denial and recidivism among high risk
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TRANSCRIPT
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Denial and recidivism among high risk, treated sexual offenders
By
Jan Looman, Ph D. C. Psych
&
Salem Beraki, B. Psych
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Denial and recidivism among high risk, treated sexual offenders
The research evidence concerning the importance of addressing denial in sexual
offender treatment is currently under debate. Some authors (Marshall, Marshall, Serran &
O'Brien, 2011) argue that explicitly addressing denial is unnecessary, based primarily on
the results of recent meta-analyses which indicate that denial is not a predictor of sexual
recidivism (Hanson & Bussiere, 1998; Hanson & Morton-Bourgon, 2005). However, a
review of the seven studies addressing denial in the Hanson and Bussiere (1998) meta-
analysis completed by Lund (2000) indicated problems with the definition of denial, lack
of consistency in when denial was assessed, as well as other methodological problems
which limit the utility of these results.
Research post Hanson & Morton-Bourgon (2005)
More recent research has suggested that, for at least some offenders, denial is an
important predictor. For example Langton, Barbaree, Harkins et al. (2008) examined the
relationship between denial and minimization, actuarial risk, psychopathy and sexual
recidivism in a sample of 436 Canadian, federally incarcerated sexual offenders. They
rated denial as both a dichotomous variable (yes, no) and as a continuous scale in which
10 items are rated on a 0,1,2 scale and summed to give both a Denial score and a
Minimization score. A subset of 102 sex offenders who received no treatment following
the initial program were examined separately. Whether or not the offender was in
categorical denial did not predict recidivism by itself. However, failure to complete
treatment, actuarial risk and Factor 2 of the PCL-R did predict recidivism. Additional
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analyses indicated that high risk offenders (RRASOR score 3 or higher) who presented
with higher levels of minimization, were more likely to sexually re-offend.
Nunes, Hanson, Firestone, Moulden, Greenberg and Bradford (2007) examined
the relationship between denial, actuarial risk, psychopathy and recidivism in a sample of
489 sexual offenders in a community-based treatment program. These researchers also
used the RRASOR and PCL-R in their study. They found that deniers were not
significantly different from admitters on psychopathy, actuarial risk, or recidivism and
that denial did not add to the prediction of recidivism when the PCL-R and RRASOR
were already considered. However, they did find that there was a higher recidivism rate
for the low risk deniers than the low risk admitters (RRASOR less than or equal to 1),
and that in the high risk group deniers re-offended at a lower rate than admitters. Similar
results were reported for analyses involving a sample from a Washington state
community program (N=490) and 73 offenders from British Columbia. They also found
that incest offenders in denial were more likely to re-offend than incest offenders who
admitted their offences.
Harkins, Beech and Goodwill (2010) followed a sample of 180 sexual offenders
for a ten-year period. They used a Denial Index, which consisted of responses on the MSI
Sex Deviance Admittance scale, the MSI Sexual Obsessions scale, the MSI Social and
Sexual Desirability scale and the Sex Offense Attitudes Questionnaire (SOAQ). They
also examined two scales on the SOAQ separately: the Denial scale and the Perception of
Risk scale. They scored the Risk Matrix 2000 as an actuarial measure of risk. Results of
their analyses indicated that the odds of sexually reoffending were significantly lower for
those who were high in denial on the Denial Index than for those who were low on the
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Denial Index. For Absolute Denial, those who denied their offenses were not significantly
more likely to re-offend that those who admitted their offenses. However, the odds of
sexually reoffending were significantly lower for those who denied future risk (i.e.,
Denial of Risk) than for those who admitted future risk, and those high in motivation
were at significantly higher risk of sexually reoffending than those who were low in
motivation. When examined in combination with risk, it was found that low risk
offenders who were high in denial where less likely to re-offend than low risk offenders
low in denial. For the high risk group a similar pattern was found with 52% of low denial
offenders sexually re-offending compared to 5.9% of high denial offenders.
Thus, for some sexual offenders some types of denial are predictive of recidivism.
