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Compendium 2000 on Effective Correctional Programming

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Violent Offender Programming


The preoccupation with violent offenders has heightened following the emphasis on risk appraisal over the past decade. It is therefore not surprising that in addition to changes in sentencing and policy, correctional jurisdictions are now attending to the treatment and management of high-risk and violent offenders. This chapter focuses on interventions and programs for violent offenders that are intended to reduce the likelihood of post-treatment reoffending. It is important, therefore, to define violence as distinct from criminality so that interventions for violent offenders can be linked to their specific treatment needs, not offending in general. As such, interventions for delinquency and criminality are not considered to be sufficient for violent offenders, either in terms of treatment targets or theoretical underpinnings. This is not to imply, however, that the management of violent offenders cannot be informed by the risk/need principles reflected in the psychology of criminal conduct (Andrews & Bonta, 1999).

For the purpose of this chapter, violent offending is considered the intentional and malevolent physical injuring of another without adequate social justification, resulting in conflict with the criminal justice system (Blackburn, 1993). Within this definition there is provision for perpetrators to be anger-motivated or goal-oriented (Buss, 1961; Zillman, 1979). Anger is therefore not a prerequisite to offender violence (Novaco & Welsh, 1989), but it is a common antecedent. While threats and psychological injury are not specifically included in this definition, this is not intended to mitigate their harmful effects on victims. It should also be noted that this definition excludes both sexual violence and self-injurious behaviour that is prevalent among offenders (Sherman & Morschauser, 1989) as these are addressed in other chapters of this Compendium.


Confusion over the definition of violent offender has been a major impediment in their treatment. Perhaps related to this is the failure to recognize violent individuals as being heterogeneous (Serin & Preston, 2001). Violent offenders are usually defined in terms that are not mutually exclusive such as criminal convictions (e.g., assaults), attitudes (e.g., hostility), emotions (e.g., anger), and victim selection (e.g., spousal assault). The failure to specifically delineate types of violent offenders has obscured the identification of treatment needs and confounds program effectiveness research (Serin, 1994). For example, predominantly instrumentally aggressive clients are unlikely to show substantive gains in an arousal management-based anger control program. Further, even observable and measurable changes by an offender, (e.g., knowledge of anger principles), may well be unrelated to reductions in future violence simply because the domain was not criminogenic for that particular offender. Upon evaluation, such a program might then be considered to be ineffective. More accurately, however, it should be considered ineffective for certain types of violent offenders.

While not as sophisticated as the typology research with sex offenders (Knight & Prentky, 1990), there have been efforts to develop typologies for violent offenders that might then inform programming efforts. Some have included offence types (Dietz, 1987) and others have reflected detailed clinical reviews (Toch, 1969). More recently, cognitive style has been described as potentially useful in differentiating among violent offenders (Novaco & Welsh, 1989). This work is similar to research by Crick and Dodge, (1994) who described social information-processing deficits in violent juveniles. Tolan and Guerra (1994) distinguished adolescent violent offenders according to patterns of their use of violence. They determined four distinct types -- situational, relationship, predatory, and psychopathological. Most importantly, they suggest that these different types of violence can be distinguished in terms of their prevalence, stability, cause, and preferred intervention. Situational violence incorporates setting, environmental cues, and social factors. Relationship violence reflects interpersonal conflict and incorporates psychological and social factors. Predatory violence denotes instrumental or goal-oriented violence, often in the context of criminality and gang activities. Finally, psycho-pathological violence, the least prevalent, reflects repetitive violence across settings, mainly because of the individual's neuropsychological deficits.

The scheme proposed by Tolan and Guerra (1994) extends earlier research attempting to define violent individuals by linking type of violence to type of intervention. Their work illustrates the utility of differentiated intervention, noting that violent offenders will not have the same onset, antecedents, treatment needs, and treatment response. Although lacking empirical support, it provides an important focus that was previously lacking in the treatment literature on violent offenders.


The Correctional Service of Canada (CSC), receives all adult offenders serving sentences of two years or more, regardless of offence type. Based solely on admitting offence, the stock population in 1995 for the Service was comprised of 78% (n = 10,983) violent offenders (offences include robbery, murder, assault, sexual assault) (Correctional Service of Canada, 1997). In 1994, CSC implemented a systematic, automated assessment strategy for all new admissions. The purpose of this initiative was to assist in the risk assessment of offenders, their treatment planning, and corporate policy development. The database now contains more than 16,000 completed intake protocols for consecutive admissions. These data permit us to refine our definition of violence to reflect history, not just index offence. Restricting the definition to persistently violent offenders, that is, those with three or more victims in their criminal history, the prevalence drops from 78% to 35.4%. Further, considering variables from seven domains of treatment needs that have been identified in the literature as related to risk of violence (i.e., impulsivity, poor empathy, age of onset, lifestyle stability, weapon use, use of threats, escape risk), a persistently violent offender index was calculated (Motiuk, Nafekh, & Serin, 1998). A cut-off for the index of one standard deviation above the mean was utilized to distinguish a high score, putatively indicative of risk. Preliminary analyses with a sample of 764 offenders indicate this index accurately predicts violent recidivism (serious assaults, armed robbery, manslaughter, or murder), with higher scores on the index (persistently violent) having recidivism rates of 50.5% versus 15.4% for the low scores.

