Kaleidoscope
Tracy, Derek K Albertson, Dawn N Lloyd, Lisa, C Shergill, Sukhwinder S
Tracy, Derek K
Albertson, Dawn N
Lloyd, Lisa, C
Shergill, Sukhwinder S
Affiliation
Coventry and Warwickshire Partnership NHS Trust
Other Contributors
Publication date
2023-03-23
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Violent offenders with personality disorders are too often considered ‘untreatable’ and indeed seldom offered clinical services. This cohort, most frequently men, is an interesting addition and counterpoint to the complex arguments about institutional misogynistic medicalisation of trauma in, most frequently, women with personality disorders. It's a group associated with serious and often repeated criminal behaviour, high rates of recidivism and an estimated annual incarceration cost of $80 billion in the USA alone. More standardised cognitive–behavioural approaches to minimising aggressive behaviour have shown only modest gains, and concerns have been raised about the utility of interventions where they are mandated. Schema therapy has been shown to have some effectiveness in helping those with so-called ‘cluster C’ personality disorders through changing engrained cognitive and emotional states, particularly in motivating and engaging individuals, lowering risks and building protective factors. Berstein et al Reference Bernstein, Keulen-de Vos, Clercx, de Vogel, Kersten and Lancel1 report on a randomised controlled trial of 3 years of schema psychotherapy for rehabilitating 133 violent offenders with personality disorders in eight high-security forensic hospitals in The Netherlands. The sample included antisocial, narcissistic, paranoid and borderline personality disorders. Schema therapy was superior to treatment as usual in terms of rehabilitation (namely attaining supervised and then unsupervised leave) and in both reducing and having faster improvement of personality disorder symptoms. Three years of therapy is a considerable therapeutic input, but these data show that it is effective in helping those too often considered ‘unhelpable’ and also potentially reduces various vicarious and surrounding harms to victims and society that can be otherwise inflicted.
Citation
Tracy DK, Albertson DN, Lloyd L, Shergill SS. Kaleidoscope. The British Journal of Psychiatry. 2023;222(4):182-183. doi:10.1192/bjp.2023.26
Type
Article