However, the studies reviewed above treat denial as a static measure. Both the Harkins et
al. study and the Nunes et al. study assessed denial at pre-treatment, while the Langton
study used post-treatment status on denial. However, denial is a dynamic measure, which
is expected to change with treatment, thus it is important to determine what, if any, effect
modifications of denial have regarding recidivism.
The purpose of the current research is to examine the predictive validity of denial
both as a static measure; by assessing denial at pretreatment and at post treatment and
determining the relationship between denial and recidivism at these discrete times, but
also to examine change in status on denial and to determine whether moving from a
denial stance vs. remaining in denial has a relationship to recidivism.
Method
Subjects
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The subjects in the current study were 210 sexual offenders treated in the high
intensity Sex Offender Treatment program at the Regional Treatment Centre (Ontario).
This program treats the highest risk/needs sexual offenders within the Ontario Region of
the Correctional Service of Canada in a 7 month cognitive-behavioural, relapse
prevention based program (see Abracen & Looman, 2004; Looman & Abracen, 2011).
The program accepts offenders in denial and maintains them in treatment provided that
their denial does not interfere with the participation of other offenders in treatment and
that they are able to identify meaningful treatment goals within the structure provided by
the program. For example, if the offender in denial begins to actively encourage other
offenders to deny, or insists that he has nothing to benefit from being in treatment; he
may be considered for discharge.
In- treatment acceptance of responsibility for offending is addressed in an
incremental fashion throughout the program through the discussion of issues related to
consent, addressing cognitive distortions related to, for example victim blame and victim
harm; challenging offenders regarding their account of the offence and using the group to
model taking responsibility. It is expected that over the course of the program offenders
who are in denial at the outset of the program will gradually begin to take greater
accountability for their offence.
Denial
Denial was assessed based on review of treatment reports at both pre- and post-
treatment. Both pre and final treatment reports were reviewed and coded to assess various
aspects of denial and minimization; loosely based on the FoSOD (Schneider & Wright,
2001; 2004). The following aspects of denial were coded:
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1) denial of facts; e.g. claiming the victim is lying or remembering incorrectly
(e.g., I wasn’t even in the house when…);
2) denial of awareness of offending (e.g. claim a blackout and cannot remember);
3) denial of impact (e.g. deny that the victim was harmed by the assault);
4) denial of responsibility (e.g. blaming of victim to avoid taking responsibility
for behaviour);
5) denial of grooming (e.g. offender denies that he planned the offence "…and the
next thing you know…");
6) denial of sexual intent (e.g. claims he “accidently” touched her);
7) denial of denial (e.g. offender appears disgusted by what has occurred in hopes
that other would not believe that he is capable of such an act - "this was completely out of
character for me…").
Denial for each of these facets was rated on a 3-point scale with a rating of (1)
representing complete denial of that type, (2) being partial denial and (3) being no denial.
Written coding guidelines with examples of each type of denial were prepared. A Denial
scale was formed by summing the values for each of the Denial types. Values ranged
from 7 to 21, with lower scores indicating a greater degree of denial.
Risk
Static-99R (Helmus, Thornton, Hanson & Babchishin, 2011). The Static-99R is
an empirically derived actuarial risk assessment tool designed to predict sexual and
violent recidivism in adult male sex offenders. It has 10 items and the total score (ranging
from -3 to 12) can be used to place offenders in one of four risk categories: -3 through 1
= Low; scores of 2 and three are considered to indicate Low-Moderate risk; scores of 4, 5
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indicate Moderate-High; and scores of 6 or higher indicate high risk (Helmus et al.,
2011). The Static-99R includes one item for age at release, which is scored on a four-
point scale so that those offenders aged 18 to 34.9 are assigned a score of one; those aged
35 to 39.9 are assigned a score of zero; those aged 40 to 59.9 are given a one-point
deduction and those aged 60 or older are assigned a three-point deduction.
Psychopathy Checklist–Revised (PCL-R). The PCL-R is perhaps the most
widely used rating instrument in the assessment of psychopathy (Hare, 2003). It has been
shown to have a high level of reliability, as well as construct validity in a wide range of
research (Hare, 2003). Scoring of the PCL-R (Hare, 1991, 2003) was completed as part of
the pre-treatment assessment for offenders in the RTCSOTP. Ratings were made based
on both clinical interview and a detailed review of official documentation for all
offenders. All raters received training in the administration and scoring of the PCL-R.
