November 2006

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Prison Officers in a Multidisciplinary Team
The Role of Operational Staff in the DSPD Unit at HMP Whitemoor

Steve Fox, Alan Jones, Lloyd Meadows and Ros Savage. The authors are all Prison Officers who have been serving in The Fens Unit, D Wing, HMP Whitemoor, throughout the period of its development so far.

Introduction
The Fens Unit — D Wing, HMP Whitemoor — is one of four Dangerous and Severe Personality Disorder (DSPD) units set up as a pilot programme under the auspices of the Health Partnership Directorate (Home Office and Department of Health). The Whitemoor unit was the first to be established, and has been in existence for over five years; the full treatment programme began to be delivered in January 2004, and a fully worked out treatment model is now in place.

A thoroughgoing multidisciplinary team approach has been integral to the Unit from the start. The role of the prison officer has developed over time, in a way that is recognizably continuous with the work of prison officers in any prison establishment, but has also evolved steadily. That evolution is traced in this article through three stages — from a prisoner management approach, through mediation between management and treatment perspectives, to an ethos which supports and facilitates treatment itself. ‘Management’ and ‘treatment’ are not of course mutually exclusive — both are combined in mature DSPD officer work — but the distinction is emphasized here in order to make the process of development clear.

To appreciate the way in which uniformed staff have adapted to comply with the treatment model, it is helpful to reflect on the traditional role of the ‘generic’ prisoner officer and to relate this to the development of the evolving role of the DSPD prison officer from the original opening of the Assessment Unit through to the current stage of the DSPD unit’s development.

The early days of D Wing DSPD Unit — before treatment
There has been a dearth of research regarding the role of prison officers. However, in 2000, Alison Liebling and David Price researched the role(s) of prison officers and identified six role model characteristics of associated with effective prison officers, these characteristics being: moral fibre; an awareness and effects of their own power; an understanding of the painfulness of prison; a professional orientation; an optimistic, but realistic attitude; and, finally, known and consistent boundaries. Furthermore it was added that the ‘best officers… were discerning, committed and unafraid to use force. They were neither over-eager to resort to force, nor reluctant. They were confident, physically fit (usually) and had a fairly clear sense of their broader purpose. They did not bear grudges and were enthusiastic, despite setbacks’ (Liebling and Price, p50). In the view of Liebling and Price good prison officers were ‘firm but fair’ managers of prisoners.

These role model characteristics were prominent in the selection of the staff that originally opened the assessment spur of the DSPD unit. It would be inaccurate to suggest, however, that these officers were a homogeneous group of typical role model characters. The officers came from a diverse range of prison environments: some staff had worked in traditional ‘discipline’ officer roles, while others had come fro m working with programmes such as the Enhanced Thinking Skills Programme or the Sexual Offenders Treatment Programme.

This intra-professional diversity was given cohesion by a shared sense of ‘broader purpose’; a shared belief that extraordinary effort by ‘ordinary’ staff in an appropriately resourced environment could make unprecedented progress with this profoundly challenging prisoner group. This staff group had to work with a positive optimistic approach in the face of the pessimism of the ‘nothing works’ philosophy that had been endemic in the service.

Initially, and for the first three years of the project at HMP Whitemoor, the uniformed staff had not been presented, formally or informally, with a treatment model — because no such model had yet been formulated. At this time the unit was exclusively an assessment unit and intervention was yet to commence. Indeed there was a conscious strategy not to treat prisoners, but to focus on ‘observing and assessing’. Nevertheless, despite this onus on observation and assessment the programme had a number of elements which leant themselves to modifying behaviour, if not personality. The psychology team, at that time, had devised a number of cognitive-based programmes that were designed in a format which a significant number of staff were already experienced in delivering. However, the comprehensive and cohesive treatment model we currently employ was not presented to the staff at this stage of the DSPD unit’s development. Despite the absence of an explicit treatment model there appeared to be some significant behavioural improvements during the assessment period. These gains may have been correlated to successful prisoner management and ‘tailor-made’ cognitive programmes that were focused through utilisation of the Daily Behaviour Record Scale (DBRS) — a tool for systematic recording of individual prisoner behaviour. It was thought, by some staff, that the DBRS was the ‘cement’ that held the programme together. It not only provided a useful assessment tool, but had the added benefit of allowing staff to focus on appreciating the functions of behaviours rather than simply ‘controlling’ behaviours. Even before the treatment model was effectively articulated, prison officers were already taking the first tentative steps towards adapting their professional practice to comply with the treatment model.

