Psychologists’ understanding of the factors influencing successful treatment in a secure forensic environment
| Published date | 13 August 2018 |
| Pages | 167-178 |
| DOI | https://doi.org/10.1108/JFP-06-2017-0023 |
| Date | 13 August 2018 |
| Author | Jessica Gale,Jane Clarbour,Kelly Rayner |
| 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 |
Psychologists’understanding of the
factors influencing successful treatment
in a secure forensic environment
Jessica Gale, Jane Clarbour and Kelly Rayner
Abstract
Purpose –Literature suggests that mentally disordered offenders are considerably more difficult to treat and
slower to respond to psychological treatment. Less is known about the particular factors that can contribute
to this resistance. A more comprehensive understanding of the factors that treating psychologists feel can
promote or inhibit progression through rehabilitative treatment may increase the likelihood of positive clinical
outcomes. This paper aims to discuss these issues.
Design/methodology/approach –Four practising psychologists employed within a male medium- and
low-secure forensic unit in the North East of England took part in a semi-structured interview. Their views,
opinions and experiences regarding patient progression through treatment pathways were recorded,
transcribed and analysed.
Findings –This thematic analysis identified that numerous patient-specific parameters influenced perceived
progression, and environmental and external factors had a significant impact on the patients’expressed
attitude towards treatment.
Practical implications –Alongside issues of motivation and engagement, participants identified external
factors that influence perceived treatment success with their forensic patients.
Originality/value –Additional research is needed to identify the factors that are the most influential in
promoting or inhibiting perceived and actual progress. This will hopefully optimise treatment engagement and
the motivation to change problematic behaviours in mentally disordered offenders.
Keywords Forensic, Offending, Treatment, Secure services, Progress, Psychologist
Paper type Research paper
Introduction
Forensic mental health services are specialist services in England and Wales for people who have
a diagnosed “mental disorder”as defined by the Mental Health Act 1983 (amended in 2007)
which includes intellectual disability (ID), autism, personality disorders (PD) or a mental health
problem. Additionally, patients have been found guilty of, or are at risk of, committing a criminal
offence and may have been arrested, been on remand or served full or partial prison sentences.
They may be unwilling and unmotivated recipients of “treatment”and may have poor insight into
their difficulties, all of which can create barriers to engagement and rehabilitation (Barnao et al.,
2016). Some individuals appear to respond very well to treatment and make rapid gains while
others make little or no progress, or even display signs of regression (McMurran and Ward,
2010). Existing literature on factors promoting good clinical outcomes in therapy has focussed
on the threats to and facilitators of the therapeutic alliance as a necessary vehicle for change
(e.g. Hersoug et al.,2001; Horvath, 2001). These studiessuggest that a more positive therapeutic
alliance is achievedwhen patients shift their values moreclosely to fit with those of the practitioner.
Patient perspectives have also been explored, and studies have highlighted the importance of a
good therapeutic relationship underpinned by stability and safety in both psychotherapy
(e.g. Lambert and Barley, 2001) and psychiatric samples (Johansson and Eklund, 2003).
Received 20 June 2017
Revised 14 November 2017
31 January 2018
Accepted 12 February 2018
Jessica Gale is a Student and
Jane Clarbour is a Senior
Lecturer, both at the
Department of Psychology,
University of York, York, UK.
Kelly Rayner is a Consultant
Clinical Psychologist at the
Tees, Esk and Wear Valleys
NHS Foundation Trust,
Harrogate, UK.
DOI 10.1108/JFP-06-2017-0023 VOL. 20 NO. 3 2018, pp. 167-178, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
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PAG E 16 7
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