Previous research examining the inter-rater reliability for the PCL-R was assessed by
comparing ratings made at the RTCSOTP and those completed at Ontario Region’s
reception center (Looman, Abracen, & Ismail, 2011). The Looman et al. (2011) sample
included 153 men from the current sample. The single measures ICC for the full-scale
PCL-R score was 0.90, p = .001, indicating a high level of agreement. The mean PCL-R
score for the sample is displayed in Table 1.
Recidivism
For purposes of the current study recidivism was defined as a new conviction for
another criminal offence following release. All recidivism data were coded according to
Finger Print Service (FPS) records. These data represent a national archive of criminal
records collected by the Royal Canadian Mounted Police (RCMP). Any sexually
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motivated offence was coded as sexual recidivism (e.g., Sexual Assault, Sexual
Interference, murder with a sexual component), while non-sexually violent offences (e.g.,
Assault, Assault Causing Bodily Harm, Armed Robbery) were coded as violent
recidivism, and nonsexual, nonviolent offences (i.e., Break and Enter, Theft, Fraud) were
coded as general recidivism. If official information (e.g., police reports, parole records)
about the new conviction indicated a sexual component (e.g., conviction for Assault that
was clearly a sexual assault) the offence was coded as both a sexual and violent re-
offence1. For some analyses sexual and violent offences were combined for a broader
serious recidivism variable. The time at risk period was defined as the time from release
to first conviction for each of the offence types.
The average follow-up time for sexual recidivism in the current study was 4.9 (sd
= 3.6) years.
Results
Types of Denial
The results indicate that a significant proportion of the sample displayed some
level of denial at pre-treatment. As displayed in Table 1, a quarter of the sample denied
the facts of their offence at pre-treatment, while half denied responsibility. Denial of
victim harm and denial of sexual intent in offending were also prevalent. As noted in the
Table 80.8% of the sample demonstrated full denial on at least one of the aspects
assessed.
Results also indicate that with treatment the level of denial decreased
significantly. Only 5.3% of the sample fully denied their offences at post-treatment and
1 Note that official information was not available for all new offences, thus some sexual re-offending may have been missed via this process.
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15.2% denied responsibility. Wilcoxan sign-ranks tests indicate that these differences
were significant z = -7.60, p = .000 for Denial of facts and z = -9.44, p = .000.
Overall, 80.8% of the sample displayed some form of denial at pre-treatment and
this was reduced by half at post-treatment. The Wilcoxan sign-ranks test indicated that
this change was significant z = -8.60, p = .000.
As noted above, a Denial scale was formed by summing the values for each of the
individual denial variables, for both pre and post-treatment. The average pre-treatment
score was 14.38 (sd = 3.52), while at post-treatment it was 17.22 (sd = 3.22), indicating
an overall decrease in the overall level of denial. This difference, once again, was
significant t (174) = -14.25, p = .0001
Denial and Psychopathy
As noted above, scores on the PCL-R were available for 162 men in the current
sample. The average total PCL-R score was 22.2 (sd = 7.6); the average Facet 1 score
was 3.5 (sd = 2.4);on Facet 2 the score was 5.0 (sd = 1.9); on Facet 3 the average score
was 5.4 (sd =2.6); and on Facet 4 the average score was 6.1 (sd = 2.7). The relationship
between psychopathy and the Denial scale was examined by means of Pearson
correlation coefficients (see Table 2). No significant relationship was found between
psychopathy and pre-treatment denial. However, for post-treatment denial there was a
significant relationship between the PCL-R total score and Facets 1 and 2, but not for
Facets 3 or 4.
Denial and Risk
In order to explore possible relationships between risk and denial, scores on the
Static-99R were correlated with the pre and post-treatment denial scale scores. Neither
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relationship was significant: pre-treatment r = .09, p = .244; post-treatment r = .01,
p .886.
