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Forensic CBT:An Innovative Training Program for

Community Corrections Practitioners

Raymond Chip Tafrate, Ph.D.

Professor & Clinical Psychologist

Department of Criminology & Criminal Justice &

Institute for the Study of Crime and Justice

Central Connecticut State University

Tafrater@ccsu.edu

Gratitude:

• Damon Mitchell, Ph.D. - Central CT State University

• Stephen Cox, Ph.D. - Central CT State University

• Tom Hogan - Consultant Retired from Court Support Services Division of Connecticut

• Forensic CBT Coaches - Court Support Services Division of Connecticut

• Susan Glass & Court Support Services Division of Connecticut Staff

• Bureau of Justice Assistance

This project is about…

the extent to which CBT interventions

and techniques can be incorporated into

probation work

(feasibility study)

Other CBT Probation Initiatives Outside

of Connecticut

• Strategic Training Initiative in Community Supervision

(STICS) James Bonta, Ph.D., Corrections Research Unit,

Public Safety Canada

• Effective Practices in Community Supervision (EPICS)

Edward Latessa, Ph.D., University of Cincinnati

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A view from the other side of the desk…

A view from around the world…

Tafrate, R., & Mitchell, D. (Eds.). (2014). Forensic CBT: A handbook for clinical practice. Chichester, West Sussex, UK: Wiley.

Part 1:

Characteristics and

Foundational Principles of the

Forensic CBT Program

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U.S. Department of Justice Grant

• Starting October 1st of 2012, Connecticut’s Court Support Services

Division (CSSD) received a two year “SMART Probation” grant

from the Bureau of Justice Assistance

• The grant sought to enhance the supervision skills of 40 probation

officers through the development of a program called “Forensic

Cognitive Behavioral Therapy”

• Central Connecticut State University (CCSU) partnered with

CSSD to develop an implement the program. University of

Southern Maine agreed to be the research partner for this project

and conduct the process evaluation

• This program is being piloted with two cohorts of probation

officers who were selected by their supervisors to participate

Research Design

(n=20)

(9-months)

Cohort #2

(n=15)(Comparison)

(FCBT skills

building)

(9-months)

Coaches(n=9)

(FCBT skills

building)

Cohort #1

Process Evaluation Methodology

• Coding recordings of three supervision sessions

(work samples) before and after training program

• Tracking clients’ compliance with treatment

referrals, drug tests, and probation violations before

and after officers participated in the FCBT program

Outcome Evaluation

• Probation completion rates

• Rearrest rates

Note. FCBT = Forensic CBT

Foundational Principles of the

Forensic CBT Program

• Curiosity and willingness to try new strategies

• Reciprocal relationship between the program

developers and POs participating in the project (We learn from each other)

• Openness (with an important caveat)

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Foundational Principles…

• Intellectual Capital

(Forensic CBT Coaches)

Foundational Principles…

• Hearing what actually happens

(Essential Equipment)

• Coaching and skills building model (Versus training & quality assurance)

– Delivered to probation officers in small doses of two sessions per month over a 9-month period of time. The officers practice one skill before the next is introduced and receive coaching to improve their skills

– Recordings are reviewed and discussed in groups that include program developers, coaches, and POs

Foundational Principles…

* The overwhelming majority of adult POs stay in their positions

for 20-years or more

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- Knowing how to ‘launch’ into productive

conversations is a critical skill

- Interactions are be brief and focused (25 minutes)

- Focus conversations on risk-relevant factors rather

than conditions of probation

- Move away from non-strategic supervision (e.g.,

“How’s it going?”) and chaos driven supervision (i.e., crisis

of the week)

Foundational Principles…

• Emphasis on scripts(Not manualized)

How One Launches Into Moves is Critical…

FCBT “Scripts”

First supervision contact S-T-D Analysis CTP Feedback

Criminogenic Need Sequences Thinking Helpsheet Values Helpsheet

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Motivational

Interviewing

Risk-Need-

Responsivity

Criminal

Thinking

Traditional

CBT

Values and

Life Priorities

Foundational Principles…

• Integration of different theoretical streams

Part 2:

What Does Forensic CBT Sound Like in

Real-World Probation Interactions?