The more important contribution, however, is the identification of treatment needs for a group of 2,214 persistently violent offenders (PVO). These data suggest that it is possible to identify chronic or persistently violent offenders whom have greater treatment needs and a higher likelihood of recidivism. Relative to other offenders, they show significantly greater need in the areas of employment, family, associations, substance abuse, community functioning, personal/emotional skills, and criminal attitudes. Table 18.1 presents these data.

TABLE 18.1 Proportion of offenders with considerable difficulties/assets by treatment domain (n = 12,093)

Need Domain
(n = 1967)
(n = 7912)
(n = 7912)
Marital/Family relationships
1 2.4/21.5
Substance Abuse
Community Functioning
Criminal Attitudes



Literature reviews of risk factors in chronically violent or aggressive individuals yield such problems as:

  • hostility (Megargee, 1976)
  • impulsivity (Henry & Moffitt, 1997)
  • substance abuse (Pihl & Peterson, 1993)
  • major mental disorders -- acute symptoms (Monahan, 1997)
  • anti-social personality, psychopathy (Hart & Hare, 1997)
  • social information-processing deficits (Dodge & Schwartz, 1997)
  • experience of poor parenting (Patterson, Reid, & Dishion, 1992)
  • neglect as a child (Widom, 1997).

As well, follow-up studies (Zamble & Quinsey, 1997) and problem surveys (Rice, Harris, Quinsey, & Cyr, 1990) point to anger as an important proximal risk factor for violence. These results illustrate the complexity of factors that must be considered in developing a general theory of violent offending, in formulating a theory about individual cases, and in responding to violence through intervention.

These factors or treatment targets can be organized into domains and compared among different types of violent offenders to demonstrate the need for matching offenders' treatment needs with program content. Table 18.2 illustrates five domains or problem areas from the literature on violent offenders that are related to their expression or inhibition of violent behaviour. These domains are:

  • competence (social skills and empathy)
  • arousal (anger)
  • schema (aggressive beliefs and hostile attributions)
  • self-regulation (impulsivity)
  • anxiety (neuroticism).
TABLE 18.2 Domains and treatment needs for types of violent offenders
(social skills, empathy)
(aggressive beliefs,
hostile attributions)
Self regulation
hostile attributions)
Note. For illustrative purposes only, requires empirical validation. Targeting a domain is hypothesized to increase the expression of violence (+), decrease its expression (-), or have an unknown effect (?).

By using the offender types proposed by Tolan and Guerra (1994), we can observe that one treatment program cannot adequately address the needs of all violent offenders, given their heterogeneity. Specifically, predatory offenders, (e.g., armed robbers), are considered to have deficits in terms of competence, schema, and self-regulation, but not arousal and anxiety. Therefore, gains in the areas of arousal and anxiety should not be expected to result in the inhibition of violence for these offenders. That is, according to this model, anger-based intervention for predatory offenders should fail to yield reductions in violent recidivism because arousal and anxiety are unrelated to their use of violence. Similar conclusions may be extrapolated for the other types represented in the model, however, this conceptual framework requires validation.


Since the assessment typically reflects the treatment targets inherent in that program, it is somewhat difficult to describe the assessment of treatment needs independent of the type of program. Predominantly, the treatment of violent offenders has focused on anger control. This approach views violence as resulting from an offender's inability to identify and manage anger. As noted previously, however, anger is neither a necessary nor sufficient antecedent to violence. Increasingly in addition to self-report aspects of anger (severity, duration, frequency, behavioural expression, triggers), psychological tests of anger deal with cognition and interpersonal interactions (Novaco, 1994). Other common tests used in violent offender programs to deter-mine treatment needs include measures of aggression (Buss & Perry, 1992), social desirability to control for response set (Paulhus, 1998), impulsivity (Eysenck, Pearson, Easting & Allsop, 1985), and assertiveness (McCormick, 1984). More recently, measures of treatment readiness, cognitive style in the form of hostile attribution biases, social problem solving, and relapse prevention knowledge and skills have been incorporated into violent offender assessments (Preston & Serin, 1999). This is consistent with the view that violent offenders are heterogeneous and that violence is multi-faceted.


The strategy for determining treatment intensity for violent offenders is not well defined. The work in the general area of treatment of offenders (Andrews, Zinger, Hoge, Bonta, Gendreau, & Cullen, 1990; Rice & Harris, 1997) provides some specific guidelines. For instance, the broader correctional treatment literature equates intensity with risk (McGuire, 1995), such that higher risk offenders require more intensive intervention for effective programming (Andrews & Bonta, 1999). This matching of treatment intensity to risk underscores the importance of reliable and valid risk assessments as part of the pre-treatment evaluation.2

Treatment intensity must balance frequency of sessions, duration of sessions, and program integrity. Clinicians' resilience and mental health must also be considered in determining treatment intensity because violent offenders are a challenging group. The setting in which treatment is provided also complicates the issue of the intensity of a program, as it is far more difficult to pro-vide higher intensity programs in the community than in institutions or residential programs.

