Reducing Recidivism with the PACER Method

Hey there everybody, and welcome to today's show on reducing recidivism with the PACER method. I'm your host, Dr. Donnelly Snipes. In today's show, we're going to identify the problem of recidivism. We'll define the PACER method, explore risk factors for recidivism, explore the connection between criminal behavior, personality disordered behavior and trauma, examine behavior as a form of communication and identify effective PACER interventions, I.e. physical, affective, cognitive, environmental and relationship interventions to reduce risk and enhance resilience. So how big is this problem? Well, unfortunately, it's pretty big. More than 2/3, 68% of people released from prison will be rearrested with within the first three years of release and 83% will be returned to the criminal justice system within nine years of release. So clearly we're missing something here. The PACER method is a trauma informed, integrative approach to reducing risk and enhancing resilience. From the perspective of the PACER method, people's behavior is a way of communicating. So we start scratching our head and saying, why is it that people are reoffending? What are they trying to communicate that they may not be able to communicate with words, or maybe they're screaming it from the rooftops and nobody's listening. Recidivism communicates that criminal behavior helps the person get their needs met more effectively than pro social behavior. So the interventions we're going to look at seek to reduce recidivism by addressing those needs and enhancing motivation and a sense of self efficacy. That is people's belief that they actually can change. As I mentioned, PACER stands for physical, affective, cognitive, environmental and relational. So let's start with the physical risk factors that may increase people's rate of recidivism. The first one is age. When people are younger, generally before the age of 24, their prefrontal cortex, which is where we have a lot of our impulse control stuff, isn't fully developed yet. So when people are younger, they tend to have more impulse in what they do. They don't step back and think. When people are younger, generally in their teens and early 20s, is also when they're going through a developmental stage where they're developing their identity. And if they are with a particular peer group that is antisocial or criminogenic, however you want to call it, then they may engage in more of those behaviors because they are trying to fit in. They're trying to figure out who they are and where they fit. So age is a factor. Cognitive abilities is Another factor, and I mentioned age, impacts people's ability for impulse control and higher order thinking. But there are also some people, and we'll talk in a little while about fetal alcohol spectrum disorders. But there are also some people who have lower levels of cognitive abilities and they have more difficulty anticipating consequences. So they may be more likely to, to be gullible and more easily manipulated by others who are antisocial or involved in criminal behavior. Addictions. I put this under physical because addictions alter our physiology. But 60 to 85% of people with substance use disorders have concurrent mental illnesses. And we also know that people with addictions have a high rate of adverse childhood experiences. Addictions themselves can predispose people to criminal behavior because they are trying to access their addiction. They need money to gamble. They need money to buy drugs or alcohol. They relapse on alcohol and get DUIs. So there are a lot of ways that addictions, when people have them, can be a risk factor for recidivism, a history of neglect or abuse, and that is R2 is one, R2, depending on whether you put them together or separate neglect and abuse. But it's an adverse childhood experience. And when people have adverse childhood experiences, it actually alters the structure of their brain. It enhances, if you want to think about it this way, it makes the amygdala stronger and it has more projections into people's fight or flight and default mode, autopilot network. So people who are exposed to trauma, especially at an early age, tend to respond and perceive the world through a traumatized lens. They see the world as unsafe, scarier. They see themselves as having less power. So a history of neglect or abuse does have a significant impact on people's ability to feel safe, to trust others, to empathize. So there are a lot of things that we need to consider when we are working with people with personality disorders who are involved in the criminal justice system and just people in general. A lot of people have histories of, of neglect or abuse or trauma. And we want to recognize that past experiences shape future perceptions and can alter future behaviors. They don't have to, but a lot of times they do. So we need to recognize all of the ways the neglect or abuse impacted the individual, because one of the core features of the interventions that we're eventually going to talk about is to help people feel safe and empowered. People who have high levels of restlessness or agitation also tend to be at higher risk for recidivism if they have difficulty sitting still. A lot of times that goes along with impulsivity and even adhd. And not saying that everybody with ADHD has trauma or everybody with ADHD engages in criminal behavior. Of course not. But it's important to recognize that people who do tend to get bored easily tend to be restless sometimes. That can be because they've got high levels of anxiety, because they don't feel safe, because they're hyper vigilant, they're looking, they're scanning, they're trying to figure out if they're safe at any point in time. And that's exhausting. I mean, just to state an obvious fact, that's exhausting. But restlessness and agitation can also cause people to be more impulsive and irritable and look for distractions. If they have weak self soothing or self regulation skills that can also predispose them to recidivism. If they went to jail for assault and battery and they get out of jail and, and they have not learned how to manage their anger more effectively, then they may lash out again and recidivate. They don't have the tools. We need to make sure people are given the tools. But we also need to explore how did this happen? When children are growing up, if they have a secure attachment to their primary caregiver, it is within the context of that attachment that they develop the skills. They learn how to identify how they're feeling and how to regulate their own emotions. They learn how to take a breath, they learn how to cope with feelings, to sit with feelings, recognize the feelings won't overwhelm them, and then problem solve and use