Section 2: Lecture Content and Teaching Notes
Innovative Approaches to Supervision of Sex Offenders in the Community
2 hours, 45 minutes
TOPIC: A COLLABORATIVE APPROACH TO SEX OFFENDER MANAGEMENT
(1 hour, 30 minutes, including Learning Activity)
The most common denominator among the approaches to sex offender management developed over the past several decades is collaboration across the boundaries of agency and professional disciplines. We have already discussed the inclusion of victims and victim advocates in the supervision of sex offenders. Later, we will be examining the close links between probation/parole and treatment providers who, along with polygraph examiners, form the core of what many in the field of sex offender management refer to as the Containment Approach.
Note: This section can be followed with the Learning Activity: Community Mapping, which gives a policy/organizational orientation to a collaborative approach to sex offender management.
Refer to handout: Section 2, Exercise 2|
This exercise builds on the collaboration learning activity in Section 1. The primary goal of this exercise is to assist all of the participants to think more broadly about sex offender managementwho is involved, what they do, where overlaps in activity and responsibility exist, etc. The similar exercise for policy teams would challenge team members to fill in gapshere the purpose is just to explore the concepts. In small communities, jurisdictions, and agencies, the landscape may be much simpler than in larger, urban areas. Trainers may want to adapt the exercise accordingly. The time allotted here assumes individual work. Group work may require additional time.
Many different players are already involved in the management of sex offenders. (Refer to list from Collaboration Learning Activity from previous section). Please refer to your participant materials for Exercise 2. This exercise takes you through the process of "mapping" the agencies and functions involved in sex offender management in your jurisdiction. Don't be concerned if there are gaps and holes in your chart.
|WHY IS COLLABORATION IMPORTANT|
FOR MANAGING SEX OFFENDERS?
Collaboration has emerged as a key characteristic of effective sex offender supervision in jurisdictions around the country for several reasons:
Collaboration also promotes interagency information exchange that enables individuals to better understand the roles and responsibilities of their colleagues in other agencies, the array of services that they provide, the ways in which one's own work influences that of others, and the methods that others are employing to address shared problems. As individuals in different agencies begin to discuss their solutions to common problems, the problem-solving abilityand the efficiency of the system as a wholeis enhanced.
- Sexual abuse falls within the purview of many criminal justice, social service, community, and public policy arenas. The police who investigate sexual abuse, the prosecutors who work with both offenders and victims to charge and prove an offense, the courts that sentence offenders, and corrections agencies that supervise offenders are only the most obvious stakeholders involved. We can add to the list: treatment providers working to intervene in offender behavior patterns, children's services agencies that are charged with protecting the victims of child sexual abuse, schools where the trauma associated with abuse is manifested in students, hospitals where victims receive treatment for the trauma associated with abuse, religious institutions where victims and their families turn for support, and state legislators who create registration, notification, sentencing, and civil commitment statutes. We could continue to add to this list for some time before it would be complete. As you can imagine, the list will vary from community to community and from jurisdiction to jurisdiction. Sexual abuse is clearly a problem that is widespread and that cuts across all segments of society. It is an issue in which all of us have a stake, and common sense tells us that we must work together if we are to address it successfully.
- One lesson learned about sex offenders is that information and disclosure are key to breaking their sexual offending patterns and cycles. Sex offenders use manipulation, lies, denial, and deceit to keep the nature of their abusive activities secret. Sex offenders must confront their secrets before they can address the behavior that jeopardizes the safety of past and potential victims. Our criminal justice system, however, often operates in such a fragmented and compartmentalized way that it enables sex offenders to maintain their secrecy and denial. How often have you been confronted by a sex offender who insists that he did not commit the crime for which he was convicted and who protests to you that he only pled guilty because of his desire to spare the victim a painful trial or because he ran out of money to pay for his legal representation? When police, prosecutors, judges, community supervision agencies, treatment professionals, victim advocates, and others work collaboratively together, it is much more difficult for offenders to maintain and continue their patterns of deception and denial.
- Without an understanding of and commitment to collaboration, and some mechanism that fosters consistent information sharing (e.g., an interagency agreement to work together on sex offender supervision issues), it is very easy for agencies to focus only on their own organizational goals and responsibilities. True collaboration can be described as a situation in which agencies and individuals who share a common problem or set of interests set aside their agendas regarding the identified concern and come together to forge a collective agenda that addresses each party's needs. When agencies work collaboratively, therefore, it becomes much more possible to focus on a common goalthe prevention of future victimizationand work toward it.
