Category: Incarcerated Individuals

The Imprisoned Brain: Psychotherapy with Inmates in Jail

Posted on by Psychotherapy.net Team

Officer Smith

There’s a strange smile I get from one of the correctional officers at the county jail where I do psychotherapy with inmates. The correctional officer?—?let’s call him Officer Smith?—?presides over the maximum security wing where one of my clients is housed. Officer Smith is not a talker. None of the small-town, yessir/nossir politeness or the jocular workaday chit-chat of some of the other COs. Just that smile?—?every time he buzzes my client out of his cell, shackles him up, escorts him to the multipurpose room where we do therapy, right up until he locks us in and steps away.

It’s an iceberg kind of a smile?—?the only visible portion a slight jut at the corner of the mouth; the rest of it looms somewhere beneath. And it conveys something different to me every day?—?anything from benign fascination to good-humored skepticism to impatience, disapproval, or even outright disdain for what I do (some COs refer to the jail counseling program as the Hug-A-Thug program). When Officer Smith smiles, I find myself smiling back, and I find myself feeling those same things?—?ranging from fascination to disdain?—?for what he does too.

It occurs to me that Officer Smith and I have been smiling at each other for months now across some kind of unbridgeable rift, and I’ve gotten to thinking about what that rift might be. We are alien to each other in so many ways. But strip away titles for a moment, his of Correctional Officer, mine of Psychologist-in-Training. Strip away disparities in age and physical stature. Strip away hierarchy and authority. Strip away every other superficial difference and I’ve realized that what really stands between officer Smith and me is this:

Mario

My client. His inmate. We’ll call him Mario. A lifelong addict who nearly killed a cyclist during a meth-induced paranoia. A man facing 25 to life for a third strike offense. A survivor of horrific, repeated, unchecked sexual and physical abuse since the age of four. A gentle, remorseful, introspective man who would almost certainly use and hurt someone again if he were to be let out of prison. A man who has sought professional help since his teens to no avail. A criminal and a victim who embodies the saying “Hurt people hurt people.”

And this is the rift: Every week Officer Smith and I smile at each other across Mario. And Officer Smith’s smile is saying “You think you can change him, but you can’t.” And my smile is saying “You think he can’t change, but he can.”

And my intractable fear is that Officer Smith may be right.

During a recent session Mario presented me with a thick document compiled by his public defender. The document presents a detailed, chronological account of the sexual and physical abuse Mario endured as a child, as well as his early exposure to drug-use by his own mother. Mario wanted me to read it because he didn’t feel comfortable talking about it. He sat there as I flipped the pages and I don’t know if my expression changed when I read the phrase “screws and bolts forcibly inserted into the anus,” or any of a dozen other phrases like it in the document. And then there were the accounts of his own crimes. His addiction and extreme aggression. The police report describing the raw and bloodied face of his ex-wife. The abject deeds done to support his habit.

Beautiful and Precious

Sometimes life just boggles the mind. It can so quickly overload our meaning-making engines?—?“hope” is one of these meanings, just like “justice”?—?that we are left slack-jawed and blank. During so many sessions Mario talked about what he would do if he got out?—?how things might be different for him. But at the end of each session Officer Smith would be there to unlock the door, and his smile would be there too, saying, “This guy?—?he’s gotten out before. He’s used again, hurt someone again, and gone to prison again. You think talking is going to change that? Talking?”

He has a point. And after reading Mario’s file I’ve felt the searing truth of that point?—?the cold, hard biology that I believe is the real mass beneath Officer Smith’s iceberg smile: that the human cerebral cortex doesn’t stand a chance against the reptilian brain. Reason, Abstract thought, symbolism, language, complex planning and executive function?—?the mainstays of talk therapy, and the very things that we insist set us apart from and above the rest of the animal kingdom?—?are imperfect and meager evolutionary tools in the context of our animal condition. My inability to make sense of the horrors of Mario’s life; Mario’s repeated relapses into drug use and violence. Inevitably?—?Officer Smith’s smile would surely insist?—?the higher brain fails to explain the world, and it fails to legislate our behavior in it.

Of course as a therapist, I’m trying to give Mario an emotional experience, not just a cerebral one. But it doesn’t change the fact that my tools for doing so are words and gestures. Mario’s own limbic system has far more potent tools?—?tools that can make even our highest, most uniquely human endeavors seem trifling. We revel in the fact that art can move us to tears, churn our stomachs, increase our heart rates, make us laugh, fill us with desire. But the limbic system can evoke these sensations with less effort and a great deal more intensity. A breathtakingly attractive person could walk by. A spider could scurry from beneath the blanket. You could be beaten, isolated, drugged, fed, fucked. Threat, reward, pain, appetite?—?art is nothing compared to this. Art is the neocortex trying desperately to emulate its older, more successful sibling. In the process it squawks and hollers about truth and meaning and humanity. But what do we generally know about the loudest ones in the room? They’re usually the weakest. The mammal in us is a quiet, ancient, powerful force. Our cortex is a small, yipping dog, ever making threats and pronouncements it can’t back up.

“Life is precious,” it insists. But I’d guess Mario has had a decidedly more animal experience of it; to the criminal justice system, to his community, to his own family?—?life was and is cheap, violent, and appetite-driven. “Life is beautiful,” our meaning-making machine cries. But it is also ugly and terrifying and senseless and painful. Nor, as we would sometimes like to believe, is even ugliness the sole domain of human behavior. Reading about Mario’s childhood, I was tempted to think, “Only humans are capable of such atrocities.” But this is just another way of setting humans apart, of maintaining our own centrality in the tapestry of life. Copernicus might have warned us of the unfolding truth?—?that the great discoveries have been a series of decenterings, of dethronings. The Earth is not the center, nor is the sun. The possibility of life beyond this planet is now a probability. And everywhere there is life, there are atrocities. Sea otters rape baby seals to death for sport. Chimps kill and dismember their own kind. Infanticide, gang rape, and physical and sexual abuse of the young and helpless are practiced?—?in the complete absence of any threat to survival or territory?—?by all manner of mammals including lions, dolphins, penguins, and meerkats. Put a rat in a cage with a lever that dispenses an opiate, and the rat will choose that lever over food, family, and ultimately, survival. We are distinctly human, yes. But far more damningly than the human condition, we inhabit the Animal Condition.

That is what Officer Smith’s smile tells me. “Let it go. They’re animals. We all are.”

And I’m almost convinced.

Except that when he smiles, I’m smiling too. And what’s that about? Defiance? Wishful thinking?

The validity of Officer Smith’s skepticism of psychotherapy is not lost on me?—?and in fact it’s helpful. When we attempt to impose the will of the higher brain, we should know what we’re up against. Any addict in recovery will tell you: taming the mesolimbic pathway?—?the brain’s reward system?—?takes a cortical feat of immense, sustained, almost unbelievable proportions.

And yet people do it.

In the overwhelming majority of significant battles, the animal brain may win; but every now and then, for some reason, it doesn’t. A torture victim finds a life beyond nightmares and flashbacks. A serial abuser tames the animal urge to hit, to hurt, to maim, and talks instead. An addict finds a way to stay sober in the face of blaring environmental and emotional cues to use.

But the thing is, the vast majority of these people?—?the ones I know of anyway?—?were only able to pull off their supermammalian feats in the context of relationships. Healthy, loving relationships. And that is what Officer Smith is missing?—?that therapists bring something decidedly animal to the table, something that a man like Mario has likely never experienced, not even from his own parents. Call it what you want: attachment, safety, nurturing, connection, love. This is not a higher function. It is basic and mammal and ancient and powerful and adaptive, just like fear and aggression.

And this, I hope, is why I smile back at Officer Smith. Because at the end of that session with Mario, after I’d finished reading his file, it so happened I had to inform him that I would be missing the next week’s session due to a medical procedure. And he’d responded, “You gonna be okay, man?”

And I’d said, “Yeah, Mario. Nothing serious. I’ll be back in two weeks.”
And just as Officer Smith opened the door to let us out, Mario said, “Well, shit, take care of yourself, brother. I’ll be sending you good thoughts.”

And in that fraction of a second?—?it was just a flicker?—?I saw Officer Smith’s smile falter.

Note: I have grossly simplified the structure of the human brain in service of clarity and meaning. And of course, personal details have been altered to protect confidentiality.

Christian Conte on Anger Management

Posted on by rezendevknowfully.com

"People Don’t Just Wake Up One Day and Become Violent'

Victor Yalom: Dr. Christian Conte, we’re here today to talk with you about your work with violent offenders, with anger management, and so on. You’ve chosen to work with a rather unusual and, most therapists might think, a difficult, challenging population. What got you interested in this kind of work in the first place?
Christian Conte: When I was an intern in a master’s program, I had an opportunity to co-run a group for sex offenders. The first group I ran was an adolescent sex offender group, and the way the person who was running the group started each group was that everybody had to introduce themselves by saying what they had done to offend on someone else. And then they had to follow it up with anything had ever been done to them.

So at the time I went in, my energy was pretty high because this was my first experience. I didn’t know what to expect. The guy who was training me said, “Look. They’re going to tell you about raping little kids. You’re going to hear all kinds of stuff.” So I sat down and the person to my left started. And, he talked about what he had done to someone else and then he said, “I, myself, have been physically, mentally, and sexually abused.”

So I thought, “Okay. I can see that.”

So then the next person goes, and same thing. “I, myself, have been physically, mentally, sexually abused.” As they went around the group, my energy started to calm down as I realized that everybody had had something happen to them. And over the last 14 or 15 years since then, I found that to be true for everybody I’m working with. People just don’t wake up one day and become violent. They don’t just wake up one day and hurt somebody. They’ve had past history that leads them to do what they’ve done. So that really got me interested.
 
VY: Other than your energy going down, can you recall what other kind of initial reactions you had, thrust into that group for the first time?
CC: I was studying CBT heavily at the time, so one thing I was doing was recognizing what my thoughts were. I think I was fairly judgmental in my thoughts when I started. And then my thoughts started to shift into thinking, “What would it be like to have to introduce yourself and say, ‘This is what I’ve done’?” Because that was the very first thing that struck me, is that someone would talk about their offenses so freely.
When you live in shame, you act out of shame.


I thought, “Well this is interesting. I’ve never had this experience before.” So I think my thoughts ranged from, “How could you?” to “Wow. How difficult would it be to actually be saying this?” That was my initial experience and I left feeling like I wanted to do more work with sex offenders. I worked at a mental health institution and I volunteered extra days of the week, so I was there 40 hours a week and it was just a practicum. I was doing that much time because I was so invested in it and I had the opportunity to do it.
VY: You said you were aware of some judgmental thoughts—which, of course, is natural. But how did you handle that? What did you do with that?
CC: Well I still look back on that very first session and I was really struck by the moment—I think it was the third person that went and I remember his face getting really red as he talked about what he did. This kid was about 15 and had forced his brother to give him oral sex and his brother was very, very young, like 5. And I thought, “My gosh. What would that be like to have to sit and tell these people that? How much shame must be coming up for him?” And I still reflect on that when I think about how I’ve tried to make getting beyond shame central to my work. Because when you live in shame, you act out of shame. 

"Oh Yeah? I’m Dr. Conte Too"

VY: How did your work progress over the years, in terms of the type of population and your ideas about it?
CC: I remember a guy came in who was straight out of prison, much bigger than I was, solid as a rock. And I just had a really good connection with this guy, I could really relate to him. When I talked to my colleague about how well things were going, he said, “Well look at you.” This might be a silly thing but I had just recently shaved my head—you know, I was losing my hair anyways so I started shaving my head—and I guess I didn’t even see myself in that way, but I think other people could see me in that way. 
VY: It’s not just your hair but you’re a big, muscular, stocky guy, and you sport tattoos to boot!
CC: All of that. I think I realized my persona fits, so I started running a group to see if my approach could be effective, which it turned out to be, and I ended up running groups for violent offenders.

On my first day there the guys were in line to sign in and, as they were getting in line to sign in, a guy said, “Hey go ahead, man.” I just had a t-shirt on so I had tattoos out and everything, and he said, “Go ahead, man.”

I said, “No, you go ahead. I’m Dr. Conte.”

He said, “Oh, yeah? I’m Dr. Conte, too. Go ahead.”