their energy effectively. The majority of people that I've worked with that have been involved in the criminal justice system, and that was my first job out of graduate school and actually my last job when I was in community mental health, I had two different episodes where I was running units that were specifically focused on people who were recently released from jail or prison. And my experience is that the majority of people in that group, majority of people who engaged in criminogenic behavior, tended to have difficulty with self regulation and self soothing. So they, when they started to feel distress, they lashed out, they fought, they fled, they became frantic, they relapsed, they tried to numb the pain, they tried a lot of different things. And it was because they felt like the emotions were going to overwhelm them. Now where do those emotions come from? Let's go back to that trauma. A child who experiences trauma experiences the world is unsafe experiences a sense of a lack of personal power. They don't know how to keep themselves safe. Those memories are Embedded, they form what we call schema that guide our future interpretations of people, of life, of situations. So they're going, okay, yeah, this place is not safe. People are not safe. So when I start to feel anxious, it triggers those schema and the brain says, warning, warning, get out of here. And they go into what I call frantic mode. And they're trying to fight or flee to protect themselves. So the goal, the interventions that we would be looking for here is to, number one, help people identify their prior experiences that contributed to them feeling unsafe and disempowered, help them figure out what they need to do so they can feel safe, and teach them self regulatory and self soothing skills, ideally building off the strengths that they already have. 45% of people who are in jail or prison reported childhood trauma. Now that is just asking them, did you experience trauma? A lot of times that was relegated simply to abuse or neglect. When we expand it to include all of what was looked at in terms of adverse childhood experiences, the majority of people who are incarcerated or involved in the criminal justice system or have personality disorders have experienced adverse childhood experiences. And those include abuse, neglect, abandonment, or living with someone having a relationship that primary attachment with a caregiver who had a significant mental health or substance use disorder that prevented them from being at least emotionally available, if not also physically available. So a child who is growing up and is having to make their own, you know, cereal all the time because their caregiver is, you know, passed out drunk, you know that even though the caregiver is physically there, they are not emotionally responsive. A child who grows up in a household in which the caregiver or caregivers are too overwhelmed with their own depression, anxiety, grief, stress, whatever, to be able to connect with the child, that also inhibits the child's development because that caregiver is not able to notice and respond to the child when they are in need of comfort, they're in need of feeling safe, they're in need of guidance on how to regulate their emotions. So a lot of people, 45% of inmates identify, yeah, I experience trauma. But if you include the adverse childhood experiences that we now know contribute to significant health and mental health problems later in life, that number goes way up. And we don't know exactly how high, but we know it goes way up. Mental illness. Inmates with both mental illness and substance use disorders recidivate at a higher rate. Well, that makes sense. And when we're talking about mental illness, we are talking about anything from ADHD all the way to schizophrenia and the whole Alphabet in between. But we do recognize that there is a high co occurrence between substance use and mental illness. A lot of people try to self medicate their depression, their anxiety, their grief, their trauma, their PTSD with substances. We also know that substances actually mimic certain physiological changes in the body that trauma does. So there are intertwined connections between psychological and physiological trauma and addiction. We want to recognize this because a person who is released from jail or prison, who has an uncontrolled mental illness, or maybe it's under control and then they get out and they can't access their meds or they start to decompensate, they are at a much higher risk for recidivism. And one of the things that I've seen, and I really hope it's not still happening, but I bet it is, is that when people are admitted to jail, a lot of times they are taken off their psychotropic medication and they are only given that medication back if they become a behavioral issue. So then they are released from jail or prison and they are not on those medications, provided obviously that they weren't a severe behavioral issue. And then it takes another four, four to six weeks, you know, if you're lucky to get them restabilized on their meds because things like antidepressants don't kick in right away. So we are creating a problem if we are not ensuring that the person is not only stable on any meds that they need, but they also have at least a 30 day supply of those meds and know where to get them refilled when they are released. Now there are some illnesses, alcohol use disorder and schizophrenia and a few other things where they have medications that can be used that are monthly injectables so the person doesn't have to remember to take them on a daily basis, which can also be helpful. But suffice it to say that we know that trauma contributes to the development of mental illness. We know that trauma may contribute to recidivism, we know that mental illness and substance use contribute to recidivism, and we know that trauma and mental illness contribute to substance use. Trauma. Yeah. So we want to recognize these things are all intertwined. The three year recidivism rate of offenders with a mental illness but not addiction is similar to the rate of offenders with neither problem, provided the person is discharged and is stable in their condition. Maybe they don't need meds, but it's important that they are stable in their condition. And when they looked at this, you know, the term mental illness is really ambiguous. A lot of times, because an offender that's released who has adhd, or what I'll call minor depression, persistent depressive disorder, is in a very different boat than an offender that's released with, or someone who is released with PTSD or bipolar disorder that is uncontrolled. So we need to recognize that certain disorders may make people more likely to recidivate, especially if it makes them