‘You can always find something inside someone to work with'

Yvette’s description of her role raised issues increasingly debated by psychologists. How can psychologists improve services (and decrease harmful or inappropriate treatment) for those who have been diagnosed as having a psychological condition? Does the time and finance required to travel the standard route to Chartership stop people from starting the journey, and decrease diversity amongst those who make it? How does psychological thinking influence high level policy?

My experience', said Yvette, ‘is that you shouldn’t be put off by the amount of time it’s going to take you to become a Forensic Psychologist. Qualifying later in life gave me time to get experience of many different people and situations. These have helped me develop the skills I use in my job now. I had always worked alongside my studies from the time I was at secondary school, and that built confidence to interact with many different sorts of people. We’re trying to offer opportunities for voluntary experiences at the prison to meet this sort of need.’

‘People are not defined by their behaviour…’

I raised a number of what seem like linked issues in the forensic psychologist role. It must be an emotionally and professionally demanding one. Is there a tension between responsibility for risk reduction and for meeting client needs and, if so, can that be resolved? How does a successful practitioner learn to cope with what must be sometimes unsafe and often challenging environments? Can forensic psychologists treat people non-judgementally whatever they’ve done?

‘I’ve never had a problem with working in these sorts of environments or with being non-judgemental. As early as my secondary school I got very used to seeing and coping with behavioural challenges. I realised from an early age that behaviour is influenced by environment: I could see at school that, say, bullying was not just an issue of someone being “naughty”; there was more going on than that. And I found I could cope with what seemed like unsafe environments.’

The longer Yvette worked, the more she realised ‘you need the best interests at heart for the person in front of you, whatever their background. Being non-judgemental springs from this and is a core approach in forensic work. You try to understand what has happened and how the person can move forward. You can always find something inside someone to work with, and, your work is also informed by your psychological and social knowledge of how behaviours are reinforced by, for instance, cycles of abuse. I’m not naive, though, and support from colleagues and supervision is critical. Some of the people I deal with have done horrific things. Thinking about it, the thing that often affects me most is cruelty to animals. I need a bit more time to process the emotional response when I read or hear about that.’

‘Some prisoners have a particular problem with psychologists, not least because psychologists’ reports and opinions are influential in informing life-changing decisions. We have to evaluate the risk someone poses and prisoners can see this as a threat. But in the sort of work I do, you do have the opportunity to spend time with an individual. You aim to establish that you want to create a genuinely collaborative process and the more open they are the better. If I offer an opinion or disagree, I give them the evidence which backs up what I say, then invite their response. My experience as a prisoner advocate – helping prisoners have a voice – has informed this approach.’

Yvette tells me what she finds really fascinating about work: ‘You’re always learning. When you talk to a prisoner, he or she is the expert and you have to listen.’

We moved on to how Yvette’s work on autism has influenced policy.

‘People with ASD have specific, sometimes unique talents’

Autism Spectrum Disorder (ASD) may be significantly over-represented in secure services. This needs more research but it’s been suggested that people who suffer from ASD are seven times more likely than those without to have some contact with the criminal justice system (including offenders, victims and witnesses). ‘But’, says Yvette, ‘even if the incidence is the same as the general population, prisons have to support them. When I noticed autistic traits – I’d worked with sufferers from ASD at a medium secure unit before working here – there was no real understanding. The reaction, when I first came into prisons about a decade ago, was “What’s the relevance of that?” The more I looked the more work needed to be done. There was no diagnostic assessment of autism for prisoners. There was a recent case of a person who had been in prison for 37 years who had a diagnosis of schizoid personality disorder. It looked more like autism to me, and so it proved. How had autism been missed? One explanation is the low level of understanding of the condition in the criminal justice system.’

In 2012 Yvette looked at what instruments were available. ‘As a clinician I do use assessments like ADOS-2 and diagnostic systems like ICD and DSM. Formal diagnostic categories can be helpful to release treatment and resources and focus discussions, but you have to understand individual needs. We have a key worker system here and the key worker is often the first person to notice particular behaviours. Most people tend to think of prisons as unchanging, regimented places. In fact they change all the time and noticing how people react to changes helps with diagnosis and treatment planning.’

Good practice in the area involves recognising autism, making provision for it and basing this work on principles of equality. Yvette’s work, which was informed by these principles, ultimately received a commendation from The Butler Trust (which promotes excellence in UK prisons).

‘At the time there was no training package available so I offered support and consultancy on ASD throughout the prison. When I took on the role of Lead for Autism at HMP Dovegate I developed and delivered a training package for staff. I also started to research a new screening tool, specifically looking at ASD in prison environments.’ All this work was recognised as best practice in the Government 2014 white paper Think Autism: Fulfilling and rewarding lives, the strategy for adults with autism in England: an update. ‘One important aspect of this is that in our work we try to emphasise that people with ASD have specific, sometimes unique talents.’

Yvette says, ‘I felt like a fraud when I received my commendation from the patron of the Butler Trust, Princess Anne at St James Palace. I felt I was just doing my job.’

‘The more you do the more you learn’

Yvette’s life experiences threaded our interview and one of her consistent points is that having experiences outside formal psychology training is essential to later practice. ‘My first degree was a joint honours in English literature and psychology, which was unusual: people usually twinned psychology with a social science. But I was, and still am, interested in writing. I got really interested in social psychology – issues like the Milgram experiments and social conformity. My Grandmother had Alzheimer’s and that influenced my interest in cognitive topics like memory.’

‘I was keen to make psychology a career and, on finishing my degree, I got an assistant psychology post at a medium secure unit. This was hugely educational. I learnt about formal training options which I hadn’t understood till then, but also experienced working with people who had challenging behaviours, ASD and learning difficulties. For a variety of reasons the next period took longer than I expected. I did a Master’s at the OU to strengthen applications for clinical trainee positions. Then I was told I needed more varied experience. I was a homeowner by then and needed some security and work-life balance. I started looking for forensic psychology positions and got one here at Dovegate. Here I did another Master’s, this time in forensic psychology. I’d originally set myself the goal to attain Chartership by the age of 25. In fact I was 35 when I got there but, as I say, that may be no bad thing.’

Yvette is Acting Head of Psychology at Dovegate, a prison built in 2001, one of the six prisons Serco runs. ‘Staff from private and publicly run prisons keep in touch. The Head of Service left so I’m Acting Head but I can’t commit to that in the longer term. I want to get the Autism Accreditation Pilot process we’re involved in off the ground and completed if possible. I have been asked to write a chapter in a book and that’s renewed my interest in writing and I need more time with my family. In fact I work quite flexibly, but I’d like to improve my work-life balance even more. I live an outdoorsy life and one of my aims is to do the three peaks challenge before I’m 40. So, I’m not slowing down.’