Mediating between the traditional ethos of ‘managing prisoners’ and the new ethos of ‘treating prisoners’, in the early stage of intervention
The commencement of ‘treatment’ proved to be a problematic process in the development of the DSPD unit with regard to adaptation of uniformed staff to a treatment model. As mentioned earlier, the uniformed staff had a shared sense of a broader purpose, however there was a lack of clarity of how this was to be achieved in the medium and longer terms. There was awareness that the work of the DSPD unit would grow increasingly clinical, however it was unclear how uniformed staff’s role would adapt to accommodate this process.

Up to this point in the DSPD unit’s development the uniformed staff had achieved significant success, in terms of reducing problematic behaviour, with this challenging prisoner group by applying a management model to the care of the prisoners. Running parallel to this process the clinical team were developing an increasingly treatment-orientated programme. It should be of no surprise that tension developed between the both these models and the professional groups that championed them. It is well established that while a management model and a treatment model are not mutually exclusive they do act in significant tension to each other. The following table identifies some of the key elements of each model. It can be seen that some elements are complementary while others contrast with one another.

This tension proved to be a significant dilemma for uniformed staff (as it did for non-uniformed staff). The uniformed staff had seen the prisoners’ behaviour, on assessment, improve radically and it appeared to be, at least in part, a result of their enthusiastic application of high quality ‘jail-craft’ (management of prisoners). The imminent ‘clinicalization’ of the DSPD unit generated professional anxieties over the potential destabilisation of the DSPD unit prisoners’ behaviour.

As the treatment of prisoners on the DSPD unit gathered momentum it confirmed that the management model and the treatment model could, and would, clash with each other. The dilemma was complex. The prison officers were acutely aware of primary, and non-negotiable, functions such as ‘keeping in custody those committed by the courts’ and keeping the good order and discipline of the establishment. These functions, by their very nature are restrictive. A treatment model that sought to understand challenging behaviour rather than suppress it, and validate the prisoner rather than punish him, was increasingly challenging this inherent restrictiveness and undermining traditional understandings of the prison officer role. While the prison officers were enthusiastic to look at new ways of protecting the public, through the potential of a therapeutic milieu, there was some anxiety that should the uniformed staff forget their primary functions this could have a detrimental affect on the good order and discipline on the DSPD unit. The enthusiasm to support effective ways of ‘treating’ prisoners on the DSPD unit was tempered, with mindfulness to matters of security and good order, resulted in some modification to the perceived role of the uniformed staff. The professional practice has maintained a tight focus on its prisoner management functions, but there evolved a mediating function where staff endeavoured to support the treatment of prisoners, where, explicitly and unequivocally it did not pose a threat to security or good order of the DSPD unit. While this adaptation was progressive, it was still a significantly restrictive practice. Elements of the treatment model such as ‘understanding function of behaviour’ and offering ‘exploration and change’ were difficult to support fully as such elements threatened, in principle, to ‘destabilise’ the prisoners and, potentially, disrupt the good order of the unit. It might be more accurate to suggest that the prison officers were, at this stage, making adaptations in regard to supporting the clinicians, so the clinicians could apply the treatment model, rather than supporting the model per se. The adaptations made by the prison officers were not so much an intellectual response to a more appropriate model, but rather an adaptive strategy to cope with inter-professional tensions related with relinquishing some elements of role that had, previously, proven to manage prisoners effectively. Whilst that model had previously been effective, it was now showing its vulnerabilities with this particular prisoner group.

Managing and mediating through to supporting and facilitating
As the DSPD unit evolved and the prisoners made progress on their therapeutic development it became evident that the management model was not the panacea it was previously thought to be. At times, the rigid application of the management model appeared to collude with the prisoner’s personality disorder, undermining his treatment and, moreover tending to compromise good order rather than facilitate it.

This was a difficult time for the prison officer group’s sense of identity. Up to this point in the evolution of the DSPD unit the prison officers had achieved their professional objectives, with significant success, performing familiar and trusted traditional roles. There had been a process of partial adaptation, whereby the prisoner officer group mediated between the management model and the treatment model in an effort to reduce inter-professional tension and explore ‘new ways’ of working with a prisoner group that historically, had resisted the rehabilitative process. However, the role of the prisoner officer within the DSPD unit treatment programme was in flux.

