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Monsters, Maniacs and Morons

Behind the headlines: how psychotherapists engage with offenders

Rebecca Mitchell

Rebecca Mitchell explores the work of forensic psychotherapists, finding the human beings behind the vilification and objectification of criminals.

Media accounts of crime and criminals both reflect and shape public opinion: we may experience disgust at the actions of the August rioters or horror as we read about child murderers like Ian Huntley and serial killers such as Levi Bellfield. The massacre of almost seventy Norwegian youngsters by lone gunman Anders Behring Breivik in July this year may have left us shocked and bewildered, his actions seeming almost to defy our comprehension. Our most immediate, visceral responses may find expression in newspaper headlines such as these which have appeared in The Sun newspaper: “Monster” (23 November 2007), “Morons” (10 August 2011) or “Maniac Killer” ( 27 July 2011). However, as criminologist Robert Reiner notes:

“…mass media news and entertainment is saturated with stories about crime. These disproportionately present the most serious and violent crimes but strip these from any analytic framework: the emphasis is on crime as the product of individual choice and free-floating evil…”(1997, p224).

Reiner also states (presciently) that the portrayal of acts of terrorism or riots is:

“…often in terms of sheer criminality, echoing the discourse of conservative politicians…” (1997,p202).

Policy-makers and academics such as Reiner will eventually provide a more considered examination of the broader socio-economic and cultural causes of major events such as the August riots. Meanwhile, professionals such as probation officers, mental health workers, social workers and others engage directly with those who offend, attempting not only to manage an individual’s behaviour to reduce harm but to try to change it; in other words, to rehabilitate. Psychotherapists and counsellors also engage with people who offend and can provide a unique perspective, both in their efforts to understand the aetiology of criminal behaviour and in their commitment to working with individual clients towards rehabilitative change.

Camila Batmanghelidjh is a psychotherapist, widely known for her work with some of this country’s most deprived and disturbed young people. In the immediate aftermath of the August riots, Batmanghelidjh made a number of media appearances, often a lone voice in her calls for understanding amidst the condemnations and demands for harsh sentences. Meanwhile, Dr Carinne Minne and Dr Matthias von der Tann (2011), who are psychiatrists and psychoanalysts, have written in the Guardian newspaper suggesting that we would do well to dispense with assessing Anders Behring Breivik along the usual lines of ‘mad or bad’, arguing that personality disorder and psychosis should not be seen as separate.

Working with offenders: community and custodial settings

Away from the headlines and media spotlight, psychotherapists and counsellors engage with offenders in various settings. Much of this work takes place within secure establishments, such as prisons and mental health institutions, however provision is patchy (McCauley and Humphrey 2003) and under constant threat as government cut-backs bite deeper into public and voluntary sector services.

In the community, there is little generic provision for offenders. One exception to this is the Portman Clinic in London which dates back to 1931, when a group of professionals got together to promote a better way of dealing with criminals than putting them in prison (Welldon 1996) and where concepts of treatment rather than punishment would be the guiding principles. Treatment at the Portman is based on psychoanalytic psychotherapy.

In addition, there are services targeted at particular types of offending; for example, the Lucy Faithfull Foundation (www.lucyfaithfull.org.uk) which works to reduce child sexual abuse and the Families without Fear Project which focuses on domestic violence (www.familieswithoutfear.org.uk). Offenders and ex-prisoners may also present in community agencies, such as mental health charities and local drugs and alcohol agencies, seeking counselling.

The pioneering work of the Portman Clinic and other community organisations is matched within the prison system by the Therapeutic Community prisons, such as that based at HMP Grendon Underwood in Buckinghamshire. Grendon was opened in 1962 as an ‘experimental prison’ after much debate about what to do with ‘psychopaths’ in prisons (Parker and Morris 2004). It houses some 240 Category B prisoners (prisoners for whom the very highest conditions of security are not necessary, but for whom escape must be made very difficult) all serving sentences of more than four years, mostly for crimes against the person. Prisoners have to apply for a place at Grendon, where there is an emphasis on group work. Treatment combines cognitive, behavioural, social learning and psychodynamic therapy. As Director of Therapy Mark Morris points out:

“Prison officers are expected to get to know prisoners, and residents are unlocked for most of the day. Externally imposed security is replaced however, by an internally imposed security… Grendon men maintain “good order and discipline” not because they have to but because they want to.” (Morris International Association for Forensic Psychotherapy Newsletter 3)

A number of studies have examined Grendon’s impact on the recidivism of its former residents, generally finding in its favour (eg Taylor 2000, Shuker and Newton 2008).

