Lessons from the front line: working with offenders with learning disability and personality disorder in a high secure therapeutic community
| Published date | 22 March 2013 |
| Date | 22 March 2013 |
| Pages | 44-52 |
| DOI | https://doi.org/10.1108/13619321311306974 |
| Author | Jon Taylor,Sarah Trout |
| Subject Matter | Health & social care |
Lessons from the front line: working with
offenders with learning disability and
personality disorder in a high secure
therapeutic community
Jon Taylor and Sarah Trout
Abstract
Purpose – The aim of this paper is to provide an overview of the experiences of nursing staff providing a
residential treatment programme for high risk offenders with an intellectual disability and personality
disorder.
Design/methodology/approach – The paper’s approach is thematic analysis of focus groups,
repeated measures EssenCES.
Findings – Nursing staff report increased insight into patients’ risk factors, improved relationships with
patients and enhanced team working.
Practical implications – This descriptive paper will be of interest to clinicians working with offenders
with intellectual disability and personality disorder.Improvements in team functioning may beof interest
to managers.
Originality/value – There are few published papers concerning treatment approaches with offenders
with intellectual disability and personality disorder. This paper fills some of the gaps.
Keywords Intellectual disability, Personality disorder, Treatment, Therapeutic communities,
Therapeutic climate, Residential culture, EssenCES, Mental health services, Patient care, Criminals,
Learning disabilities
Paper type Conceptual paper
Introduction
Numerous authors (Shuker, 2010; McManus, 2010) recognise that the engagement of
personality disordered offenders in a long-term treatment programme presents the clinical
team with a range of difficulties. Transference and counter-transference,treatment resistance
and hostility can challenge the therapeutic ethos of the clinical environment. Explicit within
the therapeutic community (TC) model is the recognition and acknowledgement of the
significance of the clinical role offered by the front line residential staff. The interpersonal
difficulties associated with personality disorder are most likely to be witnessed by those
members of the inter-disciplinary team who spend most time with the community members.
Consequently,it is thesemembers of staff who are most likely to experience the transference
processes and to capture episodes of behaviour for exploration and challenge within the
various meetings that are central to the design of a TC.
Whilst this may seem a somewhat arduous task a number of studies have also highlighted
the benefits of personal and professional engagement with the TC process. This paper
describes the experiences of staff members involved in the opening and development of a
TC for offenders with a mild learning disability and personality disorder.In order to inform the
discussion of these experiences, the development of TCs for offenders and the experiences
of staff teams working in such treatment settings are briefly explored.
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VOL. 18 NO. 1 2013, pp. 44-52, QEmerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/13619321311306974
Jon Taylor is based at
Rampton Hospital,
Nottinghamshire
Healthcare, Retford, UK
and St Andrews
Healthcare, Mansfield, UK.
Sarah Trout is based at
HMP Gartree,
Market Harborough, UK.
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