(…and how does it differ from standard practice?)

• Collaborative relationship (e.g., helping, caring)

• Structured and organized (e.g., agenda setting, focus)

• Conceptualization of key thinking and behavior patterns related to risk-relevant areas

• Eliciting thinking that precedes poor decisions in risk-relevant areas

• Providing clients with out-of-session assignments

Traditional

CBT

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• In the first 60-seconds of the initial meeting, the stage is often set for successful (or unsuccessful) engagement

• The way POs introduce themselves, describe their roles, and explain the supervision process will influence how clients respond

The Initial Contact

Audio Sample

• Before forensic CBT training

(initial contact)…

• 4 components to an opening statement. The PO…– introduces him or herself and clarifies his

or her role

–provides a general statement about the purpose of supervision

–conveys sense of collaboration

–ends with an open question that invites a response from the client

Developing an Opening Statement

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Audio sample

• After forensic CBT training

(initial contact)…

Initial Contact Script(Integrating CBT, RNR, & MI)

“Hello ______, thanks for coming in on time today. My name is Brenda. I’ll be your probation officer. Part of my job is to uphold the expectations of the court and the conditions of probation. Another part of my job is to provide support and information about community resources and to help you gain skills and knowledge to successfully complete your probation and keep you from returning to the court in the future. We will work together on identifying some of your strengths and some of the things you’ve struggled with. We will also focus on those things you think might put you at risk for having future problems. How could being on probation be helpful to you?”

Audio Sample

• Before forensic CBT training

(typical supervision session)…

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• Emphasis on OARS skills as a foundation. POs work toward

– increasing reflections

– emphasizing open questions

– weaving occasional affirmations into the conversation

– ending supervision sessions with summaries that highlight the most important issues discussed, change talk, and thinking patterns related to decisions

• Change talk– Recognizing, eliciting, and reinforcing clients’ reasons and means for behavior change

Motivational

Interviewing

Examples of Change Talk and Sustain Talk

!Change Talk

Preparatory change talk

D: Desire (I want to leave the gang life.)

A: Ability (I could leave the

neighborhood and live with my sister

across town.)

R: Reasons (My family wants me to get a job and stop selling drugs.)

N: Need (I’ve got to find another way to

support myself.)

Mobilizing change talk

C: Commitment (I’ll talk to my sister on

Monday, and see if she’s still open to

having me room with her.)

A: Activation (I plan to make an

appointment at the employment office.)

T: Taking steps (I’ve moved in with my

sister and have two interviews lined up for

next week.)

!Sustain Talk

Inverse of preparatory change talk

D: Desire (I don’t want to leave the gang.)

A: Ability (I don’t know how to do

anything except sell drugs.)

R: Reasons (If I try to leave the gang, they

will come after me.)

N: Need (Being a member of the gang is the only way to avoid trouble in my

neighborhood.)

Inverse of mobilizing change talk

C: Commitment (There is no way for me

to avoid gang activity and have a regular

job.)

A: Activation (I am prepared to accept the

risks of being a gang member.)

T: Taking steps (I started selling drugs

again last week so I can pay my child

support.)

!

!

From: Tafrate, R. C., & Luther, J. D. (2014). Integrating motivational interviewing with forensic CBT:

Promoting treatment engagement and behavior change with justice-involved clients. In R. Tafrate and D.

Mitchell (eds.), Forensic CBT: A handbook for clinical practice. Chichester, West Sussex, UK: Wiley.

!

MI Training Activities are Recalibrated

Around Risk Relevant Factors

Example exercise: Converting closed questions to open questions

- “Are you staying out of trouble?”

- “You’re not hanging out with anyone I wouldn’t want to see you

with, are you?”

- “Are you staying clean?”

