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Olive The problem investigated concerned the relative impact of imprison- ment at the State Prison of Southern Michigan (SEEM) vs. group psycho- therapy at the Ionia State Hospital.(L£i}upon the parole violation rates of Criminal Sexual Psychopaths (GSPS). The findings of two previous studies, Cook (1947) and Tremoath (1952 , reporting no significant dif- ference in parole violation rates for the two institutional programs for OBIS in hichigan were used as a direct background. The subjects were all CSPs paroled in.L1chigan from.July 1953 through June 1961. The in- dividuating characteristics which distinguish or liken them.to the gen- eral population were sketched. Based on institutional residence, a method was devised for estab- lishing two experimental groups. The environments in which they were involuntarily placed were described. It was inferred, although impos- sible to prove, that "qua" environnents it would be difficult to assess which institution supplied the greater an unt of negative incentive. It was hypothesized that the hospital group exposed to the process of a group therapy prograM'would attain greater success on parole than :ould be associated with imprisonment. The outcomes of analysis of par- ole violations in the groups disclosed a much lower rate of parole vio- lation for the 18H GSPs (BIZ vs. A95) thereby supporting the central hypathesis. As a further check on the stability of these findinys a corollary Abstract Roger O. Clive hypothesis consisting‘of three parts was made. In the SP5M.group, par- ole violations were predicted to be inversely related to group therapy experience. This hypothesis was supported in two subsequent comparisons. In the hospital group the mean length of time in group therapy for par- ole violators vs. non-parole violators was not found to differ signifi- cantly. ‘ It would appear that the group therapy program.contributed import- antly to parole successes. Limitations of the research design preclud- ed, however, a precise evaluation of the possible interaction between the hospital environment and the absence of tha group therapy variable. Generally, the results support the opinion underlying P.A. Act 165 (Lichigan 1939) that deviated sexual behavior is sometimes a symptomatic expression of personality disturbance which is amenable to psychological treatment. ‘Additionally. due to significantly longer imprisonment for SEEM parole violators. Cook's conclusion regarding the extent of the therapeutic effects of imprisonment was discounted as a significant fac- tor influencing his findings. 7 ' V‘ /,/7 ;7/ // I” 1",], {“- 1'7/ ‘ /' ' " Approved 141;: L 5]., .14 my / Iagjor Profe is Date [Z /r/ /' 2-, ’*' w 7 PAROLE VICIATIOIJ ALICIIG LICI-LIGAN CSPS 1:5 ' '33.? TO GEEUP THERAPY VS. IlfRISOZHJCEH' By Roger 0. Olive A iii—ISIS Submitted to hfichigan State University in p:;rtial fulfillment of the requirements for the degree of LZASTER OF ARTS Department of Psychology 1962 ACKNOWLEDGMENT Grateful acknowledgement is made to my committee chairman Dr. John R. Hurley. His objective evaluation, continued encourage- men , generous donation of time, and expressive support were essen- tial in the unfolding of this thesis. I also wish to thank Dr. Donald Johnson and Dr. Irwianremen without whose intervention this project could not have been completed. Their constructive comments enriched materially the meaningfulness of the final draft. The records of the patients of the Ionia State Hospital were placed at my disposal through the kindness of Dr.‘Alfred Birzgalis. Radical Superintendent, Ionia State Hospital. at $13381 $$$~3$ wanna 3?! ii Table of Contents Introduction .. ...... . ........................................ . 1 Procedure .................................. ................... ll Finding—ls O O O 0 I O O O 0000000 O O O O O O O O O O O O O O 0 O 000000 O 0 e o O O O O O O O O O O O 0 I 28 Discussion ............ . ........ . ........ . ....... .............. 33 References ......... ............... ..... .......... .. ..... ...... ho iii LIST or TnBLES i. The to tal sample and its distribution into the various com-- parison gI‘CupSoI0..loo-OOOOOIIOOOOOIOOOOCDOOOOOOQIOOIOCOOIUI 2. Incidence of EV and ZTFV between groups at ISM and SPSE. . . . . . 3. Co:.‘.:arison of ti...e in group therapy of We and IIEVs from JPJLIOOOOCO0.00.00.00.00.I.0....0.0...IIOOOOOOIOOOOOIOOOOO... 4- Parole violation apron-L; SPSI-«l subgroup as related to partici— p’atic‘n in gmlzb tileI‘aPL- O O O C O O O O O O O O O I O I O I O O I I O O O O I O I O l I C O O O O 5 . Temporal comparison of His and NPVs from SESE. . . . . . . . . . . . . . . C». Tine relationship in group therapy of WS and LH’Vs from the ISIiee.eeoeeeoeeeooooooeeooeee00.00000ooeeooeoeooeeeeeooeoeeo iv Page 28 If FI'EUDUCTION In the state of.nichigan, a: in many other places. individuals who exhibit abnormal sexual behavior, alarm.the public. A certain propor- tion of these persons are apprehended by legal authorities and become institutionalized. Afterwards, how best to approach the problem.of sex- ual deviation depends on what view is adopted regarding the significance of these acts. A conclusion reached by the Governor's commission on the deviated criminal sex offender (Michigan 1951) was that deviated sexual behavior is symptomatic of a personality disturbance which is amenable to psychological treatment. however, what constitutes adequate treat- ment has been a controversial issue. The purpose of this paper is to examine the consequences of the two principal treatment forms used with involuntarily hospitalized sexual offenders in the state of Michigan. Legal Aspects of Connnijtgnent In 1939, the Michigan Legislature passed Public Act 165, which es- tablished legal procedures for individuals designated as Criminal Sex- ual Psychopaths (CSPs). Persons falling within the provisions of the Act were committed to the Department of Mental Health (DI/EH) for an in- determinate time period. The residence of these individuals was left to the discretion of the DMH, which designated the Ionia State Hospital (ISH) as the appropriate institution. .At the hospital, due mainly to pressures for bed space, approximately half of these individuals were transferred to the State Prison of Southern Michigan (SPEED. .At ISH the treatment method consisted of intensive individual psychotherapy, and in 1953, due to increases in commdtments and shortages in the Psychiatric Staff, group therapy was adopted as the main treatment method. .At SPShi they underwent the process of imprisonment with, originally at least, monthly psychiatric interviews. In March 1958, the Supreme Court ruled that transfer of CSPs to a prison was not in keeping with the intent of the Act to provide appropriate care and treatment in a psychiatric set- ting. Legal vs. Psychiatric Views of the CSP The concept of Criminal Sexna1.Psychopathy may be compared with the psychiatric category of psychopath. sociopath, or character disorder. The main divergence between the legal and psychiatric criteria for psy- chopathy. as regards treatment. appears to be that the legal approach is more optimistic than the latter. CSPs are sent into a hospital rather than a prison because the court concurs with the view that sexual malad- justment is a symptom.of underlying conflict which may be corrected through suitable treatment. Legally, CSPs are described as individuals afflicted with a mental disorder. They are not feebleminded or insane, but have criminal propensities fer the commission of sex offenses. If sexual motivation is believed involved in a crime, the criminal may be remanded for examination by three psychiatrists approved by the DLH. They. as expert witnesses. report their findings to a judge. who makes the final decision regarding commitability. Psychiatrically. the mental status of the CSPs spans the range of the classical diagnostic categories. Current observations are consis- tent with those of Lieberman and.Siegal (1957) that as a group they are composed of psychotic. feebleminded. neurotic. sociopathic. brain in- jured, convulsively disordered. alcoholic. and some who could be consid- ered only severely maladjusted. The inclusion of feeblemdnded as one of the diagnostic categories may seem.incongruous since by legal definition they are excluded. however, Trembath (1952) found that l.