The effect of cognitive-behavioral therapy on juvenile criminal thinking
iv Table of Contents List of Tables vi List of Figures vii CHAPTER 1. INTRODUCTION 1 Introduction to the Problem 1 Statement of the Problem 1 Rationale 2 Significance of the Study 3 Goals of the Study 3 Research Questions 4 Hypotheses 4 Independent Variable 4 Dependent Variable 5 Definition of Terms 6 Assumptions 6 Limitations 8 Nature of the Study 9 CHAPTER 2. REVIEW OF THE LITERATURE 10 Samenow’s Criminal Theory 10 Cognitive-Behavioral Therapy Defined 15 Cognitive-Behavioral Theory and Aggression Studies 16 Studies Confirming the Criminal Juvenile’s Attributional Style 19 Success with Cognitive-Behavioral Therapy 20
v Critical Discussion: Samenow’s Criminal Theory 21 Critical Discussion: Cognitive-Behavioral Therapy 22 Critical Discussion: Aggression Studies 23 CHAPTER 3. METHODOLOGY 24 Research Design 24 Sampling Design 25 Instrumentation 26 Psychometric Properties 27 Data Collection 28 Ethical Considerations 29 Data Analysis 29 CHAPTER 4. DATA COLLECTION AND ANALYSIS 32 Descriptive Statistics 32 Inferential Statistics 33 CHAPTER 5. RESULTS, CONCLUSIONS, AND RECOMMENDATIONS 40 Summary and Discussion of Results 40 Conclusions 46 Recommendations 49 REFERENCES 52
vi List of Tables Table 1. Repeated Measures Analysis of Variance for the Interaction between Ohio Scales and Time of Testing among Juvenile Youth with Conduct Disorder.
Table 2. Repeated Measures t Tests in the Problem Severity and Overall Functioning of Juvenile Youth with Conduct Disorder.
Table 3. Correlation Matrix of the Pre- and Posttest Scores of the Juvenile Youth in the Ohio Scale.
vii List of Figures
Figure 1. Interaction graph between Ohio Scales and time of testing among juvenile youth with Conduct Disorder.
Figure 2. Scatter plot of the relationship between Problem Severity and Functioning Scales pretest scores among juvenile youth with Conduct Disorder.
Figure 3. Scatter plot of the relationship between Problem Severity and Functioning Scales posttest scores among juvenile youth with Conduct Disorder.
CHAPTER 1. INTRODUCTION
Introduction to the Problem
Samenow proposed a theory of criminality, Criminal Thinking Errors, to explain juvenile criminal behavior (Samenow, 1984). Through the course of the study, the research examined if Samenow’s theory of criminality is an accurate explanation of juvenile criminal behavior by utilizing the Ohio Youth Problems, Functioning and Satisfaction Scales (Ohio Scales) as a pre- and posttest measure. The Ohio Scales are instruments developed to measure outcomes for youth ages 5 to 18 who receive mental health services (Ohio Department of Mental Health, 2007). The subjects were diagnosed with Conduct Disorder and received at least one year of Cognitive-Behavioral Therapy services (CBT). Results of the study are presented identifying any changes in thinking and behavior. Cognitive and behavioral changes were analyzed utilizing follow up test data at one year. It was hypothesized that positive changes in thinking and behavior would support the preposition that CBT corrects errors in thinking and behavior among juvenile criminals and that Samenow’s theory of criminality is an accurate explanation for juvenile crime. Statement of the Problem
In 2003, law enforcement agencies reported 2.2 million juvenile arrests (U.S. Department of Justice, 2007). In 2003, approximately 15% of persons arrested for an aggressive crime (murder, nonnegligent homicide, forcible rape, robbery, and aggravated
2 assault) were juveniles. While juveniles only accounted for 25% of the population. Generation X has already brought with it the worst juvenile crime rates in recorded history (Thomas, 1995). If these trends continue, not only will murder arrests increase 145%, juvenile arrests for aggressive crimes will double by the year 2012 (Heritage Foundation, 2005). Juvenile crime appears to be headed for a national crisis, should these trends and predictions prove true. The research is one of many seeking to answer the who, what, where, when and why’s of juvenile criminal behavior. It is the author’s hope the research will guide future intervention with juvenile criminals in a humane, age appropriate and thoughtful manner. Rationale
Dr. Stanton Samenow, a leading expert in the criminology field, devoted his lifetime to the treatment of adult and juvenile criminals. In 1984, Samenow proposed a theory of criminality based on his expertise, as well as, his work with Samuel Yochelson. The purpose of the study was to review Samenow’s theory of criminality as well as others who propose similar theories and apply these theories of criminality to juvenile criminals. The thought was that such an application of criminal theory and CBT may adjust the thinking and behaviors of juvenile criminals. In order to decrease juvenile criminal behaviors, one must identify what factors contribute to the behavior and identify a treatment intervention appropriate for those
