Paul John Griffiths

Managing Anger and Conflict: Assessment, implementation and evaluation of a cognitive skills workshop within a Therapeutic Community operating as a residential drug and alcohol treatment center.

A RESEARCH PROJECT.

ABSTRACT

This research was originally submitted to the University of Birmingham, it is an analysis of the implementation of a Cognitive Behavioral Intervention namely a Managing Anger & Conflict Workshop taken from the Living Skills II package (Wycherly et. al. 1994). A retrospective study set in the Ley Community, a Drug & Alcohol Rehabilitation Center that’s run as a Residential Therapeutic Community. This study provides a comparison between the therapeutic communities in H.M.P, Grendon, Ley Community and normal Samples.

Although the study is of a predominantly male population, data from female residents is included. Resident’s ages range from 17 to 50. Several psychometric measures were included namely: Hostility & Direction of Hostility Questionnaire (Cain et. al. 1976), Skills Evaluation Checklist (Wycherly et. al. 1994), Stages of Change Questionnaire (McConnaughy et. al. 1983), Two variations of Anger Diaries (Woodward 1998). The study covers a ten-month period from December 1997 to July 1998. The Hostility & Direction of Hostility Questionnaire, was used as an initial selection tool and for continual evaluation every two months.

The results indicate that a resident, who initially returned internal hostility scores, would not benefit from undertaking the workshop. However, residents who externalized their anger and hostility significantly benefited from such an intervention (p. < 0.05, one-tailed). In the comparison between residents who underwent treatment and an untreated sample, the treated residents returned significantly lower re-test scores on Self Criticism, Guilt, Paranoid Hostility, Criticism of Others, Total Hostility, Internalized Hostility and Externalized Hostility (p. < 0.05, one-tailed). Analysis revealed that on comparison with other populations, there, was no difference between Ley Community and H.M.P. Grendon residents, except that the Ley Community’s residents are more likely to externalize their hostility. Ley Community residents, when compared with a normal population, are more likely to have difficulties in processing guilt, be more critical of other people, more hostile, with the possibility of that hostility being acted out.

CONTENTS

1. Introduction.

2. Literature Review.

2.1. Criminal Behavior & Recidivism.

2.2. Offending Behavior & Substance Misuse.

2.3. Therapeutic Communities.

2.4. Therapy & Change.

2.5. Anger.

2.6. Facilitating Change: Organizational Content.

2.7. Summary of literature Review.

3. Description of Hypothesis & Research Design.

FIGURE ONE: Research Design Managing Anger & Conflict Workshops

3.1. Research Area One.

3.2. Research Area Two.

3.3. Research Area Three.

3.4. Research Area Four.

3.5. Research Area Five.

3.6. Research Area Six.

3.7. Research Area Seven.

3.8. Research Area Eight.

3.9. Research Area Nine.

3.10. Research Area Ten.

4. Methods & Procedures.

4.1. Research Setting: The Ley Community.

4.2. Early Intervention.

4.3. Managing Anger & Conflict Workshop (M.A.C.W.).

4.4. Treatment Group Selection.

4.5. Resident Details.

4.6. Assessment Tools.

• Stages of Change.

• Hostility & Direction of Hostility Questionnaire.

• Skills Evaluation Checklist.

• Anger Diary.

• Workshop Debriefing.

• 5. Results & Analysis.

  5.1. A Comparison between ‘Comlpeters’ and ‘Non-Completers’.

  5.2. Control Group Analysis.

  5.3. Group One, Analysis.

  5.4. Group Two, Analysis.

  5.5. Pre & Post Treatment Analysis for Groups One & Two Combined.

  5.6. Pre & Post Treatment Analysis for Residents who Internalize Anger.

  5.7. Pre & Post Treatment Analysis for Residents who Externalize Anger.

  5.8. A Comparison of Ley Community Baseline with Completers.

  5.9. Comparing Ley Community Baseline, Grendon & Normal Mean Scores.

  5.10. Skill Evaluation Checklist Pre & Post Treatment Analysis.

  5.11. Residents Qualitative Feedback.

  5.12. Summary to Results Section.

  6. Discussion.

  7. Conclusion & Recommendations.

  8. References.

  9. Appendices.

  9.1 Assessment Tools.

  9.1.1. Stages of Change Questionnaire.

  9.1.2. Hostility & Direction of Hostility Questionnaire.

  9.1.3. Skills Evaluation Checklist.

  9.1.4. Anger Diaries

  9.1.5. Workshop Debriefing.

  9.2. M. A. C. W. Outline.

  9.3. Raw Data.

  9.3.1. Baseline H.D.H.Q.

  9.3.2. Control Group H.D.H.Q.

  9.3.3. Group One H.D.H.Q., and S.E.C.

  9.3.4. Group Two H.D.H.Q., and S.E.C.,

  9.4. Authority to Enter into Research.

  

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  1. INTRODUCTION Back to Contents

  This is a retrospective study that utilizes a ‘realist’ approach to criminology. The Oxford Handbook of Criminology (Maguire, Morgan & Reiner 19977) provides a definition postulated by Young (1997, p.486), namely "a realist approach sees the development of criminal behavior over time. It breaks down this trajectory of offending into component parts and notes how different agencies interact". Although, the authors personal experiences have furnished an observational understanding of "What Works", this research never the less follows the methodology and working principles of some formidable contemporary English Forensic Psychologists namely: Eric Cullen, formerly of HMP Grendon; Lawrence Jones, formerly of HMP Wormwood Scrubs; and Roland Woodward, formerly of HMP Gartree to have emerged from the Prison system in recent times. All three are therapeutic innovators responsible for some of the ‘cutting edge’ Therapeutic Communities, within England’s Prison system. It is a disappointing reflection on the Prison Department when we learn that some individuals have recently been recruited by private organizations to provide the degree of psychological intervention that is becoming increasingly difficult within the Statutory Public Sector.

  The author spent the final eighteen months of a four and a half-year sentence at the Government’s Therapeutic Prison ‘Grendon’. He considers himself fortunate to have been furnished with a particular insight into one alternative method for the rehabilitation of offenders. This experience led to an interest in not only rehabilitation but also into effective systems specifically with regards to the use of Therapeutic Communities within such a context of treatment. He subsequently read Psychology and Law at Oxford Polytechnic, graduating in 1991. After completing two ‘Assistant Psychologist’ positions for the South Birmingham Health Authority, he secured a ‘Group Workers’ position in a treatment center outside Oxford in 1994; the very setting for this piece of research. The treatment center was the Ley Community, a Therapeutic Community operating as a drug & alcohol rehabilitation center, offering a treatment service to many agencies including Health, Social Services, and the Criminal Justice System. With regards to the latter, treatment is undertaken as a possible alternative to custodial sentence.

  The belief that community sanctions without any form of rehabilitation are somehow going to reduce offending behavior is not a justifiable position (McGuire 1995). Therefore, it is the authors opinion that ‘Therapeutic Communities’ allow individuals from all types of social economic backgrounds the opportunity to live together. It allows time to highlight problematic feelings, beliefs, attitudes and behavior, and an environment to identify and implement coping strategies. Kennard (1998) reiterates that "Therapeutic Communities are a treatment in their own right", i.e. ‘periods of living together’. However, there is a need to apply some form of clinical therapeutic intervention, additional to the milieu regime offered by the Therapeutic Community. The team of Andrews, Hoge, Bonta, Grendreau & Cullen (1990a) in their paper on risk assessment suggest that criminogenic interventions, such as ‘Anger Management’ can have a positive effect on reducing recidivism. Whereas client centered interventions for example ‘Self-Esteem Enhancement Workshops’, have little long-term effect.

  The Ley Community has utilized a number of confrontational interventions for dealing with individuals who inappropriately express their anger. These include "the General Meeting"; where a resident stands facing all the seated community members, with his or her hands held behind his or her back. He or She has to tolerate verbal abuse, heated comments and continual shouting by both residents and staff. This ‘therapeutic tool’ might continue for anything up to three hours. Another method, usually as a consequence leading on from a ‘General Meeting’ would be to place the resident on a ‘Hard Works Contract’, a period of isolation, working in the grounds, supervised by another resident, known as a ‘Runner’. The Runner would be the only link between the community and the resident on ‘Contract’. During this period of unspecified time, he or she would not be allowed to speak to other residents and the other community members would be prohibited from giving eye contact or reassurance in return. The final method of dealing with anger would be for the individual to utilize the twice weekly ‘Confrontation Groups’. Unfortunately, many of the above remedies acted as a catalyst for the individuals own anger and often produced behaviors that contravened the ‘Community Rules’ of ‘No Acts or Threats of violence’. Resulting in residents being asked to leave treatment, usually without any skills in anger management being acquired.

  The author, having personally benefited from undergoing specific skill acquisition training at HMP Grendon, and having acknowledged several short comings within the then current treatment regime on offer at the Ley Community, began to research possible alternative interventions and formulate a variety of research questions. The intervention at the center of this piece of research 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.

  The research interests at the center of this study are as follows:

• The establishment of a baseline for Hostility & Direction of Hostility Questionnaire. This enables a risk assessment to be conducted on future residents at the referral stage and also highlights those individuals that could benefit from undertaking additional ‘Anger Management’ training whilst in treatment for their drug addiction.

• The comparison of the Grendon Sample with the Ley Community Residents. There is a need to contrast the Ley Community residents with other previously normed groups.

• The implementation of Managing Anger & Conflict Workshops, the analysis and evaluation of the results and to consider the appropriateness of the chosen package for the Ley Community residents.

• A comparison of the differences between Workshop Completers and Non-Completers.

• A comparison between residents who internally & externally direct their anger.

• The design and evaluation of the use of Anger Diaries.

In order to place this research into theoretical context, the first section ‘literature Review’, illustrates present scientific understanding and research into the connection between criminal behavior and recidivism, specifically, the interrelationship between offending behavior and substance misuse. The area of Therapeutic Communities and the links between therapy and change are explored with reference to the emotion of anger. Facilitating Change is the sub-section that provides information with regards the implementation of change with respect to both methodological structure and program content, primarily from an Organizational Psychological perspective.

Next the Hypothesis are put forward in detail stating the ‘Null-Hypothesis’, ‘Research Hypothesis’ and ‘Alternative Hypothesis’. The various Statistical Tests chosen are explained along with the ‘Significance Level’ and the ‘Rejection Region’. The following section entitled 'Methods & Procedure’, introduces the research design, the research setting, the Organisation, the environment, the resident’s selection procedure and the resident profile.

The 'Results' section collates all the data into tables, so that analysis can support or reject the hypotheses postulated in the previous section. The sixth section 'Discussion' comments on the results explores and interprets the data. The final sections ‘Conclusion and Recommendations’ draws the research together and makes suggestions with respect to future interventions and overall program integrity.

 Back to Contents

2. LITERATURE REVIEW Back to Contents

This Research Project is not simple or straight forward for it investigates not only the implementation and effectiveness of a cognitive behavioral treatment workshop for residents, but also, at the Organizational level with issues around change and adopting alternative clinical approaches from the Staff perspective. The majority of the residents selected had complications of not only having committed various criminal offences in the past, but had and have additional current behavioral problems due to their addiction and substance miss-use. The majority of the staff had themselves graduated from resident status to staff member without attaining formal educational qualifications or professional training. Therefore there was need to deal with each issue separately, namely: Criminal Behavior & Recidivism; Offending Behavior & Substance Misuse; Therapeutic Communities; Therapy & Change; Anger, and finally; Facilitating Change, with respect to organizational content.

2.1. CRIMINAL BEHAVIOUR & RECIDVISM Back to Contents

Criminality has long been the center for research. Early work conducted by Aichorn (1935) with regards to ‘delinquent personality’, as described by Coopersmith (1967, p.137) 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) states that in terms of prevention "too much effort has been expanded on unproductive attempts to change the criminal disposition of offenders". Hollin (1989) believes that by focusing the intervention on the offender, treatment localizes the actual cause for the offending behavior within that individual. This is clearly a ‘Classical’ or ‘Positivistic’ viewpoint, which suggests that clinical intervention can control unacceptable behavior. However, 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".

In a review of outcome studies using meta-analysis, conducted by Martinson (1974) as cited by Hollin (1996), a "bleak conclusion for men and women under treatment" was made. He found that only a small proportion of the studies indicated efficacy of clinical intervention and drew the conclusion that "nothing works". However, when Thornton (1987) cited by Hollin (1996, p.204) re-examined the data, he asserted that "psychological therapies can reduce recidivism"; and stated that the one conclusion that cannot be drawn is that "Nothing works". But Andrews, Zinger, Hodge, Bonta, Gendreau and Cullen (1990a), showed that "suitable forms of intervention at the right time are able to reduce recidivism by fifty three percent". Indeed, early research conducted by Walker, Farrington, Tucker (1981) had already found a correlation between the number of previous convictions and reconviction rates, for juvenile first offenders.

