What Works in Therapeutic Prisons

Evaluating Psychological Change in Dovegate Therapeutic Community

J. Brown, S. Miller, S. Northey, D. O'Neill

• Publisher: Palgrave Macmillan
• Year: 2014
• ISBN:
  9781137306210
• Topic: Ciencias sociales
• Subtopic: Criminología

Exploring the first purpose-built prison community of its kind, the HMP Dovegate Therapeutic Community, this book provides the most comprehensive coverage of this research to date, following the progress of individual prisoners' through therapy and highlighting the key essentials for prisoners to address their motivations and criminal behaviour.

1

Aims and Overview

Introduction

If I was in mainstream prison I’d be in a workshop but here basically I’m doing an NVQ in catering, so I’m working towards being a chef and this was something different to try, but I got the bug, it makes me wish I was 25 year younger, but I’m not, but at the end of the day I’ve got to congratulate them because they’ve come here, they haven’t gone “Oh my god, prisoners”, they’ve treated me as equals they’ve coached me when I’ve been struggling. They’ve given me encouragement; they are a nice set of people to work with.

Primarily this book is about the residents of the Therapeutic Community (TC) in Her Majesty’s Prison (HMP) Dovegate. We wanted the first, and last, words to be those of a TC resident. There are several reasons for this. First, politically, it rather pins our colours to the mast by privileging the residents as the most important people in both the therapeutic enterprise and the research that we are reporting. Second, it highlights the importance of our attentiveness to what the TC residents had to say and the insights they had to offer about their own experiences of therapy. Third, embedded within the extract is a clue about the difference between mainstream prison and a therapeutic community, and it offers some tantalising hints about the TC Dovegate ethos, which will be explained in full later. It is also suggestive about the outcomes for this resident. Ultimately interventions within prisons, particularly TCs, are about changing lives. A strong theme of this book is “change” and the role that the TC played in bringing about changes, what they are, whether they are sustainable and what they mean to individual residents.

In this Introduction we provide some background to what we, as researchers, set out to do. We thought it useful to look briefly at the work of HMP Grendon, in terms of both its TC and also some of its associated research activity, not only to show how the Dovegate TC and its research evaluation learnt from these but also to explain some similarities to and differences from the Grendon experience. As Roland Woodward, the first director of therapy at Dovegate, was very keen that the Dovegate TC “was not a replica of Grendon” (Woodward chapter in Cullen and MacKenzie, 2011, p. 129), it seemed helpful to provide some comparison.

As part of the context, we set out some of the dilemmas and tensions inherent in undertaking a complicated piece of research in a complex setting. This includes some discussion of the competing demands and sometimes conflicting aims of conducting therapy in a private prison and the challenges in undertaking research. We also describe the philosophy underpinning the research and sketch out the key theoretical constructs. A recently published joint inspection by HMI Prison and HMI Probation Services not only provides a timely reminder of why working therapeutically with prisoners is so important but also strengthens the rationale for evaluating the gains to be had from such an intervention (Criminal Justice Joint Inspection, 2013). The inspection team noted (p. 7):

prisoners were able to drift through their sentence without being challenged … Offending behaviour work done in closed prisons was not always consolidated on arrival in open conditions. Transfer from closed to open conditions was a key transitional phase of the life sentence, but prisoners were often poorly prepared for this move; as a result, many suffered a “culture shock” on their arrival in open prison . … The quality of assessments and plans completed in prison to manage risk of harm to others was insufficient, with many lacking thorough analysis of the motivation and triggers for the original offending.

This assessment indicates the continuing difficulties in getting assessments and interventions right and supporting the rehabilitative ideals of incarceration. TCs within prisons challenge and address motivation for offending in order to reduce risk of harm to others. We will be describing how this was done within the Dovegate TC and what it achieved. We found evidence of culture shock on re-entry into mainstream prison, and we discuss how ex-TC residents attempted to consolidate the progress they had made when transferring.

