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Theoretical review of principle concepts in brief psychodynamic therapy applied in a model for treatment of adult incarcerated males

ProQuest Dissertations and Theses, 2009
Dissertation
Author: James Mcleary
Abstract:
An increase in law enforcement initiatives and more stringent mandated sentencing by the judicial system over the last two decades has resulted in overcrowding in the U.S. prison system. Correctional officials have been forced to allocate their finite budget primarily on the cost and problems associated with housing the increasing number of inmates. An unfortunate consequence of limited funds has been to reduce programs and services such as mental health. The model of brief psychodynamic therapy presented in this paper was developed to utilize effective psychodynamic techniques and interventions and reflect the cultural reality of the prison environment. Examining the issues of mental health services in this population and applying a time-limited effective therapeutic approach may provide an efficient fiscal solution to an overtaxed correctional budget. A review of traditional psychodynamic therapy and application of the principals in brief therapy to address the underlying causes of an inmate's maladaptive symptoms may offer an alternative method to current mental health interventions in this population.

Table of Contents Copyright ii Signature Page iii Abstract iv CHAPTER 1: INTRODUCTION 1 CHAPTER 2: RATIONALE FOR EFFECTIVE STRATEGIES 5 CHAPTER 3: MATCHING APPLICATION AND THERORY 10 CHAPTER 4: OVERVIEW OF BRIEF PSYCHODYNAMIC THERAPY 15 CHAPTER 5: GOALS AND ANALYSIS OF BPT 24 CHAPTER 6: CORE CONCEPTS OF BPT 27 CHAPTER 7: MODEL OF BPT WITH INCARCERATED MALES 35 CHAPTER 8: GUIDELINES FOR BPT THERAPY....: 40 Beginning Phase 42 Middle Phase 44 Ending Phase 45 CHAPTER 9: OUTLINE OF SESSIONS 46 Evaluation Phase: Sessions 1-4 46 Therapeutic Phase and Dynamic Focus: Sessions 5-15 53 Termination Phase: Sessions 16-20 59 CHAPTER 10: CONCLUSIONS 63 REFERENCES 65 v

CHAPTER 1: INTRODUCTION Beginning in the 1980s, public opinion encouraged political officials to take a tough stance on crime. The legal system responded by imposing more stringent sentences, causing the number of incarcerations to increase substantially and producing an economic burden on state and federal budgets. Policy makers and correctional officials grappling with the fallout of these policies have become receptive to treatment strategies that address the security issues within institutions, provide treatment modalities that help in reducing recidivism, and are economically viable with respect to the limitations of their budgets. A review of the literature indicates that Cognitive Behavioral Therapy (CBT) is the primary strategy employed by correctional institutions to achieve the goals of prison officials. Hollenhorst (1998) cited examples from several correctional institutions in various states that have implemented CBT as a means to reduce recidivism and violence. Furthermore, she noted that, "they lack control of their emotions and the skills to process information usually provided by peers and authority figures during development through reinforcement, punishment, or extinction of behavior" (p. 53). Additionally, because CBT is a time-limited intervention, it lends itself to the economic constraints of a prison budget that has limited mental health services. Although CBT is utilized in many areas of dysfunction, a review of the literature indicates that the two most commonly targeted areas for behavior change in correctional facilities are substance abuse and anger management (Hollenhorst 1998). Substance abuse is targeted primarily because it is implicated in the drug-crime cycle and is 1

associated with a tremendous drain on financial resources. Anger management, however, is targeted because anger control may reduce security problems within the institution, as well as enhance public safety once an inmate is released. The goal of CBT and its application in prison and aftercare programs is to enhance the ability of an individual to predict and appreciate the consequences of dysfunctional behavior, prevent a reoccurrence of that behavior while incarcerated, and to deter future recidivism (Loza & Loza-Fanous, 1999; Sappington, 1996). However, the theoretical efficacy benefits of CBT may be thwarted by the reality of prison policy. For instance, an inmate may feign cooperative participation, or be less than honest with self-report instruments designed to measure improvement just to fulfill the conditions of parole (Dalton, Blain, & Bezier, 1998). It is the goal of this paper to propose that Brief Psychodynamic Therapy (BPT) is a viable treatment strategy because it too achieves the objectives targeted by correctional officials and policy makers for clinical efficacy and cost efficiency. Brief dynamic therapy is an intervention that facilitates insight into the underlying problems, which leads to violent behavior and provides an individual the ability to actively identify and cope with these impulses (Lanza, Anderson, & Boisvert, 2002). The essential goal of depth psychology facilitated through the psychodynamic approach is to provide extensive amelioration of the central disturbance and allow for the rehabilitation of the self (Kohut, 1977). Its fundamental utility is to discover that a client's symptoms are responses to significant but forgotten past occurrences and that by providing memory of these events, insight can be achieved as well as provoking changes in behavior (Fialkow & Muslin, 2

