Paul John Griffiths

Assessment & Intervention of a Resident living within a Therapeutic Community, Reference to Managing Anger & Conflict: A CASE STUDY.

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ABSTRACT

This Case Study follows a thirty one-year old, white male, an alcohol & drug abuser, through his initial assessment, admission and treatment at a rehabilitation center in Central England that’s run as a Therapeutic Community (TC). It became evident, from the information gained during one of the three monthly Internal Clinical Assessments, that this individual was having difficulty in managing his anger, especially at times of conflict. Several Psychometric Measures were administered in order to ascertain his levels of functioning: Locus of Control (LC), Culture-Free Self-Esteem Inventory for Adults (CFSEQA), Hostility & Direction of Hostility Questionnaire (HDHQ), Eysenck Personality Questionnaire (EPQ), Raven's Standard Progressive Matrices (RSPM), Stages of Change Questionnaire (SCQ) and the Skills Evaluation Checklist (SEC). His high scores on the HDHQ and his general unacceptable behavior within the TC, identified him as a candidate for a skill acquisition workshop, entitled 'Managing Anger & Conflict' based on Cognitive Behavioral Modification principles. The same psychometric measures were also administered following the workshop, when compared results indicated positive change on some levels of functioning and illustrated areas that needed further intervention during his continuing treatment.

CONTENTS

 Introduction

 Literature Review: Treatment rather than Punishment

• Criminal Behavior & Recidivism

• Addiction & Substance Misuse

• Therapeutic Communities

• Therapy & Change

• Anger

• Conclusion to Literature Review

 Environmental Information - The nature of the TC

 Resident (Client) Details

 Assessment & Functional analysis (F.A)

• Previous & Present Convictions

• Functional Behavior Analysis

 Intervention (Psychometric Measures & Hypotheses)

 Results

• Table 1. Scores from the Stages of Change Questionnaire

• Table 2. Results from Raven's Standard Progressive Matrices

• Table 3. Locus of Control Scores

• Table 4. Results from the Culture-Free Self-Esteem Inventories

• Table 5. Hostility & Direction of Hostility Questionnaire Scores

• Table 6. Eysenck’s Personality Questionnaire Scores

• Table 7. Skills Evaluation Checklist Scores

 Discussion

 References

 Appendices

• 1. Format of Managing Anger & Conflict Workshop

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INTRODUCTION Back to Contents

This Case Study was originally submitted to the University of Birmingham for the Master of Science in Criminological Psychology. The focus of this Case Study is a thirty-one year old male who has a record of previous criminal offences for violence and alcohol related crimes. The Procurator Fiscal's Department, in Scotland and his local Social Services Department, in England agreed to address his drug and alcohol problems rather than for him to face yet another prison sentence. The belief that imprisonment is an effective form of punishment or that other sanctions without any form of rehabilitation are somehow going to reduce offending behavior is not a justifiable position (Prison Reform Trust, Woolf Report and McGuire 1995).

The setting for the Case Study is a Therapeutic Community (TC) that operates as a drug & alcohol rehabilitation center offering a treatment service to many agencies including the criminal justice system. TC's allow individuals from all types of social economic backgrounds, the opportunity to live together twenty-four hours a day, three hundred and sixty five days a year. By doing so, problematic feelings, beliefs, attitudes and behavior are highlighted and alternate-coping strategies found and implemented, TC's being a treatment in their own right, i.e. Periods of living together (Kennard 1998). Sometimes there is a need to apply some form of clinical therapeutic intervention, additional to the milieu regime offered by the TC. Andrews, Hoge, Bonta, Grendreau & Cullen (1990a) in their paper on risk assessment suggest that criminogenic interventions e.g. Anger Management works to reduce recidivism, but client centered interventions like Self-Esteem Enhancement Workshops do not.

Following a detailed assessment, the intervention chosen for this resident (client) was taken from a package entitled "Living Skills II" by Dr Bob Wycherely, Clare Crellin and Tony Chiva (1994), which utilizes the conceptual framework of Cognitive Behavioral Modification. Its design follows a workshop format and is ideally administered in small group settings.

In order to put some criminological perspective into this Case Study; there is a need to gain some background information concerning treatment rather than punishment with reference to the issue of anger, especially with individuals who have problems with addiction to drugs and or alcohol. Therefore, the first section in this piece of work is a 'Literature Review'. This looks into areas of: criminal behavior, recidivism, addiction and substance use. It also acknowledges the present use of therapeutic communities within the criminal justice system. The areas of therapy and stages of change are illustrated and present research and interventions with anger are highlighted.

The following section entitled 'Environmental Information' illustrates the setting of the TC and describes the various treatment phases that all residents pass through. The section 'Resident Details' introduces the client chosen as the Case Study, giving information as to home life, school, employment and relationships etc.

In order to assign any form of intervention to an individual, a full comprehensive assessment must be undertaken. This is the subject of the next section called 'Assessment & Functional Analysis'. This is broken down into two further subsections called Previous Convictions and Functional Behavioral Analysis.

'Intervention' is the title of the fourth section. Here the Clinical Intervention is discussed together with the identification of various suitable Psychometric Measures that will enable assessment of the areas highlighted from the functional analysis conducted in the previous section. The Hypotheses that underlie the Case Study are put forward, together with the relevance of the psychometric assessment measures.

The 'Results' section collates all the data into tables, so that analysis can take place in order to support or reject the hypothesis postulated in the previous section. Finally the section 'Discussion' comments on the results explores and interprets the data. It also makes suggestion as to the areas of behavior and personal levels of functioning that would be of benefit from the individual resident to look into further, during the remainder of his time in treatment.

LITERATURE REVIEW Back to Contents

This Case Study is not straight forward; the resident selected has the complications of not only having committed various criminal offences in the past, but has additional current behavioral problems due to his addiction and substance use. Therefore, there is a need to deal with each issue separately, namely: Criminal Behavior & Recidivism; Addiction & Substance Use; Therapeutic Communities, Therapy and Change and finally Anger.

CRIMINAL BEHAVIOUR & RECIDVISM Back to Contents Literature Review

When addicts need money for drugs they need it fast (Feldman 1993). The addict and alcoholic robber often steal to obtain money to purchase more drugs or drink: these robberies are not likely to be planned or organized and Conklin (1972) suggests they are generally aimed at easy targets. The level of criminal activity is higher for daily heroin users than for the rest of the population, and among heroin users levels of crime relate systematically to increases and decreases in heroin use. There is no time to plan, either the crime or the getaway, so less of the relevant information is sought and appraised and more risks are taken than a strictly rational approach would indicate (Feldman 1993). With reference to delinquent personality, early work conducted by Aichorn (1935) proposed that it be characterized by a soft weak center of uncertainty, which is surrounded by a tougher, masking outer layer. The external presence of toughness represents a disguise against actual weakness and an attempt to gain illicitly what could not be obtained by more direct and appropriate means.

The research of Hough, Clark and Mayhew (1980), stated that in terms of prevention too much effort has been expanded on unproductive attempts to change the criminal disposition of offenders. However, by focusing the intervention on the offender, Hollin (1989) believes that treatment is localizing the cause of offending within the individual. This is clearly a 'Classical' or 'Positivistic' viewpoint, which suggests that clinical intervention, can overcome the individual’s unacceptable offending behavior. But Blackman (1995) is in favor of a more constructive approach to the person’s lack of ability to change criminal behavior and suggests an intervention that understands the systematic dynamics of interaction between behavior and the social environment.

Nevertheless, Martinson's (1974) review of outcome studies showed only a small proportion indicated efficacy of clinical intervention and drew the conclusion that "nothing works". A bleak conclusion for men and women under treatment. But Thornton (1987) re-examined the data and asserted that psychological therapies can reduce recidivism; the one conclusion that cannot be drawn is that "Nothing works". With this in view it was thought that the resident who is the subject of this particular case study displayed the inability to manage his anger and deal with conflict situations. Andrews, Zinger, Hodge, Bonta, Gendreau and Cullen. (1990a), showed that appropriately forms of intervention at the appropriate time are able to reduce recidivism by fifty three percent. Indeed, Walker, Farrington, Tucker (1981) had already found a correlation between the number of previous convictions and reconviction, but these findings were for juvenile first offenders. So it was thought useful to focus on the resident's' anger and see what factors produced it and how it might be best dealt with.

ADDICTION & SUBSTANCE USE Back to Contents Literature Review

There exists several relationships between drug use and criminal behavior; some have been described by Mary McMurran (1996) for example: substance use itself is the crime, under age drunks, possession or sale of illicit drugs, substance use changes behavior, crime supports substance use and substance use causes problems which lead to crime are only some of her ideas.

Thornton, Cookson and Clark (1990) found that seventy five percent of their offending sample had used drugs at some time, compared with twenty-one percent for the non-offending control group. Research conducted by McMurran and Hollin (1989a) found that young male offenders consumed on average fifty-eight units of alcohol per week, compared with the recommended weekly maximum of twenty-one units and thirty-eight percent admitted at least one alcohol related problem. In a study based in Scotland, Hammersley and Morrison (1988) investigated people in prison and in a drug treatment center. They found that heavier drug users commit more crimes.

