Non-Traditional Therapies in Forensic Populations: Benefits of Human-Animal Interaction, Art Therapy, and Meditation-Based Interventions
Art Therapy with Forensic Populations
Artistic expression is observed as an essential aspect of incarceration that manifests in myriad ways, including murals painted by inmates on cell walls, craft shops, envelopes containing letters to loved ones that are elaborately decorated, and tattoos intricately designed and displayed with pride. An “artist” in prison is often regarded with respect and elevated status among peers, and a number of such individuals have even been able to find mainstream popularity outside of prison walls (Gussak, 2007; Johnson, 2008). Prison art programs serve well-established functions, including as therapy that humanizes prisoners, by producing respectable pieces of art, providing alternatives to damaging behaviors, in turn, creating a safer environment (Johnson, 2008). Eight benefits art therapy programs have been delineated by Gussak (2007): 1) art is accommodating to disabilities common in forensic populations, such as illiteracy and organic issues, 2) art allows for simple expression of complex material, 3) art allows for safe disclosure by inmates, 4) art promotes disclosure despite fears of vulnerability,
5) art can bypass intentional and unintentional defenses, 6) art can be clinically beneficial without verbalizing the intervention, 7) art encourages creativity and provides diversion and escape from the harsh prison environment, and 8) art allows for expression that is acceptable both within prison and outside the institution.Treatment Outcomes for Art Therapy in Forensic Populations
Art therapy in prisons is often incorporated as part of a Cognitive-Behavioral based program and has proven to be especially adept at evading resistance by inmates as art therapy masks the therapeutic process and allows individuals to safely express themselves within a threatening environment. General findings of art therapy in prison include revelations of previously suppressed feelings, increased self-insight, and improved ability to deal with the stressful prison environment, all implications for treating those who suffer from anxiety, depression, and drug abuse as a means of self-medication (Johnson, 2008). David Gussak of Florida State University has been extensively involved in developing and implementing art therapy programs within a number of prisons in the United States. In order to examine the effects of art therapy, Gussak conducted a quasi-experimental, pre-test/post-test study in a medium- to maximum-security prison with 48 male inmates, all of whom were diagnosed with an Axis I disorder such as Bipolar Disorder and Major Depression. After a month of attending art therapy classes that met twice a week, participants were again assessed, and the results revealed statistically significant reductions in depressive symptoms and increases in positive affect. Participants also exhibited improved compliance with prison administration and greater prosocial interactions with peers (Gussak, 2004). A quantitative, true-experimental follow-up study was conducted the following year and, despite a number of limitations to the study, the results were replicated in that inmates showed significant reduction in depressive symptoms after participating in art therapy (Gussak, 2006).
Two additional studies by Gussak followed in which the researcher examined how art therapy affects locus of control in depressed inmates and the differences of treatment outcomes between male and female participants. Gussak addressed female inmates’ increased susceptibility to depression and anxiety and subsequent self-medicating drug use as a result of more frequent histories of trauma, increased pressures to maintain familial stability from prison, and staff members’ observed tendency to infantilize female inmates. All of these factors contribute to the proclivity for female inmates to have external loci of control at greater incidence than male inmates, defined as attributing control over one’s life to outside forces as opposed to believing in the power of one’s agency to define the circumstances. As with his previous studies, Gussak found that art therapy for both male and female inmates resulted in decreased depressive symptoms, increased positive affect, and improved socialization. Females responded to art therapy with greater rates of significance than the male sample and also exhibited increased autonomy and a more powerful response to the supportive group dynamic (Gussak, 2009).
In 2008, two graduate students of Florida State University conceived the Inmate Mural Arts Program (IMAP) and completed the inaugural project with 14 incarcerated male participants. The goal of IMAP and the first project was to assist inmates with developing problem-solving skills, helpful for dealing with anxiety while incarcerated as well as post-release, and to encourage greater positive socialization among the participants, a goal that directly works against the effects of prisonization. Indeed, through extensive teamwork conceptualizing and planning the mural as well as executing its creation on a prison-chapel wall, the participants demonstrated mutual respect for the contributions of each member and learned to calmly give and receive constructive criticism from their group members. Additionally, the inmates displayed great pride in their work and reported feeling a sense of accomplishment after completing the mural that, ultimately, resulted in a greater sense of positive self-regard, findings that have implications in working with depression and the effects of prisonization in a therapeutic forensic setting (Argue, Bennet, & Gussak, 2009).