1987). In addition, McGualey and Humphrey (2003) proposed that an understanding of past experiences and the impact on the current life of the inmate can facilitate meaningful decisions by prison officials. They indicated that in both medium- and maximum- security prisons, inmates are the products of inadequate or dysfunctional family units. Assessment of these inmates from a dynamic perspective can provide an understanding of the beliefs and impulses that are unconscious but operating in the inmate. Understanding the defense mechanisms and the affective state of an inmate allow for the prison personnel to be aware of how the inmate projects unconscious and aggressive behavior onto those in the environment. This understanding and meaning is also provided to the inmate through the dynamic process of insight, whereby the inmate identifies and increases his capacity to contain repeating patterns of conflicting emotions and thought. The conflict of their internal world is diffused through newly found insight and allows for a more realistic view of the external world. Insight is specifically accomplished through the process of a therapeutic alliance, which promotes a dynamic relationship between client and therapist. The relationship dyad provides an opportunity for the client to have a deeper understanding of internal motivations and external stimuli in the environment through the process of insight (Brenner, 1979; Greenson, 1965; Zetzel, 1956). Theoretically, BPT should offer an inmate a deeper understanding of the unconscious motives that drive his thinking and behavior, increase awareness of triggers in the environment, and strengthen the decision making process, which would reduce the occurrence of re-offending. In addition, BPT is also time-limited and offers the same cost advantage for prison budgets as CBT. 3

The purpose of this paper is to examine the principle concepts of BPT and propose the merit of this treatment strategy. A review of the literature will provide a rationale for the development of guidelines applicable to incarcerated males. 4

CHAPTER 2: RATIONALE FOR EFFECTVE STRATEGIES The War on Drugs and Crime launched by policy makers in the 1980s was initiated by the public's zero tolerance and resulted in legislatures mandating more stringent sentencing including longer terms, mandatory sentencing for first time offense, and life imprisonment for habitual offenders (Byrne & Brewster, 1993; Higgins, 1996). Taxpayers elected public officials who developed policies and implemented strategies that carried out their wishes and soothed their concerns. This attitude of zero tolerance by the public resulted in a cascade of troublesome events for the correctional system. For instance, increased vigilance of law enforcement led to more arrests, and a clogged legal system that began in the courts and resulted in a record number of incarcerations and parole caseloads (Byrne & Brewster). It became routine practice for law enforcement agencies to focus their efforts on a range of specific crimes targeted on a monthly basis (Bureau of Justice Statistics, 1993). This action further increased movement through the legal system and increased incarcerations. Slaton, Kern, and Curlette (2000) reported, that "during a period between 1985 and 1997, the jail population in the U.S. almost doubled and also, within an eight year period following 1986 there was an increase of 48 federal prisons and 214 state prisons" (p. 88). The public's intolerance to crime and policy makers concern for public safety created a dilemma for correction officials and legislatures. By relying on imprisonment as the solution for reducing crime, they created overcrowding in the correctional system that precipitated huge budgetary costs and serious security control in institutions (Byrne & Brewster, 1993). The dilemma also extended to daily decisions made by parole 5

officers. Pacheco (1994) described a theoretical situation in which a parole officer could decide not revoke parole of an ex-offender because he is influenced by overcrowding in correctional facilities. Furthermore, the number of incarcerated individuals has reached such severe proportions in federal and state prisons that the U.S. Federal Court has initiated orders to all but eight states "to amend the situation because it is considered cruel and unusual punishment for prisoners" (Morgan, 2002, p. 1). There are many costs associated with an individual in prison and this fluctuates from state to state, but the minimum cost of incarceration for one year is approximately $20,000 (Hunter, 2000). These costs can escalate to $65,000 a year for the elderly because they may require extensive medical care (Drummond, 1999). In addition, Drummond indicated that medical care cost may even be higher for individuals with HIV or inmates who have contracted infectious blood diseases from contaminated IV or tattoo needles. This rising cost of incarceration has prompted prison administrators to find creative ways to deal with overcrowding. For instance, the Federal Bureau of Prisons has undertaken several measures to reduce cost, such as adding housing to standing facilities and providing double instead of single beds (Higgins, 1996). However, reducing the cost per bed may provide a solution to capacity, but does not eliminate problems arising from overcrowding. Other strategies to reduce cost are being implemented by jurisdictions such as Canada, in which the use of Electronic Monitors (EM) are utilized for low-risk offenders (Harris, 1996). The cost of an Electronic Monitor is approximately $5.00 per day, which provides substantial cost savings to any jurisdiction using them. Harris

