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Freedom in Prison: The Transformative Impact of A Psycho-Spiritual Integrative Therapy (Psit) On The Psychological Well-Being of Incarcerated People
Freedom in Prison: The Transformative Impact of A Psycho-Spiritual Integrative Therapy (Psit) On The Psychological Well-Being of Incarcerated People
21(2), 104-114
igadiah@unud.ac.id
Abstract
The department of counseling services at Kerobokan Prison, Bali, Indonesia reported to the researcher of this
study that some of their inmates experienced psychological complaints which were impacting their physical
health. The researcher conducted this study with the aim of providing a means of relief for the inmates, as well as
to examine the impact of a Psycho-Spiritual Integrative Therapy (PSIT) as an intervention. A qualitative research
method was used with a multiple case study approach with a thematic analysis to determine the influence of the
intervention on the participants’ sense of life aspiration and psychological well-being. Fifteen male prisoners, who
were serving 10 or more years for drug related offenses, completed the PSIT and participated in a post interview.
The researcher found 5 main themes related to the participants’ experiences over the course of the intervention,
which were regret, forgiveness, acceptance, belief, and affirmation. The participant reports indicate the beginning
of a transformative change in perspective which may be beneficial for creating a new life for themselves upon
their release from prison. Further research is necessary to assess long-term changes in the participants’
perspectives, and how they have integrated their awareness for their return to society. The findings of this research
may be included into a residential health services module for the counseling services department at Kerobokan
Prison, as well they may be influential in further public health research.
104
Fridari et al. 105
were found for female partners and children of spiritual integrative therapy in the
incarcerated men, with much concern placed management of craving, withdraw symptoms,
on the welfare of communities with a high and mental health problems in cannabis users.
population of formerly incarcerated Using 40 male participants, between the ages
individuals. Wildeman and Wang posit the of 14 and 37, they found that there was an
need for “interventions, policies, and practices overall decrease in the scores of the marijuana
that could mitigate the harms of incarceration craving scale and cannabis withdraw scale,
and the post-incarceration period” (p. 1464). specifically related to cannabis use,
emotionality, expectancy, compulsivity,
Research conducted by Karnovinanda and purposefulness, withdraw intensity, and the
Suciati (2014) shows that the prevalence of negative impact of withdraw. The
depression among inmates is 75.4%, with intervention included the use of
levels ranging from 24.6% reporting no autosuggestion, psychoeducation, repentance,
symptoms of depression, 28.7% with mild prayer, mindful meditation, and Quran
depression, 38.5% with moderate depression, recitation. Furthermore, participants scored
and 8.2% with major depression. The study less between pre-and post-testing on the
was conducted using 151 participants from an mental health scale, specifically for anxiety,
unreported prison in Indonesia. It was found depression, loss of behavior/emotional
that all of the inmates who participated in the control, general positive affect, emotional
survey admitted to experiencing depression ties, and psychological distress. As well,
(Karnovinanda & Suciati, 2014). A similar participant scores increased for life
case was also found in Kerobokan satisfaction, psychological well-being, and
Penitentiary, which is one of the prisons in mental health index.
Bali. However, inmates were found to not
only suffer from depression but a milieu of Kadri et al. (2020) conducted a meta-analysis
other psychological disorders. A report of studies using a psycho-spiritual-based
approved by the counseling services intervention related to drug addiction
department at Kerobokan Prison, recovery and well-being. Ten out of 15 papers
administered by the Social Division of the related to the effects of such interventions on
Psychological Study Program at Udayana the frequency, symptoms, and intensity of
University, found that as many as 73 clients in drug consumption; while 13 papers focused
2018 complained of physical health issues on psychological factors like depression,
with possible psychological underpinnings. stress, anxiety, attention, emotionality, and
As many as 69 out of a total of 103 cases were aggression. The findings of the meta-analysis
the result of drug abuse, which was found to reveal that the psycho-spiritual-based
relate with the inmate’s symptoms of interventions had a significant impact on the
delusion, hallucination, and depression. These cessation of drug and psychological
psychological symptoms were found to relate symptoms, especially in regard to stress and
to excessive fear, sleep disturbance, feelings anxiety.
