Advocating for an Incarcerated Informed Lens in Therapy

Abstract

Exceptionally high rates of incarceration in the United States have caused a need for a major social justice movement. This paper explains the various collateral damages endured by the incarcerated population. Several research studies related to the unintended consequences of incarceration on outcomes related to couple and family relationships, racial disparities, employment, poverty and public health are examined. The importance of individual, couple, and family therapy and its effectiveness toward improving the lives of those negatively impacted by incarceration is discussed.

Keywords

incarceration social justice racial disparities marriage and family therapy incarcerated informed lens

A recent Bureau of Justice Statistics (2018) report illustrated the number of individuals involved in the United States (U.S.) criminal justice supervision, including incarceration in jails and prisons. An estimated 6,613,500 individuals were under the U.S. adult correctional system by the end of the year of 2016. In addition, about 1 in 38 adults (persons age 18 or older in the U.S.) were under some form of correctional supervision at the year-end of 2016 (Kaeble & Cowhig, 2018). This those incarcerated in jails and prisons, and those on probation or parole. This phenomenon of U.S. incarceration has been termed “mass incarceration.” This term illuminates the excessive and draconian use of incarceration in this country.

Many of these individuals are incarcerated either for non-violent crimes, such as possessing or using drugs, or for violating probation. With such high rates, expenditures toward jails and prisons take away from important resources, such as the U.S education system, health care, public health, and employment. Furthermore, having a criminal record makes it difficult to acquire higher education and find conventional employment, communicate effectively to family members, and meet parental and marital obligations. As a society, we must be prepared to address this growing population of released individuals. The negative consequences of mass incarceration have implications for social justice and related outcomes across the entire spectrum of all Americans. Advocating for the use of an incarcerated informed lens in therapy can bring awareness via social justice to each of these intersecting consequences of incarceration.

Racial Disparities in Incarcerated Settings

People of color, specifically Black & Hispanic individuals, make up 37% of the U.S. population, but consist of a disproportionate 67% of the prison population (Bureau of Justice Statistics, 2018). Black men are six times as likely to be incarcerated as white men, and Hispanic men are more than twice as likely to be incarcerated as non-Hispanic white men. Specific to gender, the ratio of males to females in prison is roughly nine to one (Bronson & Carson, 2019). However, from 1980 and 2017, the number of incarcerated women increased by more 750%, rising from a total of 26,378 in 1980 to 225,060 in 2017. Women in state prisons are more likely than men to be incarcerated for a drug or property offense, compared to men. In fact, 26% of incarcerated women have been convicted of a property crime, compared to 17% among incarcerated men. Sentencing policies and socioeconomic inequality contribute to racial disparities at every level of the criminal justice system (Vogel & Porter, 2016). There are several factors that contribute to incarceration disparities by race, and they occur throughout the criminal justice system process. The impact of these disproportionate incarceration rates by race on individuals and communities will be discussed and will connect racial and ethnic disparities prevalent in the incarceration population to the process of the criminal justice system. Specifically, this section will highlight these stages of the criminal justice process: law enforcement practices, prosecution, and sentencing.

Studies on racial disparities and mass incarceration suggest that several factors have influenced the increase in incarceration in the U.S. since the early 1970s. What is clear is that politics has played a role in these dramatic incarceration increases. “Get-tough” sentencing policies such as determinate sentencing, mandatory sentencing, three-strikes and truth-in-sentencing laws have had a slight impact on this growth (Jacobs & Helms, 1996; Marvell & Moody, 1996; Sorensen & Stemen, 2002). However, it does not explain the dramatic incarceration increases over the past several decades (Sorensen & Stemen, 2002). Republican partisanship seems to have influenced incarceration rate increases (Blumstein & Beck, 1999; Jacobs & Helms, 1996). There appears to be a clear racial and socioeconomic facet to this political narrative as well. Democratic partisanship has contributed to the historically extreme rates of imprisonment by passing the Crime Bill of 1994, a bill that provided law enforcement the liberty to aggressively target and imprison people of color in the U.S. During this era, nearly every U.S legal system was validating harsh and detrimental sentencing laws and the Crime Bill continued the trend of addressing crime concerns with “tough-on-crime” lawmaking (Berman, 2020). Several studies found race effects (Beckett & Western, 2001; Marvell & Moody, 1996; Sorensen & Stemen, 2002) while others found significant effects for economic inequality (Jacobs & Helms, 1996). This further supports the racial and economic threat arguments. Finally, drug crimes seem to be driving much of the prison population growth since the early 1970s (Blumstein & Beck, 1999).