Example exercise: Reinforcing change talk

Client says: “I’ve lost a lot. I’ve lost years out of my life. I can’t ever

get back time.” Next thing you would say…

Client says: “I know most people don’t think a dishwashing job is all

that much, but when I’m in my work uniform waiting for the bus and I

see those dudes across the street doing nothing, it kind of makes me feel

good.” Next thing you would say…

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ContrastingMIandCBT

MotivationalInterviewing Cognitive-BehavioralTherapy

Primaryfocusisonincreasingreadinessandpreparationforchange

Primaryfocusisonusingtoolsandpracticingbehavioralskillsforhowtosuccessfullychange

Reflective,exploratory,andclient-centered

Directive,actionoriented,andhighlystructured

Earlysessionsfocusedonallowingtheclienttoelaborateonhisorherbroaderconcerns

Earlysessionsfocusedonassessmentandinformationgathering

Argumentsforchangingbeliefsandbehaviorpatternselicitedfromtheclient

Argumentsforchangingbeliefsandbehaviorpatternsprovidedbythepractitioner

Clientistheexpertregardingwhatismostlikelytobehelpful

Practitioneristheexpertregardingskills,techniques,andhelpfulsolutions

Emphasisonclientsstrengths,resources,andefforts

Emphasisonremediatingproblematicsymptomsandskilldeficits

Practitionertemporalfocusandattentionfirmlyrootedinpresentmoment(e.g.,verbalizationsduringtheinteraction;meetingtheclientwheres/heis)

Practitionertemporalfocusandattentionisoftenseveralstepsaheadoftheclient(e.g.,caseformulation,treatmenttargets,techniques,interventions&homeworkassignmentsthatmightbeutilized)

Practitioner‘keysinto’verbalizationsandclientlanguagerelatedtochange(e.g.,changetalk–verbalizationsfavoringchange;DARN-CAT)

Practitioner‘keysinto’verbalizationsandclientlanguageindicatingproblematicthinking(e.g.,cognitivedistortions,irrationalbeliefs,orcriminalattitudes)

From: Tafrate, R. C., & Luther, J. D. (2014). Integrating motivational interviewing with forensic CBT:

Promoting treatment engagement and behavior change with justice-involved clients. In R. Tafrate and D.

Mitchell (eds.), Forensic CBT: A handbook for clinical practice. Chichester, West Sussex, UK: Wiley.

Audio sample

• After forensic CBT training

(eliciting change talk around a risk relevant factor) …

Recognizing and Responding to Change Talk (Forensic CBT Recording Assignment)

Record an interaction with a client where you recognize and reinforce Change Talk

related to a Criminogenic Risk/ Need.

Step #1: Pick a client with an obvious criminogenic need

Big Four

History of antisocial behavior

Antisocial personality pattern

Criminal friends & associates

Antisocial attitudes/values

Moderate Four

School/work

Substance abuse

Family/marital

Leisure/recreation

Step #2: Use ‘open questions’ and ‘reflections’ to explore the impact of this Need on

the person’s life.

A tip: Often, when justice-involved clients are fully engaged -- in an MI consistent style

-- and given space to explore both sides of their ambivalence, change talk bubbles up

naturally. When change talk spontaneously occurs, reflect it back to the client to elicit

more change talk.

Step #3: Invite change talk using open questions constructed to elicit such

verbalizations (see examples below). After change talk occurs, use reflections to

highlight and reinforce it further with the client.

Step #4: End the interaction with a summary that includes the client’s change talk.

Open Questions Likely to Evoke Change Talk

• How would you like your life to be different?

• What strengths do you have that might help you in changing __________?

• What is at stake if you do not change __________?

• What are the three most important reasons to change __________?

• What is most urgent for you now?

• If you did decide to change __________, why would that be a good thing?

A

d

a

©2014, Raymond C. Tafrate, Damon Mitchell, & Tom Hogan

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Values and

Life Priorities

Borrowed heavily from Acceptance and

Commitment Therapy (ACT)

Amrod, J., & Hayes, S.C. (2014). ACT for the incarcerated. In R. Tafrate and D.

Mitchell (eds.), Forensic CBT: A handbook for clinical practice. Chichester,

West Sussex, UK: Wiley.