From the outset we want to record that we were fully supported in conducting the research by the management of Dovegate and the TC staff. The research that the four of us are reporting was a collaborative effort of many hands, and we endeavour to indicate where a particular set of findings was the work of one of our collaborators. But, above all, we were not only heartened by the generosity of our TC resident research participants but also struck by their insights, and hope that, in the pages that follow, we do these justice.

In the beginning

Setting up Dovegate

Dovegate Therapeutic Community Prison opened in November 2001. Premier Prison won the competitive bid to build a modern purpose-built prison with a TC (Cullen and Miller, 2010). There were four communities, A, B, C and D, later renamed Avalon, Camelot, Genesis and Endeavour, holding up to 60 residents in each within an 800-bedded category B mainstream prison. The TC complex was built around a “market square” which had a decorative fountain and garden with no inner boundary fences. Roland Woodward, the original first director of therapy, was anxious to create a physical environment that supported the TC lifestyle that he and Eric Cullen (who was the lead consultant in the successful bid to operate the Dovegate TC) were to design (Woodward chapter in Cullen and MacKenzie, 2011). The space was important in several regards. It had to accommodate the activities that were to take place and also needed to reflect the openness of the therapeutic model that Roland Woodward wished to create. Part of that openness involved work that Roland did with the local communities living near Uttoxeter, where the prison was to be built, by finding out what it might mean for residents of the two nearby villages to have a prison close by.

There were several other distinctive features that reflected Roland’s inimitable imprint on the genesis of Dovegate. One was his approach to the training of people who were to staff the TCs, and the other was his organising principles for his management team, which became known as the Senate, and its informal shadow, “the fluffy” (more of which shortly). In order to reflect his egalitarian principles, he insisted on a round table to seat the 15 or so members of the Senate, even though this meant building the table in the room that was to house it. His logic was clear. If TC residents were to sit in circles for group therapy, so too were the members of the Senate. This was one tangible attempt to break down the “us and them” barriers. From the outset, both discipline staff and therapy staff wore uniform as a symbolic way to fuse the therapeutic and security functions and also to inhibit some informal hierarchy of professional staff vs. “screws” building up. This fusing was consolidated by the therapy managers being responsible for both functions.

The invention of “the fluffy” was a Roland inspiration, coined after a Harry Potter character (Fluffy was the name of a three-headed dog guarding the “Philosopher’s Stone”). Roland describes the origin of the naming as follows: “It was obvious that our sensitivity meeting that was meant to deal with our unconscious material could only be called one thing. What could be more obvious than the three-headed monster that guards the lower level of our being? Hence, Fluffy” (Woodward chapter in Cullen and MacKenzie, 2011, p. 141). “The fluffy” was really what members of the Senate wanted it to be – a place to express irritations and frustrations, work through rivalries and jealousies – essentially, Roland created an environment for his staff to allow them to do for themselves what the residents were being asked to do.

“Educom” was a creative mixture of education and commerce designed for the TC residents. Roland was keen that the Dovegate TC was not going to have the light industrial processes of other prisons; rather, he wanted to widen the learning skills and possibilities made available to TC residents through peer tutors as an operationalisation of the “learning from others” principle.

Staff were drawn from newly recruited prison custody officers, many of whom had no prior prison experience, and professionals from psychology, psychiatry and counselling backgrounds. Roland and Eric Cullen prepared a training programme for the new staff. In Chapter 2 we chart the historical origins of the TC movement, and in Chapter 3 we describe in more detail the founding principles and the structuring of the Dovegate TC regime.

