A Day in the Life of an Honorary Practitioner with Forensic Therapies
I always try and get to the prison by 8:30am; sometimes the gate is very busy and it can take 10 minutes or so to collect my set of keys. I also like to have a chat with the prison officer on the gate and check the list of key events that have occurred in the last 24 hours. There are always several to consider and they are a stark reminder of the amount of despair and anger that is to be found within a typical prison.
Getting to the Forensic Therapies office takes me another 10 minutes as it's quite a walk from the front gate to the landings where we are based. This morning I take slightly longer as I call in to the mess and get a bacon toastie! I meet an officer who is also working with one of my clients; the officer is eager to know how my client is progressing and I am pleased to give encouraging news (it's not always that I can say that).
Once in the office I check the message book and diary for the day and then pull out my client files. I don’t have any vacancies this morning as the two clients I shall see are both long term and are likely to be in the prison for many more months. This is good in terms of the depth of work we shall be able to achieve. My first client is very engaged in their process of exploring and developing. I notice that I’m a little anxious today, as I really need to assist the second client I see in the morning to focus on their offence. I know they have been trying to avoid this. This particular client has a long history of sexual abuse and all the shame that goes with that – they also offended against a child and that is never an easy offence to talk about. It's crucial that the client does talk about it, otherwise it will remain very difficult to assess the level of risk, victim empathy and any developing insight. Reflecting on this quickly I make my way to the wing. In the morning I only have two hours to see clients before lockdown at lunchtime – the time always goes very quickly.
I arrive on the wing – it’s very noisy this morning and when I talk with the wing governor to get an update on my client I hear that there was a disturbance at the weekend. Some prisoners have been moved and others are complaining that the routine was disrupted. I’m pleased to hear that my first client is still there and as I finish talking with the officer my client comes hurrying towards me. We find an empty association room and my client is straight into the session; some important connections have occurred in their thinking since we last met. The session goes well and I notice that my client is beginning to reflect and actually remember some of the things we touched on in previous sessions.
I’m always surprised how quickly the time passes in a session when someone is genuinely engaged and working hard to understand all that has happened in their life. Sometimes, it’s beyond comprehension; on these occasions it feels very painful and I often find myself fighting very hard to hold back the emotion. Containing unbearable feelings is a key aspect of working in a prison.
My next client is resistant to talking about the offence as I recognised from previous sessions. This session therefore goes slowly. Although I am a psychoanalytic psychotherapist I work quite cognitively with this client and in this session it produces results. Very slowly, for the first time, I get what appears to be a full account of the index offence. In the following sessions I will approach this material in a psychodynamic manner and explore some of the unconscious dynamics of the behaviour – but that is going to take time. When I finish the session I notice that I am feeling quite drained. I’ve just listened to some pretty gruelling details and it has taken all my energy. I’m relieved it's lunch time and as I go back to the office I’m encouraged to hear several other practitioners discussing more mundane matters. Over lunch we catch up on other prison news; in an institution there is always much going on.
By the beginning of the afternoon sessions I have brought all my paperwork up to date. There are always quite a lot of forms and liaison to complete. In forensic work it is not safe to work in isolation and we therefore often contribute to parole reports, sentence planning, MAPPA conferences and other decision-making processes in the prisoner's life – all this takes time.
My first client this afternoon I assess is at risk of self harm or even suicide and so we spend the session discussing her suicidal ideation. I remain concerned at the end of the session and despite her protest I open an ACCT. This is a formal and vital system of reporting, aimed to manage the associated risks by providing appropriate care. At these times I am relieved that my client is in a custodial setting and is not going off alone. My second client is a new client referred as high priority due to the fact that the client's partner was killed in the offence they were commissioning together. The client is clearly in a very closed down state and has symptoms of PTSD, also not unusual in the prison setting. I invite the client to tell me what they can remember but they keep breaking down. I witness this painful process and agree to see them again next week. As I leave the wing I hope my client isn’t moved to another prison without warning – this sometimes happens and can be very frustrating.
I have more paperwork to complete before leaving and decide to stay for the debrief. I can still feel the horror of my morning client's offence account and I feel full of sadness from the last session of the day. It's important not to take this home with me, so the debrief is a most useful and effective opportunity for me to look after myself in this challenging work.
I leave the prison almost nine hours after I arrived – it seems like five minutes. I feel energised and inspired by the various thinking processes that have taken place during the day. As I walk out of the prison into the fresh air I reflect on the fact that I have been in hidden worlds for most of the day – the hidden world that is the prison itself and the hidden inner worlds of my clients – this always prompts much thinking and I guess in many ways that is just what it is all about.