Values versus Goals

Values: are big life directions that require ongoing attention across a

lifetime

Goals: can be completed and have a clear end point

e.g., a parent might have the goal of attending their children’s soccer games and dance recitals. The goal might end once the child outgrows these activities, while the underlying value of “being an involved parent” will manifest itself in a variety of ways throughout different phases of the children’s lives.

e.g., a client might have a goal of successfully completing parole, and therefore attend a mandated domestic violence program. That goal might end once parole supervision is completed, while the underlying value of ‘having positive family relationships’ will continue to manifest itself in a variety of ways long after supervision ends.

Why Discuss Values?

• Working with clients to avoid high risk behaviors (avoidance goals) is only part of the change process; helping them develop behavioral paths to a life worth living (approach goals) is an equally important component

• The exploration of values is used to establish anchor points to guide future behavioral choices; aiding in minimizing behaviors that will interfere with core values and developing behavioral activation plans likely to lead to a more prosocial and meaningful life

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What about clients with antisocial values?

Discussions with justice-involved clients around values and goals usually reveals desires for opportunities to provide for family, connect with others, have meaningful work, etc. In the majority of instances, antisocial patterns are typically inconsistent with client values, and a reflection of unskilled attempts to meet one’s values and cope (albeit unproductively) with the challenges of life. Assuming the majority of clients have inherently antisocial values shuts the door for powerful discussions about what matters most.

Audio sample

• After forensic CBT training

(discussion about values and life priorities)…

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Risk-Need-

Responsivity

• Integrated throughout each component

- Setting the agenda and focus on risk-relevant factors

such as substance use, criminal companions,

dysfunctional family relationships, and employment

- Eliciting and reinforcing change talk around specific

risk areas

- Using scripted CBT sequences to identify thinking that

is connected with poor decisions in risk areas most

relevant for the client

Criminal

Thinking

• Thinking patterns associated with antisocial and

self-destructive behaviors (a set of beliefs that affect choices and

behaviors, which if unaltered, influence one’s life trajectory)

+ Provides a specific focus on thinking patterns that permeate day-to-

day decision-making

+ Patterns can be reliably assessed, and criminal thinking instruments

are readily available, free to use, and easily administered and scored

- In discussions POs may over-pathologize clients

Instrument # of

Factors

Psychological Inventory of Criminal Thinking Styles

(PICTS; Walters, 1995)

4

Criminal Sentiments Scale-Modified

(CSS-M; Simourd, 1997)

3

Measure of Criminal Attitudes & Associates

(MCAA; Mills, Kroner, &Hemmati, 1999)

4

Texas Christian University Criminal Thinking Scales

(TCU CTS; Knight et al., 2006)

4

Measure of Offender Thinking Styles

(MOTS; Mandracchia, et al., 2007)

3

Criminogenic Thinking Profile

(CTP; Mitchell & Tafrate, 2010)

8

Criminal Thinking Instruments

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Criminal Thinking PatternsSelf and Others

(1) Identifying with, and seeking approval from, criminal associates (e.g., “I don’t have anything in common with people who live a straight life.”)

(2) Disregard for others, lack of empathy, lack of remorse, and callousness (e.g., “There’s no point worrying about people you hurt.”)

(3) Avoiding intimacy and vulnerability (e.g., “If I open up to someone, they will take advantage of me.”)

(4) Hostility and suspiciousness toward criminal justice personnel (e.g., “The cops are the real criminals.”)

(5) Grandiosity and entitlement (e.g., “All women want me.”)

(6) Seeking dominance and control over others (e.g., “Nobody can tell me what to do.”)

Criminal Thinking Patterns

Approaching and Reacting to the Environment

(7) Demand for excitement and thrill seeking (e.g., “There is no better feeling than the rush I get when stealing.”)

(8) Exploiting and manipulating situations/ relationships for personal gain (e.g., “It doesn’t make sense to work full-time if you can get on a government program.”)

(9) Hostility toward rules, regulations, and laws (e.g., “Laws are there to hurt you, not help you.”)

(10) Justifying, minimizing, and excuse making related to harmful behaviors (e.g., “If I don’t sell drugs in my neighborhood, somebody else will.”)