more likely to relapse on substances. But even if they don't have addiction illnesses, mental illnesses that cause more impulsivity, more agitation, more anxiety, more anger often tend to be related with more recidivism. People with serious mental illnesses like schizophrenia and bipolar disorder have higher recidivism rates than those with other psychiatric disorders. Now, I don't want you to take this to mean that they are dangerous. They. No, that's not what I'm saying. What I'm saying is that, for example, people who are in a manic phase of bipolar disorder tend to be more impulsive, more thrill seeking. But both people with schizophrenia and people with bipolar disorder are certainly more at risk for substance misuse, which can in and of itself lead to criminal behavior. You know, stealing or buying drugs. You know, a lot of people are in jail because of drugs. You know, they were either selling, buying, using, etc. So there are a lot of different reasons. We don't want to just assume that somebody who is being released from prison or jail is, quote, antisocial. We really need to get away from that. A lot of people who are in the criminal justice system are there for substance related issues. And so we need to ask why were they engaging in those substance related behaviors? Whether it was, you know, using, stealing, dui, what have you. Affective and cognitive risk factors. And I kind of put these together. Affective is emotional and cognitive is obviously your thoughts. So people with fetal alcohol spectrum disorders are at a much higher rate of recidivism. Approximately 31% of people that are incarcerated are estimated to have fetal alcohol spectrum disorders. What does that mean? Well, I can't go into all of that right now because we'd be here for hours and hours. But basically, fetal alcohol spectrum disorders occur when a fetus is exposed to alcohol from the birth mother during the, you know, pregnancy. And people with fetal alcohol spectrum disorders tend to have difficulty interpreting. Other people's non verbals tend to speak at a very high level. They may be able to talk a good talk, but they don't understand. Often at the same level. A lot of times, their ability to understand and receive information from others either Auditorily listening or reading is much, much lower than the rate at which they talk. So in the criminal justice system, we. We may be asking them to do things, and they may be able to repeat back to us and talk to us about what the next right thing is to do, but they may not understand exactly what they're saying. They hear it, they parrot it back, but they don't understand it. So it's important to recognize that, and I will be doing future shows on addressing the unique needs of people with fetal alcohol spectrum disorders. Because there are a lot of people in our communities that have FASDs. 47% of people in jails and prisons have antisocial personality traits. There's another percentage that have narcissistic personality traits and another percentage that have borderline personality traits. And I say traits because not all of them meet the full criteria for antisocial personality disorder. But we do want to recognize that's less than half. So 53% of people that are in jails or prisons theoretically don't have those antisocial traits. We don't want to make that assumption that people who are involved in the criminal justice system are antisocial or term I like even less psychopaths. No, there are a lot of people who again, got involved because of their substance use or made a mistake or did something wrong for what they perceive to be the right reasons. You know, we don't want to assume. That's what I'm getting at. People who are at high risk for recidivism often have impulsivity and low frustration tolerance. And again, a lot of this goes back to having a lack of a secure attachment when they were growing up. They had a lack of an adult caregiver who could help them learn how to regulate their emotions and effectively and pro socially get their needs met. So the child grows up to be an adult who feels scared all the time, who, whenever they are triggered, they want to get away. And that looks very impulsive. So we want to recognize the impact of their past. We want to recognize what is this impulsive behavior telling us, you know, why. Why did they jump to do that? Well, a lot of times it's because either they feared that they couldn't tolerate the distress, or they felt unsafe for some reason. So we want to look back at that. If they have a low frustration tolerance, you know, that is a very childlike response. So that tells us maybe that they never learned how to tolerate frustration. They never learned how to sit with distress for a minute and be patient. We want to look at why do they have a low frustration tolerance? Do they not have the skills? Do they have something else going on like that is enhancing their impulsivity? Are they in physical pain? What's going on here? What is that lashing out that low frustration telling us they may be thrill seekers. And a lot of people who get involved in the criminal justice system and a lot of people with personality disorders tend to seem to seek out chaos or adrenaline related activities. And when they were growing up, they were bombarded with adrenaline. Their body was constantly in this state of fight or flee. So their receptors became resistant to getting excited by that adrenaline coming through. So when they aren't in an adrenaline bath, so to speak, they may feel very flat, very apathetic, very kind of Eeyore. Like when they are engaging in thrill seeking behaviors, they don't get the same rush that somebody who is, has not had exposure to trauma, may a lot of times because that helps them feel normal. You know, that helps them actually activate enough receptors which makes it seem like they are on the same plane as somebody who doesn't have that tolerance going on. The take home message here is thrill seeking is often a way of increasing adrenaline and dopamine in order to feel something. Because when they're not engaging in thrill seeking behavior, they don't feel. In people with borderline personality disorder, sometimes we see an alternate behavior and this is where the non suicidal self injury may come out because they are trying to feel something. Egocentrism, another very immature behavior. But it makes sense that if the child experienced trauma when they were growing up, they may not have learned empathy, they may not have learned to take other people's perspectives. They may feel overwhelmed with empathizing with others because that makes them recognize how little others empathize with them. And that can feel very terrifying and overwhelming and depressing. So a lot of times people exposed to trauma