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Abstract: Therapeutic Communication: Motivation, Feedback, and beyond

Decades of psychotherapy research have found that participation and accomplishment in treatment can be improved through careful attention to the therapeutic alliance and the client’s internal reasons to make changes to his or her life. It is the client’s experience of the alliance, however, that is most predictive of outcome. Unfortunately, most clinicians (including sexual offender treatment providers) believe themselves to be more helpful than their clients do (Beech & Fordham, 1997), and commonly do not recognize when their clients’ progress is in jeopardy (Lambert, 2010). In fact, clinicians rarely solicit feedback from clients in any ongoing or structured way.

This address discusses recent research and advances in therapeutic communication with people who have sexually abused. It addresses the characteristics of effective providers and discusses what is known and not known about enhancing motivation for change (e.g., through the use of approach goals and other methods for building a better life). It also discusses strategies for reducing therapist variability and the prevention of treatment failure.


David S. Prescott has worked in and around inpatient settings since 1984, and specifically with individuals who have sexually abused since 1987. He has a strong interest in sharing resources, networking, and training to increase knowledge in these fields. Specifically, his clinical and training interests focus on motivational enhancement, developing and maintaining therapeutic relationships, and assessing treatment progress.

He currently serves as Clinical Director for the Becket Programs of Maine, which provide treatment for troubled youth in Maine and New Hampshire. Prior to his move to New England, he served as the Clinical Director at the Minnesota Sex Offender Program in Moose Lake, Minnesota and Treatment Assessment Director at the Sand Ridge Secure Treatment Center in Mauston, Wisconsin. In this position, he oversaw the progress of patients and groups of patients and coordinates an early stage of the conventional treatment track. From 1992-2004, Mr. Prescott worked as a Clinical Supervisor at Bennington School, Inc., and has been a consultant to that program ever since.