¢% are defec- tive and 8.3% are borderline defective, as determined by psychodiagnos- tic examination with the Wechsler-Bellevue. Legally. CSPs are classi- fied according to the offense committed. as in cases of gross indecency, indecent exposure or indecent liberties. These categories do not accu— rately describe the act in its psychological significance as homosexual. exhibitionistic or pedophilic in nature. The range of deviated sexual behavior of this population is comparable to that listed in almost any abnormal psychology textbook that contains a section in this area. The reader is referred to Coleman (1956) whose treatise is brief but excel- lent for general purposes. Parole Success: The Criterion of Treatment In reference to the cars. the ISH accepts a twofold responsibility; (a) to provide treatment. and (b) to discharge only when the individual is no longer considered a.menace to the community. At the completion of treatment. successful adjustment for a three-year parole period is re- quired as evidence of recovery from psychopathy. In special cases, the 3-yr. period may be lengthened or shortened. In the case of infractions of rules set up to govern conduct they are returned as parole violators. The general rule governing parole is that patients remain under the jur- isdiction of the DMH. and may be returned without question at its dispo- sition. Patients are most generally supervised by psychiatrists or so- cial workers of the DMH, and may be returned at their discretion. On rare occasions paroled CSPs return voluntarily for further treatment. In most cases, parole violation means. however, that hospitalization has been reinstated as a result of a criminal offense, a justifiable com- plaint, or in anticipation of the latter. Parole violation offenses con- sist of: sex, 77.5%. drunk, a, absconded, 6.5%. homicide. 1.1% and miscel- laneous, 7.9%. p- Heview of theggiterature A ten year review of the literature revealed few studies specifical- ly relating to a comparison of treatment methods using an external cri- terion as an index of success. Earlier studies emphasized structure. dynamics. or describe a specific program.in a particular site. None was found that used the present criterion as an assessment of two programs. The sexual offender is increasingly being assigned to state and other mental hospitals for treatment: i.e.. at the Atascadero State Hospital (Kivisto, 1958); the Mendocino State HOSpital (Lieberman and Siegal. 1957;; the Henry Phipps Psychiatric Clinic. (Yalomq 1961); St. Eliza- beth's Hospital, (Cruvant, hbltzen, and Tartaglino. 1950) and the Retro- politan State Hospital, (Caheen and Coleman. 1961}. At most of these places. group therapy is designated the treatment of choice around which all other treatment activities are oriented. These sources report fa- vorably regarding the positive effects of this treatment form.in promot- ing constructive personality changes. These positive nonsystematic re- ports emphasized the need for more definitive investigation of the im- pact of the group.method upon community adjustment. Imprigonment vg, ngchotherapgutig Treatment Two studies directly relevant to the issue have been completed at 13H (Cook, 19h? and Trembath, 1952). These investigators were concerned about the relative efficacy of imprisonment versus psychotherapy. but concurred that the outcomes of both programs were roughly equivalent in terms of parole violations. The statistics derived from their popula- tions are parameter values established over a period of 12 years. Trem- bath's (1952) population included Cook's (1947) and was largely an ex- tension of the latter. The number of patients was. 135 and 69 respec- Ln tively. Two marked trends are noted in Trembath's study, (a) an in- creasing incidence of commitments, and (b) an increasing proportion of patients transferred to the prison. These previous studies were an in- valuable aid in establishing basic guide lines for comparison and des- cribing the population. Cook's Study. At the time of this study. a total of 69 patients had been paroled from the beginning of GSP commitments in 1939. By l9h7. 12 patients, or 175 had violated parole. Of these, 6 had been released from the hospital, and the other 6 from_the prison. [A nearly equal rate of parole violations, (17.1% from the prison and 17.6% in the hospital group) was observed. _The latter finding served as the basis fer Cook's equation of the two programs. He states that, 'Imprisonment is a very valuable thera- pe tic implement in treating certain types of CSPs'I (Cook. 19h7. p. 6). The general criterion used for retention or transfer of patients was. “Those showing better than average evidence that they might benefit from hospital treatment are retained at the hospital. Those who seemed un- likely to gain from active therapy were sent to the prison“, (Cook 19h7, p. 6). In addition to the general criterion outlined above, other very practical considerations were used by the staff to attain these ends. The following individuals were usually kept at the hospital: (1) Those with physical handicaps or illnesses requiring continuous medication or special care, (4) others felt to be approaching a psychotic break which night by precipitated by the transfer; (3) the comparatively young; (A) those evaluated as sincere in the desire to correct a sexual deviation. but viewed as readily susceptible to pressures to continue deviant prac- a Illll‘llh llnlfl: tices. The following were, in nest cases, transferred from the lSH to SEEM: (1) individuals who had been actively treated. paroled, and had returned; (2} those who became engaged in antisocial acting-out; and (3) when bed space was strongly in demand. except when strongly counterind- icated. almost anyone who had been evaluated at a diagnostic staff. Cook's most controversial conclusion, which he emphasized by restat- ing three times, may be paraphrased as follows: that as far as treatment outcomes were concerned. imprisonment was considered equivalent to in- tensive individual psychotherEPY. if care was exercised as regards se— lection for treatment. Several questions may be addressed to Cook's (l9h7) report. It may be reasonable to assume that negative incentives are more effective therapeutically in some cases than in others, but more systematic cri- teria for selection should be made. his concept of Ipunitive therapy“ seems insufficient to account for his findings (Cook l9h7, p. 7). The equivalence of parole violation rates was interpreted as stemming mostly from.nis evaluation that the punitive aspects. or negative incentives of the prison environment were greater than those at the hospital. he sug- gests that negative incentives were equivalent, for certain unspecified individuals. in the attainment of parole success as a more positive therapeutic approach. It is clear that all of the relevant variables impinging on his findings were not systematically investigated. Trembath's Study. his paper's emphasis is on the general charac- teristics of CSPs. Those measures specifically used by Trembath relat- ing to parole success have been reformulated to coincide with the sta- tistical presentation of the current study. Concerning treatment, group therapy is mentioned as one among sever- \] a1 available to USPS. at the time of his study, however, group therapy was not actually practiced at 13H. It is assigned no special priority, and is included in the same context with individual psychotherapy, chem- otherapy, electroshock, and luetic medication. Inasmuch as his parole success measures are very similar to Cook's (19h7) he agrees that, “The effects of incarceration are considerable with certain types of patients. The value of such motivation in therapy is obvious in theories of learn- ing" (Trembath, 1952, p. 17). It is noted that prior to January 1952, there were A26 commitments, showing a mean annual rate of 35.5 individuals. He observes that in 1940, Q53 of the yearly commitments were transferred to the prison. By 1950, the proportion of transfers had risen to 6&5. His statistics re- garding the incidence of parole success are based on a population of 159 patients, of whom u had died. 0f the 88 individuals in residence at the hospital, 13 or 1h.o£ violated parole. Of the 67 persons who had been transferred to the prison, 16 or 23.9% had violated parole. Neither the Cook nor the Trembath study found a statistically reliable difference in the incidence of parole violation as measured by Chi Square statistic between parole violators (PVs) vs. non-parole violators (NPVs) in either the hospital or prison program. Import t Diffe ences Between he r n ent Stu ies Individual psychotherapy, due to vicissitudes in the Psychiatric Staff, was gradually discontinued shortly after Trembath's (1952) stud". The group therapy program started in the latter part of 1953. The annual discharge