Static-99R scores were also compared for those who were high in denial (M = 5.2,
sd = 2.3, N= 110) versus those who were low in denial (M = 5.4, sd = 2.2, n = 59) at pre-
treatment. Scores did not differ t (167) = -0.70, p = .488. As well, those who were high in
denial (M = 5.3, sd = 2.2, n= 36) at post-treatment did not differ on Static-99R scores
from those who were low in denial (M = 5.4, sd = 2.3, n = 105) t (139) = -0.238, p
= .812.
Change in Denial, Risk and Recidivism
Previous research, as summarized above, has found differing relationships
between denial and recidivism, based on actuarial risk. As seen in Table 3, we formed
groups based on risk level on the Static-99R and denial status at pre-treatment. As can be
seen in the top of Table 3, at pre-treatment for the group that scored in the moderate
range on the Static-99R (3 to 5 points) the sexual re-offence rate for men low on denial
was higher than for other groups χ2 (3) = 8.04, p = .045 . When examining the same
relationships in terms of their post-treatment denial, men who scored in the high risk
range (i.e., 6 or higher) and were in denial sexually re-offended at a higher rate than other
groups χ2 (3) = 11.19, p = .011.
Table 4 examines risk and denial in another fashion by grouping offenders based
on their changes in status on denial with treatment. Groups were formed based on
whether they moved from high to low denial, maintained their denial, or remained low on
denial throughout treatment. Once again they were further grouped based on their
actuarial risk scores (see Table 4). As can be seen in the Table the group who was high on
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actuarial risk and maintained their denial throughout treatment re-offended at a
significantly higher rate than all of the other groups χ2 (5) = 11.83, p = .037.
Finally, analyses were conducted to determine specific aspects of denial which
predict recidivism. Two Cox Regression analyses were conducted, one for pre-treatment
denial and one for post-treatment, while controlling for actuarial risk by entering the
Static-99R separately in a first block. The final model for pre-treatment is displayed in
Table 5, and for post-treatment in Table 6.
For pre-treatment denial, when entering the denial facets on the second block of
the analysis, the model was significant; change from the first block χ2 (14) = 35.33, p
= .001 with the total model χ2 (15) = 38.65, p = .001. The odds ratio (E(B)) indicated that
men who denied the facts of their offence and denied sexual intent at pre-treatment were
more likely to re-offend sexually while men who denied victim impact and denied they
were in denial were less likely to re-offend sexually.
For post-treatment denial (see Table 6), when entering the denial facets on the
second block of the analysis, the model was significant; change from the first block χ2
(14) = 28.28, p = .013 with the total model χ2 (15) = 34.56, p = .003.Again, the odds ratio
(E(B)) indicated that men who denied the facts of their offence and denied sexual intent
at post-treatment were more likely to re-offend sexually while men who denied grooming
their victims were less likely to re-offend sexually.
Discussion
The current research adds to the extant research which demonstrates that for some
offenders denial is a predictor of sexual reoffence. Consistent with previous studies the
effect varies depending on risk level, and with the current research it appears that the
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effect varies depending on whether it is pre- or post-treatment denial which is being
considered.
The present results indicate that pre-treatment denial is unrelated to actuarial risk
and psychopathy, but psychopathy is related to post-treatment denial. Specifically, Facets
1 and 2 of the PCL-R are related to denial as assessed at post-treatment. This result
indicates that those offenders who score high in indicators of glibness, superficial charm,
callousness, grandiosity, shallow emotional expression and failure to take responsibility
(Hare, 2003) are more likely to maintain their denial throughout treatment. However, the
aspects of psychopathy specifically related to antisociality are not related to denial; a
result which is consistent with the lack of relationship found for the Static-99R.
The current study is unique in that it is the first to examine denial as a dynamic
variable. That is, previous research assessed denial at only one point in time; either pre-
treatment (Nunes, et al.2007 ; Harkins et al. 2010) or at post-treatment (Langton et al.
2008). The current study however assessed denial at pre and at post-treatment, as well as
examining changes in status on denial. Our findings indicate that the time of
measurement is important in term of the results which are drawn regarding the influence
of denial on recidivism.
Specifically, when assessed at pre-treatment, moderate risk offenders in denial
were more likely to reoffend than other offenders, however at post-treatment the high risk
offenders in denial were more likely to re-offend. The latter finding is consistent with the
results found by Langton et al. (2008), who found that higher risk offenders who
minimize their offences are more likely to reoffend, while the findings related to pre-
treatment are consistent with the results of Nunes et al. and Harkins et al.
