Despite working in the field of corrections for the past seven years and in mental health for ten, there are still aspects of this work that I find jarring. One of the most distressing elements of my work is when working with individuals who have been diagnosed with Autism or some form of neurodevelopmental disorder in which their thinking and relating is impaired. Oftentimes, these clients present as adults but function at a prepubescent to early adolescent level, all while being confined to an environment with other adults whose intellectual functioning remains age-appropriate. This is the equivalent of placing a juvenile with an incarcerated adult.


I wish that I could say that my experience in working with these individuals has been limited, but the sad reality is that this is an area in which I have unfortunately become well-versed. Not understanding social norms, the criteria for healthy relationships, the importance of consent, and boundaries have been the most common characteristics shared by these particular clients. The challenge of working with these neuro-atypical individuals within the prison setting centers around discussing and helping them address issues of sexuality, not only their own, but as they impact relationships with other inmates who are often far more sophisticated, opportunistic, and at times predatory.

I’ll never forget the day I met Ronald (a fictitious name) because my immediate thought was, “How did we get here?” Ronald functioned much lower intellectually than his stated age, and as a result entered the penal system after misunderstanding social and relational cues. Ronald was then admitted for more specialized treatment after he was taken advantage of while housed in the general population setting. This is not uncommon when impaired individuals like Ronald live side-by-side, day-to-day with others whose primary interests are their own needs, oftentimes sexual. Ronald would often parrot the phrases he heard from other residents, even when they were racially charged or otherwise provocative. He didn’t do these things because he was prejudiced, but because doing so was a symptom of his condition and something that he often did when he felt uncertain of how to fit in. He would then begin emulating those around him that he perceived to be “cool.” In a correctional environment, this is particularly dangerous because it often results in the neurodivergent individual’s being either severely assaulted or deliberately used as a pawn to antagonize someone else or a group of individuals.

Another challenge I’ve noticed with these individuals is when they openly discuss or share their money or possessions without making sure that either or both are returned or made good on in some fashion. Ronald struggled immensely in this domain, as he would often buy things for others who would never return the favor and who wanted to take as much from him as possible. Fortunately for Ronald, staff members became aware that this was occurring, and he was moved to a smaller pod with a focus on psychiatric well-being.

In this regard, the best that neurodivergent individuals entering correctional environments can hope for is attentive staff members and genuine peers who look out for them and help protect them from becoming victimized or taken advantage of. Unfortunately, these helpers are not omnipresent, leaving these residents vulnerable for no other reason than their difficulty interpreting social cues and relating to others who would intentionally hurt them.

I remember talking with Ronald about how he came to the psychiatric unit, and wondering aloud about his understanding of the situation. Ronald was not at all aware of the risks that existed in his peer interactions while in the general population, but did understand quite quickly that he felt more comfortable in a smaller, more specialized, protective unit. Treatment of Ronald has included basic social skills, education around the topic of consent, and continuously openly discussing what a healthy versus unhealthy relationship looks like. Ronald was very clear that he had never before had such discussions, which solidified for me the importance of ensuring that people who are neurodivergent are not left out of conversations that have to do with sexuality. Therapists in the carceral system can be life-altering for these individuals when they take the time to go over the “basics.” It is critical that we put our own egos aside and look at the ways we can be most effective with these particular clients, rather than quibble over which therapy or technique is more effective than the other. When I have opened myself to creative treatment interventions that addressed the developmental needs of my clients, I have done some of my best work and influenced these clients in unexpected and at times very wonderful and rewarding ways.

The treatment unit where I work strives to provide a close knit, therapeutic milieu that allows for individuals with major mental illness and neurodivergence to feel safe, cared for, and to receive the highest possible quality of care. And this has happened when I haven’t been afraid to step outside of the box.  


File under: A Day in the Life of a Therapist, Musings and Reflections