Case Studies in Forensic Psychology

Clinical Assessment and Treatment

Ruth Tully, Jennifer Bamford, Ruth Tully, Jennifer Bamford

• Publisher: Routledge
• Year: 2019
• Print ISBN:
  9781138584815
• eBook ISBN:
  9780429013126
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Case Studies in Forensic Psychology offers the reader a unique insight into the often-hidden world of psychological assessment and intervention with people who have committed serious crimes. The book contains a breadth of forensic case studies, and each chapter details the real forensic work that psychologists do in their clinical practice in prison, psychiatric, and community settings. Assessment and therapeutic approaches used in each case study are discussed, as well as the state of the literature in each area (e.g. sexual violence risk assessment, schema therapy).

Each chapter will take the reader through a variety of offender profiles, their personal background, any relevant psychiatric or psychological diagnoses, and assessments and/or treatment completed. Case studies offer valuable insight into the clinical practice and day-to-day role of a forensic psychologist, demonstrating the work undertaken that empirical research does not offer. Uniquely, Case Studies in Forensic Psychology brings together treatment models and forensic research, demonstrating how theory translates into practice and considering whether it is effective at an individual level.

It is ideal for students of forensic psychology and forensic mental health, as well as practitioners at any stage of their career in this rapidly expanding field.

Chapter 1

Introduction

Ruth J. Tully and Jennifer Bamford

Forensic psychology practice

Forensic psychologists practice psychology in the field of crime and law. They typically work with people who have committed a crime (or may be at risk of doing so), victims of crime, and organisations involved in the criminal justice system. It would therefore be easy to assume that the range of work undertaken, or settings worked in, by a forensic psychologist is somewhat limited. However, this is not the case. In the UK, forensic psychologists work within varied settings alongside other applied psychologists, such as clinical and counselling psychologists. Examples of the types of environments forensic psychologists work in include:

•Prisons

•Secure psychiatric hospitals

•Community forensic healthcare settings

•Community probation settings

•Children’s residential care homes

•Court settings

•Research settings

•Private practice

•Academia

Given these varied settings, it is clear that the client groups worked with can vary. Depending on their skills, training, and expertise, forensic psychologists can work with client groups such as:

•Any person posing a risk to other people and/or themselves

•People with mental health difficulties

•People with personality disorders

•People who have a learning disability

•People who pose a risk to those within their family

•People who have committed a crime, including sexual and violent crimes

•Victims and/or witnesses of crime

•Those who find themselves subjects of Court proceedings or initiating Court proceedings

•Prisoners

•Patients detained in secure psychiatric hospitals

•Adults, young people, and children (male or female)

•Professionals working in the criminal justice system

In the UK, there used to be a stereotype of forensic psychologists as all being criminal profilers, as was portrayed in a 1990s popular crime drama Cracker. However, in reality, there are very few psychologists directly employed by the police in the UK. It was also considered in the past that forensic psychologists work primarily in prisons and with offenders, rather than in the wide range of settings that they actually work in. However, much valuable work is undertaken by forensic psychologists with victims. Although in the UK, Her Majesty’s Prison and Probation Services (HMPPS) are the largest employer of forensic psychologists, a growing number are employed in forensic mental health care and other settings. In the UK, forensic psychiatric hospitals are run either by the National Health Service (NHS) or by private healthcare providers, which are funded by the NHS to deliver services. There is a steadily growing number of forensic psychologists working in private healthcare settings, which pose different organisational strengths and challenges when compared to publicly funded NHS settings. In healthcare settings, it is also very common that a forensic psychologist would be working alongside other applied psychologists such as clinical or counselling psychologists, each complementing the other with a different range of skills and expertise.

The training route for forensic psychology in the UK, and internationally, is intensive and takes years of study, research, and supervised clinical practice. In our experience, this rigorous and challenging process produces psychologists who are very passionate about the work they do. Due to the complex, sensitive, and confidential nature of the work completed by forensic psychologists, it is often difficult to get an insight into their day-to-day practice. This case study book therefore not only aims to provide insight into what works in the assessment, treatment, and management of those individuals whom forensic psychologists work with, but it also aims to provide the reader with a rare insight into the type of assessments and interventions undertaken by forensic psychologists.

