Vermont's Cognitive Self-Change Program: A 15-Year Review.
Symptoms of this "business-as-usual" approach are abundant. Psychologists are trained to be attentive to scientific innovation and research findings, but a recent survey indicated only 7 percent of psychologists working in prisons are members of associations dedicated to improving the practice of correctional psychology. Most still rely on the Minnesota Multiphasic Personality Inventory or Rorschach Inkblot Test, time-honored personality assessment tools with little relevance to offender risk prediction or treatment, while ignoring offender-specific tools, such as Level of Service Inventory Psychopathy Checklist, which provide far more relevant and valid data. Additionally, 60 percent of mental health treatment interventions occur in an individual, rather than group, format.  Given the sheer volume of mental health services in American prisons, this is an egregious waste of a very limited resource, based on traditional habits favored by clinicians.
This devotion to the past does not reflect best practices and yet it continues unabated, limiting access to effective treatment. U.S. prison policy tends to resist self-examination and change. Dedication to institutional security and order too often are seen as the only worthwhile goals, as we ignore the deleterious effects of the harsh prison environment on inmates and staff alike. Given the amount of political and economic attention lavished upon corrections, the taxpayer might wonder why there is so little "correcting."
In 1986, the authors of this article were involved in a critical review of the "business-as-usual" approach in the Vermont correctional system. In this small progressive state, we were aware that the old security-minded order was failing to address offenders' needs. In conjunction with the University of Vermont's Psychology Department, we began developing alternatives to traditional counseling and therapy methods. We identified a need for a much more explicit intervention, focusing on the specific cognitive structures, criminal self-image and anti-social attitudes. We wanted to introduce evidence-based practices and promising methods. We also wanted to move this intervention out of psychology staff offices and into the units, using uniformed officers and caseworkers as full participants in the treatment process. With the support and commitment of prison and central office administrations, the Cognitive Self-Change (CSC) program Was born.
CSC originally was based on techniques proposed by psychiatrist Samuel Yochelson and psychologist Stanton Samenow, both were researchers at St. Elizabeth's Hospital in Washington, D.C. It evolved to include established methods of cognitive restructuring, broadly similar to the methods of psychologist Albert Ellis and psychiatrist Aaron Beck. The premise of the program is that all people have acquired thinking and feeling habits, including underlying attitudes and beliefs, which direct and control their external behaviors. As William Healy described, "Bad habits of the mind" are more responsible for criminal conduct than social circumstances. Offenders have acquired habits of thinking and feeling that reinforce patterns of criminal or violent behavior. These ways of thinking are habitual and automatic; the offender "thinks without thinking." CSC aims to bring these automatic thinking habits under offenders' consciousness and deliberate control. 
The program proceeds through a series of steps. Each marks a progression toward self-awareness and self-responsibility. The steps are:
Step One. Offenders learn to be objective observers of their internal thoughts and feelings, attitudes and beliefs. Rather than justify or defend their thinking, they learn to observe it objectively as it occurs in their minds.
Step Two. Offenders learn to recognize how their thinking generates their criminal behaviors. They identify the particular thinking that has led them to crime and acts of violence. At this stage, offenders recognize that their behavior is not the consequence of external circumstances, but of their own thinking. They realize that the way they think is within their control.
Step Three. Offenders practice new thinking that leads them away from crime and violence. They are not told what to think; they are challenged to find their own new ways of thinking. In order to be effective, this new thinking must meet two conditions: It must lead away from crime and violence in practical, real-life situations; and must be realistic, meaningful and believable to offenders. These conditions can be challenging. It is a principle of the program that new thinking always can be found, regardless the background and circumstances of an offender. This typically requires offenders to alter some of their most basic beliefs and attitudes toward life. This step is presented as a skill to be learned, not as a demand to conform to the rules of society. The message to offenders is, "In this program, we do not demand that you change, but we do demand that you learn how to change," and we point out that until they learn to control their thinking, they are not in a position to control their lives.
CSC is presented as a process of achieving self-determination, which puts offenders in conscious control of their own lives. Although the program is confrontational and sets high standards of performance, it does not attempt to coerce compliant behavior. Our immediate goal is raising the consciousness of responsibility. Offenders are confronted about the consequences of their behaviors and how they choose to think. The program respects offenders' rights to make their own choices, and assures they are fully aware of their responsibility to make these choices.
In Vermont, CSC is presented to offenders in a structured group format, lasting from six months to two years, depending on the offenders' sentence lengths. In addition, all members participate in one year of community aftercare through the department's field service units. Both institutional and community programs are delivered to groups of eight offenders and facilitated by two trained staff members. Groups meet two to three times per week. Specific units within the institution are designated as CSC programs and all inmates and staff members of that unit participate.
Typical groups include "cognitive check-in reports" and "thinking reports." Cognitive check-ins are brief reports by each group member, consisting of a description of a recent situation in the offender's life, descriptions of his or her thoughts or feelings of that situation, and an explanation of how that thinking possibly could lead toward criminal or hurtful behavior.
Advanced group members describe the new thinking they used to steer away from such behavior. Thinking reports are extended presentations of offenders' thoughts, feelings, attitudes and beliefs behind a particular previously committed crime or act of violence. These are written and presented to the group on a scheduled basis. Groups are a cooperative process in which members help one another learn the steps of CSC. Additionally, program members are given journal assignments in which they examine their criminal behavior histories and the thinking behind them. During the institutional phase of the program, each offender creates his or her own risk management plan, based on monitoring and changing the thinking that leads to crime and violence. When the offender is discharged to the community, this becomes a relapse prevention plan for avoiding crime and violence by recognizing and intervening in the cognitive precursors to his or her criminal behavior.
