DD310 Counselling Psychology: Therapeutic Communities in Prisons

This essay critically analyzes the suitability of therapeutic communities for prisoners, considering their potential for rehabilitation and reducing recidivism. It examines various studies and perspectives on the effectiveness of therapeutic communities within correctional settings, addressing challenges such as prisoner motivation, program implementation, and the integration of mental health services. The essay also discusses the impact of therapeutic communities on prisoner behavior, drug misuse, and overall well-being, while acknowledging the complexities and limitations of these programs. The conclusion synthesizes the evidence to determine the extent to which therapeutic communities offer a viable solution for prisoner rehabilitation.

Therapeutic communities are not suitable for prisoners
Introduction
Inmates who are currently experiencing imprisonment belong to diverse race, religion,
colour and ethnicity; however there is a common factor of incarceration. The environment in
prisons can be extremely harsh, deplorable, and psychologically depressing. Since prisoners
are denied any personal belongings and even personal identity except recognition by number,
the experience can be extremely dehumanizing and humiliating. In addition, there is the
social stigma of being labelled as criminals can result in hopelessness and powerlessness. If a
prisoner abides by all rules during imprisonment like refraining from drugs, then he will be
released from all judicial obligations after the term of imprisonment ends. However, if he
fails to follow all the rules he may be re-arrested with another term at the end of which he
will be released with further stringent rules (Designing a Prisoner...., 2010). Therefore, policy
makers suggest that therapeutic communities address the trauma of being imprisoned as well
as the prison environment that conflicts with the treatment goals. There are three stages of
treatment in these communities – induction which is introducing prisoners in this community,
primary treatment which includes comprehensive treatment to change prisoner’s behaviour
related to substance use, and re-entry which include aftercare services (Incarceration-based
therapeutic communities for adults, n.d.). This paper will analyze whether therapeutic
communities are suitable for prisoners.
Correctional treatment of prisoners has undergone massive changes over decades. The
pessimistic outlook that used to exist in earlier times has been replaced by an optimistic
approach. There is now increased faith that properly structured therapeutic communities can
reduce the tendency of recidivism in some types of prisoners. The report on Grendon’s
therapeutic treatment of prisoners suffering mental health setbacks shows that to some extent

recidivism was controlled but not for all. There have been cases of prisoners escaping and
even murder within the place. In fact the first women’s prison therapeutic community started
here in HMP Grendon. One of their prisoners, Mary finds this as a generalized success story
of reducing recidivism. Noel highlighted the importance of the prisoners’ willingness or
motivation to change themselves. In order to have proper effect, the prisoners need to be
under this treatment for 18 months or more at least. Also in many cases it may so happen that
they are shifted to normal prisons from here before being released. During this time, one
common problem is that the prisoners of the common prisons might not be able to accept the
changes in the subject who has come from therapeutic community. However, usually the
prisoners in Grendon have undergone serious offences. The therapeutic treatment showed
some reduction in the severity of behaviour among the prisoners. So risk of reoffending
might be less. Grendon provided a variety of therapies in order to flexibly meet the learning
styles of prisoners (Vossler et al, 2017).
The confusion lies in understanding the effectiveness and responsiveness of treatment
provided by therapeutic communities to the psychopathic inmates because of disagreements
between clinicians regarding the structure of such communities. Shine and Hobson (2000)
have observed inmates for a period of 18 months starting from their entry into a therapy wing
and ending with their exit. The purpose of this observation was to confirm one established
theory that psychopath is a contributing factor for a prisoner’s negative behaviour in the
prison. The authors have been able to confirm this theory and have also established that
psychopathic inmates in some cases are released early from treatment in therapeutic
communities. However, the authors have also explained that this observation cannot prove
with certainty the association between psychopath and length of stay in therapeutic wings
since prisoners are inclined to misbehave during their therapeutic sessions. Rawlings (1998)
has defined behaviour changes in prisoners during treatment and these changes are observed