2.2. OFFENDING BEAVIOUR and SUBSTANCE MISUSE Back to Contents

There exist several relationships between substance misuse and criminal behavior. Some of these have been described by Mary McMurran (1996 adapted from table 8.2, p.225) 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. Typical ‘Addict’ behavior is that everything has to be obtained instantly. "When addicts need money for drugs they need it fast" (Feldman 1993, p.276). The criminal who abuses illegal substances including alcohol often steals to obtain money in order to purchase more drugs: these acts are not likely to be thought out with any precision, Conklin (1972) as cited by Hollin (1989, p.75) suggests they are generally aimed at easy targets. Feldman (1993, p.276) in citing the work of Moore (1983) and Wilson & Herrnstein (1985), states that 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. He goes onto suggest that "they have 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".

McMurran (1996, p212) cites earlier research conducted by McMurran and Hollin (1989a) who 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. Thirty-eight percent of them admitted at least one alcohol-related problem. From the research of Thornton, Cookson and Clark (1990) as described my McMurran (1996, p.212-213), we find that seventy five percent of their offending sample had used drugs at some time, compared with twenty-one percent for their non-offending control group. 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".

Hollin (1996) highlights the potential for offenders to lie or manipulate the facts when they are arrested. He reminds us that they are also "often asked if they were using substances at the time of the offence and whether this was related to their crimes". Therefore, it may be beneficial for the offender to blame alcohol or drugs for an antisocial act, rather than accept responsibility themselves. If we consider that there may be no causal relationship between substance use and criminal activity but remembering that drug & alcohol use remains a contributory factor in offending behavior, then individuals must take responsibility for their own actions. It’s the authors opinion, that this duel-diagnosis of ‘substance misuse’ and ‘offending behavior’, must therefore, be dealt with simultaneously, in order for intervention to be effective. Therefore, a cognitive behavioral intervention is appropriate.

2.3. THERAPEUTIC COMMUNITIES Back to Contents

The psychological dictionary definition provided by Reber (1988, p.769) of ‘Therapeutic Community’, is of "a social, cultural setting established for therapeutic reasons and within which those persons needing therapy live". Therapeutic factors of a group were identified by Yalom (1995), to consist of: "‘Instillation of hope’, ‘Universality’, ‘importing information’, ‘altruism’, ‘The corrective recapitulation of the primary family group’, ‘development of socializing techniques’, ‘Imitating behavior’, ‘Interpersonal learning’, ‘Group cohesiveness’, ‘Catharsis’ and ‘Essential factors’" (as cited by Barnes et. al. 1999). Kennard (1994) proposed that therapeutic communities consist of four functions: "contain, sustain, maintain and entertain" (cited by Lewis 1997, p.208-209). It is left to Yalom (1985 cited by Woodward 1997. p.226), to describe core therapeutic effects to "consist of those aspects of the experience that are intrinsic to the therapeutic process – that is, the bare-boned mechanisms of change’.

It’s Wexler (1997, p.169-169) who suggests that a higherarchical regime, works better for substance abusers than any other. The American "Stay ‘n Out" prison project was designed for convicted offenders with substance misuse issues (Wexler1997, p.167). The project was set up in 1977, as a Therapeutic Community, in New York and jointly funded, between non-profit making organizations and State Agencies. Wexler, Falkin and Lipton (1990 cited by Wexler 1997, p.164-165) conducted research into a three-year follow up of male inmates from another New York State Prison, who had participated in a "Stay ‘n Out" program. The results illustrate that inmates who went through the program had a re-arrest rate of 26.9% vs. 40.9% for the non-treatment control group.

The basis for this current piece of research is a Therapeutic Community, which has evolved out of a ‘Concept House’. The model of "Concept House", was borrowed from the United States and began as an offshoot of Alcoholics Anonymous. It utilizes the notion of concepts, for example ‘the onion concept’, ‘act as if concept’ and ‘the roller-coaster concept’. In other words, maxims, which individuals can relate to aspects of their own lives, in order to move forward in therapy. In 1958 Chuck Dederich a recovering alcoholic, founded Synanon; one of the first ‘Concept Houses’, in California USA. Wexler (1997, p.168) cites Kennard (1983) who informs us that ‘Dederich’ broke away from Alcoholics Anonymous, 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’. The Ley Community’s first Director John McCabe (deceased), was himself a graduate from Phoenix House another Concept House, in New York (Toon & Lynch 1994, p.232). The emphasis was ‘Self Help’, based originally around Confrontational Group Work Techniques in order, to challenge the very basis for individuals drug and alcohol misuse.

Within the English prison system Therapeutic Communities also exist: The best known is HMP Grendon opened in 1962, situated outside the town of Aylesbury in Buckinghamshire. Cullen (1997, p.76-75) states that Grendon is internationally renowned for it's pioneering socio-psychiatric treatment of serious offenders with histories of personality disorders and operates as a collective of therapeutic communities. The research of Genders & Player (1995, p.65) 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".

2.4. THERAPY and CHANGE Back to Contents

Treatment can be successful only if it is rigorously and properly implemented. Therefore, treatment integrity is a vital ingredient for any intended program. Hollin (1996,p.258), 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 can enhance and facilitate effective rehabilitation programs.

Most programs can be divided into three distinct overlapping parts: Assessment, Intervention and Relapse Prevention (Epps 1996, p.164). 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".

We have already discovered that some therapeutic approaches are not appropriate for general use with offenders. With respect to the type and style of service Andrews et al. (1990a) suggest 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". Garrett (1995) compared 111 studies between 1960 and 1983 that 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". Efforts are presently being made to "bridge the research-practice divide by distilling the complexities of the meta-analysis into blueprints for the design of effective programs" (Hollin 1996, p.257).

Prochaska, DiClemente and Norcross (1992) tackled the subject of assessing and quantifying therapeutic change. What emerged from their research was 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 there 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.

2.5. ANGER Back to Contents

A model postulated by Megargee (1966) as cited by Feldman (1993, p.163) and Hollin (1989, p.75) suggests the basis for anger occurring is when intense feelings or impulses exceed the individual’s level of control. The, over-controlled person will have stronger inhibitors as, "anger will occur only 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". Where as, ‘Conflict’ can be defined as a "violent collision, a struggle or contest, a battle, or a mental struggle" (Chambers 1971, p.221). However, despite its costs, anger can be adaptive and conflicts resolved.

Many of the individuals that pass through the Criminal Justice System are assessed as having had a Conduct Disorder as a child. Browne and Herbert (1997, p.192) cite Quay (1986) who defines ‘Conduct Disorder’ as anything from: ‘fighting’, ‘hitting’, ‘assaulting’, ‘temper tantrums’, ‘disobedience’, ‘defiance’, ‘destruction of property’, to ‘impertinence’, ‘smartness’, ‘impudence’, ‘uncooperation’ and ‘inconsideration’ and the list goes on. Many of the resident volunteers chosen for this research have demonstrated some of these attributes in the past. Bandura (1973) a social learning theorist, suggests that "anger enables individuals to learn new behaviors". It can either encourage or discourage them to use these behaviors by observing them being reinforced or punished. It can also act as a social prompt, facilitating similar behaviors in others. Moreover, modeling and especially pro-social modeling are prime examples. Yalom (1995), included ‘Imitative Behavior’, in his summary of what constituted essential therapeutic factors (Ibid. p.13). In other words, aggression can affect not only the behaviors but also the attitudes and values of the observers.

Hollin (1989, p.75) cites Blackburn (1968) who 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". Horn and Towl (1999) describe the research of Cundy (1995) who asked 200 women prisoners ‘what made them most angry’. Factors related to imprisonment, which angered the women included ‘pettiness’, ‘bitchiness’, ‘lack of space for expression’, ‘loss of friends’ and ‘loss of control over life’. Outside prison, issues that angered the women, included being ‘frustrated’ mainly about money or their children, ‘threats’ made to family members, and ‘anger’ connected to sexual and physical abuse. Rouse (1988) as described by Brown and Herbert (1997, p.80), 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), which 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 him in the same unfriendly fashion.

Studies that center on 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 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.

Work with forensic patients who have a serious mental health problems, has been the focus of research conducted by Raymond Navaco, a Professor at the University of California, USA, and one of the present day theorists and clinical practitioners. His material is especially useful in working with other client groups (Warren 1998). He states that anger has different functions: "energizing, expressing, signaling, disruptive, defensive and dramatic". Navaco’s ideas on ‘Controlling Anger’ are used within the ‘Managing Anger & Conflict Workshop’, the subject of this research study (Wycherely et al 1994). Novaco (1978) as described by Browne & Howells (1996, p.195-196), 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".

2.6. FACILITATING CHANGE: ORGANISATIONAL CONTENT. Back to Contents

Roberts (1995) cited by Lewis (1997, p.209) considers, that the "Therapeutic Community requires commitment from staff and residents and has in the past lost credibility where the name ‘Therapeutic Community’ has been applied to organizations which never reach the level of containing a healthy social environment, or, subject to destructive processes had become irretrievably damaged". An article entitled ‘Context for Change’ by Lewis (1997, p.209-210) supports the need for "systematic and supportive training" in order to "increase the competence and confidence of staff".

A formula for effective Organizational change was proposed by David Gleicher in the 1960’s (Buchanan & Huczynski 1997, p.473). He suggested that "Organizational change will only occur when "K x D x V > C", where ‘K’ represents knowledge of first practical steps, ‘D’ represents dissatisfaction with the status quo, ‘V’ represents the desirable vision of the future, and ‘C’ represents the cost of doing something. Thus, where dissatisfaction is high, and where there is a strong vision of a desirable future, but no clear ideas about how to proceed, change is unlikely to take place". Eccles (1994) as described by Buchanan & Huczynski (1997, p.473), identifies eight preconditions for successful change; "pressure for change; a clear and shared vision of the goal and direction; effective liaison and trust between those concern; the will and power to act; capable people with sufficient resources; suitable rewards and accountabilities; actionable first steps and finally a capacity to learn and to adapt". He suggests that where these factors are present then the organization's readiness for change will be high.

Tilles (1968) assess major strengths and weaknesses of organizations by undertaking a SWOT Analysis, standing for strengths, weaknesses, opportunities and threats. It can also be used to "assess whether there are opportunities to exploit further the unique resources or core competencies of the Organisation". The idea is to take a structured SWOT analysis, in order to provide information, which can contribute to the formulation of the modus operandi for the research project.

When too high a price is placed on the congruity and spirit of the group, loyalty to the group’s previous policies, or to the group consensus, overrides the conscience of each member, thus excluding the realistic appraisal of alternatives (Janis 1972). Janis (1972) was interested in this phenomenon and coined it "Groupthink". He suggested that cohesive groups become over-optimistic and take extraordinary risks without realizing the dangers, mainly because of the lack of discord. These groups are "quick to find rationalizations to explain away evidence that does not fit their policies". In fact, there is a tendency to be "blind to the moral or ethical implications of a policy". Victims of Groupthink quickly get into the habit of "stereotyping their enemies or other people and do not notice discordant evidence". If anyone starts to voice doubts the group exerts subtle pressures to keep him or her quiet, for he or she is allowed to express doubts but not to press them home. Members of the group are careful not to discuss their feelings or their doubts outside of the group, in order not to disturb the group cosiness. "Unanimity is important, therefore, once a decision has been reached, any divergent views are carefully screened out in people’s minds (Janis 1972)". Furthermore, members of Groupthink set themselves up as ‘bodyguards’ to the decision; thus the "doctrine of collective responsibility is invoked to stifle dissent outside of the group" (adapted from Handy 1993).

The result of Groupthink is that the "group looks at too few alternatives, is insensitive to the risks in its favorite strategy, finds it hard to rethink a strategy that is failing and becomes very selective in the sort of facts it sees and asks for" (adapted from Handy 1993, p.163). If significant effort is expended on therapeutic education then "the destructive process can be averted and a healthy social environment will be maintained" (Lewis 1997).

Woodward (1997, p.225) cites Kaplan and Shaddock (1991) who inform us that the staff group is "a powerful vehicle; but just as it has the power to heal, it also has the power to harm, as any therapeutic tool". One cannot expect everyone in an Organisation to respond in an identical manner to specific change proposals. "Different individuals and groups are likely to be affected on different ways, and are also likely to perceive the implications differently from those proposing to implement the change" (Buchanan & Huczynski 1997). Change can be threatening, especially for those without training and pragmatic skills. Change presents those involved with; new situations, new problems and challenges, and with ambiguity and uncertainty. Many people find change, or the thought of change, painful and frustrating.