Any psychologist working in a forensic environment will be aware that there is always more than one ‘client’ in any given case. This is because the patient being worked with, the general public (whose risk protection is crucial), and the organisation responsible for the treatment and assessment of the patient can all be considered as relevant ‘clients’ or stakeholders. This poses ethical and legal challenges because to detain a person who poses a high risk of harm to others deprives them of their liberty yet to not detain them may place other people (or the patient themselves) at an unacceptable risk of serious harm. The forensic psychologist therefore has a difficult balance to maintain, and defensible decision-making is paramount at every stage of working with individuals in this context. The typical expectations of seeing a psychologist or therapist, such as confidentiality, therefore do not apply in forensic contexts, and psychologists have to ensure that the patient is engaging with them on the basis of understanding the limits to confidentiality and the multiple roles of the psychologist.

These are not the only ethical issues and dilemmas faced in this area. Psychologists are often involved in forensic risk assessment, such as when contributing to the parole process and making recommendations for the progression (or otherwise) of a person to open prison or the community, or when involved in mental health review tribunals and giving opinion on the safe discharge of the patient into the community or other lower secure services. This can, at times, lead to the psychologist’s recommendations being unpopular with one party or another; for example, an individual who wants to be released from prison or discharged from hospital will not be happy if the psychologist’s recommendation is for them to remain in a secure setting. This can have a range of implications, such as client disengagement from services and a decline in their well-being. Alternatively, the recommendation may not be popular with the general public or the offender’s victim(s) if the recommendation is to progress, for example, to an open prison where potentially the offender could access victims. This demonstrates the importance of a joined-up approach to working with forensic clients, where other professionals involved also consider this range of issues, and between professionals, appropriate plans can be actioned that keep the right people informed of the right issues, and which ultimately minimise risk. The chapters of this book will serve to highlight the importance of involving a range of professionals alongside the psychologist.

Lessons learned from case studies

Case studies offer valuable insight into the clinical practice and day-to-day role of a forensic psychologist, and the work undertaken, that empirical research does not offer. There are many textbooks available that relate to this specific field, many treatment model handbooks, and much research into forensic issues. However, there is little available that draws this all together, demonstrating how this translates into practice, and considering if this is effective at an individual level. This book will provide a varied overview of assessment and treatment across some of the settings already mentioned in this chapter and will consider the impact of the work completed by the forensic psychologist in each case.

The patients we work with are not defined by their offence or client group (e.g. offender with mental health problems), although how we treat and assess patients does link back to what research has demonstrated as being effective with people with certain difficulties. For example, it has long been debated as to ‘what works?’ with sex offenders, with contemporary treatment being based on years of individual studies and meta-analyses to address this specific question. Therefore, whilst as psychologists we do not wish to define people by ‘client group’ or the setting in which we assessed or treated them, we have to offer the reader some distinction by making reference to these issues so that insight can be gained into what informed the work completed with these individuals.

