The Treatment and Rehabilitation of Offenders

Iain D Crow

• Publisher: SAGE Publications Ltd
• Year: 2001
• Print ISBN: 9780761960393, 9780761960386
• eBook ISBN: 9781446238929
• Edition: 1
• Topic: Social Sciences
• Subtopic: Criminology
• Index: Social Sciences

`[A] useful and informative book. ...I would recommend it to students wanting a good introduction to the current issues in criminal justice and probation? - Vista: Perspectives on Probation

`The three chapters on treatment in practice are all excellent; the treatment of sex offenders, mentally disordered offenders and the treatment of drug misuse are all described within the social context of public concern... Ian gives a good overview of the sex offenders? treatment program as operated in prisons and Finkelhors model which is typically used by probation in working with offenders? - Simon Bass, Caring Magazine

Treatment and rehabilitation have been central to the development of criminal justice policy, and have played an important role in the development of criminology. In recent years punishment and retribution have attracted more attention than rehabilitation, but there has been a resurgence of interest in treatment and rehabilitation, with indications that some things do ?work?, and an emphasis on ?evidence-based? policy making. It is also the belief of many that a penal policy without an adequate treatment strategy is unjust and a denial of human rights.

In this book Iain Crow provides an accessible overview of the concepts of treatment and rehabilitation, adopting a deliberately broad definition, and considers the historical basis of treatment, and its place within the penal system and British criminology. The collapse of the ?rehabilitative ideal? is examined, along with what followed it and the development of the more recent ?what works? movement. The basis for evaluating ?what works? is also subjected to critical examination. In the second part, the book looks at the part that particular agencies such as the Probation Service, prison and non-statutory organisations have played in the treatment of offenders. In Part Three, the issues raised by treatment and rehabilitation are illustrated with reference to three groups of offenders: sexual offenders, drug misusers and mentally disordered offenders.

The Treatment and Rehabilitation of Offenders will be essential reading for students of criminology and criminal justice at both undergraduate and post-graduate levels.

PART 1

THE CONCEPT OF TREATMENT

1

A SUITABLE CASE FOR TREATMENT?

I merely wish to suggest that we should treat the criminal as we treat a man suffering from plague. Each is a public danger, each must have his liberty curtailed until he has ceased to be a danger. But the man suffering from plague is an object of sympathy and commiseration whereas the criminal is an object of execration. This is quite irrational. And it is because of this difference of attitude that our prisons are so much less successful in curing criminal tendencies than our hospitals are in curing disease. (Bertrand Russell, 1925: 62)

This chapter looks first at various terms that are often used in dealing with offenders, and then goes on to consider the derivation of the notion of treatment in relation to crime and offenders. It looks at how the notion of treatment relates to criminological theory, and at the different forms which treatment and rehabilitation can take. Next, consideration is given to how treatment and rehabilitation may be differentially applied to different types of offender, especially how attitudes and provision may vary depending on differences of age and gender. The later part of the chapter considers some of the ambiguities and conflicting expectations that arise regarding the treatment and rehabilitation of offenders, and finally some of the important ethical issues that are raised by the treatment of offenders are covered.

Concepts of Treatment and Rehabilitation

In many ways the quotation at the beginning of this chapter encapsulates the treatment view of offenders. It highlights the belief that the offender is no more to blame for his or her condition than the patient suffering from a disease. At the time when Russell was writing it would have been regarded as a liberal and humanitarian sentiment; a statement which was progressive and even radical in its outlook. However, this view had considerable shortcomings.

It may be somewhat predictable to begin with a consideration of what is meant by treatment, but it would be a serious omission not to consider the meaning of the term, and related concepts. In the context of dealing with offenders, ‘treatment’ has become very much associated with medicine, and as a result has acquired a series of overtones. For example, it tends to be associated with passivity: treatment is often thought of as something done to someone, usually by a person who occupies a position of expertise, authority and a certain amount of power. It is also often assumed that the medical definition of treatment is a unitary concept, whereas, as Johnstone (1996: 5) points out, medicine is a diverse field in which treatment may take many forms. Probably the closest connections between criminology and medicine historically are to do with the treatment of the mentally disordered, and in this respect treatment has involved social and moral management as much as pharmaceutical, surgical or other medical techniques.

Treatment is not only a medical term. It can also be used to refer to the way we treat people. Thus, for example, Rule 2(iii) of the Prison Rules states that, ‘At all times the treatment of prisoners shall be such as to encourage their self-respect and a sense of personal responsibility’ (emphasis added). Looked at in the context of treating with people or institutions (as in making a treaty) what comes to the fore is negotiation and, while power is never far distant in negotiations, what is involved in such a situation is two parties working from positions of mutual recognition of each other’s position. So treatment not only has specific meanings, but carries with it diverse connotations.