The process of flux to re-formation, and a more meaningful adaptation to complying with the treatment model came with increasing staff awareness of Personality Disorders and Schemas, through formal and informal staff training, and information sharing on staff briefings. Through this training, albeit piecemeal, staff became increasingly competent at making sense of the prisoners’ behaviour in the context of their personality disorders. The ability to understand the behaviours, in regard to PD, proved to be a great benefit in ‘managing through means of treatment’. Rather than treatment conflicting with the management of prisoners it was beginning to be seen that by working towards ‘emotional safety and containment’ that ‘physical safety and containment’ would follow. It appeared that there were elements of the treatment model that actually empowered uniformed staff to manage and maintain the good order of the DSPD unit, rather than undermine it.

The experience that ‘treating’ prisoners had the potential to empower staff in the execution of their core tasks as prison officers, moved the DSPD unit closer to a paradigm where the profession felt increasingly able to support the treatment model in relation to its stated aims, rather than just for its utility in managing prisoners that responded poorly to the management model.

This appears to be a critical stage in the adaptation of the professional practice of uniformed staff to comply with the treatment model. The officer group had moved from the practice of ‘mediating’ between the management model and the treatment model, eventually to finding themselves authentically supporting the treatment model (while still achieving the objectives of
the traditional management model), and ultimately co-facilitating the treatment model.

The next section provides an overview of the treatment model’s key assumptions and outlines the some of the adaptations made, by the prison officer group, to work within that model whilst still holding the role of maintaining security within the Unit.

The key assumptions of the treatment model and the professional practice of uniformed staff

1. The treatment model must be capable of meeting multiple needs of diverse clients with diffuse problems and varying levels of insight and motivation.

Meeting multiple needs of a diverse range of clients calls for effective multi-disciplinary working. Historically, uniformed staff have tended to be charged with much of the control and delivery of both formal and informal offending behaviour work. This professional unilateralism was evident in the initial assessment unit programme. However, as the intervention unit’s treatment model began, it became evident that Livesley’s assertion that the ‘optimal treatment strategy’ may be ‘an integrated approach using a combination of interventions from different approaches’ was very much the future of the DSPD unit. Accordingly, this indicated that the prison officer group would be required to adapt to a level of multi-disciplinary working that, traditionally, the professional group was relatively unaccustomed to. This adaptation manifested as a process of yielding some ‘authority’ (over managing prisoners) and gaining some new responsibilities (treating prisoners). The prison officer group had to also become aware that ‘one response did not fit all’. Prisoners with different personality disorders required different responses to similar behaviours as the aetiology of those behaviours and thus function may be different. This required a fundamental shift by prison officers in understanding of behaviour and thus management of that behaviour. This can only be achieved by close working and consultation with the clinical team.

2. Personality has a survival function. In order to modify personality, the treatment model must enable the individual to find ways to meet their survival needs utilising a less-dysfunctional style.

This assumption of the treatment model proved to provide a profound challenge to the professional practice of the uniformed staff. At times it demanded that the uniformed staff on the DSPD unit had to make radical adaptations to the way they worked with prisoners.

For example, one not uncommon scenario was that some prisoners would become extremely refractory in order to achieve being relocated in the segregation unit as a dysfunctional survival function. Similar behaviour exhibited in other (non-DSPD unit) areas of the prison would routinely see the refractory prisoner relocated in the segregation unit, without any examination of the maladaptive function of this behaviour for the prisoner. Whereas, on the DSPD unit, the requirement for physical safety and good order became to be increasingly assessed alongside interpretations of whether the use of segregation was colluding with the individual’s dysfunctional style. Prisoners that would have been previously segregated were, increasingly, ‘treated’ and managed successfully on the Unit in an attempt to assist the prisoner develop ways to meet their survival needs in a less-dysfunctional style. More generally, as the unit evolved the uniformed staff developed an awareness that, at times, the work group might be colluding with the prisoner’s PD by taking the default uniformed staff response to managing challenging prisoner behaviour. It became evident that such incidents could be managed in a pro-treatment model, while still minimising the risk to physical safety and good order to a reasonable level. The professional practice had to adapt, in this area, to take risks to work with prisoners in new ways that might, at times, seem to be highly inappropriate to the broader professional group, particularly other uniformed staff and Governors who were unfamiliar with the dynamics of working with prisoners who meet criteria for the DSPD treatment programme. These risks were taken, however, to help individuals to find ways to meet their survival needs utilising a less-dysfunctional style, which is a core element of the treatment model. This adaptation necessitated that the professional group develop a ‘thick skin’ and the professional confidence in its own ability to support the treatment model in a style that did not comprise the groups ‘prison officer’ role. In addition this had to be achieved against a background of peer scepticism and, at times, censure.

