Ahu Kocak & Amy Rugendyke

AMC

Group Schema Therapy in

Prison

Presentation Overview
Introduction

AMC and Current offender specific programs at AMC

Schema Therapy
Schema Therapy for Forensic Populations

Quiz
Group Schema therapy at AMC
Description of the therapeutic format
Statistics & Feedback

Future Directions & conclusion

The AMC - Alexander Maconochie Centre

430 Bed prison ; currently expanding to
reach 539.
29 Female beds
2 Cell blocks
30 Special Care
5 Cottages
1 TRC cottage
10 bed suicide, 14 bed segregation unit

Mixed classification, mixed security,

remand and sentenced
No transfers must deal head on with the
long term and short term needs.
Change behaviour can not change
environment.

Current Offender Treatment Programs at AMC

Cognitive Behaviour Therapy (CBT) is currently the
principal method employed in offender treatment
programs seeking to reduce recidivism.
CBT is the core premise that dysfunctional beliefs
and behaviours are cognitively mediated, and can be
modified to bring about positive outcomes.
For significant traumatic histories, or long-standing
patterns of maladaptive behaviours, identifying and
challenging those thoughts considered maladaptive,
becomes increasingly difficult as they have little
evidence to support the contrary.

The benefits of standard CBT approaches for this

chronic population can be argued as less effective.
Focus on behaviours rather than overwhelming
emotional states and its aetiology.

Schema Therapy

Integrative, unifying theory & treatment

Used to treat complex presentations and need
seeking traits and behaviors'
Focus on core human needs
Focus on childhood experiences and early adult
relationships.
Experiential methods added to Cognitive &
Behavioural methods
Therapeutic relationship used to meet needs and
repair early relationship-representations (safe
attachment offered).

Schema Therapy
Schemas
Modes
Child Modes Emotion
Coping Modes
Behaviour
Parent Modes - Cognitive
Emerging evidence is
promising

Healthy Adult

Compliant
Surrender

Demanding
Parent

Vulnerable
Child

Angry
Child

Punitive
Parent

Conning
Manipulator

Impulsive
Child

Enraged
Child

Parent Modes

Happy
Child

Child Modes

Coping Modes

Group

Schema Therapy
Common use with borderline personality disorder with impressive
results

Adapts the standard approaches to ensure full group participation.

create a family dynamic which enables therapists to re-parent

group members.

Increases learning experiences through modelling and vicarious

learning.

Group format is a likely catalyst in the change process.

The GST program randomised control trial (Farrell & Shaw)

100% retention rate

94% no longer met the diagnostic criteria for BPD.
All improvements remained at a six-month follow-up.

Schema Therapy in forensic settings So

What..?

Bernstein and colleagues adapted the individual ST

format for use with forensic patients, and in 2013 the
therapy was approved in the United Kingdom for use in
forensic hospitals.
Explicitly links modes with criminal, violent, and
addictive behaviours, and managing these forensic
coping modes becomes the focus of treatment.

Cognitive awareness strategies and experiential

techniques can be developed to express anger in a
constructive way, improve frustration tolerance, reduce
impulsivity, and enhance reliance on more healthy
forms of coping

Bully and Attack: Uses threats,

intimidation, aggression and coercion to
get what they want. They directly harm
other people in a controlled and strategic
way emotionally, physically, sexually,
verbally, or through antisocial or criminal
acts.
Predator: Focuses on eliminating a
threat, rival, obstacle, or enemy in a cold,
ruthless, and calculating manner.
Suspicious Over Controller: Attempts to
protect themselves from a perceived or
real threat by focusing attention,
ruminating, and exercising extreme
control. A person in this mode is likely to
be perceived by others as being extremely
jealous and controlling.
Conning Manipulator Mode: Will con,
lie, or manipulate others in a manner
designed to achieve a specific goal that
benefits them and is likely to either
victimize or hurt others. It is common for
people to use this mode in order to
escape punishment.

Schema Therapy in forensic settings And Why..?

High rates of childhood abuse, Post-Traumatic Stress

Disorder and personality disorder diagnosis.

Offenders with personality disorders, particularly those

with high psychopathic traits, are three times more likely to
generally re-offend and four times more likely to re-offend
with a violent crime.

Offenders dealing with complex trauma histories are likely

to suffer intense emotions and physiological reactions.
Unsurprisingly, these highly reactive individuals with
complex psychosocial histories present as challenging
clients in therapy and in prison dynamics.

