Individual Psychological Therapies in Forensic Settings

Research and Practice

Jason Davies, Claire Nagi, Jason Davies, Claire Nagi

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138955714
• eBook ISBN: 9781317354192
• Topic: Psychology
• Subtopic: Forensic Psychology
• Index: Psychology

From the 'nothing works' maxim of the 1970s to evidence-based interventions to challenge recidivism and promote pro-social behavior, psychological therapy has played an important role in rehabilitation and risk reduction within forensic settings in recent years. And yet the typical group therapy model isn't always the appropriate path to take.

In this important new book, the aims and effectiveness of individual therapies within forensic settings, both old and new, are assessed and discussed. Including contributions from authors based in the UK, North America, Europe, Australia and New Zealand, a broad range of therapies are covered, including Cognitive Behavioural Therapy, Mentalisation Based Therapy, Schema Therapy, Acceptance and Commitment Therapy and Compassion Focussed Therapy.

Each chapter provides:

• an assessment of the evidence base for effectiveness;
• the adaptations required in a forensic setting;
• whether the therapy is aimed at recidivism or psychological change;
• the client or patient characteristics it is aimed at;
• a case study of the therapy in action.

The final section of the book looks at ethical issues, the relationship between individual and group-based treatment, therapist supervision and deciding which therapies and therapists to select.

This book is essential reading for probation staff, psychologists, criminal justice and liaison workers and specialist treatment staff. It will also be a valuable resource for any student of forensic or clinical psychology.

1

Introduction

Claire Nagi and Jason Davies

Individual psychological therapies have a long history, although their application within forensic contexts has been eclipsed by group intervention. Over the last three decades there have been numerous meta-analyses published on the efficacy of various Offender Behaviour Programmes which stand as testament to the value and impact that a groupwork format can bring when delivered according to the ‘what works’ principles. However, individually delivered treatments continue to be provided in some services and settings as the modality of choice, or where groupwork is unfeasible or contra-indicated, to complement or support group treatment or as an ‘intervention of last resort’. This chapter will provide the context and rationale for focusing on individually delivered interventions within forensic settings. This chapter concludes with a brief précis of the sections of the book and the chapters contained within them.

Individual therapy in forensic settings

Psychological therapy has played an important role in rehabilitation and risk reduction within forensic settings. Over the last 40 years, the challenge of ‘nothing works’ widely attributed to Martinson (1974) has been replaced by evidence that some interventions (e.g. psychological, social and occupational) can promote prosocial thinking and behaviour, reduce risk and foster desistance from crime. An important cornerstone has been the recognition and promotion of the Risk Needs Responsivity principles first articulated by Bonta and Andrews (2017) and built upon by many practitioners and academics. Psychologically based interventions have shown themselves to be important in addressing risk factors, with a range of evidence supporting the delivery of such treatment (e.g. see McGuire, 2013, for a review). In large part, psychoeducational group treatment (Day, Kozar, & Davey, 2013) has dominated this arena. The reasons for group treatment being employed might include resource management, perceived cost effectiveness and the addition of a group process element to treatment (see Davies, in press). However, forensic services research that not everyone benefits from group-based interventions, has led some to begin to describe when individual interventions might be selected as the preferred modality (see Polaschek, 2011, 2013; O’Brien, Sullivan, & Daffern, 2016). Thus the task of describing, choosing, delivering and evidencing individual treatment is a timely one moving individually delivered interventions from a somewhat niche position of use only in highly specialist settings to a more mainstream position. Individually delivered treatments are increasingly being employed as the ‘first line’ approach when working with those with complex needs such as those with mental health needs and those with responsivity issues or idiosyncratic offending. This is in addition to their widespread use as a precursor to group-based intervention (e.g. engagement and preparatory work) and as a secondary ‘pragmatic’ option (e.g. when group treatment is not feasible such as when there are insufficient individuals to form a group). In recent years there has also been an expansion of intervention packages that use both individual and group-based therapy. Often each modality is used for specific purposes such as the group setting for imparting knowledge and rehearsing skills and individual components for personalisation, maintaining engagement and addressing responsivity issues. These combined modality approaches are discussed more fully in Chapter 12.

