Counselling and Forensic Psychology: Investigating Crime and Therapy

Summary

Introduction

The aim of this report was to develop a report that outlines issues that should be considered to set up a therapeutic service in the forensic/prison settings, particularly where young male offenders are held up. The report has provided the benefits of offering therapy like equipping individuals with approaches and techniques to overcome depression and relapse into drug abuse and reoffending and the potential drawbacks and challenges that may be linked to offering therapy in forensic settings. It has also suggested the types of therapy that might be appropriate to offer young male offenders. For example, it has discussed attachment therapy, cognitive behavioural therapy (CBT), systemic therapy and mindfulness, including why one of these therapy (CBT) is beneficial and the drawbacks associated with this specific therapeutic approach. The report has also discussed why young male offenders many not respond to therapy and how to help those who self-harm and the victims of sexual abuse. Lastly, the report has highlighted some general suggestions and recommendations for the prison governor on how the therapeutic service should be set up in the prison. For instance, it has recommended that the governor should create space in prisons where therapy can be offered to the young prisoners. Another recommendation that has been highlighted is that the prison should guarantee security to the therapists offering therapeutic services to prisoners to make them confident to offer this service without fearing for their safety.

Introduction

Debate concerning if prisons or forensic settings can become therapeutic communities usually raise issues regarding the role of prisons as either meant for rehabilitation and changing behaviour or punishment (Bennett and Shuker, 2017). This debate is often around why it is so challenging to incorporate the therapeutic community model in forensic prison settings (Bennet and Shuker, 2017). These researchers give an example of the United States stating that in this country, prisons are perceived more for their punitive roles rather than rehabilitation centres. As a result, Bennet and Shuker (2017) claim that psychotherapy is only accepted in prisons that see rehabilitation as their principal objective. Bennet and Shuker (2017) further claim that the main purpose of rehabilitation is to reduce the chances of reoffending, a problem that is dire in many countries around the world. This paper will discuss the challenges of offering therapy in forensic settings in further details. It also highlight some of the therapy approaches that can be used in these settings and why young male prisoners, especially the victims of sexual abuse, may be reluctant to seek therapy in prisons.

