An Exploration of Cultural Sensitivity

Abstract

In seeking to provide a custodial therapeutic environment able to meet the diverse needs of every prisoner, an understanding of the background and cultural heritage of each individual is an essential component of a comprehensive assessment, case formulation, and therapeutic engagement. It is especially important for prisoners whose historical, systemic, social, and familial backgrounds deviate from those of the White British majority. This study, through qualitative interviews, explored the experiences of eight randomly selected Black or Minority Ethnic (BME) prisoners (within this study this refers to prisoners who did not identify themselves as being White British¹) who had been engaged in therapy for a minimum of 12 months, to determine how culturally sensitive HMP Grendon, as a therapeutic community prison, was to their culture and backgrounds. Transcripts were analyzed using thematic analysis. The results indicated that Grendon’s BME prisoners experienced a lack of cultural sensitivity when engaging with the therapeutic process. Five main themes emerged: therapy and cultural values; relating to others; cultural competency; cultural understanding/awareness; and responses to experiences. Ways identified to improve this include increased staff awareness and providing increased opportunities for BME prisoners to share their experiences.

Keywords

cultural sensitivity Black or Minority Ethnic (BME) prisoners HMP Grendon therapeutic communities

Introduction

In Britain, members of Black or Minority Ethnic (BME) communities are overrepresented in the criminal justice system (Cheliotis & Liebling, 2006; Wilson, 2004) and disadvantaged within both the criminal justice and mental health systems (Browne, 2007). Her Majesty’s Chief Inspector of Prisons found that BME prisoners report less positive experiences than White British prisoners across four measures indicative of a healthy prison: safety, respect, purposeful activity, and resettlement (HM Inspectorate of Prisons, 2005). Furthermore, BME prisoners have experienced discrimination on offending behavior programs, including feeling marginalized and being stereotyped (Cowburn & Lavis, 2009), with Wakama (2005) reporting a lack of understanding of the impact of cultural values on offending behavior between BME sex offenders and White British treatment facilitators.

HMP Grendon (hereafter referred to as Grendon) opened in 1962 and has throughout the past 50 years operated as a secure therapeutic prison. Its remit was given by the then Home Secretary (who has justice responsibilities), Rt Hon R. A. Butler, who stated on laying the foundation stone in 1960 that:

the regime must be flexible with the accent on treatment; and success will depend above all on an enlightened staff-inmate relationship, together with close co-operation at all levels between the different members of the staff. (Snell, 1963, p. 179)

The first senior management team decided to base the treatment provided on the therapeutic community (TC) model (Main, 1946) with each residential wing operating as an independent TC. Grendon remains the only prison within the United Kingdom that operates wholly as a TC. Campling (2001) states that:

the term TC is usually used to describe small cohesive communities where residents have a significant involvement in decision making and the practicalities of running the unit. They are deliberately structured in a way that encourages personal responsibility and avoid unhelpful dependency on professionals. (p. 365)

The TC model enables offending behavior to be addressed through different theoretical approaches. This includes social learning, cognitive behavioral, and psychodynamic approaches, the later enabling an exploration of early attachments, ascertaining the developmental pathway and the identification of unconscious processes (Shuker, 2010).

While 25% of the national prison population identify themselves as being from a BME background (Ministry of Justice, 2012), Grendon’s BME population has historically been smaller, accounting for only 16% of its total (Newberry, 2010; Newton, 2000), although this has recently increased. Sullivan (2007) identified seven explanations for why BME men may not volunteer to engage in therapy at Grendon: stigma; communication (not being fluent in English); stereotyping; cultural values; not being a good (criminal) career move; the importance of belonging; and fear. She concluded that in order to continue to be a relevant resource to prisoners across the prison system, therapeutic communities must increase their cultural understanding and welcome diversity in the context of psychotherapeutic group work and community life.