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However, as already noted, denial is not a static construct; it is expected to change
with treatment, thus the relationship between changes in denial status were assessed in
relation to risk. These results indicated that high risk offenders who maintained denial
throughout treatment were more likely to sexually re-offend than other offenders. Of
particular interest is that the only group at elevated risk for re-offence was this high
risk/denial throughout treatment group. That is, these results suggest that provided
offenders move from denial to admission of offending with treatment, pre-treatment
denial is not a meaningful construct in terms of predicting recidivism.
Interestingly moderate risk offenders who maintained denial were not at elevated
risk for sexual re-offence when compared to other groups. This difference was not due to
differing levels of denial, or a differing tendency to change in terms of denial status, as
there was not relationship between these variables and risk. It appears that denial is
simply a less salient factor for moderate risk offenders than it is for higher risk offenders.
The results related to facets of denial and risk are interesting. The results of the
current research suggest that while denial of facts of the offence, denial of responsibility
and denial of sexual intent are related to increased recidivism, denial of grooming and
denial of victim impact are related to a reduced risk of recidivism. These results can been
seen as supportive of the stance of Marshall, Marshall and Kingston (2011) and Marshall,
Marshall, Serran and O’Brien (2011) who suggest that some distortions are normal
human excuse-making while others are criminogenic and require intervention. Marshall
and colleagues suggest that it is a natural human tendency to distance oneself from
responsibility for negative behaviour, thus some aspects of denial and minimization are to
be expected and are less likely to be of concern as treatment targets/dynamic risk factors.
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However, some aspects of denial and minimization (e.g., attitudes supportive of sex with
children) are risk related and differ from normal excuse making thus warrant attention in
treatment.
The results regarding facets of denial discussed above may be interpreted in light
of the opinions expressed by Marshall and colleagues. Denial of grooming and denial of
victim impact may be examples of normal human excuse making and of the offender’s
distancing themselves from the problematic nature of their behaviour, and thus are
actually indicative of prosociality. On the other hand, denial of the facts of their offence,
and denial of personal responsibility for offending are problematic as they protect the
offender from the need to change, and thus are related to recidivism if not addressed.
Conclusion
The current research adds to the already extant research indicating that denial is
related to risk for sexual re-offence, for some offenders. It also clarifies this relationship
by demonstrating that for high risk sexual offenders remaining in denial throughout
treatment is related to future re-offending, however for lower risk offenders this
relationship does not appear to be present. Post-treatment, but not pre-treatment denial
was related to Factor 1 of the PCL-R, indicating that those high on the personality traits
associated with psychopathy are less likely to change their denial stance with treatment.
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References
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Table 1
Proportion of the sample presenting with each type of denial pre and post-treatment
Type of Denial Pre- treatment
% full denial
Pre-
treatment
% no denial
Post-treatment
% full denial
Post treatment
% no denial
Denial of Facts 25.9 31.3 5.3 42.0
Denial of awareness of
offending
8.2 71.2 3.7 64.6
