Summary of Lexie’s Presentation

client: Lexie (26 years old)

Current Status: Serving three-year sentence for supplying class A drugs

Referral Source: Probation Officer Primary

Concerns: Depression, substance use, adjustment difficulties

Lexie experiences significant symptoms of depression and social withdrawal while serving a three-year sentence for supplying class A drugs. Lexie’s troubled background s marked by traumatic childhood experiences, abused by her alcoholic father, neglected by her mother, and instability while she was in the care system. Her current difficulties manifest primarily through depressive symptoms including low mood, lack of energy, and diminished interest in previously enjoyable activities. She experiences persistent feelings of guilt, particularly regarding her separation from her son Jordan, who has been placed in foster care. This situation appears to be exacerbating her feelings of worthlessness and hopelessness about the future. In the prison environment, Lexie is struggling to form meaningful connections with others and has begun using substances (‘spice’) as a temporary coping mechanism. Her difficulty in maintaining positive relationships within the prison setting, exemplified by conflicts with co-workers in the kitchen, calling her lazy, appears to reinforce her longstanding trust issues and tendency toward social isolation. Notably, Lexie demonstrates insight into her situation and expresses a strong motivation for change. She specifically articulates a desire to develop greater acceptance of her current circumstances and to prepare for her future outside prison, with a particular focus on rebuilding her relationship with her son. This motivation and awareness provide a strong foundation for therapeutic intervention, particularly through a mindfulness-based approach that can address both her emotional regulation difficulties and her expressed desire for greater acceptance (Barker, and Cooper, 2016)

Mindfulness-Based Approach

Mindfulness is defined as the practice of maintaining a moment-by-moment awareness of thoughts, feelings, body sensations, and the surrounding environment with an attitude of curiosity and non-judgment (Barker and Cooper, 2016, p.238). This approach, derived from Buddhist contemplative traditions but secularized for therapeutic contexts, has been integrated into various evidence-based interventions such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). Research demonstrates that mindfulness-based interventions are effective in treating depression, anxiety, and stress through enhancing emotional regulation and reducing ruminative thinking patterns (Germer, Siegel and Fulton, 2005, p. 239). This approach is particularly relevant for Lexie, whose presenting problems indicate a need for developing a more nuanced understanding of her internal experiences and emotional triggers. The core therapeutic mechanisms of mindfulness include:

1. Present-moment awareness, training attention to focus (Barker and Cooper, 2016, p.238).
2. Non-judgmental acceptance, developing the capacity to observe thoughts and emotions without automatically reacting to or trying to change them
3. Learning to view thoughts and feelings as temporary mental events rather than absolute truths
4. Self-compassion, cultivating a kind and understanding attitude toward oneself, particularly in moments of difficulty (The Open University, 2025, week 20).

Research has demonstrated the effectiveness of mindfulness-based interventions for various mental health conditions, particularly depression, anxiety, and substance use disorders. In forensic settings, mindfulness-based interventions have shown promise in reducing aggressive behaviour, improving impulse control, and enhancing emotional awareness (Barker, 2013b).

Analysis of Causal Factors from a Mindfulness Perspective

Lexie’s early trauma has established automatic patterns of distrust and self-reliance (“you must look after yourself because nobody else will”). Her use of ‘spice’ represents a habitual pattern of avoiding difficult emotions rather than engaging with them mindfully. These patterns manifest in her current difficulty forming relationships in prison. Lexie’s early experiences of instability and abandonment have led to strong attachment to security and control. Her current aversion to her prison situation and resistance to accepting her circumstances intensifies her suffering. The attachment to her idealized role as a mother, coupled with the reality of separation from her son, creates significant emotional pain. Lexie’s current difficulties are exacerbated by being caught between regret about past actions and decisions, difficulty engaging with present-moment experiences and relationships, anxiety and hopelessness about the future. This disconnection from the present moment contributes to her depressive symptoms and social isolation (Barker and Cooper, 2016, p.242).