Psychological therapies have developed from a single treatment in the form of psychodynamic therapy to a wide range of treatments that vary in length and their underpinning theory. Theories of change and thus therapy have included various grouping and schools such as Psychoanalytic/dynamic (e.g. Freud, 1949; Jung, 1966); Humanistic (e.g. Maslow, 1943; Rogers, 1951); Behavioural (e.g. Watson, 1924; Pavlov, 1927; Skinner, 1953); Cognitive (e.g. Beck, 1976; Ellis, 1957); and ‘third wave’ therapies (e.g. Linehan, 1993; Segal, Williams, & Teasdale, 2002; Hayes, Strosahl, & Wilson, 1999). Each of these has introduced their own unique view on aspects such as the nature of personality, the causes and resolution of psychological difficulties, psychological strengths, emotions, relationships and motivation. Treatment efficacy and effectiveness for such individual therapies in non-forensic settings has been demonstrated through a large number of studies (e.g. Butler, Chapman, Forman, & Beck, 2006; Kahl, Winter, & Schweiger, 2012; Fonagy, 2015). For our purposes at this point, it is sufficient to note that many therapies have been shown to be better than nothing and that there is evidence of a significant effect for many of the treatments presented. For example, reviews of psychodynamic therapy have shown it to be effective for some difficulties but not others when compared to inactive control conditions (e.g. waiting list or treatment as usual) (Fonagy, 2015; Leichsenring & Leibing, 2007). Similarly, Cognitive Behavioural Therapy (CBT) has shown itself to be effective for some problems (e.g. Hofmann et al., 2012) with the evidence for third-wave therapies being mixed (e.g. Piet & Hougaard, 2011; van der Velden et al., 2015; Öst, 2008; Kahl et al., 2012).

These therapies have also had an impact on approaches to working with those who are in correctional or forensic services, for example through direct behaviour modification or in addressing cognitions believed to be associated with certain behaviour. Although there have been studies investigating the impact of individual psychological therapies in forensic settings, by way of comparison, this does not match the level and type of research conducted on this topic within the mental health field to date. Nonetheless, evidence of treatment efficacy within offender populations has been demonstrated (e.g. McGuire, 2013) warranting further exploration of the role of individual psychological therapies within forensic contexts. The chapters in Part I of this book provide a description which will provide the reader with some insight into the distinct features (and in many cases specialist language) associated with each of the interventions included. They also provide the opportunity to consider aspects common to more than one approach. The authors of each therapy chapter in this book present a summary of key evidence from non-forensic and forensic settings, allowing the reader to determine the type and scale of evidence for the intervention presented.

Definitions

For the purpose of this book, the use of terms such as client, individual, offender and patient have been left to the author(s) of each chapter and are intended as interchangeable (unless otherwise stated). However, we note that those within forensic settings often associate with the term prisoner or patient as this recognises their non-voluntary detention. In reference to the context, a forensic setting is defined as any forensic mental health setting (i.e. inpatient or community) and any correctional setting (i.e. prison or probation/parole). It is also important to note that the primary focus of this text is on psychological therapies for adults. Within this, authors have not specifically commented on issues of difference (e.g. gender, ethnicity or diagnostic group) unless there are significant adaptations made to the intervention for specific groups. The one exception is the chapter on psychodynamic therapy which focuses on working with individuals with Intellectual and Developmental Disability (IDD). As a result, this chapter highlights developmental considerations which readers can consider when examining the other approaches contained within this book. Finally, the ‘individuals’ presented as the case study in each chapter are highly anonymised or are fictitious amalgamations of several individuals that have been constructed to give a clear example of key aspects of the therapy in practice.

