“Is it better to serve in heaven or reign in hell?”
John Milton, Paradise Lost
Jon did not seem as fearsome as his reputation had made him out to be. Making his way up the prison spine, he was shorter than me with a muscular build and shaved head, no visible tattoos, and he seemed remarkably well-groomed in clean and newly ironed prison overalls. The escorting staff also knew him well, and as they casually walked towards me were in animated conversation. Jon smiled and laughed, though I noticed his eyes constantly scanned the environment, acknowledging other prisoners with brief nods or raised eyebrows as they lined up for the various morning programs. Whilst I could not be sure, it seemed that a hush descended upon the scene as congregating prisoners turned to the approaching threesome, whispering amongst each other, and appearing to acknowledge Jon deferentially.
Jon had been referred for one-to-one treatment after being removed from a group program for the intimation of other group participants. He had also recently been reintegrated after a lengthy period in maximum security. With a diagnosis of psychopathy, he was well known as a ‘prison-heavy’, with undue influence and power in the prison environment. However, his exclusion from the group programs meant that individual treatment had to be attempted to give him the best opportunity to address his outstanding treatment needs. Within the literature, whether psychopathic personalities, such as Jon, can benefit from treatment is a contentious issue, and an oft levelled concern is that such clients become better ‘predators’ (e.g., Salekin, 2002). The truth is much less convenient, and in recent years there has been cautious optimism that positive change can occur for these challenging clients (e.g., Bernstein et al., 2021; Polaschek & Daly, 2013). Forensic schema therapy, a recent innovation, uses modes, particularly the so-called forensic modes identified by Bernstein and colleagues in the mid-2000s (e.g., Bernstein, Arntz, & de Vos, 2007), as a way of making sense of the challenging interpersonal dynamics that so often make the process of therapy a harrowing one. Indeed, it’s dealing with these common problems that schema therapy comes to the fore because ‘therapy-interfering’ behaviours are understood as evidence of the client’s maladaptive coping modes. Modes that emerged in childhood to protect them, though invariably, have also become integral in their offending histories as adults.
‘I have been expecting you,’ Jon confidently asserted with a smile, an outstretched hand, and an intense stare. Softly spoken, articulate, polite, and thoroughly in control, with a disconcerting firm handshake, our five-year schema therapy journey began.
Forensic contexts differ from the more traditional clinical contexts in several important ways. Clients are typically mandated in one way or another, and whilst mental health concerns are relevant, such a focus is subordinate to the so-called’ reoffending’ risk. These clients typically will want treatment or, more precisely, proof of having completed offence-specific treatment to show decision-makers that they are fit to return to the community or gain some additional privilege. Given this context, it is perhaps no surprise that much of the focus of our initial year felt more like a long game of chess, with every session feeling like a negotiation for determining what could be exchanged and at what cost. Jon wanted reassurance that ‘it’ would all be worth his while and that he would be better off quantifiably at the end of therapy (i.e., physical privileges, community access). Of course, as a therapist in this context, such reassurances are impossible, and whilst validating his concerns, I constantly needed to ‘reality test’ his reasoning. Jon had spent most of his adult life in custody; his last time in the community had only lasted three weeks. Most of his jail time had been spent in the highest secure contexts, sometimes in maximum security or more accurately described as solitary confinement. We would later label this ‘side’ of him as ‘the Barrister ‘, an over-controller manipulative mode that sought to gain the upper hand in interactions with management (and counsellors) and obfuscate with clever debate, ‘sleights of hand’, and occasional subtle and then not-so-subtle displays of intimidation.
Jon grasped the schema model quickly, and his eventual mode map contained the expected vulnerable and avoidant modes (i.e., the abused child, detached self-soother, avoidant/angry protector) in addition to all the overcompensating modes. He found the use of modes particularly helpful as it allowed the exploration of the ‘sides’ of him that felt angry, vengeful, or simply numb without the sense of being wholly condemned, the typical felt experience in many correctional programs. Jon’s childhood was like many forensic clients, devoid of love, safety, protection, spontaneity, and fun. His earliest memories were of hiding with his mother in bushes as his enraged and drunken father roamed the house looking for them with a machete. Shortly after, his mother abandoned him to the care of his father, who died suddenly. After this, he was shuffled between relatives he barely knew and who had little interest in caring for him. There was sexual and physical abuse, drug addiction, alcohol misuse and juvenile delinquency. He spent his 11th birthday in a boy’s home. Here, being small in stature and young, he was often the target of bullies and abusers, and in the ‘dog-eat-dog’ culture of institutional environments, he learnt quickly that the only way to be safe was to be feared. By age 14, he had been raped ‘countless times’, worked as a prostitute whilst homeless, and abducted and used in a child pornography film on one occasion. ‘I realised that people are disposable,’ he reflected and recalled consciously honing his skills at identifying vulnerabilities in others he could exploit and threats to avoid or eliminate. On the streets, he mainly got by using deceit (conning manipulator) and intimidation (bully attack) to get the things he wanted, but it was wholly different in custody. It was perhaps because of the brutality of his early introduction to the institutional environment that he promised himself that as a young person returning to this environment, he would tolerate no vulnerability, and just like that the Faustian bargain was struck.
