The importance of integrated therapies for personality disorder in forensic populations: attending to content and structure of delivery
| Pages | 99-110 |
| Published date | 08 June 2015 |
| DOI | https://doi.org/10.1108/JCRPP-11-2014-0006 |
| Date | 08 June 2015 |
| Author | Jane L. Ireland,Elisabeth Hansen |
| Subject Matter | Health & social care,Criminology & forensic psychology |
The importance of integrated therapies
for personality disorder in forensic
populations: attending to content and
structure of delivery
Jane L. Ireland and Elisabeth Hansen
Jane L. Ireland is Professor of
Forensic Psychology at the
University of Central
Lancashire, Preston, UK and
Ashworth High Secure
Hospital, Mersey Care NHS
Trust, Maghull, UK.
Dr Elisabeth Hansen is Clinical
Psychologist at the Department
of Psychology, Mersey Care
NHS Trust, Ashworth High
Secure Hospital, Maghull, UK.
Abstract
Purpose –The purpose of this paper is to provide some practice considerations for working with personality
disorder, focusing on the application of assessment, formulation and therapy to complex populations such as
forensic clients. In addressing this it outlines the concept of a Multi-Modal Integrated Therapy (MMIT) and
how this is applied to personality disorder intervention.
Design/methodology/approach –The coreelements to considerin the provision of an integrated approach
areoutlined, informedby a review of therelevant literature.The paper doesnot aim to provideevaluation databut
is intended to be a clinical practicedocument.
Findings –The valueof integrating the effective componentsof therapy to addressall aspects of workingwith
forensic populations isevidenced. It is argued that appropriate approacheswill capture cognitivecomponents
(includingEarly MaladaptiveSchemas and also adaptiveschemas), CognitiveAnalytic Therapeuticapproaches
and Dialectical Behaviour Therapycomponents toproduce an effectiveframework to capturethe complexitiesof
personality disorder in forensic populations.
Practical implications –The paper outlines how a move away from focusing on a single approach to
understanding and intervening with personality disorder is key with complex populations, such as those
found within forensic settings. The authors argue that practitioners should focus routinely on the importance
of integration of principles relevant to personality disorder work.
Originality/value –The paper argues for: Adopting a truly multi-modal integrated approach to interventions
with personality disorder, highlighting the importance of MMIT. The importance of accounting for complexity
in personality presentation in forensic populations and capturing positive as well as negative functioning.
The value in identifying what is effective within existing therapies and applying these components as part of a
wider package. The core elements of an effective approach are indicated.
Keywords Treatment, Personality disorder, Offenders, Evidence-based practice, Mental health/disorders,
Throughcare
Paper type Viewpoint
Personality disorder is best conceptualised as a regular and consistent pattern of behaviour and
experiences which cause difficulties to the individuals concerned and those around them
(Paris, 2010). It represents an inflexible pattern of difficulty that has a basis in early life experiences
(e.g. APA, 2013). The “disorder”component captures the challenges these patterns produce
since personality disorder represents the extreme end of general personality. There remain
variations, however, in how personality disorder is defined, conceptualised and diagnosed
(Davey, 2014) and it is not the aim of the current paper to explore this issue. Rather, it aims to
capture those areas considered the most productive in working with those presenting with such
Received 19 November 2014
Revised 21 January 2015
Accepted 26 February 2015
DOI 10.1108/JCRPP-11-2014-0006 VOL. 1 NO. 2 2015, pp.99-110, © Emerald Group Publishing Limited, ISSN 2056-3841
j
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
j
PAG E 99
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