rate jumped from 15.9 patients, in the 1939 - 19h9 period. to 53.2 individuals, during the 1953 - 1961 interval. The previous studies report on a total of 155 paroled patients, and 29 PVs the preSent one with h27 paroled patients and 196 FVs. As a result of the Supreme Court decision, 156 CSPs were returned fiom.the prison within the year, and of these, 119 were received within 5 nonths. These large numbers of transfers required considerable re- adjustment, and extension of the group therapy program.with unmeasurable consequences. Individual interviews, with the psychologists, designed to enhance group therapy effects, have been sharply reduced since that time. Unexplored Areas of the Prison and Hospital Program The two studies cited above made no attempt to examine the length of time individuals were exposed to either intensive individual psychother- apy or imprisonment. An exploration of the temporal dimension may pro- vide more definitive information concerning the therapeutic direction of either progr~n. It seems important to inquire whether the incidence of parole success for the prison group varies as a function of the length of time in group herapy. There were individuals in the prison group who were not incorporated into the therapy groups. Do these individuals differ from the full or partial participants? If, as has been alleged, prison time is punitively therapeutic, a reasonable deduction would be that the successful parolees from prison spent a longer time in that en- vironment than the non-successful ones. Lastly, do the time relation- ships which are to be observed for the prison group, obtain for the hospital group. The Differentiatin Variable: Grou PS 0 ther It is hypothesized that the group therapy variable will contribute more positively to parole success than the prison program. .A brief def- inition of group therapy in this setting is that: it is the type of pa- tient-centered group discussion which, as a learning experience, aims at modifying or transforming unacceptable onotional urges, irrational ideas. attitudes and beliefs which underlie unacceptable sexual acting-out. In the process, the individual is expected to acquire some understanding of underlying motivations and the relationship of his sexual symptoms to others, so that he may return to the macrocommunity to live within legal sanctions. Statgmgnt of the Problgm The impetus for the present investigation is an unsystematic obser- vation that group psychotherapy has a more beneficial impact on subse- quent behavior of CSEE on parole than does imprisonment. Isolation of the group therapy variable from.the institutional matrices and precise specification of it's influence, although desirable from.the standpoint of experimental design, may not be possible within the institutional setting. Instead, these circumstances will be approximated as closely as possible. The group psychotherapy program.is clearly the major inno- vation in treatment at ISH since the studies of Cook (1947) and Trembath (1952). Also, it is the principal distinction between treatment at ISH and SEEK; It is hypothesized that GSP participants in the group therapy program.at LSH will show a lower rate of parole violation than CSPs who receive the more punitively oriented treatment at SEEM. In line with the obvious fact that psychological rehabilitation takes place in a time continuum, a corollary hypothesis consisting of three parts is ventured: (A) In the prison group, parole success will be positively related to the length of time in group therapy. (B) Length of imprisonment will be inversely related to parole success. (C) In the hospital group, the time factor for the group therapy variable will not lO vary significantly. Description of the Present study The present study concerns itself mainly with two groups of CSPs. one completed a hospital program including group psychotherapy. The other group was transferred to a prison where treatment consisted of im— prisonment exclusive of group therapy. All of the subjects used in this study initiated institutional residence at ISH. After imprisonment, they were returned to 13H prior to parole for varying lengths of time during which some of the prison group received group therapy. The prison and hospital groups are subdivided into PVs and NPVs, and comparisons will be made of the rate of parole successes and failures. The Time Dimengion: Four Compariggng. Parole Violator and HPV groups will be contrasted as regards the mean length of time in group therapy and imprisonment. .A comparison of the group therapy partici- pants vs. non-participants will be made. Lastly, the time dimension for the hospital group will be analyzed. Fourjgualitotive Descriptiopg. The CSPs are described in several places and their psychosocial characteristics detailed. The two environnents (15H and SEEM), where the CSPs spent an average of about 33 months, will be contrasted to examine Cook's (19h?) evalua- tion that the punitive aspects were more severe at the prison than at the hospital. The group therapy program will be sketched, peripherally, to justify the emphasis placed upon it as an instrument for rehabilitation. moor-413mm Introductory Remarks r711 inis part of the paper focuses on the physical and psychosocial characteristics of the two institutions. Although recognizing that it is impossible to quantitatively assess the positive and negative charac- teristics of these two institutions, the aim of this section is to give sone fuller picture of them with respect to their positive and negative traits. It is noted that Cook (1947) appraised the punitive atmosphere to be much more severe at the prison than at the hospital. The State Prison at Southern.thhigan General Considerations The State Prison at southern Michigan contains the largest number of individuals within walls of any correctional institution in the world. Individual treatment therefore, becomes an almost impossible task to carryout. as long as custodial problems do not present themselves, the inmate is generally allowed to pursue whatever schedule he selects. At the prison, a CSP wishing to escape unfavorable attention may readily take advantage of the easily available anonymity to avoid counseling or other forms of therapeutic activi y. Therefore, the extent to which the individual engaged in rehabilitative activities was largely left to his 'wn initiative. Positive Aspects of the Prison The USP “Visitors” (by “Visitors“ was meant that the CSPs were still considered patients, and remained under the jurisdiction of L3H) under— went the same classification procedures as the rest of the populatioi. They weze placed in the various occupational positions as their abili— ties allowed, and received economic remuneration commensurate with their 11 placement. They were at full liberty to take advantage of the recrea- tional and educational facilities. The counseling facilities of the prison were available, and those with alcoholic complications were en- couraged to become members of Alcoholic.Anonymous. All of the rehabil- itative facilities which were at the disposal of the inmate were open to the patient. In addition, at least initially, from.l939 to l9h6 they were interviewed once a month by a hospital psychiatrist. As the number of USPS increased, however, the frequency of these interviews decreased. .ggggtive.hspects It was Cook's (19h?) view that the transfer tended to intensify the pain attendant on the condition of indeterminacy since they were one hDIB step>remnved from the desired goal, parole status. In addition, the fact that CSPS were considered “Visitors" at the prison, compounded their rejection. EbI'the nest part, the GSPs were looked upon with sus- picion and bias at the prison. kany inmates erroneously believed that all CSPs were homosexuals. Fraternization attempts by SEEM inmates were often viewed by CSPs as instigated by homosexual purposes. These ap- proaches were generally distasteful to the CSPs since they had either been advised to attempt to break homosexual practices, or had no problem of this kind. The identity of the CSPs at the prison was distinctive, since on their cell doors appeared the label, 'CSP' instead of the five- digit number which identified the regular inmate. The other inmates of- ten directed deeply condemnatory and villifying remarks toward the CSP. Social interactions were primarily confined to each other. Transfer to the prison was often traumatic in itself, inasmuch as KDSt of them con- sidered the added designation of l'convict" detrimental to employment placement in the open community. Environmental Aspects of the Icnia State Hospital