Book review: Global perspectives on interventions in forensic therapeutic communities

Citation

Willmot, P. (2023), "Book review: Global perspectives on interventions in forensic therapeutic communities", Journal of Criminal Psychology, Vol. 13 No. 3, pp. 254-257. https://doi.org/10.1108/JCP-08-2023-055

Like medieval cathedrals in the centre of modern cities, therapeutic communities (TCs) can seem out of place in today’s prison service; ancient (by the standards of forensic psychology), slightly mysterious and apparently immune to capricious changes in culture and fashion, TCs can seem to many in mainstream prisons to exist in a sort of parallel universe. However, the growth in recent years of Psychologically Informed Planned Environments and the application of TC principles in UK prisons and approved premises, as well as the rediscovery of trauma-informed approaches across forensic settings mean that TCs are becoming increasingly relevant and that “the mainstream” has much to learn from TCs. This book, Akerman and Shuker (2022), edited by two of the UK’s foremost forensic TC practitioners, therefore, provides a timely, informative and accessible guide to the subject.

• 1. Summary and evaluation of the book

As its title suggests, the book’s focus is global. Half of its 14 chapters are written by non-UK authors from Europe, the USA and New Zealand, and the variety of perspectives illustrates not just the variety of challenges and cultural differences in priorities and approaches but also the many commonalities shared by TCs in different countries. The book’s content is comprehensive, covering the history and principles of TCs, results of outcome studies, discussion of current issues and developments and the lived experiences of residents that will be useful to both those working in TCs wanting to broaden their perspective, and to “outsiders” wishing to understand more about TCs.

Section 1 covers practice perspectives. It begins with a chapter by Geraldine Akerman and Carine Minne describing a TC intervention for gang members. It is a useful reminder that, for many prisoners, offending is rooted in relationships and community (Boduszek et al., 2021). It, therefore, makes good sense to address offending through different experiences of relationships and community, and this idea, of “community as treatment”, is a theme that runs through the book. Chapter 2, by Vicky Gavin and Claudia Vau, describes in detail the role and process of psychodrama and art-based psychodrama as alternative, non-verbal approaches to accessing and exploring emotions and trauma in the only democratic TC for women in English prisons, illustrated with accounts from two residents.

Chapter 3, by Steve Shaw and Gary Winship, describes reflective practice groups for prison officers in a TC. It highlights the emotionally intense and sometimes distressing nature of the prison officer role and the relative lack of personal and professional preparation they receive before working in an extremely challenging and unforgiving environment. The chapter uses case vignettes to illustrate the use of projective identification to promote a spirit of curiosity in exploring difficult and complex interactions with residents. This appears to be an approach that could usefully be used across the prison service, not just in TCs. Chapter 4, by Hanne Holm Hage-Ali and Johnny Lindblad Reinhardt, describes a drug rehabilitation TC in a Danish open prison. It describes some of the other elements that complement therapy by creating a safe and therapeutic environment, including relaxation and physical activity, as well as values of respect and acceptance.

Section 2 covers research perspectives. Chapter 5, by Steve Pearce, reviews the evidence for the effectiveness of TCs. While there is still a lack of methodologically rigorous evaluations showing TCs to have a clear impact on recidivism, there is clearer evidence that TCs can lead to significant psychological and behavioural change, at least while residents are in the TC, though frustratingly, it appears that those changes are often undermined, at least in the UK, where most prison TC residents return to mainstream prisons before they are released, so reversing the effects of the community as treatment. In Chapter 6, Gareth Ross and Natalie Bond detail two interpretative phenomenological analysis studies of the lived experience of therapy and provide a powerful insight into how TCs operate through providing residents with a sense of safety and genuine connection to others, often for the first time in their lives.

In Chapter 7, Jo Augustus and Jinnie Jefferies describe a qualitative evaluation of the efficacy of psychodrama and art psychotherapy at HMP Grendon. The thematic analysis of interviews with participants is an instructive approach that helps to express in words the impact of non-verbal therapies. Themes of developing insight, accessing and processing subconscious trauma, providing space to be vulnerable and supported and learning new behavioural management skills are described and illustrated with two powerful vignettes. Chapter 8, by Virginie Debaere, Kenneth Arctander Johansen and Ruslan Isaev, is a study of service users’ experiences in four Russian addiction rehabilitation centres. The chapter says relatively little about the services themselves but provides a fascinating insight into the scale and impact of substance misuse in Russia and the uncoordinated and patchy provision of services that are largely provided by private companies with little or no support or coordination from government. Chapter 9, by George De Leon, summarises the history and evaluations of prison-based TCs for substance abusers in the USA. Mirroring the conclusions from Chapter 5, it concludes that prison-based TCs can be highly effective provided they are shielded from mainstream prison culture and residents have access to TC-orientated aftercare in the community instead of returning to mainstream prisons. Finally, the authors stress the importance of constantly ensuring programme fidelity so that the values and processes of TCs are not eroded.