In criminology, treatment has traditionally been linked with ideas about the nature of criminality (about which more later), and with an approach to dealing with crime which has usually been contrasted with retribution and punishment. Those in favour of treatment have tended to be seen as of a liberal persuasion, perhaps even as ‘do-gooders’. Like many stereotypes this is an oversimplification, but because of these associations treatment is often linked to other terms, notably ‘reform’, ‘rehabilitation’ and ‘resettlement’. What these terms have in common is the notion of change, even if the change is a restorative one returning someone to a position in society which they formerly held. A dictionary definition of rehabilitation refers to restoring ‘former privileges or reputation or proper condition’ (Concise Oxford Dictionary). The title of this book refers to rehabilitation as well as treatment, and this is because I see them as two parts of a connected process; without rehabilitation the process is incomplete. In the archetypal popular crime thriller the dénouement is followed by the villain getting his or her just deserts and being hauled off for chastisement. In the real world that is not the end of the story. The criminal completes his or her sentence, and then what? A wise parent knows that, however they deal with an erring child, if the family is to flourish some restorative process is necessary. Hence in Greek drama and mythology punishment is followed by expiation, and in a more recent criminological theory shame needs to be accompanied by re-integration (Braithwaite, 1989). We neglect the second part of the process at our peril.

There has a been a distinct shift in the ways in which terms such as treatment and rehabilitation have been used in criminology and criminal justice over the years. Indeed there have also been changes in the extent to which they have been used. Reading Government White Papers, texts and articles about crime and offenders produced between the end of the Second World War and the early 1970s one finds frequent allusions to the treatment of offenders, with the term ‘treatment’ being used to cover almost any way of dealing with offenders.¹ Treatment and rehabilitation were widely regarded at that time as desirable and worthwhile objectives, and initiatives that hoped to attract political and financial backing sought to espouse these objectives. After the 1970s criminal justice discourse changed significantly. Other considerations came to the fore, and the application of the term ‘treatment’ to offenders became more likely to be reserved for certain specific forms of intervention, usually with a clear diagnostic or clinical purpose. These other considerations have been described elsewhere (Cavadino et al., 1999: Ch. 1) and have reflected a concern with prevention, retribution, efficiency (managerialism), and restoration. During much of the 1990s, for example, the language of discourse became that of penalties and punishment (even when these were non-custodial in nature), of just deserts and making amends. In part this book is about how and why this happened, and the implications that follow from it. In general, however, I intend to adopt a broad, but not limitless, definition of treatment as any form of intervention that is designed to alter the way that offenders think, feel or behave. Within this broadly based conception, the rights and responsibilities of the parties involved are an important component, and I regard the processes of treatment and rehabilitation as requiring the active participation of all parties, rather than a relationship between an active donor and a passive recipient.

The Treatment Paradigm

In order to understand the origins of the treatment paradigm in criminology it is necessary to refer to its basis in sociology, where it is linked with positivism, and in particular with an organic view of society. This view is most closely associated with the early sociologist Herbert Spencer (1820–1903), and from his organicism developed social Darwinism, which transferred Darwin’s notions of the survival of the fittest to the social and economic sphere. The sociologist Emile Durkheim also employed the organic analogy, in which the whole organism was described as constituting a unity greater than the sum of its constituent parts (as in The Elementary Forms of the Religious Life, 1912, and to some extent in his earlier work Suicide, 1897), although Durkheim was more circumspect than Spencer in his application of the organic analogy. Durkheim propounded a functionalist approach which suggested that we can best understand social structures by comparing them with biological organisms in which the organs need to work together. This means that all the parts are essential, they are interdependent, they perform a function for the whole, and work as an integrated whole. Any part of the whole that does not fulfil these criteria is dysfunctional, and therefore in need of treatment. This fitted well with societies that believed that everything was ordered and that everything and everyone had their place in this order. This conception of society is, however, a very limited one. For one thing it is a largely static conception which is constrained in its ability to explain social change and conflict. It is also a determinist view in that individuals’ capacities for independent action and interpretation are restricted, and it follows from this that since people cannot help what is wrong with them and have limited choice for action the scope for blame is also limited. The solution, where something or someone is dysfunctional, is to rectify or cure the malfunctioning part.

It is easy to see how crime and criminals are defined as dysfunctional for a healthy society and in need of treatment, hence the medical analogy. Such an approach also tends to focus on the individual as the element that needs to be dealt with and cured. The implication is that the way to solve the crime problem is to discover effective ways of treating offenders: the need to deal with social problems is thereby avoided. However, this is not to say that it is not worth making a distinction between the treatment of individuals and treating people as individuals: although the treatment approach focuses on the treatment of the individual, it is all too easy to treat offenders as if they were a homogeneous group and neglect their individuality.

Within criminology the development of a treatment approach has its roots in the Lombrosian school of positivism. This stands in contrast to what is generally referred to as the ‘classical’ school of criminology, commonly associated with the writings of Beccaria (1963). The classical school tended to see the offender in strictly legal terms as a rational actor, and consequently to focus on deterrence and retribution as the twin objectives of criminal justice (Garland, 1985: 16). The idea of reform only developed later as a result of attempts to apply scientific principles to ever more fields of human endeavour. This resulted in greater attention being given to the offender. Increasingly,

Criminals are presented as individuals to be pitied, cared for and, if possible, reclaimed. . . . since what was being presented was not just a more civilised or liberal penality, but also a more preventative, reformative and efficacious form of control. (Garland, 1985: 27)

But this was not a simple and clear cut line of development. For one thing an extreme determinism, based on physiologically predisposed criminal types, would suggest that there is little possibility of change, and therefore little point in treatment. As Garland makes clear, the form of positivism initiated by Lombroso and his followers only developed into the treatment model of the twentieth century after much modification (Garland, 1997: 31–34).

