Cognitive Behavioral Therapy Behavioral Health Types Of Therapy
Moral Reconation Therapy
Moral reconation therapy (MRT) is a cognitive-behavioral treatment with a focus on moral reasoning. This blog will cover the following: what is moral reconation therapy; goals of treatment; stages of moral reasoning; techniques of MRT, research around it and benefits.
Created in the 1980s by Drs. Greg Little and Ken Robinson, moral reconation therapy was developed for the highly resistant criminal substance abuse population.
The name may have you wondering if the goal is to improve an individual’s morality. But the focus is on increasing moral reasoning, as posited by psychologist Lawrence Kohlberg. It has since been adopted by many correctional facilities across the United States in the hope that it can reduce inmate recidivism (i.e., re-arrest) and substance abuse.
While it has been widely accepted as an institutional treatment for the incarcerated, it is not without its controversy. Here is what you need to know about moral recognition therapy.
What is Moral Reconation Therapy?
The founders of moral reconation therapy (MRT) describe their treatment as the following: “MRT is a cognitive-behavioral treatment system that leads to enhanced moral reasoning, better decision making, and more appropriate behavior.” At its heart, moral reconation therapy is a cognitive-behavioral therapy (CBT). It aims to change faulty thought processes that have led to poor decision-making and substance abuse. Its focus on moral reasoning sets it apart from other CBT-related therapies.
Moral reconation therapy is a manualized treatment that occurs primarily in group settings. Clients have a workbook that is used to guide the therapy.
The only individual component is the work that participants are asked to complete between group sessions. Administration of MRT does not appear to have yet been attempted outside of an institutional setting.
MRT is a 12-step program (four additional steps are optional) but is not to be confused with AA and associated addiction treatments.
Its premise is that participants will move through the stages of moral reasoning as they work on improving their thinking and decision-making. It should be noted that it is assumed that clients begin at a lower level of moral reasoning and require treatment to reach higher levels. Individuals can complete the treatment in three to six months, depending on their diligence and level of commitment.
Goals of Treatment
Progressing through the stages of treatment is aimed at personal growth in the following areas:
- Form a Positive Identify
- Confront Negative Behaviors, Attitudes, and Beliefs
- Assessment of Current Relationships
- Reduction in Self-Indulgence and Improved Frustration Tolerance
- Develop Improved Moral Reasoning
- Reinforce Positive Habits/Behaviors
- Improvement of Self-Concept
The Stages of Moral Reasoning
Here is a description of the hypothesized morality stages (labeled the Freedom Ladder) and the accompanying steps:
- Disloyalty is the first stage. It posits that people at this stage exhibit negative behaviors that may include lying, cheating, and stealing. Relationships are exploitative. Moral judgments are based on whether or not behavior causes pleasure or pain. Two steps are included in this stage: honesty and trust.
- Opposition is the second stage. It shares some characteristics of disloyalty but people in this stage are more honest about their behavior. Individual thinking is quite rigid and they blame others for their behavior. This stage includes step three: acceptance
- In the third stage, Uncertainty, participants begin to question their behavior but they are not yet committed to change. They may continue negative behavior and their judgments are primarily based on pleasing others. This stage includes step four: awareness.
- Injury is the fourth stage. It includes steps five and six, “healing damaged relationships” and “helping others”. Individuals in this stage begin to acknowledge the pain they have caused others and take responsibility for their actions. Despite some signs of growth, people in this stage continue to have problems meeting their obligations.
- The fifth stage is Non-Existence. People in this stage do not have a firm sense of their identity or purpose, but they can begin to have satisfying relationships. Participants in the non-existence stage begin to understand right from wrong. Step seven: long-term goals and identity, and step eight: short-term goals and consistency are part of this stage.
- Danger is the sixth stage. The major development in this stage is the commitment to long-term goals. The establishment of goals leads people to commit to relationships and lends itself to identity formation. Step nine: commitment to change and ten: maintain positive change are subsumed in the danger stage.
- The next stage is termed Emergency. Individuals in this stage display urgency in fulfilling their personal goals and responsibilities to others. Their decision-making displays a higher level of reasoning, based upon what is best for society and organizations rather than individual needs. Step 11 is part of the Emergency stage and labeled “keeping moral commitments".
- In the Normal stage, a person’s identity becomes fully formed. They make decisions based upon the welfare of others as much as their own. Relationships are based on honesty and trust. Individuals in this stage often become involved in social causes. Step 12 is part of the normal phase and is entitled “choosing moral goals”.
- Grace is the final and most evolved stage. In truth, most people never reach this stage of moral development. Individuals who ascend to this level see the needs of others as an extension of themselves. They dedicate their lives to other causes without the expectation that they will benefit. Think Mother Theresa and Gandhi. Because of this, steps 13-16 are optional and are entitled “Evaluate relationship between inner self and personality”.
Start 30-day Free Trial and explore TheraPlatform. HIPAA Compliant Video and Practice Management Software for Therapists.
Techniques of Moral Reconation Therapy
The following are techniques that therapists use in MRT to facilitate change:
- Moral dilemmas. Clients are given moral dilemmas and then discuss them in the group setting. Clients are exposed to differing levels of moral reasoning from other group members and may experience challenges to their thought processes, especially from members that have been in the group longer than them. The hope is to increase a member’s level of moral reasoning.
- Individual written exercises are used to evaluate peer and familial relationships within the group. These exercises may require the development of a specific plan to end relationships with certain people if it is determined by the group that they are interfering with personal progress.