One way forward is for the staff team to become focussed and increase arousal in positive ways, instead of taking a negative stance against innovation and effective practice. The research of Porter, Lawler & Hackman (1975, p.356) believe that "strong positive, encouraging statements increases arousal in some performance situations". Therefore, by helping the individuals to become committed to the organization's aims, and making sure they realize, that members are an essential ingredient within that Organisation, then dramatic changes, can be made.

2.7. SUMMARY TO LITERATURE REVIEW Back to Contents

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; specifically aimed at reducing offending behavior for individuals who misuse various substances.

There is now a firm base from which to design effective treatment programs (Hollin 1996). Andrews et al (1990a) identified cognitive behavioral approaches to be most effective. Cognitive Behavioral Therapy is not in opposition to ‘12-Step’ modalities for example ‘Alcoholics Anonymous’ or psychobiological models of substance abuse; in-fact, Beck et al (1993) found that the alternative systems might be actually complementary. Residential programs can be effective, they should be "linked structurally with community-based interventions" (Hollin 1992).

The various stages of change can be assessed in order to assign appropriate treatment, at a time when individuals are open to such intervention (Prochaska et. al. 1992). Novaco (1978) found that anger, can energize and be expressive. It can act as a signal or be extremely disruptive. Anger also has the ability to be used as a defensive technique and the potential to be extremely dramatic at times, thus requiring a specific intervention in order to facilitate change.

Implementing change can have its own drawback; we remember the effects of Groupthink as put forward by Janis (1972). Therefore, it is crucial when intending to introduce staff training to be aware of the theoretical and research framework that will underpin the future intended work of the staff team. Woodward (1997, p.224) states that, it is important to have a framework that is understood by all the staff, one "that can be used in a pragmatic way, and within which to work in order to make meaning of what is happening within the Therapeutic Community". It is therefore put forward that the "strong positive, encouraging statements" considered essential to facilitate staff development (Porter et.al. 1975) are the very ingredients that can have a positive impact on the resident population, especially when learning new skills, for example dealing with ‘anger and conflict’.

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3. DESCRIPTION of HYPOTHESIS & RESEARCH DESIGN

From the research reviewed in the previous section, there emerged several important findings around not only anger, but also the interrelationship between criminality and drug abuse. Therefore, it is important to establish exactly what hypotheses are to be tested within this Research Project. The following format for stating the research questions will be used: ‘Null-Hypothesis’, ‘Research Hypothesis’, ‘Alternative Hypothesis’, ‘Statistical Tests’, ‘Significance Level’ and finally the ‘Rejection Region’ will be illustrated.

3.1 Research Area One. Back to Contents

This research is initially interested in not only assessing the stages of change that the residents selected for treatment fall within, but also in ascertaining what differences, if any, are found between those residents who went on to complete the workshop and those who chose to withdraw. The psychometric measure is the ‘Stages of Change Questionnaire’ designed by McConnaughy, Prochaska and Velicer (1983).

i. Null Hypothesis. There will be no difference between residents who completed the workshop and those residents who do not, when compared with the Stages of Change Questionnaire.

Research Hypothesis. There will be a difference between those residents who complete the workshop and those who do not, when compared with the Stages of Change Questionnaire. Namely, that residents who are ‘pre-contemplators’ will be unlikely to complete the workshop.

ii. Statistical Test. The Mann-Whitney Unpaired Sample Test is chosen because, the assumptions of normal distribution can not be made.

iii. Significance Level. Let a = .05 N = 7 (non-Completers), N = 14 (Completers).

iv. Rejection Region. Since the direction of the difference is predicted, a one-tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test.

Two Psychometric measures, namely the ‘Hostility and Direction of Hostility Questionnaire (H.D.H.Q.)’ and the ‘Skills Evaluation Checklist (S.E.C.)’ are used to analyze treatment effects. The overall research design utilizing the H.D.H.Q., is illustrated in Figure One. For Group One: Between the first and second administration of the H.D.H.Q., will attended the MACW and received treatment. The period between second and third administrations was classified as ‘follow-up’. With respect to Group Two, the interval between the first and second administration will be classified as a ‘waiting period’ thus, acting as an internal control for Group One. Treatment will be implemented between the second and third administration, when residents will attended the MACW.

Figure One: Research Design Managing Anger & Conflict Workshops.

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The time period will cover approximately six months and will include three specific groups being tested together, every two months. The original design was to include three resident groups that would undergo treatment, over three independent eight-week sessions. However, due to the Ley Community’s internal dynamics, the final design can only allow two resident groups to be treated over a six-week period. Therefore, the third group will be observed as a Control, although, they had sufficient ‘Total Hostility (H)’scores to have been included in the intervention.

3.2 Research Area Two. Back to Contents

The second ‘Research Area’ analyses the separate H.D.H.Q. administration effects of all three groups. Specifically, Group Two, looking at the ‘waiting period’ between administration ‘A & B’, thus assessing the internal control aspect for Group One. With respect to the initial ‘research Areas’ (figure one): Group One, Research Hypothesis 1 and for Group Two, Research Hypothesis 1 and 2, are the central core themes.

i. CONTROL GROUP

Null Hypothesis. The test results of the H.D.H.Q.’s eight sub-sections will not differ between Pre and Posttests.

Research Hypothesis. Post Test results will demonstrate lower sub-section scores than the Pre Test Results.

Alternative Hypothesis. Posttest results will demonstrate an increase in the sub-section scores, than the Pre Test results.

GROUP ONE

Null Hypothesis. The test results of the H.D.H.Q.’s eight sub-sections will not differ between Pre and Posttests.

Research Hypothesis 1. Post Treatment Test results will demonstrate lowered Total Hostility Score, than the Pre Test Results.

Research Hypothesis 2. Post Test results will demonstrate a lower score on sub-scales, than the Pre Test Results.

Alternative Hypothesis. Posttest results will demonstrate an increase in the Hostility score, than the Pre Test results.

GROUP TWO

Null Hypothesis. The test results of the H.D.H.Q.’s eight sub-sections will not differ between Pre and Posttests.

Research Hypothesis 1. Post Treatment Test results will demonstrate a lowered Total Hostility Score, than the Pre Treatment Test Results.

Research Hypothesis 2. The Test results for H.D.H.Q. sub-scales, Pre & Post the waiting period will show no significant differences.

Research Hypothesis 3. Post Test results will demonstrate a lower score on sub-scales, than the Pre Test Results.

Alternative Hypothesis. Posttest results will demonstrate an increase in the Hostility score, than the Pre Test results.

ii. Statistical Tests. The Wilcoxon Matched-Pairs Signed-Ranks (Exact) Test, is chosen because the study employs two related samples as it produces difference scores that may be ranked in order of absolute size.

iii. Significance Level. Let a = .05 N = 7 (all three groups)

iv. Rejection Region. Since the direction of the difference is predicted, a one tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test.

3.3 Research Area Three. Back to Contents

The third ‘Research Area’ assesses the overall treatment effect for the combination of data for both groups using the H.D.H.Q.

i. Null Hypothesis. The test results of the H.D.H.Q.’s eight sub-sections will not differ between Pre and Post Treatment Tests.

Research Hypothesis 1. Post Treatment Test results will demonstrate a lowered Total Hostility Score, than the Pre Treatment Test Results.

Research Hypothesis 2. Post Treatment Test results will demonstrate a lower score on sub-scales, than the Pre Treatment Test Results.

Alternative Hypothesis. Post Treatment test results will demonstrate an increase in the Total Hostility score, than the Pre Treatment Test results.

ii. Statistical Tests. The Wilcoxon Matched-Pairs Signed-Ranks (Exact) Test, was used for comparing pre & post intervention means for the combined results of both groups One & Two. It is chosen because the study employs two related samples as it produces difference scores that may be ranked in order of absolute size.

iii. Significance Level. Let a = .05 N = 14

iv. Rejection Region. Since the direction of the difference is predicted, a one tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test.

3.4. Research Area Four. Back to Contents

The forth ‘Research Area’ uses the H.D.H.Q., and look at the treatment effect of residents who internalize their hostility.

i. Null Hypothesis. There is no difference between Pre and Post Treatment Scores. That is residents who internalize their hostility do not benefit from attending the Managing Anger and Conflict Workshops.

Research Hypothesis. Course members with high Internal Scores; Pre Treatment Tests were significantly less likely to reduce their ‘Internal Hostility’ score post treatment.

Alternative Hypothesis. Course members with high Internal Scores on Pre Treatment Tests; will demonstrate a lower score on sub-scales, post treatment.

ii. Statistical Test. The Walsh Test (Siegal 1956, p.83) is chosen because the study uses two related samples, and because the assumption that the numerical difference scores came from symmetrical populations.

iii. Significance Level. Let a = .05 N = 4

iv. Rejection Region. Since the direction of the difference is predicted, a one-tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test (H. = accept m 1 > 0, if d1 > 0).

3.5 Research Area Five. Back to Contents

The fifth ‘Research Area’, uses the H.D.H.Q., and looks at the treatment effect of residents who externalize their hostility.

i. Null Hypothesis. There is no difference between Pre and Post Treatment Scores. That is residents who externalize their hostility do not benefit from attending the Managing Anger and Conflict Workshops.

Research Hypothesis 1. Course Participants with high Pre Course External Hostility scores were more likely to demonstrate lower Total Hostility scores Post Treatment.

Research Hypothesis 2. Course Participants with high Pre Course External Hostility scores were more likely to demonstrate lower sub-scale scores Post Treatment.

Alternative Hypothesis. Course Participants with high Pre Course External Hostility scores were more likely to demonstrate an increase in Total Hostility scores Post Treatment.

ii. Statistical Test. The Wilcoxon Matched-Pairs Signed-Ranks (Exact) Test is chosen because the study employs two related samples as it produces difference scores that may be ranked in order of absolute size

iii. Significance Level. Let a = .05 N = 9

iv. Rejection Region. Since the direction of the difference is predicted, a one-tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a two-tailed test.

3.6 Research Area Six. Back to Contents

The sixth ‘Research Area’ that the H.D.H.Q. investigates, is the treatment effect of those residents who completed treatment, compared against the Ley Community’s Baseline.

i. Null Hypothesis. There is no difference between course participants scores and the Ley Community’s Baseline scores of the H.D.H.Q.

Research Hypothesis. The H.D.H.Q. score of course participants – Post Intervention will be significantly less than the general population of the Therapeutic Community’s Baseline.

ii. Statistical Test. The Mann-Whitney Unpaired Sample Test is chosen because the assumptions of normal distribution can not be made.

iii. Significance Level. Let a = .05 Baseline N = 70, Completers N = 14.

iv. Rejection Region. Since the direction of the difference is predicted, a one tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test.

3.7 Research Area Seven. Back to Contents

The seventh ‘Research Area’ uses the ‘Skills Evaluation Checklist (S.E.C.)’, which is the internal measure from the "Managing Anger & Conflict Workshop". It is administered before and after the workshop, in order to ascertain what skills are present for dealing with anger and conflict. Both group test results, have been combined for this analysis.

i. Null Hypothesis. The results of the Skills Evaluation Checklist will not differ between Pre and Post Treatment Tests.

Research Hypothesis. Course members will by the end of the course, increase their skills for dealing with anger and conflict as measured by the Skills Evaluation Checklist. Therefore, The Post Treatment Test score results will be greater than the Pre Treatment Test score results.

Alternative Hypothesis. Post-Treatment test score results will be less than the Pre Treatment, test score results.

iii. Significance Level. Let a = .05, N = 14

iv. Rejection Region. Since the direction of the difference is predicted, a one tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test.

3.8 Research Area Eight. Back to Contents

The eighth ‘Research Area’ using the Skills Evaluation Checklist (S.E.C.), investigates the treatment effect for resident who internalize their hostility or anger.

i. Null Hypothesis. There is no difference between Pre and Post Treatment scores of the S.E.C, for residents who are identified as having high scores of the H.D.H.Q.’s ‘Internalized Hostility’ sub-scale. That is residents who internalize their hostility do not benefit from attending the Managing Anger and Conflict Workshops.

Research Hypothesis. Course members identified with high ‘Internalized Hostility (IH)’ scores on the H.D.H.Q., will not increase their scores on the S.E.C., Post Treatment.

Alternative Hypothesis. Course members identified with high ‘Internalized Hostility’ scores on the H.D.H.Q., are more likely to increase their scores on the S.E.C., Post Treatment.

ii. Statistical Test. The Walsh Test (Siegal 1956, p.83) is chosen because the study uses two related samples, and because the assumption that the numerical difference scores came from symmetrical populations.

iii. Significance Level. Let a = .05 N = 4

iv. Rejection Region. Since the direction of the difference is predicted, a one-tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test (H. = accept m 1 > 0, if d1 > 0).