may become very egocentric and this may look a lot like narcissism. The world revolves around them. They are going to control everything. Well, if you grow up in an environment that is unstable, that's chaotic, that's traumatic, that then yeah, it makes sense that you want to control your little area of the world because that's the only way you can be semi confident that you're going to be safe. They may have below average verbal intelligence, low levels of educational attainment and poor consequential thinking. And we'll go through all three of those together. When people are exposed to trauma, when people are exposed to and poverty can be trauma because they're not getting their basic needs met. People who are exposed to extreme poverty may not have good nutrition. They may not be able to get their medical needs met or be in an environment that supports their learning. So a traumatic upbringing, an impoverished upbringing can impair educational attainment and impair self esteem. A lot of people then say, well, I can't do school, or I'm not good at school, so I'm going to try to find something else that I can be good at because I feel bad when I'm here. I want to feel good. Well, all of us want to feel good. We want to look at that. A lot of people who are coming out of incarceration may need assistance with developing their educational skills, getting their ged. A lot have undiagnosed learning disabilities. A lot have below average ability to read and write. And we want to identify those things and help people recognize that they can, they can do these things. They just, they were failed by the system. And helping them without criticizing them, without going, you can't read. You know, we don't want them to feel self conscious. We want them to feel comforted and empowered. We want them to feel like somebody's there going, well, hey, we missed, we dropped the ball back here. So let me help you. Let me put you in touch with resources that can help you become the best you that we know that you can be. Now, poor consequential thinking is another issue that comes with a lack of early attachment and a lack of guidance from mentors growing up. Because a lot of times people have difficulty or doing what I call playing the tape through, they think about what they want. And instead of playing the tape through and saying, okay, if I do this, what are going? What's going to be the fallout? They just think, I want it, I want it now, gonna get it, and consequences be darned. This is a skill that can be developed, but we need to help people change their, what we call default mode thinking. And if they tend to react from a disempowered, scared point of view, react impulsively, then we need to help them develop the ability to take a breath and use context to down regulate their desire to fight or flee so they can get into a more logical frame of mind and ask themselves, you know, what is it that I'm wanting and what is the best way to meet that need cognitively? People with personality disorders, trauma histories, and who are involved in the criminal justice system often have difficulty with problem solving. Problem solving is one of those higher order cognitive skills. So if they Were in an impoverished environment or in a traumatic environment when they were growing up, it likely created brain changes that made it difficult for them to not only learn in school, but learn how to solve problems. Because whenever they start to get upset, whenever they encounter a problem, they have this adrenaline dump and they want to fight or flee. And we can't think clearly when we're thinking in an adrenaline haze. So problem solving means helping people learn how to down regulate so they can get into their wise mind and examine what options are available. A lack of time perspective, very common. And that comes from an impulsive point of view, but also with trauma, you know, when you grow up in an environment where you don't feel safe, then you may not think that there is time. You may not think that, well, tomorrow's not guaranteed, so I'm going to, you know, do what I want to today and not even consider the consequences. We need to help people examine the, how accurate the accuracy of that lack of time perspective. And if they had time, you know, if they could foresee further than tomorrow, you know, what kind of person would they want to be? What would they want to be doing? People who are at high risk of recidivism Often have difficulty learning from the past or planning for the future. Again, impulsivity. They operate in default mode and impulsivity keeps coming up. So we really want to keep looking back and asking ourselves, what is this impulsivity telling us? What is it communicating? A lot of times it communicates that the person does not have distress tolerance skills, does not have coping skills, does not feel safe, and those are crucial for survival in the adult world. They may often see behaviors as isolated events. I did what I did, okay, you know, whatever. And they may not see it as a continuing pattern. So we want to help them connect the dots with their behaviors and see how their behaviors have progressed, See how their behaviors have impacted the things in their life that are important to them. They may expect success with little or no effort. And a lot of times people who expect success with little or no effort have had experiences where they have somehow garnered power and demanded success. And they demand that others do their bidding, do their work for them. So they don't. They feel entitled to not having to work for anything. They feel like they are owed something. Sometimes that can also come from a history of trauma and being angry about what has happened to you in the past, Coming from a place of rage and expecting others to basically make reparations, Decisions made based upon what you want to be true than what, rather what Is true. It's important for us to help people evaluate the accuracy of their thoughts. What are the actual facts supporting your beliefs in this context at this time? Environmentally, another risk factor is release from prison without parole. You know, parole is when people are released from prison early, but some people do their full time and then they get out. And we see the same thing when people go through residential for substance abuse treatment and then they just discharge. They don't step down to outpatient, they just discharge. And going from a highly structured environment where the person might be in a groove, they might have developed a sense of safety or at least predictability to an environment that is very unpredictable and potentially where they may feel unsafe or unsupported, that puts them at high risk for anxiety, impulsive behaviors, and a return to