posited that one problem associated with EM use is that individuals could still be participating in illegal activities because, even though officials know their whereabouts, they are unable to know what they are doing. However, none of these cost saving measures has ameliorated the reduction of services for mental health. These conditions have prompted policy makers to reevaluate the philosophy of punishment as the only restitution for criminal behavior. Many state constitutions reflect that shift of legislatures from a position of punishment to treatment, and this is primarily due to rethinking the costly policy on illegal drug activity (Sharif, 2003). Sharif noted that California's Proposition 36 provides for the courts to impose treatment responsibilities instead of jail sentences. This change was projected to reduce incarcerations and therefore reduce new prison construction resulting in saving the state hundreds of millions of dollars. The theory of reformation does not preclude the notion of restitution for criminal acts, but offers another perspective that includes a predictive aspect for determining whether or not an individual will re-offend, as well as how best to provide treatment that can modify criminal tendencies (Hartman, Wolk, Johnston, & Coyler, 1997). This position was essential to address the lack of rehabilitation efforts existing for incarcerated and released felons. For instance, one study found that completion of parole supervision fell by half in 1997, suggesting that recidivism had increased (Morgan, 2002). This and other studies supported the initiation of more in- prison programs as a meaningful tool to reduce recidivism by inmates once released into community at large (Knight, Simpson & Hiller, 1999). Byrne and Brewster (1993) also supported this position by arguing that the goals of a treatment program should promote a 7

change in the offender as well as provide for public safety for the community. Addressing the underlying causes for maladaptive behavior with psychodynamic interventions provides a foundation for an inmate's conscious participation in rehabilitation and reformation of criminal activity whether it related to an addiction or not. Although the tough stance on drug use and its consequences was the catalyst for legislation and increased activity of law enforcement policies that resulted in prison overcrowding, there was justification for it. A 1997 survey revealed, "more than half of individuals arrested have used drugs within 30 days of their crime and 83% of all prisoners had some history of drug use" (Griffith, Miller,Knight, & Simpson, 1999, p. 352). Treatment while incarcerated may well represent the only opportunity for intervention for many individuals involved in drugs and crime. The Anti Drug Abuse Act of 1986 provided part of its funding for treatment efforts in correctional institutions (Hartman et al., 1997). The intention of the legislatures was to provide rehabilitation opportunity during incarceration and to ensure continuity of this treatment through aftercare programs that may be instrumental in reducing recidivism. Studies conducted by government and various independent research groups support the view that there can be a significant reduction in recidivism and ultimately less crime when offenders are held accountable for their actions, are treated for their dependencies, and their antisocial behaviors are responded to immediately (Hunter, 2000). 8

Many researchers interested in these goals have implemented programs and sought to evaluate the effectiveness of these programs. Determining the probability of recidivism before the release of inmates allows for specificity of referral treatments and reduces the cost of mismatched interventions (Griffith et al., 1999). Griffith and his colleagues conducted a three-year outcome study with data collected from 394 parolees to examine the effectiveness of substance abuse treatment during and after incarceration. The results indicated that high-risk offenders were more likely to re-offend. They found that identifying individuals as high-risk while incarcerated allowed for greater specificity in targeting after-care treatment and may reduce re-offending. In addition, they discovered that the associated cost of drug abuse and crime was passed onto the taxpayer and could be reduced by effective after-care treatment. The authors also posited that efficacy may be linked to identifying high-risk offenders through available test and providing resources that have a level of intensity appropriate to this population of inmates. 9