3.9 Research Area Nine. Back to Contents

The ninth ‘Research Area’ uses the S.E.C., and investigates the treatment effect for residents who externalize the hostility or anger.

i. Null Hypothesis. There is no difference between Pre and Post Treatment scores of the S.E.C, for residents who are identified as having high scores of the H.D.H.Q.’s ‘Externalized Hostility’ sub-scale. That is residents who internalize their hostility do not benefit from attending the Managing Anger and Conflict Workshops.

Research Hypothesis. Course members identified with high ‘Externalized Hostility (IH)’ scores on the H.D.H.Q., will increase their scores on the S.E.C., Post Treatment.

Alternative Hypothesis. Course members identified with high ‘Externalized Hostility’ scores on the H.D.H.Q., are less likely to increase their scores on the S.E.C., Post Treatment.

ii. Statistical Test. The Wilcoxon Matched-Pairs Signed-Ranks (Exact) Test is chosen because the study employs two related samples as it produces difference scores that may be ranked in order of absolute size

iii. Significance Level. Let a = .05 N = 9

iv. Rejection Region. Since the direction of the difference is predicted, a one-tailed region of rejection is appropriate. The region of rejection consists of all values equal to or less than a = .05 for a one-tailed test.

3.10 Research Area Ten. Back to Contents

Finally ‘Research Area’ Ten compares the Ley Community Baseline against the norms generated from a normal population, and also for H.M.P. Grendon.

i. Null Hypothesis 1. There is no difference between the Ley community Baseline and the normal population

Null Hypothesis 2. There is no difference between the Ley community Baseline and H.M.P. Grendon Norms

Research Hypothesis 1. The Ley Community Baseline will be higher than the normal population.

Research Hypothesis 2. The Ley Community Baseline will be lower than the H.M.P. Grendon Norms.

Alternative Hypothesis 1. The Ley Community Baseline will be lower than the normal population.

Alternative Hypothesis 2. The Ley Community Baseline will be Higher than the H.M.P. Grendon Norms.

ii. Statistical Test. Visual Analysis of the Mean Score with reference to the standard deviation.

iii. Significance Level. Let a = < + or -1 Sd. H.M.P. Grendon N = 210: Ley Community N = 70: Normal Population N = 360.

iv. Rejection Region. The direction of the difference is predicted. Therefore, the region of rejection, consists of all values less than one Standard Deviation (a = 1 Sd.).

• 76% 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 are 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.

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4. METHOD and PROCEDURES

This section provides the methodology behind this research study. Firstly it establishes the background information required to appreciate the complexities of a therapeutic community, especially one that has evolved out of a philosophy imported from the United States of America in the format of a ‘Concept House’. Secondly, the natures of the interventions are explained and how this came about following negotiation with Senior Management. The third sub-section illustrates in detail the aims and objectives of the Managing Anger & Conflict Workshop. What follows is a sub-section on how the residents were selected for treatment and then the residents details are presented, for example ‘drug of choice’, ‘gender’ and ‘history of violence’ etc.

4.1. Research Setting: The Ley Community. Back to Contents

The setting for this research is a drug & alcohol rehabilitation center, situated in the village of Yarnton, a few miles to the north of Oxford. Dr. Bertram Mandlelbroate, a Consultant Psychiatrist in charge of The Regional Drug Dependency Service, founded the Ley Community in 1970; it was one of the first organizations to treat drug and alcohol abusers in the community, moving away from the "sick role model" of hospitalization.

The Ley Community at the time of the research occupied four houses on a seven-acre campus. Facilities include woodland, a small lake, outdoor swimming pool and a large field area. It was registered as a Care Home with Oxfordshire Social Services Department for 58 residents of both sexes over the age of eighteen. There was a provision that two of these beds, could be used for individuals between the ages of sixteen and eighteen. However, this facility has now been withdrawn and treatment now only offered to adults.

The majority of the referrals came either via individuals themselves, families, Local Authorities Social Service Departments or from within the Criminal Justice System. The Assessment Team dealt with all referrals. In the first instance, an information pack was sent out included a detailed questionnaire. Normally, drug & alcohol abusers were 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 were subsequently contacted for advice. The second stage of assessment was to invite the individual to attend a formal interview that lasted approximately two hours and provided information about the individual: family, education, medical and psychiatric histories, drug/alcohol use and previous/present offending behavior. Following this, if successful and the applicant still wished to proceed, then a future Day Placement was arranged. This is where the applicant experiences a full day at the Ley Community, talking to residents and having a good fact finding tour of all facilities.

There was also a period of assessment available to the courts, whereby defendants could be bailed for a four-week assessment in order to ascertain whether there existed a specific interrelationship between drug use and criminal behavior. If that was the finding of the assessment, then a decision as to whether the individuals and societies best interests were met by a residential period in therapy was made.

The Program lasted approximately twelve months broken down into three treatment phases. Phase One, known as "Safety Net", covered the initial six to eight weeks and allowed the resident to settle into their new environment, gradually introducing them to the community language and education, in the use of various therapeutic ‘tools’, including ‘Sanctions and Contracts’ (Ibid. 7). The most important part of ‘Phase One’ was to establish and acknowledge some of the underlying reasons for drug use and offending behavior that was known as ‘Issues’. ‘Phase Two’, was where those ‘Issues’ were processed by using of a variety of therapeutic tools: Confrontation Groups, Support Groups, Skill Groups, Relating Chairs or One to One counseling with staff members. Phase Two lasted for approximately seven months, towards the end of which residents were encouraged to reintegrate back into main stream society. A variety of methods were used, namely: voluntary work, socializing, family visits, community talks and employment preparation studies, this period was known as ‘Senior Peers’ and included; job search, interview techniques etc. Finally Phase Three, lasted for three months and commenced when the resident found full time employment. Residents lived within the grounds, supported by the community in a detached house, paying their own way, working in paid employment and also completing voluntary work, one evening a week as an Auxiliary Staff Member, looking after junior residents. Transition between each phase was celebrated with a formal ‘Progression’, where the entire resident population comes together. The ultimate graduation was where the resident completing the program ‘Stands on the Table’ (a ritual attended by all residents) and often inviting family and friends to share the event.

4.2. AN EARLY INTERVENTION Back to Contents

Initially, an agreement was reached with the Clinical Director, in late 1997, for a series of three workshops to be scheduled to run for eight respective weeks. A date was set for January 1998, for commencement of the first workshop. During December 1997, the H.D.H.Q. was administered to all residents who volunteered to participate in the research, and in conjunction with one of the Team Leaders, the results were analyzed and used to select suitable residents who could benefit from the study. Residents’ selection is discussed in greater detail in section 4.4 (Ibid. 39). Anger Diaries were given to those chosen for the first workshop, with instruction of how to compile them in ‘Antecedents, Behavior & Consequences’ (ABC) format.

An organizational ‘SWOT’ Analysis of the Ley Community was conducted over a period of three years whilst the Author was acting as an internal consultant. It suggested that staffing abilities ranged from those who had obtained university degrees, nursing training and administrative vocational training; to individuals who possessed no formal qualifications and included some who had deficits in basic literacy and numeracy. What was of interest, was an apparent professional skill deficit, in other words the higherarchical structure was top heavy with the latter category of the professionally inept. With this in mind, three comprehensive staff training sessions were scheduled to provide insight and understanding for the following topics: Recording Information, Observing Behavior and An Introduction to the Managing Anger & Conflict Workshops. Unfortunately, due to: problems in communication, internal politics, line management issues and general organizational dysfunction, the Workshops did not commence until May 1998 and then in a modified format.

4.3. MANAGING ANGER & CONFLICT WORKSHOP (M.A.C.W.) Back to Contents

The Managing Anger & Conflict Workshop (M.A.C.W.) is taken from the Living Skills II training package, researched and designed by Dr Bob Wycherely, Clare Crellin and Tony Chiva (1994). This workshop is in a revised formula that previously included sessions concerned with ‘Assertiveness’; now a separate workshop in the "Living Skills II Package". Therefore, an interest of this research will be to additionally evaluate and ascertain what individuals benefited from undergoing treatment from such an intervention. The workshop objectives are 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 residents will learn to understand and accept feelings of anger, and learn to use them constructively in order to produce change. Avoiding conflict may actually be a negative action for individuals long-term health. The workshop looks at, and allows residents to practice, skills needed during situations of conflict. Their inability to cope with other people’s anger may also be a problem, so there is an opportunity for the residents to practice recognizing and handling direct and indirect expressions of anger in others.

The M.A.C.W. takes 12 hours and consists of five session modules, 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. For an outline of the M.A.C.W., see Appendix Three. 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.

4.4. TREATMENT GROUP SELECTION Back to Contents

The Hostility & Direction of Hostility Questionnaire‘s, ‘Total Hostility Scale (H) (Ibid. 81) was used to select the treatment sample, with reference to the Grendon Norms; i.e. those residents who returned scores above 27 were selected. The ‘Direction of Hostility Scale (DH)’, which was used to identify those residents who either internalized or externalized their hostility. A balanced group membership of Internalizes and Externalizers was desired. However, due to the difficulties experienced in treatment preparation and bearing in mind the moral obligation to honor places on the workshop for residents selected for the ‘cancelled’ January workshop, several of Group Ones Total Hostility scores are low.

Two groups, one of thirteen residents and another of eight, was allowed to run consecutively over six weeks, both groups allocated a mixture of Internal and External individuals. The mean ‘Total Hostility (H)’ score was 22.4 in May 1998 for Group One and 40.9 for Group Two. Anger diaries (Ibid. 86) were specifically designed to furnish background information to be given to the residents approximately four weeks before commencement of the workshops. At the start of the Workshop, the first diaries were collected and a modified version given out, that included ‘Arousal and Aggression Bars’, also the Stages of Change Questionnaire completed. The internal ‘Skills Evaluation Checklist’ was administered; pre and post workshops and followed by a detailed debriefing on conclusion. The research design compares and contrasts two groups, including the within group ‘Internal-External Anger’. It also evaluates the effectiveness of the Managing Anger & Conflict Workshop with the control residents who completed the H.D.H.Q.’s but did not attend the workshops.

4.5. RESIDENTS DETAILS Back to Contents

In total 70 residents volunteered to participate and signed "Authority to enter into research" (Ibid. 99). Ages ranged from 17 to 50, with a gender split of 64 male’s (91%) and 6 females (9%). These became the ‘Baseline Sample’, new residents were administered the Hostility and Direction of Hostility Questionnaire (H.D.H.Q.) following admission into treatment, as part of the two monthly block sitting; starting in December 1997 through to July 1998.

The residents selected for treatment were placed into two groups. Group One’s membership consisted of 13 residents all male, with ages ranging from 21 to 39. Group Two’s membership consisted of 8 residents: 7 males and 1 female, ages ranging from 18 to 35. A control group was drawn from the Baseline and included six males and one female. On combining the two treatment groups, the sex imbalance of 93% males is highlighted. This is a general representation of the Therapeutic Community at large and even then, a figure of 7% for females is perhaps over optimistic. Drug use, includes: 50% of residents selected for treatment use Heroin only, 7% for Amphetamine & Heroin, 14% for Heroin & Crack Cocaine, 7% for Cocaine & Cannabis, 7% for Alcohol use only, 7% for Alcohol & Cannabis and 7% for Cocaine, Heroin and Alcohol. When assessing the treatment group’s criminal convictions, it emerged that 71% of the selected group had a record for violence but only 14% had undertaken some form of previous anger management course. It was agreed to conduct the workshops by way of a closed group, meaning that once participants dropped out, they remained out altogether and would have to reapply at a latter date, in order to be reconsidered.

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4.6. ASSESSMENT TOOLS Back to Contents

The various assessment tools utilized within this piece of research are described, examples of the original documents, are provided in the appendices section.

4.6.1. STAGES OF CHANGE QUESTIONNAIRE Back to Contents

It is vital to establish whether the residents are at a stage in their 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". If the residents were 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 the "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.

4.6.2. HOSTILITY and DIRECTION of HOSTILITY QUESTIONNAIRE Back to Contents

Individuals with drug and alcohol problems are particularly likely to have difficulties with relationships and may often engage in abusive behavior. Hostility and Direction of Hostility Questionnaire (HDHQ) (Caine et al. 1976) is designed to sample a wide range of possible manifestations of aggression, hostility or punitiveness. There are nine sub-scales: ‘self-criticism’ (SC), ‘guilt’ (G), ‘acting out hostility’ (AH), ‘paranoid hostility’ (PH) and ‘criticism of others’ (CO), ‘total hostility’ (H), ‘internalized hostility’ (IH), ‘externalized hostility’ (EH), and a ‘direction of hostility’ (DH) score. The direction of hostility score indicates whether the hostility is directed internally or externally (adapted from Butler 1977).