Some context

Our research at Dovegate began a decade or so after Elaine Genders and Elaine Player published their ground-breaking study of HMP Grendon TC (Genders and Player, 1995). The background to that study was the climate of despair within the prison system in general, and the therapy community in particular, because of the demise of the rehabilitative ideals of the early 1970s. What came to be labelled “nothing works”, emanating from the Martinson (1974) research, was a critical appraisal of the apparent ineffectualness of prison interventions which painted a bleak picture of the intractability of offending behaviour. In the next chapter, we present an overview of the “nothing works” debate and the development of a rather more optimistic “what works” approach. We also show where the TCs fit, as well as providing an account of TC policies and practices.

The sense of crisis was also being played out through the industrial action taken by prison officers in the 1990s. Prison buildings were in a sad state of neglect, and in 1990 prisoners at HMP Strangeways rioted for 25 days, during which the prison was virtually destroyed, one prisoner died and almost 200 officers and prisoners were injured. The subsequent Woolf report (25 February 1991) was a high water mark of pessimism, noting that the prison system itself, impoverished regimes and poor staff–inmate relationships had contributed to the rioting.

Lord Woolf found a sorry picture when he conducted his review of the prison system. In the ten-year anniversary debate of Lord Woolf’s report in the House of Commons (Hansard, 2001) it was noted that “[i]n 1989–90, the 40-odd local prisons and remand centres were overcrowded by an average of 37 per cent. Some were overcrowded 100 per cent, holding double the number of prisoners that should have been held.” The effects of the overcrowding meant that often there were three prisoners held in a cell without sanitation or washing facilities and there was a lack of “purposeful activity for prisoners”. The rising prison population exacerbated an already pressurised system.

Genders and Player suggest that, in the aftermath of Woolf, Grendon, which had opened in 1962 to provide treatment for offenders whose mental disorders were insufficient to warrant transfer to hospital, was recognised as an antidote to the dreadful conditions and punitive regimes that were the precursor to the prison riots of 1991. As they indicate, the main aim of therapy at Grendon, when they were undertaking their research, was to facilitate and promote the welfare and well-being of each individual inmate; it was not seen as the apparatus of crime control. Whilst they observed that prevention of crime was an ambition of the Grendon regime, it was not the primary one.

There were other indicators that attention to the rehabilitative aims of prison was restirring. Just when we were beginning our research at Dovegate, The House of Commons Home Affairs Committee, in its investigation into the rehabilitation of offenders, offered a strikingly upbeat note:

We endorse the view of the Prison Service that HMP Grendon is a model of good prison practice and a leader in the treatment of severe personalitydisordered offenders. Although by its nature this model of treatment will only be suitable for a minority of offenders, we consider it important that the work done at Grendon should continue. We recommend that the Government should commit itself to maintain and if possible increase the present level of resourcing of Grendon and other therapeutic units.

(House of Commons, Home Affairs Committee, 2004, para. 240)

Government reports such as Corston in 2007 and Bradley in 2009 were more sympathetic to the rehabilitative ideals of prison. The Carter review of prisons seemed, however, to counterbalance this by recommending large-scale, state-of-the-art Titan prisons and focused on the modernisation of the prison estate and better strategic management as the means to manage the ever-increasing prison population (Carter, 2007).

A resurgence of academic interest was also evident. Since the late 1980s, a movement that came to be known as therapeutic jurisprudence (Petrucci et al., 2003) had been evolving. The aim was to bring mental health insights into the legal arena and counter anti-therapeutic outcomes by improving the emotional well-being of prisoners. Work by Prochaska and DiClemente (1983) on smoking cessation had developed a model of change which, during the intervening years, had progressively evolved and been adapted to measuring change in a range of treatment contexts. Change was said to be a process and took place as a series of stages: precontemplation, when the person is unaware of or unconcerned about problem behaviour; contemplation, when there is an acknowledgement of but ambivalence about changing; action, when there is an attempt to change; and maintenance, during which change is consolidated. These ideas about readiness to change and the role of affective as well as cognitive elements, together with the means to measure these, were increasingly being used to assess progress in treatment and demonstrate changes in behaviours. Egan (2010) discusses a renewed interest in the concept of personality and an integration into models of offending, notably the work on cognitive schemas and their role in antisocial behaviour and maladaptive responses to challenging life events. Concurrently, psychometric measures were being devised and published, for example, the Psychological Inventory of Critical Thinking Styles (PICTS, Walters, 2002), which tried to capture aspects of thoughtlessness and callousness. As Egan describes, thoughtlessness is implicated in impulsivity, which is a core feature observed in offenders, and increasingly intervention programmes tried to inculcate greater self-insight and self-control and thus less inclination to offend. This is an area we address in our research, and we spend Chapter 5 discussing personality disorder (PD), its implications for offending and propensity for change within the TC, and problems in measuring it.