Mass incarceration has developed into a seemingly permanent aspect of American political culture, with both major parties being involved (Caplow & Simon, 1999; Garland, 2001; Irwin & Austin, 1994; Tonry, 1999; Wilkins, 1991). Terms such as ‘American exceptionalism’ and ‘mass incarceration’ have come to symbolize imprisonment in the U.S., with cross-national comparisons proving how unique the American experience is (Savelsberg, 1994; Sutton, 2000; Young & Brown, 1993). The targets of this political culture war appear to be ethnic and racial minorities and the poor, with politicians and social critics taking sides on whether these offenders should be considered victims of mass incarceration. An explanation for persistent racial disparities in state prisons lies in the structural disadvantages that impact people of color long before they encounter the criminal justice system. In this view, disparities observed in imprisonment are partially a function of disproportionate social factors in African American communities that are associated with poverty, employment, housing, and family (Bridges & Crutchfield, 1988).

The Collateral Consequences of Incarceration

The consequences to those incarcerated are well-established in the literature. An in-depth examination into the consequences of incarceration shows that employment and related income is a key factor in determining the direction of the life course of those formerly incarcerated. For example, research suggests that spending time in prison can negatively impact earnings in the labor market (Apel & Sweeten, 2010; Sampson & Laub, 1993, 2003; Western, 2002; Western & Beckett, 1999; Western & Pettit, 2005). Specifically, the work of Sampson and Laub (1993, 2003) and Western and Pettit (2002), and Western (2006) shows that employment and related income is a path out of crime as adolescents make their transition into adulthood. These same studies reveal that employment and related income is difficult to obtain for those released from prison. The evidence appears to be conclusive that mass incarceration has produced significant social harms, and that these negative effects are disproportionately hurting those of lower socioeconomic status (SES) and non-white populations (Hutcherson & Hanauer, 2018).

A review conducted on the collateral consequences by Kirk and Wakefield (2018), displayed negative family outcomes associated with incarceration such as many poor physical and mental health outcomes for the individuals post-release as well as their families (Johnson & Raphael, 2009; Kirk & Wakefield, 2018; Lee et al., 2014; Massoglia & Pridemore, 2015). The separation of fragile families (Apel, 2016; Massoglia et al., 2011; Turney, 2015) and decreases in civic and institutional engagement were found (Brayne, 2014; Goffman, 2014; Haskins & Jacobsen, 2017; Kirk & Wakefield, 2018; Lerman & Weaver, 2014; Manza & Uggen, 2006; Sugie, 2015; Weaver, 2014). Specifically, parental incarceration is more consistently harmful to children in the case of paternal (Geller et al., 2012; Haskins, 2014; Kirk & Wakefield, 2018; Murray et al., 2012; Wakefield & Wildeman, 2013) relative to maternal incarceration (Cho, 2009; Foster & Hagan, 2015; Kirk & Wakefield, 2017; Kruttschnitt, 2010; Turney & Wildeman, 2015; Wildeman & Turney, 2014). Increases were noted in material insecurity and reliance on public assistance (Kirk & Wakefield, 2018; Schwartz-Soicher et al., 2011; Sugie, 2012). Rising legal debts (Harris, 2016), housing and residential instability were documented (Harding et al., 2013; Herbert et al., 2015). Additionally, poor educational and health outcomes for children of incarcerated parents (Geller et al., 2012; Haskins, 2014; Kirk & Wakefield, 2018; Wakefield & Wildeman, 2013). Furthermore, high rates of incarceration and the constant cycle of recidivism (the return to prison after being released) are also linked with the following community-based outcomes: declining levels of neighborhood informal social control (Clear, 2007; Drakulich et al., 2012) and increasing levels of cynicism of the law among neighborhood residents (Kirk, 2016; Kirk & Wakefield, 2018). These conditions contribute to elevated rates of crime and recidivism (Kirk & Papachristos, 2011).