I said, “No. I really am. Go ahead and get in line.” So I learned early on that my persona does help. It certainly helps me to connect with people. And I don’t feel the same types of judgments that I hear other people feel about these guys. I really don’t. I look at people and I realize, “How do I know that I wouldn’t have been different if I didn’t grow up in their world and see the things that they saw and have their cognitive functioning?” I’ve thought that for a long time. And when I started to integrate into my personal life what I believed about counseling and psychology, and I really started to integrate it through meditation, it just became a part of who I am.

One thing that my clients have always reported is that they don’t feel judgment from me. I’m going to accept you. I’m not going to accept the behavior. I mean, guys knew I was not for violence. I wasn’t even a proponent of spanking. I don’t even spank my daughter. I’m not for violence in any way. But I’ll accept you as who you are. You may have messed up. That behavior is not acceptable, we’ve got to work to change it, but I accept the essence of who you are.
 

Yield Theory

VY: That speaks to the central theory you’ve developed—you refer to as “Yield Theory.” Can you describe that in a nutshell?
CC: In a nutshell the essence of Yield Theory is based on the fundamental assumption that if I lived every day as the other person, with that person’s cognitive functioning, with that person’s ability to experience emotions, and with that person’s life experiences, I believe I would have made every single decision that that person made in life. My experience is, when I throw that on the classroom, that causes a discussion right there.

People tend to respond with, “Well I had a hard life, but I didn’t do that,” but that is not what I’m talking about. You had a hard life, but you also had your cognitive functioning and your life experiences. You had your whole perspective. So it’s just a hypothetical assumption but what it helps me see is, I don’t know that I would have done this differently. That’s just radical empathy, I think, but what it allows me to do is if a person comes in and says, “That’s it. I’m going to kill that guy“—I don’t know how many tapes I’ve watched through the years of training counselors, the first thing they’ll say is, “Let’s just calm down. Let’s not do that.” Or somehow try to stop the person.

Where I go with the person, no matter how intense it is—if they’re saying, “I’m going to kill him,” I’ll respond in kind: “You kill him then. You need to kill him. All we need to do is sit here and talk. We’ll talk for a minute, then you go kill him.” And I really let them get out everything that they’re going to get out.

The analogy is like you’re driving down the road and you come to a merge sign and you yield with somebody, and your car’s driving along next to their car. After a while in this little hypothetical experiment, they say, “You know, we’re driving the same direction. I’m going to invite you into my car.” So you get into the other car with them and now you’re a passenger, but you’re starting to see things out of their window. And after you drive on a trip long enough with someone, they start to trust you and allow you to drive, then you can steer them down a different path.
 
VY: So that’s where the name “Yield Theory” comes from?
CC: That’s where the name Yield Theory came from. You give it up to join them.
VY: So philosophically you could get into a debate about free will and whether you would make the exact same choices they do, but what I hear you saying is, it’s a useful assumption in really deeply being empathic, understanding, and trying to see things from their point of view.
CC: Exactly. The very first time—this is just coming to me right now—the very first time I ever used it, after I really thought about it and wrote about it in a little journal exercise in a master’s program, I went into this group home to work and this adolescent female came down and she talked about how she stole this other girl’s shorts. And she was laughing about how she got away with it. So I completely went with it and even laughed with her: “that’s hilarious, and she didn’t even see that coming!”

And she said, “She’s so stupid.”

And I just kept joining with her: “I can’t believe how dumb she would be to let that happen.” And it went on like this for a while. By the end of the time that we were together, she said, “You know what? That was kind of messed up what I did.” And she gave the girl her shorts back. I went with her so much and then I would pose a questions like, “You know, I wonder though, as funny as it is, if there’s a point where, if she sees that, or if somebody finds out you’re stealing from them, if people aren’t going to start stealing from you? And I wonder what that’s going to be like?” And then she started to think about it.

So the point is that once people really believe and feel that you’re with them, then they don’t have to fight any more. So it’s a work around—getting around people’s fight-or-flight responses. That’s huge.
 
VY: Whose fight-or flight-response?
CC: The client’s. I know that’s a question for people because I think that’s what happens with violent offenders. Every time I’ve ever had an intern come in and sit with me doing my groups with violent offenders, they say, “Well that wasn’t anything like I thought it would be.” 

"I Picture These Giant Guys Sitting There with Knives"

VY: In what way was it different than they expected?
CC: They say, “Well some of these guys were like normal people. They just got really angry.”

And I say, “What did you expect them to look like?” I work with some gang members who have tattoos on their heads and everything else and on their faces and in that sense, that might be a little different for some people who go to school and train to become counselors. But for the most part, you see normal human beings who have issues. And I always say, ““There are two kinds of people in the world: people with issues and dead people.””] So if you’re alive, you got issues.

When people would walk out of the group, they’d say, “Wow, that guy was a normal guy,” or, “I could relate to that guy.” So I started to survey my interns before they went into a group for the first time, to see what they were expecting. They’d say, “I just picture these giant guys who are all like sitting there with knives.” That’s what their projections would be. And they’d get in there and say, “Well this is totally different.” I think if you’re not checking those assumptions, if you’re not checking those fears and projections, then you’re going to spew them all over your clients.
VY: You were saying earlier that you became aware that your physicality, your presence, helped you connect with the clients and helped them relate with you, but what about your more typical counselor, who might be rather bookish, and probably not at all physically imposing—can they do this work just as well?
CC: Anybody can do this work. Think of Aikido. You can take someone who weighs 80 pounds and they can throw me, because basically you’re taking the person’s own body weight and throwing them. If I push, they pull. If I pull, they push. I was trained in Akido, so I thought, well, this is the same thing mentally. I’m aware I’m 6 feet, 260lbs—I’d like to say 250 for the interview, but I’m at 260…
VY: Well, it’s right after New Year’s so hope springs eternal…
CC: Right, but I know I’m a big guy and that I can take care of myself physically, but I don’t put that out there. You can watch former cops come in and they’ll run groups or work with other cops and they talk in a tough way—I don’t do that. My intention is not to say, “Look at me. Look how tough I am. If it really comes down to it, I could kick your ass.” I always maintain that “you guys are tougher than I am.” I have no attachment to that.
VY: But have you noticed any differences or any particular struggles female therapists have working with violent or sexual offenders?
CC: The person I co-founded “Balanced Life” with in South Lake Tahoe, Lacey Noonan, was amazing. What she would do is she would handle herself extraordinarily well and then in supervision, she’d come in and say, “You know what? When so and so was standing over me, I felt all kinds of fear but I pushed through it.” She would step back and look at the person and say,
“You know, I wonder if you’re aware that you’re standing over me in an aggressive way?”
“You know, I wonder if you’re aware that you’re standing over me in an aggressive way?” She said that internally she had fear but realized that, through the years, she could trust the process, that she had to stay open and genuinely compassionate.

I would kind of stand in front of people and say, “Look. It’s me. I’m the person that’s stopping you from trying to get yourself locked up. So what I say to you when I give you this direct feedback, this is to help you.” And Lacey took on that approach, too. She’d say, “I’m not here to hurt you. I’m simply telling you the stuff that’s a little bit more direct because I want to help you.” She is a smaller female and she was tremendous at this. 
VY: But she did feel fear.
CC: Sure.
VY: So how do you help therapists that are new to working with this population handle that fear and not let it get in the way of being compassionate?
CC: Lao Tzu, the founder of Taoism, said, “ If you treat the people as though they are trustworthy, then they will be trustworthy.” If I look at you and I’m exuding peace and I’m trying to talk to that center in you that I know that you can exude peace as well, I think a transformation happens. I realize as I say it out loud, it can sound out there. 
VY: Well, it can, yeah. Just to play devil’s advocate, I have not worked with that population so I don’t have that direct experience, but it can certainly sound naive. These are people that have done some terrible things and just by being compassionate, you’re going to change that?
CC: I totally agree. I think it does sound naive. Except that I’ve seen it for thousands and thousands of hours of working with people. So it’s a matter of saying, “Look, I’m validating why you’re angry at something. You’re angry at something. You have a right to be angry. Just because you grew up in a certain area, because you look a certain way, because you look physically tough, I’m validating—hey, this is what you’ve done. But the question is, do you want the results of what you’re going to do?”

I mean, there are certainly moments when things get really intense. I had a guy one time—about 6’7”, 270 lbs—and he came his fourth time late to group. He was late by two minutes. And guess what? If you’re late by one minute, I’m calling your parole officer. I wasn’t attached to that. I didn’t have emotion around it.

But I remember going up, thinking to myself, “This guy’s bigger than I am. This could be interesting.” I went up to him and I said, “Look. I can understand you’re going to be really frustrated and will probably direct some of this anger at me, but you recognize that this is your fourth time late, and that your PO has to be contacted, and you’re likely going to go back to jail.” And he turned, and for a moment when he turned, and put his head off to the side, I thought, “Okay. Well he could turn around and swing right here. I’m aware of that.” But I said, “Look, I understand. I can understand you’re fired up. If you’re pissed off, you’re pissed off.”

And, he said, “No. I know. I want to be pissed at you guys but the truth is, I know I did it. I knew I did it.”

And I just jumped on it. I was like, “That’s huge. That’s huge for you to have that realization.” I just kind of praised that part before anything happened.
 

Avert Your Eyes

VY: Have you or anyone you’ve worked with or supervised ever been physically attacked?
CC: No. No, we have not. And we’ve have worked with a lot of people who have struggled with anger. One thing I’ll do is I also teach students about turning your body so that your body language isn’t inviting that. You know, if males sustain eye contact for too long, their testosterone actually increases, so I tell people to avert their eyes. You don’t have act tough and be like, “Let me stare you down.”
If males sustain eye contact for too long, their testosterone actually increases.


I turn to the side and make sure that I’m not in a threatening pose. I’ll put my hands in my pockets. I’ll do something to make somebody feel secure, that I’m not trying to threaten them in any way. The closest I think I’ve ever come—I had a guy who came in really high. He was really high on drugs and he wasn’t necessarily that big but he was just an angry guy and he was really high. So I was just very careful with how I approached him in regard to my body language and was very respectful that he was very pissed off and said, “You have a right to be pissed off.”
 
VY: We’ve been talking about underlying assumptions, the spirit of your work, you know, countertransference—if you want to put it in that language—but let’s back up a bit and get into some nuts and bolts. Have you worked with this population mainly in a group setting?
CC: Mainly in a group setting, yes.
VY: So how do these groups work? How are they structured? Are they mandated clients primarily?
CC: For the groups that I ran out there in California for six years, they were mandated by the State of California. If you committed a violent crime, you would be mandated to 52 weeks of anger management.
VY: And this is people that have gone to prison? Or doing this in lieu of going to prison?
CC: The majority of them went to prison. Every once in a while, you get somebody who, if they had no priors and depending on the nature of what they did, they would just get mandated to group therapy. That was few and far between.
VY: So they come out of jail and….
CC: They come out of jail or prison, and they’re mandated to spend 52 weeks in this two-hour anger management group. There were specific rules, obviously, that they had to follow for our program to maintain certification. So they had to be there at a certain time, they had to be two-hour groups, you get a 10-minute break. It was an open group so people were coming in all the time.
VY: About how many members?
CC: We would have 25 people in groups, which is way over the standard recommendation for group counseling which is eight to ten group members. But even though the groups were open and really big, we would get people sharing as though it was a closed group. I thought that was profound, the way that people would share, and I believe it was due to the atmosphere that was created for them. They were going to be accepted no matter what. I always said, “Whatever thoughts about what you want to do, talk about them. I don’t care what you want to do, let’s talk about it. I’d rather you talk about it then pretend like you’re not having these thoughts.”

So over the course of my career I developed over 100 exercises I would do with these groups at various times and I’m actually about to publish a workbook on anger management that includes all of them. So I’d take something like Gestalt therapy, the five phases of psychopathology—the phony, the phobic, the impasse, the implosive and the explosive—and I’d turn that into an exercise.

The Phony Phase

VY: What would an exercise look like, for example?
CC: So I’d start out by describing what the idea was—I’d tell them about what each layer was, but I would try to use the language that worked for them. So instead of saying, “there’s a phony layer,” I might say, “This guy, Fritz, called it a phony layer. It just kind of means that we’re superficial, we’re fake sometimes.” So then I’d teach this idea to them, and then I would give them a worksheet where they would detail, “How have I been phony in the past? How have I been phobic in the past?” I always asked, “How have you been this way in the past?” Rather than, “Were you this way?” Because if we say, “Were you?” they’re going to say, “No. Not me. I was never that way.”