3. ‘Maladaptive behaviour persists over lengthy periods, because it is based upon perceptions, expectations or constructions of the characteristics of other people that tend to be confirmed by the interpersonal consequences of the behaviour emitted’ (Carson, 1982). Any treatment model must be equipped to disconfirm the perceptions, expectations and constructions of each individual prisoner if it is to enable the individual to achieve lasting change.

Working with this assumption has proved to be somewhat more problematic for the prison officers on the treatment Unit. While the uniformed staff group are keenly focused on the potential to collude with an individual’s behaviour as a result of his personality disorder, during a ‘serious incident’, it appears that it is during the subtlety of mundane daily relationships that the prisoner group are most effective in encouraging staff to collude with these dysfunctional behaviours and thus maintain their modes of functioning. This process can often be clearly seen immediately after individual counselling sessions, or psychodynamic groups, where a prisoner has felt that a long-held maladaptive behaviour has been threatened and attempts, through their own behaviours, to reconfirm the validity of that maladaptive behaviour with the uniformed staff on the spur.

This is an area the DSPD unit are currently are acutely aware of which needs addressing at the earliest opportunity. Currently staff are engaged in training, focused on individual prisoners that will offer staff an understanding of the way in which behaviour ‘pulls’ from officers’ particular responses that maintain dysfunctional schema. The training highlights the ways in which prisoners try to encourage collusion with these behaviours and offers to staff ways of appropriately disconfirming the perceptions, expectations and constructions of that individual prisoner. The uniformed staff group recognise the problem and are aware of the benefits of adapting, but know that it will take a considerable degree of training so that all staff are equally aware of how to work with each individual prisoner.

4. Personality does not change in the absence of a profound, emotional experience. Treatment attempting to change personality must contain opportunities for new emotional experiences (McRae and Costa, 2003).

A feature of working with prisoners who meet the criteria for DSPD treatment is that the working environment can become very emotionally charged. However, prisons generally tend to restrict opportunities for emotional expression. The traditional prisoner management model is a contributor to this controlled emotional environment with its focus on ‘preventing challenging behaviour’, ‘containing difficulties’ and ‘restricting opportunities’; encouraging prisoners to calmly ‘do their time’. The uniformed staff have adapted their professional practice by gaining an insight into how pivotal emotions are in the treatment of these prisoners and attempting to facilitate the treatment model objectives. Examples of these include: providing opportunities for emotional expression and reflection and offering validation and support. The professional practice has moved from restricting the expression of emotion, to striving to limit each prisoner’s opportunities to present himself in the preferred interpersonal style, so that he may access those underlying emotions that he is avoiding. In short the professional practice has adapted to work in a way that allows the prisoners the freedom to express their underlying fears, anxieties, sadness, anger and frustrations, rather than to suppress them.

5. Treatment of offending among those who have been traumatized requires that their own trauma is also treated (De Zulueta, 1993). The treatment model for those who have not only committed acts of extreme destructiveness but have themselves been victims of extreme abuse should meet the needs of individuals who are not only perpetrators but have themselves been victims.

This is an element of the treatment model that the uniformed staff appear to have adapted to with relative ease. It might have been anticipated that this transition from perceiving prisoners almost exclusively as perpetrators to perceiving them as both ‘victims and perpetrators’ would have been particularly problematic. However, the uniformed staff have been able to appreciate the correlation between the prisoners’ victim experience and their criminal behaviours and understand that treating the individual’s own trauma is critical to risk reduction. Officers spend time in both group and individual work helping prisoners make sense of their own experience of victimization. They also support the work of the individual therapists by enabling prisoners to further process traumatic experiences by, when appropriate, talking to officers about their experiences.