of insecurity and guilt, suicidal thoughts,
mood disorders, and paranoia. There were 28 Andvig et al. (2021) studied the perception of
cases of adjustment disorders with symptoms inmates, and their experiences, on being
including stress, anxiety, anger management prepared for release from a Norwegian open
problems, social difficulties, as well as other prison. The researchers employed a
psychosomatic issues. In addition, a total of 6 qualitative method through the use of focus
cases were reported as miscellaneous, groups on 3 different workgroups of men
requiring further psychiatric and medical between 20-60 years old.
treatment. They found three main categories: 1) life
outside, 2) working as a community, and 3)
Wani and Singh (2019) conducted a study on useful learning for the future. The inmates
the effects of an Islamic-based psycho- reported feeling a greater sense of their own
humanity due to the treatment of staff, as well, had reported a difficulty in implementing the
they felt that their training related to local standard practices of the prison in regard to
democracy, hope for the future, self-reliance, inmate health and security. It is for these
and personal agency were helpful in reasons that the researchers had to be
promoting their preparation for release from additionally precautious of how to conduct the
prison. The participants also reported on study while abiding by the new restricted
feeling emotionally vulnerable, inadequately measures put in place due to Covid-19. The
prepared for working life upon release, and sterilization of equipment, furniture, and the
poor planning for release. The implication of available rooms was necessary prior to
Andvig et al.’s research further supports the interacting with participants. Participants,
need for a human centered approach to inmate researchers, and staff also needed to uphold
rehabilitation as a preparatory measure for proper physical distancing from each other, as
reentry into society, as well as the importance well as wear necessary protective equipment.
of providing a means for inmates to develop Despite the challenges of maintaining the
greater agency and interpersonal skills for the novel policies related to Covid-19, the
life outside of prison. researchers were successful in their
implementation of the study.
The objective of this study was to determine
if there was a transformative change in the METHOD
perspective of inmates, and for them to
describe their experiences, in-depth, before This study used a qualitative research method
and after therapy. As well, the purpose of this with a multiple case study approach and
research was to foster a more optimal thematic analysis. The case study method is a
psychological condition for the inmates so qualitative research method commonly used
that their overall physical and psychological in exploratory and descriptive research (Yin,
health could improve. Through developing 2014). The findings of this study cannot be
deeper insight and wisdom, the prisoners may generalized; however, the case study method
be more likely to integrate their awareness offers a way to explore and illustrate the
upon returning into the public. Furthermore, it impact of psychological intervention using a
is anticipated that an educational module may Psycho-Spiritual Integrative Therapy (PSIT)
be implemented in consideration of this technique. This research design employs
research, which may assist in the health multiple case studies which are based on the
services of Indonesian correctional institutes extraction of data using replication (Yin,
and future public health policy. 2014). When two or more cases were studied,
The primary research question for the present Yin (2014) compared them by conducting two
study was: what is the transformational impact or more experiments, thereby essentially
of a Psycho-Spiritual Integrative Therapy replicating the original cases. Replication of
(PSIT) on the psychological well-being of cases like this supports the validity of the
inmates in Kerobokan Prison? The clinical method itself, provided that the steps
implications of this research beseech for the in the therapy are consistent with positive
improvement of psychological services in transformative impacts.
Indonesian correctional institutions and
address the concern for how the psychological Demographics
conditions of Indonesian inmates can be
The research was conducted in Kerobokan
remedied. Despite the best efforts of the health
Prison, Badung District in Bali Province. The
services department in the prison, the
population of this study were male prisoners
psychological health of inmates remains an
who were serving 10 or more years for drug
ongoing concern.
related offenses and who reported to have
Due to the ongoing Covid-19 pandemic, experienced some psychological distress. The
administrators and staff of Kerobokan Prison researcher selected from a list given by the
clinical administration in Kerobokan Prison visits, once per week, which included an
30 inmates with the longest sentence of initial visit to screen and interview
incarceration. All participants received an participants; 5 visits to conduct the
informed consent and preliminary interview, psychological interventions, which included
however after completing the intervention, meditation, mindfulness, guided imagery, and
only 15 participant responses were recorded in breath work; as well as a final visit for the
the post-intervention interview because not all post-intervention group discussion and
of the initial sample completed the interviews. Ryff’s (1989) Psychological Well-
intervention process. The participants’ ages being (RYFF PWB) adapted questionnaire,
ranged from 30-35 years old. Participants which was translated into Indonesian by the
originally derived from different parts of researcher, was used during the screening
Indonesia, such as Java, Sumba, Sulawesi, and process in order to inquire upon the
Bali. participants’ psychological condition. As
well, the researcher, who has been trained in
Procedure
the PSIT, administered the intervention for the
The research team conducted a total of seven participants.
