The Interrelationship between Violence and Mental Illness

Concerns about individuals with mental illnesses perpetrating violence have been greatly amplified since the 32 homicides at Virginia Tech in 2007. However, recent research into the relationship between mental illnesses and violence shows a complicated relationship. An epidemiological study involving several thousand individuals was completed in an attempt to tease-out the impact of mental illness on the risk of violent behavior.[i]

These researchers concluded that the relationship between severe mental illness alone and violence is not statistically significant. In other words, people suffering from a severe mental illness alone, without any other risk factors, were not at an increased risk of committing a violent act, and in fact, have the same chance of being violent as any other person in the general population during the next three years.[ii]

However, that being stated, the incidence of violence is higher for individuals with mental illnesses. How could that be? The incidence of violence is higher for individuals with mental illnesses because individuals with mental illnesses are more likely than the general population to also be associated with risk factors for violence and the combination of these other risk factors and mental illness lead to higher risks for violence than just the risk factor alone.

For example, “people with co-occurring mental illness and substance abuse and/or dependence had significantly higher incidence of violent acts” , and more than people with substance abuse alone. Further, 46% people with severe mental illness also had a lifetime history of substance abuse.[iii] Also, people with severe mental illnesses are more likely to have been victimized and prone to other environmental stressors, such as unemployment, which elevates the risk of violence.[iv]

These researchers stated that “the occurrence of 3 factors (severe mental illness, substance abuse and/or dependence, history of violence) was associated with a distinctly higher than average risk of violence.[v] The researchers concluded as follows” The current study aimed to clarify the link between mental disorder and violence, and the results provide empirical evidence that (1) severe mental illness is not a robust predictor of future violence, (2) people with co-occurring severe mental illness and substance abuse/dependence have a higher incidence of violence than people with substance abuse/dependence alone; (3) people with severe mental illness report histories and environmental stressors associated with elevated violence risk; and (4) severe mental illness alone is not an independent contributor to explaining variance in multivariate analyses of different types of violence….The data shows that it is simplistic as well as inaccurate to say the cause of violence among mentally ill individuals is the mental illness itself; instead, the current study finds that mental illness is clearly relevant to violence risk but that its causal roles are complex, indirect, and embedded in a web of other (and arguably more) important individual and situational cofactors to consider.”[vi]

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[i] Elbogen, Eric B., and Sally C. Johnson, 2009, The Intricate Link Between Violence and Mental Disorder, Results from the National Epidemiologic Survey on Alcohol and Related Conditions, Arch. Gen. Psychiatry, 2009; 66(2):152-161.

[ii] Ibid. p. 157.

[iii] Ibid. p. 156.

[iv] Ibid. p. 156.

[v] Ibid p. 159

[vi] Ibid p. 159.

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

Formal Processing of Juveniles Appears to Increase Delinquency

A recent meta-analysis of 29 separate studies concluded that processing juvenile delinquency referrals through the Court system did not appear to have any crime control effect, and may actually increase delinquency. The best results came from programs that divert juveniles from the system. See the entire study, entitled Formal System Processing of Juveniles:Effects on Delinquency at the Campbell Collaboration at http://www.campbellcollaboration.org/news_/formal_processing_reduce_juvenile_delinquency.php Formal

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

Factors Moderately Associated With Crime

In my last entry I discussed the “big four” traits associated with criminal behavior. Andrews and Bonta (2010) also identified four additional traits associated with criminal behavior that they call the “moderate four”.[i] These four, along with the “big four” are what these researchers call the central eight. Andrews and Bonta calculated the correlation coefficients associated with the “moderate four” using a meta-analytic review. The grand mean of the coefficient correlations associated with these four factors averaged .17 as compared to .26 for the “big four”.[ii]

One of the “moderate four” is the offender’s family and marital circumstances. This factor assesses the quality of the offender’s relationship with their family and in older offenders, with their spouse, and the extent to which the offender’s family and spouse discourage anti-social behavior, and monitor the offender’s behavior. In young people, the factor includes the attitudes offenders have toward their parents and their parents’ opinions. With married offenders, lower risk is associated with a spouse that has pro-social expectations of the offender and keeps an eye on the offender. As Andrews and Bonta, only partly in jest, write “Do you know where your spouse is?”[iii]