3 contributing factors. The ability to identify any of the factors related to juvenile criminal behavior and subsequent treatment enables society to implement policies, procedures, and programs in various settings that serve the needs of juvenile criminals. Significance of the Study
The research proposed to identify a theory of juvenile criminal behavior that is accurate in explaining juvenile crime. Reviewing outcome measures of CBT, the research analyzed the appropriateness of such interventions that may change juvenile criminal behaviors. Should the theory and interventions be an adequate explanation for juvenile crime, the impact may be felt on a local, regional, or national level. For instance, colleges and universities may focus on this specific theory and intervention as the appropriate educational model for criminal justice, counselors, and social work students. These same colleges and universities, and even other professionals, may conduct further studies based upon this research. County and regional agencies may train in this method and utilize it in juvenile settings (e.g., detention and treatment facilities, community agencies) as the standard of care. The office of juvenile justice may also include the theory and intervention in their protocols and support further research. Goals of the Study
The research’s goals included (a) identification of an accurate theory regarding factors related to juvenile criminal behavior, (b) explanation of that theory, (c) implementation of intervention based on the identified theory, and, (d) resulting measurable changes in thought and behavior patterns.
4 Research Questions
1. What effect does CBT have on juvenile criminal’s prosocial behavior? 2. What effect does CBT have on juvenile criminal’s overall daily functioning? Hypotheses
Research Hypotheses Samenow’s theory of criminality supports a cognitive behavioral basis of juvenile criminal behavior. CBT will positively impact juvenile criminal’s prosocial behavior. CBT will positively impact juvenile criminal’s overall daily functioning. Null Hypotheses Samenow’s theory of criminality does not support a cognitive behavioral basis of juvenile criminal behavior. CBT will have no impact on juvenile criminal’s prosocial behavior. CBT will have no impact on juvenile criminal’s overall daily functioning. Independent Variable
The independent variable of the study is the time of testing (i.e., pre-intervention and post-intervention). Each male juvenile diagnosed with Conduct Disorder has received, at a minimum, one year of CBT with an independently licensed therapist in an individual counseling setting. The therapist has completed a pretest, the Ohio Scales worker version, prior to initiating counseling, and, a posttest, the Ohio Scales, worker version, after one year of individual CBT.
5 The DSM-IV-TR (312.82 Adolescent-Onset Type) identifies conduct disorder when three (or more) of the following criteria are manifest in the past 12 months, with at least one criterion present in the past 6 months: 1. Aggression to people and animals (e.g., often bullies, threatens, or intimidates others; initiates physical fights; has used a weapon that can cause serious physical harm to others; has been physically cruel to people or animals; has stolen while confronting a victim; has forced someone into sexual activity. 2. Destruction of property (e.g., deliberately set a fire with the intention of causing serious damage or deliberately destroyed others property by other means. 3. Deceitfulness or theft (e.g., broke into someone else's home, building or car; often lies to obtain goods or favors or to avoid obligations; stole items of considerable value without confronting a victim. 4. Serious violations of rules (e.g., stays out at night despite parental objections, beginning before age 13; ran away from home overnight at least twice [or once without returning for a lengthy period of time]; often truant from school, beginning before age 13. (American Psychiatric Association, 2000). Dependent Variables
The dependent variables of the study are the problem severity and functioning scores of the male juvenile criminals prior to CBT intervention (i.e., pretest) and after a
6 year of CBT intervention (i.e., posttest). Problem severity was measured by the Problem Severity Scale of the Ohio Scales. Overall daily functioning was measured by the Functioning Scale of the Ohio Scales. Definition of Terms
Behavior. An observable act either verbal or physical in nature.
CBT. Individual cognitive-behavioral counseling intervention.