till the time they exit the programs. For this purpose, Rawlings has compared the results of
their behaviour pattern of prisoners prior to entering the programs with behaviour patterns
after exiting the programs. This process is used in therapeutic communities for both prisoners
and non-prisoners and the comparisons are done in every stage of treatment so as to assist in
making internal changes in the programs.
Often the drug treatment programs become difficult to implement in correctional
centers since the lives of prisoners reflect their depression and isolated life. Since after
entering prison, an inmate is stripped of their identity and personal belongings to the extent
that they can only be identified by a number, the impact can be physical and psychological.
As such, inmate either resort to join with other inmates to revolt against the prison officials or
they revolt against everyone by considering only their own interests. With these two extreme
behavioural outcomes a prison subculture is formed. Moreover, one-on-assaults is a common
part of prison life in addition to violence between inmate gangs. Hence, one theory here is
that therapeutic communities need to develop separate from the prisons. In support of this
theory, Inciardi et al. (2001) have argued that drug treatment programs can work only in
therapeutic communities since it is isolated from the prison population. A second theory is
that the problem is the person and not the drug, and addiction is just symptom and not the
core problem. The treatment method that the programs apply is treating the person rather than
the habit of taking drugs. The overall goal remains to provide a drug free lifestyle by
changing their negative thinking and behaviour. The authors have proved that prisoners who
complete the treatment are more likely to recover from drug addiction compared to prisoners
who do not complete the treatment. Therefore, there is growing emphasis on making drug
treatment programs more and more effective. The evaluation process of such programs is
based on the degree of relapse and recidivism of prisoners who have received the treatment.
Inciardi et al. (1997) have concluded that prisoners who have received treatment during

imprisonment period and also after they have been released exhibit low rate of drug misuse
and recidivism than prisoners who have received no treatment. Dietz et al. (2003) have
studied that in-prison therapeutic communities are more orderly than prisons without such
communities. Moreover, the former also have prisoners having positive perception of their
prison environment. Also, prisoners’ grievances are less if they can participate in the
treatment programs. Another positive impact is that there is less violent behaviour since in
therapeutic communities prisoners are asked to remain accountable for each other’s actions.
Such accountability reduces the rule breaking tendency of the inmates.
Peters and Wexler (2005) agree that the unique characteristic of a prison’s settings
contributes to the treatment strategies of the inmates. Although there can be different types of
inmates with different levels of anxiety and other mental disorders, a common problem is
lack of identity and a feeling of helplessness. There are also inmates who get used to prison
environment and do not want to fight against it. Often a psychology exists that inmates who
take part in treatment programs are weak and cannot deal with drugs. Therefore, inmates who
adopt a macho attitude often discourage other inmates from participating in the programs.
With relation to recidivism, Roybal (2011) has conducted a study to determine whether
therapeutic communities can reduce the rate of recidivism. Royball (2011) is of the view that
if no treatment is offered to the prisoners they are likely to return to their former lives and get
engaged in criminal activities along with continued alcohol and drug consumption. His study
has found that therapeutic communities help reduction in recidivism rate, and it claims that
the longer is the duration of treatment the greater is the chance of achieving success in
reducing recidivism. The results of his study also corroborate the fact that to increase the
probability of success after treatment, clients should continue the treatment for at least ninety
days before the benefits of treatment can began showing their impact. During this prolonged
treatment period, the inmates will develop the control mechanisms to face the unavoidable

adversity of the environment in their community again without getting involved into its
menacing trapes. The major challenge that is faced is the increasing number of inmates every
year. Majority of the criminal offenders have low education, low employment skills and high
addiction to drugs. If the patients do not receive treatment during their period of incarceration
then these factors can be highly contributory for recidivism. Since no treatment program can
work if the inmates are not willing to participate, therefore Roybal (2011) emphasizes the
need to make such programs persuasive. This is also supported by Hobson et al. (2000) who
have concluded that low motivation of employees and high rates of attrition can increase the
difficulty of treatment programs. In their study, the authors have found that during the
duration of the treatment programs the participating inmates exhibit a consistency in their
behaviour. Psychopaths are less inclined to become involved in activities like education,
charity work and wing socials. The authors have concluded that the need is to observe the
interpersonal relationship of psychopaths and combine this with the system of observing
behaviour. This way the effects of treatment programs can be assessed. In the context of
willingness of inmates to participate in these programs, Newberry (2010) has found that black
and minority ethnics are less likely to participate in treatment programs.
Records have shown that therapeutic communities can be successful in reducing the
rate recidivism. Out of the total researches that have studied drug consumption relapse among
prisoners who have participated in treatment programs, 70 percent have observed that such
programs can be effective in reducing the rates drug consumption among the participants
(Galassi et al., 2015). It is further observed that treatment programs that adopt after care
concepts, i.e. care even after the inmates exit the programs have a greater positive impact on
rate of recidivism and drug misuse that programs that do not offer after care. Here, after care
includes teaching the inmates to adopt skills needed to get employment and coping strategies.
One important observation here is that the rate of re-arrest does not vary with participation in