4.6.3. 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.

4.6.4. ANGER DIARY Back to Contents

Two versions of the Anger Diary (Woodward 1998) were used; they were designed during clinical supervision, 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. Woodward (1997, p.243) reminds us of the fact that "people who write such diaries are able to return to their experience at a later date and re-evaluate their experience".

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.

4.6.5. WORKSHOP DEBRIEFING Back to Contents

This was designed in order to furnish some qualitative information from the participating workshop members. The debriefing took two formats, at the end of the final session residents were encouraged to air their feelings about the workshop, what they had gained, positive and negative comments were to be recorded by the facilitator. When both Groups had completed the workshops, a formal debriefing for all Completers was arranged. This was a pen and paper exercise that included six questions to be scored on a Lickert Scale and five questions requiring individual ‘qualitative’ answers.

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5. RESULTS & ANALYSIS Back to Contents

The raw data can be found in the Appendices as follows: 9.3.1 Baseline H.D.H.Q., 9.3.2 Control Group H.D.H.Q., 9.3.3 Group One H.D.H.Q., and S.E.C. & 9.3.4 Group Two H.D.H.Q., and S.E.C. Non-parametric measures are used throughout this research, due to the fact that normal distribution could not be ascertained and the numbers of respondents being relatively small.

5.1. A comparison between residents who completed the workshops & those who did not. Back to Contents

If we look at the mean 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 the residents are in the "Participation" stage and are therefore, able to benefit from undertaking the Workshop. There is no significant difference between the Completers score and the non-Completers scores: therefore, the Null Hypothesis can not be rejected.

Table One. Stages of Change Means & Mann-Whitney Unpaired Sample Test, comparing residents who completed the treatment, with those that did not complete.

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5.2. Control Group Analysis. Back to Contents

Tables; Two (a), Two (b) & Two (c), show the mean scores for the control group and illustrates that no pair, either ‘A & B’, ‘B & C’ or ‘A & C’ when analyzed for any respective sub-section, returned any significant difference. Therefore, the Null Hypothesis cannot be rejected. Namely, the test results of the H.D.H.Q.’s eight sub-sections did not differ between administrations.

Table Two (a). The Control Group’s H.D.H.Q. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations A & B.

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Table Two (b). The Control Group’s H.D.H.Q. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations B & C.

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Table Two (c). The Control Group’s H.D.H.Q. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations A & C.

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5.3. Group One Analysis of Pre & Post treatment, including follow-up period. Back to Contents

Table Three (a), reveals Group One’s mean results and shows that sub-sections ‘SC’, ‘AH’, ‘PH’, ‘CO’, ‘EH’ & ‘DH’ for Pre & Post treatment analysis of H.D.H.Q, did not returned significant differences. Therefore, the Null Hypothesis cannot be rejected. With reference to sub-scales ‘G’, ‘IH’, for pair administrations ‘A & B’ a significant difference (p < 0.05, one-tailed) was found, thus supporting the Research Hypothesis2, namely that Post Treatment results will demonstrated a lower score on sub-scales than the Pre Test results. Although, the Post treatment test results did not significantly demonstrate a lowered ‘Total Hostility (H)’ score, when compared with the pre treatment test scores, the movement of 4.5 scale points is in the right direction and of importance to this piece of research.

Table Three (a). Group One’s H.D.H.Q. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations A & B.

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Table Three (b), When comparing administrations ‘B & C’ (between Post-test and Follow-up) for Group One; again no significant differences was found for any of the sub-subsections. Therefore, the Null Hypothesis cannot be rejected.

Table Three (b). Group One’s H.D.H.Q. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations B & C.

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Table Three (c), illustrates the comparison for administrations ‘A & C’ for Group One. The following sub-sections ‘AA’, ‘PH’, ‘CO’, ‘EH’ & ‘DH’ did not return any significant differences. Therefore, the Null Hypothesis cannot be rejected. Sub-scales ‘SC’, ‘G’, ‘H’ & ‘IH’, (between Pre-Test & Follow-Up), returned a significance differences (p < 0.05, one-tailed). Therefore, overall decreases in scores were observed whereby the Null Hypothesis could be rejected in favor of the Research Hypothesis 2. Furthermore, a reduction in the ‘Total Hostility (H)’ score was observed (p. < 0.05, one-tailed), thus supporting a trend in the Research Hypothesis 1, namely Post-treatment ‘Total Hostility’ scores will be lower.

 Table Three (c). Group One’s H.D.H.Q. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations A & C.

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5.4. Group Two, Analysis of the waiting period followed by Pre & Post Treatment. Back to Contents

Table Four (a), illustrates the mean scores for Group Two and shows that sub-sections ‘G’, ‘PH’, ‘CO’, ‘H’ & ‘EH’ when analyzed for administration ‘A & B’ (between waiting period & pre-treatment test), returned no significant findings. Therefore, the Null Hypothesis for these sub-sections can be substituted in favor of Hypothesis 2, namely that the test results for H.D.H.Q. sub-scales; Pre and Post the waiting period show no significant differences. Sub-scales ‘SC’, ‘AH’, ‘IH’ & ‘DH’ did return significant differences (p < 0.05, one-tailed), therefore rejecting the Null Hypothesis in favor of Research Hypothesis 3. Namely, posttest results returned lowers scores on H.D.H.Q sub-scales than the Pre Test results.

Table Four (a). Group Two’s H.D.H.Q.’s Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations A & B.

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Table Four (b), shows that sub-sections ‘G’, ‘PH’, ‘CO’, ‘EH’ & ‘DH’, for pair administrations ‘B & C’ (Pre & Post Treatment Test) returned no significant findings. Thus, the Null Hypothesis can not be rejected. Although sub-scales ‘CO’ & ‘EH’ were not significantly different, movement was in the right direction thus suggesting an important trend for this research. Sub-section’s ‘SC’, ‘AH’, ‘H’ & ‘IH’ returned significant findings (p < 0.05, one-tailed). Therefore, the Null Hypothesis, can be rejected in favor of the Research Hypothesis 3, namely that post test results demonstrate a significantly lower scores, than the pre test results. Moreover, the ‘Total Hostility’ (H) score supports the Research Hypothesis 1; namely Post-treatment ‘Total Hostility’ test results will be lower than the Pre-treatment results.

Table Four (b). Group Two’s H.D.H.Q.’s Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations B & C.

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Table Four (c) shows the overall comparison ‘A & C’ (between Waiting Period and Post Treatment test), sub-sections ‘G’, ‘AH’, ‘CO’ & ‘DH’ returned no significant differences, therefore, the Null Hypothesis can not be rejected. However, movement for sub-scale DH was in the right direction supporting a notion of a trend. Sub-scales ‘SC’, ‘PH’, ‘H’, ‘IH’ & ‘EH’ all returned significant differences (p < 0.05, one-tailed). Therefore, the Null Hypothesis can be rejected in favor of Research Hypothesis 3. Thus posttest results return significantly lowered scores, than the pre test results. Also, the ‘Total Hostility (H)’ sub-scale returned a lower Post-Test score, supporting Research Hypothesis 1, namely Post-treatment ‘Total Hostility’ test results will be lower than the Pre-treatment results.

Table Four (c). Group Two’s H.D.H.Q.’s Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results Comparing Administrations A & C.

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5.5. Pre & Post Treatment Analysis for Groups One & Two Combined. Back to Contents

With reference to Table Five, no significant difference was found for ‘PH’, ‘CO’ & ‘DH’, therefore, the Null Hypothesis can not be rejected for these sub-scales. Sub-scale ‘CO’, although not significantly different, the movement was in the right direction and would indicate a trend. However, for sub-scales ‘SC’, ‘G’, ‘AH’, ‘CO’, ‘H’, ‘IH’ and ‘EH’, a significant difference (p < 0.05, one-tailed) was found, and supports the Hypothesis 3; namely that the Post treatment test results return lower scores than the Pre treatment test results. Also the lower ‘Total Hostility (H)’ Pre-Test score, supports the Research Hypothesis 1 (p < 0.05, one-tailed), namely Post-treatment ‘Total Hostility’ test results will be lower than the Pre-treatment results.

Table Five. Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test Results, Comparing Pre & Post Intervention of H.D.H.Q for the combined results for Groups One and Two.

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5.6. Pre & Post Treatment Analysis for Residents who Internalize Anger. Back to Contents

Table Six, illustrates the comparison for Internalizes Pre treatment & Post treatment H.D.H.Q.’s test results, utilizing the Walsh-Test. From the ‘difference scores’ we observe that sub-sections; ‘SC’, ‘AH’, ‘PH’, ‘CO’, ‘H’, ‘IH’, ‘EH’ and ‘DH’ did not return a significant difference as the ‘difference scores’ are not greater than zero, therefore, the Null Hypothesis can not be rejected. With respect to ‘IH’, this supports the Research Hypothesis; namely Residents who internalize their anger are less likely to reduce their ‘Internal Hostility’ scores post treatment. Moreover, only sub-section ‘G’, returned ‘difference scores’ greater than zero, therefore the Null Hypothesis can be rejected, in favor of the Alternative Hypothesis. This analyze overall suggests that residents who internalize their hostility do not benefit from attending the Managing Anger and Conflict Workshops.

Table Six. The Walsh Test, Comparing Pre & Post Intervention of the Hostility and Direction of Hostility Questionnaire for the combined results of both Group One and Two, for Residents who Internalize their Aggression.

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5.7. Pre & Post Treatment Analysis for Residents who Externalize Anger. Back to Contents

Table Seven, shows that sub-sections ‘G’, ‘PH’ & ‘DH’ when analyzed returned no significant differences for 'Externalizers', Pre treatment & Post treatment tests. Therefore, the Null Hypothesis cannot be rejected. However, for sub-section’s ‘SC’, ‘AH’, ‘CO’, ‘H’, ‘IH’ & ‘EH’, significant differences (p < 0.05, one-tailed) were found. Therefore, the Null Hypothesis can be rejected in favor of supporting the Research Hypothesis 2, namely; the sum of the negative ranks are greater than the sum of the positive ranks. In other words, Course participants with high Pre course External Hostility scores were significantly more likely to demonstrate lower sub-scale scores Post Treatment. Moreover, the Research Hypothesis 1 is also supported by these findings, namely ‘Course Participants’ with high Pre-Course Externalized Hostility scores are most likely to demonstrate lower Total Hostility scores Post treatment.

Table Seven. Wilcoxon Matched-Pairs Signed-Ranks (Exact) Test, Comparing Pre & Post Intervention on the Hostility and Direction of Hostility Questionnaire; for the combined results of both Groups, for residents who Externalize their Aggression.

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5.8. A Comparison of Baseline with Residents who Completed the Workshop, Pre & Post Treatment Results. Back to Contents

Table Eight (a), shows for the Pre Treatment tests results when analyzed with the Ley Community’s baseline, no sub-sections returned any significant differences. Therefore, Null Hypothesis, cannot be rejected namely the H.D.H.Q score of course participants – pre intervention was not significantly different from the general population of the Therapeutic Community’s baseline.

Table Eight (a), H.D.H.Q, Mean Scores & Mann-Whitney Unpaired Sample Test, Comparing Baseline with those who completed the workshop at the Pre-Test Stage.

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Table Eight (b), illustrates the comparison between the Post treatment tests results of the M.A.C.W. and the Ley Community’s baseline. No significant difference was found for ‘G’, ‘AH’ & ‘DH’, therefore, for these three sub-groups the Null Hypothesis, can not be rejected. However, there were significant difference (p < 0.05, one-tailed) observed for sub-groups; ‘SC’, ‘PH’, ‘CO’, ‘H’, ‘IH’ and ‘EH’. Thus, supporting the Research Hypothesis, namely the H.D.H.Q. score of course participants post intervention, was significantly less than the general population of the Therapeutic Community’s baseline.

Table Eight (b), H.D.H.Q, Mean Scores & Mann-Whitney Unpaired Sample Test, Comparing Baseline with those who completed the workshop at the Post-Test Stage.