Incarceration can negatively impact the quality of family relationships (Hairston, 2001; Tadros et al., 2019, 2020a). When an individual is incarcerated, his or her family is negatively affected as well. These stressors have a disproportionate impact on the children. A study sought to understand the experience of sisters of incarcerated brothers (Tadros et al., 2020a). Semi-structured interviews with sisters of an incarcerated brother were conducted. Themes emerged from the interviews such as emotional impact, adjustment, prison experience, family impact, and stigma emerged from the interviews. Results demonstrated the need for therapeutic intervention and broader policy change (Tadros et al., 2020a). Mental health professionals have introduced an approach to practice positive conflict resolution techniques and encourage positive communication toward their significant other while within these incarcerated settings (Marigold & Anderson, 2016). Regardless of conflicts that arise, couples who engage in positive communication are likely to have a higher contentment rates within relationships. It has been revealed that having one discussion of conflict with more positive outcomes than normal may result in more positive expectations of a partner’s responsiveness to conflict in the future (Marigold & Anderson, 2016). Please see Table 1.

Table 1.

Collateral Consequences of Incarceration—Summary of Research.

Topic	Associated studies
Economic costs
Decreased chances of employment and earnings	Sampson and Laub (1993, 2003), Western (2006), Western and Petit (2002, 2005), Apel and Sweeten (2010)
Cost to families
Poor physical and mental health outcomes	Johnson and Raphael (2009), Lee et al. (2014), Massoglia and Pridemore (2015)
The breakup of fragile families	Apel (2016), Massoglia et al. (2011), Turney (2015)
Reductions in civic and institutional engagement	Brayne (2014), Goffman (2014), Haskins and Jacobsen (2017), Lerman and Weaver (2014), Manza and Uggen (2006), Sugie (2015), Weaver (2014)
Reliance on public assistance	Schwartz-Soicher et al. (2011), Sugie (2012)
Rising legal debt	Harris (2016)
Housing and residential instability	Harding et al. (2013), Herbert et al. (2015)
Poor educational and health outcomes for children of incarcerated parents	Geller et al. (2012), Haskins (2014), Wakefield and Wildeman (2013)
Cost to communities
Decreased levels of neighborhood informal social control	Clear (2007), Drakulich et al. (2012)
Increased levels of cynicism of the law from citizens	Kirk (2016)
Increased rates of crime and recidivism	Kirk and Papachristos (2011)

Using an Incarcerated Informed Lens in Treatment

Systemic Therapy in Incarcerated Settings

Marriage and Family Therapy (MFT) is a form of psychotherapy that conceptualizes family members through a systemic lens (AAMFT, 2019). The range of physical and psychological problems treated by MFTs include marital and relational issues, parent and child conflict, mental health disorders, substance use, and as well as various other problems. Tadros and Finney (2018) offered an anti-pathological, multicultural approach to working with an incarcerated father and his son. This case conceptualization focused on often overlooked information when diagnosing, such as cultural and religious factors. This paper eliminated the notion of an identified patient, allowing a family to work collaboratively. Similarly, Tadros and Finney (2018) explored the utilization of structural and medical family therapy with an incarcerated mother living with HIV which integrated theories to treat clients experiencing physical health concerns. Treatment was deemed successful as demonstrated by reported insight into dysfunctional interactional patterns that perpetuated conflict leading to changes in hierarchy and overall family structure. Unfortunuately, most correctional facilities do not provide systemic therapy services (Tadros & Finney, 2018, 2019; Tadros et al., 2020b; Tadros & Ogden, 2020).

Conceptualizing Incarceration as a Systemic Problem

There is a common misconception that claims removing ‘criminals’ from the streets would bring positive reform to communities. However, there is growing body of evidence that suggest that this unlikely the case. Many relentless crime policies and practices create more harm than good for people of color falling into the U.S. justice system. The stigma of not only being a person of color but an incarcerated individual is rooted from racist structures and institutions in our society. Graham and Lowery (2004) emphasize the role of racial priming by police probation, and unconscious racial stereotyping among law enforcement officials. There are also deficits including lack of resources for counsel, pre-trial services, and drug treatment. Racial disparity in the justice system is exceedingly problematic. Further, the stigma and disproportionate impact of having a loved one incarcerated may carry long-term effects to the individual, family system (Dragomir & Tadros, 2020).