Areas in which officers actively participate in the treatment programme

Stage 1: Emotional engagement
• General therapeutic alliance between prisoner and wing staff
• Safety and Containment
• Managing acting-out behaviour and establishing boundaries
• Developing emotionally meaningful relationships
• 1:1 interactions with Therapist, Personal Officer and others
• Relationships — stable nurturing, consistent and able to tolerate the prisoners’ anger and distress without resorting to punitive responses

- Collaborative Case Formulation
- Individual Therapy
- Cognitive Interpersonal Therapy Groups

Role of the officers
Prison Officers first roles are to begin to build up trust and disconfirm predictions of prisoners of how officers will behave.

Assessment
The officers provide secure but humane boundaries by managing acting-out behaviours in a manner that aims to differ from the prisoners’ previous experiences. The officers run daily groups in which the initial aim is for prisoners to be able to stay in the room with other prisoners for 50 minutes. The eventual aim is for prisoners to feel safe enough to be able to offer opinions and express thoughts and feelings within a group situation. The individual time prisoners spend with officers talking about a range of issues also acts as the beginning of developing meaningful relationships with staff.

Treatment
The emotional engagement continues by the ongoing development of emotionally meaningful relationship with both officers and clinical staff. Prison Officers are sometimes asked by prisoners to ‘sit-in’ in their individual therapy sessions to facilitate those interactions. Officers are also allocated to work as facilitators within cognitive interpersonal groups. The knowledge of the officers is also important in working towards the collaborative case formulation.

Stage 2: Problem Recognition
• Understanding how personal problems affect all aspects of life
• Awareness
• Developing insight
• Building motivation for change

- Ongoing Therapy
- Cognitive Interpersonal Therapy Groups
- Psycho-education Groups
- Personality Disorder Awareness Groups
- Relationship Groups

Role of the officers
Officers spend some considerable time helping prisoners recognise behaviours that have become problematic. They aim to highlight how these behaviours have impacted on aspects of life and they are particularly important in helping develop and maintain the prisoners’ motivation. In addition to the cognitive interpersonal therapy groups, officers also co-facilitate psycho-education groups. This includes Personality Disorder Awareness and the Human Relationships group.

Stage 3: Exploration
• Recognising sequences of events that lead to problem behaviours
• Identifying alternative coping strategies

- Individual Therapy
- Cognitive Interpersonal Groups
- Schema Therapy Groups
- Psycho- educative affect regulation

Role of the officers
The additional roles for prison officers at this stage is to participate in the Schema Focused Therapy groups and Affect Regulation groups. During this phase of the treatment officers are very actively involved in providing disconfirming responses for the prisoners to help challenge their dysfunction schema and also to work closely with clinical staff to support the prisoners in identifying and dealing more appropriately with their emotions.

Stage 4: Acquisition of Alternative Behaviours
• Acquiring new skills
• Developing different coping strategies
• Inhibiting old behaviours

- Individual Therapy
- Cognitive Interpersonal Groups
- Schema Therapy Groups
- Affect regulation Groups Offence Focused Groups and Individual work
- Substance Abuse Work

Role of the officers
The work of the officers will be focused on identifying prisoners using old strategies, helping them inhibit this behaviour and developing more effective problem solving and coping strategies. The officers will also take part in the Offence Focused groups and Substance Abuse groups.

Stage 5: Consolidation and Generalisation
• Applying new skills in everyday situations
• Recognising an array of emotions
• Identify when experiencing emotions
• Learn to tolerate emotions

- Individual Therapy
- Cognitive Interpersonal Groups
- Ending Groups

Role of the officers
In addition to the above tasks, prison officers will support prisoners in consolidating their new coping strategies in diff e rent situations and in experiencing and managing feelings around ending their work within the Unit.

Conclusion: Summary of the Role of the Operational Staff
In order for the professional practice of uniformed staff to be effectively compatible with the treatment model there has been a radical challenge to the fundamental prisoner management role of the traditional prison officers. For those professionals already in the business of ‘treating’ individuals the adaptation to the treatment model may have seemed more of an exercise in consolidating their role. However, uniformed staff were faced with a direct challenge to the efficacy of the traditions of their own professional practice. This challenge required them to ‘give away’ a significant amount of authority to manage prisoners, which was exchanged for a new set of responsibilities, primarily being the treatment rather than the management of prisoners.

At the current stage in the development of the professional practice of uniformed staff it is evident that many of the staff have been relatively successful in finding ways to show increasing involvement in the treatment of prisoners, while satisfying their generic role functions. There is, however, an identified need to train staff to be more skilled in doing various aspects of this work and for prison officers to be supported by being given and participating in clinical supervision.

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