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5.9. Comparing Ley Community Baseline, Grendon & Normal Norm Mean Scores. Back to Contents

Table Nine, reveals a comparison of H.D.H.Q. Norm Mean Scores. You will notice that the results include reference to HMP Grendon norms (n = 210) {i.e. the average score obtained in that population} and a standard deviation for that Grendon mean score and similar norms generated for a Normal Population (n = 360) by Caine et. al. (1967). With reference the Ley Community Baseline (n = 70), no significant differences (within + or – 1 Sd.) are found for sub-sections: ‘G’, ‘AH’, ‘PH’, ‘CO’, ‘H’, ‘IH’ & ‘EH’). Therefore the Null Hypothesis can not be rejected. However, for sub-section ‘DH’ a significant difference was returned (within + or – 2 Sd.). Thus enabling the Null Hypothesis to be rejected in favor of the Research Hypothesis 2, namely the Ley Community Baseline Means for ‘DH’ was lower than the H.M.P. Grendon Means.

When the Normal Population Norms are compared with the Ley Community Baseline, no significant differences were observed for sub-sections, ‘SC’, ‘PH’ & ‘DH’ (within + or – 1 Sd.), therefore the Null Hypothesis, can not be rejected. Moreover, significant differences were observed for sub-sections, ‘G’ & ‘CO’ (within + or – 2 Sd.), ‘AH’ (within + or – 3 Sd.), and ‘H’ (within + or – 4 Sd.). Hence the rejection of the Null Hypothesis in favor of the Research Hypothesis 1. Namely, the Ley Community Baseline Mean Scores are higher than the Normal Population Mean Scores.

Table Nine. Comparison of H.D.H.Q Norm Mean Scores for Ley Community Baseline, Grendon Mean & Normal Mean.

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5.10. Skill Evaluation Checklist Pre & Post Treatment Analysis. Back to Contents

Table Ten (a), illustrates the analysis of Skills Evaluation Checklist, comparing Pre & Post administrations for the combined scores of groups one and two respectively. The results for found significance (p < 0.05, one-tailed) between Pre and Post tests, there bye the Null Hypothesis can be rejected in favor of the Research Hypothesis; i.e. The sum of the positive ranks were greater than the sum of the negative ranks. Thus an increase in scores for both groups one & two were returned.

Table Ten (a). A Comparison of Pre & Post Intervention of the Skills Evaluation Checklist Scores for all residents that completed treatment (n = 14); using the Wilcoxon Matched-Paired Signed Rank (Exact) Test.

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Table Ten (b), illustrates the analysis of Skills Evaluation Checklist, comparing Pre & Post administrations for residents who internalize their anger from both groups one and two. Using the Walsh Test, no significance was found, therefore the Null Hypothesis can not be rejected, i.e. the sum of the positive ranks equal the sum of the negative ranks. Thus no significant increase was observed following treatment.

Table Ten (b). Analysis of Pre & Post treatment scores for the Skills Evaluation Checklist; using the Walsh Test for all residents who internalize their anger.

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Table Ten (c), compares individuals who Externalize their Anger. A significant difference (p < 0.05, one-tailed) was observed between Pre and Post tests, there bye the Null Hypothesis can be rejected in favor of the Research Hypothesis; i.e. The sum of the positive ranks were greater than the sum of the negative ranks. Therefore, Externalizers increased their scores following treatment.

Table Ten (c). Analysis of Pre & Post treatment scores for the Skills Evaluation Checklist; using the Wilcoxon Matched-Pairs Signed-Ranked (Exact) Test for all residents who externalize their anger.

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5.11 Percentage of Residents Qualitative Feedback Back to Contents

Table Eleven reveals the feedback gained from the residents following the final session of M.A.C.W. If ‘Good’ & ‘Excellent’ are considered positive affirmations (+) and ‘Below average’ & ‘Average’ as negative affirmations (-) then the following results are returned: Organisation of Sessions 78.6% (+) 21.4% (-), Quality of Handouts 42.9% (+) 7.1% (-), Quality of O.H.P. (transparencies) 78.6% (+) 21.4% (-), Facilitating Staff Member 100% (+), Material Covered 100% (+), Overall Satisfaction 92.8% (+) 7.1% (-).

Table Eleven. Percentages of Residents Qualitative Feedback

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5.12 Summary to the Results and Analysis Section. Back to Contents

• Research Area One. No significant difference emerged between Workshop Completers & Non-Completers, when compared using the ‘Stages of Change Questionnaire’.

• Research Area Two. The Control Group H.D.H.Q. scores returned no significant differences between Pre & Posttest results on any of the three administrations, on any of the nine sub-scales. Group One did not return a significant difference for Pre & Post Intervention Test results on the ‘H’ scale, it did however, indicate movement that was in the right direction, therefore suggesting a trend. Group Two, with respect to the ‘waiting period’ returned no significant difference. However, the ‘H’ scale, Pre & Post treatment test scores were significantly different (p < 0.05, one-tailed).

• Research Area Three. Pre & Post Treatment test results indicated no significant difference for ‘PH’ and ‘DH’. For ‘CO’, although it did not return a significant difference, movement was in the right direction, therefore suggesting a trend. Significant differences (p < 0.05, one-tailed), was returned for sub-scales: ‘SC’, ‘G’, ‘AH’, ‘H’, ‘IH’ and ‘EH’.

• Research Area Four. Pre & Post Treatment test results for all residents who internalized their hostility or anger, returned no significant differences for sub-scales ‘SC’, ‘AH’, ‘PH’, ‘CO’, ‘H’, ‘EH’ and ‘DH’. However, sub-section ‘G’, returned difference scores greater than zero, therefore suggesting a trend.

• Research Area Five. Pre & Post Treatment test results for all residents, who externalized their hostility or anger, returned no significant differences for sub-sections ‘G’, ‘PH’ and ‘DH’. However, significant differences were returned (p < 0.05, one-tailed), for sub-scales: ‘SC’, ‘AH’, ‘CO’, ‘H’, ‘IH’ and ‘EH’. 

• Research Area Six. Comparing the Ley Community Baseline with workshop Completers. No significant differences were returned at the Pre Treatment stage. However, for the Post Treatment comparison, no significant difference was returned for sub-scales ‘G’, ‘AH’ and ‘DH’. Although, significant differences (p < 0.05, one-tailed) were returned for sub-scales: ‘SC’, ‘PH’, ‘CO’, ‘H’, ‘IH’ and ‘EH’.

• Research Area Seven. A comparison of Pre & Post Intervention results using the S.E.C. for all residents whom completed the M.A.C.W. A significant difference was returned (p < 0.05, one-tailed).

• Research Area Eight. Pre & Post Treatment test results of the S.E.C., for all residents who internalized their hostility or anger. On analysis no significant difference was returned.

• Research Area Nine. Pre & Post Treatment test results of the S.E.C., for all residents who externalized their hostility or anger. On this analysis a significant difference was returned (p < 0.05, one-tailed).

• Research Area Ten. Comparison of Ley Community Baseline means with H.M.P. Grendon and a Normal population means. When Ley Community Baseline means are compared against H.M.P. Grendon means, a significant difference was observed for ‘Direction of Hostility (DH)’ only (within + or – 2 Sd.). However, in a comparison with the Normal Population Means significant differences were observed for sub-sections ‘G’ & ‘CO’ (within + or – 2 Sd.), ‘AH’ (within + or – 3 Sd.), and ‘H’ (within + or – 4 Sd.).

6. DISCUSSION Back to Contents

This section draws together the research study by reiterating the hypothesis central to the various ‘research areas’ of interest. The results that emerged (Ibid. 44) will be discussed in detail and interpreted with respect to the empirical research that emerged from the literature reviewed (Ibid. 10). The limitations to this study and theories of anger will be aired and also the implications for this research with regards the Ley Community and for Therapeutic Communities at large, will be presented. Finally, the implications for future research will be put forward.

6.1 Hypothesis (Research Area One). Back to Contents

The first ‘Research Area’ hypothesizes that there will be a difference between residence who complete the workshop and those residents who do not, when compared with the ‘Stages of Change Questionnaire’. Namely, residents who are ‘pre-contemplators’ will be unlikely to complete the workshop.

McConnaughy et. al. (1983) developed the ‘stages of change questionnaire’ and postulated four theoretical stages namely: pre-contemplation, contemplation, action and maintenance. The profile that emerged from the scores is comparable to that of the 'Participation profile' (McConnaughy et. al. 1983) and suggests that the residents "could be expected to have processed considerable information about their problems and would be quite committed to change". The profile also indicates that residents will 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 that their outcome prediction would be for "relatively rapid improvement in therapy". In the comparison between residents who completed the ‘MACW’ and those who did not (Ibid. p. 44), it was revealed that no significant differences were found between the two samples. Thus suggesting that the two samples were at the same stages of change as each other. Therefore, any contributing effects with regard withdrawal must be external to the individual residents concerned. What are of interest are the resident’s personal reasons for drop out from workshops. On investigation, two residents felt too angry to attend the workshops and were advised by staff to drop out; two residents had other program commitments due to their total time in therapy and three residents were asked to leave the Ley Community altogether, due to their unacceptable behavior. Thus five out of the seven residents, who dropped out of treatment, demonstrated the very behavior that was the focus of such intervention in the first place.

6.2 Hypothesis (Research Area Two). Back to Contents

The original research design (Ibid. p.25) allowed for the comparison of three groups of residents, two groups undergoing treatment and one group acted as a control. The second ‘Research Area’, used the H.D.H.Q.’s nine sub-scales to analyses treatment effect. Within the treatment group, there was also an element of internal control with the waiting period for ‘Group Two’ acting as the control for ‘Group One’. The H.D.H.Q.’s sub-scale ‘Total Hostility’, was used not only as a selection tool but also as a continual evaluation measure. Therefore, the Hypotheses are as follows: The ‘Control Group’, will show no difference between administrations Pre & Posttests. ‘Group One’, on the ‘Total hostility’ (H) scale, will return a significantly lower score, between Pre & Post-Treatment test scores. For ‘Group Two’, the period between administration ‘A & B’ (waiting period), will show no significant difference between Pre & Post-Test result scores. However, ‘Group Two’, will return significantly lower Pot-Treatment test results (administration B & C), for the ‘Total Hostility Scale (H)’, than the Pre Treatment Test score results.

It was of interest when viewing the ‘Control Group’, to observe no significant difference between the three administrations of the H.D.H.Q.’s, ‘Total Hostility’ scale. It was also noted, that no significant difference was found for any of the sub-scales, for any of the administrations. If one was to follow Kennard’s view that "therapeutic communities are a treatment in their own right" (Kennard 1998), then one may have expected some movement on some of the scales, especially when one is reminded that a sixth month period in treatment was observed. Unfortunately, in this instance, with respect to the control group, Martinson’s conclusions that "nothing works" (Martinson 1974) could be assigned to the treatment regime on offer at the Ley Community at the time of this research. As Martinson (1974) puts it " a bleak conclusion for men and women under treatment".

Group One, did not return a significant difference when pre & post treatment results were analyzed. However, the analysis did return a W value of .063, the level of significance being .05, therefore, the overall movement of 4.5 scale points, was in the right direction and of relevance to this piece of research. For Group Two, who acted as an internal control for Group One when they were undergoing treatment, returned no significant difference for the pre & post waiting period. However, the pre & post treatment analysis did returned a significance of .039 (p < 0.05, one-tailed). Furthermore, the null hypothesis was rejected in favor of both the ‘Research Hypothesis’. Firstly, that post treatment test results demonstrate a lowered total hostility score, than the pre treatment test results and secondly, the test results for H.D.H.Q. sub scales, pre and post the waiting period showed no significant difference.

6.3 Hypothesis (Research Area Three). Back to Contents

The third ‘Research Area’, was interested in the comparison of Pre & Post test results on all nine sub-scales of the H.D.H.Q., for all fourteen residents who successfully completed treatment of the M.A.C.W. The hypothesis are firstly; that the ‘Total Hostility (H)’ test score results will be significantly lower Post-Treatment and secondly; the Post-Treatment sub-scale test score results will be significant lower than the Pre-Test score results.

Overall, when one combines the group of residents who completed treatment, and investigates the pre & post treatment effects, interesting observations are found. Table Three {a} (Ibid. p.42) illustrates that although the H.D.H.Q.’s sub-scales ‘Paranoid Hostility’ and ‘Direction of Hostility’ returned no significant difference, significant differences were returned for the other seven sub-scales (p < 0.05 one-tailed). Thus supporting the evidence that ‘Self-instructional training’ (Snyder & White 1979), ‘Anger control training’ (Hollin 1996) and ‘Cognitive Behavior Modification’ (Navaco 1978) can all have an impact, especially when designed into a single workshop namely the ‘M.A.C.W’.

6.4 Hypothesis (Research Area Four). Back to Contents

The forth ‘Research Area’, focussed on the subject of intrapunativeness; in other words; how residents directed their hostility, e.g. ‘Internally, towards themselves’. The Hypothesis postulated those course members with high ‘Internalized Hostility (IH)’ Pre Treatment test scores, were significantly less likely to reduce their ‘Internalized Hostility (IH)’ scores Post-Treatment.

