Working with Working with prisoners in the prisoners in the field of mental field of mental

health health Dr. Maura O’SullivanDr. Maura O’Sullivan

Senior Clinical PsychologistSenior Clinical Psychologist

Irish Prison ServiceIrish Prison Service

Psychology ServicePsychology Service

The Psychology Service forms part The Psychology Service forms part of the Regimes Directorate of the of the Regimes Directorate of the Irish Prison Service (IPS) and Irish Prison Service (IPS) and applies psychological research, applies psychological research, principles and skills to the needs of principles and skills to the needs of the prison service. the prison service.

IPS Psychology ServiceIPS Psychology Service

Eight Clinical Psychologists, Eight Clinical Psychologists, Seven Counselling Psychologists, Seven Counselling Psychologists, One Forensic Psychologist One Forensic Psychologist Two Psychologists in Clinical Training. Two Psychologists in Clinical Training.

(further two next year)(further two next year) Three Assistant psychologists (soon to Three Assistant psychologists (soon to

be in post)be in post) Clinical Psychologist (soon to be in Clinical Psychologist (soon to be in

post)post)

Psychologists draw on different Psychologists draw on different theoretical foundations in working theoretical foundations in working with individuals based on the client’s with individuals based on the client’s understanding of what is pertinent understanding of what is pertinent and the psychologist’s needs and and the psychologist’s needs and strength based assessment with the strength based assessment with the client. client.

Often work is considered in terms of Often work is considered in terms of the cycle of change/ spiral with the the cycle of change/ spiral with the understanding that building trust understanding that building trust between the client and the between the client and the psychologist is key.psychologist is key.

The psychology service plays a modest, The psychology service plays a modest, albeit important, role in supporting the albeit important, role in supporting the psychological well-being of prisoners. psychological well-being of prisoners.

The operation of psychology services The operation of psychology services can only be optimised within the can only be optimised within the context of an appropriate and context of an appropriate and meaningful prison regime. meaningful prison regime.

(Annual Report, 2007)(Annual Report, 2007)

In particular, psychological well-being is In particular, psychological well-being is impacted by the quality of custody, impacted by the quality of custody, specifically the nature of prison conditions, specifically the nature of prison conditions, the quality of staff-inmate relationships, the quality of staff-inmate relationships, the amount of out-of-cell time and the the amount of out-of-cell time and the provision of meaningful occupation. provision of meaningful occupation.

Consequently, in promoting the Consequently, in promoting the psychological well-being of prisoners, psychological well-being of prisoners, particular attention needs to be focused on particular attention needs to be focused on these issues.these issues.

(Annual Report, 2007)(Annual Report, 2007)

Psychology

Outside

Forensic psychiatry Pre release

Addictionservices

Education Probation

Post release

Inside

Parole Board

Medical Services

Chaplaincy

Operations

Psychologists work with clients on an Psychologists work with clients on an individual and group basis.individual and group basis.

Group workGroup work

Anxiety Management Group; Inputs Anxiety Management Group; Inputs to the Lifers group, Emotion to the Lifers group, Emotion Regulation; Mindfulness. Dialetical Regulation; Mindfulness. Dialetical Behaviour Therapy, Enhanced Behaviour Therapy, Enhanced Thinking Skills (ETS), Anger Control Thinking Skills (ETS), Anger Control Training (ACT), Motivational Training (ACT), Motivational Enhancement Training (MET)Enhancement Training (MET)

AssessmentAssessment

Various assessment tools are used Various assessment tools are used depending on the client and the depending on the client and the referral question.referral question.

Dispositional factors (including Dispositional factors (including anger, impulsivity, and personality anger, impulsivity, and personality disorders)disorders)

Clinical or psychopathological Clinical or psychopathological factors (including diagnosis of Axis 1 factors (including diagnosis of Axis 1 disorders, alcohol or substance disorders, alcohol or substance abuse, and the presence of abuse, and the presence of delusions, hallucinations or violent delusions, hallucinations or violent fantasies; obsessions)fantasies; obsessions)

Historical or case history variables Historical or case history variables (including previous violence, arrest (including previous violence, arrest history, treatment history, history of history, treatment history, history of self-harm as well as social, work, self-harm as well as social, work, and family history)and family history)

Contextual factors (including Contextual factors (including perceived stress, social support and perceived stress, social support and means for violence)means for violence)