BME prisoners at Grendon are, however, just as likely as White British prisoners to be assessed as suitable for treatment (adult male prisoners serving indeterminate sentences or determinate sentences of at least 4 years need to apply for a place at Grendon), and there is no evidence to suggest that BME prisoners are more likely to leave prematurely (HMP Grendon, 2012; Newton, 2000). Indeed the majority of BME residents felt staff treated them the same as other residents though there were mixed opinions concerning the extent to which therapy addresses their racial, ethnic, and cultural needs. Some residents felt that they were treated differently to White British residents during therapy as staff sometimes “mocked” their culture and that they were subtly racist and encouraged them to “let go of their cultural background” (Newberry, 2008).

Brookes, Glynn, and Wilson (2012) conducted a qualitative study to investigate the cultural issues of 11 men who identified themselves as “Black” and concluded that although Black men found Grendon helped them to explore and work on their offending behavior, they experienced identity difficulties through being minority members of the community. This led to feelings of isolation, powerlessness, and a sense that, within Grendon, cultural identity was not fully recognized.

Cultural Sensitivity

Resnicow, Soler, Braithwaite, Ahulwalia, and Butler (2000) defined cultural sensitivity as:

the extent to which ethnic/cultural characteristics, experiences, norms, values, behavioural patterns, and beliefs of a target population as well as relevant historical, environmental and social forces are incorporated in the design, delivery and evaluation of targeted health promotion materials and programs. (p. 272)

Foronda (2008) considered that cultural sensitivity also encompasses knowledge, consideration, understanding, and respect. Similarly, Zhu (2011) defined cultural sensitivity as “the quality of being aware of and accepting of other cultures” (p. 118). This involves the awareness that there could be differences between cultures and that these differences could affect relationships and the way people communicate with each other. Hughes and Hood (2007) extend this argument positing a view that cultural sensitivity should reflect not only a set of values and attitudes, but that this should translate into relevant changes in practice and behavior. This has been termed tailoring by Kubokawa and Ottaway (2009): amending your view to take into account some else’s viewpoint, or to consider someone else’s needs, with Hall (2001) contending that culturally sensitive therapy involves tailoring of psychotherapy to take into account different cultural factors.

Cultural Sensitivity and Access to Treatment

Those from minority ethnic groups living in the United Kingdom are more likely to be diagnosed with mental health problems, more likely to be diagnosed and admitted to hospital, more likely to experience a poor outcome from treatment, and more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health (Mental Health Foundation, 2013). Fountain and Hicks (2010) found that people from ethnic minority backgrounds’ reported that their biggest fear of seeking help was the stigma and possible repercussions, including on their marriage prospects. The fact that mental health problems often go unreported and untreated because people in some ethnic minority groups are reluctant to engage with mainstream health services, is compounded by mainstream mental health services failing to understand or provide services that are acceptable and accessible to non-White British communities, and which meet their particular cultural and other needs (Mental Health Foundation, 2013). This lack of understanding of a patients’ culture, ethnicity, and their self-expression can lead to another outcome: an overrepresentation of BME patients in, for instance, a forensic inpatient service (Warnock-Parkes, Young, & Gudjonsson, 2010).

Engagement of minority groups in treatment can also be hindered by the concept of the “individual” as rational and responsible for his or her actions, a principle that is pivotal to cognitive behavioral programs. This largely Western construct can lack relevance for those from other cultures whose sense of identity is more associated with their families and communities (Cowburn, Lavis, & Walker, 2008).

Other factors that can impact on BME offenders engaging effectively in treatment programs include course material lacking culturally relevant scenarios (Patel & Lord, 2001), the need for greater cross-cultural communication skills (Cowburn & Lavis, 2009), and an expectation for sex offenders to disclose details of their offenses that may go against non-Western culture’s approaches to discussing issues of gender and sex (Cowburn et al., 2008). For example, South Asian offenders may have difficulties in managing feelings of shame, particularly in the broader cultural context of honor and respect (Gilligan & Akhtar, 2006). Thus, the aforementioned factors need to be considered in program design.

Bhurga and Bhui (1998) highlighted the conundrum raised by the Western orientation, development, and practice of psychotherapy, and the largely ignored issues this has presented with regard to the applicability of mainstream psychotherapy to minority ethnic groups. They argue that while Western treatment approaches reduce distress through focusing on the mind, illness, and emotional distress, ethnic minority communities describe their distress in physical, somatic, and religious terms (Carothers 1953, as cited in Bhurga & Bhui, 1998), presenting a potential discrepancy of goals and expectations.