Problem-solving deficits are very common amongst substance abusers. Social Problem Solving Training has been found effective in reducing substance use and misuse. Husband and Platt (1993) reviewed the use of cognitive skills training, with respect to "substance abuse with offender populations" and suggest that the inclusion of this method of intervention is doubly important.

Clive Hollin (1996) reminds us of the potential for offenders to lie or manipulate the facts. When suspects are arrested, they are often asked if they were using substances at the time of the offence and whether this was related to their crimes. It may be beneficial for the offender to blame alcohol or drugs for an antisocial act, rather than accept responsibility themselves. It is at best to suggest that there is no causal relationship between substance use and criminal activity. However, drug & alcohol use does remain a contributory factor in some offending behavior.

THERAPEUTIC COMMUNITIES Back to Contents Literature Review

A psychological dictionary definition of a TC is of a social, cultural setting established for therapeutic reasons and within which those persons needing therapy live (Reber 1988). Wexler (1997) suggests that a higherarchical regime works better for substance abusers.

The American "Stay ‘n Out" prison project was initially designed for convicted offenders with substance use issues (Wexler1997). It is run as a TC program and was originally set up in 1977 in New York, as a joint sponsorship effort, between non-profit making organizations and State Agencies. In 1990, research was conducted into a three-year follow up of male inmates from another New York State Prison, who had participated in a "Stay ‘n Out" program (Wexler 1990). The results illustrated that inmates who went through the program had a re-arrest rate of 26.9% vs. 40.9% for the non-treatment control group.

TC's also exist within the English prison system; perhaps the best known is HMP Grendon opened in 1962 and situated outside Aylesbury in Buckinghamshire. Grendon is internationally renowned for its pioneering socio-psychiatric treatment of serious offenders with histories of personality disorders. It operates a collective of therapeutic communities (Cullen 1997). The research of Genders & Player (1995) conducted at Grendon, indicated that the staff thought that they had the greatest success with violent and aggressive prisoners, who were said to change visibly as they learnt alternative ways of dealing with feelings of anger, frustration and antipathy towards authority. TC's are explored further in the section entitled "Environmental Information - The nature of the TC."

THERAPY and CHANGE Back to Contents Literature Review

Treatment integrity is a vital ingredient for any intended program. Therefore, any treatment can be successful only if it is rigorously and properly implemented. Hollin (1996), states "solid and effective treatment programs do not magically appear overnight: they require planning for both content, and resources: trained personnel to conduct assessments and deliver treatment, and the flexibility to cope with the varying demands and problems presented by different clients"; In other words, effective management of a sound rehabilitation program (Hollin 1992).

Most programs can be divided into three distinct overlapping parts: Assessment, Intervention and Relapse Prevention (Epps 1996). Miner, Marques, Day and Nelson (1990) conducted research with offenders into the impact of relapse prevention. They suggest that Cognitive–behavioural programs which incorporate a range of ingredients, especially those that are focussed towards a number of separate change "targets", offer the best prospects of reducing re-offending amongst this particular group. The study also highlighted the importance of community based relapse prevention work.

Hollin (1996), notes that efforts are being made to bridge the research-practice divide by distilling the complexities of the meta analysis into blueprints for the design of effective programs. Garrett in 1995 compared 111 studies between 1960 and 1983. These were based on young offenders in residential treatment programs. He found that residential programs did have a small effect on outcomes and that cognitive behavioral methods were significantly more productive than Psychodynamic and life skills programs. With respect to the type and style of service, Andrews et al. (1990a) suggest that some therapeutic approaches are not appropriate for general use with offenders. Specifically, they argue that traditional Psychodynamic and non-directional client-central therapies are to be avoided within general samples of offenders because of their devious, manipulative behavior in "traditional" affective groups.

The work of Prochaska DiClemente and Norcross (1992) with clients addicted to nicotine furnishes us with a model that illustrates the "Five Stages to Change" namely: pre-contemplation, contemplation, preparation, action and maintenance. This model assists us to visualize the relationship of change within addictive or offender populations. In the pre-contemplation stage, clients are not yet concerned with overcoming their problems and are unmotivated to change addictive or offending behaviors. In the contemplation stage, individuals are willing to examine the problem associated with their behavior and consider the implication of change, although they may not take any constructive action. They are also likely to respond more positively to confrontation and education, although they may still be indecisive. In the preparation stage, clients wish to make actual changes and therefore desire help with their problems, although they may feel at a loss as to how to deal with what is necessary to adapt or change their behavior. In the action stage, clients have made a commitment to change and they have begun to actually modify behaviors. Finally in the maintenance stage, clients attempt to continue the process begun in the contemplation and action stages. Prochaska et al (1992) suggest that not all clients will go linearly through the stages but offer a "revolving door model", where individuals may make many attempts through the stages of change before achieving their long term goals. Some clients may actually get stuck in the earlier stages of change and require extra assistance, some will never move on and others will die.

ANGER Back to Contents Literature Review

A model postulated by Megargee (1966) suggested that the basis for anger occurring, is when the individuals level of control is exceeded by intense feelings or impulses. The over-controlled person has strong inhibitors, anger will only occur if the provocation is fierce or has been endured for a long period. Anger can be described as hot displeasure, often involving a desire for retaliation, wrath, and inflammation. Conflict can be defined as a violent collision, a struggle or contest, a battle, or a mental struggle. Despite its costs, anger can be adaptive (Chambers 1971).

Bandura (1973) a social learning theorist, suggests that anger enable individuals to learn new behaviors. It also encourages or discourages them to use these behaviors by observing them being reinforced or punished and it can act as a social prompt, facilitating similar behaviors in others. In other words, aggression can affect not only the behaviors but also the attitudes and values of the observers. Many of the individuals that pass through the Criminal Justice System are assessed as having had a Conduct Disorder as a child e.g.: fighting, hitting, assaulting, temper tantrums, disobedience, defiance, destruction of property, impertinence, "Smartness", impudence, uncooperation and inconsideration (adapted from Browne & Herbert 1997) and the list goes on: the individual resident chosen for this Case Study has demonstrated most of these attributes in the past.

Blackburn (1968) compared a group of extreme violent offenders with a group of moderate offenders. He found the extreme group to be significantly more introverted, conforming, over-controlled and less hostile than the moderate group. Rouse (1988), found that men under stress were more likely to use abusive conflict tactics if they had some previous exposure to the use of physical force or verbal abuse in childhood or adolescence. This was supported by some research conducted by Truscott (1992), who found that violent adolescent behavior was associated with paternal physical and verbal abused. Persons with low self-esteem were considered by Coopersmith (1967) to be particularly vulnerable to unfavorable opinion and are fearful of evoking anger. The individual appears all too ready to believe that others judge them in the same unfriendly fashion.

Studies that have employed self-instructional training with offenders have found that it increases self-control, which accordingly decreases aggressive behavior (Snyder and White 1979). This idea has already been developed further to some extent and can be found in existing interventions, principally in the form of Anger Control Training (Hollin 1996). The work of Feindler, Marriott and Iwata (1984) investigated the use of Self Instructional Training in "Group Anger Control Training" for Junior High School Delinquents and found that it was especially beneficial, when used within community settings.

One of the present day theorists and clinical practitioners is Raymond Navaco, a Professor at the University of California, USA. He works with forensic patients who have a serious degree of mental health issues; his material is especially useful in working with other client groups (Warren 1998). He states that anger has different functions: energizing, expressive, signaling, disruptive, defensive and dramatic. Navaco's ideas on "Controlling Anger" are used within the 'Managing Anger & Conflict Workshop', the subject of this case study (Wycherley et al 1994). Novaco (1978) understands the determinants of anger to be a combination of physiological arousal and a cognitive labeling of that arousal. Internal and external factors and the behavioral responses to the situation influence these cognitions.

CONCLUSION TO LITERATURE REVIEW Back to Contents Literature Review

We are fortunate that the reviews conducted by various researchers using meta analysis (Garrett 1985, Gendreau and Andrews 1990, etc.) allow a fresh look at the data and from the findings, it is possible to make positive recommendations for the design of successful rehabilitation programs aimed at reducing offending behavior. There is now a firm base from which to design effective treatment programs (Hollin 1996). Cognitive Behavioral Therapy is not in opposition to "12-Step" or psychobiological models of substance abuse; in-fact, Beck et al (1993) found that the alternative systems might be actually complementary. Andrews et al (1990a) identified cognitive behavioral approaches to be most effective. However, treatment programs conducted in the community have a stronger effect on delinquency than residential programs. While residential programs can be effective, they should be linked structurally with community based interventions (Hollin 1992) and particularly involves the family (Hollin 1992).