Preparation:
Post Intervention:
Participant Selection Intervention:
Pre-Intervention: PSIT/Observations
Group Discussion/
Interview
Preliminary Interview
On the first visit of the intervention, On the third visit, the participants received a
participants received a training in body- guided imagery exercise. Bigham et al. (2014)
scanning guided meditation. Yadav (2017) explains that “guided imagery or visualization
explains that body-scanning guided therapy is a cognitive-behavioral meditation
meditation is effective for developing technique in which a person is guided to
concentration and flexibility of attention imagine a relaxing scene or series of
through moving the mind over different experiences” (p. 29). The participants were
regions of the body to develop an awareness asked to close their eyes and imagine what
of moment-to-moment experiences. The was helping or hindering their goals in life.
participants were asked to observe the Afterward, they were asked to draw what
sensation in their body while receiving a images came into their minds. The objective
guided meditation by the primary of the exercise was for the participants to
investigator. The objective of the meditation become aware of their subconscious
was for the participants to observe their resistance or beliefs.
thoughts, feelings, and somatic responses.
On the fourth visit, the participants received a
On the second visit, the participants received breath work exercise. Aideyan et al. (2020)
a mindfulness training exercise. Lindsay and state that breath work is a way of breathing
Creswell (2016) state that mindfulness is a that allows for greater integration of conscious
way of paying attention to the present moment and unconscious processes. The participants
with receptivity and acceptance. The were asked to witness their breath as the
participants were asked to monitor their daily primary investigator guided them to breathe in
activities, like eating, walking, bathing, or for 4 seconds, hold their breath for 7 seconds,
sitting. The objective of the exercise was for
and exhale for 8 seconds. The objective of the
the participants to maintain a present exercise was for the participants to maintain
awareness of themselves over the course of an awareness of their breath.
the day.
On the fifth visit, the participants received an studying, I could not concentrate. Now, I
additional guided imagery exercise in which have ended up here, and am not successful
they were asked to acknowledge their like my friends, so yea, I am a failure.”
personal helper or hinderer and imagine that
they were a flower that was either growing JN: “I used drugs to boost my confidence,
with the aid of their personal helper or shrink and for showing off. I regret it so much
with the resistance of their personal hinderer. now and have to spend my life here in
The objective of the exercise was for the jail.”
participants to become aware of their
subconscious perceptions of limitation and LN: “I always used drugs when I was
possibility. working. It gave me stamina, but I also felt
guilty because I knew it is illegal and I
Data analysis kept feeling afraid that the police were
Data collection involved using interviews, looking for me.”
observations, and group discussions. The
AR: “My family are not here with me,
researcher also used field notes throughout the
they left me. I feel so sad and hate myself
process of data collection. The data was
for causing these separations.”
organized and analyzed using theoretical
coding (Corbin & Strauss, 2012). The overall TY: “I have difficulty sleeping at night.
process was inductive, meaning that it All I think of is how I disappointed my
proceeded from specificities to generalities. family, especially my father.”
Firstly, the researcher began by conducting an
initial coding, then an axial and selective Forgiveness
coding, followed by thematic content analysis
from recorded observations and field notes. GS: “I know who set me up, so I got
The overall goal was to create a detailed and caught. In the beginning I was angry, but
comprehensive picture of each participant’s then I felt that this is the best scenario for
transformative experience after participating me.”
in the psychological intervention of the
Psycho-Spiritual Integrative Technique SN: “I don’t know who I am blaming for
(PSIT). A cross-case analysis was used to my condition, I know this is my fault. It’s
observe similarities and differences amongst very difficult to forgive myself, but I am
participants as the research used a multiple learning, and I feel better now.”
case study approach.
TY: “My family abandoned me. My father
RESULTS AND DISCUSSION does not want to talk to me anymore. I
The purpose of this study was to describe, have a very hard time forgiving him
analyze, and interpret the transformative because I need his support. I know now
impact of a Psycho-Spiritual Integrative that I cannot make him accept me, and I
Therapy (PSIT) given to male prisoners in need to forgive him.”
