Treatment Of Personality Disordered Offenders

Craissati et al. (2002) reviewed effective treatment models for this group. The authors selected from standardised treatment programmes in England and Wales and identified the key treatment models as

• cognitive-behavioural approaches incorporating social skills training, problem-solving and social perspective taking (including programmes that specifically target aggressive/challenging behaviour or sex offenders);

• dialectical behaviour therapy;

• forensic psychoanalytic therapy and

• therapeutic communities.

They conclude that the evidence base is currently strongest for the first of these categories, which covers programmes used in prisons and the community. Friendship et al. (2002) compared 670 male offenders with custodial sentences of at least two years who had voluntarily participated in a cognitive skills programme offered by the prison service with 1 801 matched offenders who had not. They found that individuals who had taken part in the programmes experienced lower reconviction rates than the others, with those considered at medium risk of recidivism demonstrating the largest reduction (14 %). The literature suggests that most studies of cognitive-behaviour therapy-based programmes show reductions in reconviction rates of 10 % to 15 % among participants (see also Vennard, Hedderman & Sugg, 1997).

Craissati and colleagues conclude that dialectical behaviour therapy and psychoanalytic psychotherapy have yet to demonstrate efficacy with offenders, although the former is currently being evaluated in several UK prisons including Rampton High Security Hospital. Results for the therapeutic community approach seem encouraging but this is not widely available. The only remaining therapeutic community for offenders is HMP Grendon Underwood, which accepts males with personality disorders on a voluntary basis from the general prison system. Two large studies show lower reconviction rates for offenders who stayed at Grendon for at least 18 months than for matched inmates who remained within the general prison system (Marshall, 1997; Taylor, 2000).

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