Or I might take a Johari Window—I would take that and then I’d make a worksheet out of it. “So how are you in each one of those blocks?”
 
VY: So you do exercises like that where people would do some reflection, share with the group as a whole?
CC: Everyone would have something written down and then we would process what was going on. So I would give whatever topic I was going to do, and I’d talk about it for a little bit, and then they’d fill it out. If I had a particularly quiet member for a long enough period of time, and I wanted to draw that person out I could say, “What did you have there for that one?” And they’d feel confident to have something to look at. But basically we’d morph it into a process group at that point. Very powerful. Then I’d always end groups by asking them what they were taking away from the session.
VY: So when you say “a process group,” would you do much interpersonal here-and-now work, where people would give each other feedback in the moment?
CC: Absolutely. Right there in the moment, what was going on then, what was happening inside of them. Sometimes I would let things get heated, because I felt confident I could handle it. And there were one or two times where I would step in and say, “Okay. Now we’re going to step back for a minute and let’s talk about what just happened.” But again, it wouldn’t be judging them or scared or “break it up.” It would just be, “Okay. Let’s talk about this. Let’s stop right here for a second. Let’s hold on.” I tried to create an atmosphere of respect for one another by giving them respect, so they would listen when each other talked. There were 25 people in the room, so if somebody started a side conversation, I would say, “Hey, let’s stay focused right here. We’re always giving somebody respect, whoever’s speaking.” And they would. It was a very respectful atmosphere.
VY: Do any examples pop into your mind? Any recollections of heated moments that kind of stand out to you that you were able to use in a therapeutic manner?
CC: Well one time this guy was talking about how he beat this guy up, which ended with him kicking the guy in the head. He wasn’t proud of this moment, and his face started to get flushed as he told it. He said,
“I was kicking him in the head and I just, when they pulled me off, I was just, like, ‘What’s wrong with me? What did I just do?
“I was kicking him in the head and I just, when they pulled me off, I was just, like, ‘What’s wrong with me? What did I just do? I don’t understand what I just did.’”

And then, in the back of the room—boom, boom—this guy just started pounding on the floor, really loudly, with his foot, stomping on it. And it kind of echoed through you. And he said, “What the fuck is wrong with a human being that would step on somebody’s face?” He didn’t realize that, not only was he putting that guy down who finally owned up to what he did, but he was intimidating everybody in the room because he was getting so fired up, his testosterone’s flowing, as he’s pounding his foot.

I let it get heated and then somebody else defended the other guy: “Man, he just said he felt so bad about it, he couldn’t believe he did it. And look at you!” And he responded, “Look at me? I can’t believe you would do something like this.” Meanwhile, this guy himself had done some horrific stuff, so it was shadow projection.

And that was one of those times when I stepped in and I said, “Alright, now listen. Let me say something. Let me just say something. I don’t know if you’re aware of this, but as you were pounding your foot on the floor, the rest of the group members—and even me, I was feeling, ‘Whoa, this is some heavy energy.” He didn’t get it at first, so I switched it over to the other guy and said, “That was huge for you. I think he misheard what you were saying, because I saw your face and I saw how you finally had that feeling of, ‘Wow. I can’t believe I did that.’ And I really appreciate that you even got to that spot or that you would share that with us.”

So I’m trying to validate him. And then I said, “Now what else happened here? Do you notice how the group divided? Some people who happened to be sitting by him were were agreeing with him—let me ask you guys, were you really in agreement with him or was it because of where you were sitting?” So then we started to talk about how they would just naturally come to somebody’s defense just because they’re sitting right next to them.

It ended up being super powerful. We took a break—and I didn’t take a break until we had moved the energy in a different direction—but when we came back, I used humor to get it going at first, which was very helpful. And then we started to talk about it again, and the guy who had been pounding his foot said, “Man, I’m sorry, I just got so into that story.” And then he admitted, “I’m having a bad day.” So he was able to kind of work through it. That was one of the most powerful experiences; it was intense.
 
VY: Do you ever physically stand up?
CC: Most of the time I was standing already, but there were times that I would walk forward, just use my energy to cut somebody off or to say, “Okay, let me stop you right there for a second.” I definitely have used that energy in that way. I get that from being a professor. If somebody started to have a side conversation in class, I just walked over to that direction and, all of a sudden, there’s no side conversation.
VY: It sounds like to be effective, you need to feel in control.
CC: I think so.

Motivating Mandated Clients

VY: Would there be voluntary clients and mandated clients in the same group?
CC: Yes.
VY: So what was the difference? A lot of therapists think it’s hard to do treatment with mandated clients, that they don’t have the motivation. What are your thoughts?
CC: I’ve made a career out of working with mandated clients, so I don’t believe that at all. I think it’s our job to find out what their motivation is, and a lot of times people’s motivation, especially with this population, is, “I don’t want to be in prison. I don’t want to be sitting in this cell.” At the end of the day,
I’ve sat down with enough big, strong, tough people, who one-on-one will break down and cry and tell me how they don’t want to be sitting in that cell.
I’ve sat down with enough big, strong, tough people, who one-on-one will break down and cry and tell me how they don’t want to be sitting in that cell. That is a huge motivator.

I’ll say, “I’m going to make a wild guess that you don’t like rules. So why are you going to make decisions to put yourself in a place where they have tons of rules for you?” So I use that as a motivator for any mandated client, from adolescents all the way up. I had a new adolescent male in my practice the other day, it was my first time seeing him. His mother made him come, and I said, “Well that’s pretty shitty. She’s making you come sit across from this dude, a crazy bald-headed dude.”

And he kind of smiled and looked away. And I was like, “Man, I can’t believe she’s making you do that. It’s messed up. What do you need to do to not have to come here anymore?” And then we kind of worked through the goals that way.
VY: Any other general strategies, principles, to work with violent offenders, sexual offenders, that differ from standard therapeutic practice?
CC: Something that was a typical approach for anger management for the longest time was that people would have to write letters and read them out loud to the group about what they did and why they felt so bad. I strongly disagree with this type of perspective, forcing people to take accountability when they’re not ready to. All they do is learn how to say whatever needs to be said in front of the official people, without actually working to change.

So I never force people to take accountability. I never say, “You need to say this,” or “You need to feel shame about what you did.” Never. Because if you shame people, they’re just going to act out again. If you think you’re a no-good son-of-a-whatever, you’re going to keep doing it.
 

No More Letters of Apology

VY: So that first group that you led, where people had to start out saying what they had done, really made an impact on you.
CC: It did, but even more than that when I started to work with violent offenders because they had to read letters of apology for what they did, and the very first time I sat in on a group with violent offenders, I listened to what people really said: “No this is horse shit.” “You’re supposed to say this in it.” “No, no, hurry up, man, get an eraser. You’ve got to say this.” “Just say this word right here, you’ll make that dude happy.” They just said what they were supposed to say.

Since that time, all these years later, I’ve visited people in prisons and talked to people, and that’s still what they do. They’ll say in their writings whatever the therapist tells them they’re supposed to say so they can check the box and say they took accountability, but it’s not actually happening. So I threw that out before I started. There was no way I was doing that.

The first week I took over the groups I said, “No more of those letters. Those are out the window. We’re not doing that anymore.” Of course people would come in and think, “I did nothing. I didn’t do anything. I shouldn’t be here. I shouldn’t have to be experiencing this.” But over time, in accepting them and showing them and teaching them…Look if you meet one asshole in a day—what is the saying?
“You meet one asshole a day, that person might be an asshole. But if you meet five in the same day, you’re probably the asshole.”
“You meet one asshole a day, that person might be an asshole. But if you meet five in the same day, you’re probably the asshole.”

If you keep going to jail over and over again, you’ve got to be doing something wrong. So maybe everybody in the world’s messed up, or maybe it’s you. Maybe you need to start working on yourself. A statement I often said was, “Look, we’re all human beings. If a human being does it, it’s human nature. So if you do it, let’s just explain it. Let’s figure it out.” A lot of guys would comment that it helped them when I talked about it that way, “That’s just human behavior. So you got pissed off. So you hit somebody that you wish you hadn’t hit. Let’s learn from it; let’s move from here.”
 
VY: You’re passionate about what you do, and you take an optimistic and hopeful approach, which is certainly a good thing. I mean, if we can’t be hopeful about the clients we’re working with then probably we shouldn’t be doing it. But there’s certainly some thought in the field that there are certain people—we often label them “sociopaths”—that are just untreatable, unreachable. What are your thoughts on that?
CC: In all my years, I had only one person who I said was not right for the group setting. He was really locked into his worldview. He was intimidating physically and would get people to kind of join. I thought he was detrimental to the group setting, so I recommended him for individual treatment. I remember talking to his probation officer and he said, “In 30 years, he’s the only person who, when he goes to the bathroom, I have my hand on my holster on my gun.” He said, “My hairs on the back of my neck stand up.” The guy was an imposing figure, for sure. And I do think that some people probably need to stay locked up. I understand that that probably is that way for some people.

But I believe everyone can change. I still think human beings are worth it.
What I don’t see is how we’re not spending more time and more effort on trying to genuinely rehabilitate people.
What I don’t see is how we’re not spending more time and more effort on trying to genuinely rehabilitate people. Not make people write accountability letters that they’re faking, but genuinely change. Because if they’re going to come back out in society, why not have more intense programs that are really life-changing and affecting their whole psychology? Not just saying, “you’re angry,” but looking at their whole being. There are people that probably have a much more limited chance to change than others but I still want to remain hopeful that it’s possible for anybody to change
 
VY: Are there major mistakes or pitfalls that you’ve made or that you would caution other therapists about who are new to this population?
CC: Hmmm. Which ones do I want in print is the question?

I made a huge mistake one time with an adolescent male who told me about his drinking. I used Yield Theory, kind of went with him, validated him. I was a school counselor at the time and I ran out of time to talk to him, so all he got was validated about his drinking. He left and that was it. And I thought, “What the hell did I just do?” I validated his perspective, let him think it was okay, and I didn’t give myself enough time to actually complete what I was going to do.”

You Can Definitely Kill This Person, but…

VY: Yeah, you mentioned before that you validated this person’s desire to want to kill someone. So once you validate that, what do you do after that?
CC: You have to have the time to know that you’re going to finish the interaction. But what I can do faster now is I can move more quickly into options for people. So what I wasn’t able to do back then and what I can do now is within a statement or two, get into the options. “You can definitely kill this person but let’s think, let’s play it out real quick: If you do it, what’s going to happen?”

I’m kind of like a coach and I’ll use that metaphor a lot with men I work with—“You’re the pro. I’m just here to run some options by you. You can run this play and here’s the likely results; you run this play, here’s your results.”
 
VY: This reminds me a bit of Motivational Interviewing. We just did a video series and an interview on Motivational Interviewing, and I know that was an approach originally developed for addictions. It’s now been applied to healthcare and criminal justice. And it’s ultimately about respecting that the client—it’s their life and they’re ultimately going to make their own decisions. But given the challenges of your clients, when you’re discussing options with them do you really stay neutral? Because there’s a risk of just telling them what to do, which they’ve heard all their life; but it seems that there is also a risk of supporting, empathizing, validating them, and not taking a stand about, “Hey, maybe it’s not a good idea to kill someone.” What are your thoughts about that?
CC: That’s a really good question. It’s tough, especially when you watch yourself on tape, to say that your voice doesn’t go a certain way when you provide the option that you hope they’ll choose.
VY: Right.
CC: So I can say that I stay neutral, but I’m sure if I saw myself on tape, I make some options sound a bit more enticing than others. And not killing somebody—I want to make that sound good, so I probably end with it. I start with the option that they’ve been thinking of and I go with it. But I really play it out. “So you go kill him. Let’s play it out. So, you get arrested, or maybe you’re on the run for a little bit. What’s that like, when you’re on the run? Tell me about that.” My experience has been that when people do that, it’s almost like learning from experience in the future—now—by playing out their options.
VY: So your hope is that by doing that, they’ll make the right decision, but without pounding them over the head with it.
CC: Right.