Theoretical underpinnings

The theoretical foundations of psychotherapy with offenders (or forensic psychotherapy, as it is known) are psychoanalytic in origin. Whilst neither Freud nor Klein, for example, devoted much of their writing to the subject of crime, many of their ideas continue to underpin theory and practice of therapeutic work with offenders (Cordess and Cox 1996). The focus is therefore on the internal world of the offender and the crime may be understood not as a random, meaningless act but as the ‘malignant emergence of mental conflict’ (Blumenthal 2010). Basic to this approach is the attempt to understand the meaning behind the offence, one which may not be consciously available to the perpetrator.

Freudian concepts such as ‘acting out’ or ‘repetition compulsion’ provide a way of understanding offending as a failure of thought or a trauma repeated because it has not been consciously understood and worked through. Klein’s thinking, in relation to primitive processes, is also useful when working with clients who deny their offences or project their murderous wishes on to others.

In contrast, the ideas of Bowlby and attachment theory also continue to have a significant impact, stressing the importance of environmental factors in the development of both mental ill-health and offending. Bowlby’s concept of the ‘secure base’ (Bowlby 1988) has been applied to work with offenders in Grendon prison, for example (Parker and Morris 2004, op.cit). More recent developments of Bowlby’s thinking include Fonagy’s (2001) concept of mentalisation (that is, the capacity to assume thoughts and feelings in oneself and others), the failure of which is thought to lie behind much violent offending.

In practice, therapists working with offender clients increasingly come from a variety of different trainings and modalities. This increases the possibility of creative engagement with a client group who are as diverse in their needs and requirements as those encountered in private practice or elsewhere.

Some characteristics of the client group

Giving the John Bowlby Memorial Lecture in 2006, Bessel Van der Kolk stated that:

“People with childhood histories of trauma, abuse and neglect make up almost the entire criminal justice population” (in Benamer and White 2008).

Whilst these comments refer to the United States, similar conclusions may be drawn in the United Kingdom, where the NSPCC reports that over 25% of 18-24 year olds have been severely mistreated by a parent (www.nspcc.org.uk). Not all of these young people will go on to offend. However, large-scale studies in the United States have identified links between such experiences and later risk of criminal behaviour (eg Widom 1989b, Currie et al 2006).

A number of reports (eg Bradley 2009) have emphasised the high levels of mental illness and distress exhibited by those who come before the courts and who often end up in our prisons. The present prison population is at an all-time high (86,654), driven upwards most recently by the influx of those remanded in connection with the August riots (Travis 2011).

As the authors of a report for the Sainsbury Centre for Mental Health note (Sainsbury 2008):

“The majority of these prisoners need support for their mental health and experience high levels of mental distress” (Sainsbury 2008 op.cit p9).

This distress often manifests in high rates of suicide and self-harm, substance misuse and psychosis.

Focusing on the issue of trauma, for example, the authors of this report conducted interviews with almost one hundred prisoners, many of whom reported traumatic events in their past such as torture, rape and childhood physical and sexual abuse:

“Very few of the prisoners we spoke to had received any counselling or support in living with trauma and yet such experiences evidently were taking a toll on their lives” (p64).

Certainly, a prisoner’s access to services seems to be a lottery, determined primarily by whether or not he or she is held in an establishment which offers counselling or psychotherapy. And, as former Chief Inspector of Prisons Lord Ramsbotham has said:

“Prisons are not ideal environments in which to practise psychotherapy but they are places in which it is needed urgently” (in Saunders 2001 pxv).

This is a sentiment with which those of us who work therapeutically with prisoners cannot but agree.

Behind the headlines, behind bars: psychotherapy with prisoners

For my Master’s dissertation, I conducted a small-scale research project which examines practitioners’ experiences of therapy with prisoners, focusing specifically on the challenges and obstacles to building therapeutic relationships. During the course of the research, participants talked about how they imagined their clients to be and how they were in person; fantasies that were often driven by media reports. As one practitioner said to me:

“You think that they will look like monsters but in the room, they are just another human being”.

