Delivering effective cognitive behavioural group treatment for women in secure psychiatric settings
| Published date | 08 February 2013 |
| Pages | 55-67 |
| DOI | https://doi.org/10.1108/14636641311299086 |
| Date | 08 February 2013 |
| Author | Clive G. Long |
| Subject Matter | Health & social care,Public policy & environmental management,Sociology |
Delivering effective cognitive behavioural
group treatment for women in secure
psychiatric settings
Clive G. Long
Abstract
Purpose – The purpose of this paper is to review issues of relevance to practitioners using group
cognitive behavioural therapy (CBT) with women in secure settings.
Design/methodology/approach – The extant literature on CBT as applied to women in secure settings
is reviewed to highlight best practice. Aspects of best practice are illustrated with examples from a
women’s medium secure service.
Findings – Obstacles include the characteristics of the patient group, treatment non compliance and an
environmentthat accepts the primacy of security over treatment. Environmental and need factors amenable to
intervention are highlighted in addition to CBT specific considerations that include the timing and
intensivenessof treatment, content and delivery of therapy, treatment readiness and use of the groupprocess.
The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and
which is associated with treatment outcome. A focus on the social and environmentalfactors that attribute
to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the
built environment. Finally,treatment evaluation imposes a structure that can facilitate progress in treatment.
Originality/value – There is comparatively little work on CBT group treatments for women in secure
settings. Attempts to synthesise best practice initiatives in this area are helpful in guiding treatment
developments.
Keywords Individual behaviour, Women, Group work, Psychiatry, Practitioners,
Cognitive behavioural therapy, Secure settings
Paper type Viewpoint
Introduction
Women in secure settings have multiple and complex needs. The need for gender specific
and gender sensitive treatment has been repeatedly made for this group based on their need
for safety, privacy and dignity and on their specific clinical needs (Department of Health,
2002). Women face an increased prevalence of social risk factors for mental ill health. They
are more likely than men to be victims of physical and sexual abuse as children and domestic
violence as teenagers (Davenport, 2004). Depression, anxiety, eating disorders and
deliberate self harm (but not suicide) are also more common in women, while schizophrenia
has an earlier onset and a more disabling course than in men (Davenport, 2004; Spurrell,
2008). Women typically admitted to secure psychiatric services are more likely to receive a
primary diagnosis of personality disorder (PD) than men (especially borderline PD); to have
fewer previous psychiatric admissions; and to be more likely than men to be charged with or
convicted of arson and to have previous histories of fire setting behaviour (Coid et al., 2000).
These gender differences emphasise the need for different therapeutic regimes for women
who need secure inpatient services.
In forensic settings cognitive behaviour therapy (CBT) has typically been regarded as the
preferred method of treatment (Day and Doyle, 2010). The responsivity principle of the risk –
needs – responsivity model (Andrews and Bonta, 2006) emphasises that treatment
DOI 10.1108/14636641311299086 VOL. 15 NO. 1 2013, pp. 55-67, QEmerald Group Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAGE 55
Clive G. Long is based at St
Andrew’s Healthcare,
Northampton, UK.
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