The second of the “moderate four” is how the offender performs in school and work. High risk for re-offending is found with offenders who have a low commitment to school or a job, and low attachment to school or work colleagues.[iv]

The third of the “moderate four” is the level of involvement in pro-social leisure pursuits.[v] The interaction of the offender with other pro-social individuals provides the needed reinforcement to keep an offender on the straight and narrow as compared to just hanging out with criminal-minded friends. (Like work, spending time on a pro-social leisure activity reduces the time available for criminal activity. Some researchers hypothesize that potential offenders have been busy with video games and internet activities, which have displaced criminal activity.[vi])

The presence or absence of a substance abuse problem is the fourth of the “moderate four”. The offenders use and abuse of alcohol and drugs, and their attitudes toward these substances is another factor moderately associated with criminal behavior.[vii]

Factors identified as have very little or no association with criminal behavior are: lower-class origins, personal distress/psychopathology, fear of official punishment (deterrence), verbal intelligence, happiness, self-esteem, sociability, spirituality, openness to experience, and feelings of anxiety and worry.[viii]

One may ask, where are gender and age? Don’t young males offend more often than older females? They do. However, according to Andrews and Bonta these variables lose independent predictive power after one considers the “central eight” factors. For example, young males in general will test higher for impulsiveness, which is part of antisocial personality pattern (one of the “big four”), than for example, older females.[ix]

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[i] Andrews, D.A. and James Bonta, (2010), The Psychology of Criminal Conduct, 5^th Edition, Mathew Bender and Company, New Providence, NJ, p. 65.

[ii] Ibid, p. 65

[iii] Ibid p. 59

[iv] Ibid p. 59

[v] Ibid. p. 59-60.

[vi] The Economist, May 13, 2010, “…And Larry Katz, a Harvard economist, suspects that video games and websites may have kept the young and idle busy during this recession, thus explaining the surprising lack of an uptick in crime.”

[vii] Andrews and Bonta (2010) Ibid, p. 60

[viii] Ibid. p. 61 & 65.

[ix] Ibid. p. 67-68

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

Major Risk Factors for Criminal Behavior

When a judge sentences a defendant, one of the factors that he or she is required to consider and discuss on the record is the protection of the public from further criminal offenses. Judges are also required to consider the character of the defendant (or the character of the accused, as it is sometimes put—but we are beyond the accusation stage at sentencing). Why should judges consider the defendant’s character? Is it proper for a defendant to receive different punishments based solely on a judge’s assessment that the defendant is gluttonous, immodest, greedy, uneducated, lazy, unpatriotic, wasteful, or cowardly rather than generous, educated, modest, ambitious, frugal, patriotic, or brave? Should we care if a defendant is employed in industries that many in society consider immoral such as the exotic dancing industry and therefore that he or she possesses “bad character”?

I believe the proper reason to assess the character of the defendant when imposing criminal punishment is to assess only those character traits that impact the probability that the defendant will or will not re-offend. That character assessment is then used to make a judgment about the need to protect the public. Punishing a defendant for character traits that do not impact the need to protect the public from further criminal offenses is beyond the boundaries of proper criminal punishment. In a pluralistic, democratic society, a defendant is only rightly punished for a violation of the criminal law, and not for a violation of the sentiments of a judge or segments of society.

An assessment of the character of the defendant by a judge involves an examination of historical, static conditions, such as his or her criminal record, educational level, and employment history. Further, interviews by police officers or presentence report writers may also provide insight into the thought processes of defendants and therefore insights into what are considered dynamic criminal factors, or criminal needs.