In addition, collaboration fosters support for each agency and enhances the team approach that is so critical in effective sex offender management. The understanding and support that collaboration promotes increases the credibility of individual team members and each agency within the community.
When you work with a population that engenders such strong emotional reactions as sex offenders do, it's not unusual to encounter a great deal of resistance and anger from members of the community regarding the presence of these offenders in their neighborhoods. Interagency collaboration fosters a shared recognition and understanding of the requirements, responsibilities, and limitations of each agency and a collective commitment to address troublesome or difficult community-related issues. Agencies that collaborate are, therefore, able to work effectively together and present a united and supportive array of resources to communities that are grappling with these difficult issues.
Collaboration is a difficult and time-consuming endeavor. There are many challenges to successful collaboration, and it does not always work. Still, the benefits far outweigh the challenges.
|COLLABORATIVE TEAM ACTIVITIES|
Exchange of Information
A vital component of effective collaboration is the exchange of information. Once supervision has begun, all of the stakeholders who share responsibility for sex offender supervision should meet together on a regular basis to discuss individual cases, set treatment and supervision goals, modify supervision plans, and discuss any new information they have acquired since the last staffing. In many jurisdictions, these formalized groups are referred to as sex offender management or supervision teams. Emergency staffings should occur when necessary to address crises or other problematic situations.
Note: The trainer should seek input from participants about their experiences in all of the collaboration team activities listed.
Note: Depending on the experience level of the audience, these activities can be reviewed very quickly, almost as a list, or they can be handled in depth as they're written.
One implication for probation or parole officers is that they find themselves in a "team" approach to management along with offender treatment providers. In many agencies, this team also includes a polygraph examiner, a victim advocate, a social services worker, and others. Probation/parole officers should view themselves as the leader and the "glue" that holds the case management team together, because they are the ones legally responsible for the case. Being the leader does not mean that probation/parole officers can override all decisions. It does mean, however, that they should not just "turn over" the case for treatment, for a polygraph exam, etc., nor should they be making treatment decisions, developing polygraph questions, or taking responsibility for all victim contact.
The team may also meet with or conduct staffings with a sex offender's family members in order to assess whether the offender is ready for a new step in supervision or treatment. The presence of more than one member of the team allows for different perspectives to be brought to bear on discussions with family members.
Collaborative teamwork functions very well when one representative from each participating agency works exclusively with sex offenders. However, what if there are 15 probation/parole officers, 17 treatment providers, etc.? One solution is to exchange information regularly by phone, fax, or e-mail. Another is to organize an arrangement that fosters frequent and consistent in-person interactions with members of the team. Some jurisdictions have found it to be very helpful for treatment providers to visit the probation/parole office every week or every month on specific days and at designated times. This is one reason why specialization makes sense for the key stakeholders involved in sex offender supervision.
New disclosures of any significant information and any concerns should be shared as quickly as possible with other members of the team. Such information might include marked changes in the offender's affect, crises in personal relationships, movement in his offense cycle, changes in living or work arrangements, regression with respect to denial, or a new arrest. In particular, treatment providers must inform probation/parole officers and other team members of any failure to attend treatment or any significant occurrences during treatmentsuch as notable progress or an unwillingness to participate fullyso supervising officers can respond appropriately.
? Discussion Question: What methods have you found to be most helpful and effective in your efforts to communicate consistently with other individuals and agencies?
All important decisions regarding supervision or treatment (e.g., modifying community supervision conditions, permitting changes in residence or place of employment, deciding to advance or demote from one phase of treatment to another, preparing for a polygraph examination, or considering family reunification) should be discussed fully among team members. The team should strive for consensus in its decisions, recognizing that each member is ultimately responsible for certain kinds of decisions (e.g., the supervising officer maintains responsibility for deciding how to respond to violations).
? Discussion Question: What challenges have you encountered in your efforts to share decisionmaking with other stakeholders? How have you addressed these challenges?
Refer to handout: For information on distinguishing collaboration from such related activities as networking and coordination, see the CSOM policy brief on collaboration.