CHAPTER 3: MATCHING APPLICATION AND THEORY Policy makers have undergone a fundamental shift in the philosophy underlying legislation from punishment to reformation (Pacheco, 1994). Pacheco noted that language in laws governing punishment for criminal offenses have shifted to reformation. For instance, the state constitution in Oregon provides that principles of reform be reflected in the goals of justice. Byrne and Brewster (1993) posited that correction's practices should shift from punishment to rehabilitative interventions as a fundamental goal of the justice system. This shift in philosophy has resulted in financial support for treatment for both prison and after care rehabilitation programs. As a result, correctional officials have altered their focus from the sole purpose of prison safety to include public safety, by implementing programs to reduce recidivism and address the needs of inmates. CBT applies technique that addresses the underling dysfunction in both cognitive and behavioral domains of an individual and targets these areas for change (Bandura, 1977; Meichenbaum, 1977). The focus of the cognitive dimension in therapy is to assess the internal views of self and the world, and change dysfunctional thoughts and schemas, whereas the behavioral emphasis is promoting change through awareness of what affects actions (Arkowitz & Messer, 1984). One of two populations where CBT is usually targeted is in individuals with a history of substance abuse, primarily because this consumes so much of the federal and state budgets. The other area of focus is anger management, because of its perceived value for enhancement of security in prison and public safety once released (Loza & Loza-Fanous, 1999; Sappington, 1996). Notwithstanding the fact that policy makers and 10

correctional officials support these two areas philosophically and financially, it is the intent of this paper to focus on the attributes for change that these officials are interested, and the techniques of BPT therapy that are effective. It is first prudent to explore the areas targeted by CBT to establish a precedent for areas later explored with BPT. Sappington (1996) investigated 48 inmates participating in an anger management program and examined the relationship of cognition and belief with prison adjustment. The adjustment measures he used included the number of discipline notices assigned to inmates for violation of rules, because it is one way for correctional officials to monitor the level of security in an institution. He associated the measure with anger, which he defined by assault and failure to obey a direct order from a prison guard. He also relied on self-report measures such as an affect checklist designed to discover negative affect and an anger measurement scale. The inmate's cognition was measured through belief and coping style. Although he admitted that this data is correlation and not meant to suggest casual directions relating to behavior, he noted that a lack of self-efficacy correlates to poor adjustment and problem-solving style correlated with better adjustment in prison. Theoretically, self-efficacy effects behavior because an individual's expectation of this attribute determines whether coping strategies are initiated, as well as the amount of effort expended to sustain behavior under stress (Bandura, 1989). Bandura proposed that individuals engage in activity and function with assurance, when their belief confirms a capability to succeed. Anger management programs in correctional facilities are modeled on the principle and techniques of CBT (Hollenhorst, 1998). She postulated that an anger 11

management program mirrors CBT because the intention to promote change in the offender utilizes the same principle of analyzing the pattern and underlying assumptions of an inmate's cognitions that maintain antisocial behavior. In addition, methods employed by an anger management program include reinforcement of new learning and providing the opportunity for modeling desirable behavior. This may be accomplished through group discussion and role-play opportunities that are intended to provide alternative beliefs and behaviors. Pioneers in CBT hypothesized and provided a theoretical basis for examining supportive underpinnings of an individual's cognitions, and the subsequent behavior flowing from them. Meichenbaum (1977) postulated that the cognitive process was a mediating factor for behavior and that an individual's internal dialogue could affect change in the belief of one's ability to cope with presenting circumstances. He posited that by refocusing attention from negative to productive thought, a positive shift of self- appraisal and physiological reactions could set the stage for positive behavioral outcome. Simply put, interaction involving positive internal dialogue mediates an individual's cognitive structures and can facilitate adaptive behavior change. Cognitive structures are core beliefs related to personality that include fundamental beliefs of self and the world, and are referred to as a person's schemata (Beck 1976). Individuals revert to primitive processing when experiencing psychological stress and this causes cognitive distortions or errors in their reasoning capabilities. Beck asserted that effective therapy is directed towards identifying those thoughts that are causing distortion in reasoning, and thereby correct maladaptive behavior. 12