Potential benefits and drawbacks with offering therapy in forensic settings

One of the things that is usually seen as aiding in the rehabilitation of offenders is probation (Wampold and Imel, 2015). The criminal justice system also influences this process as it is capable of influencing psychotherapy contexts in forensic or prison contexts since it is in charge of creating robust institutional structures in prisons (Wampold and Imel, 2015). It is believe that offering therapy in such settings can lead to changed prisoners with less reoffending tendencies and individuals who can successfully be integrated back into society (Wampold and Imel, 2015). Even though there is a growing interest to establish therapeutic communities in forensic settings or prisons, this has been met with the challenge of establishing robust therapeutic relationships between individuals prisoners and the mental health professionals, hampered by the poor prison institutional environment (Wampold and Imel, 2015). These authors opine that this situation exists because, rather than focusing on rehabilitation, these institutions concentrate on punishment and prison security (not allowing prisoners to escape). Together with other issues that are discussed below, these makes it difficult to establish therapeutic communities in forensic settings or prisons (Wampld and Imel, 2015). According to Merkt et al. (2020), psychotherapists are often concerned about working in prison settings because of security issues because some of the offenders in these areas have committed serious or capital crimes and still pose a threat to life, a thing that increases the professionals’ anxiety levels and a factor that may influence the development of therapeutic relationships that are important for successful therapy. These researchers also claim that it is it is difficult to have successful therapy processes in prisons because usually, prisoners are not willing to share information about committed crimes, hampering information flow needed by the psychotherapist to achieve successful therapy. I also believe that security is key when working in prison settings and that the lack of proper flow of data might hamper the whole process of attempting to offer therapy in prisons. According to Robinson and Crow (2009 cited in the Open University 2020), offering therapy in forensic settings has become difficult because of some researchers who have contributed to the notion that people have exaggerated the effectiveness of rehabilitation in reducing recidivism (reoffending). For instance, Robinson and Crow (2009 cited in the Open University 2020) highlight the research by Lipton, Martinson and Wilks (1975) in starting the ‘Nothing Works’ movement that sought of campaigned against increasing rehabilitation services in prisons, leading to budget cuts towards such services. According to Owen et al. (2009), too much focus is being placed in diagnostic categories. Additionally, the Mental Capacity Act of 2005, as well as the Mental Health Act of 1983 enforce placing mental health under the care of the NHS as the principal decision maker that often sanctions forensic psychiatrists to help offenders. These diagnostic categorisation and the sanctioning of forensic experts by the NHS makes it difficult for prisoners who experience mental health problems like substance abuse, post-traumatic stress or personality disorders to find sufficient help in forensic settings (Phillips, McKeown and Sandford, 2010). There is also no single model that has been found to be effective for these settings plus the fact that some of the mental health problems experienced by prisoners take quite long to treat, needed uninterrupted whole year or two-year therapy, making it difficult to be achieved in prison settings, especially where prisoners can easily be transferred to other institutions (Dowsett and Craissati, 2008 cited in Logan 2020). Lotfi et al. (2018) also note that some of the mental health conditions may require the collaboration of different health professionals and sophisticated treatment techniques to be treated, for instance, the Dialectical Behaviour Therapy. Lotfi et al. (2018) say that the difficult or rigid nature of forensic settings with limited prisoner movement hampers team collaboration and the achievement of the required treatment. Bell (2013 cited in the Open University 2020) claim that prisoners are often pressured into seeking mental health services rather than being compelled, a situation that makes them less willing to corporate. Lastly, most prisons do not have dedicated spaces where therapy can be offered (Durcan and Zwemstra, 2014). The few available spaces are usually dedicated for thinks like waiting rooms, conferences, chapels and workout areas. The lack of proper therapy rooms makes psychotherapy quite uncomfortable both for willing prisoners and therapists (Durcan and Zwemstra, 2014).

Modes of therapy appropriate for young offenders in prisons

Group Therapy

There are different types of therapy service provisions that are suitable for prison settings. Psychotherapists can choose between group and individual therapy or decide to try establishing therapeutic communities in prison settings, especially where a majority of offenders are young people. According to Jalali and colleagues (2017), group therapy is beneficial because it offers a broader perspective especially when dealing with young offenders with similar experiences. These individuals claim that group therapy provides a wider perspective concerning the challenges being addressed in the therapy sessions. Group therapy also results in increased positive support perceived by the offenders attending the service, making it possible to address an individual’s problems constructively because they can support each other during the process (Jalali and colleagues, 2017). Jalali and colleagues (2017) also claim that group therapy is useful in that it can lead to long lasting positive connections and relationships with a group member or members, which can enhance the quantity and quality of individuals seeking social support. The main challenge associated with this therapy option is its less direct nature where the psychotherapist pays less attention to individual challenges (Jalali and colleagues, 2017). The less individual nature also makes it challenging to some individuals who may want their issues to remain confidential (Jalali and colleagues, 2017). Some offenders may find it inappropriate, especially those with conditions like active psychosis and who are aggressive or shy (Jalali and colleagues, 2017).

Therapeutic communities in prisons

Establishing therapeutic communities in prisons is a new trend where part of a prison or an entire wing of the prison is converted into a therapeutic community where prisoners can spend several hours, every day of the week attending psychotherapy (Wexler & Prendergast, 2010). Wexler and Prendergast (2010) say that therapeutic communities can be separate from the rest of the prison and offenders attending treatment are allowed to live in the community as they receive mutual help. Treatment staff may include ex-criminals/offenders, acting as good role models who also lead social learning activities. According to Wexler & Prendergast (2010), these communities allow offenders to be trained on how to become self-reliant, how to live honestly and emotion management, as well as becoming responsible for their choices and actions. The benefit of this mode of therapy is that those who have gone through therapy communities are less likely to reoffend when released into community (Burdon et al., 2007).