treatment programs. This is because re-arrest is more likely for ex-offenders even for minor
misdeeds than general population.
To determine whether therapeutic communities are suitable for prisoners, Sacks and
Sacks (2010) have studied the impact of modified therapeutic communities on prisoners with
dual problem of mental disorders and substance use disorders. It was evident that prisoners
who remained three months in treatment programs shows signs of reduced use of drugs, and
this reduced rate is more for prisoners who have completed their treatment programs
compared to their drug use prior to entering the treatment programs. Sacks and Sacks have
determined that in order to have positive impact of prisoners with both mental disorder and
drug misuse, therapeutic communities should consist of mental health specialists and
psychiatric consultation, as well as access to on- or off-site psychopharmacologic
consultation. However, today most treatment programs lack sufficient funding, organizational
structure and proper specialists. In spite of this, these programs have high positive effect on
prisoners experiencing high rate of drug misuse along with varying degrees of mental
disorders (excepting severe mental disorder). It is further observed that programs having
members with specialization in either mental disorder or drug misuse fail to understand each
other’s perceptions of prisoners. Therefore, it is important that therapeutic communities have
members with specialization in both mental disorder and drug misuse.
In order to make treatment programs more effective for prisoners, Akerman
(2008) has described the concept of a fantasy management programme which is designed to
integrate skills needed to manage inappropriate sexual and violent fantasies within a
therapeutic community. The author has explained that such fantasy management program
helps prisoners to realize the amount of time they spend in fantasizing and also helps the
patients to develop skills to control their imaginations and feel empowered.

Taylor (2017) offers recommendations on how to improve the effectiveness of
treatment programs and reduce recidivism. The first point that he mentions is that the
program must be evidence based. This implies that the programs should be designed in a way
that is similar to those programs that have passed rigorous screening and have been proved
effective in reducing recidivism and must be implemented with fidelity. Second advice is that
programs should be assessed for cost effectiveness. Despite the fact that an evidenced based
program implemented with fidelity has a high likelihood of being effective, yet the program
needs to be evaluated directly for two primary reasons. One, to ascertain the actual impact of
the program on recidivism and two,to judge whether the effect is strong enough to justify the
continuity of the program. That is to say, it in critical to evaluate the program in the light of
its cost effectiveness to ensure that the limited resources that the state is allocating for
rehabilitation programs are being put into best use and are yielding maximum results. The
third recommendation of Taylor is that the program should emphasize on highest-need and
highest-need prisoners. The rationale is that researches have indicated that highest-risk,
highest-need criminals is the most potential group that can reduce recidivism rate. Moreover,
effectiveness implementation of programs on highest-risk, highest-need criminals also have a
direct relation with the lowering of criminal activities in future and save state resources for
other productive utilization.
Patricia Frisch and Alan Emery (2019) focused on the importance of inmate
counselling as part of inmate treatment program to reduce recidivism. The argued that
counselling has direct and positive effect on the inmates as it helps lower their stress level.
Counselling assists in altering dysfunctional attitudes, distorted beliefs and values, and
violent criminal behaviour. It also improves their communication skills and thereby improves
interpersonal relations with fellow inmates and staffs leading to an enhancement in their
custody status. Their study found that prisoners responded positively to the one hour

counselling sessions per week as it allowed them to be interviewed, evaluated and screened
for individual treatment and helped them unearth their potentials according to which they
were allotted services within the institution.
Conclusions
Offenders could be labeled as ‘mad’ or they could be criminalized as ‘bad’ when their
activities and behaviors are different from the conventional norms of the society and
concerning regulations. If a certain behavior is diagnosed and marked as criminal or a
consequence of mental disturbance depends on several social aspects. This idea of crime and
mental health is socially influenced or built such that people can be treated in therapeutic set
up. Yet individual explanations of these problems still persists. Treatment of approaches
towards rehabilitation emphasizes upon the social environment and individual offender
(Vossler et al, 2017).
Although Grendon shows the method of designing the prison setting of a therapeutic
community for addressing mental health problems, it might be doubtful whether this model
will suit all kinds of prisoners. On one hand motivation of the prisoner matters and also
prisoners are being sent to other prisons before release. In order to establish a therapeutic
community within prison set up one needs to dismantle the formal social and physical
structures which can maintain safety within the prisons. In this kind of set up externally
imposed security will be replaced by that internally imposed by every individual and group.
At the same time the effectiveness of the outcome will depend a lot of the security of the
place. The place usually has to allow residents to develop their own responsibilities.
Although it is a good prison practice mainly for patients affected by severe disorders, the
efficacy of the treatment will depend a lot of the prisoners themselves and their learning
abilities.

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