Back to Contents

ENVIRONMENTAL INFORMATION - The nature of the TC

NOTE At the request of my employer no reference will be made in name, to the Organisation or its agents. Back to Contents

The Environmental Setting for this Case Study is a drug & alcohol rehabilitation center that is run as a Therapeutic Community (TC) and a ‘Concept House’. Founded in 1970 by a Psychiatrist in charge of The Regional Drug Dependency Service, it remains one of the first organizations, to have treated drug and alcohol abusers within the local community, moving away from the "sick role model" of hospitalization.

The model of "Concept Houses" was borrowed from the United States and began as an offshoot of Alcoholics Anonymous (AA). In 1958 Chuck Dederich a recovering alcoholic, founded Synanon in California USA. He broke away from AA because of his dislike of their rigid alcohol focus and their rejection of substance abusers, which were more likely to be poor and members of minority groups (Kennard 1983). The TC’s first Director John McCabe (deceased), was a graduate himself from Phoenix House another Concept House, in New York (Toon & Lynch 1994). The emphasis was ‘Self Help’ and based originally around Confrontational Group Work Techniques in order, to challenge the very basis for individuals drug and alcohol use.

The TC now occupies four houses on a seven-acre campus in a small village, five miles outside of a medium sized University City in Central England. Facilities include woodlands, a small lake, an outdoor swimming pool and a sports field. It's registered as a Care Home with the local authority for 58 residents of both sexes over the age of eighteen. However, there is a possibility that two of these beds could be used for individuals between the ages of sixteen and eighteen.

The majority of the referrals come via individuals themselves, families, Local Authorities Social Service Departments or from within the Criminal Justice System. The Assessment Team deals with all referrals. In the first instance, an information pack is sent out including a detailed questionnaire. Normally, drug & alcohol abusers are already receiving some form of input from other agencies, e.g. Street Drug Agencies, Community Drug & Alcohol Teams, Mental Health Services, Probation Services or Local General Medical Practitioners; these agencies are then contacted for their advice. The second stage of assessment is to invite the individual to the TC in order to attend a formal interview lasting approximately two hours and provide useful information about the individual: family, education, medical and psychiatric histories, drug/alcohol use and previous/present offending behavior. Following this if the interview is successful and the individual still wishes to proceed with his or her application, then a Day Placement will be arranged. This is where the applicant can experience a full day in a therapeutic community, talk to residents and have a good fact finding tour of all facilities.

There is a period of assessment available to the courts, whereby defendants can be bailed to the TC for a four-week assessment in order to ascertain whether there exists a specific interrelationship between drug use and criminal behavior. If this is the finding of the assessment, then a decision as to whether the individuals and societies best interests are met by a residential period in therapy is made.

The Program lasts approximately twelve months and is broken down into three treatment phases: Phase One, known as "Safety Net", covers the initial six to eight weeks. This allows the person to settle into his or her new environment gradually by being introduced to the community language and by becoming educated in the use of various therapeutic tools. Perhaps the most important part of phase one is to establish and acknowledge some of the underlying reasons for drug use and offending behavior, known as ‘Issues’. Phase Two, is where these ‘Issues’ are processed by use of a number of therapeutic tools: Confrontation Groups, Support Groups, Skill Groups, Relating Chairs or One to One counseling with staff members. This phase lasts for approximately seven months, towards the end of which residents are encouraged to start to reintegrate within main stream society by using various methods: voluntary work, socializing, family visits, community talks and employment preparation studies (this includes job search, interview techniques etc.). Phase Three, last for three months and commences when the resident is in full time employment. These residents live with the support of the community in a detached house in the grounds, paying their own way, working and also completing an evening a week as an Auxiliary Staff Member, looking after junior residents. Transition between each phase is celebrated with a formal ‘Progression’, where the entire resident population comes together. The ultimate graduation is where the resident completing the program ‘Stands on the Table’ (a ritual attended by all residents) he or she often inviting family and friends to share the event.

RESIDENT (CLIENT) DETAILS Back to Contents

In order to establish anonymity, the client will be known as Rupert Macintosh, a 31 year-old male, born in Scotland. Rupert is the youngest of six children, having one sister and four brothers; two brothers have since died, one due to a car accident in 19XX and the other took his own life in August 19XX. He recalls a normal early childhood with his mother and father. However, when he was six, his mother became ill and died from cancer, following this his Sister took over the responsibility for looking after the family. After a while she gained full-time employment in a local factory; on occasion returning home after Rupert had got in from school, this part of his early life was spent fending for himself.

Although Rupert believes that he did not receive the same affection that his peers gained from their own families, he is aware that his family was very close and as the youngest at the time, he lacked nothing. However, he claimed that his father would drink and occasionally administer physical punishment but only following ‘bad behavior’. His older brother, who Rupert suggests, was his father's favorite, never received physical punishment himself. The corporal punishment stopped by the time Rupert turned eleven.

Feeling frustrated by not being able to express himself, Rupert often resorted to fighting his brother and lashing out at others. He was always looking for something especially money. Rupert started using solvents at the age of eight, after hanging around with other juveniles from his home area, usually older than himself by a few years. He was caught using solvents three times by his brother and father, and severely caned on each occasion.

He attended a Secondary school, in Scotland. He states that this was a "nightmare time and hated it". It was a difficult period, especially considering he held down a job on a Milk Round, working from 5.00am till 9.00am in the first year and from 3.30am to 9.00am in his final year; he still managed to attend School on most days and participated in all lessons. It was at the age of thirteen, that Rupert started to date girls. With the money earned from the Milk Round, he was able to attract girls with gifts etc. Also, the milk round introduced him to other "bad" areas. He would drink alcohol and gain courage, in order to challenge and fight other youths on the various estates. He became frustrated, annoyed, and found that alcohol would help to suppress these feelings. A consequence to the use of alcohol was that he usually became more violent and hence earns a bad reputation. A relationship with a young woman (Karen) who was in his class at school, was started at the age of fifteen, she became his sweetheart and later his fiancée. He suggests that at this time he consider he was an extrovert and sought attention. Whatever he attempted, he had to win, by whatever means available. At school he would fight other pupils and often went out of his way to prove himself against others; thus providing good feelings. However, he left school without any formal qualifications.

Employment history consists of a few months spent on a Youth Training Scheme, working as a Mechanic. He left to work for another Garage, where he underwent some form of Apprenticeship over a three-year period. It was during this period at the age of eighteen that he was arrested for an assault, which arose from a fight while under the influence of drink. Following completion of his apprenticeship, he left work in order to become self- employed, within a partnership of another Garage; this lasted for six months. He dealt in second hand cars and built up a thriving business. However, greed got the better of him and he turned to "Ringing" cars. About the age of nineteen, he was stripping cars down, that had been stolen by others, in order to build other damaged ones. He was eventually caught by the police, arrested, charged with theft and subsequently, remanded in custody. It was whilst he was in prison remand, for five weeks, that he started smoking cannabis.

He married his childhood sweetheart in December 1986. At first, this was a happy time and Rupert was again making money, this time by selling cannabis and ecstasy, he was also, buying stolen goods and selling them on to others. It was at this time that he started taking Benzodiazepines. His car business was developing; he would purchase "damaged repairables" and fix these up with stolen parts off other cars. He loved the financial rewards and the reputation of being a "Big Man". The adrenaline rush of his involvement in a criminal subculture appealed to him. He had a mortgage, nice house and in 1988, their first son Stuart was born.

This life style of drug dealing, violence and selling "doggy" cars earned him not only a reputation but also a number of enemies. He had himself been robbed at knifepoint and suffered a stabbing to his hand by two masked men. He started to build up a number of people who would sell his drugs for him. He began to carry knives in order to protect himself; he would have no problems in the prospect of having to defend himself but would not threaten anybody just for fun. He was eventually caught by police on a "Stop & Search", arrested and convicted of possession of an offensive weapon for which he received a small fine.

His lifestyle improved and they subsequently had two more sons. He had a speedboat and cabin cruiser, together with four sports cars. He began to play the field with other girls behind his wife's back. He frequented and hosted parties where he would consume large quantities of ecstasy and Benzodiazepines (Temazipan). He felt good and claimed that nobody could touch him. He was under a certain amount of pressure from other drug dealers. He gained a mortgage on a house that he rented out to students and other people. One of his tenants was an older man, who seventeen years previously had been his father's employer. He remembers that one-day he had witnessed this man sack his father, his father subsequently, begged for his job to be returned. With this in mind he intended to have this gentleman robbed by some associates. However, late one night a telephone argument evolved, over the sale of one of the "doggy cars", that this man had purchased from Rupert earlier that week. Enraged and high on drugs, Rupert visited the flat, knocked down the door and attacked the man with a hammer causing severe injuries. Rupert was eventually arrested and sentenced to an eighteen month custody for grievous bodily harm, whilst in prison he became addicted to heroin.

