The history of the prison system in the US is inextricably linked to Christianity. Penitentiary shares its root word, penitence, with repentance. Quakers and Congregationalists started the very first prisons because they viewed the corporal punishment of that time to be cruel (Graber 20). Even today, prisons are required to hire chaplains to make sure incarcerated people have the freedom to practice religion inside of the prison. The largest volunteer group serving incarcerated people is Prison Fellowship, an arm of the Religious Right which began in the 1970s and is now the largest faith based group of its kind1 (Prison Fellowship “Benefits”). Under the umbrella of Prison Fellowship, a pre-release program called InnerChange Freedom Initiative was developed with the specific goal of transforming incarcerated men in order to lower recidivism rates. The Religious Right claims to have positive effects on incarcerated people beyond cultivating spirituality, such as better rehabilitation and lower recidivism. However, their claims have not withstood scientific scrutiny. This begs the question, what are the effects of the Religious Right’s programming inside of prisons? The US prison system, created with the intent of protecting society from criminals, was developed primarily by straight, white, Christian men who intended the system to be for men. Every aspect of a resident’s life is controlled by someone else;

Background: The current literature concerning self-harm and suicide has shown firstly that self-harm is a major public health problem, secondly that people who self-harm are at increased risk of suicide and thirdly, that women prisoners have a higher rate of self-harm than women in the general population and than male prisoners. Women prisoners are therefore particularly high risk of self-harm and suicide and yet to date, no specific intervention has been developed for this group. Aims: This study intends to build on an intervention found to be effective in the community and to describe a methodology of conducting a therapeutic intervention in a prison environment. Method: The research utilized both qualitative and quantitative methods conducted over four phases. In Phase 1, semi-structured interviews were completed with women prisoners who self-harm and with prison staff. Data was analysed thematically. In Phase 2, the results from the analysis were then used to inform the modification of a Psychodynamic Interpersonal skills Therapy (PIT) model originally used in the community. During the third phase of the study, prison staff were recruited and trained to deliver the therapy. Finally, the fourth phase consisted of a feasibility and acceptability study with 64 women prisoners who had recently self-harmed. Thirty-two were randomized to the treatment group which consisted of four sessions of individual PIT therapy and 32 to the control condition which consisted of four sessions with a member of staff not trained in the therapy. Rates of self-harm were measured pre- and post-treatment. Standardized measures for depression, suicide intention, hopelessness and interpersonal skills were also administered. These data were further supported by interviews conducted with participants who completed the intervention, therapists and therapy supervisors. The methods used in the study were constantly evaluated and amended when required to describe a methodology suitable for this environment. Results: There was evidence of a lack of understanding of self-harm by prison officers. The trial phase of the study did not show evidence of efficacy for the intervention. There was an overall reduction in rates of self-harm pre- and post- treatment across the sample. Comparison of scores on outcome measures, pre- and post-intervention, showed a reduction on all tests in both treatment groups but this was not significant. It was not feasible to deliver the therapy as originally envisaged and substantial changes to the methods were needed. The results showed that prison staff had the skill and capacity to deliver PIT therapy but that the prison was not able to support such a role. As a result external therapists had to be brought in to the study. Conclusions: It is acknowledged that the study was not feasible as originally designed, but due to the small sample size we cannot say it was not effective and therefore, not worthy of further study.