General Considerations The Ionia State hospital for the Criminally Insane is a maximum se— urity institution which incorporates the features of a hospital and a prison. The patient body is a highly complex microcommunity consisting of (a) Individuals charged with a crime and legally insane, (b) A number of individuals who have been behavior problems, sometimes homicidal, from.other state institutions, (c) Commitments under Public Act 165 and (d) Emergency probate court cornfitnmnts. Lhny have acted-out their ag— gressive feelings with very serious consequences, and have therefore been sent to 153. Because of such circumstances, ISH operates under a system of rules which are strictly enforced. In comparison to the aver- age mental hospital, the main departures would be a drastic reduction in freedom of movement and increased supervision and observation. The organizational structure of the hospital lends itself to very close observation of the total adjustmant Spheres of the patient. The social interactions and idiosyncracies of the patient come under close scrutiny. The lack of life space tends to elicit in broader relief the personality traits of the patient, whether aggressive or passive, gre— garious or withdrawn, guarded or frank. In some cases, individuals su- perficially well controlled becore acutely disturbed. Sexual adjustment can, in most cases, be fairly well determined. Fluctuations in eating, sleeping or work habits are often reliable indices of the emotional state of the patient. .Attempts are made to gauge the degree of accept- ance or resistance to authority. It is possible in some instances to evoke reactions to frustrating conditions. If the patient has previous- lv manifested undue instabilit , stressful situations are sometimes in- J 1h duced to assess gains made in this area. Positive_§spect§fof the hospital Except for differences in location, the GSPs undergo basically the same diagnostic, medical, psychological, and social work procedures as the psychotic patients. They are recommended fer medical, occupational, or recreational therapy in much the same way. Essentially, they are in- tegrated into all of the departments of the hospital. The group therapy pregram.was initiated specifically for the GSPs, and they are strongly urged to participate even when strong disinclinations to attend are man- ifested. Personal interviews with their ward physician are granted on request whenever possible, but are sharply limited by staff shortages. Since 1939, the CSPs have made great strides in establishing their worth by positive contributions to the hospital community. They have shown competency in handling assignments too varied to describe here. In many cases there is sympathetic understanding of the problems of the psychotic patient. While it would be a misstatement to imply that all CSPs are 'therapeutic carriers”, the more rational and socially oriented psychotic patients prefer'to associate with the CSPs rather than with other psychotic patients. Negative Asgects of the Hospital Criminal sexual psychopaths have been coming to the hospital for 22 years. At the start, there was relatively slight established knowledge concerning their characteristics. Their potential for destructive act- ing-out was grossly overestimated. Initially they were literally “per- sonae non grate.” Even today this attitude persists, in only slightly modified form, in the behavior of almost all hospital employees. The 03? initiates his residence in the hospital on a different ward than the psychotic patient. The intake wards are on the same floor of the same building, and are separated only by a metal door, which is for the most part, locked. During the quarantine period these patients eat together, but after the two-week period is over, they go to heads with their respective wards. Criminal.Sexual Psychopaths soon learn that there are two distinct groups, i.e., those who are considered insane or psychotic, and the minority group to which they belong. Some employees manifest hyperawareness of the difference, and find it difficult to understand that individuals who are seemingly well should take up bed space intended for psychotic patients. Because CSPs are more intellectually alert, they are more apt to question the poli- cies and regulations of the hospital, and sometimes enhance existing negative staff attitudes. hbny patients and employees still believe that tne ternt'CSP” is synonymous with homosexuality. Psychotic pa- tients, recommended for group therapy in almost all instances, request not to be placed in groups that contain GSPs, since such identification is fraught with anticipated derogation. many CSPs are informed in court that residence at the hospital ranges from.lh to 90 days. When they learn that the average length of confinement is approximately three years, it is not only disillusioning, but also tends to engenderinis- trust of hospital personnel. Work is classified as occupational therapy, but the limit earnable on an assignment is three candy bars or the equi— valent value in tobacco. Some favorable statements have been used to describe the progress of the GSPs. They still, however, experience considerable discomfort and conflict in their efforts to satisfactorily integrate the therapeutic attitude with the restriction of movement and privilege. Initially, a lo connonly held expectation is that the therapeutic approach must of ne- cessity be accompanied by only positive incentives in the form of overly permissive freedom, loose regard for rules, and above average subsist- ence. In time, the insightful come to realize that only within an at— mosphere of positive and negative incentive, pleasurable and painful ex— periences which are part and parcel of all existence, is it possible to work through problems of the severity which they, in most cases, present. Summary of Conditions it ISH and SPSM In both institutions the condition of indeterminacy of commitment is operating. In either place, GSPs were a well marked.minority group. strong cultural biases and fear of deviated sexual practices are not znitigated in either institutional setting. Custodial security is great- er at the hospital than at the prison. The latter factor would appear to be associated with greater restriction of movement and increased neg- ative incentive. Economic remuneration for work assignments, an import- ant advantage from the perspective of those institutionalized. is great- er at the prison than at the hospital. As regards treatment at the pri- son, it was left largely to individual initiative. ‘At the.hospital, a definite treatment program was operating for almost every CSP. The point of view adopted in this paper regarding environment, is that neither an excessively punitive or permissive atmosphere is optimal for personality growth. In addition, the environment, as such, has pos- itive or negative influences on the patient's adjustment, depending on his individual characteristics. Dependent individuals, for the most part, accept the rigid institutional life as a relief from the frustra- tions involved in assuming responsibility. 0n the other hand, the inde- pendent, self-reliant individual chafes and rebels against strict con- trols represented by an institution. Therefore, whether the institu- tional environment, in the long run, becomes a negative, positive, or neutral force for rehabilitation depends upon the patient's ability to come to terns with the prevailing conditions and to integrate them.into his ideational and emotional rehabilitation. The Group Therapy Program Theoretical Predispgsitions The two therapists interacting with the patients groups, herein re- ported, have been eclectic since there has been no compulsion or pres- sure to follow any systematic orientation. As they observed and listen- ed to the experiences of the patients at varying levels of awareness, it was sensed that certain concepts best described what was being empiri- cally observed. For example, strong resistance has been encountered. Yalom.