Reinforcement, role-playing, and modeling are additional techniques implemented in anger management programs to produce desirable behavior in offenders (Hollenhorst, 1998). These cognitive and behavioral areas of functioning or domains are affected by efficacy expectations of the individual (Bandura, 1977). Bandura hypothesized that efficacy expectations are influenced by information from four sources and that it is through these sources that modalities of treatment are focused. Allowing a person to model change can facilitate a positive effect on performance accomplishment and allow an individual to generalize this behavior outcome to other situations. This modality allows for desensitization reduction in actual and imaginary threats and removes the autonomic responses in the individual. Although less effective, the vicarious experience of observing corrective behavior or symbolic modeling through imagery also provides a source for implementing change as well as using verbal persuasion to encourage the individual to be led by suggestion (Bandura, 1977). Bandura also posited that emotional arousal could be ameliorated through visualization and relaxation techniques that increased an individual's expectancy to cope with situations more effectively. Although CBT provides techniques and interventions that can'effectively modify behavior and thinking, BPT provides an opportunity for the inmate to understand the root cause for a particular focal issue. The key theoretical concepts promoted in a therapeutic relationship provide a vehicle for successful interventions in the patterns of maladaptive behavior. 13

CHAPTER 4: OVERVIEW OF BRIEF PSYCHODYNAMIC THERAPY The advent of Managed Care System in the United States has initiated a demand for brief but efficient forms of therapy and precipitated a competitive drive among therapists 14

to be proficient in these interventions (Levenson & Evans, 2000; Magnavita, 1993; Peake & Meyers, 1997). The expectations of Managed Care officials have heightened therapists' sensitivity to decisions and interventions during therapy through the use of empirical peer-reviewed options (Peake & Meyers). Magnavita (1993) noted that Freud believed that the process of psychoanalysis required a long time for the client to strengthen his ego structure against painful insights emerging from the unconscious. This ordeal was accomplished through the important relationship between the therapist and the client, and required time. However, Magnavita noted that Freud accomplished successful results in a number of his cases during short periods of time, and in this sense he may have contributed to the movement for time- limited therapy. Over the years, therapists have placed greater emphasis on this role and elaborated on their specific duties. The role of the therapist in BPT by necessity needs to be active to accomplish results in a short time frame (Magnavita, 1993). Alexander (1963) postulated the need for therapists to take an active role versus the traditional position of a blank page and that this passive role is the reason for extended time in therapy. One of the goals in time-limited dynamic therapy is accomplished by developing specific guidelines for selection to assess and determine the appropriate patient. The process also entails a contract for a specific time line and a description of the roles of client and therapist (Magnavita, 1993). The purpose for well defined guidelines, rigid assessment, and focused selection procedures was to ensure that the individual could manage the therapist's confrontational interpretations and insights 15

(Peake & Meyer, 1997). For instance, Malan (1995) specified the length of treatment, informed the client of specific role expectations during therapy, and tested interpretations during the initial interview to determine if the individual could respond to these insights. Other brief oriented therapists such as Mann, Sifneos, and Davanloo screened for individuals who presented with Oedipal issues (Peake & Meyers, 1997). Some of the early fundamental concepts of psychodynamic therapy were modified by pioneers in BPT such as Alexander and French,, as a means to broaden the availability of treatment to a wider segment of the population through time-limited therapy (Peake & Meyers, 1997). Alexander and French (1946) posited that time-limited therapy could be achieved through direct and aggressive probing and this could facilitate addressing reactions of the client in the third person to provide insight. This technique decreased the time it took for a client to recognize the transference aspects of his past in the present and accelerate the therapeutic process (Davanloo, 1990). Alexander and French (1946) developed the concept of a "corrective emotional experience" (p. 294) and hypothesized that this was the curative element in therapy. They described this experience as the client's ability to freely express emotion in the transference without hesitation. In addition, they posited that the corrective experience was based on the construct of the transference process and its success. Their reasoning included the hypothesis that the transference experience provided a new opportunity to work through past relationships. The ego was then allowed to process unresolved conflicts under new circumstances because the therapist had different reactions than past parental reactions (Bernier & Dozier, 2002). Although Alexander and French laid the 16