If possible, treatment providers should help probation/parole officers monitor sex offenders by asking specific questions related to supervision during treatment sessions. Relevant information garnered during treatment sessions should be shared with probation/parole officers. Similarly, probation/parole officers should engage sex offenders in discussions regarding their progress and work in treatment and report any new or troubling information to treatment providers. Some supervision agents and treatment providers have found that weekly checklists covering issues related to supervision and compliance that are reviewed by the treatment provider and the offender in therapy sessions are particularly helpful monitoring tools. In some communities, victim advocates participate in field visits and offer insights based on their expertise in observing victim and offender behavior.
? Discussion Question: Who else do you collaborate with in an effort to monitor the sex offenders on your caseload more closely?
Members of the case management team educate each other formally and informally on their various disciplines, perspectives, and limitations so that each team member better understands the resources the team has at its disposal to supervise sex offenders safely and effectively.
? Discussion Question: What have you learnedboth formally and informallyabout the work and the perspectives of other stakeholders who share responsibility for sex offender supervision? Have you used this information to enhance your own work? If so, how?
The management team often works together to identify or develop resources where they are most needed. One example of this is advocating new treatment resources or the implementation of the polygraph to enhance community supervision and treatment. Some teams have worked with district attorneys to identify and train a specialized prosecutor who works exclusively with sex crimes.
? Discussion Question: Have you ever worked with your colleagues to gain access to additional resources? What were your results?
System problem solving
If there are any gaps in the myriad services provided by child welfare, social service, or treatment systems, the team should work together to identify and implement viable solutions in a mutually agreeable, collaborative fashion.
|MAINTAINING A COLLABORATIVE APPROACH|
Problems will inevitably arise in maintaining a collaborative approach to case management. This makes the development of close, professional working relationships particularly important in order to be able to create enough investment in the collaboration to ensure that the members of the team will do what it takes to solve those problems appropriately. Offenders can quickly sense any rift developing among members of the team and will move to exploit it. Offenders will also work to initiate a rift because rifts work to their advantage.
? Discussion Question: If you are engaged in a collaborative approach to sex offender supervision in your jurisdiction, how have you maintained it? Do you have guidance that you think might be helpful to other training participants as they begin to strategize about how to sustain a collaborative approach?
Ways to prevent problems from arising include the following:
- Refrain from criticizing members of the team or other professionals in the presence of the offender;
- Unless a situation involves extreme danger where immediate action is required, do not make a significant decision regarding supervision or treatment without first consulting other team members. In addition, team members should be very clear with each other about the information communicated to offenders;
- Be willing to admit that you have made a mistake and be willing to take responsibility for it; and
- Be aware that collaboration must occur at the agency and policy levels as well as the case management level. This will foster the development of interagency agreements and policies that support and institutionalize ongoing collaboration at the case management level.
|AN ESSENTIAL ARENA FOR COLLABORATION: THE RELATIONSHIP BETWEEN SUPERVISION, TREATMENT, AND VICTIM ADVOCACY |
An essential characteristic of emerging sex offender management practices is that sex offenders who are being supervised in the community must participate in offense-specific treatment. Perhaps the first area in which collaborative endeavors have emerged is in the relationship between probation or parole supervision and treatment. This is a good example of how collaboration has served to reshape practice toward the achievement of a common goal.
In the past, criminal justice agencies have tended to maintain a distance from treatment providers working with offenders. This distance grew, at least partially, from the traditional view of therapists as offender advocates who expected traditional client-therapist confidentiality to be respected. These views have changed among many treatment providers and criminal justice agencies.
|Use Slide #11: Collaboration Between Supervision and Treatment|
[Click to Enlarge]
As the unique characteristics of sex offender-specific treatment have emerged, it has become clear that effective sex offender therapy is different from traditional psychotherapy. It values the free flow of information between therapist and probation/parole officerthereby limiting client-therapist confidentialityand holds offenders accountable for their actions. In addition, treatment providers often play a very active role on the multidisciplinary management team, sharing information openly with their colleagues regarding offender risk and progress in treatment. Although some sex offender treatment providers stop short of stating that the victim is the client (rather than the offender whom they are treating), most will agree that preventing future victimization is a primary goal of their work. This focus has led to the incorporation of a third essential player: the victim advocate.