(l961) calls it recalcitrance, in one farm or another in almost every patient. And as they haltingly or glibly relate episodes in their lives, they defend in innumerable ways against the pain entailed in frankly discussing happenings that are deflating or reveal superego de- ficiencies. Invariably the therapist or others in the group become ob- jects of the narrator's positive or negative emotional reactions to rel— atives, friend or significant acquaintances. Host patients admit that if nothing else, pent-up emotions are alleviated; in other words, 'I got it out of my system.II In many cases, a particular sexual pattern may have symbolic meaning extending far beyond mere sexual motivation, i.e., a deviated sexual act may be a compensatory expression of virility for feelings of inadequacy, an aggressive act against a parental figure, or vicarious gratification of incestual wishes. As many contributing factors as possible are elicited and worked through, so that the most characteristic defense of the patient may not be missed. Concepts like introversion, or extroversion, or inferiority complex, or unconscious.notivation are, in many cases, already known to the patients, and are sometimes useful in interpreting developmental processes. A belief has developed from the many cases that have been reviewed, that single events, except in rare instances, are not usually of suffi- cient import to determine most serious problems. Instead, attention is focused on repetative patterns of behavior. It is these complex sequen- ces which are believed to be the basic elements of personality configur- ations. A summary of theoretical orientation would concede that the various theoretical positions, whether psychoanalytic, behavioristic, or gestalt, have contributed many concepts and emphases which can be imple- mented to understand individuals with pathologic sexual problems. Group Therapy: History and Structural Develgpggnt The group therapy program.was initiated at the 13H on request of the Radical Superintendent in the latter part of 1953. .At first it was under the immediate direction of one of the psychiatrists. Several ap- proaches were attempted, i.e., group projections onto the TAT cards and detailed, but brief, testimonials of the specific 'offense committed by the individual. For various reasons, these methods were subsequently modified or discarded. In the early part of 1954, the Psychiatric Staff, overburdened by added pressures, asked the Psychology Department to continue the activ- ity. Both therapists were in substantial agreement that many of the principles which apply to individual dynamic psychotherapy can be ap- plied to the group, therefore, each member of the group was requested to [.4 \O discuss his life history. Once the idea was accepted, this mode of pro— cedure has becone standard. Group members are encouraged to make obser- vations, relate the on-going content to their lives, or to offer inter- pretations. The broup meetings are of one hour duration. The first group consisted of 12 persons; at present there are 18 groups with an average number of 18 persons per group. In the beginning there was concern about the optimal size of the group, and it was at- tempted as much as possible to restrict them to a range of 8 to 12. At the time of the 1957 Supreme Court decision, large numbers of CSPs were returned from the prison, and the size of most groups was increased to 20. These larger groups do not differ to any great degree from.the smaller ones. Smaller groups are nore desirable since they provide several bene- fits. There is no predetermined time span within which a patient must complete his narration. In smaller groups individuals would assume this role much sooner than is now the case. The range of attention maintain- ed by the therapist would be narrowed over a smaller field. This would result in closer observation of unverbalized reactions. Individuals who '0 r.tionalized their silence with the statement that large groups frighten or embarrass them, would lose one more plate of their defensive armor. In-group feeling is slower to develop in a large group than in a smaller one. Abreaction would be facilitated since fear of breaches of confi- dentiality would be decreased. Oppn vg. Closed Groups The groups have always been open. There is a constant influx and discharge of patients. As soon as one individual leaves a group, there is anothex'to take his place. Local y, open groups lend themselves more 20 readily to the continuity of in-group feeling. They accelerate the time element in the therapeutic process since there are always individuals at various levels of sophistication who pass on to the newer members the nethods of critical analysis and interpretation acquired in their own experiences. Lembers convinced of the merit of group therapy frequently becone valuable allies of the therapist, and in many instances confront differences With other patients on a more egualitarian peer basis. and with more telling effect. Tine Phases of Group Interaction In general. three phases of an individual's development within the axon; are perceived. In the first period. the individual learns what is expected regarding relevant experiences. He is conditioned to accept constructive criticism of the others so that when he fills the narra- tor's status. which is the second stage. he will not feel so severely threatened. In the third sequence, he contributes maximally as a result of the understandin; gained from his personal experience. The narrator is asked, as much as possible, to present material to the group chrono- logically. Homogeneous vs. Heterogeneous Structure From the beginning, every attempt has been made to apply the princi— ple of honotberapy. The significance of homogeneity in enhancing this principle has been undergoing transformation gradually but consistently. At first, groups were considered homogeneous because all the members were CSPs. The first indication that the patients did not consider the groups homogeneous bodies was that some of the members who had committed one type of sex offense complained that they were different than those with an unlike sexual problem. There was general agreement that full 21 cm of expres- F') *J (L7 L. -: in ,‘ ii. :., ~ -, :.,_ . ._ .2 ,. , ..,..,, . - ' L‘U»1K-.L4.U 0e gld. Il‘L. o8 derived $11858 chol‘ .iao “BJCLUul 3;. , which could not be achieved in mixed groups. d- ._.a pa ( I pplications of These conumnications Made it easier for further a_ grin ipl . How UFCLPS are differentiated on the basis of age, type of sexual probleu, intelligence, recidivism and physical handicap. As yet, there has been insufficient time to determine whether the specific Ljoups exhibit marked variance in nodal personality or dynamics. The Role of the Therapist In int:oduci-g this section, the reader should bear in mind that these remarks apgly to involuntarily coaafitted. and in some cases, se— verely disturbed individuals who do not possess the conventional selec- tion criteria for psychotherapy; they neither admit that a problem ex- ists, or express a desire for treatment. There is no selection of ca- ses; group therapy is prescribed in alhost every case by the Psychiatric Staff. It is considered the treatment of choice for sexual deviates. The exceptions consist of individuals who are handicapped by age or physically so that it nakes locomotion or communication difficult. At the present time there are approximately 350 sexual offenders attending one or another of the groups. The area of the qualifications of the therapist is a controversial one, but aside from academic requirements, the therapist must be ethical, impartial, and able to withstand considerable stress. Elaboration of th=se concepts could provide sufficient material for another paper. The Question of directiveness versus nondirectiveness must, to a certain extent, be viewed from the perspective of the expediencies of tine and the group welfare. In a feebleminded group it is often neces— sary to be directive. There are instances when the narrator becomes re- calcitrant and will not utter a word even in response to direct gues- tioning. In other groups. even if it were wished. it would be difficult to be directive because of the spontaneous interaction, spirited inquiry, good hunor, high tolerance for traumatic material. and insightful level of interpretation. In other bnoups, especially adolescent ones. changes iiou;one role to the other are advisable depending on the climate exhib- ited, i.e., whether the group is inhibited. disorganized. or outgoing. Institutional incidents change atmospheres, so that sensitivity to the predominant mood characterizing the then current situation calls for adaptive flexibility on the part of the therapist. The principle of nondirectiveness is applied whenever possible for several reasons. Lbre than the directive approach it encourages inde— pendent critical thinking. If the patient feels that he shares almost equally in the tasks of uncovering significant material, decreasing the strength of ineffective defenses. or reinforcing the process of reality awareness. his self-esteem is raised. In the process of contributing, some patients sharpen their allocentric perceptions and