What does the research say about which character traits are associated with the risk to re-offend? Andrews and Bonta (2010) reported the results of eight different met-analyses that calculated the correlation between various factors and criminal behavior.[i] These researchers found that four factors that were consistently more correlated to criminal behavior than others. They call these factors the “big four”, and they have correlation coefficients averaging .26.[ii]

The first of the “big four” is a history of antisocial behavior. This factor includes the number of times that the defendant was involved in antisocial behavior such as arrests, convictions, probation violations, rule violations within prison; the different types of antisocial behavior; and early onset of that behavior. The severity of the offenses is not part of this factor.[iii]

The second of the “big four” is the defendant having an antisocial personality pattern. Andrews and Bonta (2010) define it as “In everyday language: impulsive, adventurous, pleasure-seeking, generalized trouble (multiple persons, multiple settings), restlessly aggressive, callous disregard for others.”[iv]

The third of the “big four” is antisocial cognition. This factor includes thought processes that are favorable for committing a crime, such as rationalizing crime, such as the victim deserves it, the victim liked being assaulted, society is unfair, societal rules are stupid, the criminal justice system is corrupt. Also included in this factor are attitudes of defiance toward the rules and an identification with criminals.[v]

The fourth of the “big four” is antisocial associates. How closely is the person associated with other individuals who support the defendant’s criminal behavior? What is his social support for crime? Are his friends and family all involved in criminal activity? [vi]

These risk factors have been consistently identified as being associated with criminal activity. Other risk factors have been shown to be associated with criminal activity to a lesser extent than the big four. I will address those factors and some factors that have not been associated with criminal behavior in another blog entry.

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[i] Andrews, D.A. and James Bonta, (2010), The Psychology of Criminal Conduct, 5^th Edition, Mathew Bender and Company, New Providence, NJ, p. 65.

[ii] Ibid, p. 64

[iii] Ibid. p. 58

[iv] Ibid. p.58

[v] Ibid. p. 59

[vi] Ibid. p. 59

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

The Effectiveness of Boot Camps in Reducing Recidivism

Correctional boot camps, sometimes called shock or intensive incarceration, that use a military boot camp paradigm, exist in many states throughout the U.S.. These programs often employ physical exercise, drills, ceremony, and uniforms, in an attempt to instill discipline and respect in criminal defendants.

As someone who, as a child, revered Vince Lombardi and was trained to be up to milk cows at 5:00 a.m., I can understand the political popularity of these types of programs. Shouldn’t individuals who committed crimes be taught the value of discipline and respect that we all learned as children? Despite the strong intuitive allure of these programs, are these programs effective in reducing recidivism?

A systematic review of 32 research studies was undertaken to answer this question.[i] These researchers could not find any statistical difference in recidivism between offenders who participated in a boot camp and those who did not participate in a boot camp. The offenders who had not participated in a boot camp did not have a lower recidivism rate than non-participating offenders, nor did they do have any greater recidivism. The researchers concluded that the military component (drills, exercise, uniforms, etc.) had no effect, one way or another, on recidivism.[ii]

The researchers also cautioned that when added to boot camps, effective treatment may make boot camps effective for treating criminal behavior. (Wisconsin’s challenge incarceration program involves alcohol and drug treatment.) The question yet to be answered is whether the boot camp setting for the treatment causes any further reduction in recidivism beyond the effects of the treatment alone.

These researchers further discuss that there may be other benefits of boot camps, such as reduced need for prison beds, improved pro-social attitudes, attachment to community or reduced impulsivity. These factors were not studied, but regardless, any positive changes in these factors resulting from boot camp did not result in less crime.[iii]

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[i] Wilson, David B., Doris L. MacKensie, Fawn Ngo Mitchell, (2008), “Effects of Correctional Boot Camps on Reoffending.” Campbell Systematic Reviews, 2003:1, p. 12.

[ii] Ibid. p. 19.

[iii] Ibid. p. 20

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

Juvenile Sex Offenders

Juvenile sex offenders pose a challenge to decision-makers in the criminal justice system. To ensure the protection of society, decision-makers want to know whether or not the offending behavior is a youthful indiscretion or the start of a life-long series of predatory sex offenses.

Sexual behavior that would not be criminal if the participants were adults becomes criminal when the participants are juveniles. The behavior is a malum prohibitum because of the age of the participants. Other juvenile sexual behavior may be exploitative, and in addition to being a malum prohibitum, is a malum in se sex offense. Sometimes, the line between these two types of offenses is blurry—especially when age differences between the participants exist.