Protective factorsProtective factors

Personality disorderPersonality disorder

Narcissistic personality disorder Narcissistic personality disorder (Factor one)(Factor one)

Antisocial personality disorder Antisocial personality disorder (Factor two)(Factor two)

(Logan, C 2008)(Logan, C 2008)

Specific Parole Board Specific Parole Board Assessments Assessments

Internation Personality Disorder Internation Personality Disorder EvaluationEvaluation

Psychopathy Check List –Revised (PCL-R)Psychopathy Check List –Revised (PCL-R) Violence Risk Scale; Violence Risk Scale; Violence Risk Scale –Sex Offender (VRS-Violence Risk Scale –Sex Offender (VRS-

SO)SO) Personality Assessment Inventory (PAI)Personality Assessment Inventory (PAI) Comprehensive Assessment of Comprehensive Assessment of

Psychopathic Disorder (CAPP)Psychopathic Disorder (CAPP)

CAPP: Comprehensive CAPP: Comprehensive Assessment of Psychopathic Assessment of Psychopathic

DisorderDisorder Self domainSelf domain Emotional domainEmotional domain Dominance domainDominance domain Attachment domainAttachment domain Behavioural domainBehavioural domain Cognitive domainCognitive domain

Cooke, Hart, Logan, and MichieCooke, Hart, Logan, and Michie

Relevant risk factors and protective Relevant risk factors and protective factorsfactors

FormulationFormulation Risk managementRisk management Supervision Supervision MonitoringMonitoring

ChangeChange

CAPP allows for the possibility of CAPP allows for the possibility of changechange

Maturation, medication, detoxification, Maturation, medication, detoxification, and an environment of structure and and an environment of structure and control may bring about considerable control may bring about considerable behavioural, interpersonal, and behavioural, interpersonal, and affective changes. affective changes.

It is therefore important to allow for It is therefore important to allow for adaptive responses to become apparent adaptive responses to become apparent in any measure of psychopathyin any measure of psychopathy

Logan, C. 2008Logan, C. 2008

Individuals must be perceived as Individuals must be perceived as resilient and having strengths before resilient and having strengths before a strengths based approach can be a strengths based approach can be sucessfully implemented (Utesch). sucessfully implemented (Utesch).

By emphasising strengths, the inate By emphasising strengths, the inate resilience of an individual is enabled resilience of an individual is enabled to assist them in their attempts to to assist them in their attempts to overcome adversity. overcome adversity.

Individuals typically seen as Individuals typically seen as hopeless and without resources are hopeless and without resources are persumed to be able to make persumed to be able to make significant positive strides when significant positive strides when their own strengths and abilities are their own strengths and abilities are identified, emphasised, and built identified, emphasised, and built upon within the context of adverse upon within the context of adverse conditions.conditions.

A strengths based approach is A strengths based approach is characterised by its emphasis upon characterised by its emphasis upon capacities, competencies, and capacities, competencies, and resources that exist within and outside resources that exist within and outside of the individual, family or community. of the individual, family or community.

Key researchers and writers in this Key researchers and writers in this area are Waters and Lawrence (1993) area are Waters and Lawrence (1993) and Pianta (1990). These were my and Pianta (1990). These were my mentors in my years in Virginia!!mentors in my years in Virginia!!

Strengths based approaches are Strengths based approaches are developmental and process oriented.developmental and process oriented.

They identify and reveal internal They identify and reveal internal strengths and resources strengths and resources (resiliencies) that exist within an (resiliencies) that exist within an individual, family, or group as they individual, family, or group as they occur in specific problem contexts. occur in specific problem contexts.

Making the transition from a deficit Making the transition from a deficit to strength orientation can be to strength orientation can be difficult. There is a tendency to rely difficult. There is a tendency to rely upon programmes to create upon programmes to create resilience instead of using resilience instead of using programming to facilitate strengths programming to facilitate strengths that capitalize on resilience factors that capitalize on resilience factors that already exist. that already exist.

Pianta, R. (1993) Beyond the Parent. Pianta, R. (1993) Beyond the Parent. The role of other adults in chidren’s The role of other adults in chidren’s lives.lives.

Waters, D.B. & Lawrence, E.C. Waters, D.B. & Lawrence, E.C. (1993) Competence, Courage and (1993) Competence, Courage and Change: An approach to Family Change: An approach to Family Therapy. Therapy.