Cognitive. The act or process of thinking.
Conduct Disorder. A diagnosis consistent with juvenile criminal behavior
derived from the DSM-IV-TR.
Crime. An act or commission of an act that is forbidden by law.
Criminal Thinking Error. Patterns in thinking that indicate criminal propensity.
Juvenile Criminal. A youth (aged 12 to 17) diagnosed with Conduct Disorder.
Ohio Scales. The Ohio Youth Problem and Functioning Scales are instruments
developed to measure outcomes for youth ages 5 to 18 who receive mental health
Therapy. Individual cognitive-behavioral counseling.
The research assumed that errors in thinking, otherwise known as Criminal Thinking Errors, proposed by Dr. Stanton Samenow, accurately explains one of the factors associated with juvenile criminal behavior. Should the theory be an accurate explanation of one of the factors associated with criminal behavior, CBT would address
7 said thinking errors. Thus, if thinking errors are a factor associated with crime, therapy would reduce or replace those thinking errors, reducing or eliminating the propensity for criminal behavior. The research proposed that the existence of the thinking errors and juvenile criminal behaviors can be measured by the Ohio Scales (pretest). The research also proposed that the adjustment in thinking and juvenile criminal behaviors can be measured by the Ohio Scales (posttest). The research assumed that test retest bias is greatly reduced by the number of questions associated with the Ohio Scales and by the passage of time between pre- and posttest applications. Epistemological Assumption. The research relied on the information available as a guide in a post-positivist paradigm. In this paradigm, it is difficult to control for complex social and psychological variables but it is necessary to begin gathering information about those things that affect the social and emotional lives of people (Glicken, 2003). Ontological Assumption. According to the post-positivist assumption there is one reality that is knowable and quantifiable through measurement and probability (Mertens, 2005). The obvious downfall of this assumption is when dealing with human beings; only one reality does not necessarily explain behavior.
Axiological Assumption. Everyone is biased in some manner based on their personal experience, gender, age, culture, etc., including researchers, according to the post-positivist assumption (Mertens, 2005). Thus, researchers must take care not to effect the data collection or subsequent reporting of the data. This researcher does have a
8 background in juvenile justice and is licensed as a mental health counselor. Therefore, this researcher does approach the research with previous experience and bias and must take great care not to allow that to influence the research process.
Methodological Assumption. The research was quantitative and therefore the constructs of the study were assigned numerical values or scores. On the other hand, it does not provide room for subjective input from the participants or this researcher. Limitations
First, the search of the literature was limited, in that, the majority of research and theories about juvenile criminal behavior are related specifically to male adolescents. Thus, the research encompassed only information relevant to male juvenile criminals (hence the male biased language). Therefore, one cannot generalize the findings to female juvenile criminals, as the existing research does not generally include them. Second, the research was conducted with a limited number of youth in a local community counseling facility. Furthermore, the study did not control for race, socioeconomic status, age, and other specific demographics. However, studies examining specific demographics have already been conducted. Due to the sampling, findings may not be applicable to a larger population of youth, especially those who do not reside in a rural area in central United States. Should the research be unsuccessful, it is likely the other demographic factors mentioned above may more accurately explain juvenile criminal behavior to the exclusion of Criminal Thinking Errors.
9 Nature of the Study
Based upon the research questions and hypotheses, a quasi-experimental research design was best suited for the study. The quasi-experimental design allows the researcher to compare criminal behavior, daily functioning, and prosocial behaviors before and after CBT. The quasi-experimental design allowed for the discovery of a particular effect on a particular group rather than assigning control and experimental groups (Mertens, 2005). The research was quantitative utilizing pre- and posttest measures. The 76 male adolescents reviewed in the research were diagnosed with Conduct Disorder and have received CBT for at least one year. The Ohio Scales were completed by the counselor prior to the start of counseling and at one year follow-up.