reformulate their consciences. Too directive an approach fosters undue dependence on authority figures, lowers the level of communication by inhibiting erbalization, or merely echoing the opinion of the therapist. Ingroup feeling is delayed since the patients do not as readily get to know one- another. The therapist must guard lest he Shirk responsibility for the pro- gression of the group. He defines and maintains boundaries within which the groups operates. i.e., discourages to the fullest extent breaches of confidentiality, keeps to a minimmm.descriptively obscene language. opens and closes meetings as much as possible on schedule, and keeps to '43 a minimum, peneral and “gripe” sessions. As regards content. the idea is continually reinforced that greater expressiveness is desirable since it is symbolic of trust and self-un- derstanding. The confronting of differences has been found to be inev- itable. But from the confronting should emerge increased respect for each other's integrity. Differences of opinion are explained as found— ed on individuality, and are to be manifested with a minimnm.of person- al involvement or fear of retaliation. The therapist should initiate discussion of pertinent points when by-passed as a result of apathy, re- sistance or concealed aggression toward him.or each other. As often as necessary, misinformation steaming from distorted or inaccurate learning experience is corrected. Inte pretations which do not fit facts evoked from the individual's life, must be reformulated. The rare important instances which form the core of the maladjustive pattern must be inte- grated and surmarized in language which can be readily understood by everyone. In sexual maladjustment. group therapy aims to focus problems. Thus, it renders them.a more realistic threat and alleviates undue anx- iety. By specifying areas of conflict, inadequacy and competence. it makes possible the adoption of modified responses. .As ingroup solidar- ity is brought about. the group technique highlights the universality of basic needs. the uniqueness of individual experience, and the necessity for exploring differences between surface sexual symptom and the dynam- ics underlying overt behavior. Description of theiggpulation Trembath summarized the characteristics of GSPs in the following 2a tion. This sample, at least. is quite similar in education and intel- ligence. Lore of them have experienced marital discord of their parents during their formative years. and have shown less capacity or desire for stable marital relationships of their own. They constitute a greater number of excessive drinkers than is found in the population at large.“ (Trembath, 19;2, p. 8) For too purposes of the present study it will be assumed that, in general. except for the youngest age group. the distribution of person- ality characteristics of the individuals in the prison and hospital groups are roughly equal, or randomly distributed. Supporting this as- sumption is evidence offered by Cook, (1947} and Trembath, (1952) that most of the traits they studied. i.e., intelligence, socioeconomic sta- tus, marital, education, parental relationship. degree of use of alcohol. or type of offense were not used systematically as a basis for either retention at the hospital or transfer to the prison. Further supporting this view are their findings of no significant differences between the incidence of PV in the prison and hospital groups. Concerning ape. Cook reports, ”The average of successful paroles is 36 years, and parole violators, 2o§ years (Cook, l9h7. p. h). Cur- rently the mean age of the lh3 SESE.PVS is 45.1, and of the 128 NPVs 43.6. The average age of the LSH PVs is 36.4, and of the HPVS h1.0. «hen the groups are combined as in Cook's (19h?) study, the current age of successful parolees is h2.0, and PVs 43.3. In light of present findinus, the age factor seems negligible in differentiating parole suc— cess from failure. Selection qii$ubjects The present study includes 427 CSPs discharged from.ISH over a per- Kn iod of eight years from.July 1233 through June 1961. However. indirect— ly, except for the period from.January l9h9 to June 1953, all of the discharged CSPS since 1939 have been used to tvace the evolution of the treatment process. Four females have been committed within the history of the Act. but none is included in the current context. since none was discharged within the period under review.‘ The subjects comprise the complete list of hhé discharges noted on tne daily calendar sheets of the ISM in chronological seguence. nineteen cases were set aside for the followind reasons: Five returned voluntarily for further treatment; four died on parole after release from the hospital; three were sent di- rectly to prison to continue serving a sentence; two were given an out- right discharge by he court; one was returned as psychotic for psychi- atric treatment; one was discharged directly to a U.S..Marshall and fol~ low-up data is not available; in one case there was an incomplete record. so that the necessary information could not be obtained. afterwards. the personal records of the individuals were examined to determine placement in one of the several groups used in the various comparisons. The criteria for inclusion in the hospital groups were either full term residence at the hospital and participation. or non- participation, in the group therapy program. For the prison groups, the criterion was simply transfer to the prison before discharge from the hospital. The prison group is subdivided into a non-participant and participant groups. Within the groups. the subjects were separated into those returned from parole to continue hospitalization, and these re- maining in the community. In this study. the NPVs are currently in the open community. They are reporting as instructed by their supervisors and are generally con- siderod to be nahing a satisfactory or marginal adjustment by he DMH. Parole violators have been so designated and returned; have absconded from parole; have a detainer placed upon them by the court; or have, without authorization, either left the state or are not reporting as scheduled. The last two descriptive phrases apply to only 6.5% cases. Iiultiple Parole'Violation Altogether there have been 172 PVs. However, 22 patients returned twice and accounts for hh of them. Only 150 cases will be used to as- sess the central hypothesis. This method of dealing with double entries has been adopted to comply with the requirements of statistical proce- dures. The PVs will be assigned to that group where they were situated at the time of their first PV in the first statistical analysis. In a subsequent comparison all 172 cases will be used to investigate possible fluctuations attendant on placement in a different. or the same. program. This particular time sample was selected primarily because it encomr passes the period in which the group therapy program.was initiated. It signaled the newer concept in the treatment of the GSPs and affords an evaluation as comprehensive of the program.es possible. Also, it coin- ciles with the fiscal year limits of the State of Michigan, thus facili- tating computation. The actual time period involved is somewhat greater than indicated above. since some of the patients who were discharged within this eight-year tine span. were admitted to the LSH for varying lengths of tine prior to their discharge. The LSH groups consisted of 156 patients. Of the latter group, 37 did not participate in the group therapy progr n, and have been used in a separate comparison. In the SEEM groups there were 271. In this latter group are included 20 cases which averaged 5.25 months at the prison and 24.1 months in group ther- 27 apy 'hat are successfully continuing parole. These ambiguous cases were arbitrarily assigned to the numbervof those successfully adjusting on parole from the prison to permit a more rigorous test of the central hy- pothesis. The criterion for the eventual return of the transferred patients to the hospital was the clinical judgement of a hospital psychiatrist who interviewed them at least once every six months. Return to the ISH did not constitute an automatic grant of parole status. On occasion, pa- tients were returned to SEEM for additional imprisonment. Reco.