- Public Service. All group members are asked to do engage in activities that help others. Some may be allowed to do this work outside their institution while others are required to commit to service within their residential communities.
- Enhancement of self-concept. Early in the treatment, group members are exposed to a lot of criticism. In later sessions, they will undergo activities and receive praise for their improved behavior that serves to improve their self-concept.
- Goal evaluation. Members initially describe previous life goals and receive feedback from other group members. As a result, participants craft more realistic personal goals that serve to help themselves and others around them.
- Diligence toward treatment can be rewarded or punished by behavioral factors within the program in which the clients reside, whether that be a prison or another residential facility. For example, a participant could receive rewards at a prison if they meet time-based requirements for completing treatment steps.
Who Can Benefit from MRT?
The focus of moral reconation therapy remains on substance abusers that have engaged in criminal activity. The authors state it is also appropriate for treating trauma, anger management, and smoking cessation. Similar to motivational interviewing, it lends itself to populations that have exhibited resistance to traditional therapy.
MRT is most commonly used in the US prison system but its use has expanded to other facilities, including residential settings associated with the Veterans Administration (VA) and group homes for juveniles. It has also been used for people on probation, parole, and those associated with drug court. All of these programs have in common that participation is mandatory and enforced by the legal system. What is unknown is whether people would participate in MRT on a voluntary basis.
Does MRT Work?
There are some legitimate concerns regarding the research on moral reconation therapy. First, much of the research conducted on MRT has been done by its founders and is not peer-reviewed. While that does not entirely rule out its validity, it does present a bias concern. Second, most of the studies conducted on MRT do not involve a strong research design (I.e., randomized control trials). Those concerns aside, the outcomes of the studies themselves are mixed.
- In one meta-analysis conducted by researchers independent of the founders of MRT, the mean effect size was 0.16. Although this result was barely statistically significant, it should be noted that any effect size under 0.2 is considered negligible at best. This same study did not find a significant result with juveniles.
- In a meta-analysis on probationers and parolees, MRT did statistically reduces recidivism but the effect size was small (0.22).
- In a randomized controlled trial on incarcerated offenders aged 15-22, the effects of MRT were found insignificant when compared to the control group.
- Another study involving juveniles found that participants who underwent MRT possessed less antisocial characteristics, reported fewer problems, and had significantly higher levels of moral reasoning. In addition, the six-month recidivism rate was 13.3 percent for program participants, which was 39 percent to 60 percent lower than the recidivism rate for comparable youth.
At one time moral reconation therapy was named an evidenced-based treatment for adults by the Substance Abuse and Mental Health Services Administration (SAMHSA). For juveniles, though, it was only granted “promising practice” status. If you currently search for moral reconation therapy in the SAMHSA database, however, it no longer appears as an evidence-based therapy.
MRT Resources
Unlike CBT and other most other therapies, moral reconation therapy is a self-enclosed system. The only place to find the necessary resources to perform MRT is on the Correctional Counseling Inc. website. Additionally, you must be certified in MRT or be an institution that uses MRT to receive the workbooks and materials to administer it. You can sign up on that same website to receive official training and certification. Additional information, including links to research, news articles, and videos can be found on the MRT website.
Is Moral Reconation Therapy a Reputable Treatment?
Despite denials from its creators, moral reconation therapy has been linked with Scientology. It has been noted that MRT’s Freedom Ladder is very similar to Scientology’s “Life Conditions”, the stages of existence that people need to go through to attain success. While an association with religion does not necessarily impact the validity of a particular therapy, it may show some bias and a lack of objectivity.
Another point of criticism is the assumption that participants have deficient moral reasoning. Although the creators are clear that this does not mean that clients are immoral, it could easily be construed that way by people unfamiliar with Kohlberg’s stages of moral reasoning. One could see how participants might feel shamed, angry, and humiliated by this assumption, hardly a way to start therapy. Further, it is untrue that criminals automatically have low levels of moral reasoning. For example, an alcoholic or drug addict might have high levels of moral reasoning but perform criminal acts as a way to satisfy their addiction.
Maybe the biggest area of concern is MRT’s effectiveness. Much of the research is not psychometrically sound (e.g., lack of peer reviews and strong scientific design) and the results are not particularly impressive. Even the studies that do show a statistically significant reduction in recidivism do not have substantial effect sizes.
Some news organizations have questioned the overall legitimacy of MRT. Taking into account the links to Scientology, potential shaming, and scant evidence of effectiveness, scathing articles in the Cut, Raw Story, and Vice call MRT nothing short of harmful pseudoscience. With its base in CBT, one would think that moral reconation therapy would exhibit more success. However, there are serious concerns as to whether or not MRT is a useful treatment.
If you want information on proven therapies, check out Theraplatform’s blog and resource center for free therapy worksheets.
If you are in private practice or considering starting your own private practice, check out TheraPlatform for your practice management, EMR/EHR and teletherapy needs. TheraPlatform offers scheduling, documenting, client portal, billing, insurance, telehealth and more.TheraPlatform, an all-in-one EHR, practice management and teletherapy tool was built for therapists to help them save time on admin tasks. You can test drive it by signing up for a free trial and no credit card is required to get started.
Resources:
- CBT for Anxiety Disorders
- Cognitive behavioral therapy techniques
- Cognitive Behavioral Therapy Tips for Therapists
- Adapting Cognitive Behavioral Therapy for Teletherapy
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