The solution to dismantling mass incarceration is to reduce it. To overcome racial inequality, history must be confronted. Therefore, the conscious, intentional usage of a structural racism lens must be applied (Dragomir & Tadros, 2020). In response to current events, it is particularly vital to acknowledge the conditions embedded from systemic racism. At an early age, criminalization and excessive and exclusionary school discipline policies are visible. Kakade et al. (2012) found that African American youth with an arrest history at baseline, were more likely than White youth to fail to complete a high school education as of 2003. In addition, these authors found that overall, African American youth were more likely to not only be arrested, but be arrested multiple times, as compared to White youth (Kakade et al., 2012). The juvenile justice involvement pushes youth of color deeper into the criminal justice system and can lead to long-term consequences of legal involvement being negatively associated with youths’ outlook of the future. Additionally, policy decisions continuously target people of color in disinvested neighborhoods, and then are over policed (Dragomir & Tadros, 2020). Mental health professions treating this population need to understand how systemic and racial inequalities benefit the criminal justice system (Tadros & Owens, 2020). Exposure to family services and mental health treatment are essential to coping with the consequences of systemic oppression (Dragomir & Tadros, 2020). It is critical to point out the link between these policies and covert white supremacy. It is not enough to only recognized personalized privilege, but to actively challenge the narrative in everyday life to combat the illusion of diversity and inclusion. With first acknowledging the existence of systemic racism and informatively working to end it will bring the justice system closer to reformation.

The Tadros theory of change is an integrated structural, narrative, and solution-focused approach (Tadros, 2019). This theory is defined by a family’s structure, socially constructed goals for treatment, social location, and strengths. This integration is formed by encompassing a structural conceptualization of families while incorporating narrative attitudes of empowerment, solution-focused’s goal-orientation, a multicultural framework, and a strengths-based positivity to better serve clients. This paper provides general structure for providing systemic treatment, but it appears this theory could be applied to incarcerated populations. Clinicians are advised to review the tenets, conceptualize, and treat incarcerated clients and their families via The Tadros theory of change in conjunction with an incarcerated informed lens. The points posited in this paper about the various factors and adversities faced by this population must be considered.

It is vital that therapists focus on empowering and encouraging their clients as well as challenging them in order to produce change within the family. However, this can prove to be difficult when an individual is incarcerated. Few incarcerated facilities have made efforts to accommodate couples and families by providing opportunities for incarcerated individuals to improve their abilities to bond with a significant other and children during incarceration and upon release. There should be programs that enhance parenting skills, provide psychological services, encourage maintaining ties through weekly letter writing, and improve children’s access to visitation. Moreover, there are essential factors that should be explored when treating individuals, couples, and families while incarcerated and post-release.

Incarcerated individuals may come from all types of environmental backgrounds. Keeping this in mind while approaching members with treatment is crucial. Some incarcerated individuals were raised around crime, parental absence, and did not witness healthy relationships. Additionally, race and ethnicity play a huge role in incarcerated couples’ therapy, as some families have a disproportionate amount of financial and other resources compared to other racial and ethnic groups. Incarceration has a lasting and strong effect on individuals’ health, social support networks, and general well-being. Yet the role of personal factors in health outcomes remains unclear, particularly for racial and ethnic minorities. Prisons, with crowded living areas and shared bathroom facilities, invite the potential spread of infectious diseases such as hepatitis C and HIV/AIDS. The overwhelming majority of incarcerated individuals will eventually be released back to their communities, bringing with them any health-related issues acquired in prison and beforehand. Mental health professionals should recognize how physical health and the health conditions of prison systems can take a toll on the mental health of these individuals.

Mental health professionals must explore the prominent factor of any current or past substance abuse for individuals who are treated during incarceration. Several studies have documented the higher prevalence of emotional, behavioral, and substance use problems among offenders in the criminal justice system when compared to the general population. (Domalanta et al., 2003; Teplin et al., 2002). Incarcerated couples’ therapy may not be sufficient as a standalone treatment method in improving the individual’s mental health and/or substance use issues. Therefore, incarcerated persons with a history of alcohol-related problems may require supplemental psychoeducation, in addition to substance abuse services, to address adverse symptoms and coping skill deficits.