Scope and content

Although we have tried to provide a sample of widely used and emerging therapies that can be implemented, it is accepted that this is not an exhaustive, encyclopaedic review of all possible treatments that could be delivered. Although this book contains therapies across a spectrum of approaches, evidently the breadth of individual therapies delivered within forensic settings has meant that therapeutic approaches have been omitted. It is important to emphasise that this book is not an endorsement or recommendation of specific therapies – readers should also not infer anything from treatment approaches being included or absent from this book. Nevertheless, this book will provide the reader with a range of different therapies currently used to enable them to consider methods for selecting individual therapy approaches and/or therapists for particular needs or clients. This idea of treatment selection is discussed further in Chapter 15. This book will allow the reader to examine therapies (old and new) as described by those who practise them, providing details of the approach and the therapy evidence base. Many of the therapies included can be or are also delivered in group formats; however, within this book we focus on their application in a one-to-one format. Our desire is to bring together examples of practice from a range of settings, countries and approaches, in order to showcase ten treatments that can be provided individually and set the scene for reasserting the need to actively consider and examine the place for individual therapy in forensic settings. The chapters in this book are written by contributors, many of whom are active practitioner-researchers, with extensive experience from across the globe including the United Kingdom, Europe, America, Australia and New Zealand.

The book is divided into two parts. In the first, ten therapies are described with most of the chapters using a common framework, in which core information about the therapy, its use in forensic settings and the current state of the evidence base for the therapy is presented. In this section, each chapter will also outline the practicalities faced within practice, including therapy adaptations required for offender populations. In Part I, the chapters have been sequenced in alphabetical order. A brief outline of the chapters in Part I is provided next.

The most widely used basis for group-based interventions within correctional settings is the CBT approach. In Chapter 3, Andrew Day highlights the limited guidance available to therapists in relation to the specifics of CBT when used with forensic clients. He considers adaptations that are needed to implement the approach in the forensic setting and explores approaches to assessing the quality and integrity of treatment. As an extension of cognitive approaches, a third-wave therapy, namely Acceptance and Commitment Therapy (ACT), is described by David Brillhart in Chapter 2. ACT is an action-focused cognitive-behavioural/mindfulness therapy that fosters the development of acceptance of those things that cannot be changed while promoting purposeful living through six core processes. This chapter outlines the evidence base for ACT with offender populations and describes therapy adaptations required for ACT when addressing offender risk.

In Chapter 8, Kelly’s Personal Construct Therapy (PCT; Kelly, 1955) is presented by Adrian Needs and Lawrence Jones. Despite a long history in forensic settings, the use of PCT has waxed and waned over the years. In this chapter, the authors examine the use of PCT in a prison setting along with the ways the approach lends itself to assessing individual change. In addition to its use as an approach in its own right, PCT has influenced (and has incorporated aspects into) many other therapy approaches. This includes Cognitive Analytic Therapy (CAT) which is presented by Karen Shannon and Philip Pollock in Chapter 4. This therapeutic model integrates aspects of PCT, cognitive therapy and psychoanalytic ideas. From its origins as a brief therapy for use in the UK National Health Service, the theory and application has been broadened to include complex cases such as those of personality disorder and offender populations. Through case examples, Chapter 4 describes use of CAT with ‘hard to help’ clients and as an explicit framework to inform staff/team/system care and risk management. In Chapter 6, another integrative therapy – Eye Movement Desensitisation and Reprocessing (EMDR) – is presented by Ronald Ricci and Cheryl Clayton. This approach has been widely used outside the forensic arena as a therapy for trauma and anxiety-based disorders (Shapiro, 1989). They describe the application of EMDR within forensic settings with specific attention to its role as part of a wider package of intervention and management. A final integrative approach, schema therapy, is presented by Marije Keulen-de Vos and David Bernstein in Chapter 10. Schema therapy was first described by Jeffrey Young in the 1990s (e.g. Young, 1990) and was originally developed for working with complex individuals. As a result it has been widely adopted in services for individuals with personality disorder and latterly in forensic settings. It has been subject to a number of research studies in forensic settings, some of which are presented by the authors.

The oldest form of psychotherapy – psychodynamic psychotherapy – is described by Nigel Beail in Chapter 9. This approach has been widely used within specialist forensic services for several decades. The ch...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Contributors
• 1 Introduction
• Part I Individual therapies
• Part II Key issues associated with individual therapies
• Subject Index
• Author Index