Weatherhead and Daiches (2010) explored Muslim views on psychotherapy, where participants reflected on the possible coexistence of Western secular and Islamic religious beliefs. Highlighting the challenges this can present, some participants identified that seeking help from services is in conflict with their religious beliefs as it would be considered a direct rejection of Allah. Other participants felt that they could coexist, but respect and understanding of religious beliefs was an important factor, which added to the value attributed to the therapeutic relationship.

Mandikate (2007) also highlighted a phenomenon where ethnic minority clients, when discussing issues relating to their culture, would have these “interpreted away” by the White therapist. He also describes a “denial of difference” that refers to a subtle message that the goal of the client is to move less toward seeing their self-identity as immersed within their own culture and more toward that of cultural identity of the treatment providers. Comas-Diaz and Minrath (1985) identify a similar concept where clients may try to gain an identity by taking on the therapist’s identity.

The aforementioned literature indicates that traditional psychotherapy, unless sensitive and responsive to cultural backgrounds, is unlikely to meet the needs of BME prisoners; in extreme cases, it could also have the potential to exacerbate distress. Sue, Fujino, Hu, Takeuchi, and Zane (1991, as cited in Hall, 2001) argue that many ethnic minority clients desire psychotherapy services that are culturally sensitive. They highlighted that ethnic minority clients who share the same ethnicity as their therapists and who speak the same language tend to stay in therapy longer than those who have therapists who are not matched on these criteria. Hall (2001) identified that a number of culturally sensitive theoretical models of psychotherapy for ethnic minority groups have been developed; for example, a model developed for African Americans emphasizes racial identity development.

The literature reviewed indicates a need for interventions to be culturally sensitive to non-Western prisoners/clients. However, Singh (2007) reminds us, cultural factors form only one aspect of a patient’s formulation and care plan and, focusing inappropriately on culture and ethnicity without using sound clinical judgment, could increase the possibility of offering poorer instead of better care to patients from minority ethnic groups (as cited in Warnock-Parkes et al., 2010). In a counter perspective offered by Alvidrez, Azocar, and Miranda (1996), it is argued that amending approaches to different cultural groups may indeed not be required (as cited in Hall, 2001). This is due to the belief that disorders and interventions for these disorders are universal, a view that has had some support by research which has found few ethnic differences in psychopathology (Kessler et al., 1994, as cited in Hall, 2001).

Aims of This Study

As Grendon offers treatment to prisoners from a range of different cultural and ethnic backgrounds, and as the literature indicates that cultural sensitivity is a crucial element that should be taken into account when working with BME prisoners, the question that needs to be asked is whether Grendon is culturally sensitive to such prisoners? As Bennett (2007) points out, part of the problem of attracting BME prisoners to Grendon may be due to the theory and practice of therapy itself, though he argues that the latter is likely to be the determining factor.

While previous research has indicated that BME prisoners are likely to experience barriers when engaging in manualized offending behavior programs (interventions which have a prescribed session content and structure) or undertaking psychotherapy within the community, this needs to be extended to those who undertake a “living–learning” TC-based intervention. Brookes et al. (2012) reported on the cultural experiences of Black men, and this study extends this to explore the extent to which Grendon was culturally sensitive to the backgrounds and culture of a wider range of BME men. It will utilize Zhu’s (2011) concept of cultural sensitivity, which is the quality of being aware of, and accepting of other cultures.

Method

The study involved eight male prisoners from four residential wings within Grendon, who had been engaging in therapy for a minimum of 12 months. Participants were identified as being from a BME group, and they were from a range of different ethnic backgrounds; Black Caribbean, Black British, Mixed, Mixed/White/Black Caribbean, White other, White Irish, and Asian other. Participants were randomly selected from the establishment’s database and approached individually where they were informed about the nature of the research, asked whether they wished to participate, and notified of the procedure for withdrawing at a later date if they wanted to do so.