Denial of victim harm 47.7 20.2 10.7 34.6
Denial of responsibility 55.5 16.0 15.2 37.4
Denial of Planning 54.3 16.0 20.6 30.9
Denial of Sexual Intent 30.0 44.0 11.5 54.3
Denial of Denial 14.4 69.1 4.6 83.9
Any denial 80.8 41.5
Note – all changes significant p < .01 or better
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Table 2
Correlation between Psychopathy and Denial
Pre-treatment denial Post-treatment denial
PCL-R total -.11 -.25**
Facet 1 (interpersonal) -.08 -.26**
Facet 2 (Affective) -.15+ -.29***
Facet 3 (lifestyle) -.08 -.13
Facet 4 (Antisocial) -.08 -.19*
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Table 3
Recidivism by Risk/Denial level Groups
No Sexual re-offence
(n, %)
Sexual re-offence
(n,%)
Pre-treatment Denial
Static 3-5, Low denial 28 (75.7%) 9 (24.3%)*
Static 6+, Low denial 41 (91.1%) 4 (8.9%)
Static 3-5, hi denial 41 (95.3%) 2 (4.7%)
Static 6+, hi denial 33 (91.1%) 7 (8.9%)
Post-Treatment Denial
Static 3-5, Low denial 33 (89.2%) 4 (10.8)
Static 6+, Low denial 54 (88.5%) 7 (11.5%)
Static 3-5, hi denial 15 (93.8%) 1 (6.3%)
Static 6+, hi denial 11 (61.1%) 7 (38.9%) **
Note * p < .05, **p < .01
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Table 4
Risk, Changes in denial with treatment and recidivism
No Sexual re-offence
(n, %)
Sexual re-offence
(n,%)
Static 3-5
Denial throughout
15 (93.8%) 1 (6.3%)
Static 3-5
High to low denial
16 (94.1%) 1 (5.9%)
Static 3-5
No denial
17 (85.0%) 3 (15.0%)
Static 6+
Denial throughout
11 (61.1%) 7 (38.9%)*
Static 6+
High to Low denial
27 (90.0%) 3 (10.0%)
Static 6+
No denial
26 (89.7%) 3 (10.3%)
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Table 5
Cox Regression analyses pre-treatment denial predicting sexual recidivism
B SE Wald df Sig. Exp(B)
Static99R .765 .179 18.359 1 .000 2.149
Denial of Facts
No denial 11.636 2 .003
Compete denial 3.520 1.032 11.629 1 .001 33.773
Partial Denial 1.994 .796 6.274 1 .012 7.346
Denial of awareness of Offending
No denial .104 2 .949
Complete Denial -12.835 556.128 .001 1 .982 .000
Partial Denial .199 .619 .104 1 .747 1.221
Denial of victim impact
No denial 12.463 2 .002
Complete denial -3.178 .904 12.364 1 .000 .042
Partial Denial -2.319 .936 6.142 1 .013 .098
Denial of Responsibility
No Denial 2.181 2 .336
Full Denial .980 .968 1.024 1 .311 2.664
Partial Denial 1.432 .973 2.167 1 .141 4.186
Denial of Grooming
No Denial 2.342 2 .310
Full Denial -1.090 .722 2.282 1 .131 .336
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Partial Denial -.849 .761 1.246 1 .264 .428
Denial of Sexual Intent
No Denial 6.409 2
.
041
Full Denial 1.571 .646 5.910 1 .015 4.812
Partial Denial .179 .673 .071 1 .790 1.196
Denial of Denial
No Denial 10.196 2 .006
Full Denial -3.134 1.053 8.861 1 .003 .044
Partial denial -1.850 .813 5.176 1 .023 .157
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Table 6
Cox Regression analyses post-treatment denial predicting sexual recidivism
B SE Wald df Sig. Exp(B)
Static99R .492 .152 10.543 1 .001 1.635
Denial of Facts
No denial 10.702 2 .005
Compete denial 4.273 1.397 9.360 1 .002 71.761
Partial Denial 1.833 .729 6.320 1 .012 6.253
Denial of awareness of Offending
No denial 1.405 2 .495
Complete Denial -12.894 727.326 .000 1 .986 .000
Partial Denial -1.357 1.145 1.405 1 .236 .257
Denial of victim impact
No denial .174 2 .917
Complete denial -.328 1.125 .085 1 .771 .720
Partial Denial .064 .648 .010 1 .921 1.066
Denial of Responsibility
No Denial 2.636 2 .268
Full Denial -1.972 1.242 2.523 1 .112 .139
Partial Denial -1.102 .860 1.641 1 .200 .332
Denial of Grooming
No Denial 5.092 2 .078
Full Denial -1.945 1.151 2.856 1 .091 .143
25
Partial Denial -1.583 .721 4.818 1 .028 .205
Denmial of Sexual Intent
No Denial 5.357 2 .069
Full Denial 2.263 1.095 4.269 1 .039 9.616
Partial Denial 1.516 .836 3.287 1 .070 4.553
Denial of Denial
No Denial 2.147 2 .342
Full Denial -13.861 908.692 .000 1 .988 .000
Partial denial -1.496 1.021 2.147 1 .143 .224