|ROLES OF THE SUPERVISION TEAM MEMBERS |
The Probation/Parole Officer
The probation/parole officer is the leader of the supervision team. As the representative of the criminal justice system, he or she is the primary enforcer of conditions imposed by the court and is empowered to use the coercive power of the criminal justice system to control the offender's external environment. Probation/parole officers do this through a range of different kinds of monitoring and case work, the use of restrictive intermediate sanctions, and the threat of incarceration. They ensure that relevant and important information is available to treatment providers, victim advocates, and polygraph examiners (in jurisdictions where it is used) through waivers of confidentiality and meticulous fieldwork. For example, information regarding an offender's use of pornography, dishonesty (e.g., with significant others), inappropriate fantasies, and other problematic behavior is immediately made known to the treatment provider. Probation/parole officers are responsible for making recommendations to the court based on the information provided by treatment providers and polygraph examiners (if available). They also work to ensure the safety of past and potential victims by restricting offenders' activities, responding to inappropriate behavior with appropriate controls and sanctions, and rewarding progress when appropriate.
The probation/parole officer is often the person who manages and convenes the multidisciplinary supervision team and encourages stakeholders who are not a part of the team to begin participating in its collaborative work. Probation/parole officers often play a very active role in keeping the team together and functioning in a collaborative and mutually beneficial way.
In some jurisdictions, probation/parole officers interact directly with victims, keeping them informed of the case progress, eliciting input, and assisting in the development of a victim safety plan. In other jurisdictions, direct contact with the victim may be handled through another agency, such as a freestanding victim advocacy organization or a staff person located within a prosecutor's or probation/parole office. However, the supervision officer is always responsible for using victim impact information from available sources to accommodate victim concerns in the supervision plan.
The Treatment Provider
Note: Sex offender treatment and its differences from traditional mental health treatment will be covered more depth in Section 3.
Treatment providers work to create internal controls within the mindset of the offender. These internal controls work in tandem with the external controls implemented and managed by probation/parole officers to ensure victim and community safety. Treatment providers provide information about treatment progress that may affect the supervision plan created by probation/parole officers. They may modify the treatment plan based on information from supervision agents or polygraph exams and provide valuable insights for supervision agents regarding offender risk and dangerousness.
Treatment providers may also help other members of the supervision team understand the offense so the overall supervision can better protect victims and potential victims. Treatment providers help sex offenders develop coping skills regarding the constraints of supervision and learn how to handle stress and anger appropriately. They teach offenders self-management approaches, such as relapse prevention, that help them understand and recognize the triggers that are precursors to offending behavior. They also help offenders develop victim empathy (which may lessen the likelihood of a re-offense), work with offenders to manage and reduce deviant arousal patterns, and reward progress toward treatment goals. Treatment providers may also help educate family members and other associates of the offender about sex offender behavior.
The Victim Advocate
The primary role of victim advocates is to ensure that sex offender management policies and practices are designed and implemented in ways that promote victim safety and recovery. Advocates are also responsible for ensuring that decisions made by the supervision team consider the potential impact on victims and that victims understand the sex offender management process and their potential role in it. In jurisdictions where victim advocates are part of the supervision team, the advocate serves as the primary contact with the victim. He or she initiates contact and makes sure that information about the offender, his status, his location, and other information relevant to victim safety and well-being are communicated to the victim. The victim advocate provides support services and advocacy for primary and secondary victims, including members of the victim's or offender's families. The advocate also serves as the liaison between victims and the rest of the supervision team. He or she is responsible for ensuring that information from the victim about the offender is communicated to the team if the victim elects to have it used for this purpose. This can include information about the offender's compliance with his supervision conditions or other relevant information.
In jurisdictions where victim advocates participate on a policy level and/or as part of community outreach and education initiatives, their roles are similar in that they are responsible for promoting victim safety and recovery and minimizing revictimization. A victim advocate may be part of the community notification team and may be the one to inform a victim in advance that community notification activities about the offender are going to occur. Victim advocates also participate on policy development teams and work with treatment providers to develop components for empathy enhancement treatment and family education. Victim advocates also provide training and information to criminal justice system agencies and treatment providers on how to work more effectively with and for victims and create effective victim-centered policies.
|THE CONTAINMENT APPROACH: SUPERVISION, TREATMENT, AND THE POLYGRAPH|
Up to this point, we've talked about collaboration and specifically addressed the roles of three key players: the supervising officer, the treatment provider, and the victim advocate. In this next part, we're going to talk in a little more detail about a framework for this collaboration work that includes an additional player: the polygraph examiner.