Rehabilitation of a juvenile sex offender is rightly more central to decisions about consequences to the offender for the criminal behavior than it is in the adult system. Juveniles do dumb things because of their youth. But because they are young, and still developing physically, mentally, and emotionally, they may quickly grow out of the criminal behavior. An adjudication for some juvenile sex offenses may have negative life-long implications, such as a lifetime requirement to register as a sex offender—all working against successful rehabilitation.

A recent study done by a University of Wisconsin-Madison researcher took a look at recidivism rates of juvenile sex offenders.[i] This research was comprised of a literature review and meta-analysis of 63 data sets tracking recidivism of juvenile sex offenders. The results showed that for a mean follow-up period of 59.4 months, the mean sexual recidivism rate was 7.08%. (Less than the 13-15% for adult sex offenders at the five-year mark reported in my last blog entry.) The mean average age of the offenders was 14.8 years.[ii]

Caldwell (2010) further found that the recidivism rate for juvenile sex offenders was about 4 times higher for the period of time after their offense when they remained juveniles, than for the period of time after their offense when they became adults.[iii] Although, a diminishing marginal re-offense rate is typical when studying recidivism, this researcher thought the measured difference was inordinately high. He opined that juvenile sex offenders, like most juvenile delinquents, may stop offending in response to developmental maturity. In effect, they grow out of the behavior as they move through adolescence.[iv]

The result of this research is consistent with studies that have repeatedly shown that juvenile delinquents, in general, re-offend more often in their juvenile years, and then age out of the criminal justice system.[v] (Some have argued that this differential may also be the result of the deterrent effect of the adult system.)[vi]

Caldwell (2010) argues that studies of adult sex offenses may not be applicable to juvenile sex offenders. He writes: “Recent studies have also found that the overwhelming majority of adult sex offenses are committed by individuals that were not known to be juvenile sexual offenders and raised questions as to whether juvenile sex offenders pose a risk of adult sexual recidivism that is significantly different from that of other serious delinquent offenders.”[vii]

Caldwell (2010) concludes that his findings support treating juvenile sex offenders differently than adult offenders. He writes: “Cognitive changes related to brain development, hormonal changes related to the onset of puberty, the role of family and peer relationships, judgment, impulse control, bonds to school and other pro-social groups, and the response to social stressors such as child abuse could all play an important role in repeated adolescent sexual misconduct but may have little impact on persistent adult sexual offending.”[viii]

He states that targeting offenders during their teen years with interventions, when they are the highest risk to re-offend, appears to be the most likely successful intervention to prevent another offense.[ix]

This research supports the proposition that juvenile sex offenders should not necessarily be considered as adult sex-offenders in training, and for the criminal justice system to function properly, it must recognize this difference.

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[i] Caldwell, Michael F., 2010, “Study Characteristics and Recidivism Rates in Juneile Sex Offender Recidivism, Int. Jour. Of Offender Therapy and Comparative Criminology, Vol. 54 No. 2, pp. 197-212.

[ii] Ibid p. 202.

[iii] Ibid. p. 204.

[iv] Ibid. p. 205.

[v] Ibid. p. 206.

[vi] See for example, Levitt, Steve D., 1998, “Juvenile Crime and Punishment,”, Journal of Political Economy, vol. 106 No. 6 pp 1156-1185.

[vii] Ibid. p. 207.

[viii] Ibid. p. 207

[ix] Ibid. p 207

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

Sex Offender Recidivism Base Rates

We have all heard the claim that sex offenders cannot be rehabilitated and that they all will invariably reoffend if allowed back into the community. What does the research tell us about that? What are the recidivism base rates for sex offenders? Are there differences in the recidivism base rates for offenders with different types of sex offenses or that possess different traits? As sex offenses are among the most serious offenses in our society, these are important questions for community safety reasons and the treatment of sex offenders.

There are many different studies that attempt to calculate recidivism base rates for sex offenders. A base rate is the proportion of a group of sex offenders that will reoffend within a specified period following any incarceration period (where the assumption is they are not able to re-offend—an assumption which is not always correct).