substance use. A lack of employment opportunities can be another risk factor. Too much time on your hands can contribute to too much thinking and reminiscing and maybe glorifying what you used to do. Those criminal behaviors or substance using behaviors. Lack of employment opportunities is important to address because some people don't want to hire people who've been in jail or in prison. So we need to advocate for them. We need to make sure that everybody knows about the federal bonding program for hard to play employees. So there are opportunities for employment. Other people may have hostility about having to work, resistance towards work or job dissatisfaction. What is this behavior saying? A lot of times people who are hostile about having to work may have social anxiety. They may fear failure. They may have other issues that are going on where they just. They're struggling to get through, to deal with their trauma, to deal with their depression, and they can't imagine working 40 hours. That's just completely overwhelming to them. So we want to explore with them, where is this hostility and resistance coming from? What is it about work that you find so distasteful in people who have experienced trauma? Loss of control is a huge issue. And when you go to work for somebody, they have a certain amount of control. They tell you what to wear, they tell you how to do your job. There's the risk and likelihood of constructive feedback. So people may be resistant to going to work because they're afraid of losing control. They don't want to be told what to do. Likewise, job dissatisfaction may come out when people feel like they're doing a job that is below them, when they feel like they're being asked to do something that they shouldn't have to do. And it's important to explore with them why they're dissatisfied Is it too hard or, you know, as I said, do they feel it below them and it's hurting their self esteem, it's hurting their pride. What does it mean that you are working as line staff at this particular store? What would you, what do you think you should be doing instead? And okay, how do you get there? You know, you're probably not going to get hired in as the CEO the minute you walk out of prison. So if you want to get up to management, how do you do that? Poverty is another risk factor for recidivism. When people are impoverished, when they don't know where their next meal is coming from or whether they're going to have safe housing, it's stressful. So poverty itself can promote engaging in high risk behaviors to make ends meet can also promote relapse on substances because people feel so hopeless and helpless, they'd rather just kind of numb it all out. The type of crime people commit is another risk factor. Sexual offenders tend to have a higher recidivism rate, for example, than other offenders. People who get DUIs tend to have a higher recidivism rate. A lot of people don't just get one dui. Housing instability kind of goes with that poverty. But if people are out of the criminal justice system and they don't have a safe place to lay their head, if they don't know where they're going to sleep or they're going back to that same environment filled with those same people and things that supported them in their criminal behaviors, then they are at high risk for recidivism. Relationally ineffective communication skills. Well, people who've experienced trauma, especially as children, often don't have that secure attachment where they learn how to effectively identify their emotions, empathize with others, and assertively communicate. A lot of times people who are in the criminal justice system have very aggressive communication skills because that's the skill they've used, that's the strategy they've had that's helped them feel somewhat safe and survive until now. We may need to help people learn more effective assertive communication skills. A history of low levels of familial affection and weak socialization are also high risk factors because familial affection and socialization help people develop the capacity for empathy. Help people move from being that infant that cries and demands somebody takes care of them to the, you know, elementary school child that recognizes they have needs, but they can balance their needs with the needs of others. A criminal identity is something else that we want to consider. If part of my self esteem is Being a criminal of some sort, then if I am not that, I may not know what I am. I may not have another identity to assume. And that's really terrifying. It's like, well if I don't do that, I don't know what the heck I'm going to do. We need to help people reconceptualize their themselves. Neutralization and non empathy is another risk factor. And this goes along with blaming because people who have difficulty empathizing will have less difficulty taking advantage of others. So they are more likely to, to reoffend, to recidivate. Because why not? You know, they don't recognize the impact they're having on other people or they blame others for quote making them do the criminal behaviors. Conflicts with and negative attitudes toward authority. Well, if you've experienced trauma, then clearly somewhere along the way authority and society has let you down. And some people may hold on to this fear of authority. Especially if an authority figure or a caregiver is the one who let you down and created an unsafe environment, then it makes sense that one might not trust authority figures and rebel against them for fear of them trying to take your power. We need to help people again use context. That authority figure in the past, that person may have been very dangerous. This authority figure in this place and time, are they dangerous? Conflicts with peers and having pro criminal associates can also increase the risk for, for recidivism. The conflicts since people we already talked about the fact that they may be more impulsive, they may seek to demonstrate their power in order to help themselves feel safe by trying to exact revenge. So conflicts with peers can escalate into criminal behavior. Pro criminal associates tend to egg on criminal behavior. The victim mentality or failing to accept responsibility also contributes to excuse making, denying, blaming, justifying, rationalizing criminal behaviors. And we want to help people adopt a survivor mentality. Adopt a mentality that they are empowered to do the next right thing. Some have a sense of uniqueness. You don't understand what I went through, you don't understand what my life has been. So you can't possibly understand why I do what I do. And my response to that is, you're probably right. So explain it to me. I don't want to assume. Help me understand what your unique needs are. They may have fear of exposure to