My own client, Sam, is a case in point. Sam is serving a long sentence for Arson with Intent to Endanger Life. Newspaper reports described Sam as a prostitute and crack addict and the mug-shot used to illustrate the reports shows Sam scowling at the camera, looking very threatening indeed. In person, Sam, who is twenty-two years old, is a thoughtful and reflective individual who fully admits the offence. Sam’s own history of victimisation includes severe physical abuse in the family home and several experiences of violent rape, the first at the age of fifteen.

Practitioners who work therapeutically with offenders will routinely hear stories such as Sam’s, recalling Van der Kolk’s comments above. The therapists I interviewed described the impact of repeatedly hearing traumatic material, feeling ‘wrung out’ or as if they had been ‘hit over the head’ at the end of a working day because they have heard so much horror. One practitioner described a close identification with a client, experiencing feelings of murderous rage towards the client’s abusers and fantasising about killing them on her behalf. As another practitioner said:

“It can be a highly evocative setting which tests every single boundary from the minute you walk in.”

Of course, hearing traumatic material is not exclusive to work with prisoner clients. However, in forensic work, practitioners are trying to build therapeutic relationships with people who are both victims and perpetrators. Traumatic material, therefore, may relate both to someone’s past history and also to their offence. For practitioners, such work often involves an intense push and pull of counter-transference feelings; of empathy and compassion with the abused child and irritation or anger towards the adult perpetrator. Being able to hold on to ambivalence, to contain the client’s projections, to be neither seduced into colluding with the client nor propelled towards acting on hateful feelings, is a crucial part of the work. As Winnicott says:

“ A mother has to be able to tolerate hating her baby without doing anything about it” (1949,p355).

This comment is so pertinent when we think about people who have committed terrible crimes and who may often evoke powerful feelings of anger, hatred or disgust in those working with them.

All the therapists I spoke to in the course of my research were clear that discussing someone’s offence was a critical part of this work, even if this meant having to hear graphic details relating to it. Practitioners expressed a view that discussing the offence was more likely to strengthen the therapeutic relationship than damage it. After all, what message are you giving if you do not discuss it? Will the client think that you are too scared to hear it? That you are not interested in it or in them? As one practitioner said:

“ I think I find it almost strengthens it, it becomes part of it that you bear it and I think that’s an unusual experience for them to find someone who is apparently able to bear this material that they find unbearable “

Another issue for practitioners is working with those clients who deny their offences, who minimise their actions or who blame their victims for their predicament. It can be frustrating work. However, practitioners stressed the need to understand their clients’ defensive strategies and build a trusting relationship. After all, these are people who have had so little cause to trust in the past. One therapist said to me:

“ It seems to me that you’ve got to do some repair work before you can do anything else……So I think that putting the offence to one side and dealing with this very vulnerable person is the work.”

As mentioned earlier, much of the limited provision of psychotherapy and counselling for offenders is offered within prison establishments. Recalling Lord Ramsbotham’s comments, prisons are not ideal places in which to practise psychotherapy. For practitioners, the challenges presented by the client group are easily matched by the peculiar demands of the setting: a lack of a proper room to work in, high noise levels, constant interruptions and worst of all, the sudden release or transfer of a client with no opportunity for a proper ending. However, for some clients, prison can bring order to chaotic lives: a period of respite and containment, both concrete and psychological. Imprisonment may create a space, or secure base, from which a client can begin thinking about themselves, away from the courts which sentence them and the press which declares that they are monsters, maniacs or morons. As my client Sam said to me:

“There are times when I really don’t want to come here and talk with you. It’s hard to think about what I’ve done. But I know that you’re not here to judge me. The court’s already done that. I know you’re here to help “

In their ability to see beyond the presenting problem to the individual and their particular history, psychotherapists and counsellors can provide invaluable support to clients, their families and communities by helping to reduce both mental distress and the harm caused by offending behaviour. Despite scarce resources and a public discourse which inclines towards condemnation and punishment, forensic psychotherapy somehow survives as a distinct area of work within the wider field of psychotherapy and counselling.

In my experience, offender clients and the therapists who work with them demonstrate an extraordinary resilience and commitment to the work, in the face of many obstacles. It is to be hoped that further research in this area will help to evaluate it and provide the evidence to support its continuation.

Rebecca Mitchell has completed the MA in Integrative Counselling and Psychotherapy at The Minster Centre. She is currently working as an honorary forensic practitioner in a prison and has a private practice. She has many years’ experience as a Probation Officer and also previously worked in television news.

References
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