One of the largest meta-analysis studies of this topic showed the following recidivism base rates for sex offenders.[i]

Follow-up period Recidivism rate (95% CI)

5 years 13-15%

10 years 19-21%

15 years 22-26%

20 years 24-30%

The marginal increase in the recidivism rates decline over time. In other words, the longer a sex offender has gone without reoffending, the lower the chances are that he will reoffend. That conclusion seems to have face validity.

Hanson et al (2003) found that sex offenders with an adult victim have similar recidivism rates for another sex offense as sex offenders with child victims. However, sex offenders with adult victims have higher recidivism rates for other nonsexual violent offenses than child sex offenders.[ii]

Offenders that offend against different victims appear to have different base recidivism rates. Offenders who have offended against unrelated boy victims have a recidivism rate approximately 10 % greater than the average rate at a ten year follow-up period (30% compared to 20%). Offenders who have offended against unrelated girl victims have a recidivism rate approximately 8 % lower than the average rate at a ten year follow-up period (12% compared to 20%). Incest offenders have a recidivism rate approximately 10 % lower than the average rate at a ten year follow-up period (10% compared to 20%). [iii]

These researchers discuss the problem that many sexual offenses are not reported to police and that these recidivism rates include only the reported offenses. These researchers believe that the reported rates for the 20 year follow-up period under-estimate the actual recidivism rate due to unreported offenses, and the rates should be increased by “at least” 10% to 15% with a proportionate increase for the other follow-up periods.[iv]

This research also looked at the correlation between possible risk factors and sexual offense recidivism rates. Sexual interest in children as measured by a phallometric assessment was the risk factor most highly associated with increased recidivism with a correlation coefficient of .32. All of the following factors were correlated with increased recidivism rates; any deviant sexual preference, a history of prior sexual offenses, having any stranger victims, early onset, any related victims, any boy victims, diverse sexual crimes, antisocial personality, any prior criminal history, age, never married, and treatment dropout. The correlation coefficients for these factors ranged from a high of .22 to a low of .10. [v]

(It is important to note that although these correlation coefficients show a relationship between a factor and a recidivism rate, the correlation coefficients are far less than one, the highest correlation coefficient. A correlation coefficient of one is defined as the data showing that the factor and the recidivism rate kept in perfect step, and that the presence of one factor was always associated with an increase in the recidivism rate by an identical percentage.)

These researchers also concluded that several factors were not related to increased recidivism. These factors include, victim empathy, denial of sex offense, unmotivated for treatment, general psychological problems, sexually abused as a child, and degree of sexual contact. [vi]

The above-described research explains the base-rates of sex offenders, what does the research say about identifying those more likely to re-offender. We will take a look at that question in a future blog entry.

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[i] Hanson, Kelly R, Kelly E. Morton, and Andrew J.R. Harris, (2003) Sexual Offender Recidivism Risk, What We Know and What We Need to Know, Ann. N.Y. Acad. Sci. 989: 154-166, page 155.

[ii] Ibid, p. 155.

[iii] Ibid. p. 156.

[iv] Ibid. p. 157.

[v] Ibid. p. 157

[vi] Ibid. p. 158.

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

Lies, Damn Lies, and Numbers

Science and numbers go hand-in-hand. As the foundation of science is the use of empirical research in a search for knowledge, to interpret and apply science, one requires at least a basic understanding of mathematics and its close cousin statistics. And because the use of numbers has been shown to be as equally persuasive in both science and propaganda, one needs to learn to evaluate the use of numbers with a critical eye—especially when using numbers to decide a legal issue. Early in my academic career, a statistics professor told me to never forget that statistics never lie but that only liars use statistics. Of course that was hyperbole, but the admonition has served me well through the years.

A couple of mathematically astute legal commentators have lamented the deficiency in mathematics in the legal profession:

“The fact that many judges suffer from an estrangement from, resistance to, and incapacity in mathematics should not be surprising. This condition, after all, afflicts most lawyers, as it does most Americans. One need not conduct a study to know that law students are typically smart people who do not like math. Law professors are of little help to their students, because legal academics tend not to have a background in, or use statistical analysis, or are unfamiliar with empirical data collection. Indeed, it is clear that there is a prevalent (and disgraceful) math-block that afflicts the legal profession.”[i]

There are a couple of good books I can recommend related to the use of mathematics in the law. The first is Calculated Risks-How to Know When Numbers Deceive You, by Gerd Gigerenzer. This is an excellent book with many examples related to the law. The other one is Proofiness – The Dark Arts of Mathematical Deception by Charles Seife. Seife covers the use of math in science, elections, and propaganda.