The range and severity of the treatment needs, then, not criminal convictions should determine the ideal length of a pro-gram for violent offenders. Central to this question is the use of intermediate measures of treatment outcome to determine effectiveness (Van Voorhis, Cullen, & Applegate, 1995). Typically, however, operational requirements rather than a consideration of the research determine these decisions. Finally, there are not accepted guidelines for what duration or dosage of intervention constitutes high intensity for violent non-sexual offenders. Currently the range in duration of such programs is 4 to 6 months with a minimum of 135 hours programming, although some programs pro-vide 240 hours of combined group and individual treatment.


Poor attendance is a key issue in community-based intervention. Demanding more intensive treatment, then, would be problematic. Also, consultants who have other work demands usually pro-vide treatment. Further, offenders have family and employment requirements that limit their availability. Interestingly in Multi-Systemic Therapy (MST) the family is engaged to facilitate rather than hinder intervention. Not surprisingly, non-compliance with respect to program attendance and homework completion in community sessions is markedly higher (Michenbaum & Turk, 1987). A final concern for community programs is how to deal with high-risk violent offenders, particularly if their program participation is essentially involuntary, their program performance is marginal, or the agency cannot refuse the offender.

Conversely, residential programs provide increased control to clinicians. Compliance is higher, although attendance and punctuality are far from perfect. Programming can be more flexible, (e.g., longer programs are more easily accommodated, as are programs that require more frequent sessions or morning or after-noon sessions). Residential programs can also utilize milieu treatment and/or token economies which specifically address offender motivation (Agee, 1979). Also, institutional programs increasingly seem to focus on high-risk situations as an important aspect of treatment. The application of relapse prevention to violent offender treatment is appealing, but there is little empirical evidence for its uncritical use with the different types of violent offenders.

One disadvantage of residential or in-patient programs is that treatment effects seldom generalize across settings (Quinsey et al., 1998). Thus, an advantage of community or outpatient treatment is the opportunity to practice, in vivo, new skills. Perhaps for this reason, in other types of programming, community sites have yielded greater results (Robinson, 1996) while also being less costly.


A final consideration in developing interventions for violent offenders relates to their interpersonal characteristics. In discussing treatment intensity, it was noted that violent offenders are a challenging group. In particular, persistently violent offenders tend to be described as treatment resistant.3 Offender non-compliance and attrition present practical and methodological problems and have implications for treatment efficacy. Accordingly, those who intervene with persistently violent offenders must make every effort to motivate them to commit them-selves to treatment. Related to this is the delivery of treatment in ways that will maximize the likelihood that these individuals will make significant behavioural changes.

In order to assist clients to shift their “motivational balance” in favour of the benefits of change versus those of the status quo, therapists should challenge clients' views and the likely consequences of maintaining their current behaviour and potential advantages of changing. This could be done by completing a cost-benefit analysis of the short-term and long-term advantages and disadvantages of completing versus not completing a violent offender treatment program. This analysis should include the perspectives of offenders, their families and significant others, friends, victims, victims' families and significant others, and society in general. This helps offenders to see the discrepancy between their current behaviour and important personal goals (Preston & Murphy, 1997). The use of disclosure and thinking reports have also proved to be important with violent offenders, but these are often resisted when initially introduced.


In addition to the general and accepted characteristics of good pro-gram staff as being fair but firm (Andrews & Bonta, 1999), recent research with offenders highlights that therapist characteristics do have an impact on treatment performance and outcome (Fernandez, Serran, & Marshall, 1999). These researchers found that empathy and related characteristics in therapists predicted whether an offender accepted responsibility for his crime. Further, style of delivery and therapists' skills predicted group participation. Although preliminary, these data are encouraging because they indicate that therapists' attributes and skills are related to different aspects of positive treatment effects. As well, linking the risk/need profiles of offenders to therapists' skills is the central tenet to responsivity.4 Lastly, delivering programs to violent, resistant offenders is emotionally draining and some consideration must be given to staff selection and training, staff retention, and maintenance of their skills for high treatment integrity and program effectiveness.


It should be clear from the review thus far that interventions for chronic or persistently violent offenders must be multi-modal and reflect proximal (individual) and distal (societal, cultural, familial) risk factors for violence. The distal factors imply primary and secondary interventions while proximal factors have been addressed by tertiary-level interventions. Tolan and Guerra (1994) provide an excellent review of primary and secondary interventions for violent juveniles. Accordingly, only a review of tertiary level pharmacological and psychological programs will be provided.


At this time, no medication has been developed or approved specifically for the treatment of violent behaviour. Several classes of psychotropic medications, however, have been utilized with some success with specific types of violent individuals. Anti-depressants have been used to treat children and adolescents diagnosed with depression, agitation and attention deficit/hyperactivity disorder, and adults who are violent as a result of depression, personality disorders, brain injury, dementia, and schizophrenia. There have been cases, however, where patients have shown an increase in suicidality or aggression following treatment with anti-depressants.

