LECTURE NOTES
Treatment and Rehabilitation in Forensic Psychology
Alternative Interventions
Mental Health Courts
The increasing “criminalization” of the mentally ill indicates the need for basic services and
supports that public systems have failed to deliver. This has led a number of communities to
establish mental health courts to process criminal cases involving people with serious mental
illnesses.
Goals of Mental Health Courts
(1) To break the cycle of mental deterioration and criminal behavior that begins with the failure
of the community mental health system
The use of mental health courts can include:
(1) Police diversion programs that replace arrests for minor offenses with access to services and
community supports
Initiating such programs require:
(1) Training for judges, prosecutors, and defense attorneys in how to deal with the mentally ill
Alternate Dispute Resolution
Alternative dispute resolution (ADL) refers to a variety of processes available for the resolution
Mediation
Mediation is a form of negotiation which involves the use of a third party to facilitate reaching a
settlement.
Arbitration
Arbitration is an adjudicatory process by which a third party decides the outcome of the dispute.
Treatment
Treating Victims of Domestic Violence
Community resources that could be helpful to victims and clinicians if available, include:
(1) First response teams
(2) Safe-shelter environments and 24-hour crisis phone lines.
(3) Affordable housing independent of abusers
Psychological Reactions to Violent Crime
Certain traumas do much more than injure us physically and even psychologically. They violate
our very sense of safety and stability. This is known as ontological security. Other symptoms in
response to violent crime include:
Treating Victims of Violent Crime
The National Organization for Victim Assistance (NOVA) has developed a generic model of victim
services that contains these major components:
(1) Emergency response at the time of the crisis
(2) Victim stabilization in the days following the trauma
Treating Victims of Child Abuse
(2) Anger management therapy
(4) Cognitive-behavioral therapy
Treating Child Sexual Abuse Offenders
(1) Aversive conditioning: counter–conditioning using mild electric shock or ammonia odors paired with
repeated presentations of sexual stimuli depicting children
(4) Drug treatments and medical interventions: attempt to reduce sexual behavior directed toward
children by targeting the hormones or neurotransmitters underlying sexual drive, arousal, and
(5) Surgical castration: removal of the testes, which results in the near complete elimination of the
production of androgens.
Treatment of Posttraumatic Stress Disorder − in Prison
Rates of PTSD are particularly high in prison inmates. Gibson et al., (1999) report the rate of PTSD
among male inmates to be 21%.
Exposure and Desensitization Treatments
Eye movement desensitization and reprocessing (EMDR): EMDR is an exposure treatment that
involves cognitive restructuring. Two main distinguishing factors of EMDR are short exposure times
Cognitive Treatments
Cognitive behavioral therapy: restructuring of beliefs together with behavior therapy
Skills-based Treatments
Integrated therapeutic approach emphasizing self-control strategies
Terrorism-induced Psychological Disturbances
Only in the last twenty years has terrorism become a significant fact of life for Americans.
Unfortunately, these events have been increasing in frequency and many experts maintain that
the worst is yet to come.
A study cited in Miller (2002) of the 2001 World Trade Center attack found that 11% of all New
Yorkers showed symptoms of PTSD 2 months following the incident, which is almost three times the
national average.
Immediate Psychological Interventions
The first responder
First responders should avoid empty statements such as “Everything will be all right,” and instead
offer more concrete and realistic information such as “We‘re going to take you to a safe hospital.” A
victim’s wishes should be accommodated as much as reasonably possible, if, for example, the victim
wants a family member or friend to remain during treatment or questioning.
Individual Psychotherapy
Intervention should include empathic support, validation, and normalization of the patient’s reaction to
the traumatic loss. Survivors should be prepared for the emotional, financial, practical, and social
losses that follow the terrorist killing of a family member.
Relaxation training, biofeedback, desensitization, and cognitive–behavioral techniques can be
applied to symptom management. Opportunities should be provided, arranged, or planned for
patients to take back some control of their lives, for example, by helping and educating others or
running support groups.
A model to deal with the aftermath of terror and proposed by Hanscom (2001) is called the
HEARTS Model.
H = Listening to the history
E = Focusing on emotions and reactions
Community Responses
Commendations and awards to professional first responders, volunteer rescue workers, service
providers, and others who have distinguished themselves are important components of the
community recovery process.
Memorials to the victims of the terrorist disaster are part of the healing process and should be
Stress associated with Military Deployment
According to a report by the American Psychological Association, deployment can be a complex
and overwhelming process. Deployment means extended separations and the uncertainty of
having a loved one in a combat zone. The situation creates an environment in which the
development of significant emotional problems for military personnel and their families is a real
possibility (APA, 2007).
The APA report also identified serious barriers to accessing quality mental health care for
military personnel and their families. A 40% vacancy rate of active duty psychologists
contributes to the increased stress and diminished morale among the other mental health and
medical providers in the military care system. This shortage leads to high attrition rates for
psychologists and necessitates an overflow of referrals to civilian psychologists who may
not have as much training as military psychologists on issues related to the military and
deployment.
In order to help reduce the stressful impact of military deployment on families, there are
certain actions which preventative actions which can be taken. These include:
(1) Educating military leadership about the importance of mental health issues on active duty
personnel and their dependants
(2) Taking measures to reduce the stigma often associated with seeking mental health services,
such as by making certain mental health services mandatory upon return from military
Restoring Psycholological Competency
Polling of directors of forensic facilities throughout the United States indicate that less than half of
their patients who had been adjudicated incompetent to stand trial, were provided treatment differing
from other patients in the facility.
Bertman et al., (2003) found substantial improvement utilizing a treatment protocol which educated
incompetent defendants on their individualized legal rights such the meaning of the charges against
them, and the potential consequences related to their alleged offenses.
Mental retardation can also be a significant factor in judicial findings of incompetence to stand
Trial. Mental retardation is manifested by low intellectual abilities and impairment in functioning in
major areas of life (such as communication, self care, interpersonal skills, health, and safety).
From a policy standpoint, without restoration efforts for mentally disordered offenders, the
question of warehousing untreated individuals could become a significant concern.
SUMMARY
Mental health courts are designed to promote court-imposed treatment as a substitute
for incarceration. Such courts are designed to break the cycle of mental deterioration and
criminal behavior associated with the failure of the community mental health system, and to
provide effective treatment options instead of the usual criminal sanctions for offenders with
mental illnesses. The concepts of therapeutic jurisprudential and alternate dispute
resolution serves to treat interpersonal conflict and encourage effective communication
without the stress of litigation. The success of such techniques is greatly dependent upon
efforts by law schools to teach these approaches.
management training and support groups.
Child sexual abuse offenders are often treated using classical counter-conditioning
paradigms such as the pairing of noxious stimuli with repeated presentations of sexual
stimuli in either an overt sensitization mode (live) or a covert sensitization mode
(imagined). Cognitive–behavioral programs and interventions aimed to increase
empathy, change distorted thinking patterns, improve social skills and teach self –
control are also utilized. Drugs such as Antiandrogens (e.g. DepoProvera) that interfere
with the action of testosterone, and hormonal agents such as the Gonadotropin are means of
“chemical castration” and are used to decrease or eliminate sexual drive. In rare cases,
actual surgical castration is used for the same purpose.
REVIEW QUESTIONS
1. What roles do mental health courts play in the criminal justice system?
5. What are the various therapeutic approaches for dealing with domestic violence?
6. How is posttraumatic stress disorder dealt with in prison settings?