Note: The Containment Approach as defined by English, Pullen, and Jones is one model for a comprehensive approach to the management of sex offenders. We also use "containment" more generally to refer to the concept of surrounding an offender with a variety of control mechanisms in order to "contain" his risk to the community.
Note: Trainers should be prepared for comments questioning the validity of the polygraph. They may want to remind participants that in this context, the polygraph is not being used to determine guilt or innocence or as the sole basis for a revocation. Rather, it is being used to assist in the development and monitoring of a supervision and treatment plan, and those who are using it find it extremely helpful.
In January 1996, the results of a key piece of research were published regarding the management of sex offenders in the community. The report summarized the responses to a survey of 732 probation/parole supervisors nationwide regarding their sex offender supervision practices. In addition to finding that emerging sex offender suppervision practices included a victim-centered, collaborative team approach with consistent policies and quality control mechanisms, the research found that communities were beginning to use a Containment Approach.
Containment involves the criminal justice system (probation/parole), treatment, and a polygraph examiner. (Although this particular model of sex offender management does not include victim advocates, it is consistent with a victim-centered approach.) This three-sided Containment Approach casts three individuals as a team to exchange information and share decisionmaking responsibilities.1
The Role of the Polygraph Examiner
Many individuals are familiar with the polygraph or "lie detector" as a law enforcement toolto assist in an investigation. For our purposes, it is used at the postconviction stage in supervision and treatment. The use of the polygraph in this manner is increasing, but many practitioners and jurisdictions are still unfamiliar with it.
The polygraph is by no means a silver bullet or panacea. It will not solve all of the challenges associated with sex offender treatment and supervision, and its existence does not guarantee a reduction in sexual recidivism, fewer victims, or safer streets. When used responsibly and thoughtfully, and in the context of a larger, collaborative sex offender management approach, however, it can be a very valuable component of a jurisdiction's strategy to prevent future victimization.
The effectiveness of the polygraph depends primarily on the training, knowledge, expertise, and skills the examiner possesses and on his or her willingness to work collaboratively with supervision agents and treatment providers (as well as their willingness to work with the polygraph examiner). Collaboration and information sharing among all parties are absolutely essential.
Polygraph examiners work in very close concert with treatment providers and supervision agents to help them accomplish several very important tasks, including
- Breaking down offender denial regarding the instant offense (the offense for which the offender is being supervised in the community). It is very difficult for treatment providers to work with sex offenders who continue over time to deny all or a part of their instant offense.
David D'Amora, Center Director of the Center for the Treatment of Problem Sexual Behavior in Middletown, Connecticut, reports that before integrating the polygraph into his program's work with sex offenders, they were breaking down denial in approximately 75 percent of their cases within 6 to 9 months (in many programs, offenders still in denial after 6 to 9 months are terminated from treatment). The use of the polygraph has enabled the program to break down denial in almost 90 percent of cases in 6 months. Both research and anecdotal evidence suggest that this enhances community safety. Karl Hanson's research indicates that failure to complete treatment is a factor that increases sexual recidivism risk.
Refer to handout: D'Amora's program and New Haven, Connecticut's comprehensive approach to sex offender management are discussed in the CSOM case studies.
Note: Responses to additional crime or victim disclosures vary by jurisdiction. Trainers may want to check with the local prosecutor's office to determine how this issue plays itself out in his/her jurisdiction, especially if it is a jurisdiction in which the polygraph is used.
- Assisting in the development of a sex offender's complete sexual history. Many treatment providers and supervision agents find that information in the sexual histories of the offenders with whom they are working can help them develop treatment and supervision plans that directly address the offenders' specific needs, risk factors, and offense precursors. Working in very close concert with the treatment provider and the supervision agent, the polygraph examiner can develop a strategy (that may include specific issues to broach and/or questions to ask during the polygraph examination) that will help determine whether or not a sex offender is withholding information from his sexual history (as well as the information being withheld).