Yield Theory for All

VY: So you’ve been talking mainly about your work in groups. What pointers would you have for a therapist who doesn’t have a particular focus or experience with this, but encounters in their private practice, a patient—maybe you’d call them “borderline” or whatever—but who really struggles with rage, aggression, acting impulsively and self-destructively. What advice would you have for them?
CC: Let’s say you’re struggling with someone with a borderline personality disorder, and you want to teach them a new skill, and you’re getting wound up in so much resistance and feeling stuck. That’s the moment to implement Yield Theory and really get into their worldview, and watch—just try it on, something as simple as that and watch how that will shift things for you.

And then it’s a matter of skill, of teaching the options. So for somebody struggling with borderline personality disorder, it would be about helping them become aware of what they’re doing, with mindfulness, and kind of going with them, yielding with them in a way that allows them to feel safe enough to become aware of themselves, and then helping them become aware of what’s happening in interactions between them and others.
VY: What would you advise students or beginning or experienced therapists who are wanting to work with this population or have the opportunity to work with them?
CC: As you said, I’m super passionate. I’m really an intense person and I’m really passionate about what I do. I was really passionate about students looking at their own lives, just like I’m passionate about looking at my own life and looking at mistakes I’ve made. I’m pretty effective at not repeating mistakes, but I’m really creative at making new mistakes every day. So I really try to look at my own life every day and ask myself, “Am I living according to what I’m trying to preach and what I’m teaching?”

But the reality is, as a supervisor for the last decade in this field, watching people’s tapes, listening to students, the bottom line is, the majority of people in our field are fairly judgmental. They’re opinionated, they try to get their opinions across in therapy sessions, and I see that a ton.
The bottom line is, the majority of people in our field are fairly judgmental.


One exercise I would do in class is, I would draw a normal bell curve, and I’d say, “This bell curve says that the majority of you, in this room right now, are going to fall right here. You’re going to be average counselors. That means when people come see you with their emotions, trusting you with their lives and telling you about their life, you’re going to give them an average response. You tell me where you want to be.”

Of course, every student would go and mark the top and say, “I’m going to be this elite counselor.” And I’d say, “Well what’s it going to take to be there? You have to read incessantly. You have to learn about your life incessantly. You have to be passionate about saying ‘What am I doing in my personal life?’ You can’t be super judgmental in your personal life and then walk into a session and just think all of a sudden you’re not going to be super judgmental.” So I really try to get people to practice what they preach. 

Let’s learn more. What are our biases? What do we think? What do we really believe? What are we attached to? I teach a lot about confirmation bias and the idea that people get so locked into, “This is my religion. This is my politics,” that kind of stuff. They hate the other side or don’t like the other side and then go into a counseling session and can’t separate themselves from that.

 
VY: Really attending to our own growth, our own biases, is a refreshing perspective, especially in this day of “empirically validated treatments,” where it’s all about the technique and not about the therapist. So I really appreciate your passion about that.
CC: I like the way you’ve rephrased it. That’s much more concisely said than what I said. I like the idea of counseling as an art, and it’s never which martial art can win, it’s which artist, as a counselor, can be effective? And so we’ve really got to learn about ourselves. I think we’re charged with doing that. I think we have an oath with saying that we’ll do that in our personal lives. People who do that become very effective counselors.
VY: Right. Well I think that’s a wonderful note to end on, so I want to thank you for taking the time to share this with us. For readers who want to get more of a sense of who you are and the spirit of your approach, we’re delighted that we’ll be releasing a video of you coinciding with the publication of this interview. I would urge people to take a look at that, as well.

The Tao of Anger Management: A Yield Theory Approach

Posted on by rezendevknowfully.com

“The gentlest thing in the world overcomes the hardest thing in the world.” —Lao Tzu

Brian had been incarcerated for taking a baseball bat to his girlfriend’s truck with her inside of it; he then pulled her out and beat her unconscious. He was out of prison and in my anger management group for two weeks when he reported, “What I did may have been too much, but she deserved it because she stole my money.” He claimed that he shouldn’t have gotten in that much trouble because it was “my truck anyway,” and besides, she “slipped and hit her head on the ice.” Brian was still in the precontemplation stage of change: he didn’t think he had a problem.

Things got worse before they got better. The following week Brian was furious when he came to group, complaining that he had been called in by his probation officer two days in a row to be drug-tested. The only reason for this, he claimed, was that his ex was “sleeping with a cop.” In a state of rage, his face flushed, his fists and feet pounding wildly, he shouted about police corruption and denounced his ex-girlfriend, the “whore” who was just out to get him. 

Instead of asking him to calm down, take a breath, or do anything other than be where he was in the moment, I simply validated him. I imagined what the world would look like from Brian’s perspective as I said, “Man, that’s just plain messed up.” I knew that Brian didn’t know anything other than what he knew in that moment, and he needed someone to see what he saw, so I went with him further: “You know, it sucks that you work so hard to be sober, and then people go and pull this shit, and test you even more.” I paused briefly, made a projection about what he might be thinking and added, “I mean, they tested you literally, but they’re also testing your limits too. It’s like they’re trying to set you back.”

He responded emphatically, “Exactly! They’re pushing me!”

“You know what?” I said, “this was kind of messed up, so I’m not even going to ask you to calm down right now.” I paused, shook my head, and waited for a moment before continuing. “In fact, even if this is supposed to be anger management, it would be stupid for someone to think you need to learn from this right now, because you have a right to be pissed off.”

He nodded his head in agreement, and he was visibly calmer, so I went on.

“I’m not going to tell you to learn anything from this right now, but let’s say this was tomorrow at this time, what do you think you might say about this experience?”

“I don’t know.” He paused. I waited. “I guess I would say that I probably overreacted.”

I then said, “I’m not going to say that you overreacted because it was really messed up, but, I don’t know—I wonder if this was like a week later… I wonder what you’d say about this experience then?”

 “I don’t know,” he said. “I guess I’d say that probation has a right to test me two days in a row in case I’m using or something.” He was calming down more, and moving more and more into his frontal lobes.

So I said finally, “Look, I know you’re pissed off, and I see you’re hurting about this, and we don’t need to talk about this tonight—but if this were a month from now, I wonder what you might say about this whole night?”

Almost completely calm now, Brian replied, “I guess if this were a month from now, I would probably look back on this night and see that I was still doing the same thing I always did: blaming her for me not wanting to be drug tested.” 

The shift occurred. The door was open to future work. 

Behind the Mask

"Treat the people as trustworthy, and they will be trustworthy." —Lao Tzu


When Brian came in furious and outraged, it could have elicited fear in me—he was, after all, an imposing figure—but I knew that Brian wasn’t angry at the world or at me; he was angry at having to take responsibility for something unpleasant. When that happens, people are usually blinded with rage, but not likely to hurt someone they don’t know. Brian was scared to face the world without what he had come to depend on: drugs to alter his state of mind. He was not ready in that moment to genuinely be accountable for what he did—so that was not the time to get on a soapbox and criticize his actions. 

More importantly, Brian didn’t scare me because I am armed with the knowledge that anger masks fear. Just as you wouldn’t walk into a costume party and believe that goblins and monsters are suddenly alive and dancing with each other because you would know it was people dressed in costumes, so too do I see that when people are angry, they are wearing a mask to hide what is really going on inside them. It was important for me to trust the deepest part of Brian’s essence: the part that is, in my view, inherently good. 

As a therapist, my goal is to facilitate people’s journey through the depths of their undiscovered psyches in a way that helps them move beyond the battle of the ego/true-self dynamic so that they can find, hold, and live in expanded consciousness. My working assumption is that the essence of people is much deeper than what we can see on the surface. This assumption helps me view people as vastly greater than their actions, and infinitely more than any pain and suffering they have caused or experienced. 

I specialize in working with people who have been convicted of violent crimes: murder, rape, and the abuse of others. The work is not easy, but it is some of the most rewarding work that I have ever done, due in part to the amazing transformations that I’ve witnessed throughout the years. I’ve watched gang members gain awareness and perspective enough to walk away from their gangs; I’ve seen people who train as fighters walk away from street fights; I’ve seen people who have spent their lives believing that life is about getting “respect,” make incredible changes and learn to more deeply respect themselves and the world around them. 

“No one sets out to be defined by his or her worst moment in life, yet almost every violent offender is judged, convicted, and defined by his or her worst moment.” Just imagine if everyone in your life defined you by your worst moment, that this moment accompanied you like a badge of shame throughout your life, limiting all future possibilities, including your hopes and dreams. It would seem terribly unjust; and yet this is what we do with violent offenders. They carry the burden of our shadow projections and are left believing that they are terrible people because they have done terrible things. And because they lose hope about the possibility of breaking free from these deeply internalized expectations, they live up to their self-fulfilling prophecies by continuing to do terrible things. 

The startling recidivism rates in our country (close to 70% of violent offenders return to a life of crime after imprisonment) should be all the evidence we need to understand that our system of rehabilitation-by-incarceration alone simply doesn’t work, but it’s not. The “more shame, more guilt, and more punishment” approach—though it has a long history among treatment of violent offenders—has led to 7 out of 10 people returning to lock-up. It’s clear that it is time for a new approach to this problem, and it requires a change in consciousness, not only among violent offenders, but also among the population at large. 

Yield Theory

“Knowing how to yield is strength.” —Lao Tzu


My approach to working with clients who have committed the most heinous of crimes is grounded in what I call “Yield Theory,” a powerful and compassionate approach to communication that essentially boils down to radical empathy delivered with intentionality. Taoism is a spiritual tradition—the core of which is seeing beyond the black and white world of either/or, good/bad, and recognizing balance through the single essence of everything. Founded by the legendary Lao Tzu more than 2,500 years ago, “Tao” means the way. For me, the journey that clients take to personal growth is the same as what we all undertake along the way in life.

Yield Theory differs from radical empathy in that in addition to attempting to think and feel entirely from clients’ perspectives, therapists also go with or literally yield to what clients are saying in the moment, with the intention of guiding them to new insight on situations. This approach involves more than simply understanding that multiple factors contribute to violent interactions—you must cultivate the ability to not resist even the angriest outbursts. Yielding entails both joining with the essence of who clients are, and “going with” clients to circumambulate their fight-or-flight responses so they will be more open to the possibility of healthier options.

The underlying assumption of Yield Theory is this: If we lived every day as another human being—not just walked a metaphorical mile in that person’s shoes, but actually had the exact same cognitive functioning, affective range, and life experiences—then we would make every single decision that that person has ever made. Every single decision. This goes beyond simple empathy: it is the capacity to truly recognize the essence of others, and non-judgmentally accept who people are, regardless of their choices and actions—including violence. 

By yielding with others and genuinely trying to understand why they have done what they’ve done rather than judging them, I have found that people are more than just willing to open up and talk—they are also much more open to the possibility of change. I have found that by accepting the essence of people, I have an easier time approaching violence with compassion. The Yield Theory framework has allowed me to rid myself of judgment and do the job I was intended to do: assess people accurately and help them change and lead lives directed by their true selves (their essence), rather than by their egos (introjected identities). 

My anger management program is predicated on respecting all human beings who enter treatment, regardless of their actions, and strives to meet every person where he or she actually is. I call it, “conscious education rooted in compassion.” Even the most resistant clients who ardently deny any accountability for significantly harming others are accepted as readily as those who are actively seeking change. Everyone has a story, and people’s cognitive functioning, ability to process emotions, and life experiences shape and continually influence them.

“Though many therapists and counselors may claim to “accept all people,” in practice, most struggle in their work with people who have violent tendencies.” It could be that the natural fight-or-flight response triggers their survival fears and causes them to write off violent offenders as incapable of change, dangerous, and hence deserving of judgment; but it could also be because human beings tend to value their own standards of living, beliefs, and ideas over those of others and in subtle and often unconscious ways judge people who are different—particularly when those differences appear threatening. 

It is hard for most people to grasp that fully accepting a person who commits a violent crime has absolutely nothing to do with condoning that person’s actions. Truly understanding this, however, makes all the difference in our work with those who are pushed the margins of society. 