Table Three {b} (Ibid. p.46) analyses the pre & post treatment effect for residents who internalize their anger. What was surprising that there was no significant difference for any of the sub-scales except for an indication of a ‘trend’ for the ‘Guilt’ scale (w = 0.062 p < 0.05). One could argue that the sample size was too small to analyze; however, the Walsh Test was selected for its suitability for small sample data. But one still has to remain cautious as to the interpretation from such small sample sizes.

6.5 Hypothesis (Research Area Five). Back to Contents

The fifth ‘Research Area’, is interested in ‘Extrapunitiveness’, e.g. residents who directed their anger externally, either towards others, or other things. The Hypothesis stated firstly: that course participants with high Pre-Course ‘Externalized (EH)’, scores were more likely to demonstrate lower ‘Total Hostility (TH)’ scores Post-Treatment. Secondly, H.D.H.Q. sub-scale test score results, would be lower Post-Test than Pre-Test.

When statistical analysis was conducted on the results for residents who externalized anger (Ibid. p.51), six of the nine sub-scales ‘SC’, ‘AH’, ‘CO’, ‘H’, ‘IH’ and ‘EH’, all returned significant differences (p < 0.05 one-tailed). However, no significant differences were identified for ‘Guilt’, ‘Paranoid Hostility’ and ‘Direction of Hostility’.

6.6 Hypothesis (Research Area Six). Back to Contents

The sixth ‘Research Area’ uses the H.D.H.Q. to investigate the treatment effect of residents who completed the M.A.C.W., against the Ley Community Baseline. The Hypothesis is that for the course participants Post Intervention would be significantly less than the general population of the Ley Community’s Baseline.

On comparison between the Ley Community’s Baseline to the pre treatment test scores of the ‘selected for treatment’ sample (Ibid. p.52), no significant difference was returned. However, when the same Baseline was compared with the post treatment ‘selected for treatment sample’ (Ibid. p.52), significant differences (p < 0.05 one-tailed) emerged for all sub-scales except the ‘Acting-out of Hostility (AH)’ and the ‘Direction of Hostility (DH)’ scales. Thus suggesting that individuals who underwent treatment utilizing the ‘MACW’ significantly (p < 0.05 one-tailed) lowered scores for ‘Self-Criticism (SC)’, ‘Guilt (G)’, ‘Paranoid Hostility (PH)’, ‘Criticism of Others (CO)’, ‘Total Hostility (H)’, ‘Internalized Hostility (IH)’ and ‘Externalized Hostility (EH)’, when compared against the Ley Community Baseline.

6.7 Hypothesis (Research Area Seven). Back to Contents

The seventh ‘Research Area’ uses the ‘Skills Evaluation Checklist (S.E.C.)’ to analyses the overall treatment effect for the combined data for both groups. The Hypothesis states that Post Treatment test score results will be greater than the Pre Treatment test score results.

The pre & post treatment test results using the ‘Skills Evaluation Checklist’ (Ibid. p.54), returned a significant difference (p < 0.05 one-tailed). Thus supporting the finding for ‘Research Area Six’ (Ibid. 30). Henceforth, suggesting a positive treatment effect for resident undergoing treatment.

6.8 Hypothesis (Research Area Eight). Back to Contents

The eighth ‘Research Area’, focussed on residents who were identified on the H.D.H.Q., as individuals who internalize their hostility or anger. The Hypothesis stated that residents identified as high ‘Internalized Hostility’ scores on the H.D.H.Q were less likely to increase their scores on the S.E.C, Post Treatment.

Table Ten {b} (Ibid. p.54) analyses the pre & post treatment effect for residents who internalize their anger. There was no significant difference returned, supporting the earlier analysis using the H.D.H.Q. (Research Area Four Ibid. p. 61). Thus clearly indicating that it is of little use for those residents who internalize their hostility, who may in fact benefit from alternative interventions.

6.9 Hypothesis (Research Area Nine). Back to Contents

The ninth ‘Research Area’ was interested in those residents who direct their anger externally. The Hypothesis stated that residents identified as high ‘Externalized Hostility’ were more likely to increase their scores on the S.E.C. Post Test.

The pre & post treatment test result scores, returned a significant difference (p < 0.05 one-tailed) supporting the earlier results of the H.D.H.Q. (Ibid. p. 54). Thus suggesting that the ‘M.A.C.W.’ can be of benefit for people who externalize their hostility.

6.10 Hypothesis (Research Area Ten). Back to Contents

The tenth and final ‘Research Area’ compared the Ley Community Baseline Mean scores against the H.M.P. Grendon and Normal Population Mean sores. The two ‘Research Hypothesis’, put forward that the Ley Community Baseline Means will be higher than the Normal Population Mean scores, and secondly, the Ley Community Baseline Means will be lower than the H.M.P. Grendon Norms Means. Two ‘Alternative Hypothesis’ were also postulated namely, the Ley Community Baseline Means will be lower than the Normal Population Mean Score and secondly, the Ley Community Baseline Mean will be higher than the H.M.P. Grendon Mean score.

When the norms generated for The Ley Community were compared against those of the Governments experimental prison, "Grendon" and a normal population (Table five, Ibid. p.50), similar results to those of the Grendon sample were found. The only exception being the ‘Direction of Hostility Scales’ that suggests that the Ley Community residents on the whole, externalize their hostility, compared with the internalized hostility of the Grendon Prison population. However, when one compares the Ley Community against a normal population, Scales of ‘Guilt’ and ‘Criticism of Others’ are found to be within two standard deviations, ‘Acting-out Hostility’ within three standard deviations and ‘Hostility’ within four standard deviations from the mean. Thus suggesting areas in need of intervention when designing a clinical treatment regime, for a population of individuals as found within the Ley Community.

6.11 Implications for the Ley Community and Therapeutic Communities at large. Back to Contents

This research highlights that for those individuals who are considered suitable for ‘community’, rather than ‘custodial’ sentences, do have in fact similar behavioral problems, therefore, requiring appropriately designed interventions, in order for their specific needs to be met. The only difference between the two populations, is the severity of index crimes. H.M.P. Grendon will generally only consider individuals who have been awarded a minimum of four & a half years imprisonment and have at least eighteen months left to serve, whilst the Ley Community will accommodate residents on ‘Probation Orders’ with a ‘Condition of Residence’ attached. When reminded by Cullen (1997, p.76), that H.M.P. Grendon treats "serious offenders with histories of personality disorder" a realization must be made, when faced with the above results, that the client group seeking rehabilitation at the Ley Community (at the time of research), may also be entitled to have a similar labels attached to them, or at least have the potential to become serious offenders with a personality disorder, in the future, if they remain untreated.

Feedback is a crucial exercise for any Organisation to undertake. On the final workshop day an informal feedback session took place alongside the post treatment administration of the ‘Skills Evaluation Checklist’. A formal feedback session was also organized one evening, where both qualitative and quantitative information, from both Completers and non-Completers was arranged; nineteen residents in total attended. The quantitative results (Ibid. p.55) reveal that 93% of residents found overall satisfaction in the M.A.C.W., 100% were happy with the facilitating staff member and 100% of residents considered that sufficient material was covered.

Qualitative information was gained by asking five searching questions. Firstly residents were asked to comment on particular exercises they found useful. It appears that the residents enjoyed the role play, self-talk, identifying feelings, learning self control, relaxation, finding a positive side to anger, understanding thought processes and learning how to express anger without loosing control.

The second question that was asked related to suggestions for changes to the workshop. The majority of residents thought that little needed to be changed to the actual workshop. However, pertinent to the first workshop, was a need for a permanent venue and a consistent time slot. Some residents thought it would be an idea to be provided with a follow up workshop to work through issues that arose during the interim period. Some residents wanted more confrontation within the workshop setting and some wanted personalized information concerning their own anger and how it manifests.

The third question asked how the workshops personally benefited the residents. They reported that they enjoyed finding new ways of looking at anger, specifically in understanding that anger isn’t wrong, also "learning how to deal with it". On the whole the residents gained a sense of achievement, in identifying anger in others. They also became more self aware in looking at the underlying reasons before reacting and learning how to control anger in a positive constructive manner rather than destructive. It appears that the most impact came when residents realized they could take control of their own behavior.

The next question returned a unanimous verdict, namely that they would recommend the M.A.C.W., to others. Some said simply ‘yes’, others wrote the following; "…I would as there is not enough understanding on how people get angry…", "Yes they are very informative", "Yes it’s very useful" and "Yes definitely, I got a lot out from it, it was very interesting".

Finally, the residents were asked what other workshops they would like the Ley Community to provide in future. Their suggestions included the following areas: ‘Criminality’, ‘Living Skills’, ‘Social Skills’, ‘Communication Skills’, "Same one, so that {other} people can learn how to deal with anger", ‘Relaxation’, ‘Sexuality’, ‘Abuse’, ‘Panic Attacks’, ‘Relationships’, ‘Deviousness and manipulation’, ‘Stress management’, ‘Assertiveness’, ‘Confidence’, ‘Self-Worth & Self-Esteem’, and even ‘Victim Empathy’. This would be a comprehensive list by any therapists standards, but at the same time rather worrying, especially when one remembers these are desired by residents, currently accommodated within a Therapeutic Community.

Staff preparation and training were given implemented on three separate occasions, prior to the workshop commencing. The sessions occupied the Friday afternoon slot, which was traditionally set aside for training and compulsory for all staff to attend. The design and content was in part researched in conjunction with the training section of Oxfordshire County Councils, Social Services Department. The areas covered included, ‘Recording Information’, Observing Behavior’ and ‘An Introduction to the Managing Anger & Conflict Workshops’ all designed to provide insight and understanding for the staff team. Out of a total staff complement of eighteen, only two attended all training days and one of these, was from the administrative team. It appeared that the notion of change was an issue more difficult for the staff to comprehend, than for the residents.

The greatest staff attendance was for the session entitled ‘Observing Behavior’. Here two senior residents volunteered to provide an episode of drama, in order for the team to observe and recall. The staffs resulting behavior raised concern for how potentially volatile incidents were not only handled but highlighted the lack of procedure for such events. However, it did act as a focus for the introduction of the workshops, ‘Anger Diary’s’. It also reiterated the importance of the staff teams role, input and support, for those residents selected for treatment. It was no surprise, to learn from the staff team, that they as individuals were in need of such training along-side the residents, when it came to managing anger and situations of conflict. The staff team who volunteered to participate in undertaking the H.D.H.Q. returned higher ‘Total Hostility Scores’ than the Ley Community (resident) Baseline and a significantly higher eternalized score for the ‘Direction of Hostility Scale’, thus raising issues of staff selection and highlights possible areas where pro-social modeling, from staff to residents, could be a negative factor.

6.12 Theories of Anger. Back to Contents

The initial ‘Anger Diaries’, acted almost as a badge of office, being orange in color and carried in the residents back pockets, stood out a mile. It was interesting to observe residents who internalized hostility, using the diaries to gain "Dutch courage", in order to communicate with residents who they previously considered unapproachable, often within a few moments of receiving the diary. Externalizers, on the other hand, utilized the diaries to remind other residents that they had a specific problem and should best stay away, thus avoiding the need to communicate. All residents from both groups returned the diaries on the first respective workshop day and exchanged these for the blue ones, which included the ‘arousal’ and ‘aggression’ bars. The average resident’s anger diary record of incidents over the four-week period, was five. The inclusion of the arousal & aggression bars graphically illustrated the antecedence, behavior and consequence of any interaction. One resident was able to plot nine entries for one single event of anger, and was therefore, actually able to see the escalation and reduction of these two feelings for himself.

6.13 The limitations to this study & Implications for Future Research. Back to Contents

It is unfortunate that this research lacked a balanced gender mix, for the female resident with a previous anger problem, commented positively on the benefits of completing the M.A.C.W. Therefore, future research needs to be conducted on the effects of mixed & single gender workshop membership. The research sample size although sufficient to establish treatment effect, is nether the less small in number, thus suggesting a need for a lager sample size in future. It is unfortunate that the Anger Diaries were not fully utilized by all residents, because the data collected from the ‘Arousal & Aggression Bars’ could have furnished further information. Therefore, the importance of completing such material must be seen as a M.A.C.W. core requirement. The internal psychometric measures were sufficient for this study, however a comprehensive psychological profile would be useful to map change over time. This study suggests that identified individuals can benefit from skill acquisition workshops. It would be of interest for future research to ascertain whether the ‘Assertiveness Workshop’ from the "Living Skills II Package" (Wycherely et. al. 1994) would benefit those residents who ‘internalize ’their hostility or not.