Lithium, used primarily in the treatment of bipolar disorder, has been shown to reduce violence in children and adolescents with conduct disorder and episodic dyscontrol and in children, adolescents, and adults who are developmentally delayed. It has also reduced violence in adults who are brain-injured, personality disordered, and schizophrenic, as well as those diagnosed with schizoaffective and organic mood disorders.

Anti-psychotics, because of their sedative effects, are used primarily for the acute management of violent behaviour, usually resulting from a psychotic episode. Such violence may be related to delusions, hallucinations, or thought disorders. Anti-psychotics are not recommended for the long-term management of violent behaviour because prolonged sedation profoundly affects patients' quality of life, may exacerbate dyscontrol, rage, and violence, and are associated with serious neurological side effects. The latter is associated with patient non-compliance with medication.

Anti-anxiety or sedative medications are also used primarily for the acute management of violent behaviour. Because they increase seizure thresholds and are associated with few side effects, they are often the medication of choice in emergency situations. They have been shown to be effective with those demonstrating violent behaviour as a result of alcohol withdrawal and acute psychosis as well as those exhibiting manic agitation and episodic temper outbursts.

Anti-hypertensive medications have reduced aggressiveness and impulsivity in children and adolescents with intermit-tent explosive disorder, conduct disorder, and attention-deficit disorder. They have also been effective with adults with neurological impairments, chronic organic brain syndromes, and mental retardation. They have fewer neurological side effects than anti-psychotic medications thus they may be better tolerated by those with organic mental disorders.

Anti-convulsant medications have been shown to have an impact on the aggressive behaviours of those with brain damage, particularly those with abnormal electroencephalograms. They have reduced aggression in some patients with dementia, some who are developmentally delayed and some that have organic mental disorders or impulse control problems.

While positive reports about the impact of medication on violent behaviour are encouraging, this literature is plagued with numerous methodological problems, including small sample sizes, lack of control groups, failure to utilize double-blind procedures, issues of non-compliance, and poor diagnostic accuracy. As well, although medication may have an impact on certain biological causes of violent behaviour, on its own it is rarely effective in reducing violence over the long-term. This is primarily because medication cannot eliminate the numerous psychosocial causes of violence. Clearly, for those whose violence can be partially attributed to biology, an integrated approach utilizing both pharmacological and psychological interventions would be most effective. The vast majority of violent offenders, however, would neither require nor benefit from pharmacological treatment. For them, psychological interventions should have some utility.


Evidence from juvenile and adult studies with offenders consistently underscore the relative importance of behaviour modification, cognitive-behavioural training and social skills training to reduce anti-social behaviour, and in some cases, violence. Psychotherapy and social casework have not proved effective at reducing anti-social behaviour (Kazdin, 1993; Quinsey et al., 1998). In the juvenile literature, multidimensional programs such as those involving family systems have had the greatest impact, but the results are often confounded by such factors as intensity and caseload level (Tolan & Guerra, 1994).

When provided, descriptions of programs for violent offenders lead one to conclude that different clinicians label similar interventions differently. For instance, some programs are described as social skills training, yet target several different components, for example, assertion, self-control (arousal reduction), and social anxiety. Within these studies there are assumptions that theoretically relate patients' poor social skills to violent behaviour. While it is likely that these targets all fall within a cluster of interactional skill deficiencies, it is not clear that all violent offenders are equally deficient in these areas (Henderson, 1989).

The most common category of programming for violent offenders is that of anger management or anger control. While the specific treatment components vary somewhat across pro-grams and settings, components typically address arousal levels and rehearse alternative thinking. Both stress inoculation (Novaco, 1975) and irrational beliefs (Rational Behaviour Therapy -- Ellis, 1977) have been incorporated into these programs, although it is uncertain which contributes greatest to treatment gain, or the manner in which they may interact.

Stress inoculation programs consider:

  • awareness of hierarchy of individual anger cues
  • relation between self-statements and anger level
  • model of anger and measurement of parameters (intensity, duration, frequency, behavioural outcome)
  • reappraisal of anger situations
  • self-instructional coping aids
  • relaxation training to reduce arousal level and facilitate self-control
  • skills practice

All of these strategies are aimed at reducing the arousal level of an individual. The view is that increased arousal equals decreased anger control. Arousal reduction involves systematic relaxation, distraction, or imagery techniques (although our experience is that offenders feel awkward about practicing to mastery). Learning to recognize and control arousal decreases the likelihood of aggressive responses in perceived conflict situations. Increasingly, communication and assertion skills have been incorporated into this approach, although the core elements are cognitive preparation, skill acquisition, and practice.

The Rational Behaviour Therapy approach more specifically emphasizes the role of cognitions, notably irrational beliefs, in the provocation and maintenance of anger levels. Offenders are taught that their irrational beliefs result in increased arousal (anger) and that their arousal precipitates aggressive behaviour. Intervention targets the link between thoughts and feelings, challenging offenders to refute irrational beliefs, presumably decreasing the likelihood of aggressive responses.