Analysis of Maintaining Factors from a Mindfulness Perspective

Lexie shows clear patterns of trying to escape or avoid difficult emotional experiences. While she recognizes that use of ‘spice’ provides momentary escape and ultimately makes her feel worse, she continues to engage in this avoidance behaviour. This pattern of avoiding difficult emotions likely prevents her from developing more adaptive coping strategies (Barker and Cooper, 2016 as stated in Himelstein, 2011, p. 244).

The case notes indicate that Lexie is “constantly ruminating and feeling guilty about having abandoned her son.” From a mindfulness perspective, this suggests she is heavily fused with these thoughts – treating them as absolute truths rather than mental events that come and go. This fusion with negative self-judgments about being “a failure” and feeling “hopeless about the future” likely intensifies her emotional distress and maintains her low mood.

Lexie is “avoiding socialising and talking to others” in prison. This withdrawal behaviour may stem from her early life experiences that taught her “not to trust other people,” but it now serves to maintain her current difficulties. The case study notes that Lexie wants to “feel more accepting of what has happened in her life and where she finds herself now.” This suggests she is struggling with accepting her current reality, which from a mindfulness perspective, can increase suffering (Barker and Cooper, 2016 as stated in Katz & Toner, 2013, p. 245). These maintaining factors create a cycle where, Distressing thoughts and feelings arise. The underlying difficulties remain unaddressed. Her isolation increases and opportunities for positive change decrease. This reinforces her negative beliefs about herself and her situation.

Identified Change Facilitation Factors

A key foundation for change is that Lexie has expressed genuine motivation. She specifically wants to “find a way of overcoming her difficulties” and become “a good mother for her son, Jordan.” This intrinsic motivation could be leveraged to help her engage with mindfulness practices, even when they feel challenging. While prison is undoubtedly difficult, the structured environment could support mindfulness practice. The relatively predictable schedule and limited external distractions could provide a container for developing regular mindfulness habits (Scott-Whitney, 2002, p.245). Despite her challenges, Lexie has experienced periods of stability and positive relationships in her life – particularly during her first foster placement and when she first became a mother. These experiences demonstrate her capacity for positive engagement and could serve as touchstones for developing self-compassion and hope.

Given Lexie’s history of disrupted attachments, the therapeutic relationship itself could be a powerful vehicle for change. A consistent, accepting therapeutic presence could help her. Experience being held in awareness without judgment. Learn to trust another person gradually. Have a model for relating to difficult experiences with compassion Lexie’s desire to prepare for life outside prison and reconnect with her son provides concrete motivation for developing mindfulness skills. Framing mindfulness practices in terms of these goals (like managing triggers, making conscious choices, being present with her son) could help her engage with the work.

While Lexie currently avoids others, mindfulness-based group work could provide a supported way to break this isolation. Starting with brief, accessible mindfulness practices focused on simple present-moment awareness could build Lexie’s confidence and provide immediate experiences of having choices in how she relates to her experience. These factors suggest that while Lexie faces significant challenges, there are multiple pathways that could support positive change through mindfulness-based approaches. The key would be working with these elements in a way that feels manageable and meaningful to her specific situation and goals (Shonin et al., 2015)

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Proposed Therapeutic Interventions and Treatment Plan

Initial Phase – Building Foundation and Safety. Psychoeducation about mindfulness, framed in accessible terms focused on her goals (being present with her son, making conscious choices, managing difficult emotions). Simple grounding exercises using physical sensations (feeling feet on floor, hands on lap) to develop basic present-moment awareness skills. Brief mindful breathing practices, starting with very short durations (1-2 minutes) to build confidence and prevent overwhelm

Developing Core Skills

Mindful movement practices (gentle stretching, walking meditation) which can:

• Provide an accessible entry point to mindfulness through the body
• Help with physical tension and low energy
• Be practiced safely within prison constraints

Specific practices for working with difficult emotions:

• RAIN practice (Recognize, Allow, Investigate, Nurture) for working with guilt about her son
• 3-minute breathing space for managing drug cravings
• Self-compassion practices to counter harsh self-judgment

Mindful communication exercises:

• Starting with one-to-one practices in therapy
• Gradually building to mindful listening/speaking in daily interactions
• Supporting her to rebuild social connections safely

Later Phase – Integration and Future Planning:

• Values clarification work through mindful reflection
• Mindful decision-making practices
• Development of personal practice routine
• Planning for maintaining practice after release

Evidence Base: Research has shown promising results for mindfulness interventions in prison settings:

• Reduced substance uses and cravings
• Improved emotional regulation
• Decreased aggression and impulsivity
• Better stress management
• Improved relationships with other inmates and staff

(McKay, Wood & Brantley, 2007, p.246)

Potential Barriers and Solutions

Trust Issues:

Isolation, Solution: Start with very concrete, body-based practices, Build trust gradually through consistent therapeutic presence

Emotional Intensity: Barrier: Risk of being overwhelmed by difficult emotions. Solution: Start with external anchors (sounds, physical sensations), Develop “emergency brake” skills first, Titrate exposure to emotional material carefully

Motivation Fluctuations, Barrier: Periods of hopelessness affecting engagement. Solution: Link practices explicitly to her goals regarding her son, celebrate small successes, Build flexibility into practice expectations, Implementation Considerations:

Integration with Daily Life. Identify specific trigger points in prison routine where skills could be applied, Develop concrete coping plans for high-risk situations, Practice applying mindfulness to real-life challenges

Success would be measured not just by symptom reduction but by Lexie’s increased capacity to stay present with difficult experiences without needing to escape, make conscious choices aligned with her values. Relate to herself with more compassion, build meaningful connections with others, prepare for positive reintegration after release (The Open University, 2025, week 20). Regular review and adjustment of the plan would ensure it remains responsive to Lexie’s needs and progress throughout her sentence.

Problems With Mindfulness Approach

Mindfulness also has some downfalls, some individuals specially in prisons may experience negative results and the reasons may be:

• Meditation may increase and not decrease distress, often if done as a one-size-fits-all approach (Farias & Wikholm, 2015).
• The commercialization and privatization of traditional wisdom and practices, raises moral concerns (Barker, 2013b).
• When people find meditation or mindfulness challenging, they may turn this into another source of self-blame and harsh self-judgment (Chödrön, 2001; Magid, 2008).
• Modern capitalist society and its institutions push people to constantly monitor and control themselves, pursuing desires and avoiding discomforts in their individual quest for achievement and contentment (Barker, 2015)
• Mindfulness interventions, particularly in institutional settings, are sometimes promoted as a cost-effective solution to mental health issues (Purser and Loy, 2013).

Conclusion

Lexie presents as a 26-year-old woman whose current difficulties must be understood within the context of her challenging early life experiences, which taught her not to trust others and to rely solely on herself. Her childhood was marked by exposure to abuse, multiple disrupted attachments, and eventual placement in care, leading to patterns of avoidance and difficulty in managing emotional distress. The current prison environment has intensified these challenges, manifesting in symptoms of depression, social withdrawal, and problematic substance use. However, several factors suggest Lexie could benefit significantly from mindfulness-based therapeutic intervention. Her expressed motivation to change, desire to be a better mother to Jordan, and recognition that current coping strategies (using ‘spice’) are ultimately unhelpful provide important foundations for engagement in therapy. A mindfulness-based approach could help Lexie develop new ways of relating to difficult thoughts and feelings, while building skills for present-moment awareness and emotional regulation. Key recommendations include starting with basic grounding and present-moment awareness practices, gradually building to more complex emotional regulation skills, and eventually incorporating mindful communication practices to support social reengagement. Regular review of progress and flexibility in adapting interventions will be essential to ensure the therapeutic work remains aligned with her needs and circumstances