This last prison sentence and his addiction to heroin affected not only himself but his home life and his relationship as well. He called himself a "mad junkie" at this time and he consumed quantities of alcohol. He felt extremely dirty and would do "mad things" e.g. take 'shoplifters' out to various places and return with carloads of goods. Once more he was arrested and received a prison sentence.

On release from prison, he emerged with a bigger drug habit than he originally had. He began to sell drugs in order to feed his own habit. He considers at that time "he was a mess, his wife was a mess and his life was a mess". People were after him, he had no enthusiasm to work and realized that he was extremely stubborn, refusing to accept any help or that thing were going down hill fast etc. He received several injuries from people: he was stabbed and slashed in the face, stabbed in the neck, had both legs broken and had his hands smashed. He was arrested on charges of possession of controlled substances and sentenced to nine months in prison. Unfortunately, his middle son died due to a car accident where he ran into the road and was hit by an on-coming car. This occurred whilst Rupert was serving this prison sentence in 1996.

Following these problems in Scotland and on release from prison he moved with his young family to London, initially he decided to get himself sorted out and withdrew from drugs "cold turkey style". He started a window cleaning round but also started drinking. His brother-in-law came to stay; chased out of Scotland by the same people responsible for Rupert's injuries. He again became involved in dealing and using drugs. He registered as a drug addict and began a Methadone Maintenance Program with the local Drug Agency. It was via a referral from the Drug Agency, following yet another prison sentence for various driving offences, that the TC became involved.

ASSESSMENT & FUNCTIONAL ANALYSIS Back to Contents

The TC uses several paper exercises and Assessment Tools that have been internally developed. The 'Assessment Interview' & 'Resident Case History' are two forms, similar in format and specifically designed to gain as much background information as possible. They include areas such as social, family, relationship, criminal record, employment, educational, medical/mental health issues, drug/alcohol use and previous intervention. When residents are in Phase One, they complete several paper exercises: Significant People, Significant Events, Goals, Strengths & Weaknesses and reasons for moving to phase Two. On completion of the Assessment Interview conducted with Rupert on his arrival and subsequent compilation of his Case History and Phase One Papers, it was possible to build a picture, in order to analyze overall behavior; this is called a "functional analysis". (NOTE. These assessment measures are considered Confidential Documents and are therefore not included in the appendices)

PREVIOUS and PRESENT CONVICTIONS: Back to Contents

Rupert has several previous criminal offences recorded against him. These are listed below in chronological order. The information includes date of conviction along with his age; nature/type of criminal offence and from which Statute; Disposals of the Court e.g. fine, imprisonment etc.

February 1985 Age 18

Assault Common Law

Breach of Conditions of Bail Bail etc (Scotland) Act 1975 s. 338 (2)

Fine £60.00

May 1985 Age 18

Fail To Appear (after Summons) Crim. Proc. (Scot.) Act 1975 s. 338 (2)

Fine £20.00

August 1986 Age 19

Theft of Motor Vehicle Common Law

Admonished Disq. From driving 12 month, Lice. End.

February 1989 Age 22

Reset (stolen goods) Common Law

Admonished, Deferred Sentence

November 1991 Age 24

Possessing Off. Weap. in Pub. Prevention of Crime Act 1953 s. 1

Fine £175.00

Dec 1992 Age 25

Grievous Bodily Harm Offences Against the Person Act 1861 Eighteen month imprisonment

July 1994 Age 27

Theft Common Law

Theft by Shoplifting Common Law

Theft by Shoplifting Common Law

Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)

Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)

Nine months imprisonment

October 1995 Age 28

Driv. Whilst Disq. Road Traffic Act 1988 s. 103 (1) (b)

Minor Road Traffic Offence

Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)

Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)

Four months imprisonment, Disq. Driv. 3 years, Driv. Lice. Endor.

October 1995 Age 28.5

Theft by Shoplifting Common Law

Breach of the Peace Common Law

Six months imprisonment.

April 1996 Age 29

Poss. Cont. Drug Use of Drugs Act 1971 s. 5 (2)

Breach of Con. of Bail Bail Etc. (Scot.) Act 1980 s. 3 (1) (b)

Fail to Appear (Bail) Bail Etc. (Scot.) Act 1980 s. 3 (1) (a)

Nine months imprisonment.

August 1997 Age 30

Dangerous Driving

Driving While Disqualified

Driving While Unfit

Failing to Provide a Breath Specimen

No Insurance

Six months imprisonment.

Present outstanding charge Back to Contents

Possession of Heroin & Intent to Supply

FUNCTIONAL BEHAVIOUR ANALYSIS Back to Contents

Stage 1. Early Childhood (0-9 years of age)

ANTECEDENTS mothers death; looked after by sister; Family arguments; Physical punishment off father; Believed that his brother was father's favorite.

BEHAVIOUR Anger; Frustration; Could not express himself; Fought with older brother; Lashed out; Bored.

CONSEQUENCE Hung out with local children; Found acceptance with other children; started to sniff glue & enjoyed the sensation; Caught three times by father and caned.

KEY LEARNING Using solvents helped Rupert to fit into the group culture, this led to acceptance by that group and additionally received good feelings; Found a way to relieve boredom and an outlet for his anger.

Stage 2. Early Adolescence (10-14 years of age)

ANTECEDENCE Sequenced in stage 1, plus: Working on a milk round often in "bad areas".

BEHAVIOUR With his income from the milk-round was able to buy alcohol; Girls were attracted to him; Bought girls presents; Would fight other boys from "bad areas"; Started socializing in the evenings with older youths; Felt frustrated & annoyed.

CONSEQUENCES Developed a reputation as a fighter; felt adult like, working and receiving a wage.

KEY LEARNING Alcohol enabled Rupert to express himself more; He became more confident and more violent following drinking; Felt good about earning a 'bad reputation'.

Stage 3. Late Adolescence (15-19 year of age)

ANTECEDENCE Sequence in stage 2, plus: Started dating the daughter off one of his milk-round customers, who was also in his class at school; Left school at sixteen and entered into an apprenticeship as a mechanic.

BEHAVIOUR Attention-seeking, had to be the best in what ever he did; Extroverted, went out of his way to prove himself; General behavior problems at school e.g. fighting etc; Enjoyed being a mechanic and working with cars, behavior changed for the better.

CONSEQUENCES Felt good; Gained people's respect and the reputation for being a good mechanic; Earns high wages.

KEY LEARNING A good reputation delivered good feelings and good money, people gave him respect and attention.

Stage 4. Early Adulthood (20-24 years of age)

ANTECEDENCE Sequence in stage 3, plus: became a self employed mechanic; Married and brought his own house; Served five weeks on remand for theft of a car: Introduced to cannabis in prison.

BEHAVIOUR Started buying damaged repairable cars and fixing these with stolen parts; Began selling cannabis and Sulphate; Carried a knife for self defense; Had to physically defend his reputation.

CONSEQUENCES High earnings; Nice house; Convicted for stolen goods, contents of house confiscated and a fine; Convicted of possessing an offensive weapon, received a fine; Started taking Ecstasy and Benzodiazepines.

KEY LEARNING Selling cars repaired with stolen parts was a cheep way of making money: Selling drugs delivered high financial gains; When caught he only received a small fine or lost possession that he could replace; Crime & drugs earns high rewards and good feelings; Taking drugs enabled him to perform better.

Stage 5. Early Adulthood (25-29 years of age)

ANTECEDENCE Sequenced in stage 4, plus: started to employ people to sell the drugs; Became complacent; Started to live the high life, sports cars, boats and property.

BEHAVIOUR Consumed large quantities of Temazipan (Benzodiazepines) in order to deal with the pressure from other drug dealers; Held on to a grudge for seventeen years toward a man that sacked his father, when he had the opportunity, coupled with drug & drink intoxication, attacked the man with a hammer.

CONSEQUENCES Convicted of Grievous Bodily Harm, served 12 months of an 18 month prison sentenced; Gained a prison heroin habit; On release started doing mad things, developed a large heroin habit: Sold drugs just to feed his own habit; Considers himself a mess: Became stubborn: Shoplifted and caught, received a nine month custodial sentence. Received terrible beatings from drug dealers e.g. both legs intentionally broken, face slashed, stabbed etc. Whilst in prison his son was killed in a car accident; Moved with his family to London, England.

KEY LEARNING Drugs no longer were a luxury but a necessity: He needed drugs to cope with everyday events: If he stayed in Scotland he would be killed; He was no longer 'Mr Big' and his present reputation was as a low life; His drug use cost him everything; Found by running away he could leave problems behind.

Stage 6. Adulthood (30 years of age to present)

ANTECENENTS Sequenced in stage 5, plus: managed to detoxify himself and establish a window cleaning round.

BEHAVIOUR Started to regain his ability to function again, business was developing and money was coming in; Put his brother-in-law up, as he was chased out of Scotland by the same people responsible for Rupert's injuries.

CONSEQUENCES Returned to using drugs: Could no longer cope especially after another son was injured in another car accident; Couple of custodial sentences later, placed himself on a methadone script and sought help of the local drug support unit of the Social Services Department; Depressed, near mental breakdown.