10 CHAPTER 2. REVIEW OF THE LITERATURE
Criminals come from a wide variety of backgrounds – from the inner city, suburbia, rural areas, and small towns. They may be from any religious, racial, or ethnic group. They may be from close-knit families, unstable homes, or foster homes. They may be grade-school dropouts or college graduates. They may have brothers or sisters who grew up alongside them but did not become criminals. Despite a multitude of differences in their backgrounds and crime patterns, criminals are alike in one way: how they think (Samenow, 2004). Samenow’s Criminal Theory
Samenow (1984) theorized that behavior is mostly the product of thinking. That is, everything we do is preceded by, accomplished through, and followed by thinking. Neither bad neighborhoods, inadequate parents, television, schools, drugs, nor unemployment cause crime. Criminals cause crime. Crime, therefore, resides in the minds of human beings. Samenow’s theory concludes that the criminal (a) chooses crime; (b) chooses his associates; (c) chooses his way of life; (d) chooses the kinds of crimes he commits; (e) believes he is entitled to whatever he desires; and (f) values people only because they can be manipulated. The person who makes crime his way of life has a radically different way of thinking from those individuals who behave responsibly. Samenow’s (1984) original theory was based on research he conducted at New York’s St. Elizabeth’s Hospital. His sample group was completely comprised of adult
11 males who had been adjudged criminally insane. Samenow further indicates that he developed his theory based on criminals, who were not part of the St. Elizabeth study, but who he had observed and counseled over his many years of practice. His specialization is criminal behavior. Samenow further developed his theory over the next twenty years and released several books explaining his further developments. Based on his study and experience, Samenow (1984) believed that criminals must change their self-perception and worldview if they are to cease their criminal activity. He believed helping criminals change the way they think was essential. Every criminal who is under court supervision for committing a crime will one day be released unless he has a sentence of death or life without parole. Samenow believed that changing the way the criminal thinks does subsequently change the criminal’s behavior. Samenow (1984) also believed that despite different backgrounds and different crimes, criminals seem to be alike in the way they think. As Samenow explained, criminals are suffering from a wrong outlook on the world, a wrong estimate of their self- importance and others are not important. Further, according to Samenow’s theory, criminals understand the difference between right and wrong but they believe that whatever they want or do at any given time is right. In general, crime requires logic and some self-control. Thus, Samenow believes that the criminal is rational, calculating, and deliberate, as he described: A detailed and lengthy examination of the mind of a criminal will reveal that, no matter how bizarre or repugnant the crime, he’s rational, calculating, and deliberate in his actions – not mentally ill. Criminals know right from wrong. In fact, some
12 know the law better than their lawyers do. But they believe that whatever they want to do at any given time is right for them. Their crimes require logic and self-control (Samenow, 2004, p. 2). Eventually, Samenow (1984) expanded his theory to include juvenile criminals and reports that at an early age each juvenile criminal begins making a series of choices to live a life that he considers exciting, a life in which he is determined to do whatever he wants. The juvenile and his peer group partake in exciting behavior (adventure and risk- taking), often become embroiled in difficulties, and then demand to be bailed out and forgiven, while avoiding work and other responsibilities. Peer groups exert a force all children, including juvenile criminals, must contend with. The juvenile criminal does chose which peer group he will belong to. He chooses the company he keeps and has determined what kind of status he wants among those peers. Furthermore, Samenow (1984) asserts that the juvenile criminal is not enticed into crime; rather, he admires and pursues that crowd that is into the same behavior. He rejects peers that do not meet his quest for excitement by lying, stealing, fighting, and engaging in power plays. Samenow explains that by adulthood, the criminal has tailored his behavior to his individual style. In addition, Samenow contends that the criminal does not feel any other obligation but to remain true to his contempt of the world. He does not regard himself as obligated to anyone and rarely justifies his actions, even to himself. The criminal’s only use for people is to manipulate them to do his will (Samenow, 1984). He controls his presenting persona to influence his standing in the peer group or
