Working Positively with Personality Disorder in Secure Settings (eBook)

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

'This book provides a timely reminder of the progress that
has been made in working positively and therapeutically with
personality disordered people in secure mental health settings. The
editors and contributors have done an excellent job in
communicating issues that arise at the clinical coal-face. Highly
recommended.'

--Professor Kevin Howells, Professor of Forensic
Clinical Psychology, Institute of Mental Health and Nottingham
University, UK

'This book is essential reading for practitioners and
service managers, researchers and even service users in facilities
for people with personality disorder - in forensic mental
health, prison and probation. Using the Personality Disorder
Service at Rampton Hospital as its focus, this book examines every
aspect of the organised therapeutic response to personality
disordered offenders - from changing patterns in referrals
and care pathways to evidence-based assessments and treatments;
from therapeutic engagement and style to boundaries; from workforce
planning and development to the service user experience. This is a
treasure chest of essential guidance from those in a position to
lead the way.'

--Dr Caroline Logan, Greater Manchester West Mental
Health NHS Foundation Trust and University of Manchester, UK