KEY LEARNING No longer able to feel good from using drugs; Drugs made him feel worse; No longer able to look after himself, wife or family; Desperately needed help and assistance to get and stay off drugs.

INTERVENTION Back to Contents

Rupert joined the TC in February 1998 following an initial referral in November 1997 by the Social Services Department of his local London Borough Council. He attended an interview at the TC in January 1998, where a full assessment was undertaken. This indicated that he had a significant alcohol and drug problem, compounded by an interrelationship with criminal activity. He was deemed suitable for a residential rehabilitation center and funding was subsequently secured.

On arrival, he initially presented as an individual who was self-assured and committed to changing his offending and drug using behavior. However, it was not long before his true behavior emerged. He became very aggressive to other residents, portrayed an aggressive "Prison Image", and talked about violence most of the time. Criticism from other residents included that he "Played Head Games" was devious "Talking the talk on the floor", but being very negative away from the staff team. Also, he was continually in "Negative Contracts" with other negative people.

Several unacceptable aspects of his behavior emerged especially one: namely lying about a particular incident, alleging that a resident stole something from another, which resulted in physical confrontation and the resident in question being asked to leave. This other resident was in fact the innocent party. Other incidents included inappropriate sexual suggestions to young male resident and continual negative relationships with other residents. He was eventually placed on several Therapeutic Contracts. It was during one of these that the Ravens Progressive Matrices were administered. This was in order to ascertain the level that he processed cognitive information. He was present when a 'Group Administration' of the Hostility & Direction of Hostility Questionnaire (HDHQ) was completed by the whole of the TC in February 1998. This highlighted that Rupert had a high 'Hostility' score and a high negative 'Direction of Hostility' score, suggesting that he had several issues in processing feelings around hostility and when he did, it would be more likely to express this externally towards others or other objects.

It was suggested to Rupert that he could benefit from undertaking a skill acquisition workshop on Managing Anger and Conflict. He agreed to this and was included in the workshop to commence in May 1998. It was important to have a broad picture of the way Rupert interpreted events, especially with regard to his general cognitive functioning ability and personality attributes. Therefore, several psychometric measures were selected and administered as a Battery of tests in May 1998 and again in July 1998. Roland Woodward, my Clinical Supervisor and Principle Psychologist at HMP Gartree agreed to score these blind once both administrations had been conducted, this was to ensure against any form of administrator/facilitator bias or contamination.

The Managing Anger & Conflict Workshop, is taken from the Living Skills II training package, researched and designed by Dr Bob Wycherely, Clare Crellin and Tony Chiva (1994). The workshop objective is to establish that it is not always possible to avoid conflict and that individuals have to get into battles, at times, if they are not to be exploited or harmed by others. This means that the group learns to understand and accept feelings of anger, and learns to use them constructively in order to produce change. Avoiding conflict may be bad for individuals long-term health. The workshop looks at, and allows practice in, the skills needed during situations of conflict. Individuals' ability to cope with other people’s anger may also be a problem, so there is an opportunity for the group to practice recognizing and handling direct and indirect expressions of anger in others.

The Managing Anger & Conflict Workshop takes 12 hours and consists of five sessions, namely: Feeling Angry, Concealed Anger, Anger: The Good Side, Be Prepared and Managing Conflict and two sessions of introduction and debriefing where the internal measures are administered. Several learning strategies are implemented within the workshop for example: group work, brainstorming, paper exercises and personal profiles etc. These help facilitate the "Socratic Method" of teaching, in other-words the insistence upon thorough critical analysis of ethical concepts, namely the logic of behavior (Macmillan Encyclopaedia 1994). This method elicits answers from residents to reveal inconsistencies in their own accepted opinions.

From the research reviewed earlier, there emerged several important findings around the area, of not only anger but also the interrelationship between criminality, drug and/or alcohol abuse. Therefore, it is important to establish exactly what hypotheses are to be tested in this Case Study. To simplify the matter, each psychometric measure is now discussed with a particular hypothesis proposed.

STAGES OF CHANGE QUESTIONNAIRE Back to Contents

It is vital to establish whether the client is at a stage in his treatment to benefit from any form of Clinical Intervention. Prochaska & DiClemente (1982), suggest that therapists seldom pay attention to what stage of change clients are in and often proceed as if all clients are in need of contemplation, or are ready for action highlight this. If Rupert was not ready to participate in treatment, then any intervention would be futile and a waste of resources. The 'Stages of Change Questionnaire' defines the four theoretical stages of change: Precontemplation, Contemplation, Action and Maintenance. This questionnaire assesses individual's readiness for involvement in change at the start of therapy (McConnoughy, Prochaska and Velicer 1983). The four scales have thirty-two items, with eight items measuring each scale. The questionnaire has a five point Likert format in which a score of one indicates strong disagreement and a score of five shows strong agreement. From conversations with Rupert during face to face sessions, I expected him to be beyond the Precontemplation stage and perhaps entering the action stage.

RAVEN'S STANDARD PROGRESSIVE MATRICES Back to Contents

The research conducted by Genders & Player (1995) states that a higher level of intelligence is likely to assist individuals in dealing with the intellectual component of therapeutic progression. It enables comparisons of people with respect to their immediate capacities for observation and clear thinking (Butler 1977). This tool designed by J. Raven in 1958, consists of a set of matrices, or arrangements of design elements into rows and columns, from each, a part has been removed. The task is to choose the missing insert from given alternatives (Anastasi 1990). The easier items require accuracy of discrimination; the more difficult items involve analogies, permutations and alternations of pattern. The tool is non-verbal and was designed to span a whole range of intellectual development. Cullen (1997) states that men who score well below average, a score of 25 or less tend not to do as well in therapy as do those with higher scores. Therefore, if Rupert scores average or above, he would be expected to have the intellectual capacity to comprehend and complete the workshop.

LOCUS of CONTROL Back to Contents

This questionnaire measures the relative amounts of internal and external control being exercised in a person’s behavior (Butler 1977). Internal control refers to the perception of an event, as contingent upon one's owns behavior or one’s relatively permanent characteristics. External control indicates that a positive or negative reinforcement following some action of the individual is perceived as not being entirely causal upon his or her own action but the result of chance, fate or luck. It may also be perceived as under the control of powerful others and is unpredictable because of the complexity of forces surrounding the individual. This tool is a forced-choice self-report inventory, consisting of eighteen statements. Research in to the perception of Locus of Control in alcoholics was conducted by Oziel, Obitz & Kerpon (1972) who suggested that the passive-aggressive drinking and social behavior seen amongst alcoholics is the reaction by internally controlled individuals to resist manipulation by others who want them to stop drinking. This notion of internal control for alcoholics is supported by the research of Goss & Morosko (1970).

Hypothesis: That Rupert's Locus of Control score will indicate Internal Control on the first administration and subsequently will reduce on the second administration.

Null Hypothesis: There will be no difference in scores of Internal Locus of Control between administrations.

CULTURE-FREE SELF-ESTEEM Back to Contents

Self-Esteem is a personal judgement of worthiness that is expressed in the attitude the individual holds towards them selves (Coopersmith 1967). Alcoholics and drug addicts suffer from chronic feeling of poor self-esteem due to their inability to accurately evaluate themselves and judge their relationships. They greatly depend on others as sources outside themselves for approval and confirmation (Flores 1988). Feldman (1996) suggests that low self-esteem is expected to correlate with high criminality and vice versa, this is supported by the earlier research conducted by Bennett et al. (1971) who found that offender populations tend to be lower in self-esteem, than non offender populations.

The Culture-Free Self-Esteem Inventory for Adults {Form Ad} (Battle 1981) is a self-report scale for individuals aged fifteen and older. It contains sixty items that measure an individual’s perception in the areas of general, personal, and social self-esteem. The individual selects for each item either Yes or No. The self-esteem score is the total number of items checked which indicate either high or low self-esteem (Battel, Hawkins, Carson, Ord & Precht 1986). Measures of self-esteem are considered by Coopersmith (1967) to be significantly related to the individual's ability to adapt to environmental demands and Lawrence Jones (1989) proposes therapeutic change by suggesting that it can be brought about by confronting core criminogenic beliefs about self and others. This scale is effective in identifying those in need of therapeutic intervention and individuals experiencing depression (Battle 1981) anxiety and neurotic symptoms (Coopersmith 1967). As there is a built-in Lie Scale, it is possible to assess for validity. Therefore, if the Lie Score is less than six, it may be excluded from the Case Study.

Hypothesis: Low self esteem scores on first administration, increasing on second administration.

Null Hypothesis: No differences in self esteem scores between administrations.