Research indicates that paternal incarceration disrupts familial bonds and outcomes (Snyder, 2009; Tuerk & Loper, 2006; Young & Smith, 2000). Nearly nine out of ten (88%) fathers in state prisons reported that their child’s caregiver is their biological mother (Glaze & Maruschak, 2008). When mothers and fathers’ relationship is amicable, mothers are more likely to bring children to visit their fathers in prison (Cecil et al., 2008; Hairston, 1998). Thus, the coparenting relationship quality between mothers and fathers plays an integral role in father-child engagement. Further, it is crucial to receive therapeutic services to help build or rebuild relationships with significant others and other family members after being released from prison or jail.

When treating incarcerated individuals, mental health professionals should introduce community-based programs as an opportunity for continuous care for the ones effected by imprisonment post-release. Some cities have constructed groups to mitigate the harmful effects of reentry. Community-based institutions may effectively provide reentry assistance including counseling, substance use treatment, health care, housing, and job training. For example, MFT groups and parenting classes can help the formerly incarcerated parent build positive social capital, while learning skills to take an active role in their child’s development.

The main concept of the following therapeutic approach is to mold an incarcerated informed lens into therapy. Presenting therapeutic approaches in therapy can be difficult, and as noted earlier, there are many factors within the criminal justice system that contribute to mental illness. Numerous research studies support the idea that mental health professional must have a descriptive background of all the factors that may lead to such health problems for those who have been incarcerated. The goal of the therapist through the following approach is to conceptualize contextually when treating individuals who have been ostracized and stigmatized by our current society (Tadros et al., 2020b). Several implications can be made regarding the effectiveness of couples and family therapy’s use within incarcerated settings. Engaging incarcerated individuals and their families in therapy provides a supportive, safe place for incarcerated individuals to connect. Additionally, implications could lead to helping couples and families heal from the socio-emotional impact the criminal justice system can have on the persons directly or indirectly involved. Research has shown that mental health problems are exacerbated while incarcerated and maintain them post- release, such as the notion of feeling dehumanized due to the isolation and restrictive rules as well as the overarching stigma of being incarcerated. The shift in perspective can lead to the development of socio-political and community-level interventions.

Future Directions

In the literature, the difficulties of managing facilities saftey and the challenges that correctional employees face in trying to offer just health care to people whose liberties are so restricted have been mentioned. However, at minimum, clinicians and correctional employees should commit to making constant improvement in the health conditions and care systems to motivate more just care for incarcerated individuals. Therapeutic services should be continued post-release. Incarcerated individuals should be referred to community organizations for follow-up medical care and treatment of substance use disorders before they are released from imprisonment. Prison systems must begin to take the pains of imprisonment and the nature of institutionalization seriously during the re-entry process and provide individuals with effective decompression programs in which they are re-acclimated to the nature and norms of the free world. Supporting the importance of the use of an incarcerated informed lens in therapy, taking action to improve public safety and forming social justice movements can help bring awareness to families affected by incarceration and can promote destigmitization.

This paper highlighted and introduced a comprehensive view of approaching therapy with individuals and their families during and post incarceration. Tadros et al. (2019) argued the importance of using cultural humility and culturally competent approaches in therapy within incarcerated facilities. What about the culture of incarcerated facilities and the culture of released individuals and their families? These facets must be further explored and disseminated into the literature so that clinicians can best serve this population. Policy collaboration between the criminal justice system, child welfare agencies, etc. could support interventions that keep families together, help families stay in touch or reconnect, and build the capacity of communities. Additionally, families and neighborhood networks may promote public safety in ways that police and correctional facilities often cannot (Gust, 2012).

Research on incarceration must center on the influences on strengthen familial relationships and enhance overall family dynamics. Fortunately, there is an abundance of research on parents of incarcerated children and children of an incarcerated parents, however, there is a scarcity in the literature on other members of the family unit such as siblings and coparents. Further, this gap showcases the little information known about less commonly studied individuals impacted by incarceration. The researchers recommend the goal be to apply research to the clinical therapy room, bridging research to practice. It is not sufficient to conduct research if we’re not utilizing findings to aid this underserved population. There are various injustices associated with incarceration; researchers and clinicians as individuals with some privilege due to education and career status, need to advocate for those that do may not have the ability or platform to do so.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Eman Tadros

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