Reasoning and Rehabilitation 2
Number of sessions: 16
Frequency of sessions: Weekly
Facilitators: Clinical Psychologist & Deputy Ward Manager
Number of attendees: 7
Number completed: 7
Attendance: 95%
Background
Reasoning and Rehabilitation 2 (R&R 2; Ross & Young, 2007) is a 16-week group programme designed to meet the needs of individuals with a history of violent or anti-social behaviour who also have a severe mental illness. It is based on the empirically validated and widely utilised Reasoning and Rehabilitation programme (R&R; Ross, Fabiano & Ross, 1986) which focused predominantly on reducing anti-social behaviour.
In order to evaluate the effectiveness of R&R 2, we are participating in a multi-centre trial in collaboration with the Institute of Psychiatry, Kings College, London. Through the use of pre-and post- group psychological assessment, we hope to demonstrate that R&R 2 is as effective as its predecessor in achieving a reduction in re-offending as well as an increase in cognitive, attitudinal, emotional and behavioural skills.
Outcomes
Outcome measures used:
- Patient Motivation Inventory (PMI)
- Maudsley Violence Questionnaire (MVQ)
- Social Problem Solving Inventory (SPSI)
- Reaction to Provocation: Personal Affect Questionnaire
- Locus of Control Inventory (Norwicki-Strickland)
Outcomes:
- A preliminary review of the results indicates that the higher functioning patients made the most progress, had increased insight into their mental illness, and were most stable in their mental state at the time of the group.
- No differences were found in participant’s motivation to change, although there was some reduction in participant’s feelings of failure in relation to treatment (2/7 participants).
- There was a reduction in anti-social thinking as assessed specifically by the 'Machismo' factor (6/7 participants) of the MVQ and some further reductions in participants acceptance of violence as a way of life (4/7 participants).
- The majority of participants demonstrated a reduction in Negative Problem Solving Orientation (5/7 participants) on the SPI and there was also some increase in participant’s ability to solve problems using a Rational Problem Solving Orientation (3/7 participants).
- There was little change as assessed by the Reaction to Provocation: Personal Affect Questionnaire, although some participants saw an improvement in their cognitive mediation of anger (3/7 participants).
- The Locus of Control Inventory indicated that over half the participants had a greater sense of control over events in their lives following the group (4/7 participants).
Discussion
From a preliminary review of data, it would also seem that the R & R II group is an important tool in attitudinal change. Although participants did not evidence reduced scores in some of the factors assessed e.g., internal motivation to engage in treatment, some areas of social problem solving and their reactions to provocation, importantly, their attitudes toward violence seemed to be more pro-social and their acceptance of violence seemed to decrease. This is a similar finding to previous research, e.g., Young, Chick & Gudjonsson, (2009). Furthermore, some participants demonstrated a reduction in negative problem solving, an increase in rational problem solving, improvement in how they make sense of a provocative situation, and an increased sense of having control over their lives. Again, it is important to note that this data is taken from only seven participants in total and is not statistically analysed for significance levels.
Clinically, there appeared to be important ‘group therapeutic factors’ which were of benefit to group members such as increased cohesion, alleviating hospital related anxiety, and a sense of universality (as discussed by Yalom, 1995). These factors have not been assessed at this point but seemed clinically relevant in relation to ward atmosphere and ward relations.
Future recommendations
Considering that participants who were most likely to make changes within the R&R II group were those who had higher functioning, greater insight into their mental health difficulties, and who were more stable at the time of the group, it may be helpful if Meridian ward’s therapy programme focuses more heavily on improving insight into mental illness through group and individual work prior to engagement in the R&R II group. Such findings may also help the clinical team ensure that those who are more likely to benefit most from R&R II are prioritised in the referral process.
As recommended in previous literature, e.g., Young et al., (2009) it might also be useful to include pre- R&R II groups for potential participants. It would appear that some of the concepts provided in the R & R II group seem to require participants to be able to generalise abstract concepts to everyday practical concerns they have. Pre-R & R II groups might help participants practice this skill and educate them in how R & R II ‘works’, essentially. It may also improve participant motivation, and allow the facilitators time to assess suitability for the group. The possibility of higher and lower functioning groups may be another possibility.
References
Yalom, I. D. (1995). Theory and Practice of Group Psychotherapy – Fourth Edition, New York: Basic Books.
Young, S.J., Chick, K. & Gudjonsson, G. (2010). A preliminary evaluation of reasoning and rehabilitation 2 in mentally disordered offenders (R&R2M) across two secure forensic settings in the United Kingdom. Journal of Forensic Psychiatry and Psychology. Online at http://www.informaworld.com
Young, S. J., & Ross, R. R. (2007). R&R2 for youths and adults with mental health problems: A pro-social competence training program. Ottawa, ON: Cognitive Centre of Canada.
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