Inmate Counseling & Therapy: Eight Years Inside San Quentin
by Patricia Frisch Ph.D. and Alan Emery
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From 1976 to 1984 we conducted a comprehensive independent inmate treatment and staff training program inside San Quentin and other California prisons. In revisiting our work, which ended 17 years ago, we believe that independent psychologically oriented services for inmates and staff belong within prison settings. It is with this in mind that we present our work. Now as we look back, our initial vision of 1976 comes alive again today. We hope this article inspires others to carry on with this work. Our programs inside San Quentin were equally balanced between services for inmates and programs for staff. However, due to space limitations here we will focus mainly on the inmate treatment aspects of our work.
In 1976, we saw at San Quentin a desperate human services need for both prison staff and inmates. We responded to that need by co-founding Counseling & Training Consultants (CTC), a nonprofit corporation, to provide psychological services for inmates and stress reduction and communication trainings for correctional staff.
Then as now, the focus of prison was predominately custodial. Human services were a low priority and minimally provided. The harsh environment, limited space, and deprived atmosphere, coupled with warring camps of race against race, inmate against staff, and gang against gang, made the need for psychological services acute. Inmates were suffering from depression, acute withdrawal, psychosomatic illnesses and other clinical symptoms. These problems were magnified by drug abuse and addiction. The mandate for longer sentences made the atmosphere tense, full of conflict, hopelessness, and despair.
The quality of life for inmates was diminished and the stress level for staff was dangerously high. From 1976 to 1984 we worked to bring a humanizing perspective into this closed custodial environment. Our program worked because it was independent from the institution. As consultants, we brought a freshness from the community that was sorely needed within the bureaucracy. Further, our independence gave us freedom to maintain therapeutic integrity as professional clinicians.
Although we maintained an office inside San Quentin to conduct business and interface with staff and inmates, we also maintained a community presence through our office outside the walls where we conducted non-correctional clinical work. Thus our independence both financially and psychologically allowed us to sustain intimate involvement within a difficult setting. First we established a working relationship with inmates through group and individual psychological treatment services. We began as volunteers leading one substance abuse treatment group. After forming the nonprofit corporation, the number of groups expanded, and interest inside the prison grew. The participating inmates named their groups the “Personal Expansion Program” (PEP) and became ardent supporters of the project.
From the beginning, the warden acknowledged the value of the program and through his strong support, it became integrated as an independent institutional program and was followed with interest by the California Department of Corrections. From these small beginning steps our program expanded its inmate services from one group to eight and added additional therapeutic options.
At the same time we developed an accredited graduate student internship program to train and supervise graduate students from Bay Area universities to work with the incarcerated population. Interns conducted individual therapy sessions and participated in group sessions under licensed supervision. It soon became apparent that we needed to work with both sides of the prison population. So we developed an 18week Correctional Officer Communications and Stress Reduction Training Program, including a comprehensive training curriculum. We also developed a detailed step-by-step trainer manual containing all the training elements needed for the program. Our intention was to have this program incorporated into the California Department of Corrections on a statewide basis with the idea of training correctional officers to teach the course.
The training included presentation of didactic material on communication within the context of a group process. Thus the experiential training format was both educational and therapeutic. Early on we recognized the importance of defining specific and measurable goals for both the inmate and correctional staff aspects of the program.
For the inmate program, we identified objectives that were realistic and achievable within the prison setting and relevant to the inmates’ quality of life. For the Correctional Officer Training Program, we identified specific, desired outcomes that were useful on the job and in their personal lives. An independent researcher was hired to design, implement, analyze, and report the findings on an annual basis.
— Patricia Frisch and Alan Emery
Inmate Treament Programs
Inmate treatment programs were designed to provide inmates with an environment of safety and support while teaching them more effective communication skills, healthier emotional self expression, positive attitudinal change, and ultimately encouraging higher self-esteem. Characterological changes were seen in a few inmates who stuck with the program long-term. These goals were achieved through group, individual, and reentry services. The inmate programs provided a forum for serious, internal growth work, which created an opportunity for inmates to change their lives inside prison. Throughout the life of the program, there was enthusiastic participation from the inmate population and waiting lists for all treatment modalities. Entry into all programs began with a multi-step screening process. Inmates were evaluated for suitability for psychological work. Each modality had a specific treatment contract including confidentiality, attendance, and behavioral commitments.
Inmate Group Therapy
Eight inmate therapy groups comprised the group treatment aspect of the program. There were approximately 20 men in each group facilitated by two leaders, one graduate student intern, and ultimately an inmate peer counselor. Group members committed themselves to a minimum of a full year of participation. The groups were composed of “mainline” inmates whose felony convictions included drug trafficking, armed robbery, assault, and murder. The age range was 17 to 50 years of age. During that period at San Quentin, younger men were serving extraordinarily longer sentences, entering as young as age 17, with sentences stretching to as long as 118 years.