Implicit in the proliferation of anger control programs is that violent offenders are angry and that their level of anger exceeds that of non-violent offenders. Accordingly, reduced levels of anger are anticipated to result in less frequent and optimally less violent behaviour. This is a curious notion in that violence is relatively infrequent, unreliably measured, and often appears to be motivated for reasons other than anger (Henderson, 1984). Recent programs now include skills practice in the areas of social skills, assertion, problem solving, and empathy.

In order to develop working models for assessment and intervention, treatment efforts have been organized as either relating to self-regulation and cognitive processing. These two approaches imply that most violence can be attributed to either high arousal/poor self-regulation or poor problem-solving skills in the context of conflict situations.

Self-regulation strategies

Some authors have incorporated several of the following components into a more comprehensive package (Goldstein & Keller, 1987), however, the key treatment targets are:

  • arousal reduction techniques (Levey & Howells, 1990)
  • interpersonal skill acquisition, (e.g., social skills, assertion, problem-solving) (Guerra & Slaby, 1990)
  • cognitive distortions (Ellis, 1977; Rokach, 1987)

Cutting across various prison settings and populations, evidence exists to support the application of relaxation training or stress inoculation to anger control issues (Hughes, 1993; Hunter, 1993; Kennedy, 1990; Rokach, 1987; Schlichter & Horan, 1981; Serin & Kuriychuk, 1994; Stermac, 1987). It is not clear, however, that arousal reduction strategies are necessarily superior to skill acquisition (social interactions, problem solving, or cognitive coping skills). Further research is required before conclusions can be made regarding the differential treatment effects of components of typical anger control programs.

Some programs target impulsivity, yet these appear to reflect a problem-solving strategy with a delay or pause feature comparable to self-instructional training (Camp, Blom, Herbert, & Van Doorninck, 1977). One novel application has been Rokach's (1987) use of a forced delay feature as part of a process reviewing simulated social situations such that pausing may inhibit expression of negative thoughts and facilitate the generation of alternative coping responses.

Cognitive processing strategies

Novaco and Welsh (1989) describe the importance of appraisals and expectations in viewing potentially provocative events and promoting an aggressive response. Prior beliefs or cognitive schema influence automatic processing of information, which is but one form of cognitive processing. Research with adult offenders has demonstrated irrational beliefs (Ford, 1991) and attributional biases (Serin, 1991) in violent offenders. As well, Meloy (1988) has distinguished between affective and predatory violence, the latter implying schema or information processing deficits. Research in the area of juvenile violence has highlighted the critical role information-processing deficits play in determining and maintaining aggressive behaviour (Crick & Dodge, 1994). Aggressive juvenile offenders have been found to be deficient in social problem-solving skills and to espouse many beliefs supporting aggression. Specifically, they tend to define problems in hostile ways, adopt hostile goals, seek less confirmatory information, generate fewer alternative solutions, anticipate fewer consequences for aggressive solutions, and choose less effective solutions.

While several examples of these efforts can be found in the developmental literature for aggressive and delinquent youth (Feindler, Marriot, & Iwata, 1984; Hains, 1989), the most ambitious effort with juvenile offenders described the utility of a problem-solving strategy that targeted biased thinking skills (Guerra & Slaby, 1990). The cognitive mediation training specifically targeted the deficits noted previously by Slaby and Guerra (1988). Those familiar with the psychology of criminal conduct (Andrews & Bonta, 1999) will note this is a specific application of targeting the thinking that maintains violent criminal behaviour.


Several studies have examined the efficacy of cognitive-behavioural interventions for aggressive adult offenders. Hunter (1993) offered a 10-week anger management program to 28 incarcerated male offenders who had a propensity for inter-personal violence, using a control group of 27 inmates. The intervention included relaxation therapy, stress management, conflict resolution, and cognitive therapy, the latter targeting errors in thinking (hostile and aggressive thoughts), irrational beliefs, and negative self-talk. Offenders in both groups completed pre- and post-treatment self-report measures pertaining to personality, cognitions, behaviour, and social desirability and researchers recorded other behavioural indices including institutional infractions. Hunter found that treated offenders showed significant gains relative to non-treated offenders across self-report and behavioural ratings. No follow-up data are avail-able, however, and the total sample is only 55 offenders.

Hughes (1993) provided a 12-week anger management program to 52 incarcerated adult offenders and attempted to compare them to a control group of 27 offenders. The latter were men who either dropped out of the program after one or two sessions, or who opted not to participate in the program for a variety of reasons. The program, described as both educational and experiential, consisted of relaxation therapy, assertiveness training, moral reasoning, problem-solving, and rational emotive therapy. Offenders in the treatment group completed a number of self-report measures pre- and post-treatment. Also for the treatment group, Hughes completed behavioural ratings of role-plays pre- and post-treatment. Offenders in the control group completed pre-treatment self-report measures only. Hughes attempted to gather post-treatment data from the control group, but few of them agreed to complete the tests. Finally, four years after program completion he gathered staff ratings of treated offenders' ability to cope with anger, anxiety, and various problem situations and obtained recidivism data. Hughes found that treated offenders reported post-treatment gains regarding anger scores, irrational beliefs, and in role-plays. However, there was no difference in recidivism rates between the treated and non-treated groups.