A qualitative design was adopted that used in-depth semi-structured interviews to explore participants’ experiences throughout their time at Grendon and how culturally sensitive it is to their cultures. While an interview guide provided structure and highlighted areas of interest, it was not prescriptive and allowed explorations of topics as they evolved. Open-ended questions ensured that participants were able to freely recall their experiences, while probing questions developed a deeper understanding of their experiences. The men were interviewed individually, and each interview was tape-recorded to allow for transcription.

Thematic analysis procedures were employed in data analysis, where a number of stages were conducted (Braun & Clarke, 2006; Howitt, 2010). This involved (1) data familiarization, (2) generation of initial coding, (3) identification of themes based on the initial coding, (4) review of themes, and (5) theme definition and labeling.

Results

Data analysis revealed five main themes: (1) therapy and cultural values, (2) relating to others, (3) cultural competency, (4) cultural understanding/awareness, and (5) responses to experiences.

Therapy and Cultural Values

This theme encapsulates participants’ experiences of how therapy coexisted with their cultural values. It encompasses three subthemes: (1) identity, (2) cultural differences, and (3) incongruence between therapy and culture. Incongruence between therapy and culture was identified as the most prominent experience, where participants experienced that therapy clashed with their cultural values. This is evident in the following quote:

it was hard for me because my culture played too much part, I keep things in the family, so you understand, it was like it was worse like that, go and express your feelings, what’s going on in your family, what’s going on in your past. Like in our culture … it’s like you have broken the code of the family, you can’t do that, go outside. (Participant D)

The men felt they needed to adapt their cultural values in order to engage effectively in treatment:

what would happen is like, if I was to adapt to the way therapy expect me to adapt and do my therapy and address my offending behaviour, if I was to go back within my culture that would be a problem. (Participant G)

It was also expressed that therapy was more orientated to those from nonminority backgrounds:

I don’t think a lot of people take into account … other cultures where the strap is you know is also used to troubled children. They don’t take into account the effect that that might have. I don’t feel it is targeted enough in therapy. It comes from the angle, umm sort of middle class sort of umm English way so you know. (Participant H)

Relating to Others

This theme includes five subthemes: (1) shared ethnicity increased relatedness, (2) marginalization, (3) difficulty relating to others (White British), (4) others (White British) cannot relate, and (5) shared ethnicity increased engagement. This is an extensive area that focuses on participants’ experiences of relating to others (prisoners and staff) as they progressed through therapy. This theme identifies the enhanced sense of relatedness experienced by participants and of being valued and understood by others. However, it also reveals that this tends to be in situations where they are in relationships with those who are also from BME backgrounds, both staff and other residents.

Nearly all the participants expressed that they had increased relatedness with other BME prisoners:

I just feel more comfortable, I feel I can express myself and not be judged, not be looked down on, ‘cause sometimes I do feel like I get looked down on. (Participant B)

It feels good, you know someone who really understands me, someone can really link in you know, it’s like vice versa cause I can link in what he’s talking about so you know we kinda support each other a lot. (Participant F)

This was also highlighted among relationships with staff

One of the staff is Muslim … a practicing Muslim … oh it, it makes the atmosphere here a lot different. (Participant B)

Participants expressed that they found it difficult relating to others as there was a lack of BME prisoners:

when I was on (the assessment and induction) wing it wasn’t that many foreign, umm it was one, one black person and that was it, and it was only me and him … it was a bit hard, umm, I couldn’t really with regard to the cultural background I couldn’t really link in with anyone, except one person, umm the person who is here now and that was the first person I got closed to, sort of thing … you sort of bond to foreign people more. (Participant A)

The experience of belonging featured as a central theme for participants, however, for many participants this seemed to be intrinsically connected to their having other BME residents within the therapeutic setting. What became apparent was that for many participants they experienced a sense of isolation and a perception that, at some point within their journey at Grendon, they did not “belong”; this experience was closely linked to their experience of being part of a minority.