Components of Yield Theory

Vulnerability takes courage—especially amongst people who define themselves by how “tough” they are—and yet I have found in my anger management groups (which are open, so there always new people coming in) that people share with the same level of vulnerability and honesty as any therapy group I’ve ever witnessed. I believe this is due to the key components of Yield Theory that I apply in my groups: acceptance, the elimination of shame, mindfulness, creativity, conscious education, non-attachment and authenticity.

Acceptance
The potential for everything great and everything terrible resides inside all human beings. If a human being has performed an act, then it is accurate to say that it is “human nature.” If we can accept the nature of human beings (that we will at times be loving and kind, at other times hurtful and cruel, and everything in between and beyond), then we can evaluate others, as well as ourselves, in terms of trying to simply understand human behavior. Furthermore, if we accept the premise that we cannot do one single thing to change the past, and we merely have the ability to impact the present to shape the future, then we can see that pejorative, judgmental approaches do little to impact the present or future in positive ways; whereas acceptance of what is, along with acceptance of the essence of people, can set the stage for conscious learning and change.

With Brian, it was important to accept him for the essence of who he is, and from there to accept where he was cognitively and emotionally in that moment. From his perspective, after all, things were unjust and unfair, so acknowledging that was an important first step.
 
Shame
Years of studying people who commit violent crimes has led me to the conclusion that people who live in shame act out of shame.Eliminating shame, therefore, has become central to my work. At first glance, it may seem difficult to swallow the idea of not shaming someone who has committed a violent act; however, as David Hawkins (2002) suggested in his “map of consciousness,” shame is the lowest form of consciousness that human beings experience. What I have learned is that it is difficult for human beings to make highly conscious choices from low levels of consciousness, so helping people have expanded consciousness becomes paramount to changing their actions.

It would have shamed Brian to try to get him to see what he did wrong while he was in a state of fear and anger. It was not the time to have him acknowledge responsibility or even awareness of anything he did that was hurtful. Instead, it was important to work with what was available for him cognitively and emotionally in the present moment.

Mindfulness
Mindfulness was first described in the Dhammapada as a way that the Buddha taught others to observe and keep constant watch over their thoughts. Engaging in “right mindfulness” entails expanding the awareness that we have not only for ourselves, but also for the world around us. The more mindful we can be in every moment, the more likely we are to consider alternative ways of interacting with others. Mindfulness begins with self-awareness, but it also extends to an awareness of the environment and what is going on inside other people as well. As a group leader, I both practice and teach mindfulness. Though it is fairly easy for therapists to learn how to teach or simply read a basic mindfulness exercise in a group setting, it is the role modeling of mindfulness (i.e., the therapist’s constant awareness of present moment intra and interpersonal experiences) that seems to make the biggest impact on clients. As many people who teach mindfulness would explain: mindfulness must be lived to be understood. 

It was important for me to be mindful and aware of my own thoughts when Brian began railing against his parole officer and his ex, and to be careful not to get caught up by them. I tried to be as aware as possible about what might be going on inside of him, based on what I was seeing in him and my own internal reactions, but ultimately the best we can do as therapists is project what we imagine others are thinking, and then check those projections. In this instance, my projection appeared to be accurate. But mindfulness goes much deeper than just awareness of my thoughts and his; it is also an awareness of the environment in the moment, and a willingness to stay present with whatever unfolds without reverting into a reactive or defensive posture.

Creativity
In my experience, having the ability to genuinely meet a diverse group of clients where they are separates average therapists from very good ones. If we are charged with meeting people where they are, then we must consider that people have varied learning styles, and forcing clients to only get information in the way that we think works is, in my view, irresponsible. To implement creativity in therapy is to constantly evaluate one’s own communication style, and to be open to adjusting it accordingly to what people need. I believe the onus of communicating effectively rests with the therapist, so when clients are not getting what we are communicating, I believe it is our responsibility to find creative ways to meet them where they are. Creativity can come in the form of analogies, metaphors, techniques, or even just in the openness to develop new ways to say things in ways clients can fully hear. 

In the heated moment with Brian, I chose to use a future-self technique with him. I have found that in working with a largely angry population, being able to think quickly and creatively is not only a bonus, but a necessity. 

Conscious Education

“What is a good man, but a bad man’s teacher? What is a bad man, but a good man’s job?” —Lao Tzu

In my view, it is the responsibility of therapists to offer something more than just listening to their clients. Teaching skills is essential to helping people who are struggling with anger. We cannot expect people to respond differently to the world until we teach them different options. For counselors to implement conscious education, they must be willing to teach concepts patiently and compassionately until clients understand the ideas. This is quite different than simply relating concepts and assuming that clients understand them. In conscious education, therapists do not assume their clients should already have specific information; instead, they make the effort to teach in compassionate ways that meet diverse learners where they are.

As a former tenured professor, I know all too well how lengthy the discussions can be over the semantics of what does and does not constitute teaching. Outside of the world of academia, however, I would argue that we are always teaching others—even if the lesson is about how we are likely to respond in a given situation. I know from further interactions with Brian that he learned that day how to implement the future-self technique. He subsequently reported using it several times and even taught it to another group member during an anger management session.

Non-attachment
The idea of non-attachment is at the foundation of healthy learning. Whereas it is fairly easy for most Westerners to understand the idea of attachment to material goods through identification (“I’m a homeowner” or “This is my car” or “I am a good person because I have a high-paying job”), the notion that we are equally attached to our ideas seems far less widespread. “As long as our ideas are a part of who we are, we become defensive when people disagree with us.” When we can separate ourselves from our things, as well as from our very ideas, we are engaged in the process of non-attachment. As therapists model this concept, they create a safe path for clients to learn to express themselves openly, knowing they will not offend their therapist in any way. 

As a caution to those becoming too attached to the idea of non-attachment, Zen practitioners offer the concept of the “soap of the teachings.” Consider that to clean a shirt, it is necessary to use soap; but if the suds are not rinsed out, the garment will not truly be clean. In this same way, non-attachment to the idea of non-attachment becomes central to practicing the concept. 

In the case of Brian, I was not attached to his response, and would have been content with being off base had he told me that was the case. I was also not attached to the technique I was using with him; had it not helped, I was ready to readjust my technique to something more useful. 

Authenticity
People can spot disingenuousness easily. Mirror neurons are not only the root of vicarious learning, but are also the key part of our neurology that helps us identify when people are being authentic with us or not. It is well known in our field that clients will use the inauthenticity of their therapists as a reason they cannot or should not have to change. On the other hand, when people experience authenticity and know that we sincerely have their best interest at heart, they are much more open to learning about themselves.

The most pragmatic way therapists can convey authenticity is to regularly practice the ideas that they are teaching in their personal lives. It is paramount to practice what we preach. We do not have all the answers, nor should we purport to. We make mistakes as equally as our clients: not better or worse mistakes, just different mistakes, and we are all in this process of experiencing what it is like to be fully human. 

Conclusion

“Can you love the people and lead them without imposing your will?” —Lao Tzu

To understand people’s stories is, in a sense, to journey with them to the depths of their psyches. As a modern journeyman, I like to use vehicles as an analogy for journeying. Here’s my analogy for using Yield Theory to work with clients: Imagine that you are riding in a car and you come to a merge point (a yield sign). You merge with another car until you are side-by-side. Suspend what you know about reality, and imagine that as you travel beside the car long enough, the other driver sees that you are going in the same direction, so he invites you into his car. 

As a passenger now in this person’s metaphorical car, you have a better opportunity to see the road as he sees it, through his windshield. As the trip goes on, perhaps the driver gets tired and is ready to rest for a bit. You are now trusted enough to take the wheel. When you do, you can help steer the car down a more effective path. 

Lao Tzu said, “What is painted on these scrolls today will appear in different forms in many generations to come.” Similarly, the words of all therapies emerge at different times and come in different forms, but they are always essentially the same. For Yield Theorists, accepting the core of who people are, finding creative ways to communicate so that we are actually heard, teaching in some form, modeling openness, facilitating awareness and being authentic are therapeutic concepts that are simultaneously a way of life. 

The first practice of the Tao is something called undiscriminating virtue. It means taking care of those who are deserving and also—and equally—taking care of those who are not. When therapists practice Yield Theory, they are practicing undiscriminating virtue by immersing themselves into the psyches of others—regardless of anything they have done up to that point. Violence as a human construct probably cannot be eliminated; however, people—even those with the most violent backgrounds and intense struggles with anger—can learn a different way. 

We can continue to stand on our soapboxes and preach against violence and against the people who perpetrate it, but violence will always exist and shaming people simply doesn’t work. If we truly want to help people overcome their violent tendencies, we must work from a place of consciousness, choose to merge with others—see the world as they see it, attempt to understand what they understand, and help support them in their journey to new levels of awareness and peace. 

“To the highly evolved being, there is no such thing as tolerance, because there is no such thing as other.” —Lao Tzu



 

James Gilligan on the Psychology and Treatment of Violent Offenders

Posted on by rezendevknowfully.com

Why Violence?

Rebecca Aponte: You worked with highly violent individuals for many years. Most people are not particularly inclined to work with those kinds of populations. What drew you to work with this population?
James Gilligan: That's a good question. I think the ultimate answer, as with most major life decisions that people make, goes back to my earliest childhood. I grew up in a family with a father who was quite violent toward my two brothers. He was only violent toward me when there was a medical excuse for it—he was a surgeon. But my brothers he would really whack around. He would knock them across the room to the point where I was really scared he would accidentally kill one of them.

Now, it's true, the level of violence didn't reach the extremes that I later became familiar with when I worked with prison inmates who were often the children of fathers or mothers who actually had killed a family member. My father didn't go that far. He was never arrested, and nobody ever made a complaint of child abuse or anything. That was in the days before people even had a concept of child abuse. The whole concept of the battered child syndrome wasn't articulated and expressed until around 1963 in the Journal of the American Medical Association. Before that, people didn't even talk about child abuse.

So this was, you might say, "invisible," even though it was happening in a small town in Nebraska where everybody knew everybody else. People could see the bruises on my brothers, but nobody would say a word.

So without consciously intending this at all, I became interested in becoming a peacemaker and trying to figure out how to prevent violence—how to get it stopped, or how to prevent it from happening in the first place. I wouldn't say that I consciously articulated that to myself at the time, and not until years and years later.

But when I became a psychiatrist, I was not at all interested in working with violent patients. I wanted to work with people more or less like myself.
When I became a psychiatrist, I was not at all interested in working with violent patients. I wanted to work with people more or less like myself.
I wanted to become a psychoanalyst and work with the ordinary neuroses that everybody has to one degree or another.

When I was in my residency training at the Harvard Medical School, the teaching hospital was paying me such a small salary that I couldn't afford the expenses I had, because I already had a wife and three children. I needed to supplement my salary, which I learned I could do by spending one day a week in a state prison doing something I had never heard of before and had no interest in, called prison psychiatry.

So I went into this project with no high hopes. I thought it would be an exercise in futility. I thought it would be boring. And I had been taught up to that point that the kinds of people who wind up in prison are totally untreatable—they have no motivation to examine themselves, no motivation for introspection. They wouldn't tell you the truth. They would try to manipulate you by lying to you so that you could help them get an early release date, and on and on.

I was taught all of this and believed it. Then I went into the prisons and discovered that almost everything I had been taught was wrong. And I discovered that it was the most moving experience I had ever had in psychiatry, because I was face to face with the deepest human tragedies on a daily basis. And I mean not just the tragedies these criminals had inflicted on their victims, but also the tragedies they themselves had been victims of in the course of their lives.

What I found was that the most violent among them, and many of those who weren't even at the highest level of violence, had been subjected to a level of child abuse that was beyond the scale of anything I had even thought of applying that term to. As I said earlier, the most violent people were really the survivors of lethal violence, either of their own attempted murders at the hands of one of their parents, or the actual murders of close family members who were often killed by other family members right in front of their eyes.

In the Danger Zone

RA: You have said that the first prerequisite for a therapist working with violent patients is to learn how not to become their victims. How do they do that?
JG: Let me just say two things I would emphasize there. One is simply a practical matter of common sense, which is when you are dealing with a dangerous population, make sure there is plenty of security around. “One of my mentors said, “”If you don’t realize how dangerous these people are, you are more out of touch with reality than they are.”
RA: Aside from the fact that prisoners are obviously in a situation where they are being humiliated so frequently, do you find that therapy with regular people and therapy with violent individuals is really all that different? Or is it very similar?
JG: That's a good question, because throughout the time I was doing this work in the prisons, I was working probably between 70 to 80 hours a week, but I had a very active private practice, too, with people more like myself—Harvard faculty members, Harvard graduate students, local professional people, and so forth.