Kennedy (1990) compared the relative efficacy of stress inoculation treatment to a behavioural skills treatment with a sample of 37 incarcerated adult offenders. Offenders completed several self-report measures both pre- and post-treatment. As well, Kennedy completed pre- and post-treatment behavioural ratings of structured role-plays, and reviewed offender files for relevant incident reports. She found that offenders showed post-treatment gains on several of the measures. However, she also completed an interim assessment of treatment gain and found that order of presentation of treatment had no effect. The greatest treatment gain occurred in the initial phase of treatment regardless of which treatment was offered initially.

An intensive two year correctional program in Vermont that focuses on criminal thinking in violent offenders has demonstrated a reduction in violent recidivism relative to an untreated group (Bush, 1995). Some innovations in the program include the use of a therapeutic milieu, the utilization of “thinking reports”, and the use of paraprofessional staff (trained correctional officers). The program has now been delivered for nine years and has incorporated a complementary community aftercare component.

Guerra and Slaby's (1990) intervention consisted of 120 aggressive adolescents, equally divided by gender, being randomly assigned to a 12-week cognitive mediation training, attention control, or no-treatment control. Pre- and post-treatment assessment incorporated measures of social cognition (beliefs about aggression), behaviour ratings, and self-report. Post-treatment gains for the treatment group were noted in terms of increased skills in solving social problems, reduced support of aggressive beliefs, and reduced aggressive behaviours (based on blind raters). The follow-up period was 24 months for the recidivism analyses. The inference is that these socio-cognitive factors regulate aggressive behaviour, yet recidivism rates for the treated subjects, although reduced, were not significantly lower than the controls.

The Correctional Service of Canada has begun the evaluation of an Anger and Emotions Management Program (Dowden, Blanchette, & Serin, 1999). Recidivism data for a matched sample (on risk, age and major admitting offence) of 110 male offenders who completed the program indicate it was effective. Greatest effects were noted for higher-risk offenders, with a 69% reduction in non-violent recidivism and 86% reduction in violent recidivism, although the two groups differed with respect to time at risk. Further, change scores on several self-report measures were significantly related to outcome. Subsequent analyses (Dowden & Serin in press) have indicated that treatment dropouts have violent failure rates 8 times that of the treatment group (40% versus 5%) and twice that of the controls (40% versus 17%). A newly created program performance factor was significantly correlated with recidivism (r = 0.32, p < 0.01), and approached statistical significance in a regression analysis. Finally, a comparison of 41 matched (age, risk, past program performance) pairs of offenders indicated that the controls had rates of recidivism 3 times that of the treated group, but this difference was not statistically significant.

Lastly, in 1996 the Correctional Service of Canada developed an intensive treatment demonstration program for incarcerated persistently violent adult offenders (Serin, 1995). The treatment program is intense, involving four group sessions and one individual session per week for 16 weeks. Treatment is provided by two staff -- a doctoral level registered psychologist and a bachelor's level therapist. Based on a review of the literature, treatment targets include motivation for treatment and behaviour change, aggressive beliefs, cognitive distortions, arousal management, impulsivity, conflict resolution, problem-solving, assertiveness, empathy enhancement, and relapse prevention. An exhaustive multi-method assessment protocol has been developed and preliminary data are available (Preston & Serin, 1999) that support modest gains, as measured by the test battery and behavioural ratings with more detailed analyses in terms of out-come to be forthcoming. This protocol is summarized in Table 18.3. The conceptual framework for this program has also been adapted for implementation in a large number of sites within the Service under the auspices of a Violence Prevention Program (Bettman, 1999).

TABLE 18.3 Assessment protocol for treatment needs of violent offenders (from PVO program)

Domain Scale Type of
Pre or
Pre & Post)
Format: Group
or Individual
Intelligence Shipley Institute of Living Scale Self-report Pre Group
Risk SIR File-based Pre N/A
Motivation URICA Self-report Pre & Post Group or Individual
Motivation Treatment Readiness Behavioural rating Pre & Post Individual
Anger Reactions to Provocation Scale Self-report Pre & Post Group or Individual
Anger Reactions to Hostile Situations Self-report Pre & Post Group or Individual
Aggression Reasons for Aggression Self-report Pre & Post Group or Individual
Aggression Aggression Questionnaire Self-report Pre & Post Group or Individual
Aggression Vignettes Behavioural rating Pre & Post Individual
Impulsivity Eysenck I7 Self-report Pre & Post Group or Individual
Anxiety Welsh Anxiety Scale Self-report Pre & Post Group or Individual
Attachment Relationship Style Questionnaire Self-report Pre & Post Group or Individual
Empathy Empathy Skills Behavioural rating Pre & Post Individual
Empathy Interpersonal Reactivity Index Self-report Pre & Post Group or Individual
Social Desirability Paulhus Deception Scales Behavioural rating Pre & Post Group or Individual
Personality Personal Reaction Questionnaire Self-report Pre & Post Group or Individual
Personality Interpersonal Style Behavioural rating Pre & Post Individual
Criminality Criminal Attribution Inventory Self-report Pre & Post Group or Individual
Treatment Gain Treatment Performance Behavioural rating Post Individual

An overview of these programs is presented in Table 18.4. It should be noted that all programs report some treatment effects, but few provide the rigor, (i.e., control groups), to conclude that intervention for violent adults reduces violent recidivism. Also, the relationship between response to treatment and subsequent dangerousness has yet to be demonstrated empirically. Suggestions have been made that treatment should be re-conceptualized as a mechanism for enhanced risk management through continuing intervention in the community (Serin, 1998).

