual and is viewed as the major therapeutic agent.

Intervention with Families

·        Not all family counseling programs have been effective, but those which focus on improving family communication and teaching parents disciplining and decision-making skills have a good record, particularly compared with other treatment methods.

·        Family intervention requires that the family not be so severely disorganized that members cannot use therapy.

Intervention Methods for Pure Prevention

·        It is important to recognize that some of these methods also are used in prevention programs for youth who are not adjudicated as delinquent.

·        In many cases the prevention programs concentrate services on youth who are considered to be at high risk for delinquency, for instance those who have serious school problems or who exhibit acting out behavior in the family or the community.

CLASSROOM DISCUSSION:

1.      Which treatment methods seem to be most effective for different types of delinquents?

2.      Which of the most common treatment methods seem to be quite ineffective with delinquents?

3.      What training, education, and personal characteristics are required for staff to be effective in applying the various treatment methods?

4.      What are the theories of delinquency causation behind each of the treatment methods discussed?

5.      What are the possible misuses of behavior modifications?