7. CONCLUSION AND RECOMMENDATIONS Back to Contents

It’s unfortunate that implementation of new interventions are seldom met without resistance. Richard Laws (1974) reported the failure of a residential "token economy", and 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) as cited by Hollin (1996, p.258), who comment "…behavior-modification advocates who do not recognize that much of their time will be spent trying to change behavior of staff, 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".

It is clear that the implementation of change is a difficult process for a variety of people, therefore, the vehicle for change has to be carefully selected and fine tuned, in order for it to become accepted. It is unfortunate that the Ley Community did not support this piece of research at the time. However, the future could look extremely promising for the Organisation, with the possibilities of further change and the additional recruitment of qualified experienced staff. Thus enabling those individuals who seek help with drug misuse and offending behavior, specifically with regard to managing anger and conflict, to be furnished with the input and intervention they so desperately seek. Specific Interventions for example the one at the center of this research can be extremely effective, therefore, the following recommendations are offered:

• The recruitment, selection and training of suitable individuals for staff members.

• The initiation of training and active support for continual professional development.

• To manage, and effectively supervise staff.

• To conduct a Clinical Audit as to program design and effectiveness.

• Implement those findings.

• Adopt Policies & Procedures appropriate for dealing with resident’s conflict and aggression.

• To incorporate Cognitive Behavioral Modification techniques into the Ley Community culture and philosophy.

• To design and implement of a battery of psychometric measures, in order to select, continually assess and assign suitable clinical interventions to identified residents.

• To become proactive towards resident’s needs, especially concerning e.g. Drug Misuse, Alcohol Misuse, Sexuality, Abuse, Employment, Gambling, Criminality, Communication, Relationships, Family, Thinking Skills, Managing Anger and Conflict. etc.

• To incorporate Relapse Prevention from the outset of the program.

• To employ the services of an experienced Psychologist as Clinical Director, responsible for overall treatment and program integrity.

• In the future to be aware of the effects of Groupthink, specifically towards individuals who question organizational dysfunction and advocate professional good practice.

7. REFERENCES Back to Contents

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Bandura, A. (1973). Aggression: A Social Learning Analysis. Englewood Cliffs: Freeman & Company.

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Browne, K. & Howells, K. (1996). Violent Offenders. Chapter seven in Hollin, C. (1996). Working with Offenders. Chichester: John Wiley & Sons, p.195-196.

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Butler, S. (1977). Psychological Tests in Use at HMP Grendon. Psychology Department, HMP Grendon, (unpublished).

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Cullen, E. (1997). Can a Prison be a Therapeutic Community? The Grendon Template. In E. Cullen, L Jones and R. Woodward (Eds.). Therapeutic Communities for Offenders. Chichester: John Wiley & Sons, p.75.

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Garrett, C. (1985). Effects of residential treatment of adjudicated delinquents: A meta-analysis. Cited in C. Hollin. (1992). Criminal Behavior: A Psychological Approach to Explanation and Prevention. London: The Falmer Press.

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Gendreau, P. (1996). Offender rehabilitation: What we know and what needs to be done. Criminal Justice and Behavior. 23:144-161.

Gendreau, P. & Andrews, D. (1990). Tertiary prevention: what the meta-analysis of the offender treatment literature tells us about "what works". Canadian Journal of Criminology. 32: 173-184.

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Kennard, D. (1983). An Introduction to Therapeutic Communities. As Cited in E. Cullen, L Jones and R. Woodward (Eds.). Therapeutic Communities for Offenders. Chichester: John Wiley & Sons, p.168.

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Kennard, D. (1994). Response to Whiteley, S., 18^th S. H. Foulkes Lecture. Cited in E. Cullen, L Jones and R. Woodward (Eds.). Therapeutic Communities for Offenders. Chichester: John Wiley & Sons, p.208-209.

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Warren, S. (1998). Cognitive Behavioral Approaches to Anger & Aggression. Criminological Psychology Lecture at the University of Birmingham on Tuesday 05^th May 1998.

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9.1.1. APPENDICIES ONE (One):

STAGES OF CHANGE QUESTIONNAIRE

(McConnaughy et. al. 1983: 1989. Originally reproduced by kind permission of authors and publishers)

Each statement describes how a person might feel about his or her problems. Please indicate the extent to which you tend to agree or disagree with each statement. In each case, make your choice in terms of how you feel right now, not what you have felt in the past or would like to feel.

Please contact Test Publishers for current copy.

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9.1.2. APPENDICIES ONE (Two):

HOSTILITY AND DIRECTION OF HOSTILITY QUESTIONNAIRE

P. AND P. I. QUESTIONNAIRES

PERSONALITY QUESTIONNAIRE

(HDHQ)

by T. M. CAINE

and G. A. FOULDS

Surname ………………………………………………..

Christian Names ……………………………………….

Age ……………………………………………………...

Sex ………………………………………………………

Occupation ……………………………………………..

Marital Status ………………………………………….

Date ……………………………………………………..

Instructions:-

Please fill in this form by putting a circle round the "True" or the "False" after each of the statements overleaf. If you find it difficult to decide, ask yourself whether you think the statement is on the whole true or false and put a circle around the appropriate word.

Please contact Test Publishers for current copy.

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9.1.3. APPENDICIES ONE (Three):

SKILLS EVALUATION CHECKLIST

Designed by Wycherely B., Crellin C., & Chiva T. (1994).

Read each of the statements below and put a tick in the column, which shows how much you feel it is like you. Your answers should show how you feel at the present time.

Very like me Like me Unlike me Very unlike me

1. I can easily tell when someone is angry with

me even if they don’t show this directly.

• I have no difficulty showing my anger in a

controlled way.

• I always get angry to a person’s face and don’t

show it in disguised ways.

• I am in touch with my angry feelings,

• I feel that ‘sitting on’ anger is not a good

thing in the long run.

• I have no fear that my anger will get out

Of control if I let go.

• I let that sometimes getting angry is the only

Way to sort out a situation.

• I feel that it’s important you be able to get

angry at times.

• I feel in control of my anger when I express it.

• At times I have to get angry just to make

People listen.

• When I feel angry it’s generally a sign that

I’m being trodden on.

Very like me Like me Unlike me Very unlike me

• I try to look at every confrontation afterwards

So that I can learn to handle them better.

• I weigh up possible confrontations carefully

to decide whether it is wise to get involved.

• When I’m being threatened with conflict I

know what approach to take to defuse it.

• Before I get into a confrontation I get clear

in my mind what I want to achieve from it.

• I prepare for difficult encounters by looking

at all the factors which might make me

‘loose my cool’.

• I can control my anger by relaxing and

talking myself through a difficult situation.

• I am aware of situations, or people. Which

make it more likely that I will get angry.

• I understand the thoughts and beliefs which

often lie behind my angry feelings.

• I don’t ‘bottle things up’.

Column totals

Multiply - Not available for Internet access (PJG)

Totals

Add up the number of ticks in each column and write them in the spaces for COLUMN TOTALS. Then multiply each column total by the number under it and write the result in the space below that. Add the numbers across all the columns to give your TOTAL SCORE and write this here:

Total score ……………………

Higher scores show a greater ability to manage anger and conflict effectively.

You should keep this checklist safe, as you will be able it in again at the end of the unit so that you can then see if your score had changed.

Please note that there is no score that is ‘normal’ and that the scores are simply to give you a way of seeing the progress you have made.

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9.1.4. APPENDICIES ONE (Four):

ANGER DIARIES

(Initial Anger Diary was Orange in Color)

Not available for Internet Viewing (PJG)

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9.1.5. APPENDICIES ONE (Five):

WORKSHOP DEBRIEFING

(Original, printed on Ley Community letter headed paper)

Please complete the following in CONFIDENCE.

• AGE

• SEX

• DRUG & CHOICE

• CRIMINAL RECORD FOR VIOLENCE

• HOW LONG HAVE YOU BEEN AT THE LEY?

• HAVE YOU EVER ATTENDED A COURSE FOR ANGER MANAGEMENT?

• DID YOU COMPLETE THE WORKSHOP?

• IF NOT WHY NOT?

Please answer the following questions by circling either 1 n- 5, with 5 = Good, 4 = Average, 3 = Fair, 2 = Below Average and 1= Poor.

Please use the following space to comment on particular exercises covered in the workshop found useful. 

What changes would you make to the workshop.

What has benefited you personally from attending the workshops?

Would you recommend others to this workshop?

What other workshops would you like the Ley Community to provide? Please give ideas!

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9.2. APPENDICIES TWO:

M.A.C.W. OUTLINE

In order to illustrate what occurred within the workshop, with references to the session’s aims and objectives, a summary of the twelve hours follows:

SESSION ONE: The objectives of "Feeling Angry", is to examine the experience of anger and the common belief that to express anger is wrong. Residents are provided with the means to become aware of the effects of suppressing anger before going onto to think about the valuable uses that anger has. This session is broken down into four exercises. The first exercise entitled 'Angry' allows the residents to examine the positive and negative experiences of anger and its emotional, cognitive, physical and behavioral components, "Feelings, Beliefs, Attitudes & Behavior". The next exercise, 'festering’ unravels the idea that it’s common for suppressed anger to result in irritability, tension problems and anxiety. This is followed by ‘Smouldering’ which looks at some of the commonly-held beliefs that to express anger is wrong and allows the residents 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 useful ways. Finally, ‘Pros & Cons’: looks at the negative and positive uses of anger in the light of the residents own experiences. The whole point of this exercise is to stress the significance 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. Therefore, it is important that residents accept anger is accepted as a valid emotion, a means of communication and a springboard for constructive action. To achieve this, residents must become familiar with expressing it (adapted from Wycherely et. al. 1994).

SESSION TWO: The objective of "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 residents 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 Defence’ 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 residents to recognize and work out strategies for themselves, for dealing with this type of anger in specific situations that may confront them (adapted from Wycherely et. al. 1994).

SESSION THREE: "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 energize 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 residents 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 residents 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 entitled, ‘Profile’. This provides residents with an opportunity to consider what problems 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 (adapted from Wycherely et. al. 1994).

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. Residents will appreciate that understanding and modifying the factors that contribute to it can control anger levels. Residents practice reducing anger through relaxation and positive self-talk. There are seven specific exercises in this session: Firstly, ‘Inflamed’. It is important that residents grasp the idea that it is thoughts and beliefs about events which lead to anger, and not the events themselves. Secondly ‘Thoughts’, reinforces the previous exercise. This is a difficult but is useful as it helps residents 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 that can lead to angry thoughts, feelings and behavior are worked through. The overall aim of the exercise is to encourage awareness and beliefs residents hold and to help them to prevent anger by modifying their beliefs. The fifth exercise is entitled ‘Trigger Happy’, and 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 residents with an opportunity to identify and acknowledge the existence of internal speech and to rehearse alternatives. Homework is also set to encourage residents to develop their own scheme of positive self-talk and relaxation. Finally, the seventh exercise entitled; ‘Anticipation’ furnishes residents with some 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 (adapted from Wycherely et. al. 1994).

Finally, SESSION FIVE: "Managing Conflict", is divided into four exercises. The objectives are to introduce basic guidelines for dealing with conflict. Residents will explore the effect of different responses in a threatening situation and the importance of a friendly-assertive response to a threat. It enables residents 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. It considers 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 (adapted from Wycherely et. al. 1994).

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9.3.1. APPENDICIES THREE (One):

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BASELINE H.D.H.Q.

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9.3.2. APPENDICIES THREE (Two):

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CONTROL GROUP H.D.H.Q.

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9.3.3. APPENDICIES THREE (Three):

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GROUP ONE H.D.H.Q. & S.E.C.

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9.3.4. APPENDICIES THREE (Four):

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GROUP TWO H.D.H.Q. & S.E.C.

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9.4. APPENDICIES FOUR:

AUTHORITY to ENTER into RESEARCH

I ______________ __________________ do hereby give my consent to Paul John Griffiths, to administer various Psychometric Measures and utilize the results in his research for a Masters in Criminological Psychology studies.

Signed: ……………………….. Dated: ……………….

I Paul John Griffiths do hereby honor the above residents wishes to enter into my research and will ensure that all material is kept in confidence and only used for my studies. Residents will not be mentioned by name and any personalized information will be kept secret. I carry Public and Product Liability to the tune of two & a half million pound sterling.

Signed ……………………….. Dated: …………………

University of Birmingham

Psychology Unit

Edgbaston

Birmingham

Tutor: Dr. Liz Gilchrist (Chartered Forensic Psychologist)

HMP GARTREE

Gallow Field Road

Market Harbourgh

Leicestershire

Clinical Supervisor: Roland Woodward (Chartered Forensic Psychologist)

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