TABLE 18.4 Summary of adult violent offender treatment outcome studies

Study Subjects Treatment Attributes Evaluation Outcome
Rokach (1987) 51 treated incarcerated men offenders, 44 controls with violent criminal history & self-report anger problems Anger management, cognitive-behavioural, short term (27 hrs), group format Non random referrals, partially matched controls, pre/post test self-reports, non-blind post treatment interviews, no recidivism data Positive within treatment effects, no recidivism data
Stermac (1987)

Offenders remanded to METFORS* for psychiatric assessment, 20 treated & 20 controls with anger problem

Anger management, cognitive-behavioural, short term (12 hours), group format

Randomly assigned, control group, pre/post self-report measures, no recidivism data

Some positive within treatment effects, no recidivism data

Kennedy (1990)

Canadian provincially incarcerated men referred for anger management, 19 treated and 18 controls

Anger management, cognitive-behavioural, short term (60 hours), group format

Non random, unmatched delayed treatment control group, pre/post self-report measures, blind behavioural ratings of role plays, 2 month follow-up assessing institutional misconducts

Positive within treatment effects and mixed findings regarding institutional misconducts

Rice, Harris, & Cormier (1992)

176 treated mentally disordered men offenders & 146 matched controls with violent histories

Intensive 2 year therapeutic community therapy, group therapy, 80 hours per week

Non random, matched controls, retrospective 10-year follow-up measuring general & violent recidivism

No significant overall treatment effects but treated psychopaths exhibited higher failure rates than untreated psychopaths
Hughes (1993) Federally incarcerated men offenders, 52 treated and 27 controls with violent criminal histories Cognitive behavioural, anger management, short term (24 hours), group format

Referrals served as non-random, not matched controls, pre/post self-report measures, role plays, coping ability ratings, 4-year follow-up assessing time to re-arrest, and recidivism.

Positive within treatment effects, mixed results regarding effects on recidivism

Hunter (1993) Federally incarcerated men, 28 treated, 27 controls with violent histories

Cognitive behavioural anger management, short term (10 weeks), group format

Non random, unmatched waiting list controls, pre/post self-report measures, 2 months follow-up assessing institutional misconducts

Positive within treatment effects and post treatment effects

Smiley, Mulloy, & Brown (1995)

134 treated federally incarcerated men offenders with violent index offence, 14,500 controls

Cognitive Behavioural Violent offender personality disorder program, group therapy, 8 months

Non random, control group not matched, unspecified follow-up period, recidivism: success or failure on conditional release No post treatment effects
Bush (1995) 81 treated violent male offenders and 287 men controls, both from Vermont Department of Corrections

Cognitive Self Change Program, targets attitudes, beliefs & thoughts supportive of violence, group format, 6 month-2 year institution component & 1 year community component

Non random, control group not matched, 1-3 year post community treatment follow-up period, recidivism: arrest or parole violation Positive treatment effects; recidivism rate was twice as high for untreated group than for treated group (more than 7 months in treatment).
Dowden, Blanchette, & Serin (1999) 110 treated violent male offenders and matched controls. Anger & Emotions Management Program, targets anger & aggression, managing arousal, thinking patterns, assertiveness, other emotions Non random, control group matched (age, risk, admitting offence), 2-3  year post community treatment follow-up period, recidivism: non violent (NV) & violent (V) Positive treatment effects; recidivism rate was three (NV) to six times (V) higher for control group than for treated group
* Metropolitan Toronto Forensic Service



One major shortcoming of this literature on the treatment of violent offenders is the over-reliance on self-report measures of treatment gain. The reality is that intervention is often accepted under duress and less than favourable post-treatment reports have significant negative consequences for offenders. Hence, efforts to control for social desirability and/or intelligence appear warranted. Related to this concern about self-report instruments is that many have been developed for non-offender populations, they lack validity scales, and often have such transparent items that interpreting post-treatment improvement without corroborating indices of gain may be at best speculative. An additional concern is that violent offenders inconsistently report higher scores post-treatment, and therefore greater problems, on self-report measures of anger, aggressiveness, and hostility (Novaco, 1994; Serin & Kuriychuk, 1994). Baseline measures or within subjects comparisons therefore appear warranted so that individual offender's improvement may be considered.

