CPN 4TH ANNUAL CONFERENCE
Celebrating Therapy in the
Custodial Setting
Therapeutic Communities,
The Treatment Regime at HMP Grendon
& Some Ethical Considerations
Professor Michael Brookes
Director of Therapeutic Communities: HMP Grendon
Visiting Professor: Birmingham City University
1939 East-Hubert Report
This report recommended that a special
institution be built with its conclusion
being that “psychotherapy as an adjunct
to an ordinary prison sentence appears
to be effective in preventing or reducing
the chance of future anti-social
behaviour, provided the cases to which
treatment is applied are carefully
selected”
Rt Hon R.A. Butler, Home Secretary,
on laying the foundation stone on
1 July 1960 said:
“The regime must be flexible with the
accent on treatment; and success will
depend above all on an enlightened
staff-inmate relationship, together with
close co-operation at all levels between
the different members of the staff”
HMP Grendon
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240 bed Category B prison
No Segregation Unit
Opened in 1962
Each of the six wings is an individual therapeutic
community
• Fully accredited CSAP intervention
• Warren et al (2003) cite TCs as having the ‘most
promising evidence’ in the treatment of severe
personality disorder
Prisoner Characteristics (1)
• 90% serving life sentences (47% mandatory lifer, 21%
discretionary lifer, 31% IPP, 1% Section 2).
• 2% serving 4 - 7 years, 2% serving 7 - 10 years, 6%
serving 10 years or more.
• 21% aged 21-30, 31% aged 31-40, 37% 41-50, 11%
over 50.
• High % personality disturbance (81% assessed as
having at least 1 personality disorder)
• Significant levels of emotional distress (anxiety,
depression, histories of abuse)
Prisoner Characteristics (2)
• The majority of residents at Grendon are serving
sentences for murder, manslaughter or violence
(including those with sexual elements)
• Many studies have drawn attention to the combination of
both the extensive criminal history and disturbed
personality profiles of Grendon prisoners
• Grendon receives more psychopaths than any other type
of English prison
• Large proportion of the Grendon population (50% to
75%) identified as having Dangerous and Severe
Personality Disorder characteristics
Referral Criteria
• Has more than 18 months to serve
• Has been off Category A status for the last
6 months
• Meets ‘drug free’ criteria (within 2 months)
• No diagnosis of major mental illness
• Comprehension of rules & signs compact
• Accepts responsibility for offence
• Meets self harm criteria (within 2 months)
Responsivity Criteria
• Sufficiently motivated
• Necessary insight & psychological mindedness
• IQ criteria (29 or over on the Raven’s
Progressive Matrices or 80 and above on the
WAIS/WASI)
• Psychopathy criteria: those scoring 25 or over
on the PCL-R will be subject to further
assessment prior to acceptance for treatment
Therapeutic Community Model
LINKS BETWEEN DIFFERENT THERAPEUTIC ACTIVITIES
THERAPEUTIC CULTURE
THERAPY GROUP
WORK
EDUCATION
LEISURE
ACTIVITIES
COMPLEMENTARY
THERAPIES
WING
RELATIONSHIPS
INMATE
FEEDBACK
STAFF
FEEDBACK
COMMUNITY
RESPONSIBILITY
OFFENCE ACCOUNT
COMMUNITY MEETING
CASE REVIEW
Principles of therapeutic communities
(Rapoport, 1960; HMPS, 2007)
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Democratisation
Permissiveness
Communalism
Reality Confrontation
A living learning experience
Culture of enquiry
Confidentiality/No secrets
Guiding Structures of Democratic TCs
Therapeutic
alliances
Safety,
boundaries
and
containment
Debate,
exploration
and
enquiry
Involvement,
participation
and
responsibility
Decision
making and
democratisation
Affective
experience
Interpersonal
dynamics
Belief systems
Analytic
Engagement
Attachments
Developmental
Experiences
Reality
Testing
Theoretical
Integration
Social
feedback
Cognitive
Behavioural
Problem
solving
‘Living
learning’
Pro social
culture
Social Learning
Modelling
Vicarious
learning
Appraisals
Perspective
taking
Needs Addressed Within Grendon
• anti-social attitudes and feelings;
• distorted thinking used to justify/minimise offending;
• difficulty in recognising relevant risk factors and in
generating appropriate strategies to cope with them;
• dependency on alcohol and drugs;
• adverse social and/or family histories and
circumstances;
• deviant sexual or violent interests, especially arousal
patterns and pre-occupations;
• poor social, interpersonal skills which are often offencerelevant.
Ethical Considerations
• Power relationships: staff vs resident
decision-making
• Voluntary engagement, addressing risk
factors/treatment targets and process for
withdrawing from therapy
• Confidentiality & disclosure of information
• Conditioning, compromise & integrity
• Staff support
Power relationships: staff vs
resident decision-making
• To what extent can power in a Category B prison
be truly devolved?
• Should staff vote in community meetings in the
same way as residents?
• When should staff overrule votes taken by
residents?
• What impact does the personality mix of
residents have in the resident decision-making
process?
• How does life ‘upstairs’ impact on life
‘downstairs’?
Voluntary engagement, addressing risk
factors/treatment targets and process for
withdrawing from therapy
• Informed consent? What about ISPs?
• Treatment within a TC: awareness of
intensity of group based approach
• ‘Opening up’ responsibilities: ‘capacity to
cope’
• Impact of RTU & community/staff
deselection
• Outstanding risk factors and treatment
needs/targets: divergent views
Confidentiality & disclosure of
information
• Staff allegiances to different stakeholders
(employing organisation, court requirement, professional body,
client)
• Working in multi-disciplinary teams/multi-agency arrangements:
information sharing/shared records
• Need to protect the public - risk assessments, report writing, working
notes
• Need to ensure the safety of the individual (self-harm disclosure or if
someone else at risk)
• Potential for staff compromise/collusion/splitting if told something
‘in-confidence’
• Additional offences
• Security of the establishment & SIRs
• Establishing the right culture within each TC: ‘encouragement to do
the right thing – share all relevant information’
Conditioning, compromise &
integrity
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Closeness of working arrangements
Supportive therapeutic relationships
Impact of hearing distressing material
Maintaining personal boundaries
Role of the staff team
Containing own frustrations/expressed
hostility of residents
• Always acting respectfully, competently,
responsibly, decently & with integrity
Staff Support Mechanisms
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Pre-group/community meeting briefing
Post group supervision/de-briefing
Post community meeting de-briefing
Weekly sensitivity meetings
Individual supervision (contracted)
Group supervision
Informal (and if necessary formal)
individual/group peer and/or clinical team
discussions (particularly if distressed)
Further Reading
Brookes, M. and Shuker, R (Eds.) Grendon 50th
Anniversary Edition. The Howard Journal, 49, (5).
Jones, D (Ed.) (2004). Working with dangerous people:
The psychotherapy of violence. Oxford: Radcliffe Medical
Press.
Parker, M (Ed.) (2007). Dynamic security: The democratic
therapeutic community in prison. London: Jessica Kingsley
Shuker, R. and Sullivan. E.L (Eds.) (2010), Grendon and
the Emergence of Forensic Therapeutic Communities:
Developments in Research and Practice, Chichester:
Wiley-Blackwell.
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Celebrating Therapy in the Custodial Settings