Individual Therapy

This approach is often the most liked psychotherapy mode even for offenders (Khodayarifard et al., 2010). One of the reasons that it is preferred to other methods is how it allows for high confidentiality levels where offenders are assured that their information is protected (Khodayarifard et al., 2010). It is also a much focused treatment approach where individuals can receive focused and personalised help that is directed towards their challenges and needs (Khodayarifard et al., 2010). Some of the challenges associated with this approach, however, include a limited view on the issue experienced by the patient unlike the group therapy which offers a wider view and perspective on diverse but similar problems (Khodayarifard et al., 2010). Additionally, individuals may not be highly motivated to engage in the therapy because they might find the process quite embarrassing to open up alone to a therapist about their challenges (Khodayarifard et al., 2010). Nonetheless, I find this mode better and quite appropriate for prison settings as compared to group therapy and therapeutic communities because the high confidentiality levels may encourage more prisoners to seek help.

The types of therapy that are appropriate for young male offenders

Attachment therapy

This kind of therapy is credited to John Bowlby who came up with the theory of attachment, an important concept in social care and psychology today (Miller and Klockner, 2019). According to this theory, the environment and social surrounding of an individual plays a significant role in influencing their behaviour and temperament (Miller and Klockner, 2019). From John Bowlby’s own perspective, children need security or the kind of care that is responsive to their needs reduce anxiety and increase the feeling of one being understood (Testoni et al., 2019). When this is absent, an individual’s development suffers significantly. According to John Bowlby, insecure attachment is likely to result in affectionless psychopathy where an individual is not concerned about others and cannot form long-lasting relationships (Testoni et al., 2019). This approach has been found useful when dealing with young offenders who do not know or understand how to control their mental states, for instance, those with anger management issues (Madden and Ireland, 2017). It is also vital for helping those who cannot access other people’s mental state or have empathy towards others (Madden and Ireland, 2017). According to Fonagy and Levinson (2004), this approach helps instil a psychological capacity where an individual develops the ability to think about their thought process and to be able to know when they are low or angry and have insight into the things or issues that make them feel different (to reach a self-reflective function). According to Madden and Ireland (2017), individuals who are securely attached think of their relationships and feelings and contemplate them to make good decisions. This technique also helps offenders to be connected and access their psychic state or ability to control their emotions (Yang and Perkins, 2020). Using the theory of attachment, psychotherapists can spend time forming a positively pitched dialogue to put worlds in the thoughts of an offender. This nurtures the ability to identify, as well as verbalise different emotional states, something known as emotional literacy or emotional intelligence (Yang and Perkins, 2020). The offender becomes able to put word to feelings and thoughts, develop empathy and emotional management (Yang and Perkins, 2020). From my point of view, this approach is suitable for young male offenders, especially those who suffered insecure attachment while young.

Systemic therapy

This therapy method targets changing one’s response to their environment and changing the systems that affect their development, systems like life purpose, oppression issues, culture and family (Herrera, 2020). To reach this goal, psychotherapists use different clinical techniques from psychodynamic methods to evaluate the established therapeutic alliance, mindfulness, cognitive behavioural therapy or art therapy, the theory of family systems (emotion-focused, solution-focused, existential, experiential and structural theories), among other techniques according to an offender’s needs (Herrera, 2020). In prisons, systemic psychotherapy directly refers to the notion that human character or behaviour can be well understood based on sub- or mini-systems like siblings or parents that combine to form the whole family system (Herrera, 2020). What the therapists does in this approach is returning the ability or power to change to the patient. The therapist simply empowers the individual to begin the change process by taking the professional or expert position (Herrera, 2020).

Mindfulness

This approach was derived from the medication Buddhists’ practices and secularise into modern society to train individuals about attentional awareness and to enhance their behavioural and emotional regulation abilities (Hölzel et al. 2011). Mindfulness based therapy has been found to be effective in improving the wellbeing and mental health of individuals (Kuyken et al., 2015). Lao et al. (2016) found that mindfulness may enhance memory, increase executive function (set shifting and inhibition), increase meta-awareness and cause cognitive flexibility, making it appropriate for helping young male offenders. Mindfulness based medication has been found to enhance people’s ability to regulate stress and manage their emotions (Hölzel et al., 2011). According to Witkiewitz et al. (2013), mindfulness training provides individuals with cognitive tools that make them skilful in tackling stressors and improves their ability to tolerate negative emotions. Witkiewitz et al. (2013) suggests that these characteristics make mindfulness based therapy essential in addressing important underlying issues of offending behaviors.