Similar to HAI programs, art therapy shows to be effective in generating positive therapeutic changes in offenders who suffer from affective and anxiety disorders or symptoms as well as those who are affected by prisonization. Also like HAI, Art Therapy has a limitation in that it requires resources in the form of art supplies or therapists to lead groups. Considering the restrictions of the prison environment, it is important to explore interventions that can be executed without much, if any, expenditure on resources or extensive assistance from professionals, like meditation.
Meditation-Based Interventions with Forensic Populations
Meditation-based interventions have gained popularity in the United States over the last three decades as a seeming panacea across a number of populations. Hawkins (2003) summarizes dozens of studies that have shown meditation to be effective in promoting physiological balance and decreasing biochemical markers of stress, reducing depression and anxiety, improving self-esteem, emotional maturity, and cognitive clarity, and increasing overall positive affect, among a number of other benefits. Due to its adaptability, meditation-based interventions (MBIs) present as particularly useful techniques for affecting change in criminal behavior, which manifests uniquely in each offender as a result of an unspecified combination of social, political, physiological, economic, and psychological factors (Goodman, Walton, Orme-Johnson, & Boyer, 2003).
MBIs most commonly utilized in correctional settings include Transcendental Meditation (TM), Vipassana meditation, and Mindfulness-Based Stress Reduction (MBSR) (Himelstein, 2011). Maharishi Mahesh Yogi, in the 1960s, popularized in the West the practice of Transcendental Meditation, a state of being defined by simultaneous cognitive alertness and physiological tranquility. TM is designed to result in an individual’s development of a more sophisticated experience of consciousness that ultimately leads one to transcendence of suffering and duality. The practice of TM is encouraged to take place twice a day for 15-20 minutes per session with the recitation of a mantra that serves as an anchor for naturally wandering minds. Vipassana meditation is an insight-driven exercise based in Buddhism that serves to increase in practitioners an awareness and recognition of the impermanence of all things, particularly sensations, that leads to psychological detachment and full liberation of self. Practicing Vipassana meditation is a rigorous commitment as it is taught within the format of a 10-day residential retreat in which participants must maintain absolute silence and complete ten hours of meditation per day as well as agree to five moral precepts: abstinence from intoxicants, sexual misconduct, lying, stealing and violence. Mindfulness-Based Stress Reduction, or MBSR, was developed by Jon Kabat-Zinn in the late 1970s as a derivation of ancient Asian meditation techniques and modified for accessibility by Westerners who were not necessarily motivated to meditate for spiritual reasons but, instead, to manage conditions such as chronic pain. Three primary techniques comprise MBSR: careful attention to breathing while in sitting meditation, “body scanning” while in a lying position, and a series of Hatha yoga postures. Instruction is delivered over 8 weeks by both a teacher and through the use of audiotapes; at the conclusion of the 8-week period, participants can continue Mindfulness with a practice that they are able to individualize to best fit their needs. The goal of MBSR is to cultivate passive awareness of one’s ongoing intellectual processes that, ultimately, leads to positive cognitive change, increased relaxation and self-control, and acceptance of life’s triumphs and trials (Himelstein, 2011).
Treatment Outcomes for Meditation-Based Interventions
One of the earliest recorded meditation-based interventions utilized in a forensic population took place at La Tuna Federal Penitentiary near El Paso, Texas in 1971. Seventeen male inmates, every one convicted of a drug-related crime(s), participated as either control- or experimental-group members in a study that guided the inmates through a four-day introductory course on Transcendental Meditation and then asked them to practice for twenty minutes twice a day for the remainder of the two-month period of the experiment. Comparison of pre- and post-test results of spontaneous skin resistance responses and MMPI profiles showed significant benefits to both the regular meditators, defined as those who meditated 60 out of the 120 possible times during the 2-month period, and the irregular meditators. Meditating participants exhibited increased autonomic stability and flexibility of cognition and behavior as well as reductions in obsessional thinking, compulsive behaviors, and rigidity, all results are effective in treating anxiety and depression in offenders as well as the effects of prisonization and the underlying motivations to abuse substances (Orme-Johnson & Moore, 2003).Continued on Next Page »