There is one illustration of the use of statistics that both books discuss which is called either the prosecutor’s or defense attorney’s fallacy—depending on which side is using it. The example that is referenced in both books comes from the OJ Simpson trial where a defense attorney attempted to preclude any evidence of former domestic violence on the grounds that it was irrelevant.

The argument went something like this. A past domestic violence perpetrator is on trial for now killing his victim. Statistics show that there is only a 1 in 5,000 chance that a defendant with a history of domestic violence with a victim will kill his victim. Therefore, the defense attorney argues, there is only a 1 in 5,000 chance that his or her client has killed his victim, making any evidence of domestic violence irrelevant.

The error in this example comes in confusing the odds that a defendant with a domestic violence history with his victim will murder his victim with the odds that given that his victim is murdered, that a defendant with a domestic violence history with the victim was the murderer. A murdered domestic-violence victim is relatively rare, but once a domestic violence victim has been murdered, the odds are much higher that the former domestic violence perpetrator was the murderer.

The way to look at this is that a 1 in 5,000 chance that a defendant with a history of domestic violence with his victim will kill his victim means that for every 100,000 victims of domestic violence, 20 will be murdered by individuals who had previously perpetrated a domestic violence incident on the victim. If we also know that an additional 5 women per 100,000 will be murdered by someone other than someone who had previously perpetrated a domestic violence incident on the victim, then we know 25 women per 100,000 (20 plus 5) will be murdered. Of the 25 women who are murdered, 20 will have been killed by a former domestic violence perpetrator, or 20 out of 25 women who are murdered (80%) are murdered by a former domestic violence perpetrator —a chance far higher than the 1 in 5,000 chance argued by the defense attorney.

Meyerson et al (2010) (which I also recommend), as well as the authors of the two books referenced above, argue that people, including judges, are quite easily swayed by mathematical arguments. Oliver Wendell Holmes Jr. once wrote that numbers “flatter that longing for certainty and for repose which is in every human mind. But certainty generally is illusion, and repose is not the destiny of man.”[ii]

Meyerson et al (2010) argue that judges’ misunderstanding of mathematics and statistics sometimes result in decisions that unwittingly favor one side of a dispute over another. [iii] These authors conclude:

“It is not necessary for judges to become ‘amateur mathematicians’ in order to reclaim their rightful role. However, they must be aware that the apparent objectivity of mathematics often masks subjective judgments, and not be fooled when ‘hard’ numbers are really based on little more than intuition and guesswork. Numbers can communicate important information. Judges just need to make sure that they are able to comprehend what those numbers are trying to say.”[iv]

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[i] Meyerson, Michael I and William Meyerson, 2010, “Significant Statistics: The Unwitting Policy Making of Mathematically Ignorant Judges.” 37 Pepp. L. Rev. 771.

[ii] Ibid, p. 10., quoting Holmes’s The Path of the Law.

[iii] Ibid. p. 14. The article also discusses the problems of a court adopting science’s risk of error, which leads to tipping of the equities in favor of one party or the other..

[iv] Ibid. p. 33.

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

How to Increase the Effectiveness of Treatment

In an earlier blog entry, I discussed research that showed cognitive behavioral therapy (CBT) to be effective in reducing criminal recidivism. Cognitive Behavioral Treatment Reduces Recidivism I will discuss factors impacting the effectiveness of CBT in this entry. If you follow the literature on the effectiveness of various treatment modalities for criminality, you will see that some studies show that a treatment modality is effective and some studies show that the same treatment modality is ineffective in reducing further criminal acts. (Occasionally, one sees that a treatment actually causes additional criminality.)