One group was specifically designed for this population. The groups were racially mixed and participation was strictly voluntary. Word of mouth was the most effective recruiting technique. Articles describing the program appeared periodically in the weekly San Quentin inmate newspaper. Inmate therapy group participants developed a unique culture within the institution. Inmates involved in the groups and individual treatment began to form a cohesive larger community.
The inmates acknowledged this budding culture by creating traditions and events honoring it. At the same time, the institution acknowledged the value of the therapeutic program (PEP) by allowing it to have annual banquets with special food, entertainment, and social time together. PEP banquets became a highly prized annual social event, which consolidated the therapeutic community, values, and status of the participants. A culture shift founded on consciousness, responsibility, and community was anomalous within the primitive, violent prison setting.
Enhanced communication was a goal achieved through a context of trust in a confidential and safe setting. Group members were encouraged to openly, honestly, and directly communicate. This open communication commitment was in direct defiance of the inmates’ closed, secretive norm. Emotional self-disclosure began when the men communicated their feelings and attitudes and shared. They learned to give feedback and to express anger nonviolently and tolerate a reasonable amount of anxiety and vulnerability given the situation. Attitudinal change occurred through a confrontative communication process, increased self-awareness, and positive mutual identification among the members.
The groups were highly confrontive, and rationalizations and other defenses that justified criminal acting out were faced. Cognitive approaches examined beliefs, values, and ideas that led to criminal behavior. Positive peer pressure opposing acting out led to shifts in attitudes and behaviors. The group encouraged personal historical review, which clarified the evolution of destructive patterns, habits, and beliefs. Through peer confrontation and intimate sharing, psychopathic defensive structures shifted to enable greater capacities for consciousness and empathy.
As the individuals changed, the group became a positive peer influence reinforcing a new set of values. Stress reduction resulted from the group process. Bottled up emotions cause tension and physical symptoms. In an emotionally deprived environment the opportunity to talk and share intimately with one another helped to reduce the isolation, alienation, and stress of prison life. Behavioral changes came about through increased communication, better self-awareness, positive attitudinal change, strong positive peer pressure, and reduced stress. The men became better equipped to function in the prison setting. Their quality of life improved. Their interactions with the correctional staff, families, and peers improved. As their defensive structures changed, communication skills improved, and they did not have to rely on negative behavioral patterns.
Peer Group Facilitators
Fifteen inmates who had participated for a minimum of two years in inmate treatment groups and met the acceptance criteria comprised our peer group facilitator training program. From the inception of the program, a core group of interested, devoted, and committed inmates emerged who were motivated to gain training in counseling and facilitation leadership skills and techniques.
The Peer Group Counseling program focused on the concept of self help as both an in-prison need, and as a meaningful vocational and educational training program. We received undergraduate university accreditation from Sonoma State University for inmate participants who were interested in gaining college credits. This group met two hours each week and received intensive group therapy as the experiential model for learning group leadership skills. Members of this group interned in other ongoing PEP treatment groups. Participants were trained and supervised by our professional therapists.
Reentry services assisted inmates 3 to 12 months from parole, both inside the institutional walls and outside at the minimum security facility called The Ranch. The groups impacted approximately 60 inmates. Specific issues of inmates nearing parole were dealt with, which assisted and supported them in that period of transition.
Reentry counseling was available to those in the reentry group and to others who requested specific counseling with this focus. The assistance was practical in nature and identified referral needs including: halfway houses, drug treatment referral sources, vocational training, employment direction, and other appropriate referral sources. A reentry manual compiling all Bay Area resources was provided, as well as professional assistance in how to use it use to ensure identification of the resources and liaison contact in the community. The program provided a coordinated and cooperative strategy among various reentry support organizations, both inside the institution and in the community.
Once a week, hourly therapy sessions were provided for approximately 65 inmates. Inmates were interviewed, evaluated, and screened for individual treatment, and referred to other services within the institution.
Inmate Treatment Program Objectives
The program’s overriding objective was to provide psychological services to approximately 165 inmates, and reentry services to another 60 inmates each year. Specific objectives were:
- To assist inmates in changing dysfunctional attitudes, beliefs and values, and criminal behavior.
- To lower drug usage within the institution.
- To decrease violent, actingout behaviors.
- To improve their custody status.
- To lower stress.
- To increase inmates’ facility in interactional communication skills and improve interpersonal relations.
