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The Treatment and Management of Female Offenders

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Abstract

The treatment and management of female offenders provide unique challenges to even the most experienced clinicians. Incarcerated women, in addition to exhibiting multiple mental health issues, trauma histories, and chronic substance use, provoke strong countertransference reactions that if not managed, threaten the integrity of any treatment endeavor. Diagnosis and assessment are essential to guiding interventions and managing the antisocial woman’s distinctive psychodynamics (Gacono, Nieberding, Owen, Rubel, & Bodholdt, 2001; see Chapters 3 and 4Chapter 3Chapter 4). In this chapter, we discuss essential clinical issues, a conceptual model of female psychopaths, management versus treatment, a treatment process including managing transference/countertransference, and effective treatment interventions. We conclude by offering a case example of the use of the assessment process in treating Anna, an incarcerated non-psychopathic woman.

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Chapter
IntroductionThe Construct of Psychopathy and Its Presence in WomenHow Psychopathic Women PresentThe Practical Management of Women With Psychopathic TraitsFuture Directions in Practice and ResearchReferences
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Chapter
About 20 years ago, Hare and Schalling (1978) edited a book on the results of the first NATO Advanced Study Institute on psychopathy. This volume contained a chapter on “Approaches to Treatment” from Suedfeld and Landon (1978) that began as follows: “Even a quick review of the literature suggests that a chapter on effective treatment should be the shortest in any book concerned with psychopathy. In fact, it has been suggested that one sentence would suffice:’ No demonstrably effective treatment has been found. ” (p. 347). In a review from the 1990s, Blackburn (1993, p. 202) drew two main conclusions: “First, while classical psychopaths have been shown to respond poorly to some traditional therapeutic interventions, it has yet to be established that “nothing works” with this group. Second, some offenders with personality disorders do appear to change with psychological treatment. ”
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This study examined 91 women entering Oregon's prison system using a combination of psychometric testing and clinical interviews, to assess their need for mental health care. The incidence of mental disorders was high in this population and rarely did the women receive only one diagnosis. Substance abuse/dependence (91%) and affective disorders (42%) were the most prevalent diagnoses that co-occurred in the majority of cases. Psychotic disorders were not often identified. Our study points to two overlapping groups of women who are need of treatment while in prison, those with affective and/or substance abuse problems.
Yochelson and Samenow's approach to treating and/or rehabilitating juvenile and adult offenders has become very popular with mental health and criminal justice practitioners, particularly for those working in juvenile or adult correctional settings. Their approach has evolved into the most publicized cognitive therapy for treating antisocial behavior. The conceptual and theoretical weaknesses of Yochelson and Samenow's work notwithstanding, the author focuses on the methodological weaknesses, giving special attention to their implications for practitioners working with incarcerated minority and female offenders. Several potential areas of research and practice for psychological criminology, mental health, and criminal justice are proposed.
Article
The relationship between unconscious defensive process and conscious cognitive style in psychopaths was empirically investigated using cognitive, behavioral, and psychodynamic measures. In the study, 39 prison inmates diagnosed with antisocial personality disorder and 18 college students were classified as primary psychopaths, secondary psychopaths, or nonpsychopaths by means of the Psychopathy Checklist—Revised. Unconscious process was elicited through presentation of a film segment of a violent rape scene and measured using a defense checklist based on Kernberg's model of borderline personality organization. Cognitive style was measured using a cognitive checklist based on Yochelson and Samenow's criminal personality model. Checklist scores were compared across the three groups. The results suggest that unconscious defensive process can be inferred from conscious cognitive style in primary psychopaths. Implications of the findings for understanding and assessing psychopathy are discussed.
Article
The authors rated 404 incarcerated female participants in a substance abuse treatment efficacy study using either the Hare Psychopathy Checklist-Revised (PCL-R) or the Psychopathy Checklist: Screening Version (PCL:SV). Participants were then randomly assigned among three treatment conditions. Psychopathy scores were significantly associated with poor treatment response with regard to program retention, removal for serious non-compliance, violent and disruptive rule violations, avoidance of urinalysis testing, treatment module attendance, and therapist ratings. Cox regression analyses indicated that psychopathy scores (particularly Factor 1 scores) better predicted new charges in the community than a combination of other variables. The authors concluded that Hare psychopathy scores can be used validly for assessment for placement, risk assessment, and individual treatment planning for female offenders.
Article
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In 1972, a federal court reinforced the deinstitutionalization of state psychiatric hospitals when they held that people with mental illness have a constitutional right to treatment (Wyatt v. Stickney, 1972). Although many states released patients and closed hospitals in response to this decision, they neglected to provide adequate community-based treatment resulting in the unintended reinstitutionalization of this population into our state and local jails. Recently, many state and local stakeholders have come together to address this situation. This article will discuss how the criminal justice system has become a primary mental health provider and strategies being utilized to reform the current system.
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This article examines the specific experiences of women in prison, focusing on previous (and continuing) physical and mental abuse, the consequent health care requirements of women prisoners, the policy response and the availability of suitable health care in prisons across the EU. It draws from an extensive review of the literature on women prisoners across Europe that was part of an on-going European Project funded by the DAPHNE programme of the European Commission, entitled 'DAPHNE Strong'. It also uses the field research from the project collected via surveys and in-depth interviews with key personnel in organisations that work with women prisoners or ex-prisoners and staff with a strategic overview of activity from the ministries of justice, police, prison service and women's support organisations. There are probably many more women prisoners with a history of domestic abuse than is officially recognised. Many of the women prison population who have experienced violence and abuse mask this by problematic drug or alcohol use as well as self-injury. These are key areas that training for prison staff needs to address. The availability of services for this group of women is inconsistent within and between countries of the EU. The political will to address the situation of women in prison, as distinct from the norms applied to men, is variable and it seems to take the determined efforts of active lobby groups to make inroads into an area of latent inertia.
Article
Traumatic victimization and associated problems with posttraumatic stress disorder (PTSD) and affect dysregulation are prevalent among incarcerated women, but there is limited evidence to support psychotherapeutic interventions for these problems in this underserved population. A group psychotherapy designed to enhance affect regulation without trauma memory processing-Trauma Affect Regulation: Guide for Education and Therapy (TARGET)-was compared to a supportive group therapy (SGT) in a randomized clinical trial with 72 incarcerated women with full or partial PTSD. Both interventions achieved statistically significant reductions in PTSD and associated symptom severity and increased self-efficacy. Dropout rates for both interventions were low (<5%). TARGET was more effective than SGT in increasing sense of forgiveness toward others who have caused harm in the past. Group therapy that teaches affect regulation may enhance incarcerated women's ability to achieve affective resolution (forgiveness) while also reducing their victimization-related PTSD and associated symptoms. Experiential-focused supportive group therapy also may reduce victimization-related PTSD and associated symptoms. Both group therapy approaches warrant further study with this vulnerable population.