(11) Willfully lazy attitude, path of least resistance (e.g., “Everything will take care of itself.”)

(12) Giving up in the face adversity (e.g., “When I don’t understand things I give up.”)

(13) Underestimating negative consequences (e.g., “I’ll never go to jail for selling drugs because I know all my clients.”)

Disregard for others

Demand for excitement

Poor judgment

Emotionally disengaged

Parasitic/ exploitive

Justifying

Inability to cope

Grandiosity

lack of concern, empathy, and/or remorse

low tolerance for boredom, impulsivity

underestimating negative outcomes

avoidance of emotions -> vulnerability/intimacy

exploitive, evading responsibility

justification/minimization of antisocial behavior

giving up easily/ ineffective problem solving

overestimating abilities, skills, inner qualities

Criminogenic Thinking Profile (CTP)

62 items; Provides scores in the following areas:

Mitchell, D., Tafrate, R. C., Hogan, T., & Olver, M. E. (2013). An exploration of the association between criminal thinking and community program attrition. Journal of Criminal Justice, 41, 81-89.Mitchell, D., & Tafrate, R. (2012). Conceptualization and measurement of criminal thinking: Initial validation of the Criminogenic Thinking Profile. International Journal of Offender Therapy and Rehabilitation, 56, 1080-1102.

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Audio sample

• After forensic CBT training

(Conversation about “inability to cope”)…

©2014, Raymond C. Tafrate, Damon Mitchell, & Tom Hogan

Traditional

CBT

Risk-Need-

Responsivity

• Many programs the focus is on the thoughts that come

after behaviors (i.e., justifying). We are more focused on

thoughts that preceded specific instances of risky and self-

defeating behavior that occurred in the clients life

• CBT sequence have been developed around 6 risk-

relevant areas

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CBT Sequences

-STD (Situation-Thoughts-Decision) high risk for justice involvement

-FTD (Friend-Thoughts-Decision)

-LTD (Leisure-Thoughts-Decision)

-TRTD (Toxic Relationship-Thoughts-Decision) family relationships

-SUTD (Supervision Use-Thoughts-Decision) drug testing

-EAA (Employment Attitude Analysis)

Audio sample

• After forensic CBT training

(CBT sequence “FTD analysis: Friend-Thoughts-Decisions”)…

F-T-D Analysis

Friend-Thoughts-Decisions (To be used with clients with antisocial peers; associate/BFF/co-accused, etc.)

(1) Explore the high risk FRIEND and the role the friend plays in high-risk

behavior

Looking back over the past year, tell me about a relative, friend, or acquaintance of yours that

tends to get in trouble with the law or who you think is probably a bad influence on you in some

ways.

What is about this person that makes him/her a bad influence or that seems to lead to trouble?

What makes it hard to avoid spending time with him/her?

(2) Explore the risky DECISIONS connected with this person

Give me an example of some of the trouble you have gotten into with this person.

(Or) Give me an example of something you did with this person that you think was probably bad

for you, or self-defeating.

(3) Explore the THOUGHTS preceding the risky decisions related to this person

What were you telling yourself when you agreed to…(Insert incident)?

(Or) What was going through your mind when you went along with…(Insert person)?

(4) Explore a better DECISION related to avoiding this person’s influence

Give me an example of a time when you were able to avoid this person’s influence and get out of

a potentially bad situation with him/her.

(5) Explore the THOUGHTS preceding the better decision

What was going through your mind when didn’t go along with _____ (Insert person)?

(Or) How was your thinking different when you…(Insert positive incident)?

(6) Summarize the contrast in THINKING that leads to two decisions

So, summing up the connection between _____ (insert person) and bad outcomes, it sounds like

you’re thinking _______; while the times you’ve made better decisions, you’re thinking was more

like this _____.

(7) Ask a question that reinforces the better thinking and decision-making

How can you strengthen the better thinking and avoid the influence of _________ in the future?

Note. Use reflections to underline the thinking and any change talk that emerges.