others. They have kept themselves somewhat safe to date by having this big facade of being the big man on campus or whatever it is. And they don't want to appear weak, they don't want to appear vulnerable, they don't want to appear to not be able to do everything. So this fear of exposure is huge because when they're exposed, it's basically exposing that wounded child that. That traumatized child that nobody ever took care of. They may use power to control. You know, the best way to keep people from exposing you is to keep them away, to keep them under control. So it makes sense. Now. We want to help people figure out how to use their power to feel safe and to control themselves, as opposed to always having to try to control others. They may seek excitement. We already talked about that. Other characteristics, people who offend and people with antisocial personality disorder often have high levels of anxiety or fearfulness. What are these behaviors communicating? They're often communicating, I don't feel safe, and so I need to prove that I am stronger. I need to do whatever I'm gonna do, or I need to do whatever I want to do that's gonna make me happy in the moment, because ain't nobody care about me anyway. They may have a sense of withdrawal or separation from internal and external deterrence. They don't have empathy, remorse, or concern about punishment. A lot of times they have been so hurt, so traumatized that they've walled off that emotional empathetic component. And it is, I'm going to do what I'm going to do right now in order to make me happy in the moment. And then I'll decide five minutes from now what the next thing is to do. A lot of times the punishments that people are given for the behaviors that they do are not really all that punishing to them. When they go to jail or prison, they may feel safer in some ways because it's predictable. They may feel safer in some ways because they've grown up there. They may not be concerned about it because they know how to work that system, whereas on the outside, it's a lot more confusing. They may pursue power and control with irritability, aggression, lying and manipulation. This is very common because they are scared. They are acting from, if you will, their wounded inner child. That is the child person coming out and saying, I'm going to throw a temper tantrum and I'm going to get what I want because I want it. And that comes from a very primitive or childlike place. So what is it about having power and control that helps that person feel safe? That helps them feel good about themselves? They may be unable to fully function independent of others. And that's kind of a head scratcher because you're saying, well, you know, they've been trying to Push people away and dominate and manipulate people. Well, yeah, they may be unable to fully function independent of others who do their bidding. They may need to have other people who surround them, that validate them, that, that make them feel worthy because they don't feel worthy inside. And self esteem work is huge. To helping people switch from needing other people's approval to being able to validate and love themselves. When they don't get their own way, they feel put down. Now, put down is the typical term that you might hear or disrespected. But what does that mean? A lot of times it means they felt rejected, which is terrifying. They felt vulnerable. Again, terrifying. When they've been rejected or vulnerable or out of control in the past, it's often led to bad things, especially when they were a child. So as an adult, those child schema, those child memories are being activated every time they feel rejected, vulnerable or out of control, and they're lashing out to try to protect themselves when feeling vulnerable. A lot of times people with personality disorders and people who are involved in the criminal justice system may fight, flee, behave frantically or just say forget it. They may engage in goal directed action relentlessly in order to help them survive. They just keep doing something because they are determined to make it happen. They may use stealth or force in order to try to protect themselves and feel less vulnerable. So stealth I think of as fleeing and force as fighting. Or they may default to short term impulsive thinking in lieu of long range thinking. So they become frantic to try to get out of it. They'll do whatever they need to do in order to not feel vulnerable. Or they may just say forget it. And a lot of times the way that looks for people when they're feeling vulnerable and feeling threatened is addiction relapse and they just, they just decide to numb it out. Fine, I'm just gonna go get high. What we want to do is empower people to envision a rich and meaningful life that creates hope and teach them that they can head in a different direction by changing their thinking and their behaviors, identifying the facts and things over which they have control. It's important to remember there are a lot of different reasons people may not be on board with trying to change. You know they're coming in to see you probably because they have to. So we want to examine what may keep them from being motivated to change their life. Well, number one, that's kind of overwhelming to think that I've got to change my whole life. But they may be reluctant to change because they're afraid of the discomfort if they start changing. They may also have to set boundaries and distance between them and some of their friends. They may have to do things that they're not sure that they can do. They may do things, they may be going out of their comfort zone, which causes anxiety. And some people may not want to go there. You know, it takes a lot of courage to step out of your comfort zone. They may lack knowledge of the problem. You know, they may not see all of the different ways that, for example, their inability to read or their prior trauma history is currently impacting them. And they may have an unawareness of alternatives. They're like, well, if I'm not doing this, I don't know what I do. If I don't behave this way, I have no idea how to react. They may be resigned because they know they lack the skills or resources to solve the problem. They're just like, I don't have any way to deal with that. Or they may lack self efficacy, the belief that they can actually do something, partly because they're overwhelmed with the prospect of everything they've got to do. They may be looking back and seeing prior failures, but prior issues of recidivism. Or they may be overwhelmed because of, you know, all of the pacer issues that are going on, Needing housing, needing to find a job, needing to work on their self esteem and their communication skills and the list goes on. And they may see that and just