-.mendation for parole, in every instance. was relatively inde- pendent of the time element, but entirely demndent on the evaluation of the medical staff at ISH. The evaluation was based on the patient's verbalization to such considerations as the following: Does the patient understand how specific life experiences contributed to the development of the sexual problem? How has the total institutional facility been implemented to foster insight into his social breakdown? What gains or changes in personality have been made or acquired to prevent a recur- rence of the sexual symptom? Are the consequences of the deviated sex- ual acts understood? Have realistic plans been made for the future? The staff attempts to estimate whether the potential for antisocial act- ing-out is sufficiently strong to render the patient a real threat to the open community. When decision is doubtful, further psychological testing is administered for additional leads. F I1 EDI: 138 The total frequencies for the eight-year period are offered in table one in summary form to present a comprehensive picture of the various groupings. Cases of multiple parole violation are entered singly. The overall rate of PV for the L27 cases is 45.93. Table l The total sample and its distribution into the various comparison groups. ISH Number - 156 $176M Number - 271 Group Therapy an‘ Group Therapy an- Group Therapy 4 Group Therapy II 7-; N 3.7 N % N 3: PV 29 2h 24 6h-9 1&3 52-8 69 7&2 my 90 76 13 35 .1 128 u? .2 2a 2 5 .8 Totals 119 100 37 100 271 100 93 100 Central IVpothesis The 368 discharges abstracted for the present comparison yield the following frequencies. From the hospital group llS received an uninter- rupted course of group therapy, and 25 returned. This constitutes a 2rz parole violation rate. Of the 253 from.the prison group, 125 violated parole for a 4%3 return rate. When these frequencies are analyzed by Chi Square technique they yield a X? of 25.0 (P‘=.OOl). 28 29 Table 2 Incidence of PV and NPV between groups at ISH and SPELL L3H SEEM. Totals PV 25 125 150 my 90 128 218 Totals ll5 253 368 It was noted that 22 of the cases contributed an of the PVs. If either subsample, especially the prison group. were heavily weighted with assumed prognostically unfavorable individuals, the difference at- 'tributed to the influence of group psychotherapy might just as readily be considered to stem from bias inherent in the loading favoring ISH. when the initial fre uencies are corrected for multiple parole violation, i.e., h added to 16H and 22 to SEEM, the following proportions are ob- tained: The PV rate of ISH increases from 21% to 214%. and for SPELL from 9% to 52.3%. However. the 2d; difference (21% minus hat) between the first percentages, is slightly less than the corrected difference of 2o.8§$. Another possible 5 urce of error acting to bias results might be that HPVs and PVs for the current year (l960-l96l) were used. It is .1- reasonable U0 assume that a longer tire period should be allowed to elapse for violation to occur. Differential rate of PV might mate ially 31 or the obtained significant difference. This eventuality is particu- larly relevant inasmuch as the mean length of ime on parole is 16.6 months Scr the ISH group, and for SPSIsI 17.6 months. From July 1960 V - ‘I l- V‘. 1" o . v '4 q I tnrzugh June lgol there were 7 er and 22 JFVs from 15d, and 9 TVs and Ki) 0 2O .7le fr; 1.; 51:31.-.1‘Jhon these frequencies are subtracted from the ap- propriate sells, the EV rate of ISM is 20.93, and for SP"! 52.313. The difference between percentages in this case is 31.353. Again, the latter difference is very similar, but slightly larger than, the original 285-3. Thus. two corrections for bias. i.e., multiple PV and insufficient vio- lation time, do not substantially modify the findings. Instead. they strengthen confidence in the reliability of the difference. The most salient limitation of the present study has been the ab- Sence of a randozfly selected control group large enough to serve as a check on the effects of ISH environrent on PV ratios without the influ~ ence of group therapy. however, the 37 hospitalized. non-group therapy participants were not excluded from the groups because of any predeter— mined characteristic. Therefore random conditions may be operating. In this group there was a 61+.955 FV rate, closely approximating that of the similar SP3}; group. The Corollary Hypotheses Time in Group Therapy of SPSI-I Group The ...ean length of time in group there .3; of the 1143 Fla was 8.9 :';;onths. The average time spent in group therapy for the successful dis- charges from the prison group was 12.115 months. The reliability of the difference between the means is reflected by a 1 ratio of 3.26 (P<.01) (Guilford. 1950) . 31 Table 3 Comparison of time in group therapy of We and NPVs from SPSM. Lie an Months: SD t Value N PV 11-3 8.90 5.55 3026'? NPV 128 12.45 11.05 s P <1 .31 G ou T‘ ' Particination v Non-Partici lation amo * SPSM Inmates Of the 271 parole discharges from the prison group, 93 spent no time in group therapy, and 178 participated from 1-60 months. Parole viola- tions among, the no-thcrapy subgroup numbered 69, or 7h.2%. There were '71; His. or a rate of 211.6%. from those receiving some group therapn . A Chi Square analysis of these frequencies as described in Table 1;, yield— ed a x2 of 26.08. (P<.001). Table 4 Parole violation among SPSI.: subgroup as related to participation in group therapy. PV 1va Totals Some group therapy 71; 1014 178 No group therapy 69 24 93 Totals 114,3 128 271 Parole Success and Time Serve at I A summary of tire in prison of the 143 NS was 31.7 months. For the 123 non-parole violators. the average time in prison was 25.8 months. The reliability of the difference between means is reflected by a _t_ ra- KAI) 7“ ‘\fl --e.,- ' . y .3" ‘ ' w _ ' r‘ -‘ 1,: rerpordl CChagJI‘lSQJ OJ. 3le and -TPJs from a? 1.- N Lbnths SD 1: value PSI 113 31.7 ;_c.21 3-07* 1“ L28 2-5.“) (—1.... To determine the degree of relationship between the time in group therapy of both hospital groups. a biserial correlation method was used. The 1:.ch tim in grou therapy of the 29 Ws was 25 .62 months. For the 90 non-parole violators the mean time was 23.73 months. The resulting coefficient of -.O9 is not statistically significant. Table 6 Time relationships in group therapy of We and I‘IPVs from the ISH. IJ Mean _ SD of Iv'onths Total Sample I'm-a. 12014.8 “009 111.503.3310: Environmental Implications of Hon-Participation in Group Therapy It will be recalled that there are two groups (one of 37 ISH pa- tients, the other of 90 SRSM cases) reflecting the consequences of in- stitutionalization without the influence of group therapy. The SL‘M group of non-participants showed a parole violation rate of 74.23. In the 15H non-participants the PV rate was 6h.9%. The inference of hardly any difference between the two environments is supported by the findings. The attempt to isolate the group therapy variable from the institutional settings strengthened the viewpoint concerning the near equality of pun- itive effects. A reflection is added that the process of catalyzing personality change is a laborious and painstaking task, which is not voided by mere institutionalization. Cook (l9h7) and Trembath's (1952) findings regarding the incidence of PV, 17% and 22% respectively, are markedly variant from the present combined total of 45.9%. The emerging trend was that as the number of admissions to the hospital, and transfers to the prison increased, there was a proportional increase in the number of parole violations. From 1939 to 1952 the mean annual admission rate was 35.5; from.l953 to 1960 it was 59.0. The percentages of transfers to the prison increased from a mean of 44.63 in 1940, to a mean of 61.63 from.l953 to 1956. It was previously noted that, initially. an ISH psychiatrist inter- viewed the patients at the prison once a.nonth. At first, he was able to review almost all of them.in the allotted time. It seems possible that these therapeutic contacts accounted, to a considerable degree, for the earlier equivalence of the SPsm.program.with that of the ISH. How— ever, as the number of GSPs increased. it became impossible to provide 33 ’3 ya so much individual treatment. Concomitant y, the potential for deviated sexual acting-out of the relatively untreated CJPs, remained relatively high. Another finding strengthenin" this explanation was that the 21% par- ole violation rate currently derived from.the hospital group is not sig- nificantly higher than the proportions found by Cook (19h?) and Trembath (195;); 17.553 and 14.8% respectively. It is noted that these three pro- portions occurred where direct contact with psychiatrists or psycholo- gists was maintained. In contrast, the three ratios 17.155. 