What is the Healthy Sex Programme?

HSP is based on a biopsychosocial model of change and draws on a variety of intervention procedures from across a wide spectrum clinical practice in applied psychology. The programme is open to those with and without learning disability and challenges and is typically accessed following the completion of a primary accredited programme.

It provides 12 to 30 hours of one-to-one therapeutic time, split across five modules of clinical content, and is designed to increase safe sexual self-regulation, to strengthen social capacities for prosocial change and motivation to desist from crime through its eight aims set out below.

1. Understand healthy and unhealthy sex.
2. Identify and regulate triggers to arousal to healthy and unhealthy sex.
3. Increase arousal to healthy sex and reduce arousal to unhealthy sex.
4. Increase behavioural control over sexual thoughts and urges.
5. Strengthen skills for adult intimacy.
6. Strengthen a compassionate self with intention and skills to be helpful not harmful.
7. Clarify personal values and ensure values dignify learning skills for change.
8. Update Relapse Prevention plans.

About the study

The study, conducted by Nicholas Blagden, Luke Vinter, Jade Mason, Eve Penford & Polly Delliere-Moor from the University of Derby, was a relatively large-scale multi-prison qualitative evaluation of HSP. Data was collected from 34 in-depth face-to-face interviews with male and transgender female adults who had completed the programme.

Key findings

The qualitative analysis highlighted four main themes, which are set out below.

Programme with a difference

Participants noted several features of HSP that positively distinguished it from other accredited offending behaviour programmes, including helpful qualities of the therapist and their therapists’ efforts to tailor the programme to them as individuals. Participants also highlighted the importance of HSP being holistically focused, providing the opportunity for whole-life learning beyond healthy sex. 

Developing sexual self and sexual self-regulation

Through completing HSP, participants expressed a greater understanding of their sexual self. This led to participants feeling they had gained greater insight into which skills and techniques would be most appropriate for them to manage their thoughts, feelings and behaviours. A greater understanding of their sexual selves appeared to enable participants to identify and effectively manage their triggers, become more open and comfortable with their sexuality and reduce feelings of shame. Reflecting on past experiences and relationships played a valuable role in participants’ ability to develop an understanding of their sexual selves. Mindfulness skills and behaviour modification techniques were highlighted as useful self-regulation strategies.

Relational growth

Most participants articulated that HSP had helped them foster healthy relationships, not only with others but also with themselves. New understandings of healthy sex and healthy relationships were developed alongside building an awareness of harmful forms of sex and unhealthy relationships.

Participants expressed that they were now able to be more trusting and open with others, particularly their therapists and wider prison staff, something which they had struggled with prior to HSP. Additionally, HSP’s focus on cultivating compassion also appeared to allow for internal relational growth with many participants able to develop a greater understanding of, and skills for managing, high levels of internalised shame (self-criticism).

Not a silver bullet

Despite participants describing many positive experiences and outcomes associated with HSP, they recognised that the programme was not a “cure” and, (in line with wider evidence on the efficacy of the therapeutic techniques used on the programme), participants recognised the need for ongoing practice of skills, particularly as they move back into the community.

Participants also identified various barriers within the wider prison which can impact progress, for example, some participants reported long waiting lists, limited pre-programme information, shared accommodation (lacking privacy), medication and prison as an artificial testing ground for practicing self-regulation skills.

Recommendations

The study concludes by making four recommendations, described as “points for consideration”:

1. Therapeutic relationships and alliance: Therapists should continue to focus on building compassionate, non-judgmental, genuine, and sensitive relationships with participants to create a safe environment that allows for trust and openness whilst being flexible to participants’ unique needs.
2. Holistic and compassion-oriented approach: The HSP’s whole-person approach to supporting growth, compassion, building healthy adaptive sexual identities, and capacities for healthier sex are powerful qualities of the programme.
3. Addressing barriers: To address potential barriers, attention should be given to strengthening the quality of pre-programme information provided to participants, ensuring single cell occupancy during the programme, and increasing opportunities for skills practice whilst in prison.
4. Post-programme and post-release support: Programme graduates would benefit from continual professional support following HSP, for example through structured conversations as part of supervision, or refreshers which keep them engaged with their goals, and practicing the self-regulation skills they have learned. For many, this would alleviate apprehensions about life post-release.

Thanks to K. Mitch Hodge for kind permission to use the header image in this post which was previously published on Unsplash.