The rock and the hard place: How the prison psychotherapist balances treatment needs with security needs

Research on traditional psychotherapy suggests that the quality of the relationship between the therapist and client is the most important element of effective mental health work. In contrast, prison policies often require that staff maintain an emotional distance from offenders, and many elements of the prison environment and characteristics of the offenders may be counterproductive to the therapeutic relationship. Due to the competing demands of psychotherapy and prisons, it is important to understand how prison psychotherapists reconcile the aims of both in their work. This dissertation examined the psychometric properties of a new measure of how prison therapists balance the security and safety demands of the prison environment compared with the emotional and relational needs of the therapeutic process. The Prison Therapist Orientation Measure (PTOM) assessed therapists’ views of the aims of prison therapy, offenders in general, and their level of emotional engagement during therapy. Responses appeared reliable (α = .79, &ohgr; = .83), and correlations with other measures supported construct validity. 237 prison therapists gave diverse responses in their opinions about the balance of security and treatment demands. A prison therapist’s PTOM score was not well predicted by the hypothesized variables, except for the sex of the offenders on a therapist’s caseload—therapists working with female offenders emphasized the rehabilitative aims more than those working with males, but this was true only for female therapists. Decisions in 2 treatment scenarios were not well predicted by orientation scores. Respondents reported role conflict, generally high satisfaction with their positions, and good working relationships with offenders. Their overall attitudes toward offenders were positive, with some reservations. Implications of the findings and future directions for the PTOM are discussed