23 .953 and 1;).353 of l-Vs from the prison groups yielded a Chi Square of 26 .15, show- ing a significant increment in the incidence of parole violation. Time 1in Group Therapy of the SPELL Group The finding among the SRSLI patients that the NPVs spent a longer time in group therapy than did the WS, is congruent with prior specula- tion. It is, also, both a first step in substantiating the corollary hypothesis and offers further support for the central hypothesis. The mean time for successful parolees in group therapy at ISH was 23.7 months. For the successful SPSIvl group, the mean time in group therapy was 14.5 months. However, the PV rate for the latter group is 111.6%. substantially higher than the 21% PV rate among 13H participants, but much lower than the 71; .27; rate found for the SPSM non-participants. The findings suggest that partial group therapy would improve the chances of parole success to some extent, but not as extensively as full participa- tion. Parole Succegg and Group Therapy Partigipation The significant difference extracted from this comparison among the STEM group uncovers the hypothesized relationship regarding the group therapy variable. This comparison suggests that the incidence of parole success increased with participation in group therapy. Up to this point the following percentages of parole success are noted: full participa- tion.(ISH) 793, partial participation (SEEM) 58.h§. non-participation (13H) 35.1%. and non-participation (SPEND 25.8%. The last rate suggests strongly that these individuals left SEEM with much the same personality ”configuration that was present when they entered. Since no systematic efforts Were made to foster change, alteration in personality could not reasonably be expected. Time in Prison The finding that the length of time in prison is significantly long- er for the parole violators of the prison group does not support Cook's (19h?) conclusion regarding the effectiveness of imprisonment. A rather different process appeared to be operating. General y, as the length of tine increased, the incidence of parole violation concomitantly increas- ed. It is suggested, instead, that the 17.1% parole violation earlier noted by Cook (1947), nay have been largely attributable to psychiatric intervention. It would further seem reasonable to infer that those par- oled from the prison in the beginning received a greater arount of ther- apeutic attention, whereas, many paroled during the time of this study received much less. In addition, residence at SEEM predisposed a grow- ing body of prognostically unfavorable cases. Time Re;§tionships in the Hospita; Gropp The lack of a clear relationship between the length of participation in group therapy and parole success, or failure, was not entirely unex- pected. The present data does not support the view that length of par- ticipation in group therapy, per se, is a significant factor in every 36 case. This emphasizes the ingoriance of concern with the quality of Lproup therapy participation as distinct from the sheer axount of ses- sions attended. Implications for further Research The factors on which parole violation are based, especially if an individual has maintained a therapeutic relationship, are complex. A crucial need aimed at the reduction of PV would be the development of a scale to measure quality of participation as related to measures of PV. Individuals differ markedly with respect to the temporal speed with which they verbalize understanding of their own, or the problems of others. Initially, most patients resist therapy, and absolve the self by minimizing, rationalizing, projecting blame onto social happenings or specific individuals, or eloping. Some have attended the groups for 3 or 4 years before they finally admit that their resistance was irration- al and unwarranted. Sympathetic relatives, at tines, reinforce the re- sistive process. From the start, some are obviously less accessible to therapy, depending on the severity of emotional, intellectual or physi— cal disturbance. A greater than average number present alcoholic com— plications, Cook (1947) 225;, and Trembath (1952) 36. 5;. In some of these latter cases, there is real doubt whether amnesia fer commdtted offenses is feigned. Further exploration is also needed (in the area of personality and intellectual testing) to investigate the relationships to parole viola— tion rates, i.e., are there differences in parole violation among indi— viduals of below average, average, and above average endowment. Do pro- jective or other personality tests discriminate between those with a positive prognosis as opposed to a poor one. Traditionally, the younger ‘1‘! \J age group has been considered prognostically more favorable. Does this penerally accepted principle hold true in this population. .Are there differences in parole violation.anon¢ the three host frequent sexual de- viations, namely, exhibitionism, pedophilia and homosexuality. Finally, are there levels of insight, and to what extent can these be used to predict successful adjustment. The problem investigated concerned the relative impact of imprison- rent at the State Prison of Southern Michigan (SPSM) vs. group psycho- therapy at the Ionia State Hospital (ISH) upon the parole violation rates of Criminal Sexual Psychopaths (CSPS). The findings of two pre- vions studies, Cook (191;?) and Trembath (1952 , reporting no significant difference in parole violation rates for the two institutional programs for GEES in Michigan were used as a direct background. The subjects were all USPS paroled in Michigan from July 1953 through June 1961. The individuating characteristics which distinguish or liken them.t3 the general population, were sketched. Based on institutional residence, a method was devised for estab- lishing two experimental groups. The environments in which they were involuztarily placed were described. It was inferred. although impossi- ble to prove, that "qua" environnents it would be difficult to assess which institution supplied the greater amount of negative incentive. It was hypothesized that the hospital group exposed to the process of a group therapy program would attain Creator success on parole tion would be as ociated with imprisonment. The outcomes of analysis of violations in the groups disclosed a much lower rate of parole violation for the ISH GSPs (2l3 vs. haé) thereby supporting the central hypothesis. As a further check on the stability of these findings a corollary hypothesis consisting of three parts was made. In the SPSM.group, par— ole violations vere predicted to be inversely related to group therapy e.perience. This hypothesis was supported in two subseduent com.arisons. In the hospital group the mean length of time in group therapy for par- ole violators vs. non-parole violators was not found to differ signifi- 38 KL) \ .0 costly. 0 J It would appear that the éroup therapy propram.contributed import- antly to parole successes. Limitations of the research design preclud- ed, however, a precise evaluation of the possible inte‘action between the hospital environment and the absence of the group therapy variable. Gene~al y. the results support the opinion underlying P.A. Act 165 (hichigan 1939) that deviated sexual behavior is sometimes a symptomatic expression of personality disturbance which is amenable to psychological treatzent. Additionally. due to significantly longer imprisonment for SEBLlpe1ole violators, Cook's conclusion regarding the extent of the therapeutic effects of imprisonment was discounted as a significant fac- \ tor influencing his findings. an Pmarcss Cabeen, C.N. and Coleman, J.C. Group therapy with sexual offenders: Description and evaluation of a group therapy program in an insti- tutional setting. J. Clin. Psychol.. 1961, 2, 122-l29. Case Records. July, 1953 — June, 1961, Ionia State Hospital. Coleman, J.C. Abnoxnal.Psychology and medern Life. (2nd Ed.) New York: 1956. Cook, C.}I. Problems of the Criminal Sexual Psychopath, Dis. of the Item. System. 19M), 5, 1-7. , 3., Lbltzen, h., and Tartaglino, F3 An institutional program for cozizitted sexual deviants. Asher. J. Psychiat., 1950, 107, l/iO-‘lgho Guilford, J.P. Fundamentals in Psychology and Education. New York: KcGraw-Hill, 1950. ‘ hivisto, P. Treatmen of‘Sexnal Offenders in Califbrnia” Lbnt. Hyg., 1C7? n9 ~O_8e l—I— ’ Lt”, (U U. Liebernan, D. and Siegal, B. .A program for Sexual Psychopaths in a state mental hospital. .Amer. J. Psychiat., 1957. 113, 801-807. Report of tne Governor's conmission on the Deviated Criminal Sex Offend- er , Iviichiéan , 1951 . Trcnbath, W.E. hfichigan Sexual Psychopaths, 1352, Unpublished study, 1952, Ionia State Hospital. Yalom, 1.3. Group therapy of incarcerated sexual deviants. J. Ierv. 1.5.ent. Dis. 1961, 13.2, 158-170. 40