go, whoa, that's just too freaking much. I can't do it. Or they may be what they call rebellious because they fear losing control. If they are coming to you, especially involuntarily, and you start telling them you need to fill in the blank, you are taking their power. So it's really important to use motivational enhancement strategies to empower people to evaluate their options and change or choose how they're going to change. So motivational enhancement, we typically use the mnemonic frames. F stands for feedback. We want to provide them with feedback about their current situation and we also want to help them explore, you know, what does this situation look like to you? And how do you define your rich and meaningful life? What do you want out of life? So help them do some introspection so they can figure out if there's a difference between where they are now and what they want. Generally there is, and we can help them figure out how to close that gap. We want to place the responsibility for change or not change squarely on them. We're not going to make them do anything now with people who are on parole or probation, you do have a little extra because a lot of times they're on papers. So if they don't follow their treatment plan, they're probably going back to jail or going to jail. So that gives you a little bit of power. But ultimately the responsibility for their decisions is on them. If they choose to violate their probation, that's their choice. Now, in frames, typically the A stands for advice. But when you're working with the criminogenic population, people who have experienced trauma and are afraid of losing control, then providing advice often feels like taking their power. So instead of advice, I say appreciation. We want to express our appreciation, our awareness of how difficult it is for them to be vulnerable and look at the things they might need to change. And we also want to show appreciation or recognition of how they've done the best they could with the tools they had up until now in order to survive. You know, I can appreciate some creative problem solving and it's important to, to develop that sense of awareness with the person. Present a menu of options. So brainstorm together. What are some potential options for you to get your needs met, to feel safe and empowered and move towards this life that you want. Empathize. Let them know that you recognize how exhausting, how overwhelming, how terrifying this might be, and how hard they're working, you know, especially in those follow up visits. And finally, safety and self efficacy. We want to make sure that we are helping them recognize that they are safe and the ways they are safe and what they can do to help themselves stay safe in this new life that they're trying to create. Another aspect of motivational enhancement is increasing motivation. So for each thing that they are doing that they choose to do in their treatment plan, we want to enhance as many different aspects of motivation as we can. So physically, how will it help them be physically safer? How will it help them have more energy, feel better, stay healthier, live longer, whatever, affectively, how is doing this, doing the hard work going to ultimately make them a happier person? Cognitively, how does it make sense that doing this is going to help them achieve their goals? Environmentally, in what ways will doing this improve their living situation, improve their environment? Will it help them be around people who could help them? Will it help them feel safer, have a house, have a roof over their head? You know, environmentally, in what ways will this help them? And finally, relationally, how is it going to help improve their relationships with others, Especially those others that are important to them, like their kids, their parents, their significant others, their best friend, whoever it is, Cognitive strategies. Mindfulness is super important. A lot of people with personality disorders and who've been involved in the criminal justice system system don't spend a lot of time on self reflection. So mindfulness is the first step because it's important to be aware of early warning signs of feeling anxious or angry so they can intervene before they react impulsively. Cognitive self change help them develop skills for emotion regulation and cognitive restructuring, problem solving skills and addressing that. Inner critic. A lot of people with personality disorders and who've been involved in the criminal justice system or who have addictions have a very loud, very harsh inner critic. A lot of times that's been internalized from their primary caregivers and from their social affiliates up until then. And so it's important to address some of those issues so they can feel safe in their own head. They don't feel like they've got somebody literally living in their head that's constantly telling them that they suck. Social skills we want to help people develop boundaries and assertiveness. We need to help them create safety. Identify their future goals using the smart method. Goals that are specific, measurable, action oriented, realistic and relevant, and time limited. Don't set goals that are a year from now. Set goals, especially immediately after they are released from jail or prison or put on probation. Set goals that are for this week. For some people, it may be even for tomorrow. One of the probation officers that I used to have the office right next to when his people would first come to see him, the first month they had to report in every single day so he could see them, see that they were dressed appropriately to go start applying for jobs, and he could check in on them. And then as they were had proved themselves and had been on his caseload longer, he would start spacing that out. So then it was once a week, and then it was once a month. We want to help people identify their strengths and resources to achieve those goals. It's a whole lot easier to help people change by strengthening things that they already know or things that they already know do. And a lot of the people that I worked with had incredible strengths, creativity, you know, it was just a matter of using it for good instead of for criminal behavior through Socratic questioning. Assist the person in learning from the past. That means instead of assuming you know why they did what they did, asking them, why do you think that happened? Or tell me a little bit about how you got to this point. Helping them feel empowered. We want to help them explore how trauma created a default mode of reaction. So experiencing Trauma prevented them from being able to learn how to tolerate their emotions and set them on this almost persistent autopilot. Explore how their repeated behaviors are keeping them stuck and