HOSTILITY and DIRECTION of HOSTILITY QUESTIONNAIRE Back to Contents

Individuals with drug and alcohol problems are particularly likely to have difficulties in family relationships and may engage in abusive behavior. Hostility and Direction of Hostility Questionnaire (Caine et al. 1976) is designed to sample a wide range of possible manifestations of aggression, hostility or punitiveness. There are five main scales: self-criticism, guilt, acts out hostility, paranoid hostility and criticism of others. These can be combined to give a total hostility score and a direction of hostility score. The direction of hostility score indicates whether the hostility is directed internally or externally (Butler 1977).

Hypothesis 1: Rupert will have a High Hostility Score and to externalize his Hostility.

Null Hypothesis 1: No difference between Hostility Score and Normal Male Mean and balanced Direction of Hostility.

Hypothesis 2: Reduction in Hostility and Direction of Hostility scores between administrations.

Null Hypothesis 2: No difference in either the Hostility score or the Direction of Hostility score between administrations.

EYSENCK'S PERSONALITY QUESTIONNAIRE Back to Contents

Eysenck Personality Questionnaire is a self report inventory consisting of one hundred and six questions to which the respondent has to select either Yes or No. The tool is designed around five scales: Psychoticsm, Extroversion/Introversion, Neuroticism, Lie and Criminality and produces two extra scales of Criminality and Addictiveness. Eysenck (1977) suggested that it would be expected for individuals with strong antisocial inclinations to have high P, high E and high N scores.

Hypothesis 1: Rupert will have High Scores on Scales of E, N, P, A & C.

Null Hypothesis 1: No difference between scores and mean scores

Hypothesis 2: Rupert will have low lie score.

Null Hypothesis 2: There will be no difference between Lie score and Mean Lie score

Hypothesis 3: There will be a reduction in scores between administrations

Null Hypothesis 3: There will be no reduction in scores between administrations

SKILLS EVALUATION CHECKLIST Back to Contents

This is the internal measure from the "Managing Anger & Conflict Workshop" taken from Living Skills II package. It consists of 20 statements and a Likert scale tick-box of 'Very Like Me', 'Like Me', 'Unlike Me' and 'Very Unlike Me' in order to record the answers. This checklist is administered before and following the workshop, in order to ascertain what skills are present for dealing with anger and conflict.

Hypothesis: There will be an increase in scores between administrations

Null Hypothesis: There will be no increase in scores between administrations

ANGER DIARY Back to Contents

Two versions of the Anger Diary were used; they were designed in order to gain information in the "Antecedents, Behavior & Consequences" (A. B. C.) format. This allows analysis, by understanding the factors of Antecedence that were present immediately prior to the behavior or feelings of anger and to record the direct consequence of this episode.

The first anger diary contained a request to record the sequence of behavior in A.B.C. format; this was given to the resident with training four weeks before the workshop was to start. The second anger diary, included two "indicator bars", namely an 'arousal bar' and an 'aggression bar'. The arousal bar was designed for the resident to compare this current event against a time when they considered, they were most aroused. Similarly, the aggression bar was designed in order to record how angry they became during this event, compared with the most anger they have been in the past. Instruction was provided to all residents in how to fill out the diaries and that several A.B.C. entries may in fact lead into one another.

WORKSHOP DEBRIEFING Back to Contents

This was designed in order to furnish some qualitative information from the participating workshop members. It was originally designed for use in the Research Project in year two of the Masters Course in Criminological Psychology at the University of Birmingham. However, useful comments were made by Rupert and therefore are of interest to this case Study and are included in the discussion section.

RESULTS Back to Contents

You will notice that the following results include reference to HMP Grendon norms (i.e. the average score obtained in that population) and a standard deviation for that Grendon mean score. Standard deviation is a statistical concept that provides information about the spread of the scores. It is worthwhile to bear in mind the following approximate limits that apply if the scores are normally distributed (Butler 1977).

• 67% of the scores fall within + or - one standard deviation from the mean i.e. the normal range.

• 95% of scores fall within + or - two standard deviations from the mean. Scores outside this range are thus somewhat extreme and certainly noteworthy.

• 99% of scores fall within + or - three standard deviations from the mean. Scores outside this range are obviously very extreme and are therefore particularly noteworthy.

If we look at the scores from the Stages of Change Questionnaire in table one, we note that all scores are below 40, the highest possible mark. The profile suggests that this resident is in the "Participation" stage and able to benefit from undertaking the Workshop.

Table 1. Scores from the Stages of Change Questionnaire

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In table two, we find the results from Raven's Standard Progressive Matrices. In the timed administration of twenty minutes the resident scored 38 and was graded 'D' (below average). However, the un-timed score returned 45 and graded 'C-', which is average. As this is higher than the Grendon "well below average" score of 25, he is deemed suitable for this particular Clinical Intervention.

The average Matrices score for Grendon inmates is 43, (Sd. = 7.3 N = 210)

Table 2. Results from Raven's Standard Progressive Matrices

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The Locus of Control scores is illustrated in table 3. The first administration returned a score of 52 and the second 72; both of these suggest Internal Control.

Table 3. Locus of Control Scores

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In table four, the results from the Culture Free Self-Esteem Inventory are reported. The Lie scale scored higher than six in both administrations, therefore, this measure can be included in the Case Study. As the total Self-Esteem scores have increased between administrations, the Null Hypothesis can be rejected.

Mean and Standard Deviation scores refer to HMP Grendon norms (*= Battle et al 1986)

Table 4. Results from the Culture-Free Self-Esteem Inventories

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Hostility and Direction of Hostility Questionnaire scores are recorded in table five. These represent the first administration on admission into treatment, the second was conducted 'Pre' clinical intervention and the third, was conducted 'Post' clinical intervention. The total Hostility score reduced between administrations: 26, 21 and 12 respectively. However, the Direction of Hostility score remained constant at -08 in the first & second administrations, but dropped to -01 in the third administration. On the first administration, the Hostility score of 26 was over 2 standard deviations larger than the normal male mean. He also returned a high negative Direction of Hostility score. Therefore, the first Null Hypothesis can be rejected. There is a difference between the second administration and the third administration of Hostility scores, namely 21 & 12 and also Direction of Hostility scores from -08 to -01 respectively. Therefore, the second Null Hypothesis can also be rejected.

Key

SC = Self criticism

G = Guilt

AH = Urge to act out hostility

PH = Projected delusional (i.e. paranoid) hostility

CO = Criticism of others

H = Hostility

IH = Internalized Hostility

EH = Externalized Hostility

DH = Direction of Hostility

 Table 5. Hostility & Direction of Hostility Questionnaire Scores

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 Table six, reports the results of the two administrations of the Eysenck's Personality Questionnaire. All scores are significant on first administration: E< 1Sd over Grendon Mean, N < 1 Sd over Grendon Mean, P < 2 Sd over Grendon Mean, L > 1 Sd under Grendon Mean, A < 2 Sd over Grendon Mean and C < 3 Sd over Grendon mean. Therefore, the first Null Hypothesis is rejected. The Lie scores in both administrations are low; therefore, the second Null Hypothesis can be rejected. There was a reduction between administrations in all scores except 'E', which remained at 22, and 'L', which increased by one point. Therefore the third Null Hypothesis can not be rejected (see Discussion).

Mean and Standard Deviation scores refer to HMP Grendon norms

KEY:

E = Extroversion

N = Neuroticism

P = Psychoticsm

L = Lie

A = Addiction

C = Criminality

Table 6. Eysenck’s Personality Questionnaire Scores

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Finally, table seven illustrates the scores of the Skills evaluation Checklist. The first administration produced a score of 55 and the second administration of 72. Therefore, the Null Hypothesis can be rejected.

Table 7. Skills Evaluation Checklist Scores

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DISCUSSION Back to Contents

The TC in which the Case Study is based, does not currently conduct either research or regular psychometric testing, therefore I have utilized the Norms generated at HMP Grendon in order to compare and contrast Rupert's scores with those of a similar population.

The results of the 'Process of Change Scale' clearly indicate that Rupert at the time of administration was through the Pre-Contemplation stage and working on Action and Maintenance items. It is interesting, that there is still a score within the Contemplative items, this is because if a client is presently working within a TC, then he or she is in the process of discovering how to resolve things; it always throws up new issues that the client needs to think about. That might well reflect the fact that Rupert is in that process. The profile that emerged from the scores is comparable to that of McConnaughy et al (1983), 'Participation profile'. They suggest that clients represented "could be expected to have processed considerable information about their problems and would be quite committed to change". They also indicate that a client with this profile would be sensitive to undertaking some form of processes to facilitate change, however, they highlight that individuals might become resistant to "Just Talking in therapy", but their outcome prediction would be for "relatively rapid improvement in therapy".

Unfortunately, Rupert rejected the Anger Diary early on in the pre-workshop stage. Whilst he was working through a 'therapeutic Contract', that isolated him away from the rest of the TC, he claimed to have washed the diary in a pair of overalls. He later explained this as a rebellious act as a stance against a symbol of authority. The second diary that included the two 'indicator bars', was also rejected by Rupert, complaining that he could not be bothered to write things down. However, during several of the workshop sessions, exercises required gleaning information from participant's diaries. With hindsight, he was able to see the importance and relevance of such an activity. Other residents were able to see the graphical; representation of Aggression and Arousal attached to the various ABC's.