I need to do better, I hate myself when I realise I am in here. I

think you sh*t, fat idiot, you can never do anything right..I
have never done anything right
So I smoke pot, so the pain is not so bad, you know..
I feel outraged..like when noone cares and I am ignored so I
lose my sh*t
so I [want to] hurt them, show them I am worth listening to, I
dominate and get feared
It makes me feelexposed, sad, scared even..
I dont talk, just shut down, usually stop going to the group
SometimesI just do what they want, like clean the whole
pod, give my stuff away, its easier that way..
I feel like I can do what I want, noone can tell me otherwise,
rules are stupid here
I told him he cant treat me that way, im not like the other
prisoners , I can read for starters..he is obliged to give me an
explanation
sometimes I think its not worth it. The bigger picture is its
their job to do, and there Is no winning..I just want to do my
time and get home..At the end of the day I am responsible for
my actions

Angry Child

Undisciplined Child

Happy Child

Vulnerable Child

Compliant Surrender

Detached protector

Detached self soother

Self Aggrandizer

Bully and Attack

Conning/Manipulative

Punitive Parent

Healthy Adult

Group Schema Therapy at AMC : Mode Awareness

and Management (MAaM)

So far we have completed two groups, and commenced a third.

Referral Criteria: disruptive need seeking/ problem behaviours,

min. 8 months remaining on their sentence or remand period,
and a willingness to integrate with detainees of a different
security classification to themselves

Exclusion Criteria: Evidence of an active psychotic disorder,

possible autism spectrum disorder, and/or charges of child sex
offenses

Pilot Group Schema Therapy at

AMC : MAaM
Manualised with clinician manuals and
participant workbooks
2 facilitators psychologists trained in
Schema
2 individual sessions screening and
developmental history
20 group sessions, once per week 90-120
minutes each, with a 10 minute break
2 follow up sessions upon completion
No external or monetary incentive

Group Schema Therapy at AMC : MAaM

Identify needs and dominant maladaptive coping modes.
focus is placed on understanding why maladaptive coping
modes may have developed, and negative consequences of such
modes.

Goal: meet the need of connection and belonging, as evidence

contrary to their schemas of defectiveness and abandonment

Reparenting, empathetic confrontation of maladaptive attitudes

and behaviours, limit setting, and unconditional positive regard.

Focus on meeting the need of acceptance and encouraging

intrinsic motivation for change.

1. Group cohesion
Connectedness
Understanding childhood
needs
Safety and connection
Positive regard

3. Mode management
Behavioral
Experiential
Crime tracking

2. Mode awareness

Cognitive awareness
Insight
Motivation

1:1 session - rescripting

4. Mode change (introduced only)

Behavior pattern breaking
Values
Goals
Relapse prevention
closure

Statistics and Feedback

Statistics

Low numbers mean no conclusions can be drawn from quantitative data

but there is promising trends in descriptive and qualitative data.
Drop out rate 0% (high motivation to engage)

Psychometrics include pre and post :DASS, PANAS, TLV, Social Self Esteem,
and Fear of intimacy all showing good results so far.

Effect of program on behavior change, diagnostic criteria for Cluster B and

Recidivism? Too soon to tell. However only 5% of completed participants
have received internal disciplines post program (contraband related).

Feedback

Therapeutic community, other clinical and other programs staff high

interest and good feedback

Custodial Staff commenting on behavioural changes of detainees after

program completion

From detainees VERY POSITIVE FEEDBACK, high interest

many self referrals

To the question: the best thing

about this group is ..

Informative and enjoyable

Learning to stop and think of consequences
Life skills
We never had new teachers or participants, always the
same so we could trust them

Realising I am basically good and can better myself

To the question: The worst thing

about group is...
It ending
The days I was sick and missed out
There was nothing bad
It finished
It went for too long
The homework

To the question: compared to

other groups at AMC this group
is...
Its extraordinary and different
It heaps better
I haven't done others I get kicked out

Is not just for parole its for me

Was fantastic should be more like this

To the question: any other

feedback?
Best program

The future prospects for this group are high I believe

There could be more one on one sessions if possible

I enjoyed every session

If there is ever a part two I would sign up straight away

Looking forward to putting it all into practise

Please don't change this group! Ever!
Thank you for my new life

Future Directions/Limitations
Cost-benefit analysis
Longitudinal analysis
Recidivism
Severity of offence/problem behaviour

Community corrections
Female detainees
Generalizability

Uniform Staff Training

Refresher/Maintenance Modules
Relationship between intervention and change of
behaviour not yet statistically known

Conclusion
The MAaM GST program has a strong
therapeutic focus while also attempting
to address criminogenic needs and
maladaptive behavioural patterns. The
program appears to have resulted in
positive outcomes for detainees with
complex presentations, personality
disordered traits, and traumatic
histories. Feedback from participants,
other clinical staff and case management
has also been positive.

Relationships matter: the currency for systemic

change was trust, and trust comes through forming
healthy working relationships. People, not programs,
change people. Dr Bruce Perry

Thank you for your efforts and support. Don't

give up trying to get through the walls, and
remember anything man made can be
unmade Bill (participant)

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