- Identifying, confirming, and/or evaluating a specific problematic behavior or allegation during supervision. Sex offenders are secretive and very manipulative. If a treatment provider or supervision agent suspects that an offender is engaging in high-risk behavior, he or she can work in collaboration with the polygraph examiner to develop a strategy that will confirm or refute the suspicion and further clarify the nature, extent, scope, and severity of the behavior. In addition, polygraph examiners often examine sex offenders who seem to be complying with their conditions of supervision and their treatment plans. These tests, administered with significant input from treatment providers and supervision agents, can verify offenders' compliance with treatment and supervision requirements or bring to the surface problematic issues that need to be investigated further by the supervision agent and/or the treatment provider.
Three types of post-conviction sex offender polygraph examinations are used to accomplish the tasks that I have just outlined. They include
|Use Slide #19: Types of Post-Conviction Polygraph Examinations|
[Click to Enlarge]
There is no consensus in the field regarding the order in which these examinations should be given or their frequency (i.e., how much time there should be between exams).2
- A full disclosure or sexual history examination to ensure complete disclosure by the offender of his sexual history. This examination is typically administered after an offender has been in treatment for 3 to 6 months and has had an opportunity to record his comprehensive sexual history in the treatment setting.
- A specific issue examination to evaluate a specific behavior or allegation during supervision. It is also used when an offender either is in complete denial or maintains that he did not commit the crime of convictionin particular, offenders who are sentenced under an Alford Plea or offenders who continue to minimize their responsibility for the abuse despite their conviction. An Alford Plea allows an offender to admit that there is enough evidence to convict him at trial without admitting to the offense of record. This type of plea often subverts treatment because it is very difficult to treat a sex offender who has not admitted responsibility for his offense.
- A maintenance or monitoring examination to verify the offender's compliance with his treatment plan and supervision conditions. This type of exam is administered on a periodic basis, usually every 6 months. In most cases, offenders are not tested more than three times per year.
Because the use of the polygraph as a sex offender supervision and treatment tool is relatively new, training, guidelines, and standards to govern its use are still under development in many states. Individuals who are interested in learning more about the use of the post-conviction polygraph exam with sex offenders should visit the American Polygraph Association's (APA's) Web site at www.polygraph.org, contact APA directly at 1-800-APA-8037, or see CSOM's training curriculum dedicated to the polygraph.
The APA is an excellent source of training for polygraph examiners who are interested in working with convicted sex offenders. When a jurisdiction (or a supervision agent or a treatment provider) identifies a polygraph examiner with whom to work, they should always inquire about the training that the examiner has received and, more specifically, if the training has been endorsed by the APA.
Note: Trainers are encouraged to research guidelines for polygraph testing in the jurisdiction(s) where they are training. The APA is a good place to start such a search.|
Refer to handout:
Refer to CSOM Case Studies for examples of jurisdictions that use the polygraph, and those that do not.
In sum, the polygraph is not a "silver bullet" or a "panacea" and there are jurisdictions out there who are doing very effective work with sex offenders without it. However, many jurisdictions have found it to be an immensely helpful piece of their sex offender management strategy. While conducting their research for The Management of Sex Offenders in the Community: A Containment Approach, the researchers heard many probation/parole practitioners observe that, although they may have been reluctant to use the polygraph originally, now they would not want to do the work without it.3 The Center for Sex Offender Management's work in the field confirms that many practitioners find the polygraph to be extremely useful in reducing lengthy periods of offender denial and encouraging offender honesty.
|CAUTIONS ABOUT OVERLAPPING ROLES|
Collaboration involves the sharing of responsibilities among probation/parole officers, treatment providers, victim advocates, polygraph examiners, and other stakeholders involved in the community supervision of sex offenders. All stakeholders exchange information about sex offenders and engage in problem solving to enhance effective management and community safety. In addition, they facilitate each other's workone of the strengths of the collaborative approach. Because this approach involves collaboration and close communication among at least these three core professions (probation/parole, treatment, and polygraph), there is a tendency for team members to take on one another's rolesalso known as "role creep"and for a slight blurring or sharing of roles to occur.
Although it is appropriate and necessary for team members to possess the same information, understand each other's roles and responsibilities, share responsibility for monitoring offenders' compliance with supervision and treatment conditions, work collaboratively to assess continually the level of risk that offenders pose, and work together to counter offenders' deceit, deception, and manipulation, each party must react to the same information in very different ways. For example, it is not appropriate for a probation/parole officer to attempt a psychological intervention with a severely depressed offender or for a treatment provider to threaten incarceration during a therapy session.