Although the ideal of seeing the treatment and rehabilitation of offenders as a major part of the answer to crime has its roots in an organic model and a certain stream of criminological thinking, the organic model has given rise to some specific theories about crime and offending. For example, the work of Cloward and Ohlin (1960) on delinquency as a response to the lack of legitimate opportunity stems in part from the organic school, by way of the functionalism of Robert Merton. At the same time, while some theories about crime and criminality are concerned with the nature of society, others are biological or psychological (Hollin, 1996b: Chapter 2). Theories about what causes crime and offending give rise to hypotheses about what might be done to reduce them. Consequently there are many ideas about what kinds of intervention are needed. Some of these forms of intervention are referred to as treatment. In a later chapter we will encounter what are termed cognitive behavioural programmes for offenders, which are based on psychological theories of social learning. Some forms of intervention are not concerned with individual offenders at all, but more concerned with social change. What follows from this is that when we encounter an attempt to do something about crime and offending, whether it be directed at the individual offender, his or her community, or the wider society, we need to ask what theory lies behind the intervention. Although this may sound obvious, it is often overlooked when various forms of intervention are being evaluated. I shall return to this theme in Chapter 3, where more consideration is given to the evaluation of treatment and rehabilitation.

Types of Treatment and Rehabilitation

The adoption of a treatment paradigm in dealing with offenders means that some forms of intervention have been literally medical or quasi-medical in nature, involving various forms of therapy. But many other forms of intervention have gone under the broad heading of treatment and rehabilitation. In order to give some idea of the range of possible interventions which can be encompassed by this heading, I will briefly mention some of the most common types, although not all are clearly and easily defined. Similar types of intervention may go under different titles at different times, depending on the latest thinking in criminal justice policy.

The first form of intervention is that which is medical in nature. This is a wide ranging category, although the use of surgical attempts to alter behaviour through such procedures as lobotomy has now largely (but not entirely) disappeared. Medical treatment has also included the use of drugs, such as Antabuse for alcoholism, and what is referred to as ‘chemical castration’ for sex offenders. More commonly, drugs are used in conjunction with some other form of treatment. In the context of offenders medical interventions most commonly take the form of psychiatric treatment, such as psychotherapy. Johnstone (1996) outlines two main forms of psychiatric approach, the medical-somatic approach, which tends to be modelled on treatment in physical medicine, and the social-psychological approach, consisting of ‘the use of environmental, organisational and personal influences’ (Johnstone, 1996: 21). According to Johnstone, psychotherapy falls somewhere between these two approaches, and consists ‘not of physical tinkering, but of talk – albeit a special type of talk – which the therapist uses as an instrument of personal influence’ (Johnstone, 1996: 20). Closely related to the medical profession are clinical psychologists, and various psychological approaches to the treatment of offenders have been used for many years and are currently attracting much interest.²

Less medical in nature, but nonetheless based on a treatment paradigm are casework, which has been used by social workers and probation officers for many years, and counselling techniques. These are usually based on a one-to-one relationship. Other forms of intervention involve group work, including role play and encounter groups – especially likely to be found in therapeutic communities – which will be referred to again later. Some forms of intervention focus on the development of skills, such as cognitive skills, social skills, parenting skills and anger management, while others centre on promoting certain activities. Examples of the latter include motor projects, arts projects and projects featuring sports and other forms of physical activity. Other types of treatment are directed at offences and offending, either general offending behaviour or specific offences, such as sex offences, driving offences or offences of violence. Last, but by no means finally, there is a wide variety of interventions directed towards the social re-integration of offenders. These include schemes which aim to provide offenders with accommodation, education, training and employment. They are more concerned with rehabilitation and resettlement than with what is traditionally regarded as treatment, but they are included here partly because of the linkage between treatment and rehabilitation made earlier, and also because such schemes are usually concerned with the needs of individuals rather than with the underlying problems of high unemployment, inadequate housing and poor educational or training provision per se.

This is by no means a complete list or a full description of the efforts made at treating and rehabilitating offenders. More will be encountered as the book proceeds. Nor are the various approaches to offenders mentioned above mutually exclusive. For example, schemes directed at enhancing skills may use group work as a means of achieving their ends. Indeed, many programmes use more than one technique or approach and are therefore multi-modal. This can lead to complications regarding the aims, delivery and evaluation of such programmes, but it is often thought that using a combination of approaches may be more successful than using a single form o...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Acknowledgements
• Foreword
• Part 1: The Concept of Treatment
• Part 2: The Institutions of Treatment
• Part 3: Treatment in Practice
• Part 4: Beyond Treatment
• References
• Index