First of all, the basic principle of respect certainly is universal—that is part of all therapy. But the main difference is the prison work was much more skewed toward crisis intervention. That is, the prisons are the environment in which crises are not just an everyday occurrence, but a several-times-a-day occurrence. Prisons are in a state of chronic recurrent crisis. So when I was actually talking with people in the prison, it often was in order to resolve a current crisis.

What I learned was, however, that when you learn how to deal with the crises, a lot of very constructive work can be done. The prisoner, for example, can learn how you can resolve a crisis by talking rather than by using your fists or a weapon, because they would see how we did it—and that, in fact, it was more effective than their way of trying to solve a crisis, which was to hit somebody, or try to strangle them or stab them.

So a lot of useful work got done that way, but certainly the prison environment and also the personalities of the kinds of people who wind up in prison were different enough from my ordinary private patients that we were certainly not even in any way attempting to mimic a lot of the ordinary routines of psychotherapy or psychoanalysis. We certainly didn't have people lying down on the couch five times a week, free-associating.

We were much more face-to-face, dealing with a concrete reality. But in the course of that, as we got the crises resolved, the prisoners then became capable and motivated to talk with us about their lifelong issues, and could talk to us about the most painful and formative experiences in their earliest childhood and so forth.

Common Misconceptions and the Meaning of Attention

RA: And you have trained a lot of therapists to work with violent individuals, haven’t you?
JG: Yes, I did, and I and many of my colleagues, over many years.
RA: Do you find that therapists have any general misconceptions about working with violent individuals?
JG: Oh, yes, I really do—just as I did before I first started working with violent people. I was full of misconceptions. One of the commonest, actually, was one I didn't share quite as much, and that was a total fear of working with people who had a history of violence or were at high risk of it. Every time I worked in the prisons, I was working as a member of faculty of one of the Harvard teaching hospitals. And we would try to make sure that part of the training of the psychiatric residents—or sometimes even medical students and forensic psychiatry fellows, along with clinical psychologists, psychiatric social workers—consisted of spending a certain number of months as clinicians in either the state prison mental hospital or the prisons themselves.

What we found was that we got a lot of resistance. Many of the people who were very happy to see mentally ill people at, say, Maclean Hospital or the Massachusetts Mental Health Center, the Harvard teaching hospital, didn't want to go near a prison or a prison mental hospital, and were scared to death of it. We tried to convince them that ironically, in some ways, because there is so much security, the prisons and prison mental hospitals can be some of the safer places to work, as long as you know how to do it.

So that was one misconception—that this population was too dangerous to work with. The other was the misconception I had had, which is that they were untreatable. I found it totally untrue. In fact, I would go so far as to say that, while I frequently had the experience of meeting somebody in the prison or the prison mental hospital who I thought was untreatable at first,
I came to the conclusion, over the course of working for 25 years, that nobody is untreatable. I wouldn't give up on anybody.
I came to the conclusion, over the course of working for 25 years, that nobody is untreatable. I wouldn't give up on anybody. I saw people who seemed intractably violent, and in some cases intractably psychotic, in the case of the mentally ill prisoners. And I reached the position that everybody can be brought to a point where they stop being violent toward other people. They just do not use that as a means of trying to solve their life problems anymore.
RA: Going back to what you were saying about people being afraid to work with these populations, I’m wondering about the times that you were assaulted when you were new to this. What do you think went wrong?
JG: In the 25 years I did this, I was really seriously assaulted about three times—I mean, punched in the face. I didn't get a broken nose or a broken jaw, though I easily could have if I hadn't been lucky. That was really it. And when I asked myself, "What happened? What led to this? What could I learn from it?" I began to realize that each of these incidents had occurred under almost identical circumstances. Namely, it was late in the afternoon, I was getting tired, I was eager to get home to see my wife and family. And what occurred to me was the analogy that skiing accidents typically around 4 o'clock in the afternoon, when the sun is going down and you want just one last descent along the ski slopes before you go home—people are tired, they are distracted, and that's when the accidents happen.

I found that that was what was happening, and I realized that the prisoners, in fact, were correct that they thought that I was really not giving them my full attention, that I was a little distracted or impatient, I wasn't really completely listening to them, and they succeeded in getting my attention. That's how you do it—you hit somebody, you sure get their attention.

And I realized another thing about it: the German word for attention, "Achtung," also means respect. And it struck me that paying attention to people is a form of showing respect for them.
The German word for attention, "Achtung," also means respect. And it struck me that paying attention to people is a form of showing respect for them.
And not paying attention to them is a way of disrespecting them. In fact, that's one reason that I think that psychotherapy is one of the most profound forums of showing respect toward another human being, because the therapist is sitting there giving that person his or her entire unadulterated attention. That alone is part of the curative therapeutic process, I'm convinced.

But I also realized that what I was doing in the prisons was I was not giving them my full attention, and I was disrespecting them. What I heard from the most violent inmates over the years when I would ask them why they had hit somebody—not myself but anybody—they would say, "It is because he disrespected me." And they used that term so often, they abbreviated it into the slang term, "He dissed me." It struck me that anytime a word gets used so often it gets abbreviated, it tells you how central it is in the moral and emotional vocabulary of the person using it.

Disrespect is central to the ideology of violence. When I became a victim of violence, I would say I had provoked it by inadvertently, unconsciously disrespecting the people I was supposedly talking with.

Confronting the Horror

RA: I want to talk a little bit more about that role of disrespect or shame in violence. When you are working with the prison population, how do you balance your sense of respect and dignity for them with the serious and grave impact of the actions that landed them in prison?
JG: Again, that's an excellent question I asked myself many times. I have tried to make the distinction, when I think about that, between the horror and the outrage that one can't help feeling when you realize how horribly this person mutilated somebody else or caused them horrendous suffering. So when I talk about respect for this population, I don't mean pretending that you respect somebody for that part of their behavior.

What I mean is something much more basic than that. First of all, no matter how horrified I am about the behavior that led them to be sent to prison, I'm not there to humiliate them about it.
No matter how horrified I am about the behavior that led them to be sent to prison, I'm not there to humiliate them about it.
I am there to try to understand what caused this behavior on their part. I am an investigator. It is a scientific process. I am a physician that is a part of science, and I am there to try to learn something from them. So it is precisely the most horrendous offenders who I regarded as my teachers, and I was their student. I was trying to learn from them what had led them to behave in this way, which of course I found just horrendous. So when I say I would treat them with respect, that doesn't mean I respected what they had done. But on the other hand, I also felt it was not my job to punish them or humiliate them for it. My job is to try to understand what had caused them to do it.

The other thing—in my first book on the subject of violence, called Violence: Reflections on a National Epidemic, one of the epigraphs was a quotation from a book by a political scientist who said, "Of human beings, none are good but all are sacred." Now that is, in a sense, a religious way of putting it. But actually you don't have to commit yourself to a particular form of religious belief to believe that some things are sacred and that, just being human, there are some things we just don't do. And I felt the one thing I would not do, no matter what the person was in front of me had done—I was not going to strip that person of their human dignity. They still were human beings no matter what they had done.

And that there was something about the human personality or the human soul or psyche, whatever you want to call it, that is sacred. There are just some things that you don't do to a person's psyche.
RA: But you must have negative feelings from time to time towards the person that you are working with. How do you manage that countertransference?
JG: I will tell you about one of the most horrendous case that affected me personally, that really forced me to confront that in myself. This is a man who had raped and murdered a 14-year-old girl who lived in the house next door to him, and he then buried her body in his basement. He dug a hole in the dirt floor of the basement and buried her in it. Then he went upstairs and watched a football game on television, and waited until his wife and daughters got home, and acted as though nothing had happened.

When her family realized she was missing, a group of citizens was formed in the community to have a search party and try to find her. He joined the search party as if he did not know where she was. He finally was caught and apprehended, and convicted of murder.
RA: That’s chilling.
JG: When he told me this story I felt literally sick in my stomach. I thought I was going to throw up. I was so offended. The whole story was so horrible. How can you sleep after hearing something like this? And I felt a sense of compassion for this girl that is just endless. How much more horrible can anything be?

Then I realized, "Well, I have experienced that feeling before." When I was a medical student, we learned anatomy by dissecting a cadaver that smelled of formaldehyde. And you worked very hard in medical school. Sometimes people had to eat lunch while they were dissecting a cadaver. It would make you sick to your stomach. And then in the pathology lab, the same thing. We would be doing autopsies and dissecting disease tissue, tumors and so forth. And, again, totally disgusting. I would feel sick in my stomach.

But when I was in medical school, the attitude I took was, "Well, okay, that's a normal response to something that in fact is a source of illness in pathology. And, yes, you should be disgusted by it. It's a normal, human, biological response. But I will tolerate the disgust and nausea in order to learn what caused this person to die—in order to learn more about the pathology that was involved." So I realized, with this murderer, I was doing the same thing—but as a psychiatrist, not as a surgeon or pathologist. I was, in a sense, dissecting his soul, which was full of pathology, and it was disgusting. It was horrible. It made me nauseated. But I said, "Again,
I am doing this in order to try to learn something. I'm trying to learn what was the pathology that killed this girl.
I am doing this in order to try to learn something. I'm trying to learn what was the pathology that killed this girl." And that was the only way I could do it—by tolerating the sense of nausea in order to try to learn something.
RA: If the person that you are speaking with is expressing remorse, do you find that your own sense of disgust is mitigated by that?
JG: I would absolutely say that. And I think it's true for several reasons. One is, when a person has a sense of remorse, I am less worried that they are going to be likely to repeat the same behavior. I feel that also there is more to work with. They are more treatable. One thing that I learned over the years, though—I would see people who had committed murders and felt no sense of remorse whatsoever. They felt totally justified. They felt they were the victims, and on and on.

Finally, when they began to realize what they had done, how much human suffering they had caused to other people, when they finally reached the point where they could recognize how much pain they had caused, then they would begin starting to feel remorse and say, "Oh my god, what have I done?" And at that point I was dealing with a suicidal person, because the remorse is one aspect of feelings of guilt. When people feel guilty, they typically have a need to punish themselves. In many cases these were the people who would kill a family member, a wife or a child, and minimize it at first. Then, finally, when they were able to face what a horrible thing they had done, they really were seriously suicidal, and the staff and I would spend a year or two trying to prevent a suicide before the prisoner could finally integrate what they had done, who they were, and where they could go from there.

Once they had learned to live with the remorse and not kill themselves over it, the one thing they seemed to find that made life livable for them was when they found out how they could be of service to other people. And when these men in the prison, who otherwise just seemed unremittingly suicidal, realized they could actually be useful to other people, they had something to live for.

It might be as simple as they could teach other inmates how to read or write. A lot of prisoners are illiterate, and those who knew how to read or write could teach the others to read and write. Another person might become the librarian at the law library in the prison, and kind of be the jailhouse lawyer and help prisoners to write up a legal brief for themselves and so forth. Or they might help out with the school educational programs, or cooking things in the cafeteria. It almost didn't matter what they did, but if there was something that was useful and had a useful place, they then had something to live for.

What struck me about that was, after all, in a sense, that is true of all of us. What makes life meaningful and worthwhile for anybody is the sense that actually they are useful to other people.
RA: Once someone has reached that point of experiencing remorse, is it dangerous to bring that up, to try to treat it directly? What do you do at that point?
JG: At the concrete level, we would certainly put them on suicide precaution and try to make sure that they didn't have access to anything they could hurt themselves with. But I would talk with them. I would try to acknowledge their pain—the pain of realizing how much pain they had caused others—and try to talk with them about how they are actually not helping anybody if they kill themselves. They are not undoing anything. In fact, maybe they could find a way to, so to speak, try to make up for what they had committed. I would certainly try to steer them in the direction of finding some way to make their own lives useful to other people.

But I was certainly aware that they were dangerous to themselves, for often a year or two. In fact, the only suicides that I did see happen in this world were of people who had reached that point, who had originally felt totally justified in the homicide they committed and then later realized that they really weren't—there's no justification for killing somebody else.