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Audio sample

• After forensic CBT training(CBT Homework: “Thinking Helpsheet”)…

!Thinking Helpsheet

Part 1: To be completed by practitioner:

Thinking pattern:

!

Part 2: To be completed by client

Identify a Situation

Where The

Thinking Pattern

Emerged: Specify

what happened,

where, and who was

involved

Circle the Problem

Area or Areas

Related to the

Situation

Immediate Thinking:

Write a sentence or two that captures

what was going through your mind

during the situation

Better Thinking:

Write down another way of

thinking that led you to a better

decision or that would have led

you in a better direction in this

situation

!

Thinking:

Thinking:

Friends and Associates

Family

Substance Use

Employment or

Education

Leisure or downtime

Other: ___________

Actual Decision: Write down what you ended up doing

!

From: Mitchell, D., Tafrate, R., & Freeman, A. (2014). Antisocial personality disorder. In A. Beck, D. Davis, & A.

Freeman (eds.), Cognitive Therapy of Personality Disorders 3rd edition. New York: Guilford Press.

Proposed Supervision Session Structure

(1) Agenda: Taking the lead and introducing agenda for the session

(2) Loose Ends: Quick review of loose ends/assignments from last meeting, (e.g., follow up on referrals, CBT homework given to the client, job search update)

(3) Forensic CBT: Addressing criminogenic needs (e.g., eliciting change talk, CBT sequences, CBT exercises, discussions around values and life priorities, increasing awareness of the relationship between thinking patterns and decision-making)

(4) Conditions: Quick review of practical issues related to conditions that did not come up in the session (e.g., change of address, new police contact, employment changes; restitution)

(5) Summary: Summarize what was accomplished and what the client should be doing between now and next session

(6) Documentation: Putting notes into file, copies, etc.

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Part 3:

Lessons Learned (Thus far…)

Is the Incorporation of CBT Skills

and Techniques into Probation

Supervision Feasible?

YES!

• With practice, POs can successfully integrate CBT interventions into their supervision

• We have only scratched the surface as to what is possible. There are numerous interventions that could be adapted and added to the menu of what POs do with their clients

Exit Surveys with the Cohort I

Probation Officers

- Reactions to the Forensic CBT training program were very positive

- More efficient meetings with clients

- Clients liked the idea that probation officers cared about them

- Clients became more engaged

- CBT scripts kept the meetings focused on major issues

- Clients did the homework assignments

- When approached skillfully, the vast majority of clients wanted

help in changing their lives

- Forensic CBT became self-reinforcing for POs who were willing to

try it out. This is similar to what has been described in CBT

projects with community corrections practitioners in Canada

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Aren’t We Just Turning POs Into

Counselors and Therapists?

NO!

• PO roles of behavior change and safety of others

• Consequences of supervision failure (not just a bad day for the client)

• Client deficits in motivation and awareness

• Brief sessions

• Focus is on client decision-making rather than symptom relief

• Emphasis is on thinking targets that are often dissimilar to those seen in anxious and depressed clients

• A focus on life areas and risk-relevant factors that have been statistically linked to continued self-defeating and destructive behaviors

Other Initial Impressions:

• Compassion

- Compassion: “sensitivity to the suffering of others and a desire to alleviate suffering” (Kolts & Chodron, 2013)

- Foundational for successful engagement in any type of helping relationship

- POs with a diminished capacity to come to the table with a level of compassion for those with whom they work do not do well with FCBT

• Culture

- A strong culture is produced when cohesion exists around issues of values, conduct, and practices

- A strong culture provides a system of informal rules and peer pressures that can be very powerful in determining PO behavior and performance

- Culturally approved behaviors thrive while disapproved behaviors are discouraged or punished

- We too often focus on changing policies and rules rather than focusing on changing culture

Other Initial Impressions:

Adapted from: Grodnitzky, G. (2014). Culture trumps everything.

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Unresolved Issues

• What is the impact of forensic CBT on client recidivism?

• How much dosage is needed for POs to learn these skills? (coaching and skills building)

• What is the best way of sustaining a culture that supports and maintains PO’s Forensic CBT skills?

A different view from the other side

of the desk…