The aspect of Rupert's refusal and apparent sabotage of the 'Anger Diary' furnishes us with information concerning how he can still be stubborn and rebellious. Fearing the facilitators perceived ability to gain special insight into his "Psyche" he regained control by removing the threat. These supports the idea that he returns excessive 'Internal Locus of Control' scores by fearing, or at least acknowledging the existence of some external control within his personality.

Self-Esteem scores suggest when you have somebody undergoing change, quite often, depending on where the person is in therapy, self-esteem may be a difficult issue. The factors tends to rise, the further one goes in therapy, for there is an opportunity to reinforce the changed behavior by doing new things. Depending on how long Rupert had been in therapy, he might not have had sufficient time to practice and demonstrates new skills internalize them and therefore get the rise in self-esteem. There was an increase in the total Self-Esteem score, from the first to second administrations, but the increase isn’t large. The general one has risen by three points. The Personal one has remained the same. So, one would have difficulty in saying that there has been a significant rise in Self-Esteem, but the movement is in the right direction. He is well within the Grendon means on all of them; in fact, he is in-line with them. There is no evidence to suggest he is lying. Coopersmith (1967) informs us that persons with high self-esteem scores are more independent in conformity-inducing situations, manifest greater confidence that they will succeed.

The EPQ results indicate some interesting areas. However, we must bear in mind the findings of Cullen (1997) that the Grendon sample are above average in terms of Neuroticism, Criminality and Addictiveness with additional tendencies towards impulsively, risk taking, solitary and disturbed behavior than either the general male population or other prisoners. The Psychoticsm scale assesses attributes such as a preference for solitude, a lack of feelings for others, sensation-seeking, tough mindedness and aggression. Eysenck & Eysenck (1972) suggest that P might better be called "Psychopath" than "Psychotesism". Rupert's P score was above average on first administration but this too had dropped within normal range by the second administration. The Addiction scales on first administration was above the Norms for both populations, clearly indicating addictive personality, This had dropped on the second administration to within normal scores. Criminality scores were extremely high on first administration but by the second administration, this had also dropped within the normal range.

Research conducted by Aleisco and Hollin (1996) into response bias to the EPQ, found that it is prone to a type of 'Offender Stereotype Bias', suggesting the possibility that offenders may be able to "fake Good" on these measures. However, bearing this in mind and interpreting the results as read; neither of the two administrations with regards the Lie scale suggested that nowhere is "faked good".

Rupert's results from the EPQ saw no change between administrations in the Extroversion score of 22. This was above both the Grendon and Normal Male means, suggesting that he is more extraverted than both populations. Hollin (1996) informs us that the extroverted is considered as cortically under aroused and therefore, is continually seeking stimulation to maintain cortical arousal at an optimal level: thus the extroverted is impulsive and seeks excitement. The Neurotecisim score on the first administration was above the score manifested by the general population but similar to that of the Grendon population. He would be considered a 'Neurotic Extrovert' (Hollin 1996) as he had high N score and high E score, if he kept to this then he would condition least well. However, the second administration revealed a difference of some 10 points less, thus indicating that Rupert presented as being less anxious, less worried and generally being more in control. He can now be classified as a 'Stable Extrovert' (Hollin 1996) something that is found in both offender and non-offender populations. Apart from the Extroversion score, all scales showed significant reductions to be within the norms of the normal population. Rupert remained constant on the Extroversion scores perhaps the most difficult score to change; it reflects how he reacts to stimulation e.g. likely to be compulsive. Therefore, coupled with first administration scores, this is likely to be considered bad news. However, coupled with the second scores suggests that Rupert is now more controlled.

For the Locus of Control, the first administration produced a score of 52, which shows internal locus of control, a fairly balanced score that could do with being slightly higher. The second administration, produced the maximum score possible of 72. The problem with that was that he developed a response set on the questionnaire of either answering "Strongly Agree" or "Strongly Disagree". This ties into the high Extraversion scores (EPQ), therefore a likelihood of going to the extremes of one end or the other and could account for the black and white thinking. With reference to the high Psychoticsm scores (EPQ), this suggest that Rupert would have a tendency to go for one thing or another and be less tolerant of ambiguity in other people.

The HDHQ on the first administration returned scores that were all within one standard deviation of the Grendon mean, except for Paranoid Hostility, where the score was within two standard deviations of the Grendon norm and Internal Hostility score that was again within two standard deviations from the Grendon norm. The Direction of Hostility score was within three standard deviations from the Grendon norm, in a negative direction. These first administration scores indicate that Rupert was although similar to the Grendon sample on the majority of the scales, suggesting generally disturbed behavior (Butler 1977), he was significantly more paranoid, less internal and was more likely to direct his anger externally than the Grendon population. When comparing Rupert against a 'normal' population on two scales we find that he was within three standard deviations from the normal mean on 'hostility' and within two standard deviations from the normal mean on direction of 'hostility'. Thus suggesting that in comparison with the average 'normal' person he was significantly more angry and when he was he would direct this externally.

Between the first administration and the second, there was no significant change recorded, except for the 'criticism of others' score that had reduced by one standard deviation. This indicated that whilst in therapy he had started to become less critical of others, as commented on by Kennard (1998) as an expected part of living within a TC. By the third administration, and in comparison with the first, there had been movement in all nine scales. However, in comparison with the Grendon population there was no significant change on 'self criticism', 'acting out hostility' and 'internalized hostility' scales. There was a significant change of two standard deviations for 'criticism of others' and 'externalized hostility' and a difference of one standard deviation for 'guilt', 'paranoid hostility', 'hostility' and 'direction of hostility'. In comparison with normal population means, both the 'hostility' score and the 'direction of hostility' scores are now within one standard deviations the normal range.

To conclude the observations from the HDHQ: Rupert returned very high hostility scores on most levels, significantly higher than the normal population. No significant change was noticed in the second administration. However, by the third administration, not only had there been a significant decrease in scores when compared with the Grendon population, the scores had in fact returned to those found within a normal population.

During the final debriefing session, two paper exercise were completed, the second administration of the 'Skills Evaluation Checklist' (Appendix 8.) and the 'Debriefing from Workshop' (Appendix 10.). Rupert returned a score of seventy-one on the second administration compared with fifty-five, on the first (see table 7.). Therefore, this would suggest that he has increased his skill reference-base, for dealing with anger and conflict by some sixteen points. The debriefing session gained some useful information. Rupert attended all sessions and indicated that he had not previously attended any formal training for 'Anger Management'. When asked to score six categories of the workshop, via a Likert scale, he returned 'good' for each namely: Organisation of session, handouts, overhead transparencies, facilitating staff member, material covered and overall satisfaction with workshop. He found particularly useful the aspect of self-control and how not to feed into situations, especially other people's anger. He now feels he has a greater understanding of how anger is better used in a positive way and more aware of the various potentially dangerous situations. Rupert especially enjoyed the exercises entitled "Rules for Fighting", "Self-Talk" and "Anger the Good Side" and was interested in learning about how other workshop participants viewed anger. On the critical side, Rupert considered that the continual changing of venue to have been an unnecessarily disruptive distractions. Also, he felt that the staff team on the whole were not supportive of the workshops and recalled one staff members comments "the TC has been dealing with anger for twenty five years, so why change now?" However, overall he personally found this a very enlightening experience and that he would have no hesitation to recommend the workshop to other residents who displayed similar behavior.

It’s unfortunate that implementation of new interventions are seldom met without resistance. Richard Laws (1974) reported the failure of a residential "token economy". He found that the very institution that is to benefit could create its own barriers to setting up behavioral programs. This is highlighted by Burchard & Lane (1982), who comment "…behavior-modification advocates who do not recognize that much of their time will be spent trying to change behavior of staff and policy and administrators are in for a rude awakening." Paul Gendreau (1996) in his paper on "Offender Rehabilitation" illustrates several hurdles to future progress in the field of effective treatment of offenders. He identifies these as theoreticsm, failure to effect technology transfer and a deficiency of suitable training programs.

DISCUSSION SUMMARY Back to Contents

One could put the blame for Rupert's behavior firmly in his formative years. This would clearly follow Bewlby's (1951) ideas, which formulated a theory that early maternal depravation was causally related to later antisocial behavior. However, Clark & Clark (1976) remind us that it is the actual quality of upbringing, rather than hypothesized causal links between maternal separation and childhood delinquency. Therefore, we had to look further a field. It is evident from the various assessments conducted throughout this case study, that there is no single etiology to either the offending behavior or his subsequent drug use. However, it is also possible to suggest that there are significant factors that jointly contributing to the behavior and that there is the relationship between his drug use and criminality. Rupert's early offending behavior was mainly alcohol induced. However, when drugs became a problem, the nature of his offending also increased. He also claims to have "dealt drugs in a big way". He has suffered severe personal injuries as a direct consequence of this, namely having both his legs broken and face disfigured by some of his criminal associates.

