Ill. Admin. Code tit. 20, § 1905.100 - Treatment Methods
a)
Treatment providers working with sexual abusers shall utilize empirically
supported methods of intervention. Recommended methods include structured,
cognitive-behavioral, and skills-oriented treatment approaches that target
dynamic risk factors.
1) Treatment providers
deliver services to clients using a variety of modalities, including
individual, family and group therapy, that are matched to each client's
individual intervention needs and responsivity factors.
2) Treatment providers assist clients with
identifying and analyzing the individual's factors (e.g., environmental,
cognitive, affective and relational) that increase the individual's
vulnerability to engage in sexually abusive behaviors.
3) Treatment providers use
cognitive-behavioral techniques, at the earliest opportunity, to help clients
develop and rehearse strategies (i.e., avoid or escape high risk situations,
use adequate coping skills) to effectively manage situations that may increase
their risk of sexually abusing or otherwise reoffending.
4) Treatment providers use behavioral
methods, such as education, prosocial modeling, skill practice, rehearsal of
strategies, redirection and positive reinforcement, to teach or enhance skills
that will help clients achieve prosocial goals.
5) Treatment providers encourage clients to
practice the skills they learned in treatment and ensure that these skills
generalize to clients' environments.
6) Treatment providers assist clients in
developing individualized strategies and plans for effectively managing their
risk of sexual abuse or other harmful or illegal behaviors. These plans include
specific strategies for avoiding or limiting access to potential victims,
recognizing and coping with risk factors, and building social support
systems.
7) Treatment providers
assist clients with identifying and enhancing prosocial interests, skills and
behaviors that the clients themselves seek to enhance or attain (i.e., approach
goals that are oriented toward a nonoffending lifestyle), as opposed to
strictly focusing on managing inappropriate thoughts, interests, behaviors and
risky situations (i.e., avoidance goals).
b) Dynamic Risk Factors
Treatment providers shall focus treatment interventions primarily on research-supported dynamic risk factors that are linked to sexual and nonsexual recidivism (i.e., criminogenic needs) over factors that have not been shown to be associated with recidivism, as outlined in this subsection (b).
1) General Self-regulation
A) Treatment providers assist clients in
learning to self-manage emotional states that support or contribute to their
potential to sexually abuse.
B)
Treatment providers assist clients in learning and practicing problem-solving
and impulse control skills.
C)
Treatment providers assist clients in obtaining appropriate services for
evident problems related to the clients' mental health and substance use
patterns.
2) Sexual
Self-regulation
A) Treatment providers use
cognitive-behavioral, behavioral and/or pharmacological techniques to promote
healthier sexual interests and arousal, fantasies and behaviors oriented toward
age-appropriate and consensual partners.
B) Treatment providers use
cognitive-behavioral, behavioral and/or pharmacological techniques known to be
associated with:
i) reductions in sexual
preoccupation (paraphilic and nonparaphilic) and deviant sexual interests and
arousal; and
ii) improvements in
the management and control of sexual impulses.
C) Treatment providers target cognitions that
are supportive of age-inappropriate and nonconsensual sexual interest, arousal
and behavior in order to assist clients in enhancing their sexual
self-regulation.
D) Treatment
providers help clients find effective ways to minimize contact with persons or
situations that evoke or increase clients' deviant interests and
arousal.
3) Attitudes
Supportive of Sexual Abuse
A) Treatment
providers recognize that client attitudes and beliefs that are tolerant of
sexual abuse (e.g., women enjoy being raped, children should be able to make up
their own mind about having sex with adults) are important treatment
targets.
B) Treatment providers:
i) use established cognitive therapy
techniques to strengthen attitudes, beliefs and values that support prosocial
sexual behaviors; and
ii) help
clients manage or decrease those that support sexually abusive
behavior.
C) Treatment
providers are aware that, although clients may hold attitudes, beliefs and
values that are unconventional but unrelated to their risk for sexually abusive
or criminal behaviors, these attitudes, beliefs and values are not deemed
appropriate primary treatment targets.
4) Intimate Relationships
A) Treatment providers assist the client in
the development of skills that can enable the experience of prosocial intimate
relationships with adults. Treatment providers orient their interventions so
that they build on strengths in the client's existing relationships, when
appropriate.
B) Treatment providers
aim, when possible and appropriate, to include adult romantic partners in
treatment in order to maximize treatment gains and enhance prosocial
lifestyles.
5) Social
and Community Supports
A) Treatment providers
encourage and assist clients in identifying appropriate, prosocial individuals
who can act as positive support persons.
B) Treatment providers encourage family
members and other support persons to actively participate in the treatment
process and to help clients achieve and maintain prosocial
lifestyles.
C) Treatment providers
assist clients who are transitioning to the community or are already in the
community to develop and maintain stable prosocial lifestyles, which are
characterized by stable and appropriate housing, employment and leisure
activities.
D) Treatment providers
recognize that developing a support network may be contraindicated with clients
who have a history of violence toward support persons and have not been
violence-free for a significant amount of time. Hence, treatment providers
encourage clients to make small and gradual changes and closely monitor these
changes to ensure clients are receiving or have received interventions to
address these issues and reduce the risk for violence.
6) Treatment providers may, as warranted for
a given client based on a comprehensive assessment, also include treatment
targets that are not clearly established by research to be dynamic risk factors
(e.g., denial and minimization, low self-esteem) but that, when addressed,
enhance therapeutic alliance, treatment engagement and treatment
responsiveness.
c)
Treatment Engagement and Goal Setting
1)
Treatment providers shall strive to foster clients' engagement and internal
motivation at the onset, and throughout the course of, sexual abuser-specific
treatment, recognizing that these process-related variables enhance treatment
responsiveness and outcomes.
2)
Treatment providers recognize that, although many clients present for sexual
abuser-specific treatment as direct result of legal or other mandates, external
motivators alone are generally insufficient for producing long-term change
among clients.
3) Treatment
providers provide services in a respectful, directive and humane manner and
facilitate a therapeutic climate that is conducive to trust and
candor.
4) Treatment providers
recognize that client engagement may increase, and resistance may decrease,
when the treatment provider and client are in relative agreement about
treatment goals and objectives. To the extent possible, treatment providers
involve clients in the development of their treatment plans and in the
identification of realistic goals and objectives.
5) Treatment providers clarify, at the onset
of sexual abuser-specific treatment, the client's understanding of the problems
for which the client referred to treatment and that primary treatment
objectives are often specific to modifying deviant sexual attitudes, interests,
arousal and behaviors.
6) Treatment
providers are aware that clients present with differing levels of internal
motivation to change (and varied types and levels of denial and minimization
related to sexually abusive behavior, interests, arousal and attitudes and
beliefs), but that such characteristics do not preclude access to
treatment.
7) Treatment providers
recognize that denial and minimization may impact the client's engagement in
treatment, but that the influence of denial and minimization on sexual
recidivism risk has not yet been clearly established and may vary among client
groups.
8) Treatment providers
support the client in being honest in discussing the client history and
functioning, but acknowledge that it is not the role of treatment providers to
attempt to determine or verify a client's legal guilt or innocence or to coerce
confessions of unreported or undetected sexually abusive behaviors.
9) Treatment providers are aware that
attempting to provide treatment for problems that a client persistently denies
having results in limitations in making reliable clinical recommendations about
the individual's treatment progress and re-offense risk, and that this has
ethical implications.
10) Treatment
providers routinely seek and explore the client's perspectives and offer
feedback on the client's engagement, motivation and progress in treatment, or
lack thereof.
Notes
Amended at 29 Ill. Reg. 12273, effective July 25, 2005
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