CSC is delivered in more than 20 jurisdictions throughout the United States, as well as Canada and Europe. In some sites, it is delivered in periods of as short as six weeks. A shorter delivery period helps offenders learn that they can control the thinking that controls their lives. Longer and more intense delivery penetrates more deeply into offenders' thinking habits, attitudes and beliefs that lie behind their criminal behaviors and permits the development of new alternative thinking.
Vermont's CSC Program is delivered to violent offenders. Because it focuses on the thinking patterns of each individual, the program easily adapts to a variety of offenders: juveniles, females, drug abusers and sex offenders. Generally, it is recommended that CSC be offered to high-risk offenders. This is consistent with the risk principle of intensive correctional treatment, which stresses the importance of reserving intensive services for offenders who demonstrate higher levels of criminal risk and need.  Serious emotional disabilities may render a client unable to understand or participate in the CSC process. Intellectual deficits and illiteracy can be accommodated, and such offenders typically benefit from the program.
One of the distinguishing features of the CSC program, as practiced in Vermont, is its inclusion of line staff in intervention delivery. Because it is a clear, straightforward approach with a high degree of accountability, correctional officers and caseworkers appreciate and support the program. Many are accomplished practitioners and group facilitators of the program. This is not a service relegated to the mental health or psychology services, although some are involved as supervisors and program facilitators.
This raises an important question: What if all staff, correctional officers in particular, were taught and encouraged to identify and address offenders' underlying risk by using specialized communication skills to penetrate offenders' core cognitive distortions? As long as we focus only on noncompliant behavior, offenders will remain defensive and in their defensive state, they see authority as the enemy. They will not find motivation for change. In Vermont, all staff are incorporated into the Department of Correction's (DOC) mission: Protect the public through the reduction of offender risk and restoration of victims. If staff believe control of institutional behavior is their only role, they distance themselves from the process of change. This is viewed as a wasted opportunity for offenders and staff.
Using Cognitive Reflective Communication, staff members are trained to understand that communication and related human connections are complex and multifaceted. Each progressive level of human communication allows for greater human connection. With stronger human connection comes the ability to affect, support and influence offenders' insights through self-reflection. If offenders see staff members taking a genuine interest in their efforts, the communication will influence offenders in a more positive manner. This requires professional objectivity and investment. Cognitive Reflective Communication teaches self-reflection, self-control and self-risk management.
Including correctional officers in the CSC process is a defining characteristic of the program. It takes the program out of the therapist's office and onto the block. Since officers are a constant presence in a prison setting, the program is able to systematically monitor offenders' behavior and provide feedback at all times. Officers bring their observations to the groups and contribute to the development of offenders' awareness of their thoughts and actions. This can be a challenge for staff who may have negative attitudes and beliefs about offenders. For officers working in CSC program units, there is an expectation that they see themselves as part of the process. This does not imply lack of vigilance or security. It has been found that officers who enforce rules in a fair, even-handed manner often are able to explicitly relate their actions to the offenders' program progress and integrate their roles as keepers of order and agents of change. This requires training, support and supervision. It also requir es officers to take inventory of their own belief systems. This is an excellent investment in the management of the institution, as well as the change process. CSC units typically have few problems or disciplinary infractions.
Over the years, correctional officers have become the program's most effective advocates. The emphasis on personal responsibility and conscientious confrontation of old thinking has inherent appeal for many staff. As officers develop cognitive reflective communication skills, they become increasingly involved and invested in the program. They represent authority in a nonantagonistic manner, and they expect accountability and effort by the offenders. This expanded role provides officers with career opportunities and increased job satisfaction.
The Vermont DOC's mission statement and professional principles stress the interconnected concepts of rehabilitation, restoration and personal responsibility. The CSC Violent Offender Program provides incarcerated men and women with an opportunity to engage in a long-term change process to lower their risk of crime. We have noted a 20 percent reduction in recidivism for men who participated in the program compared with a matched sample of inmates who did not participate.  Results from a study of a similar program in Michigan indicated reduced likelihood of disobeyed orders and assaults among program participants.  The author of this study cites the importance of training officers "to personalize cooperation by showing a willingness to enter into cooperative relationships with inmates." While there is a need for more of this type of research, these studies provide a glimpse into the benefits of the program.
Correctional systems are swamped with inmates whose lives have been shaped by addiction, social pathologies of every imaginable form and hopelessness toward the future. Rather than using knowledge and science to forge new systems for changing the life course of these millions of men and women, society has relegated them to crowded, under-resourced institutions where they languish. Since politicians have never lost a vote by being unsympathetic to offenders, we should not expect inmate numbers to decrease or conditions to improve. No-frills punishment has achieved respectability in statehouses across the county. This is particularly curious in light of recent FBI data showing significant reductions in all categories of crime over the past decade.
We need to look within our own institutions and ourselves to find new ways of addressing old problems. The CSC program represents a cost-effective, accessible option for institutions willing to set aside the "them and us" ideology. The program promotes change in inmates, staff and the system, which, left to its own devices, promotes all the stereotypes we love to hate. It is an opportunity for collaboration and restoration in an environment in which such words often are forgotten. Fifteen years after commencing this program, we have found that we can change. This is good news indeed.
Tom Powell, Ph.D., is clinical director of the Vermont Department of Corrections. Jack Bush, Ph.D., is a consultant for Criminal Justice Strategies, Inc. Brian Bilodeau is program manager of Vermont Community Corrections in Burlington, Vt.
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