I spoke this topic, I saw it from day one I was in the wing, and it feel it’s not no place for minorities here. (Participant D)

Umm, I guess it makes you feel like you don’t belong to this place, obviously I had that feeling quite a few times, even when I was outside, thinking that you don’t actually belong to the country in a way, but that’s how you feel, you feel you know this is not my place. (Participant A)

Cultural Competency

The idea of cultural competency refers to the ability of others to interact effectively with people of different cultures. It encapsulates two subthemes that represent opposite experiences: (1) negative interactions and (2) positive interactions. Notably, the majority of participants experienced negative interactions, with differential treatment and external censorship being the most prominent experiences.

Participants gave examples of differential treatment where the use of their own cultural dialects such as Jamaican “patois” was challenged by staff. They reported however that White British prisoners were freely allowed to use their own cultural language, for example, where they spoke “cockney,” East London slang.

You know they would pull you about using slang and blah, but this isn’t slang this is Caribbean banter, this is you know, you know, I felt rough. Meanwhile people using cockney they were fine, there wasn’t a problem at all, and I felt that this was a liberty again, you know you can use cockney slang and no-one ever complained about it, not one word. And that’s the difference and I can see those differences. (Participant A)

The majority of participants also expressed that they were censored (not able to express their opinions, feelings, and emotions) due to other’s behavior.

They just get immediately defensive [when discussing racism], not, yeah upset cause some peoples walked out some point, you know when people try to explain how they feel they have got up and walked out, but it’s, it’s clearly that people feel really defensive, absolutely defensive, over, over this thing so it makes it really difficult to work on. (Participant H)

As soon as you see certain body language you know, you know fear or people fidgeting, people just don’t want really listen. That’s what you tend to do you watch people’s body language when discussing certain subjects. Soon as you see people certain body language it put you off … you withdraw. (Participant F)

Cultural Understanding/Awareness

Participants’ experiences of feeling understood by others, while connected with their experience of belonging, seemed to emerge as a distinctive theme of its own. This theme also encompassed the extent to which participants considered that others were aware of, or understanding, of their cultural background and comprised three subthemes: (1) lack of cultural understanding/awareness, (2) understanding of culture, and (3) understanding developed in time. The analysis highlighted that the majority of participants experienced a lack of cultural understanding and awareness. For example, one resident whose background was in Northern Ireland stated:

They didn’t really understand it, they just knew that Protestants were killing Catholics and Catholics were killing Protestants and they couldn’t see the logic behind this or what it’s all about … it got very frustrating because they couldn’t understand the like, the life that I basically grew up in. (Participant E)

They don’t understand about, you know the culture and what you going through and the way you look at things you know … I feel the group still don’t understand me. (Participant G)

However, participants expressed that understanding did develop as they progressed through therapy:

People are learning more, little, little baby steps but people are learning more I suppose, so it doesn’t mean, it doesn’t mean it’s stagnant. (Participant H)

Responses to Experiences

The final theme encapsulates participants’ responses to their experiences and has five subthemes: (1) internal censorship, (2) negative emotions, (3) educating others, (4) desire for change, and (5) coping strategies. The most prominent theme experienced by participants was internal censorship which refers to them feeling suppressed and unable to freely express themselves:

I find because I’m a single voice I can be easily drowned out. So what’s the point you know, there’s been enough fighting back home over this, I ain’t intending to do this. I keep me own thoughts and feelings to me self then. (Participant E)

Never ever in two years I’ve been here, I’ve been at Grendon 34 months and I’ve never ever been able to express it. I think I wouldn’t know where to start, I wouldn’t know where to start, honestly I wouldn’t know where to start because I think for one they wouldn’t understand. (Participant B)

The analysis also highlighted a range of negative emotions experienced by participants in response to their experiences:

Well it made me angry [receiving racist comments] but I came here for a reason so I had to swallow that. (Participant C)

It hurt, really hurt because I don’t disrespect anybody else’s culture because of my beliefs in my own culture, I realise what people have in theirs and I wouldn’t do that cause I know how it feels. (Participant E)

Discussion

Therapy and Cultural Values

This study supports previous research (Comas-Diaz & Minrath, 1985) which has highlighted that for ethnic minorities there are cultural issues that can hinder their engagement in treatment. Participants felt they needed to adapt their cultural values to engage in treatment, and this raises important questions about the extent to which treatment is culturally sensitive. To be culturally sensitive and aid engagement, it is argued that treatment should be responsive to prisoners’ cultural values. There is a considerable body of literature within forensic psychology suggesting that “responsivity” needs to be carefully considered within treatment design; this means that interventions should take into account people’s different learning styles, personality, motivation, and background experiences when planning and delivering treatment (McGuire, 1995). This research supports the extension of this principle to interventions with those from BME backgrounds.

