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| “Maintenance” for Corrections Behavioral Health Providers - Part 1 |
| By Caterina Spinaris |
| Published: 05/22/2017 |
The number of Behavioral Health Providers (BHPs) employed in the criminal justice system in the United States is growing as it is increasingly recognized that a substantial percentage of offenders suffer from psychiatric disorders. This is the case in corrections and detention facilities, and also in community corrections settings. This article is the result of my conversations with corrections BHPs from across the country over the past 16 years. It presents an overview of areas of challenge for these corrections professionals, as well as some basic solutions for reducing or overcoming the effects of these challenges. Even under ideal circumstances, treating people who are dealing with psychiatric disorders is a complex and difficult process, as multiple layers of factors may contribute to these conditions. These can include individuals’ history, learned behaviors, temperament, motivation, circumstances, neurobiochemistry, physiology, and genetics. In corrections settings, BHPs have all these issues to contend with plus several more. So what is it like to do behavioral health work with offenders, and what does it take for BHPs to maintain their professional effectiveness in these settings? A common motivation of those who enter the field of behavioral health is the desire to help alleviate others’ psychological suffering, and promote healing and wholeness. Those who enter correctional behavioral health are no different. Besides a paycheck, they yearn to assist those in the criminal justice system recover from psychiatric disorders or manage symptoms sufficiently so they can function in their daily lives, not engage in self-destructive practices, and not re-offend. Due to their clinical training, and if they have treated non-corrections populations prior to coming to corrections, BHPs may already have preconceptions of how client management and clinical treatment are supposed to unfold. Once in a corrections setting, however, they may discover substantial differences in doing behavioral health work in these settings as compared to non-corrections treatment environments. Security First First and foremost, BHPs have to adjust to the fact that in corrections settings concerns about physical safety are high. Making sure that all—staff and offenders—are safe is the predominant goal. Routine, predictability, planning, privacy, even confidentiality, come second. Due to security issues, there may be disruptions in clinical services provided, as when an offender has to be moved, when there is a lockdown, or when there is an emergency with another offender. BHPs also have to get used to the fact that there is no complete confidentiality as to who is receiving their services. Security staff need to know where BHPs are and where offenders are, or BHPs may meet with a certain offender upon the request of security staff. After an incident, BH records are going to be reviewed in an attempt to analyze retroactively an offender’s mental status and possible motivations. Clashing Mindsets At times, BHPs may not see eye-to-eye with security staff regarding what constitutes effective interactions with mentally ill offenders. These disagreements can create tension between clinical teams and security teams, and so bring about division and conflict. BHPs may be concerned that security staff may “undo” what they were able to accomplish with a mentally ill offender, due to their insufficient understanding of psychiatric disorders, what helps de-escalate offenders, and what makes them likely to cooperate. On the other hand, security staff may be resentful towards BHPs, thinking that BHPs have too much power in decision-making regarding offender management, but insufficient understanding of what it takes to keep the environment secure. Alternatively, BHPs in small teams may attempt to meet their own need for connection/community at work by overly embracing a security mindset, focusing more on ways to attain offender compliance and control, and less on therapeutic approaches appropriate for mentally ill offenders. This can result in role ambiguity and role conflict for BHPs (are they cops or treaters?), lessen their clinical effectiveness, and lead to conflict with offenders. (Personal communication, Susan Jones, PhD, April 30, 2017.) Not Enough Time The sheer volume of human suffering and human need in corrections facilities or in community settings may be such, that treatment, as the BHP would envisage it with other populations, is not possible. There is not enough time to provide regular treatment sessions to all who need them, while also assessing offenders as requested by security staff, and keeping on top of emergencies and related paperwork. Due to sparse treatment sessions, BHPs may feel like they are “spinning their wheels,” that they cannot get enough “traction” to move forward with certain offenders on their caseload. Not being able to do their job as they would like to for optimal results can be a source of frustration that affects BHPs’ ability to derive positive meaning and satisfaction from their work. Concerns about the Type of “Client” For correctional BHPs, the awareness of the possibility of danger is ever present about their own physical safety. This is based on facts that BHPs know only too well about violence offenders have inflicted on others and on themselves. The BHPs’ own vulnerability creates a sense of unease, which can interfere with the clinical treatment process. Not feeling physically safe around offenders is bound to affect the capacity to make a genuine emotional connection with them, and be a source of support, guidance, encouragement and confrontation, as needed. In clinical terms, the therapeutic alliance between BHP and offender client can be strained or impaired due to BHPs’ concerns about their physical safety. These concerns are exacerbated when offenders make threats towards BHPs, or engage in retaliatory behaviors against them. Examples are when offenders file grievances against BHPs or make other accusations against them when BHPs hold them accountable for their actions (for instance, by removing