The Role of Therapy in Prison

By Aisling McMahon

Prison inmates, as part of the wider community they come from, have a right to the same services that are available to them outside of prison. Thus, they have a right of access to therapeutic services in the same way that they have rights to medical, educational and occupational facilities while in prison. This article, written by a clinical psychologist working in Irish prisons, outlines some distinctive aspects of therapeutic work with prisoners. The important role of therapeutic services is emphasised in three main areas – in the rehabilitation of offenders in custody; in reducing the potentially damaging effects of imprisonment on psychological or societal adjustment; and in meeting the needs of those prisoners with mental health problems.

Introduction

While this article focuses on some of the distinctive aspects of working therapeutically with prisoners, such clients clearly do not form an homogenous group. As clients, they have varied needs and any therapeutic service working in prisons has to recognise this and respond to individual circumstances. Having said this, there are some aspects to working in the context of a prison, with clients who have breached the accepted mores, which add an extra dimension to the therapeutic work.

Rehabilitative role of therapeutic work with offenders

Psychological or therapeutic services have a small part to play in the overall rehabilitative needs of offenders in custody. It will always be the case in a large community, whether it be within or without prison walls, that only a small proportion of that community will attend individual or group therapy. The rehabilitative ethos, or otherwise, of a prison, will have more to do with its management rules and style; the nature of relationships between prisoners and staff, including how conflict and aggression is managed by staff; and the availability of a range of rehabilitative opportunities such as education and work training. In relation to this, a significant part of the psychologist’s work in a prison is contributing to interdisciplinary meetings about specific aspects of the running of that prison. However, in their direct work with offenders, a rehabilitative focus occurs most commonly in the following areas:

a) focusing on crime/criminal career – including identifying motivations, triggers, risk factors for reoffending, choices for alternative lifestyles.

b) identifying needs for readjustment to society e.g. education, work training, relationship skills, anger management skills.

c) identifying ways of overcoming blocks to a stable and crime-free readjustment to society e.g. a drug or alcohol addiction.

The community as the broader client

Defining one’s role as a psychologist in a prison setting can be challenging. The interests of many groups are involved when working with an offender in custody – those of the prisoner, the prison staff and the Governor, the Department of Justice and the community to which the offender will return. Focusing on enabling change in ‘deviant’ behaviour may lead to a feeling for the individual practitioner that ‘social control’ issues are taking prededence over a client-centred approach (see Howells, 1987, on this point). In addition, the imbalance of power, which exists in any client-therapist relationship, can often be intensified in a prison setting where part of the psychologist’s role with some offenders (e.g. life-sentenced prisoners) is to make judgements about their rehabilitation needs and their suitability for release. While maintaining a client-centred approach, it is clear to the psychologist working with offenders that there is more at stake than the psychological health of their client, as their continued offending on release has wider implications for the safety of others.

Motivational work with clients

Given the awareness of the broader issue of the risks of continued re­offending, including those to the client (e.g. more prison terms, loss of relationships) the psychologist will often initiate motivational work with the client (see Miller & Rollnick, 1991). Clients may have little intrinsic motivation to focus on what others (e.g. family, prison authorities, society in general) are defining as problem behaviours. For instance, violent behaviour can be ego-syntonic for some offenders, being perceived as a legitimate way of resolving conflict (Howells, 1987). Similarly, crime usually brings material and social rewards which many offenders are not willing to forego in the absence of equally attractive alternatives. With addictions, attitudes about change are always ambivalent. Increasing the client’s awareness of decision points and their perceived access to alternative choices is an important part of work with offenders.

Developing problem-solving skills

Helping clients to develop problem-solving skills, to anticipate consequences and make informed choices about how to respond to situations, rather than acting on impulse with habitual styles, of often a significant part of the work with offenders in custody. The prisoner’s style of managing problems is more usually behavioural than verbal. S/he more often ‘acts out’ feelings of frustration, anger and sadness through aggression at others, at property or at themselves (e.g. through self-cutting). As Scott (1993) has commented, most offenders are excellent at observing others and the consequences of others’ actions on them. Many of their backgrounds are full of incidences of abuse and neglect and they can become stuck in a ‘victim’ mentality, which they can use to rationalise their own disrespect or abuse towards others. Often the most important work with these clients is helping them to become more self-observant than other-observant, to learn how to verbalise often difficult and painful feelings, and to practise responding to challenges in a less reactive and more self-empowered way.