Some participants questioned whether therapy at Grendon was more orientated to those from an English/middle-class background. Their view resonates with Morgan (2008) who argues that psychoanalytic theory is essentially Eurocentric and not applicable beyond a White, middle-class world. Furthermore, some participants stated that they experienced their identity being eroded, reflecting a lack of cultural sensitivity. Their views repeat a finding from HMP Grendon’s Inspectorate Report (2009) which found that BME prisoners described sacrificing their identity to survive therapy.

Relating to Others

While Grendon has historically had a low number of BME prisoners, the majority of participants expressed that they developed closer and more meaningful relationships with those from similar cultural backgrounds. The results suggest that these relationships provided support, acceptance, and understanding that perhaps were not available from relationships with those from White British backgrounds. Similarly, participants experienced more positive relationships with BME staff, though professional competence has been highlighted as being of more importance than the staff member’s ethnicity (Gilligan & Akhtar 2006).

A further point linked to these experiences is that many participants felt marginalized, and this could be seen as both a result of there being few BME prisoners who they can relate to and a lack of acceptance from others. Sullivan (2007) highlights the importance of belonging to social groups where cultural heritage is shared among its members. Furthermore, Fernando (1991) argues that ethnicity is the sense of belonging (as cited in Dalal, 2002) and that this idea of belonging is associated with the notion of identity (Dalal, 2002). Thus, it could be argued that BME prisoners feel marginalized as there are few prisoners who share their ethnicity and who can relate to their sense of identity. This also links to the above point that participants felt their identity was being stripped away.

Cultural Competency, Understanding, and Awareness

A clear finding was that the majority of participants experienced a lack of cultural understanding from others, which in turn has implications for how men engage in and respond to treatment. This supports the findings of HM Inspectorate of Prisons (2005) which also recorded that BME prisoners considered that staff lacked cultural and racial awareness. Furthermore, Smith (1998) argues that cultural sensitivity provides a foundation for the development of cultural competence (as cited in Hughes & Hood, 2007).

This lack of cultural sensitivity experienced by Grendon residents may provide some understanding of why some responded by feeling shut down and unable to express their thoughts and emotions. It is in line with research which has found that Black prisoners adopt a passive response to authority by “keeping quiet,” relying on each other as sources of comfort and support when they are stressed (Wilson, 2004) and links to the finding of increased relatedness with other BME prisoners.

Conversely, Warnock-Parkes, Young, and Gudjonsson (2010) found that the majority of service users did not think their ethnicity affected the treatment they received, or that their treatment would have been different if they had engaged with staff who had greater understanding of their experiences. They raised an important question, is there the potential for organizations to place too much emphasis on services being culturally sensitive when the service is successfully meeting the needs of service users? The results from our study would not support either their findings or their question.

Implications of the Research

The findings from this study indicate that Grendon is not as culturally sensitive to BME prisoners as it ought to be, and that it needs to develop in order to provide a more effective therapeutic environment for BME men. Raising awareness of cultural differences and implications for treatment could help to empower staff and prisoners to talk about sensitive issues. The first step could be to acknowledge these difficulties and then take a collaborative approach with prisoners to consider how to overcome these. Participants mentioned that developing trust was a key process in their progression through therapy, so developing therapeutic alliances appears to be an important process.

Training could be provided to develop staff awareness of working with prisoners from different cultural backgrounds, cross-cultural communication skills, and cultural sensitivity. This could be important for Grendon’s assessment unit where some prisoners highlighted in particular that they felt they were treated unfairly and received less support.