‘The sexual assaults in the boy’s homes taught me about fear and how to control others; to be scotched* was the worst thing that could happen to you, and I used that fear when I returned to prison‘
(*To be ‘scotched’ is prison slang for being raped in custody)
From his return to custody, Jon described a chronic pattern of sexual violence focused on controlling the prison environment, eliminating rivals, and gratifying himself. In schema therapy, he eventually broke down these offences detailing the key modes and mode sequences that played a part. For instance, in the prison environment, he constantly scanned for threats (paranoid over controller); anyone identified as such needed to be eliminated (predator), and his use of sexual violence on these occasions was explicitly motivated to cause maximal injury and humiliation to destroy the victim psychologically. On other occasions, he used sexual violence to relieve boredom (detached self-stimulator), intimidate the prison unit and assert his supposed authority (bully and attack) or revel in the sense of power and control (self-aggrandizer). Early in the therapy, there was only a cursory acknowledgement of his vulnerable child (‘yeah, it’s there, but I am over it’). His core activating schemas seemed primarily to be ‘mistrust and abuse’ (i.e., people are going to hurt me) or ‘entitlement’ (‘I deserve this’), and a notable reoccurring feature of the retelling of his callousness was simultaneously a sense of self-aggrandisement and menace.
For these reasons, limited reparent was complicated. Jon’s essential unmet emotional needs were safety, trust, fairness, and justice. Early in the therapy, there was very little access to his vulnerable sides, and the times we had attempted imagery, it had not gone well. Jon struggled to close his eyes and feel safe in the room. When he could do this, he did not sit with vulnerability for long and flipped into a menacing and scary overcompensating mode or wholly detached.
In these harrowing moments, I learnt that it was essential to remain present physically and psychologically speaking (I was scared and wanted to run), and, as best as I could, be empathic but also authentic and genuine about the effect of his behaviour on me. I noticed that by repeatedly being able to link his current coping modes to his appalling child abuse history and conceptualising his reactions as understandable given this context, he started to soften. He had always been labelled a ‘monster’, and whilst a part of him revelled in the notoriety, the label was heavy to bear and came at a significant cost. Always being ‘on’ (i.e., hypervigilant) and ready to respond to challenges was exhausting, and the physical toll of fighting accumulated. In our fourth year, Jon spoke about vulnerability and love. He had an intellectual sense of these things and an emerging awareness that being safe, understood, and genuinely cared for by another would be good. He occasionally wept when talking about these things and could intellectually recognise the overcompensating modes for what they were. The imagery was still challenging for him, and he preferred chair work for debating with the avoidant and overcompensating sides. His vulnerable child could now be in the room, but accessing it remained problematic and complicated.
Given his institutional history, it was perhaps inevitable. One day when I attended the prison for our regular session, I was informed that he had been returned to maximum security. Seeing Jon behind the bulletproof glass in handcuffs was difficult, and in our initial session here, I could see that the Barrister was in full flight. “There’s a misunderstanding… how does one actually define consent?… It’s not what happened, Lars, it’s what you can prove!. In subsequent sessions, Jon seemed more authentic though resigned and reflected, ‘Maybe this is all I am. When I walk out of here eventually and into a unit, I own it and everyone in it; why would I give that up?’ In prison, memories are long, and grudges are held, the higher you are in the dominance hierarchy, the greater the fall. Having some understanding of Jon’s reign of terror, I understood the implications of letting go of the overcompensating modes and the dilemma he confronted.
Because of the additional charges, the institution eventually stopped our sessions. Over time, Jon had become increasingly despondent about his prospects for the future; however, he remained engaged in our sessions but often wanted to only talk about how he had been feeling and the new hobbies he had developed. In our final session, he looked like an accountant shuffling into the non-contacts booth with a trim greying bread, round glasses, and a middle-aged paunch. He told me excitedly about having passed the initial semester of a university mathematics degree, ‘Hah, not bad for someone that only completed schooling to grade seven,’ he gloated but then became teary, said thank you and immediately called the officers to take him back to his cell.
Months later, a retired priest supporting Jon contacted me, asking whether I would be on his parole application as his therapist. He spoke confidently about Jon’s innocence and the impending court matters; I nodded politely thinking about Jon’s Barrister mode and how convincing it could be. I, of course, agreed to see Jon should he gain release, but I knew that this would not happen any time soon.
Jon would undoubtedly represent one of the most extreme presentations in a forensic context. Schema therapy was attempted with him over five years under challenging circumstances, and whilst this was ended prematurely, there was evidence that this had benefited him. Towards the end of our time together, he was able to be vulnerable, the size of the overcompensating modes had reduced, and he verbalised acknowledgement and desire for connection and love. I believe that some of the key ingredients to this progress was the ‘in the moment’ limited reparenting moments of being authentic, compassionate, and warm, however, also setting limits to the overcompensating modes and holding these aspects of him accountable. And, of course, there was time. The five years of working together using the schema model provided the opportunity to embody a predictable, consistence, and genuine attachment.
References
Bernstein, D. P., Arntz, A., & de Vos, M. E. (2007). Schema-Focused Therapy in forensic settings:
theoretical model and recommendations for best clinical practice. International Journal of Forensic Mental Health, 6(2): 169–83.
Bernstein DP et al (2021). Schema therapy for violent PD offenders: a randomized clinical trial.
Psychological Medicine, 1–15.
Polaschek, D.L.L. & Daly, T.E. (2013). Treatment and psychopathy in forensic settings.
Aggression and Violent Behavior, 18, 592–603
Salekin, R. T. (2002). Psychopathy and therapeutic pessimism: Clinical lore or clinical reality? Clinical Psychology Review, 22, 79–112.