One of the reasons for these differences is that treatment modalities for criminality are not homogeneous like for example, a specific medication. If researchers study the effect of 81 mg of aspirin, we can be relatively assured that the treatment group received 81 mg of acetylsalicylic acid in each and every study. However, researchers testing, for example, CBT may be testing a different technique of CBT, a different topic for the CBT such as domestic violence, sex offending, or general criminality, and these programs will be delivered by different service providers at differing skill levels. Each CBT program is in many ways sui generis.

A recent study took a closer look at this issue as it relates to CBT.[i] First, these researchers performed a meta-analysis on 58 different studies of CBT. This research showed that CBT resulted in a reduction of the mean recidivism rate by about 25%.[ii] The researchers also determined that the most effect CBT programs were twice as effective as the average program resulting in a decrease in recidivism of about 50% over those individuals who were not treated.[iii]

The researchers then attempted to ascertain what factors made a CBT program more or less effective. The researchers made these conclusions:

1. The most important factor in making CBT effective was high quality implementation, which was associated with low treatment dropout, close monitoring of program quality and implementation, and adequately trained CBT providers.

2. There were no significant benefits of using “brand-name” CBT programs and that it was the general technique of CBT that was effective.

3. An anger control component and an interpersonal problem solving and peer pressure component within a CBT program enhance its effectiveness.

4. A victim impact component (getting offenders to consider the impact of their behavior on victims) and a behavioral modification component (behavioral contracts and rewards/punishment schemes) appear to reduce CBT’s effectiveness.

5. That treatment effects were greater for higher risk offenders than for low risk offenders. (Refuting the hypothesis that higher risk offenders are not amenable to treatment, and confirming the hypothesis that offenders need to first be assessed for risk, with the high risk offenders receiving the treatment)[iv]

6. CBT was as effective for juveniles as for adults.

7. The treatment setting had no effect on effectiveness. Treatment in prison was as effect as treatment in the community.[v]

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[i] Lipsey, Mark W., Nana A. Landenberger, Sandra J. Wilson (2007), “Effects of Cognitive Behavioral Programs for Criminal Offenders”, Campbell Systematic Reviews, The Campbell Collection, pp. 1-27.

[ii] Ibid. p 12.

[iii] Ibid p. 21

[iv] The treatment of high risk offenders, because of their otherwise higher recidivism rates, has a greater potential for reducing recidivism compared to low risk offenders who may never recidivate even without treatment.

[v] Ibid. p. 22-23.

The views expressed in this blog are solely the views of the author(s) and do not represent the views of any other public official or organization.

DV Treatment Efficacy Questioned

In my last blog entry, I discussed the dangers of potential “side-effects” of treating people convicted of crimes. The consideration of “side-effects” is especially important in domestic violence (DV) cases.

First, with domestic crimes, the victim and perpetrator are not independent of each other. The victim may continue to live with the perpetrator, or may at least intend to again live with the perpetrator. The victim and the perpetrator may remain a single economic unit, sharing income and expenses. Financial costs of interventions will not only fall upon the perpetrator, but also fall on the victim. We all know of situations where defendants lose their jobs because of incarceration or court appearances, and the victim of the crime, who is also dependant on the income from the defendant, suffers. If perpetrators are required to pay for probation and therapy, that money also comes out of the household of the victim.

Further, if the treatment, including jail time, probation, and counseling, antagonizes the defendant, the victim may experience the result of this antagonism, through verbal and even additional physical abuse. Even if the victim does not continue living with the perpetrator, if the victim has children with the perpetrator, she may be required to continue to interact regularly with him and be subject to his abuse.

Research shows that the most informing predictor of whether a domestic violence victim returns to an abusing spouse is whether the perpetrator received counseling.[i] Victims believe that the counseling will result in a reduction of the abuse, and rely on that belief.

Unfortunately, the research on the efficacy of domestic violence treatment is mixed at best. Researchers have voiced a concern: “If treatment is essentially ineffective in decreasing recidivism, then continuing to mandate treatment may be inadvertently providing these victims with a false sense of security that, in the end, may lead to a higher likelihood of future injury.”[ii]

I have examined the research on domestic violence treatment and will present it here. I use analytic and systematic literature reviews and meta-analyses as these research techniques combine multiple smaller studies into a larger study in an attempt to increase accuracy of estimates of effectiveness.