The primary settings of these case studies are legal (Court), secure psychiatric services, and prisons, with each chapter offering a different theme such as sexual deviance, psychopathy, and mental health. Each case we work with is different. For example, one female forensic patient with a diagnosis of schizophrenia is significantly different from another female forensic patient with the same diagnosis, and whilst we have to look at the literature and evidence base as to ‘what works’ with this particular group of people, we also have to consider what have commonly been referred to as ‘RNR’ principles, meaning risk, needs, and responsivity. These principles assist in prioritising treatment appropriately and provide the most suitable intensity or level of service for a patient based on the level of ‘risk’, as well as helping psychologists consider the type of treatment required, based on treatment and risk-related ‘needs’. The ‘responsivity’ principle allows us to consider the sometimes clear and sometimes subtle issues that apply to a patient and which might impact their ability to engage in assessment and treatment. These issues can link to learning needs, or triggers for distress, and personality style. By being aware of these issues, psychologists can then plan so as to attempt to maximise the impact of treatment for that individual. This RNR model was first put forward in 1990 by Andrews, Bonta and Hoge (1990), although has since been expanded upon and discussed in the context of cognitive social learning theory and personality (e.g. Andrews & Bonta, 2006). Other principles are commonly discussed in the literature alongside the RNR model, such as the therapeutic relationship between client and therapist/supervisor, and organisational issues that can facilitate the provision of services designed to assist change. Ultimately, the RNR principles operate on the premise that risk reduction is possible, and the literature over time about what works and for whom has been mixed, although positively these mixed findings have resulted in more methodologically sound research in this area, and researchers have also developed hypotheses as to why some treatments have been effective for some offenders and others have not been (Andrews et al., 1990).

In the forensic field, as in any area of healthcare, there is a focus on providing evidence-based assessment and interventions, underpinned by rigorous research. It is clear that a ‘one size fits all’ approach to working with offenders or victims is unlikely to be successful, based on the ‘responsivity’ principle when considering offenders, and the case studies within this book all demonstrate the importance of not just the individual’s characteristics but also the context or environment in which they are being assessed and treated. It is one thing to consult the research, for instance, on effective risk-reduction treatment, but another to translate this into effective treatment in practice, with Andrews and Bonta (2006) discussing that ‘real world’ treatment effects are smaller than those found in research conditions. Despite this, the RNR principles have been considered successful, with organisations that apply RNR principles being found to more significantly reduce reoffending when compared to organisations that do not apply these principles (Lowenkamp, Latessa & Smith, 2006). Therefore, the RNR model tends to be considered and applied within contemporary forensic services alongside what can be varied modes of therapy. For instance, Cognitive Analytic Therapy (CAT), which considers reciprocal roles (Ryle, 1997) underpinned by psychoanalytic, cognitive, and personal construct theory, has been found to be useful for offenders (Pollock, 2006; Tully & Barrow, 2017). Additionally, within the field of sex-offender treatment, cognitive behavioural approaches have been considered to be effective in risk reduction (Moster, Wnuk & Jeglic, 2008), although this remains a controversial area with findings in the UK recently being less than promising (Mews, Di Bella & Purver, 2017). These approaches to treatment highlight that the RNR principles can be applied within and alongside other models, and the cases discussed in this book are good examples of the application of such principles in the assessment and treatment of individuals with a history of offending behaviour, or at risk of harming themselves and/or other people.

It is important to note that because of the very nature of the work completed by forensic psychologists, clinical judgement is a big part of the job. Structured tools may guide practice, and research may inform practice, but often clinical interpretation is how we make sense of all of that, balanced against what we know about our client. This means that sometimes clinicians can disagree about cases: how someone is defined, what their risks are, what treatment they may need, and how that treatment is delivered. There are lots of variables to consider and room for sometimes differing clinical viewpoints on each of them. The chapters in this book represent the clinical view and practice of each psychologist author in relation to that patient and the context of the assessment and treatment at that time. Whilst we will outline the theories and research that have underpinned our assessment, we accept that there may be a number of differing viewpoints from clinicians on an individual case. This, after all, is what sparks healthy, helpful debate am...

Table of contents

• Cover
• Series Page
• Half Title
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Tables
• Acknowledgements
• Editors
• Contributors
• 1 Introduction
• 2 Young people: offending behaviour and community services
• 3 Sexual deviancy: assessment for court
• 4 Male personality disorder: treatment approaches within a secure mental health setting
• 5 Neurodevelopmental disorder: learning disability in secure forensic psychiatric services
• 6 Autism spectrum disorder: females in secure forensic psychiatric services
• 7 Female sexual sadism: psychological assessment for prison parole review
• 8 Mental health and violence: forensic risk assessment and formulation
• 9 Conclusion
• Glossary of terms
• Index