HoST: a radical collaboration in
HMP Holloway
The HoST (Holloway Skills and Therapy) project is a joint initiative of Forensic Therapies and HMP Holloway. It is funded by the Social Exclusion Project of the Cabinet Office, for three years, under the ACE (Adults Facing Chronic Social Exclusion) initiative to address the needs of the most socially excluded populations.
This project brings together honorary therapists from Forensic Therapies, and workers from HMP Holloway, CNWL NHS Foundation Trust and Camden and Islington Mental Health Trust to provide a modified dialectical behaviour therapy (DBT) programme for women who meet the criteria for Borderline Personality Disorder.
The Issue for Clients
Borderline Personality Disorder is a common diagnosis within female prisoner populations. It is generally thought to be precipitated by insecure, abusive or fragmented early experiences, which lead someone to develop a way of being which is impulsive, risk-taking, self-harming, emotionally extreme and leads to great difficulties in forming consistent or mutually supportive relationships.
Women with these behaviours are over-represented in prison populations and may be particularly prone to substance abuse, self or other harming, suicide or acting impulsively. They can be difficult clients to work with in that they find it hard to engage with others consistently and may go in and out of crises for much of their lives.
The Treatment Offered
DBT is one of the few kinds of treatment or psychotherapy which has any kind of track record in helping people with these kinds of patterns. It promotes the development of skills to manage these overpowering and destructive feelings and impulses and to support women to break some of the repetitive (and unhelpful) patterns of relationship and self harming.
Given that one of the issues for these clients is the difficulty in sustaining any contact with helping services or individuals, prison may provide a unique opportunity for these women to address what may have been lifetime patterns. Prison may provide the kind of external structure which enables them to have a stable enough context to start to make changes in their way of reacting and relating.
The Programme
The programme provides an eight-week modular programme of two skills groups a week, plus a once-weekly individual therapy session. The structure responds to the needs of a shifting prison population, where women may be moving from prison to prison or to release quite swiftly. Longer term treatments may founder under these conditions, whereas clients within HoST can do as many modules as they want, or as many as their length of time in Holloway permits.
The first module has run successfully and clients have attended their ‘graduation ceremony’. The early feedback seems to indicate that participants have found that the skills they learn do help them manage the destructive impulses that they experience daily.
The Future
Personality disorder patterns tend to be present in all prisoner populations and undoubtedly contribute to the high levels of recidivism and concurrent high levels of drug and alcohol use in these populations. Research indicates they are not successfully addressed by psychopharmacology or generic psychotherapeutic interventions.
The evidence-based nature of this intervention, the collaborative agency approach and the adaptations for a prison context give us hope that this may be a programme which could usefully be adapted to other prison populations. Forensic Therapies will be exploring these possibilities in the year ahead.