13 community only to the extent that it serves him. The criminal has a self-centered view of the world and he believes he is entitled to whatever he wants. People and property are opportunities for conquest and if there is something the criminal wants, he will knock down every barrier until he gets it. Even the criminal’s parents become victims to his self-centered view. Even as a young child, he was sneaky and defiant, and the older he grew, the more he lied to his parents, stole and destroyed their property, and threatened them. He made life at home unbearable as he turned even innocuous requests into a battleground. He conned his parents to get whatever he wanted, or else he wore them down through endless argument. It was the criminal who rejected his parents rather than vice versa (Samenow, 2004, p. 6). Additionally, the criminal, knows the difference between right and wrong, but, he decides to make exceptions for himself because it suites him at that particular time (Samenow, 1984). Because he wants to do it, he is right. A few criminals apparently feel guilt and/or remorse. But, they are experts at isolating unpleasant emotions, such as these, so that they do not interfere with their objectives. Despite isolating feelings of guilt and remorse, the criminal does feel anger. Not only do criminals have an inflated sense of self, they are also almost always angry (Samenow, 1984). According to Samenow (1984) only the slightest of slights to their self-image sets them off, and anyone or anything in the vicinity may become a target of their aggression. Furthermore, disappointment, no matter how small, can trigger a total collapse of their inflated self-concepts. However, this may also be the time that the
14 criminal may become fed up with himself and desire to change his behavior. Some may get sick of disappointing those who care for them while others may no longer be able to hold back the unpleasant emotions of guilt and self-loathing. Now is the time to intervene. According to Samenow this is the time when the criminal must be placed in a demanding program that corrects the thinking errors of the criminal and holds him accountable for all behavioral changes including his aggressive tendencies. Thus, according to Samenow’s theory of criminality, behavior follows thought. To eliminate the criminal behavior, it is necessary to demolish the old thinking patterns, lay a new foundation through teaching new concepts, and build a new structure of thinking patterns wherein the criminal puts into action what he has learned (Samenow, 1984). Analysis of the previous concept reveals Samenow’s support for Cognitive- Behavioral theory and its application to criminality. If the criminal learns to view him and the world more realistically he will have fewer thoughts that bother him and he will then react constructively rather than aggressively when things go wrong. With effort, through CBT, the criminal will discover that he can live a worthwhile and satisfying life without engaging in criminal behavior. Because the truth that every child who is locked up will someday be released (except for the relative few sentenced to death or life without parole) with the same thought patterns that they had prior to their arrest.
15 Cognitive-Behavioral Therapy Defined
According to the CBT website, sponsored by the Cognitive Therapy Center of Brooklyn, CBT has become the preferred treatment for most emotional and behavioral problems. The website claims that hundreds of studies have been conducted by psychologists and psychiatrists who concluded that cognitive-behavioral therapy should be the preferred treatment for conditions such as inadequate coping skills, poor methods utilized when coping, and aggression (CBT). The website goes on to explain that CBT combines two very effective kinds of therapy – Cognitive and Behavioral. Behavior therapy helps to break the connections between troublesome situations and habitual reactions (e.g., rage, aggression). It also teaches how to calm one’s mind and body, so one can feel better, think more clearly, and make better decisions. Cognitive therapy teaches how certain thinking patterns are causing certain symptoms by giving a distorted picture of what is truly going on in one’s life, and making one feel angry for no good reason which can provoke ill-chosen behaviors. Therefore, CBT appears to match with Samenow’s theory of criminality. Kendall and Mindel (1995) describe CBT as using performance-based and cognitive interventions to produce changes in thinking and behavior. CBT is concerned with both the external environment and the criminal’s internal processing of the world. CBT combines cognition change with behavioral management and new learning experiences to help change the distorted or deficient information processing.