The EPQ scores are significant and suggest stabilization of some of the initial extreme scales. However, the scale of Extroversion remains high and needs to be an issue to be addressed in the remainder of his time in treatment; it may well be found that being a 'Stable Extrovert' is his baseline within personality. The change on the Locus of Control is significant but remains internal. There is also a word of warning as this might reflect something on his style of dealing with things, without any middle ground being taken into consideration. This is something to be worked on in the future, as this will assist him to move away from his concretic style of thinking. His self-esteem scores suggest that he is benefiting from being in a TC. His self-confidence is increasing as he develops new skills. Therefore, we expect this to continue throughout his stay.

The benefits of attending the Managing Anger & Conflict workshops, were illustrated in the HDHQ and Skill Evaluation Checklist; these both indicated significant improvement. There is also Rupert's general improvement in everyday behavior; he now communicates at a higher level than he once did and is no longer perceived as an intimidator by other residents. If he continues in treatment with the same enthusiasm for working through other aspects of his behavior as he has done around the issue of anger; then his long-term prognosis looks favorable so long as he remains drug and alcohol free.

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REFERENCES

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APPENDIX ONE Back to Contents

FORMAT OF MANAGING ANGER & CONFLICT WORKSHOP

SESSION ONE

The objectives of the first session "Feeling Angry", is to examine the experience of anger and the common belief that to express anger is wrong. To become aware of some of the consequences of suppressing anger. To consider the constructive use of anger. This session is broken down into four exercises. The first exercise entitled 'Angry' allows the group to examine the positive and negative experiences of anger and its emotional, cognitive, physical and behavioral components. Anger may be expressed towards the self as well as others, and may give rise to secondary feelings of guilt, anxiety, and hopelessness "Feelings, Beliefs, Attitudes & Behavior". The next exercise, festering’: It is common for suppressed anger to result in irritability, tension problems and anxiety. The role of anger in physical and psychiatric illness is more complex and speculative. It is likely that chronically unexpressed anger caused, for instance, by disturbed relationships, may result in chronic frustration that could lead to illness. Next, ‘Smouldering’ looks at some commonly-held beliefs that expressing anger is wrong and allows the group to examine their own beliefs about their expression of anger. Being aware of these beliefs can help individuals to express anger in more direct or constructive ways. Finally, Pros & Cons: looks at the negative and positive uses of anger in the light of the groups own experiences. The whole point of this exercise is to emphasise the importance of being able to express anger in a controlled way. Fear of expressing anger can lead to over-control and resentment as well as exploitation by others because of an inability to express dissent. On the other hand, uncontrolled expressions of anger can lead others to fear and avoid them, or to retaliate destructively. It is important that anger is accepted as a valid emotion, a means of communication and a springboard for constructive action. To achieve this, the group must become familiar with expressing it.

SESSION TWO Back to Contents

The objective of the second session "Concealed Anger", is to recognize ways in which anger may be expressed indirectly and also, to consider ways of combating this. There are three exercises: firstly, ‘Hidden Aggressors’ recognises ways in which anger may be expressed indirectly. The methodology behind this is that the grievance is not always clearly stated in indirectly expressed anger so the underlying problem cannot be addressed. Often this means that the person’s behavior appears confusing. Secondly, ‘More Hidden Aggressors’ allow the group members to practice recognizing different types of indirectly expressed anger. This type of behavior is generally based on fear of the consequences of expressing anger directly and a belief that this is wrong or uncivilised. The final exercise of this session ‘Self Defense’ allows the group to consider ways of combating indirectly expressed anger. This is not easy, as one of the characteristics of this type of anger is that the individual can deny that he or she is expressing anger at all. Indirectly expressed anger is difficult to deal with and is generally acknowledged. The aim of the exercise is to encourage participants to recognize and work out strategies for dealing with this type of anger in specific situations that may confront them.

SESSION THREE Back to Contents

The third session, "Anger: The Good Side", has three exercises with the objective of understanding anger as a signal, a form of communication and a motivating force. To introduce the skills needed to control and use anger to achieve constructive solutions. The first exercise called ‘Mole’ suggests that emotions have a signaling function, informing us about the state of our lives. Negative emotions such as depression, anger or anxiety, signal that something is wrong but not precisely what. They can, however, lead individuals to search for the underlying problem and then resolve it. The underlying idea is that anger can warn that personal rights are being infringed and that the individual may be exploited. It is an active emotion, an urge to attack the source of a problem, which can energise and mobilise. Its free expression can be destructive but if controlled, can become the catalyst for constructive solutions. The second exercise is called ‘Anne & Rose’. This illustrates that as well as providing a signal about internal states, emotions also have a role to play in communication with others; somebody in tears is likely to be seen by others as distressed. If individuals let emotions show, other people will be aware of their internal state. However, they may choose to hide their feelings if the situation is not appropriate or not safe. Therefore, the aim of the exercise is to allow the group to develop the skills of expressing emotion when appropriate, and controlling and channelling it when it is not. The final exercise of session three is ‘Profile’. This provides the group with an opportunity to consider what problem anger may present for them. The importance is also emphasised for using anger in a controlled and constructive way. It is noted that as well as informing and motivating anger can act as a means for communication to others. This exercise suggests that if anger is well expressed, others will listen and take notice, perhaps for the first time.

SESSION FOUR Back to Contents

Session four "Be Prepared" is designed to enhance the skills both of expression and control by examining some of the thoughts and beliefs, which underlie anger and understand that these can be modified. It also acknowledges things that make it hard to control anger. Resident group members will appreciate that understanding and modifying the factors that contribute to it can control anger levels. Participants practice reducing anger through relaxation and positive self-talk. There are seven specific exercises in this session: Firstly, ‘Inflamed’. It is important that participants grasp the idea that it is thoughts and beliefs about events which lead to anger, and not the events themselves. Secondly ‘Thoughts’, reinforces the notion that it is Thoughts and not events, that lead to anger. This is a difficult exercise but is useful as it helps individuals to understand that their interpretation of events leads to angry feelings; the events themselves do not. It vividly illustrates that everybody’s feelings and behavior in response to a particular event will be different, as the event has a different meaning to each person, and they will tell themselves different things about it. Thirdly, ‘Distortions’, allows the group to become aware of some common distortions in thinking. Fourthly ‘Beliefs’, looks at the influence of beliefs on the way people feel and behave surrounding anger. Beliefs act as filters which view the world, select and distort information. Several popular beliefs are illustrated that can lead to angry thoughts, feelings and behavior. The overall aim of the exercise is to encourage awareness and beliefs individuals hold and to help them to prevent anger by modifying their beliefs. The fifth exercise is entitled ‘Trigger Happy’, this encourages residents to begin analysing their anger in terms of internal and external factors which make the uncontrolled expression of anger more likely. The ways, in which individuals allow other people to trigger anger, is also an important issue that is worked through. Sixthly, ‘Self Talk’, is intended to provide individuals an opportunity to identify and acknowledge the existence of internal speech and to rehearse alternatives. Further practice is encouraged in order, for these strategies to have maximum. Greater reductions in perceived anger are likely to be achieved as skills and confidences improve with repeated practice in real-life situations. Homework is set to encourage group members to develop their own scheme of positive self-talk and relaxation. Finally, the seventh exercise, ‘Anticipation’. Participants are given some general guidance in controlling anger to the point where constructive dialogue can begin. Anger is seen as a response to multiple factors in oneself and the environment, each of which may be controllable. Anger can be used in a constructive, rather than a destructive, way.

SESSION FIVE Back to Contents

The final session "Managing Conflict", is divided into four exercises. The objectives are to introduce basic guidelines for dealing with conflict. To explore the effect of different responses in a threatening situation and the importance of a friendly-assertive response to threat. To enable individuals to improve their skills in direct confrontation and to encourage a strategic view of 'fighting' in circumstances where it is necessary to 'fight' for one’s rights or those of others. To consider circumstances under which a confrontation should be avoided. Firstly, ‘Threat’ looks at Friendly-assertive behavior and how it can attract similar behavior from others. Hostile behavior tends to do so too! Secondly, ‘Confrontation’ explores how fighting is simply negotiating under conditions of heightened emotion and need not involve condemnation of the other person. The rules or fighting are similar to the rules for negotiating. In a sudden disagreement, the preparatory stages might not be feasible, but applying the rules for managing the conflict will be. If followed, they will prevent the worst excesses of angry behavior and help focus the anger on constructive problem solving. The third exercise ‘Fighting back’ utilizes role-play and highlights guidelines for dealing with situations where direct conflict is unavoidable, giving participants a chance to practice. The final exercise is called ‘Debriefing’ the importance of reviewing each encounter is emphasised. Fighting skills are improved with practice; mistakes offer an opportunity to learn to do better, in future encounters and should not be viewed as personal failures.

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