The Point of It All

RA: As you know, the “bread and butter” of psychotherapy is to help people reduce anxiety and depression and adjust to new life situations. What are typical treatment goals in working with violent offenders?
JG: First of all, to prevent further violence. That's not the ultimate goal—that's just the first step. But we would have to reach that point before we could do anything further. In other words, as long as violence was continuing, any other therapy was a waste of time. It's beside the point. So the first goal would be to help them to reach a point where they would stop using violence as their optional tool for solving life problems.

A second one would be to give them the tools they needed and the resources they needed in order to gain the sense of self-respect, which they simply had never been able to develop. The reason they were hypersensitive to being disrespected by others was because they were so lacking in self-respect, and that means lacking in the precondition that any of us need in a given day to be able to respect ourselves.

For example, everybody gets humiliated at one time or another, but most people never commit a serious act of violence in their lives. And I would say one reason for that is because most people have enough internal and external resources available to them that they can restore their self-esteem, even when they have felt humiliated. You have an education, you have some skills, knowledge that you can respect and that other people will respect. The guys in the prison, almost all of them had none of those. They were often illiterate. They had often been unemployed, homeless. They have been abused and treated as worthless from the time they were born. I mean, their self-respect is zero.

I learned that if we gave them the tools they needed, they could gain self-respect just through the process of education and development. For example, I always regarded education as a therapeutic tool. Education can serve a lot of purposes—people can get better jobs if they have a good education, and so on. But I felt it was therapeutic for this population to gain a set of knowledge and skills that they could respect themselves and treat other people with respect.

In fact, we found that the single most effective therapy in the prisons in preventing violent recidivism after people left the prison was prisoners getting a college degree while in prison.
We found that the single most effective therapy in the prisons in preventing violent recidivism after people left the prison was prisoners getting a college degree while in prison.
We had a program like that that had been in effect for 25 years. Professors from Boston University taught courses for credit, and the prisoner could get a college degree from Boston University.

We found that over a 25-year period, several hundred prisoners had gotten a college degree, and not one of them had been returned to prison in that time. When we extended the study to 30 years, we found that two people had been returned. That was much less than a 1 percent recidivism rate. Phenomenal compared to the usual recidivism rate of 65 percent in three years—this was less than 1 percent over 30 years.

But, for me, the reason was they built up their self-esteem. They could respect themselves.
RA: So preventing future violence and tools for self-respect—are those the core of the work that you are doing?
JG: Certainly that was, at the level of emotions, prerequisite to everything else. For example, I felt that certainly one thing that had been missing that had made it possible for them to commit serious harm to others was their lack of a capacity for empathy with the suffering of others, and a lack of the capacity to care about others or to love others.

But what struck me was they couldn't respect other people or treat other people with esteem if they were lacking in self-esteem and self-respect. So helping them reach the point where they gained self-respect and self-esteem was really a prerequisite to their being able then to care about others enough so that they would not violate the rights or inflict harm on other people.

But that is all at the emotional level. At a more cognitive level, one major thing that we did in the jails of San Francisco when I worked there over a ten-year period was to focus on cognitive issues—namely what we call the Male Role Belief System, which we felt had underlain the violence these men had committed. And by that we meant all of the assumptions they had been taught as to how you define masculinity and what you need to do in order to be a man, what you are entitled to do, what you are obligated to do, how should women treat you, how should you treat them, and on and on—the whole set of assumptions that almost all men in our society are raised with. The assumption underlying this very skewed patriarchal, somewhat misogynistic view is that the social universe, that is, the whole population, is divided into the superior and the inferior. In that division, men are supposed to be in the superior part and women in the inferior part. And, in fact, the really superior man has also got to be superior to other men. So they are also inferior.

This is a recipe for violence because most people don't want to be cast into the role of the inferior.
RA: And it is a roadmap for feeling disrespected.
JG: Exactly. So we engaged in intensive group therapy with these jail inmates—all of them were in for a violent crime. I was amazed how quickly they grasped that point. And not only did they get the point, they began to say things like, "I've been brainwashed by the society I have grown up in." They would want to then start educating the new inmates about what they had learned.

So we said, "Great," and we would train them to lead the groups themselves, kind of like Alcoholics Anonymous where the people suffering from the problem are sometimes the best therapists. So we trained them to lead these groups, and we found the level of violence in the prison dropped to zero, and the level of recidivism after they left the prison was down 83% compared with people who had been in an ordinary jail without these kinds of programs.
We found the level of violence in the prison dropped to zero, and the level of recidivism after they left the prison was down 83%.
So that is a concrete example.

At a more abstract level, we were trying to increase their ability to be self-aware, to recognize their own motivations, to recognize how they were behaving in ways that were really self-defeating—this wasn't helping them get what they really wanted. In fact, their behavior was often costing them relationships that they actually wanted to maintain.

So, like any psychotherapy, you are ultimately trying to get at the greater sense of self-awareness and a greater degree of self-control that comes from the self-awareness. If you are lucky, that is what will happen. The goals of therapy and the methods of therapy did share those features in common with psychotherapy with any population.

Violence in Childhood: Bullying and Corporal Punishment

RA: I want to transition into talking about the earliest possible interventions. We know that violent behavior begins fairly early in life. How do you think that child and school counselors should be responding to bullying? Do you think parents are to blame? Should they be involved in the response?
JG: First of all, I certainly think that bullying is a prime example of the kinds of experiences that stimulate violence. That is hardly an original observation on my part, but I think people in general are increasingly aware how much school violence and violence out of school is caused by bullying.

I would like to see a truly cooperative effort on the part of schoolteachers, school administrators, and parents to identify and respond to a bullying situation and to get it stopped. Whenever there is a bullying situation, there are three parties involved. It’s not just the bully and the victim. The third party is the bystander, the witness, whether that is a schoolteacher or whoever. I really think that it is vitally important that nobody take this as just normal. Many of the people I saw in prison, for example, would talk about how they had been bullied in school, come home and tell their parents about it, and the parents, instead of going to the school and saying, “This is a problem we should work together to solve,” would tell their son, “You go back and beat him up, and if you don’t beat him up I will beat you up myself.”

That’s how you teach children to be violent.
RA: Do you feel that the chronic victims of bullying are at a similar risk for violence as the chronic perpetrators?
JG: That's a good question. I don't want to give you an answer that would imply that I am sure I know what the answer is. That is one I am not sure off the top of my head. Very often, bullies also have been victims. They aren't necessarily just one or the other. Often you find they are overlapping categories.

Without being able to be sure how I could predict which of those groups is most dangerous in the future, I would share pretty much an equal sense of concern for both. I would want to pay just as much attention to one as to the other—to the bully in order to get the bullying stopped, and to the victim in order to make sure that the victim doesn't ultimately turn into a bully.

Whenever I see a situation like that, I would want to intervene. But I would like to do so in a way that is not aimed at humiliating or at punishing, but is really aimed at restraining, in the sense of saying, "This is not permissible. You can't do this. We will not tolerate this. But we are not going to bully you ourselves. We are not going to beat you up or spank you. What we are going to do is limit your freedom to do this until the point you can stop yourself. If you can limit yourself from doing this, then fine, we don't need to do anything."

In other words, the only way to stop violence is with nonviolent means. That doesn't mean you don't need restraint, but it does mean that I would make a sharp distinction between punishment and restraint. I think parents who have two-year-old children running in front of traffic need to restrain the children so they don't get hurt. But that doesn't mean they have to hurt the children themselves. The whole point of restraining them is so the children won't get hurt.
RA: You mentioned not using spanking. Every time there has been a new movement to try to outlaw spanking, it has been met with quite a bit of controversy in the name of parental rights. What would you say to parents who think that spanking is a necessary tool?
JG: First of all, I think most of the empirical research on this subject has found that spanking is counterproductive. Over the last 60 or 70 years, there have been literally dozens of studies, if not hundreds, about child rearing and child development. The whole process of child development is so complicated and there are so many variables that not very many generalizations have been almost universally replicated. But the one conclusion on which there is the highest degree of consensus is that the more severely a child is punished, the more violent the child becomes. Using violent means to limit violence is just self-defeating. Violence stimulates violence. Obviously, you can talk about different degrees of spanking, and you talk about it so that it is not really painful—not going to cause bruises and so forth. But just the sheer idea that an adult can do something to a child which would be called assault and battery if they did it to another adult—I mean, the legal system recognizes the difference between a violent and a nonviolent intervention. And I just don't think an adult is doing anything except stimulating violence. To me, that is what the empirical research has shown. From my experience working with prisoners, I have already mentioned the most violent prisoners are the ones that have experienced the most violence at home. If violent punishment would prevent violence, then the people who wound up in the prisons would never have become violent in the first place, because they had suffered as much violent punishment as you could inflict on a person without actually killing them. As I said, many of them were the survivors of their own attempted murders.

I understand people who believe in spanking and say, "Well, we are not attempting murder." One problem is that people who have studied child abuse have found over and over again that it often starts just as so-called harmless spanking and escalates—parents get carried away.

I have treated parents who came to me in my private practice because they were afraid they were losing control and they were going to really injure the child more than they intended. They couldn't stop themselves once they got started. I would recommend that the United States follow the example of an increasing number of nations around the world—I think Sweden was one of the first, but by now there are at least a dozen if not more—who have made it a law that corporal punishment of children is assault and battery.

Intervening with Victims of Violence

RA: I'm wondering also whether you have any insights from your work with violent individuals that would be helpful to therapists who primarily work with victims of violence, maybe a battered spouse or adult children of violent parents.
JG: First of all, I would begin the work I do with the victim of violence with the unequivocal assertion that violence is not justified. Nobody deserves to be victimized by violence. It is important that they realize that they weren't the cause of this. No matter what they did, that doesn't justify the person who harmed them.

The second thing is that, precisely because nobody deserves to be treated this way, it is vitally important that they do everything they can to protect themselves from it and to make sure that they don't expose themselves to the risk of further violence of this sort. If they are involved with somebody who does not appear to be capable of renouncing violence as a form of trying to influence the person they are involved with, it is vitally important that they separate themselves from this person.

Otherwise, you have to then shift the focus to the question of, where is their need for punishment coming from? I would really focus on trying to prevent violence there by trying to prevent their victimization. You have heard of the Tarasoff Rule and the Tarasoff Warning—the legal rule that if the therapist has reason to believe that a patient of his or hers is at risk of being injured by someone else, they have a legal obligation to inform the patient of their concern and to clarify who it is they feel they are in danger from, and to recommend that they do everything that they can to separate themselves from that person and to protect themselves.

We had a terribly tragic situation in Massachusetts when a man was sent to the prison mental hospital because he had been threatening a woman he had had a love affair with, and he would keep breaking up with her and then wanting to get back together. Finally she got tired of it and said, "No, forget it, go away." And he couldn't, he was obsessed with her, and would keep threatening her. He was sent to the prison mental hospital for the crime of threats, which he had been convicted of.

We reported to the court that we thought this man was indeed dangerous to her. We also sent her a letter saying that we thought he was dangerous and she should do everything she could to escape from him, to not let him know where she was, and to leave. The letter went to the judge, it went to the sheriff of the jail this man went to. But the man was not psychotic. We couldn't commit him to the prison mental hospital on grounds of insanity because he wasn't insane. And he got sent to the jail with the letter in which the judge ordered the sheriff to notify the police in this woman's hometown when this man was going to be released from jail, because the maximum sentence for the crime of threats was only six months.

So this guy, after only six months, was released from jail. The sheriff screwed up and didn't notify the police in her hometown, didn't notify her, and the man went to her home and killed her.

It was a tragic, tragic case where the victim could have been saved. On the other hand, you might say it is one of the difficulties in our legal system that this man could only be locked up for six months according to the law. I could understand this woman's sense that she wouldn't want to be going into a witness protection program like where the FBI puts informants against other criminals or something. She would literally have to change her social security number, and move to the other end of the country or something, change her name—literally, because this man was obsessed with her and was very dangerous, and was willing to do something.

He now has a natural life sentence. He will never be out of a prison in his life. So clearly he didn't care; he wasn't restrained by anything. You talk about dealing with the victims—that was the worst case I think I have ever seen. It was not just frustrating, but horrendous. It was appalling. The Boston Globe reviewed all the circumstances and concluded this could have been avoided if the sheriff and the police had provided some protection as the judge had ordered. But it's even more complicated than that. “It's a very difficult thing to help the people who have been victimized to realize how much danger they may be in.”