16 Berkowitz (1990) theorized that negative affect tends to activate ideas, memories, and expressive-motor reactions associated with anger and aggression, as well as, rudimentary angry feelings. According to this theory, bodily reactions and emotion- relevant thoughts can activate the other components of the particular emotion network to which they are linked. Berkowitz’ theory explains that networks of emotions link specific types of feelings with specific thoughts and memories. These are then linked with certain kinds of expressive-motor and physiological reactions. One must only activate one of these linkages to have other parts of the linkages respond. Deffenbacher (1990) conducted an exercise that demonstrated the influence of cognitive processes on emotion and behavior by evaluating 138 psychology students. By exposing the subjects to cognitive scenarios (visual) he demonstrated that all of the subjects’ reactions varied in type and intensity as a function of cognitive processing. Cognitive-Behavioral Theory and Aggression Studies
Lochman and Lenhart (1993) define aggression as an exhibition of deliberate actions directed towards other people or objects with at least some intention of destroying or injuring the target. Acker (1997) further explains that aggression can be physical or verbal in nature, and is intended to cause physical, psychological, or emotional harm. Cognitive-Behavioral models of aggression focus on thinking processes that underlie behavior (Baron & Richardson, 1994). This perspective suggests that if juveniles interpret a threat, how they think about it will influence how they behave. Whether juveniles respond aggressively depends on attributions – perceptions about why
17 other persons have acted in certain ways. Furthermore, according to these same authors, how children react to the message they read, hear, or see depends considerably on their interpretations of the message; the ideas they bring with them to the communication, and the thoughts that are activated by it. Copello and Tata (1990) cite multiple studies that have confirmed a tendency of violent interpretations in aggressive boys. These authors found that ambiguous interpersonal situations were found to increase the rate of aggressive responses from aggressive boys who were also more likely to respond as if a peer had acted with hostile intent. Lochman and Dodge (1994) also found that aggressive boys attribute hostile intent more often than their non-aggressive peers when faced with ambiguous interpersonal situations. Their research indicates that hostile attributional biases of criminal male adolescents were positively correlated with their levels of conduct disorders, reactive aggression, and violent crimes. These associations held even when the effects of race, socioeconomic status, and intelligence were controlled. Lochman and Dodge (1994) also found that aggressive adolescents (relative to average peers), have found to (a) attend to fewer cues, and (b) are more likely to attribute other’s behavior as hostile. Further, aggressors report lower levels of fear and sadness and higher levels of anger when labeling, generate fewer alternative solutions, expect aggressive solutions will successfully reduce aversive behavior of others, and report lower levels of perceived self-worth. Aggressive children do not use all the data given to them in making decisions, and demonstrate biased recall of hostile cues (Kendall & Mindel, 1995). They attribute other’s behaviors to hostile overtures (cognitive distortions or thinking errors). Aggressive children have cognitive deficiencies that limit their
18 problem-solving skills and rely upon quick action-oriented solutions to problems. Thus, aggressive boys expect that aggressive solutions will successfully stop the aversive behavior of others. As Lochman and Dodge indicate, the aggressive behavior of aggressive adolescents appears to be more planned and proactive rather than disorganized and reactive. Childhood aggression becomes clinically significant when it occurs across settings with high intensity (Kendall & Mindel, 1995). Aggression is often a persistent and stable pattern of behavior and is correlated with future aggression. Longitudinal studies also demonstrate that aggression is related to the development of other negative behavioral patterns, including criminality (Lochman & Lenhart, 1993). Empirical studies have shown that children maintain aggressive behavior by associating with other individuals who engage in and encourage aggressive behavior (Acker, 1997). Kendall and Mindel also found that aggression, when not treated, is a stable pattern of behavior, over time, and associated with juvenile criminal behavior. Aggressiveness, when it appears between the ages of four and nine, creates a higher probability that the aggressive behavior will continue into adulthood (Acker, 1997). Approximately five to eight percent of males display this pattern of aggression. Schuster (1990) also confirms this long term concern when through his meta-analysis of previous research discovered that highly aggressive children were three to four more times likely to be criminally convicted (at age twenty-four in follow-up studies) than normal children.
19 Does teaching juvenile criminals to think differently modify their behavior? In order to address this question one must first cite the empirical data that supports the fact that juvenile criminals do think differently. Second, one must cite the empirical data that supports the fact that cognitive-behavioral therapy has been proven successful.
Studies Confirming the Juvenile Criminal’s Attributional Style
Fondacaro and Heller (1990) investigated attributional style in 36 offenders and 18 non-offenders (aged 14-27 years). They found that juvenile offenders were more likely to attribute blame to others in ambiguous problem situations. Among juvenile offenders, external, person-centered blame attributions were significantly related to those juvenile offenders identified as aggressive. Zagar, Arbit, Sylvies, and Busch (1990) conducted a study concerning homicidal adolescents. They matched 30 homicidal juvenile criminals with 30 nonviolent juvenile criminals on age, race, sex, and socioeconomic status. Both groups received physical, psychological, educational, psychiatric, and social examinations. Zagar et al.’s results showed that homicidal adolescents shared the following symptoms: severe learning difficulties, perceptual deficits, and cognitive dysfunctions. Lewis, Lovely, Yeager, and Famina (1990) did a follow-up study of 95 formerly incarcerated juvenile criminals utilizing data from the Federal Bureau of Investigation and state police records. The authors found that 89 of the subjects had adult criminal records. Juvenile violence and cognitive vulnerabilities proved to be reliable predictors of future adult violent crime.