- To provide a context in which psychological treatment is validated as an essential and highly prioritized institutional service.
- To provide the institution with professionally trained psychotherapists.
Research data on the inmate treatment program was compiled longitudinally for four years and annually for five years. The methodology included psychological prepost test batteries, audiotape analysis of inmate groups, group leader and intern evaluations, analysis of demographic characteristics, and behavior tracking of participants. Evaluation summaries consistently reported a continued level of program effectiveness. To quote from Inside San Quentin- Research and Evaluation Project Year (04), “The overall longitudinal study clearly demonstrates the viability of providing professional, psychotherapeutic services to incarcerated felons within the context of individual, group psychotherapy. This study suggests that the weekly group psychotherapy experience has had its greatest impact on reducing individual stress in coping and adjusting to the prison environment .. it is obvious that the improved functioning within the institution is a significant goal in itself, impacting both the individual and the prison community.”
We believe strongly that improved functioning and enhanced quality of life inside the walls are realistic and critical goals. Recidivism, although thought of as the most compelling measure of success, is often a grandiose expectation and difficult and expensive to track. As the independent researcher concluded, “.this project should include a focus on improved individual functioning and prison adjustment factors, rather than expectations of treatment impact on recidivism rates, cures to chronic addiction patterns and other long range rehabilitation goals.”
Graduate Student Internship Program
Our graduate internship program was sought after by graduate students from Bay Area universities as a unique training in group and individual therapy. Eight graduate student interns in psychology from Bay area universities provided an additional eighty hours each week of staff support in ongoing inmate treatment. Interns were master’s and doctoral level students, applying for Marriage, Family Therapist, and Psychologist licenses. They were under the direct supervision of the staff therapists, and were assigned as cofacilitators in the inmate therapy groups and carried an individual caseload. They also participated in a weekly intern training seminar.
The California Department of Alcohol and Drug Abuse funded our San Quentin Program from its inception through early 1980, through a contract with the California Department of Corrections. After that we received 75% of our funding from the Office of Criminal Justice Planning (O.C.J.P.), with the rest coming from the San Francisco Foundation and the Packard Foundation. Later, the program was also funded by the San Francisco Foundation, the Packard Foundation, and the Evelyn and Walter Haas, Jr. Fund. We became increasingly convinced that, just as all of our original funding came from government sources, our evolving dependence on private foundations was extremely risky. Without direct, longterm funding from a variety of sources, the program would eventually have to close.
Programs must have the endorsement of the California Department of Corrections before being allowed inside an institution. Our program was fully supported by the Executive Program Planning body of the State Department of Corrections in Sacramento. In 1979 we ranked second in the program priority list of the California Department of Corrections in their request for program funding. In 1981, we were ranked first in their priority list. Our program at San Quentin was cited in 1978 as a “model pilot program” for both inmate treatment and counselor training in a report by the California Department of Health.
In this report, it was recommended that our program be continued and, if proved successful, “the California Department of Corrections should seek funding to expand the program to other institutions.” Integration of community professionals into a prison is extremely difficult. Both staff and inmate populations are reluctant and resistant to accepting outsiders. We withstood the testing inside San Quentin and became successfully integrated.
Our program functioned successfully because we established liaisons and support within the institution. We established vital reentry links and became well-known and accepted in the outside community. As psychologists looking back on our long and intense experience inside California prisons, we recall that period with great satisfaction. Those days seem like a dream, yet the aliveness and spirit we felt as we created these programs and worked inside those walls are unforgettable. Images of inmates and correctional officers drift through our minds as we recall special moments of healing. Images of inmates and graduate students intimately engaged are compelling.
Part of the reason our experience was so positive was that we worked as a team supporting and reinforcing each other within an environment that at times threatened to overwhelm our psyches. Life inside the walls is a bleak reality, often brutal, scary and alien, yet psychologists can impact that reality.
The inmates say it best
The program has proven successful in providing a personal atmosphere in San Quentin as well as emphasizing the positive aspects of myself and has, through the examples of its staff, motivated me toward effecting a real change in my life.
– R.R., San Quentin Inmate
Speaking for myself they’ve helped me recognize and restructure some of my thought processes to where I’m more and more at ease with doing what we call in group as ‘taking risks to work’ with my feelings, problems or issues that have in the past been slowing down my growth process as a person.
– D.L.M., San Quentin Inmate
During group meetings I’m able to share myself, my problems, anxieties, fears, hopes, and I’m able to be honest about myself. I never had the opportunity to expose myself so deeply for the past four years in prison, where there weren’t any games involved. Now I can still be myself and my own man.
– K.G.R., San Quentin Inmate