Training could help to develop cultural understanding and awareness which in turn could help to develop staff and prisoner relationships. Achieving a greater sense of inclusion, relatedness, and openness to discussing issues such as racism could help to create a more culturally sensitive environment. This could have implications for BME prisoners feeling that their identity is accepted and that they are very much part of the TC within which they reside. Furthermore, it is important that both staff and prisoners are empowered to challenge negative behaviors, such as stereotyping, in order to maintain a culturally sensitive community and prison.

Conclusion

Brookes et al. (2012) analysis of narratives of a small sample of Black men at Grendon highlighted themes such as isolation, powerless, and loss of identity in relation to their racialized experiences at the prison. This study built upon their work by including prisoners from a wider range of ethnic backgrounds within its sample. Our results reflect their findings as it was found that that the establishment lacks cultural sensitivity to not only Black prisoners but those from other minority ethnic groups.

However, it is important to note that participants also expressed that they personally gained from engaging with the TC process, and some did experience respect and understanding. Thus, Grendon has shown the capacity to work with BME prisoners although there is a need to develop its cultural sensitivity in order to work more effectively with diverse cultural groups.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Note

References

Alvidrez

Azocar

Miranda

(1996). Demystifying the concept of ethnicity for psychotherapy researchers. Journal of Consulting and Clinical Psychology, 64, 903–908.

Bennett

(2007). Why do relatively few BME prisoners choose to come to Grendon? Prison Service Journal, 173, 5–8.

Bhurga

Bhui

(1998). Psychotherapy for ethnic minorities: issues, context and practice. British Journal of Psychotherapy, 14, 310–326.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

Brookes

Glynn

Wilson

(2012). Black men, therapeutic communities and HMP Grendon. Therapeutic Communities: The International Journal of Therapeutic Communities, 33, 16–26.

Browne

(2007). A dangerous intersection. Black communities, mental health and the criminal justice system. Safer Society, 33, 28–30.

Campling

(2001). Therapeutic communities. Advances in Psychiatric Treatment, 7, 365–372.

Cheliotis

Liebling

(2006). Race matters in British prisons. British Journal of Criminology, 46, 286–317.

Comas-Diaz

Minrath

(1985). Psychotherapy with ethnic minority borderline clients. Psychotherapy, 22, 418–426.

10.

Cowburn

Lavis

(2009). Race relations in prison: Managing performance and developing engagement. British Journal of Community Justice, 7, 77–89.

11.

Cowburn

Lavis

Walker

(2008). BME sex offenders in prison. The problem of participation in offending behaviour group work programmes. A tripartite model of understanding. British Journal of Community Justice, 6, 19–34.

12.

Dalal

(2002). Race, colour and the process of racilization. New perspectives from group analysis, psychoanalysis and sociology. East Sussex, Englnad: Routledge.

13.

Fernando

(1991). Mental health, race and culture. London: Macmillan.

14.

Foronda

(2008). A concept analysis of cultural sensitivity. Journal of Transcultural Nursing, 19, 207–212.

15.

Fountain

Hicks

(2010). Delivering race equality in mental health care: Report on the findings and outcomes of the community engagement programme 2005-2008. Lancashire, England: International School for Communities, Rights and Inclusion (ISCRI), University of Central Lancashire (UCLAN).

16.

Gilligan

Akhtar

(2006). Cultural barriers to the disclosure of child sexual abuse in Asian communities: Listening to what women say. British Journal of Social Work, 36, 1361–1377.

17.

Hall

(2001). Psychotherapy research with ethnic minorities: Empirical, ethical and conceptual issues. Journal of Consulting and Clinical Psychology, 69, 502–510.

18.

HM Chief Inspector of Prisons. (2009). Report on an announced inspection of HMP Grendon, 2-6 March 2009. London, England: HM Inspectorate of Prisons.

19.

HM Inspectorate of Prisons. (2005). Parallel worlds. A thematic review of race relations in prisons. London, England: Author.

20.

HMP Grendon. (2012). Annual review of Grendon receptions 2011. Unpublished internal psychology department report.

21.