How to Abandon the Prison System, and Why

RA: I want to give you a chance to talk about your more recent work, which is violence prevention at the societal level. You have said that prisons should be demolished and replaced with secure residential schools, colleges, and therapeutic communities. I wonder if you could briefly outline your theory behind this.
JG: The modern prison system is a fairly recent invention. It was only in the late 18th to early 19th century, starting in countries like England and the United States, to some extent Italy and other European countries, that prisons became long-term residential facilities for purposes of punishment rather than being short-term settings just awaiting trial, and at the outcome of the trial they would either be executed or tortured and mutilated, or acquitted and just let go.

But what we have now, where people come into prison and spend years there, or maybe the rest of their lives—that is a new development. It is a well-meaning experiment that has failed. It was well meaning because it was originally developed as an alternative to torture and execution. It was an attempt to protect people from such horrendous experiences. But in fact, it does not work in its stated purpose, which is to make society safer, except insofar as it certainly serves purposes of restraint. I mean, you keep somebody violent from the community—that I am in favor of, and I think we do need to do.

But if you want to look at the long-term effect on society, more than 90 percent of the people who get sent to prison are back in the community within a few years. They would have to be, or otherwise the prisons would be ten times larger than they are now, and they are already something like 7.5 times larger than they were in the mid-1970s on a per-capita basis.

Humanizing Predators

RA: Aside from the cost of doing something like that, probably the biggest resistance to that idea would be the conventional wisdom that there is a certain subset of people who are true sociopaths who are not going to be helped. You said earlier that nobody is untreatable. Is the "predator personality" a myth?
JG: Well, in one sense it is. But let me make clear, too, that I do not mean to imply that I am so optimistic about everybody that I think everybody that comes into the prison, no matter how violent they have been, can necessarily be returned to the community.

What I am saying is they can be rendered nonviolent. But I certainly have known people that I think should in fact remain institutionalized, because I think they have been too damaged. I will give you a case example. We had a man sent to us when I was running the prison mental hospital in Massachusetts, an African-American man who had been a pimp of a stable of prostitutes. He killed several people in the community, including some of his own prostitutes, was arrested for multiple murders and sent to the Charles Street Jail in Boston to await trial for murder.

He promptly killed one of the other inmates. So they realized he was too dangerous to await trial there. He had to be sent to the maximum-security prison to await trial, even though that is where you would normally be sent only after being convicted. And he killed an inmate in the prison. So they sent him to me at the prison mental hospital.

Now this man, when he came to the door, was mute—he was like a zombie. He was paranoid. He couldn't relate to anybody. Everybody was, of course, scared to death of him, knowing his history. And he seemed equally terrified and suspicious of everybody. When saw this guy, I thought, "This is someone who is untreatable. He is actively violent. You can't do psychotherapy with somebody who is mute, with his kind of history. The best we can hope for is to limit the violence that he would commit." So I had him put in a maximum-security residential unit we have where he would be in a locked bedroom at night so he couldn't hurt anybody and they couldn't hurt him. And I told people during the day to just keep a six-foot invisible wall between him and everybody else so that nobody would crowd him. One of our staff wanted to try to engage him in psychotherapy and I said, "Don't even bother. That he would experience that as a violation of his space." I said, "Give him space."

And after a month or two of this he didn't harm anybody; nobody harmed him. He found that there was a profoundly retarded 18-year-old man in the same residential facility there, same dormitory building, and this kid was so retarded he could hardly tie his shoelaces. He really needed somebody to look out for him. This multiple murderer took this guy under his wing and would walk with him to and from the dining hall and make sure that nobody abused him, robbed him, raped him, assaulted him, anything. He protected him.

And from the moment I saw this happen I said, "Thank god. This may be this guy's restoration to humanity." But I wasn't sure. He still didn't seem treatable in any conventional sense. But we let this go on, and for several months he was the caretaker of this kid, and still not talking much to anybody.

Finally he reached the point where he was relaxed enough that he did start wanting to talk. I sat down with him several times, and he basically told me the story of his life. His childhood was horrifying, blood-curdling. But he got this off his shoulders. By the way, we gave him very small doses of medication as he came in looking paranoid, but actually, he wound up to be more depressed than anything else. And we gave him very small doses of an antidepressant. As far as I know, he is probably still taking it.

But it was minimal medication involved. He really wasn't psychotic. Once he got to the point of talking, he was perfectly sane. But he had had horrendous child abuse in his lifetime. He still is at the prison mental hospital. He has several life sentences. He will never be out of prison. He will never be back in the community. Frankly, I don't think he would know what to do if somebody sent him back into the community.

So when I say that I wouldn't give up on anybody, I don't mean that this is somebody that is really going to be fit to return to the community and live in it. I think he is too badly damaged. But on the other hand, I think we don't need to keep punishing him. We can provide him a place where, for example, he has a job in the hospital. So, again, he is of use to other people. He gets some degree of self-respect from that, and people are grateful. He has filled a useful role in the hospital. When I come back to visit from time to time, he will smile and say, "Hello, Dr. Gilligan, how are you?" You know, behave like a normal human being—no longer mute, paranoid, menacing. And he has not harmed a hair on anybody's head since coming to that prison mental hospital.

So when I say I don't give up on anybody, this was somebody who was still killing people even after he was sent to prison. He has been there for 25 years now, and hasn't harmed anybody. And to me, that's success. I don't care if he goes back into the community. I think he would die if he went back into the community.

Discipline, Not Punish

RA: In a therapeutic community in a prison setting, how are rules enforced? Obviously you would have a no-violence policy. Does that mean that somebody can be ejected from the program or not be allowed to do certain group activities that they like? How do you do that in a way that manages respect but also enforces rules?
JG: I would try to focus on attempting to learn what was motivating the person to break the rules, including the most important rules, which would be rules against violence.

Again, let me give a case example to illustrate how I would approach it. We had a fellow at the state prison mental hospital who, on a regular basis, would engage in what we called sucker punching. That means hitting somebody just out of the blue with no provocation, no warning—being in an ordinary conversation with them, and then just suddenly punching them in the face, and sometimes really injuring people.

When that would happen, he would be immediately removed to a locked individual room where he would be isolated from other prisoners so he couldn't hurt anybody. Then a therapist would go over to talk with him repeatedly, day after day, until we figured out whether he was ready to come back into the community and not hurt people. After awhile, he would come back in and then he would be nonviolent for a couple of weeks or a couple of months, and then he would repeat the same behavior.

Finally, we sat down with him and said, "What's going on here? Why are you doing this? You know you get locked up when you do it." What we learned was that he wanted to be locked up. There were times that he just felt either he was losing control and felt he needed to be locked up, or he was afraid other people were dangers to him and he wanted to be saved, locked up. I think he was more afraid of himself than of others, but he knew that this was a way that he could get locked up for several days and feel safe. But everybody around him was safe.

What we said to him was, "Look, you don't need to hit anybody in order to be locked up. If you just tell us that you feel you need to be locked up, we will do that. We will put you in this room and lock the door, and we will keep the door locked until you can tell us you feel ready to come out again."

And what was amazing was that worked. He stopped sucker punching. He would tell us that he really wanted to be locked up. We said, "Fine, we will do it right now." And then we would go and talk to him about why he felt the need to be locked up. We wouldn't deny him the wish.

That would be one way in a therapeutic community that one would deal with rule violators. It's try to learn why they are breaking the rule, and to approach it not in the spirit of, "We are going to punish you for doing that," but rather, "We are going to try to help you to reach the point where you don't need to do that in order to get what you want"—and try to clarify what their goal is.

That's only one example, and I'm sure we can think of a hundred others that might not be so easily or neatly resolved. But the basic principle is you restrain people from hurting other people, absolutely. Clearly there are some people not ready to be in the group, like I mentioned with the multiple murderer. I didn't want him in a group at first. I thought he would experience that as an assault on his living space. He needed to be separate from other people for a while. So my emphasis would be less what are the rules than on what is motivating this person, what is his current mental status, to what degree is he in control of himself, what are his goals—in other words, a very psychological approach to everything, rather than a kind of rules-based approach.

I don't mean to say you don't need rules. You do need very clear rules, something that is acceptable to others. That does need to be made clear and unambiguous. But a violation of them should be not punishment but rather, first of all, restraint, and then inquiry and an attempt to learn, what was going on? Why did this happen?

Never a Boring Day

RA: You have obviously had a career full of very challenging work. What has been rewarding to you about it?
JG: That's, in a way, almost too easy to answer. It has been constantly rewarding. I have felt so fulfilled by this work. I felt so fortunate to be able to engage in it.

First of all, it satisfied my curiosity. I was able to learn a lot about things that I didn't understand earlier and I wanted to learn about. Secondly, this wish of mine that goes back to childhood to try to find ways to limit violence or prevent violence—I have certainly been able to gratify that wish through this work.

The third thing is I have talked to many of my colleagues who went into an ordinary psychoanalytic or psychotherapeutic career and finally, after 30 or 40 years of that, would tell me they were feeling bored—they were just doing the same thing over and over again, but they weren't learning anything new. I felt sorry for them, because I felt
I have never had a boring day of work in my life. I look forward to every opportunity to engage in this work.
I have never had a boring day of work in my life. I look forward to every opportunity to engage in this work. It's endlessly interesting, gratifying, moving. And I would recommend it unreservedly. And I mean I really recommend it. I'm not like Freud, who, when the Gestapo arrested him in Vienna and required him to write a note telling how well they treated him, ended it by signing, "And I would recommend the Gestapo to anyone." It's probably ironic and sarcastic, so I don't mean it in that sense. I mean that I really would recommend this kind of work to anybody.

I would love to see the mentally ill moved out of the prisons, where they really don't belong, and back into the mental health system. But I also want to see the prisons themselves really turn into therapeutic communities rather than being just places for punishment.

I think one of the biggest mistakes we have made—and when I say "we" I mean all of western civilization—over the last two or two and a half centuries has been this mistaken belief that punishment would prevent violence. I think in fact it just stimulates more violence. But that doesn't mean we should unlock the doors and let everybody run free. I do believe in restraint—in restraining those who hurt others, stopping them from hurting others through coercion and restraint and constraints and force—when necessary. But that doesn't mean violence and punishment. That is the vital distinction I would like to make.
RA: Do you have any final thoughts that you would like to share?
JG: I want to thank you for your interest in this work. Let me say one thing that I think applies to all psychotherapy. Again, what I have talked about is certainly very, very different from the population that 99 percent of therapists work with. But I do think it is worth recognizing that psychotherapy is a modern invention, a great social experiment in self-education. Sure, it has roots in everything from confession in the church to philosophic introspection and so on. There are antecedents for modern psychotherapy, but nothing really comparable.

It is a great, unprecedented social experiment, and I think we are only beginning to realize how important it is and how valuable it can be. When I first was trying to decide whether to become a psychoanalyst, I talked with a friend of mine, the late Peter Newbauer, who was a psychoanalyst in New York. I said, "Peter, if I become a psychoanalyst, I can only treat a few hundred people in my whole lifetime, and yet the need for this is so overwhelming. There are six billion people on this planet, and all of the psychoanalysts in the world can't treat more than a tiny handful. How can I think about this?"

He said, "Of course, you are right." But he said he felt that the ultimate benefit of psychoanalysis would come not simply from the actual treatment of individuals you are seeing, but from what you learn from treating them that could then be applied in other contexts such as in child rearing, in education, in the criminal justice system, and so on. Even in ordinary medicine—psychological insights have transformed so much of what we do in medicine.

When my children were born, I wasn't allowed in the delivery room. Nowadays people bend over backwards to try to increase the bonding between parents and children and to protect the bond between the father and mother and so on. That is one of gazillions of examples. The way children are treated in hospitals now is totally different from what it was when I was a medical student. These are examples of applying psychoanalytic knowledge into completely different contexts. So I have often felt that what I have done is applied psychoanalysis. It is not psychoanalysis as such—we don't put prisoners on the couch and have them free-associate five days a week—but we apply what we know from psychoanalysis in that different context, and then we can learn more things.