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This Mental Health Program Helps People Stay Out of Prison

It's based on cognitive behavioral therapy.
Linda Davidson / The Washington Post via Getty Images

Isiah Richey says he'd lost some common sense. Last year, Washington state found him guilty of assault with a deadly weapon and sentenced him to 47 months and one week in prison. Now, he says, he's regained it: He’s one of about 500 men at Larch Corrections Center who have graduated from Thinking for a Change (T4C), a four-month cognitive behavioral intervention (CBI) aimed at reducing recidivism rates at Larch and other prisons across the country.


“I never really realized how uncommon common sense was,” says Richey, 26. “One of the things that the class teaches you is stuff that you should already know from growing up and your experiences through life, but some of these people forgot a lot of those things.”

It's no secret that the US has a major mass incarceration problem: It's the home of less than five percent of the global population, but is currently responsible for 22 percent of the world’s prison population. More than 2 million people are incarcerated in prisons, jails, and detention centers across the country. In 2015, states and taxpayers paid more than $43 billion—about $33,000 per inmate—to keep prisons up and running, according to a report by the Vera Institute of Justice.

Research published last year shows that within eight years of being released, half of all federal offenders are rearrested, one-third are reconvicted, and one-quarter are reincarcerated. Researchers are exploring much-needed new ways to help these men and women stay out of prison.

CBI programs—including T4C and others, like Aggression Replacement Training and Moral Reconation Therapy—help with that. A 2009 study published in Criminal Justice and Behavior found that offenders who didn’t participate in a cognitive behavioral program were 57 percent more likely to be rearrested during follow-up compared to those who graduated from T4C. Another report found that the most effective CBIs can cut recidivism rates in half. Research also found that men who committed alcohol-related crimes were 2.5 times more likely to be rearrested for similar infractions when they didn’t complete a CBI versus men who did.


You may have heard of cognitive behavioral therapy, arguably the most effective treatment for everything from anxiety and eating disorders to dealing with anger and PTSD. On the outside, therapists offer CBT in clinical settings. CBI is based on CBT, but it's not called "therapy" due to the circumstances under which it's administered, says Jack Bush, who helped develop the T4C curriculum. Rather than therapists, correctional officers and specialists lead the sessions.

“The criminal behavior is not itself a pathology. There’s a certain kind of bias in clinical treatment of criminal behavior that misses the point of the responsibility of the offender,” says Bush, who's worked on cognitive behavioral treatments for offenders for about four decades. “Therapists can be very good with cognitive treatment of offenders, but they need to practice identifying with the law. They need to speak with a voice of legal authority and not just as a clinician.”

Washington State Department of Corrections implemented T4C at other facilities in 2012. When it grew in popularity, it “made perfect sense” to expand it to Larch, says Don Feist, the administrator for the state DOC’s Cognitive Behavioral Change program. One big reason why? All the men at Larch have less than four years left of their sentences. “It’s very important that we focus these tools and these programs towards the end of their incarceration,” he says. “To be honest, some of the things that they learn [don’t reflect] the appropriate way to behave or respond to a number of situations in prison, because prison is obviously a very different society.”


At Larch, groups of ten to 12 men meet with facilitators twice a week for 90 minutes. The program has three parts: In the first chunk of lessons, the men learn to pay attention to their thinking, to recognize that it affects their actions, and to replace their problematic thoughts with new ones that lead to better outcomes.

“There are a lot of thoughts that go through someone’s mind before they do something,” says Debra Smith, a correction specialist and T4C facilitator at Larch. “We focus on those risky thoughts that get you into trouble. What can you do differently to have a different outcome? There’s going to be a consequence no matter what you do, but what is that consequence going to be?”

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Next, the men learn social skills like introducing themselves, asking questions, apologizing, negotiating, and understanding their own feelings and the feelings of others. Toward the end of the class, the men combine the skills they learned in the first two sections to help them work through real-life situations that they face in prison or that they anticipate facing upon release.

Timothy Fultz arrived at Larch earlier this year after he was found guilty of money laundering and identity theft. He graduated from T4C in November. “Taking the class, it just brought me back to, I need to really think through my thoughts before I do [something], and I need to remember that I need to change my life,” says Fultz, 47. “I’m here for one reason or another, but one day I’m going to leave. I’m going to leave and I don’t want to come back.” Fultz went to private counseling on the outside, but he says T4C did him more good.


Researchers in Chicago recently examined the effectiveness of a cognitive behavioral program in the Cook County Juvenile Temporary Detention Center. The study began in 2007, after a federal judge took over the facility as a result of a lawsuit the American Civil Liberties Union filed over the conditions there. What happened next created the perfect setting for a natural experiment. The federal court appointed a temporary administrator named Earl Dunlap, who divided the massive 500-bed facility into ten separate 50-bed units. The detention center rolled out cognitive behavioral reform unit by unit to make implementation more manageable.

“Halfway through this rollout of reforms, litigation halted things,” says Julia Quinn, the associate director of the Crime and Education Labs at the University of Chicago. “It created an extended period of itime where some of the residential centers were operating with the new reforms, which included [CBT], and other units in the facility were operating on the old status quo.”

From November 2009 to March 2011, the almost 6,000 young men who came and went were randomly assigned to either the reform or status quo units when they arrived at JTDC. The researchers found that over the 18-month period, the CBI-based reforms reduced recidivism rates by 21 percent—and they only cost about $60 per participant.

“Based on the evidence we’ve generated so far, we really do think that cognitive behavioral programs are helping kids to physically slow down their decision-making and respond more reflectively when they’re in really high-stakes situations that can be dangerous or get them into trouble,” Quinn says. “If this represents a relatively inexpensive way to help people stay out when they get out and give them helpful skills as they’re transitioning back into society, it seems like a no-brainer.”


T4C often uses exercises like role play to help people work through tough scenarios. The lessons taught Kevin McCracken, 36, to consider other people’s perspectives before acting.

“Rather than just make these rash decisions, I step back and I think, Okay, what’s this person going through? What are their thoughts? Are they having a bad day?” says McCracken, a T4C grad who came to Larch after getting a 30-month sentence for violating a protection order. “You can’t just make these quick decisions, especially for us, because we’ll just go to the hole.”

McCracken, Fultz, and Richey all say that T4C taught them valuable skills that will help them when they reenter society. Until then, they can use them in everyday life at Larch. Richey feels more confident talking to his family and more prepared to make important decisions. Fultz made the conscious decision to stop using vulgar language and to “be an active person whether [he’s] in prison or not.” McCracken learned to stop, take a breath, and think. “From waking up in the morning to going to bed at night, they help us all day,” he says.

None of them intend to come back to prison once they’re out. “It seems obvious, but a lot of people don’t realize these folks don’t want to come back,” Feist says. “We want to help them do what it is they already want to do.”

The US justice system needs a lot of improvement—there’s no question about it. But for now, CBIs fill a gap that has existed for decades. “Our criminal justice system historically has not been very focused on rehabilitation and helping people develop skills that are helpful while they’re locked up,” Quinn says. “If we did a lot more to support people in jails and prisons with programs and job training, that could go a long way.”

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