Research on DBT applications in correctional settings, although limited in terms of number and scope, has produced promising results. Its use over the past two decades should at this point define it as a viable evidence based method. Repeated studies over a twenty-year period have established its effectiveness in treating women and men.

There are caveats to consider. The problems are frequently modified or partially implemented DBT variants, too little monitoring, and no long term experimental studies.

The use of DBT also requires a broad base of support and an organizational culture that upholds the belief that people can change. It is resource intensive.

Its founder, Marsha Lineham is concerned about setting standards for DBT.

There is a line to walk between the proliferation of creative variants of her work in different settings with particular demands and the scientific rigor; and the essential training Prof. Lineham wants to accompany the use of DBT.

Dialectical Behavior Therapy (DBT)

Send me your toughest cases


DBT is an approach to mental health treatment that combines the techniques of standard cognitive behavioral therapy (CBT) with elements from the behavioral sciences, dialectical philosophy, and Zen and Western contemplative practice. It was developed by Marsha M. Linehan in the late 1970s to treat women with the symptoms of borderline personality disorder (BPD).

The the effectiveness of the therapeutic approach in treating BPD has been found to be effective in treating emotional instability, cognitive disturbances, self-harming behavior, chronic feelings of emptiness, interpersonal problems, poor impulse control and anger management.

More recent research supports the utilization of DBT in effectively treating individuals with the varied symptoms and behaviors associated with spectrum mood disorders, self-injury, sexual abuse, and substance abuse.

Sugggested readings:

The Dialectical Behavior Therapy Skills Workbook. Practical DBT exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance, (2007) Matthew McKay, Jeffrey C. Wood, Jeffrey Brantley, New Harbinger Publishers.

Civil rights for pregnant women

A study found on the National Advocates for Pregnant Women (NAPW) website found hundreds of cases in which pregnant women were arrested, detained, or otherwise deprived of personal liberty, as a result of the “passage of feticide measures and laws restricting access to safe abortion care that, like so-called ‘personhood’ measures, encourage state actors to treat eggs, embryos, and fetuses as if they are legally separate from the pregnant woman.” Since the conclusion of the study in 2005, approximately 250 more cases have been discovered. Fifty-two percent of the women were African American, 71 percent were low income, 69 percent were under the age of 30,. No comprehensive source could be identified from Native American tribal courts. Read the study here.

Sentencing patterns: the war on drugs

African-American females have an incarceration rate that is almost eight times higher than their white counterparts.[6]  Much of the increase in women’s incarceration rate comes from the impact of mandatory sentencing laws,

passed during the 1980s crackdown on crime.  Under many of these laws, mitigating circumstances (e.g., having children, few or no prior offenses, non-violent offenses) are rarely allowed.  One survey found that just over half (51%) of women in state prisons had none or only one

prior offense, compared to 39 percent of the male prisoners.[7]  It should also be noted that drug convictions account for the bulk of these increases, as has been the case for all prisoners, as I will note below.  What is of critical importance for women offenders is the fact that

more than 80 percent of them have children and in most of these cases the women have sole responsibility to take care of them.[8]

Suggested reading: Freeing Tammy, Jody Raphael (2007)

Defining evidence-based

What does "evidence based"actually mean? Stories of success are not enough. Without good evaluations it is a question without an answer.

Ed Latessa, a nationally recognized researcher and advisor, says we need better science to define program success. If we do not recognize what works more comprehensively, we can do harm. He talks about the different ways organizations go about evidence-based practice. The tools might be different but the key is how are they used? There are steps involved in evidence based thinking. It starts with assessments.

Second, what does the research say about the effectiveness of a chosen approach? What other programs are available. Finally, the least recognized step evaluation. "At the end of the day, to truly be evidence based you have to be data driven. Investing in training is essential. It is the staff that has to understand how to apply this work.


The effects of prison on health

Only two groups have a constitutional right to health care are prisoners and Native Americans. This includes women, but how well are they represented? Reproductive health receives little or no constitutional protection. Health and Incarceration, published by the National Research Council (NRC) presents findings from a 2012 convening of experts representing the fields of healthcare, prisoner advocacy, and corrections.

The report examines the impact of incarceration on health, identifying collateral consequences, and presents opportunities for reducing health risks.

A background paper identifies health risks that contribute to incarceration.

For instance, women in prison have positive pap smears of 25% compared to 7% in the general population. They also have a higher incidence of  "less observed" mental health issues compared to male prisoners and the general population.

The NRC report is a precursor to a comprehensive work scheduled to be released sometime in 2014 on the causes and consequences of high rates of incarceration in the United States. While there is little reference to reproductive health in the report, it does briefly note that while female inmates are only around 10 percent of the correctional population they have higher rates of disease. Women, and even more so mothers, are the least recognized in California partly because women are lumped statistically with men.

Noted in the March 2014 blog of the Huffington Post, if prison health is bad, the health status of women and minorities in particular is even worse once they leave prison.