How do high-risk young adult prisoners with emerging personality disorders describe the process of change in therapy?
| Pages | 32-41 |
| DOI | https://doi.org/10.1108/JFP-09-2017-0039 |
| Date | 12 February 2018 |
| Published date | 12 February 2018 |
| Author | Jake Shaw,Owen Forster |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
How do high-risk young adult prisoners
with emerging personality disorders
describe the process of change
in therapy?
Jake Shaw and Owen Forster
Abstract
Purpose –The purpose of this paper is to investigate the views of young adult prisoners with emerging
personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on
the process of therapeutic change in a non-residential treatment service in a UK young offender institute.
The treatment model utilises an integrated approach, specifically adapted for the developmental needs of
young adults and combining therapies for PD with offence focussed interventions and regular keywork.
Design/methodology/approach –In total,13 participants, who had completedat least one year of therapy,
were interviewed about their perspectives about what, if any, change had occurred and how any reported
change had taken place. The interviews weretranscribed verbatim and analysedvia thematic analysis.
Findings –All participants described having made positive therapeutic change. Three overarching change
themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff
were described as the key mechanism through which change was achieved. Specific treatment interventions
were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were
also described as drivers to change.
Originality/value –The findings suggest the possibility of positive therapeutic outcomes for this complex
service user group. They also suggest that the domains of change and associated mechanisms may be
similar to those reported for other service user groups and in other settings.
Keywords Young offenders, Therapy, Emerging personality disorder, High risk
Paper type Research paper
Introduction
In contrast to the therapeutic pessimism that previously surrounded the treatment of personality
disorder (PD), there is now increasing evidence that certain individual and group psychotherapies can
be effective in reducing the symptomatic expression of this disorder (Verheul and Herbrink, 2007).
Several specific therapies developed to address personality pathology have been successful in
demonstrating their efficacy (Cristea et al., 2017). Mentalisation-based therapy, dialectical behaviour
therapy and schema therapy, amongst others, have all been found to reduce behavioural symptoms
of PD, such as self-injury and aggression, as well as positively impacting on negative mood,
anxiety and interpersonal difficulties.
Beyond the outcomesassociated with these approaches, there is also a body of researchwhich
has focussed on the mechanisms that underpin therapeutic change (Clarkin and Levy, 2006).
Within non-forensic settings,positive treatment outcomeshave been associated with the common
factors that underpin all psychotherapies, Indeed, specific factors related to the therapist
(Fernandez-A lvarez et al., 2006), the relationship (Critchfield and Benjamin, 2006), the techniques
employed (Linehanet al., 2006), therapist competence andallegiance and the therapeutic alliance
(Messer and Wampold, 2002), have all been highlighted as core components. Specific identified
mechanisms of change include the correction of interpersonal dynamics (Markowitz et al., 2006),
Received 22 September 2017
Revised 28 October 2017
15 November 2017
20 November 2017
Accepted 23 November 2017
The authors would like to thank
Melanie Merola, Sara Rees-Evans,
Bryony Fenton and Jenny Richards
for assisting with data collection
and transcription for
this study.
Jake Shaw is a Consultant
Forensic Psychologist at
London Pathways Partnership,
London, UK.
Owen Forster is a Highly
Specialised Clinical
Psychologist at Pathways
Service, London Pathways
Partnership, Aylesbury, UK.
PAG E 32
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 20 NO. 1 2018, pp. 32-41, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-09-2017-0039
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