Kerobokan Prison, Bali, Indonesia. The
JN: “Every day I think of my stupidity, but
results obtained from this research are
I cannot live with this feeling all of the
explained below, which include five themes
time. I have to forgive myself and move
taken from the participants’ experiences,
on.”
along with brief examples from their
interview responses: Acceptance
Regret
GS: “I believe in karma, so my situation
RT: “I started using drugs when I was in right now is because of my karma. I
high school. While my friends were busy cannot escape from my karma.”
AR: “I am now enjoying the activities that week, I could see my hopes and dreams,
they have here in prison, that’s why I also and I felt good just thinking about them.”
want to participate in this event. I want to
make the best of my time here.” AR: “My friends pushed me to participate
in this event. I didn’t really want to do it,
AG: “What else can I do? I cannot fight but now I can feel the benefit for me. I am
the guards, the system, I just need to face learning how to manage my mind and
my punishment.” keep strong and keep moving forward.”
GS: “At first, I could not follow the SI: “I see myself burning and from it
instructions, but on the second week, I felt comes a new version of me. I am going to
like I could feel the sensation in my body start my life far from where I am from, and
and focus more, and I could see many start a new life with new friends and just
different colors when we were doing the forget about the past. I already burned it
flower exercise. It makes me happy and away.”
encouraged again.”
The themes indicated convey a transformative
AG: “When I participated here on the first change in perspective from regret to
day, I just wanted this event to be over affirmation. Mezirow (2008) states that there
soon. I felt so bored and confused because are 10 phases of perspective transformation:
I didn’t really know what I supposed to do. 1) a disorienting dilemma; 2) self-
But on the second time, the exercise was examination with feelings of fear, anger, guilt
interesting for me, and I could feel more or shame; 3) a critical assessment of
relaxed, and I enjoyed it more. The third assumptions; 4) recognition that one’s
and feelings of love for others. Surrey and from the participants, they reported having
Kramer (2013) explain that mindfulness is a received many benefits through participating
practice that promotes awareness towards in this program, and they felt grateful in the
how information is processed and influences midst of the pandemic. Despite not being
one’s character. Mindfulness is a capacity to allowed to receive family visitations, our
be one hundred percent with oneself. This presence as a support system for them to
fully conscious energy allows the individual express their mental and emotional states was
to recognize any presence (Hanh, 2012), and very meaningful. They experienced the
is the capacity for recognizing, embracing, beginning of a transformative change in
and caring for negativity. Many studies have perspective characterized by feelings of
shown that mindfulness or mindfulness-based regret, forgiveness, acceptance, belief, and
therapies help develop effective emotional affirmation. It is through the intervention that
regulation (Corcoran et al., 2010). Most they felt inspired and could see their
people feel problematic emotions because of conditions from a broader and more
strong and painful memories or traumas which diversified perspective, which enabled them
they do not know how to process (Hanh, to begin to manage their psychological
2012). Transpersonal psychotherapy teaches processes in order to better serve out their
inmates to return to themselves and bring prison sentences. Further consideration
forth conscious energy that protects the should be given to the long-term impact of the
individual. Emotions may still be present, but PSIT on the participants of this study, and
they do not take over the individual’s behavior how they have continued to incorporate their
(Hanh, 2012). In addition, being mindful can experiences.
reduce spontaneous reactions and increase
emotional flexibility (Cahn & Polich, 2006). ACKNOWLEDGEMENT
These benefits can provide inmates with
greater peace of mind regarding their The researcher would like to give thanks to the
incarceration, and a healthier outlook on life Research and Community Service
upon their release from prison. Considering Department (LPPM) at Udayana University
that governmental modifications to inmate for funding this service program; to dr. Anak
health services may take time, the Agung Hartawan, The Head of the Clinical
responsibility for coping and resiliency must Department in Kerobokan Prison; all of the
be upon the inmates. However, it is hoped that health care team in Kerobokan who helped a
after learning the PSIT technique, the lot with the participants recruitment process;
participants may find greater peace, share this all of the research participants who were
with others, and have a more successful willing to participate in this research; and all
adaptation back into society upon completing other parties who were involved in order to
their prison sentences. make this activity successful.
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