The use of recidivism rates as a measure of treatment gain has been debated (Blackburn, 1993), yet for offender populations the expectation of increased community safety and reduced violent recidivism is often their raison d'être. Multiple outcome measures are also recommended to detect partial successes that may be obscured by dichotomous success/fail definitions, as are survival analyses to control for unequal release times (Chung, Schmidt, & Witte, 1991).

Treatment outcome should be measured in a number of ways (Van Voorhis et al., 1995). For residential or institutional settings, intermediate measures of treatment gain include reductions in the frequency and severity of institutional infractions, especially verbal threats and physical assaults. An increase in the number of participants seeking and maintaining institutional employment post-treatment would also be an intermediate gain. So too, would improved compliance with correctional treatment plans, transfers to reduced security institutions, and the granting of parole or discretionary release. For community or out-patient settings, intermediate measures of treatment gain include seeking and maintaining employment, and compliance with community supervision. Finally, long-term measures of outcome include increased time to re-offence, reduction in the severity of re-offences, and reduction in violent recidivism rates.

Further, some of the intermediate targets may assist clinicians to respond to questions about the effectiveness of a new pro-gram before longer-term outcome data are available. For instance, after the completion of two PVO groups, program staff was able to report a 50% reduction in institutional infractions, relative to the previous six months. Other notable outcomes for the pro-gram included improved employment post-treatment and transfers to reduced security (Preston & Murphy, 1997). It remains to be determined whether such intermediate gains are predictive of recidivism.

Pre-post treatment changes on self-report measures are also important intermediate indices of treatment gain, yet they have not proved particularly effective predictors of outcome with offender populations (Rice & Harris, 1997). Social desirability, transparency of items, and predominantly historical items all contribute to concerns about reliance on offenders' self-report as indices of treatment gain. With this in mind, alternative strategies for use by clinicians to assess treatment readiness, inter-personal style, and treatment performance have been developed (Serin & Kennedy, 1998).


The theme throughout this chapter is the heterogeneity of violent offenders. It should be apparent, then, that the current array of interventions reviewed fail to adequately address the requirement for a range of treatment needs. It is also a clinical reality that few settings have the resources to provide multiple programs for different types of violent offenders. Also, although appealing from a methodological viewpoint, the operational juggling required to match offenders to specific treatment modules, from an inventory, and based on pre-treatment assessment, is quite arduous. Such a strategy also necessitates the use of open groups and this might interfere with the group dynamics and cohesion, because not all offenders would receive all treatment components. Notwithstanding these problems, improvements in the prescription of programs to better match the treatment needs of different violent offenders' remains an important goal.

From the treatment responsivity research (Kennedy & Serin, 1997), it is clear that program effectiveness will be increased according to the extent to which programs are prescriptively applied to offenders. Perhaps utilizing a more comprehensive assessment protocol to determine different types of violent offenders and their specific treatment needs will lead to more differentiated programming. If offenders are inappropriately assigned to a specific treatment program, then demonstration of treatment effectiveness will be markedly impaired. Therefore the issue is more what type of program works for which offender(s) than does a program reduce violent recidivism.


Notwithstanding the concern about violent offenders, there exists a surprisingly small body of literature describing effective treatment efforts, particularly in contrast to other groups such as sexual offenders and spousal abusers. Most published studies do report treatment gains, but this has mainly been restricted to self-reports and has not generalized to improved recidivism rates. To date, measurement of treatment efficacy has been confounded by this over-reliance on self-report questionnaires, the absence of control groups, and problems in the definition of violent offenders.

Efforts should be initiated to better incorporate best practices from the juvenile literature into treatment programs for violent adult offenders. The juvenile literature also places greater emphasis on skill acquisition in the areas of family dynamics and problem solving than the emphasis with adults on arousal management, although this appears to be changing. Conceptual models, then, that integrate arousal level, self-regulation, and cognitive style may prove helpful as clinicians strive to provide programs for an array of different types of violent offenders. It appears that this is the direction the field is moving as various correctional jurisdictions de-emphasize arousal-based anger control programs.

What are the implications for incorporating treatment into risk management strategies for violent offenders? In those programs that focus on relapse prevention, the offence cycle provides a mechanism to discover antecedents or proximal factors to an offender's use of violence. Also, in those programs that utilize comprehensive risk appraisals, treatment provides an opportunity to comment on the intensity and nature of community aftercare and super-vision. Explicit decision rules to assist clinicians against unbridled optimism might be advantageous in incorporating treatment performance into risk management strategies (Serin, 1998).

Lastly, there is increasing consensus regarding the “correct” components for a treatment program, methods to address treatment resistance, and methodology to demonstrate treatment gain and treatment effectiveness. Equally importantly, these are increasingly being applied to the specific target of violent offending.

1 Correctional Service of Canada

2 See Quinsey, Harris, Rice, & Cormier (1998) for a scholarly review of assessment issues germane to violent offenders.

3 For more information on treatment resistance, see Chapters 7 and 8 of this Compendium.

4 See Chapter 5 of this Compendium.

5 See Corrigan, Yudofsky, & Silver (1993), and Karper & Krystal (1997) for comprehensive reviews of pharmacological interventions for violent behaviour. This section is a summary of these two reviews.


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