The prison psychotherapist

I had a conversation last week with a fellow psychotherapist who I have known for many years and we meet up now and then to ‘chew the fat’ as they say. But an exchange happened in our chat that has stayed with me. I was talking about my experiences of working in prison and I said that I had liked working there. She asked why and I said a few things and then I said:

“It was exciting. It’s an exciting place to work as there is always the threat of violence in the air.”

She replied:

“That’s the exact reason most psychotherapists don’t want to work there.”

Her response kind of surprised me a bit. I didn’t expect it and I have remembered it. I wondered what it meant about me and so forth. It is true. I worked in a male adult prison and assaults did occur. There were no murders whilst I was there but assaults did occur on at least a semi regular basis. You had to always be alert for that and I found that exciting. I have also subsequently wondered if this has got anything to do with my liking for skulls as I have no idea where that came from and what that is about.


For a psychotherapist however a prison is like the candy store of psychopathology. It is the ‘Toys-r-us” of the psychoses and neuroses. If you ever want to study abnormal psychology go and work in a prison. In there you see it all from the commonplace like anxiety and depression to the unusual conditions like pica, hebephrenia, sexual sadism and multiple personality disorder (MPD). At least these are some I came across that I rarely see in my usual practice.

Also you have a captive client base in a prison as they aren’t going anywhere for a long time. They usually want to come and talk with you even if they feel it is not assisting all that much because it’s better than going to work or sitting in your cell twiddling your thumbs. If you are a pretty female therapist then you will always have a waiting list of clients. There is an opportunity to get to know some of these people very well.

I recall one guy that was brought to me because he was costing the prison money. They wanted him ‘fixed up’ because they kept having to give him new blankets. He had a habit of eating the ones he already had (pica). There was also a couple of MPD that I diagnosed. In my view they were true MPD which is interesting as it is a very rare condition. About 10 to 15 years ago MPD got popularised and all of a sudden everyone had it. I remember watching Oprah one day and she had a woman on who had written a book about her self and her 21 personalities and she was claiming she was MPD. That is not MPD so unfortunately the term fell into disrepute for some time because of this sensationalisation.


Tattooing in prison is illegal but it is rampant. “Prison tatts” are usually a badge of honour. With one man who was a well known prison tattooist the guards never could find the needle he was using. He had kept it secreted up his nose for a couple of years.




There was one guy who used to be in the army and he had two personalities that could switch between each other and not recall each other. However he had marital problems and his wife was going to leave him if he didn’t change when he got out. He would just disappear for a few weeks at a time. When he finally came home she asked him where he had been and he couldn’t tell her. He had no recollection but she thought he was lying and had another women somewhere. I told him I thought he had MPD, he told his wife this and then she told him to tell me that she was so happy and that I had saved their marriage. It made sense to her now. She apparently wanted to give me a gift of some kind but staff can never accept gifts from prisoners or their associates.

The other thing I noted was I expected to be diagnosing anti social personalities more than I did. However I made more diagnoses of narcissistic personality instead. This surprised me as logically it is not what one would expect. However from what I saw it is the narcissistic personality that is more likely to end up in the prison system.

I also got adept at diagnosing schizophrenia. I had the training and authority to ‘form’ some one as it was said. Under the Mental Health Act I could have a prisoner removed from the prison and placed in a locked ward of a psychiatric hospital. This is a powerful piece of legislation as there are very few ways a prisoner can leave a prison before completing their sentence, and this was one such way. It got known amongst the prison population that I could do this and I started to get all these inmates coming to see me with schizophrenic symptoms. I had to diagnose which were real and which were fake presentations and some of them were quite convincing. It is much nicer to do your prison time in a hospital than it is in a prison and they get to have sex with women for a change.

Never a dull moment when working in a prison and great training for one’s diagnostic skills of some quite unusual forms of psychopathology.

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