"The black box of scary memories": a prison-based trauma intervention case report.

Abstract

Purpose: Women in prison face profound challenges, including high rates of trauma and gender inequalities. This paper aims to explore the barriers to delivering effective psychotherapy in these settings and the importance of approaches tailored to women's specific needs.

Design/methodology/approach: A case study is presented of "Clare", a white, British woman in her early 30s, with diagnoses of autism and severe depression, serving a life sentence for murder in a women's prison in England. The intervention combined cognitive behavioural therapy with systemic working delivered within a National Health Service commissioned service. Outcomes were assessed using the Clinical Outcomes in Routine Evaluation and Problem Behaviour Checklist, supported by qualitative reflections on therapeutic resources, strengths and limitations.

Findings: The intervention produced significant improvements suggesting partial support for the therapeutic approach. The case highlights the therapeutic potential of collaborative and tailored interventions, while recognising the challenges related to gender, trauma, autism and the constraints of the prison environment. Additional complexities were noted in the context of COVID-19 and social isolation.

Research limitations/implications: This case study offers in-depth clinical insight but is limited by its single-subject design and lack of post-discharge follow-up data. The absence of longitudinal outcome measures restricts conclusions about the sustainability of change. Further research is needed to explore adapted therapeutic models for individuals with complex trauma and co-occurring neurodivergence in forensic settings. Ethical challenges surrounding consent, particularly posthumously, highlight the importance of developing clearer publication frameworks for clinical learning. Future studies could strengthen the evidence base by combining individual case data with service-level evaluations of trauma-informed approaches in secure environments.

Practical implications: This paper illustrates how trauma-informed psychological therapy, adapted for neurodivergent needs, can be delivered safely and effectively within a high-security women's prison. It highlights the value of flexible, relationship-based work supported by robust supervision and multi-agency collaboration. The case emphasises the importance of formulation-driven approaches, staff training and managing systemic barriers such as restricted access, risk procedures and limited specialist services. Clinicians working in secure settings may draw on this example to inform safe and ethical trauma work, particularly when navigating complex presentations, co-occurring diagnoses and environments that often compound psychological distress.

Social implications: This case highlights the impact of social inequalities, institutional trauma and system-induced distress on women in prison, particularly those with neurodivergent needs. It raises important questions about access to psychological care in secure settings, the potential for re-traumatisation and the risks of exclusion from therapy. The work reinforces the need for equity in mental health provision for marginalised groups, especially those affected by intersecting vulnerabilities. Sharing this anonymised account may help inform service development, promote more compassionate care and advocate for change within carceral systems that often neglect the psychological needs of those most affected by adversity.

Originality/value: This case study contributes to the limited literature on trauma-focused psychotherapy with women in prison. It illustrates how adapted, evidence-informed interventions can promote recovery in an often-overlooked client group, offering insights into the intersectionality of trauma, gender and imprisonment.