Developing empathic skills

Helping clients to develop empathic skills is important in building an intrinsic motivation to end a criminal career, rather than decisions about re­offending being based only on extrinsic factors such as the relative likelihood of material proceeds versus a prison sentence. Csudner and Mueller (1987), in exploring this issue, have proposed that the self-centredness of the average offender blocks his/her awareness of the hurt inflicted on loved ones and victims. As suggested by these clinicians, therapy can involve fostering guilt feelings in the client, through increasing awareness of the pain suffered by others, and then harnessing that awareness to motivate change.

Reducing the potential negative impact of imprisonment

Prisons contain informal social systems with definite codes of behaviour to which new inmates are exposed and which they learn (Mortimer, 1993) As Erikson has noted: ‘such institutions gather people together into tightly segregated groups, give them an opportunity to teach each other skills and attitudes of a deviant career, and often provoke them into employing these skills by reinforcing their sense of alienation from the rest of society.’ (Erikson, 1964, p.15). A prison sentence can serve to establish an individual firmly on a criminal career and/or into a chronic drug addiction. He or she can become absorbed into a group mentality and style which is anti-authoritarian, anti-establishment and which focuses on short-term needs and interests rather than the long-term picture.

Work with individual clients often works to redress this imbalance, where a more personal, longer-term perspective is encouraged. It is often only with increasing age and an increased awareness of lost opportunities (e.g. to see their children growing up) than an offender may detach him/herself from the short-term, reactive focus of the criminal grouping and begin to consider how to make significant changes to their attitude and lifestyle. It is then that focused therapeutic work is timely, helping the client to make decisions about how to use the time of imprisonment to his/her advantage rather than it being a time of further entrenchment in a life of crime or addiction.

Meeting the mental health needs of prisoners

As in any community, prisoners present to the psychology service with many mental health needs. Most of the psychologist’s therapeutic work in prisons is carried out with clients who are dealing with one or some of the following: depression, anxiety, panic attacks, a history of physical abuse, neglect, child sexual abuse or rape, a bereavement, poor self-esteem, relationship difficulties and so on. The largest category of individual referrals to the psychology service in Mountjoy prison in 1995 was for clients with a potential suicide risk (12% of clients seen) and mental health issues, as outlined above, were addressed with 61% of clients that year. There are many clients within the prison system who have been the subject of abuse and neglect in their backgrounds which has led to unresolved emotional and adjustment problems. Usually, their contact with a psychologist in prison is the first time they have had an opportunity to review their life story with a mental health professional, to express their pain verbally and to be facilitated to come to a point where they can make choices about living their life in a less self-damaging, as well as other-damaging way.

Conclusion

In a survey of therapeutic work in a women’s prison in England, prisoners were asked to define what they thought was therapeutic. They identified ‘a space to be themselves (a respite from a sense of constant surveillance), to be in control of their own lives and/or an opportunity to value and be valued by others’ (Kendall, 1995, p.8) These same elements are those which prisons, by their very nature, suppress and deny. While recognising the intrinsic value of psychotherapy, particularly in such a repressive context, it is clear that those prisoners attending therapy will always represent a small proportion of offenders in custody. Thus, while this article outlines some of the important functions of a therapeutic service in prisons, a wider focus on developing a rehabilitative ethos in prisons would do more to benefit the welfare of offenders and the staff who work with them. There we leave the therapeutic domain and enter a political minefield where developments are slow and painstaking (see O’Mahony, 1994).

References

Czudner, G. & Mueller, R. (1987).   The role of guilt and its Implication in the treatment of Criminals. International journal of Offender therapy and Comparative Criminology,        31, 71-78.

Erikson, K. (1964). Notes on the sociology of deviance. In H. Becker (Ed.), The Other Side: Perspectives on Deviance. Free Press: New York,

Howells, K (1987). Forensic Problems: Treatment. In S. Lindsay it G. Powell (Eds.), A Handbook of Adult Clinical Psychology.  Gower: Aldershot.

Kendall, K. (1995).   Therapy behind prison walls: A contradiction in terms? Prison Service Journal, 96, 2-11.

Miller, W. & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behaviour.   Guildford: New York.

Mortimer, D. (1993). History and Treatment Efforts for a Prison Management Unit. The Psychiatrist’s Role in the Special Management Unit. International Journal of Offender Therapy and Comparative Criminology, 37, 117-130.

O’Mahony, P. ( 1994). The Irish psyche imprisoned.  The Irish Journal of Psychology, 15, 456-468.

Scott, E. (1993). History and Treatment Efforts for a Prison Management Unit. Prison Group Therapy with Mentally and Emotionally Disturbed Offenders. International Journal of Offender Therapy and Comparative Criminology, 37, 131-145.

Aisling McMahon works as a Clinical Psychologist in the Department of Justice. The views expressed in this article are her own and do not necessarily represent the views of the Department of Justice.