keeping them from achieving the life that they want. Explore the meaning of their behaviors from a safety and empowerment perspective. How does this behavior or how did your reaction. How was. Was that designed to help you stay safe or feel empowered so you didn't feel vulnerable? And in what ways was that brought up as a result of feeling vulnerable in the past? And what needs to change to break the cycle? We want to help people decondition triggers using that contextual cognitive behavioral intervention. You know, words like case manager for some people are very triggering because the case managers they've been involved with in the past were unsympathetic at best and definitely not trauma informed. So helping them work with people, you know, whether it's a counselor or a case manager or probation officer, and examine that person in that context at that point in time. Is this person helping me? Instead of assuming all case managers are or no case managers are going to help me or no probation officer is going to help me, looking at it and going, okay, up until now, yeah, not been a great experience, but in this situation, you know, is this person seeming like they're helping me? And yeah, trust is earned, so it's going to take a minute. But encouraging them to regularly check the context and examine whether their beliefs about the person and the situation are true in that context or whether they're projecting stuff from the past. We want to help them understand the connection between self care, emotions and behavior and develop a responsive support system. Potential other skills that they can learn. Active listening so when they're talking to somebody, they can learn how to listen to hear paraphrase, validate what the person said and then respond. Help them learn how to ask questions instead of assuming or engaging in mind reading. Help them learn how to give effective constructive feedback using the Think mnemonic. Is it truthful? Is it helpful? Are you saying it in a way that's inspirational? Is it even necessary to say something? And if it is, are you saying it in the kindest way possible? Help them work on asking for help. A lot of people that makes them feel very vulnerable. So learning how to ask for help as well as hear no without getting defensive is important. Help them work on identifying feelings and explore how thoughts impact feelings, what they pay attention to, their perception of the world and behavior. So when we are in an angry or anxious feeling state, a lot of times we pay attention to the threats in the environment and not the good things. We perceive things from that lens of negativity and pessimism and often react in from a place of feeling unsafe or disempowered. Recognize and mitigate risks and vulnerabilities. What are some things that could cause you to reoffend? What are some things that could cause you to engage in behaviors that you don't want to engage in anymore and how can we address those? Help them define a rich and meaningful life using their new thinking skills that are goal directed and past informed. We're not eliminating the past. Their past has shaped who they are and how they perceive the world. But we want to help them recognize not only the impact of the past, but the impact of the present. What's going on in the present context and what is the best response to help them move towards their goals. Self esteem enhancement so they don't rely on others or for validation. That way it's not as scary if they feel like they are being rejected or criticized in some way. Empathy and apologizing Coping with Anger, Anxiety, Guilt, Grief and Envy A lot of times we fail miserably in the criminal justice system to help people process all of their emotions. We may teach them anger management skills, but we fail to acknowledge the tangible as well as the intangible things that they need to grieve and fail to process with them. Some of the things they may feel guilty about because those feelings guilt, grief that makes them feel vulnerable. Envy often indicates that somebody feels vulnerable because they feel that somebody else has something that they want. They feel that somebody else might be more important or more powerful than them and that's terrifying. We want to help them learn how to respond to anger from others. Negotiate with themselves and others for what needs to be done and yeah, negotiate with yourself. Am I going to get out of bed and go to work today? We need to help them create a inner parent, so to speak. We want to help them learn how to stop and think. Turn off that autopilot, that default mode responding and when they get upset, be able to down regulate. Get into their wise mind and choose the best option to improve the next moment. Help them with problem identification. Considering choices that are available to them and playing the tape through so they look at each choice and say okay, if I do this, it might feel real good in the moment, but do I really want to endure the consequences? Play the tape through. What's going to happen if you go to the bar? Relapse? There are resources online that you can look up that help with teaching social skills. So those are some other tools that people may need. Many, if not most offenders have a history of adverse childhood experiences which alter their default schema. So they created these memories that the world is an unsafe, scary place and there's nobody I can trust and it may have altered their HPA axis or their threat response system. It's important to explore the meaning of criminogenic behaviors and develop alternatives to meet those needs to reduce recidivism. So if they are acting in order to try to maintain their facade of power so they don't get taken advantage of, if they're acting out in order to try to help themselves feel safe, we need to explore with them what are some other ways to do that. Cognitive behavioral interventions are effective at assisting offenders in adapting their reactions. Essential skills include social skills training, cognitive self change, and problem solving skills. But it's also vital to pay attention to all those other issues that we talked about. The physical making sure that they've got safe housing and they're physically safe and they're getting their medical needs met. Making sure that they feel not overwhelmed by their emotions, that they feel like they can tolerate their emotions and cope. Make sure that they have supportive relationships that will help them in their journey towards a pro social lifestyle. Find out more about working with people involved in the criminal justice system@docsnipes.com YouTube this show was produced by Mr. Charles Snipes presenter Dr. Donnelly Snipes, both of whom can be contact at 1633 West Main Street, Suite 902, Lebanon, TN 37087.