Working Positively with Personality Disorder in Secure Settings

Phil Willmot is a Consultant Forensic and Clinical Psychologist with the Personality Disorder Directorate at Rampton Hospital, Nottinghamshire, and a Senior Fellow of the Institute of Mental Health. He has over 20 years’ experience of working with personality disorder in forensic settings in prison and healthcare environments. He specialises in the assessment and the treatment of offenders with a diagnosis of personality disorder. Dr Neil Gordon is a Psychotherapist who works as a senior clinician and supervisor in a high secure forensic setting. He is a Fellow of the Higher Education Academy, and a visiting Senior Lecturer at Sheffield Hallam University. He is currently seconded as a Senior Fellow to the Institute of Mental Health, Nottingham University, where he is the Head of Doctoral Programmes and Masters Programme Lead for the National Personality Disorder Knowledge and Understanding Framework (KUF) recently commissioned by the Department of Health and the Ministry of Justice.

About the Editors and Contributors x

Series Preface xiv
Eddie Kane

Preface xvii

Foreword xix
Kath Lovell

Acknowledgements xx

Introduction 1
Phil Willmot and Neil Gordon

Section 1: Context 11

Chapter 1 From ‘Anxious and Sad’ to ‘Risky and Bad’: Changing Patterns of Referrals to the Personality Disorder Service 13
Jenny Marshall and Phil Willmot

Chapter 2 Trapped in the ‘Special Hospital’: The Problems Encountered in the Pathway to Medium Secure Units 22
Amanda Tetley and Gopi Krishnan

Section 2: The Treatment Process 33

Chapter 3 What Works with Forensic Patients with Personality Disorder? Integrating the Literature on Personality Disorder, Correctional Programmes and Psychopathy 35
Phil Willmot and Amanda Tetley

Chapter 4 Assessing Personality Disorder in Forensic Settings 49
Phil Willmot

Chapter 5 A Treatment Pathway for High Security Offenders with a Personality Disorder 66
Sue Evershed

Section 3: The Therapeutic Relationship 91

Chapter 6 Attachment Theory and the Therapeutic Relationship in the Treatment of Personality Disorder 93
Louise Sainsbury

Chapter 7 Therapeutic Style and Adapting Approaches to Therapy 115
Kerry Beckley

Chapter 8 The Grey Areas of Boundary Issues When Working with Forensic Patients Who Have a Personality Disorder 127
Sue Evershed

Chapter 9 One Patient’s Therapeutic Journey 147
‘James’ and Louise Sainsbury

Section 4: Supporting and Developing the Therapeutic Workforce 157

Chapter 10 Therapists’ Experiences of Therapy 159
Neil Gordon, Kerry Beckley and Graham Lowings

Chapter 11 Making Sense of Interpersonal Dynamics: A Schema Focused Approach 172
Kerry Beckley

Chapter 12 The Importance of Systemic Workforce Development in High Secure Settings 188
Andrea Milligan and Neil Gordon

Chapter 13 Establishing a Supervision Culture for Clinicians Working with Personality Disordered Offenders in a High Secure Hospital 200
Andrea Daykin and Neil Gordon

Section 5: Outcomes 211

Chapter 14 An Individual Approach to Assessing Change 213
Jason Davies

Chapter 15 Patient Experiences of Therapeutic and Anti-therapeutic Processes 232
Phil Willmot

Chapter 16 Looking to the Future 243
Neil Gordon and Phil Willmot

Index 247