Howitt

(2010). Introduction to qualitative methods in psychology. Essex, England: Pearsons Education Limited.

22.

Hughes

Hood

(2007). Teaching methods and an outcome tool for measuring cultural sensitivity in undergraduate nursing students. Journal of Transcultural Nursing, 18, 57–62.

23.

Kubokawa

Ottaway

(2009). Positive psychology and cultural sensitivity: A review of the literature. Graduate Journal of Counselling Psychology, 1, 130–138.

24.

Main

T. F

. (1946).The hospital as a therapeutic institution. Bulletin of the Menninger Clinic, 10, 66–70. (Reprinted in Therapeutic Communities (1996) 17, 77–80.

25.

Mandikate

(2007). Culture and psychotherapy. Prison Service Journal, 173, 15–20.

26.

McGuire

(1995). What works: Reducing reoffending. Guidelines from research and practice. Chichester, England: John Wiley.

27.

Mental Health Foundation. (2013). Black and minority ethnic communities. Retrieved January 20, 2013, from http://www.mentalhealth.org.uk/help-information/mental-health-a-z/B/BME-communities/

28.

Ministry of Justice. (2012). Offender management statistics quarterly bulletin: January to March 2012, England and Wales. Retrieved December 4, 2012, from http://www.justice.gov.uk.uk/statistics/prisons-and-probation/oms-quarterly/oms-quarterly-editions

29.

Morgan

(2008). Issues of ‘race’ in psychoanalytic psychotherapy: Whose problem is it anyway? British Journal of Psychotherapy, 24, 34–49.

30.

Newberry

(2008). The needs of black and minority ethnic residents at HMP Grendon in relation to the therapeutic process. Unpublished Prison Service Report.

31.

Newberry

(2010). The experiences of black and minority ethnic (BME) prisoners in a therapeutic community prison. In Shuker

Sullivan

(Eds.), Grendon and the emergence of forensic therapeutic communities. Developments in research and practice (pp. 305–315). Chichester, England: Wiley-Blackwell.

32.

Newton

(2000). Ethnic minorities at Grendon: Trends in admission and length of stay. In Shine

(Ed.), A compilation of Grendon research (pp. 37–44). PES: HMP Leyhill.

33.

Patel

Lord

(2001). Ethnic minority sex offenders’ experiences of treatment. The Journal of Sexual Aggression, 7, 40–50.

34.

Resnicow

Soler

Braithwaite

Ahluwalia

Butler

(2000). Cultural sensitivity in substance use prevention. Journal of Community Psychology, 28, 271–290.

35.

Shuker

(2010). Personality disorder: Using therapeutic communities as an integrative approach to address risk. In Shuker

Sullivan

(Eds.), Grendon and the emergence of forensic therapeutic communities. Developments in research and practice (pp. 115–136). Oxford, England: John Wiley.

36.

Singh

(2007). Institutional racism in psychiatry: Lessons from inquiries. Psychiatric Bulletin, 31, 363–365.

37.

Smith

(1998). Concept analysis: Culture competence. Journal of Cultural Diversity, 5, 4–10.

38.

Snell

H. K.

(1963). The new prison at Grendon Underwood. Medico-Legal Journal, 31, 175–188.

39.

Sullivan

(2007). Straight from the horse’s mouth. Prison Service Journal, 173, 9–14.

40.

Wakama

(2005). The impact of race and culture on the sex offender treatment programme: From the perspective of ethnic minority prisoners and white facilitators (Unpublished masters dissertation). University of Leicester, England.

41.

Warnock-Parkes

Young

Gudjonsson

(2010). Cultural sensitivity in forensic services: Findings from an audit of south London forensic inpatient services. The Journal of Forensic Psychiatry and Psychology, 21, 156–166.

42.

Weatherhead

Daiches

(2010). Muslim views on mental health and psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 83, 7–89.

43.

Wilson

(2004). ‘Keeping quiet’ or ‘going nuts’: Strategies used by young, black, men in custody. The Howard Journal, 43, 317–330.

44.

Zhu

(2011). From intercultural awareness to intercultural empathy. English Language Teaching, 4, 116–119.