Therapy and/or Punishment: Part I

Philosophical Musings On Therapy In The Correctional Setting

I think it was around age 13 or so that I knew I wanted to be a psychologist. While I have since actively pursued said dream, the way this has unfolded has shifted throughout the years.

For the longest time, I saw correctional counseling in my professional future; often as the only future I wanted to picture. As a very passionate advocate of therapeutic praxes at the intersection of systems, that was the ultimate goal. But then life happened, as it so often does, and my goals and dreams took me to different spaces, literally and figuratively, of systemic healing work.

As an undergrad senior, however, I had the privilege of interning at the Korydallos correctional facility in Greece.

One measure of knowing that an experience has been fulfilling and has made me grow is by assessing how many questions it has ignited within me and the imperative nature of their exploration. In particular, my experience in Korydallos sparked so many questions regarding the role of therapy itself, the concept of institutions, the social representations of dangerousness and criminality, as well as the criminal justice system in particular that defines which acts require punishment and/or therapeutic intervention. And it’s that and/or that is so fascinating to explore:

Is punishment independent from therapy?

Are we talking about a manichaeistic binary of punitive sentences and well-intentional, benign therapy?

Or can therapy itself be a form of punishment in this context?

How does therapy fit into the “corrective” paradigm it finds itself in? Is there a de facto need to “correct” something? And who has the power to dictate what requires correction?

How often can therapy in the correctional context be self-governed in a context that is by definition other-defined, that is a “total institution” according to Goffman?

How does psychology, and psychotherapy in particular, contribute to institutionalized behavioral control?

How do we alternately move between the criminalization and psychiatrization of “deviance”, between surveying/imprisoning/controlling the body to the mind, between punishment and correction?

How often is the biomedical model, stamped with “objective” scientific approval (cloaking moral imperatives), appropriated by psychologists/psychiatrists in order to medicalize and marginalize otherness?

How is the inherent power differential, already present in every therapeutic relationship, reinforced in this setting? How might it contribute to further patronization and/or victimization? How does it influence not only the content but the therapeutic process?

And how can the therapeutic methods used inhibit or facilitate the creation of a genuine therapeutic alliance?

Let’s take CBT, for example (Cognitive Behavioral Therapy). CBT is perhaps the most popular form of therapy right now, and it has been widely hailed as the most effective, evidence-based intervention in treating many different types of classified disorders (see: eating disorders, depression, anxiety, etc). It’s a guided and structured type of therapy that is typically short-term. It targets and challenges faulty patterns of thinking and changes those dogmatic/ irrational/ catastrophic/ black-and-white thoughts. Therapy here is seen more as a guided learning experience, where folks learn to challenge old ways of thinking and acquire new ones, and develop skills in problem-solving. It sounds pretty great, right? It is, and I would argue that there are some risks inherent in solely utilizing CBT interventions in any context but especially in the correctional one.

I feel like by focusing on one’s thought patterns and how these affect one’s emotional/cognitive/physical state and actions it becomes very easy to overlook the systemic factors that contributed (and still contribute) to the therapeutic (or “rehabilitative”) issue at hand (see: interplay with systems: courts, police, prisons, schools, mental health etc).

This type of therapy can easily move from highlighting accountability, which is a necessary component of personal growth, to assigning personal responsibility — assuming that one need only will the regulation of their behavior by regulating their thoughts. This process is called “responsibilization”, and the way it underlines all these personal variables can make oppression seem like an issue of choice.

I also tend to be pretty allergic to formulas that pathologize various types of thinking without often looking at the root causes of their formation. Formulas that often localize said pathology by attributing the cause of one’s suffering within the individual.

But let’s say that one chooses a different form of therapy, or a combination of different tools with the goal of serving these folks effectively.

Is therapy in a de facto stripped-of-freedoms setting even possible? Can this essentialized space of non-self-determination foster or even make time/space for exploration of issues such as personal growth? How much is this also influenced by the ideas re: immutability of characteristics that make up labels such as “personality disorders”?

This discussion will continue in Part II, coming soon :)