them from a drug and alcohol treatment class for being disruptive), or when BHPs do not give offenders what they want (for example, a favorable evaluation for the parole board). Reactions to Offender Behaviors In addition to BHPs feeling particularly anxious around certain offenders, they may experience a deep dislike of them, a sense of revulsion toward them, or at the very least, negative judgments about them, and a pessimistic conclusion that “people who are that severe do not get any better.” This type of negative emotional reaction to offenders can be partly due to the type of criminal activity that the offender has engaged in, and partly due to BHPs’ history, temperament, personality, coping style, selfimage and current life experiences. Unless they have exceptional self-control and advanced clinical skills, BHPs that develop a strong dislike of offenders may adopt a negative slant in their dealings with them. For example, they might communicate with them in terse and “cold” terms; remain emotionally distant; keep sessions short; procrastinate about meeting with them; make discouraging or critical comments to them or about them to others (instead of making encouraging, hopeful remarks); or question, minimize or overlook offenders’ attempts to improve themselves (instead of affirming them and reinforcing these positive behaviors). On the flip side, BHPs may identify with offenders too much, viewing them with a positive bias—all the way to embarking on their own “rescue mission” of these individuals, or even having a personal relationship with them. This can happen, for example, when offenders remind them of a sibling or a child who had struggled with drug use, and whom they were unable to help. When this occurs and is not resolved by the BHPs on their own or during their supervision time, they may dismiss red flags in offenders’ conduct, make excuses for lack of offenders’ compliance to treatment requirements, or downplay in their minds the possibility of danger to themselves or others that offenders may pose. BHPs that get overly involved with offenders may also favor them by trying to meet with them more often than with other offenders, or even violate policy by making exceptions to rules for them, for example, by providing them with materials or information that they should not be given. Such behaviors put BHPs in a dangerous place of compromise, and, inevitably, on a collision course with security staff and even with other BHPs who may observe some of what is transpiring. Sooner or later, these behaviors also usually end destroying BHPs’ corrections career. Empathy BHPs pursue clients’ psychological healing and “repairs” in their thinking patterns and emotions. Healing can start when a person experiences BHPs as understanding, able to relate to them, caring, validating, and non-judgmental—that is, as empathetic. Empathy is a bridge that connects the one receiving help with the helper. It makes it more likely that the one being helped will open up and be receptive to the helper’s advice and direction. Empathy can be difficult to experience and maintain by BHPs when dealing with offenders whose behaviors (past or current) are experienced by the BHPs as disgusting, repulsive, or horrifying. In fact, it would be safe to venture that empathy will likely be drastically diminished under the circumstances. This can be the case especially when BHPs are traumatized indirectly (through reading offender files or through conversations with offenders), or directly (through witnessing offenders’ self-injurious behaviors, attempted or completed suicides, or assaults of others). When that happens, BHPs may end up feeling numb, indifferent, and “go through the motions,” without putting any heart into their work. The capacity for empathy towards offenders can also be severely undermined by having other types of negative experiences with them, such as by discovering that they had believed offenders’ statements, only to find out they were lied to, very elaborately and convincingly. Questionable and Fragile Motivation Outside of the criminal justice system, BHPs usually treat adults who enter treatment voluntarily, in which case there is an established level of motivation of the client to engage in this process. In corrections settings, offenders’ motivation regarding treatment can be much more complex. Some offenders are assessed by BHPs upon the request of security staff, due to concerns about their mental health status—whether they want to be assessed or not. Others enroll in drug and alcohol classes because they hope that doing so will help them when they go before a parole board. Yet others ask to meet with a BHP because they want to try a game with them, or because they are bored. Additionally, in corrections environments, compared to “free world” clients, the motivation may be higher to withhold significant information, as the offenders’ freedom is at stake, and BHPs work for the corrections agency. So they may misrepresent facts, or not admit to actual guilt (for obvious reasons). Moreover, if, due to safety concerns and legal requirements, BHPs report information about offenders which results in negative consequences for them, that destroys whatever degree of therapeutic alliance may have existed between them, and may result in offenders refusing to talk to BHPs again. These are only some of the difficulties that BHPs face when working in the criminal justice system. Their impact on BHPs’ clinical effectiveness may be reflected in several areas of their professional functioning, including:
This article as been reprinted with permission from the May 2017 Issue of Correctional Oasis, a monthly e-publication of "Desert Waters Correctional Outreach". Editor's note: Caterina Spinaris is the Executive Director at Desert Waters Correctional Outreach and a Licensed Professional Counselor in the State of Colorado. She continues to contribute to the field of corrections staff well-being individually and organizationally, in particularly regarding issues of traumatic stress due to exposure to violence, injury, death on the job, and also issues of organizational climate improvement. Visit the Caterina Spinaris page Other articles by Spinaris: |
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