The final section covers narrative perspectives and developments. A real strength of this book is the efforts the editors have gone to in not just limiting their book to the UK or English-speaking nations, but including contributions from other, less familiar jurisdictions, including Denmark, Italy, Greece and Russia. In Chapter 10, Simone Bruschetta reflects on the replacement of Italy’s forensic psychiatric hospital system with smaller secure units run by community mental health teams, and on the tension between the therapeutic and custodial roles. This appears to be exacerbated in Italy, where the concept of “social danger” extends to people who do not present a significant risk of harm to others but who lack adequate residential or rehabilitative support. Chapter 11, by Rod Mullen and Nya Arbiter, presents a narrative history of prison TCs in California. Picking up the theme of the importance of integrated aftercare, they describe an impressive study by Wexler et al. (1999) that reported a 27% reincarceration rate for men completing prison TC and aftercare TC, compared to reincarceration rates of between 75% and 82% for control and dropout groups. Tragically, while this study prompted a massive expansion of TCs in California, underfunding, poor training and poor planning, particularly for the all-important aftercare TCs, together with political and economic pressures, meant that by 2009 all the TCs had closed, to be replaced by an emphasis on less effective CBT-based interventions.

In Chapter 12, Apostolos Tsigoulas describes the Greek model of drug treatment in prison-based TCs. This appears an enlightened and well-designed approach that sees drug addiction among prisoners as a mental health issue rather than a criminal justice issue. People with addiction problems are treated more favourably by the courts and have a legal right to treatment. While this leads to challenges, such as people pretending to have addiction problems to have a better quality of life on a TC, the chapter describes positive effects, including influencing the staff and culture of the wider prisons in which TCs are located. Chapter 13, by Jacqui Johnson and Andrew Frost, is a departure from the rest of the book. It starts by describing the tensions and conflicts inherent in prison mother and baby units; between support and control; intimacy and distance; autonomy and control. It then discusses how many of these issues are also found in TCs and concludes that mother and baby units could benefit from applying TC principles to become the “village it takes to raise a child”. Although this is not an idea that has yet been tried in practice, it is a fascinating reflection on the parallels and opportunities for learning between two ostensibly unconnected forms of prison community.

The concluding chapter by Richard Shuker makes a powerful case for the culture of belonging, collaboration and empowerment that is core to TCs being applied more widely to counter the detrimental psychological and social effects of incarceration. Though TCs will not be suitable for everyone, their cultural values of safety, connection, respect and hope are often desperately lacking in mainstream prisons whose toxic environments often exacerbate the harm done to already traumatised prisoners.

• 2. Unique value and contribution of the book

The first-hand accounts of TC residents are particularly interesting and informative. There are powerful therapeutic processes at work in TCs, both in group processes and in non-verbal creative therapies, and while those processes are difficult to describe, they often seem better captured by the first-hand accounts of residents than by the more formal and analytic style of the therapists and academics. For a good example that marries resident and therapist perspectives of TC processes, see Akerman and Joshua (2022). Likewise, Bennett and Shuker (2018) who attempt to understand distinct best practices that might be applied more widely throughout the broader prison estate.

There are some important themes that run through this book. One is the importance of the wider criminal justice environment to outcomes. This is a point that applies to all forensic interventions, but perhaps particularly to TCs because their culture of safety, community and respect run counter to the culture of many other parts of the criminal justice system. Time and again, different contributors describe how the therapeutic gains from TCs are largely wiped out when residents are returned to the mainstream, both in prison and in the community.

Another running theme is the importance of trauma. The fact that developmental trauma is widespread among forensic populations has been widely overlooked as a result of “Just Deserts” criminal justice policies and a focus in correctional programmes on treating a prescribed list of criminogenic needs. TCs have their roots in trauma; in the UK they began during the Second World War as a way to treat traumatised soldiers and addressing trauma is central to their treatment model. There is, therefore, much that can be learned from them about not only addressing past traumatic experiences but also minimising the risk of trauma caused by imprisonment (Willmot and Jones, 2022). As such, Akerman and Shuker’s (2022) book draws together wide-ranging global perspectives on the current and future landscape of TCs among forensic populations and settings, essential for those academics, practitioners and students seeking to understand best practices available.