By the 1990s there was a growing response to the “nothing works” critique. Better statistical techniques and new conceptual thinking drew attention to models of change (McMurran, 2010). Andrews and Bonta (1990) developed the risk-need-responsivity (RNR) model. The risk principle states that criminal behaviour can be reliably predicted and that treatment should focus on high-risk offenders. The need principle argues that treatment interventions should focus on issues that relate to criminal behaviour, that is, criminogenic needs. The responsivity principle looks to maximise the offender’s motivation and ability to engage in treatment and behaviour change. We incorporated these principles within our research design. We describe our approaches to measuring change in Chapter 4 and present our results in chapters 6–10, dividing these according to the primary research method, which to some extent also corresponds to the chronological sequence of the prisoners’ progression through Dovegate, back into mainstream prison and into the outside world.

Countering the “nothing works” argument was an impetus to develop more and better evaluations of prison-based treatment interventions. Another was the drive to have accredited interventions, and a third was to demonstrate value for money, spawned in the wake of the New Public Sector Management initiatives (Wakeling and Travers, 2010). The government wanted to ensure that interventions were reducing recidivism and warranted the investment of public money in programmes, and defined reduction in reoffending as one of its main objectives. In 2002, the Home Office had set a Public Service Agreement Target of reducing the predicted rate of reoffending by 5% by April 2004, and again by 5% by April 2006. The Prison Service stated that “reducing re-offending by released prisoners is central to reducing crime and is therefore part of the Prison Service’s core business of protecting the public” (House of Commons Home Affairs Committee, 2005). A further identifiable trend has been the recognition that the service users’ perspective should be incorporated into programme evaluations (Glasby et al., 2003).

The implications from these trends are twofold. First, they confront the question of what constitutes outcomes, and, second, they provoke the issue of how to measure these, or, more broadly, what research methods to employ. We describe more fully the way we went about conducting the research and its more technical aspects in Chapter 4. Here we wanted to lay out our approach and present some of the conundrums and our solutions to these before we explain the detail.

Evolving our approach to the research

As mentioned above, Genders and Player (1995) alluded to the goals of the Grendon TC being wider than the crime control and desistence from offending desired by the authorities, and this had an impact on their research questions and methods. So it was with our research. The research brief set by Roland Woodward encouraged those bidding for the research contract to consider (a) the extent and process of psychological and behavioural change within Dovegate TC; (b) TC residents’ behaviour and experiences after transfer to another prison; and (c) TC residents’ behaviour and experiences after release into the community. Roland Woodward did not want just a replication of a study of TC social processes that had characterised the Grendon research at that time. As well as having a post-Dovegate element to the research design, he was keen to explore the therapeutic process “as it related to individuals reaching a point of psychological change readiness” (Woodward’s chapter in Cullen and MacKenzie, 2011, p. 148). Roland described his notion of change and the centrality of meaning in his conception of the Dovegate TC in a study undertaken by a Counselling and Psychotherapy doctoral student, Amelie Bobsien, in 2004. In answer to Amelie’s question of what the Dovegate TC was all about, Roland said:

It’s about making meaning. It’s about how each individual makes a new meaning of their lives and how they make sense of their universe and their place in it … so it’s...