Cognitive behavioural therapy (CBT) and why this form of therapy might be beneficial

This approach is meant to adjust a young individual’s attitudes (cognitions and thoughts) and lead to positive behavioural changes (Wannachaiyakul et al., 2017). This technique is applied in different interventions or programs such as in aggression replacement training and rehabilitation and reasoning training (Wannachaiyakul et al., 2017). Evidence suggests that CBT reduces reoffending in young or juvenile males and in adults because it makes individuals aware of their behaviours and thoughts (Wannachaiyakul et al., 2017). In many CBT programs, individuals are equipped with problem-solving skills, social skills, moral reasoning, self-efficacy, impulse management, self-control and critical reasoning (Wannachaiyakul et al., 2017). CBT helps to restructure maladaptive or distorted perception and thinking that can make an individual to behave badly and positively change a person’s attitudes, beliefs and values and how they interact with others and view reality (Wannachaiyakul et al., 2017). These characteristics make this approach more appropriate in offering psychotherapy to young male offenders in prisons.

Why young offenders may not respond to therapy

Young offenders may not respond to therapy when positive relationship with counsellors is not established. This happens when counsellors have a bad or negative attitude of these offenders, preventing them from creating a relationship with them but instead seeing them as individuals who only need treatment. According to Ryals (2003), the counselling relationship is important in resulting into positive attitudinal and behavioural outcomes in juvenile offenders. There are challenges when helping young male offenders who self-harm and who are victims of sexual abuse. Male offenders tend to keep their suffering a secret and continue to live in pain and denial concerning their past actions and things that happened to them (Howerton et al., 2007). According to Howerton et al. (2007), this situation is because of the cultural influence that emphasises man rules that suggest that they should not show weakness or admit things like being abused because they might experience disdain and disbelief rom society. However, therapist should be keen to understand the signs of male offenders who are victims of sexual abuse or who are suffering from self-harm (Howerton et al., 2007). Evidence suggests that such individuals tend to be isolated and avoid social groups. They also do not trust others and feel very insecure (Howerton et al., 2007). These individuals may also become abuse in their relationships, for instance, by being violent (Howerton et al., 2007). They are over vigilant and experience serious mood swings (Howerton et al., 2007). Borrill et al. (2005) claim that young offenders are at the highest risk of self-harming because they experience hopelessness that they no longer have a future. The early lack of connectedness also pushes them to engage in suicidal ideations (Borrill et al., 2005). With the help of tools such as Assessment, Care in Custody and Teamwork tools, therapist may identify victims of abuse and offenders who are at risk of self-harm (Borrill et al., 2005). The psychotherapist can then attempt to develop positive relationships with these individuals and form peer mentoring programs that can identify distressed individuals and help them overcome their mental health challenges (Borrill et al., 2005). Using techniques provided in therapy programs like CBT, for instance, emotional management, coping techniques, meditation and approaches to reduce relapse into previous negative behaviours, the young offenders may be helped to heal from their mental health problems (Borrill et al., 2005).

Conclusion and Recommendations

Establishing mental health communities in prisons is not an easy tasks because besides the difficulty in establishing a positive relationship between prisoners and the therapists due to trust issues, these facilities do not have spaces or an ideal therapy model to facilitate offering therapy to prisoners. The prison governor should therefore do the following: Enhance security in prisons to assure psychotherapists that they are safe to come in and help prisoners with mental health issues. Create space to be used in offering therapy to make the whole process comfortable both to the clients and professionals. Compel prisoners rather than forcing them into psychotherapy Do further research to determine which therapy model is most appropriate for their settings Focus on rehabilitation rather than punishmen

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