A 2008 meta-analysis identified fifty-seven studies of domestic violence counseling studies.[iii] The researchers identified four experimental studies and six quasi-experimental studies that met their predetermined eligibility criteria for research rigor. The studies involved evaluations of psycho-educational or cognitive behavioral approaches to treatment. The treatment ranged from a minimum of 8 two-hour sessions to the maximum of 32 sessions.[iv]

These researchers found an average reduction in the recidivism rates of 26%, which was statistically significant, but with great variation among the studies. These researchers were concerned that official arrest rates did not accurately reflect the amount of repeat domestic violence actually experienced by the victims as reported domestic violence is a small fraction of the actual domestic violence that occurs.[v]

The researchers looked at seven studies that included information regarding victims’ reports of continued domestic abuse. The result of their research, using victims’ reports as a measure of recidivism, showed that the treatment had no effect on recidivism. These researchers concluded as follows:

“The findings from this meta-analysis combined with the caveats above raise questions as to the value of these programs. While additional research is needed, the meta-analysis does not offer strong support that court-mandating treatment to misdemeanor domestic violence offenders reduces the likelihood of further re-assault.”[vi]

A 2006 systematic review of the literature conducted by researchers in the State of Washington reviewed nine rigorous evaluations of educative/cognitive behavioral treatment of domestic violence offenders. They concluded: “Based on our review of nine rigorous evaluations, domestic violence treatment programs have yet, on average, to demonstrate reductions in recidivism.[vii]

Another 2006 systematic review of six studies of feminist interventions (involving education regarding sexist attitudes) and six studies of cognitive behavioral interventions was completed in Maryland. The investigators concluded: “Using the Maryland criteria, none of the interventions examined in this analysis show strong evidence that they work to reduce domestic violence. Neither of the two types of treatment programs, feminist or cognitive-behavioral, produced two studies with clear significant results favoring the treatment group over the control group.”[viii] However, the researchers concluded that both the feminist and cognitive behavior interventions were classified as promising as the results of the studies showed a positive effect of the interventions in reducing recidivism, however the reductions were not statistically significant.[ix]

In most of the reported studies, the researchers reported the percent reduction in the recidivism rate without reporting the actual recidivism rate. Feder et al (2002) did report that 24% of the offenders in both the treatment group and control group were rearrested during the one year of probation following conviction. [x]

Feder et al (2002) raised an interesting point that although domestic abuse counseling itself did not appear to be effective, perpetrators failing to complete the counseling sessions had constellations of personality traits that also made them more likely to re-offend. Therefore, failure to attend the counseling sessions was a marker that could be used to identify those perpetrators who were more likely to re-offend. Victims apparently can rely on the successful completion of counseling as being an indicator of their future safety from the perpetrator.

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[i] Gondolf, E. 1987, “Seeing through smoke and mirrors, a guide to batters program evaluations”, Journal of Interpersonal Violence, 12, 83-98.

[ii] Feder, Lynetter and Laura Dugan, 2002, “A test of the efficacy of court-mandated counseling for domestic violence offenders: The Broward Experiment”, Justice Quarterly, Vol. 19, No. 2.

[iii] Feder, Lynette, David B. Wilson, and Sabrina Austin, 2008, “Court-Mandated Interventions for Individuals Convicted of Domestic Violence”, Campbell Systematic Reviews, 2008:12. Pp 1-46

[iv] Ibid p. 11

[v] Ibid. p. 14

[vi] Ibid. p. 18.

[vii] Aos, Steve, Marna Miller, and Elizabeth Drake, (2006). “Evidence-Based Adult Corrections Programs: What Works and What Does Not.” Olympia:Washington State Institute for Public Policy. P. 5.

[viii] MacKenzie, Doris Layton (2006), What works in Corrections-Reducing the Criminal Activities of Offenders and Delinquents, New York, Cambridge University Press, p . 212

[ix] Ibid. p. 212.

[x] Feder, Lynetter and Laura Dugan, 2002, “A test of the efficacy of court-mandated counseling for domestic violence offenders: The Broward Experiment”, Justice Quarterly, Vol. 19, No. 2, p. 366.

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