conceptual groundwork for others to follow they did not provide specific guidelines for duration or criteria for treatment (Magnavita, 1993). Among the first to develop a road map and implement strategy for brief treatment was David Malan (Peake & Meyer, 1997). According to Peake and Meyer, he emphasized a thorough assessment for client selection and the utility of providing an explicit contract outlining the expectations of client and therapist. The selection process was accomplished through an interview in which a client was tested with interpretations made by the evaluator. If the client had the ego strength to handle this trial run, he was considered to be a good candidate for an insight-oriented approach. Malan (2004) also postulated a two-fold triangulated model, one involving "conflict between wishes, desires, and behaviors and the other involving persons in present, past, and the therapeutic relationship" (p.90). The focus is on patterns of behaviors that can be linked to the past, which seemed to be selective for clients with psychosocial issues rooted unresolved during early development. Malan linked a client's conflict with the therapist to past issues with parent figures. He made his interpretations of this conflict through the "triangulated adult relationships" (p. 90), which he concluded were based on the unresolved psychosexual issues originating during this stage of development. Therapists interested in time-limited therapy, such as Mann, were motivated to shorten therapy to reduce the congestion in the clinics (Magnavita, 1993). Magnavita noted that Mann developed an approach to therapy that was limited to 12 weeks, which he postulated provoked conflict in the individual due to unsuccessful separation from the 17

caregiver. Magnavita agreed with Mann that, during therapy, the therapist could ameliorate the grief activated when termination of therapy occurred with empathy provided throughout the therapeutic process. Further, this would provoke conflict between four basic developmental struggles in an individual, which includes the tension to achieve independence, productive activity, adequate self-esteem, and unresolved grief. These conflicts in development when successfully negotiated provide an individual with ego strength and virtues necessary to navigate through life (Erikson, 1968, 1982). Erikson postulated that during the first stage the individual develops a basic optimism nurtured through love and adequate handling is imbued with a sense of trust. The second psychosocial crisis allows the child a sense of autonomy fostered by successful initiatives of his will to act, and engenders independence with an absence of debilitating shame. In the third stage, the child learns to socialize and broaden the skills necessary to escape an immobilizing fear and guilt, which stifles independence and initiative. The next stage, if successfully navigated, will foster a sense of industry for accomplishment versus inferiority and doubts for the future. The child in the next crisis stage should successfully discover who he is and acquires a self-certainty rather than self-doubt. Learning genuine intimacy during the next stage allows the child to participate and enjoy enduring relationships in the future. The next stage should provide the successful learning process for a sense of operating productively. If the individual has learned to mature through these stages, the last stage provides for a sense of integrity and wisdom. Understanding Erikson's model provides the language that therapists' need to effectively implement BPT, to conceptualize the problem, and attend to a focal issue 18

encountered during a particular stage of development (Peake & Meyers, 1997). The client's issues could have initiated anytime during the eight developmental stages outlined in Erikson's theory. The therapist should have a theoretical understanding of the conflicts arising during these stages, so that he can interpret the transference material emerging. The developmental frame also helps the therapist to choose techniques that match the client's level of maturity so that the client can integrate the new insight or accommodate the new understanding. This facilitates a process by which the therapeutic process can be abbreviated. Magnavita (1993) noted that BPT therapists such as Sifneos also embraced the concept of enforced rigid patient selection on the premise that individuals needed a certain amount sophistication to profit for BPT. A prerequisite for selection demanded that a patient have sufficient intelligence and psychological mindedness to delineate a problem, have had a stable relationship with someone as a child, participate fully with the therapist during sessions, and be motivated to fundamentally change. Magnavita posited that the first session involved an agreement that the client would focus on a well-defined psychodynamic issue, such as unresolved conflicts with a parent or successful separation from parental protection. These criteria provided an anchor for patients to have the necessary ego strength to handle the anxiety-provoking style of confronting and insightful interpretations. Davanloo (1990), in his quest to shorten therapy, developed in intense format of BPT. He postulated that the therapist should work within a triangle consisting of the relationship between the therapist and client and its connection to past and present and 19

Full document contains 78 pages
Abstract: An increase in law enforcement initiatives and more stringent mandated sentencing by the judicial system over the last two decades has resulted in overcrowding in the U.S. prison system. Correctional officials have been forced to allocate their finite budget primarily on the cost and problems associated with housing the increasing number of inmates. An unfortunate consequence of limited funds has been to reduce programs and services such as mental health. The model of brief psychodynamic therapy presented in this paper was developed to utilize effective psychodynamic techniques and interventions and reflect the cultural reality of the prison environment. Examining the issues of mental health services in this population and applying a time-limited effective therapeutic approach may provide an efficient fiscal solution to an overtaxed correctional budget. A review of traditional psychodynamic therapy and application of the principals in brief therapy to address the underlying causes of an inmate's maladaptive symptoms may offer an alternative method to current mental health interventions in this population.