This article reports a systematic review of engagement measures for psychosocial therapy. MEDLINE, EMBASE, and PsycINFO databases were searched to identify English-language studies (published 1980 to February 2010) that reported on an instrument/rating scale to measure engagement in psychosocial treatment for mental health difficulties. Forty-seven studies were identified, reporting information on 40 measures of treatment engagement. Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess, they also reveal that there is little consensus in the definition of engagement employed. Few measures are generalizable across treatment settings and clinical populations, and limited information is reported on the indices of reliability and validity. It is concluded that further work is required to develop adequate measures of therapeutic engagement.

Clients with personality disorder (PD) can encounter difficulties engaging in psychosocial therapy. One way to address this is to identify the factors that contribute to their low engagement. The Multifactor Offender Readiness Model (MORM), a model developed to explain poor treatment engagement in offenders, might guide the identification of engagement difficulties in clients with PD. In this study, we sought to validate and extend the MORM for clients with PD by identifying the perceived barriers to and facilitators of their engagement. A two-round Delphi Survey was employed to identify clients' and clinicians' levels of agreement on the factors that impair and promote engagement. Seventy-six clients and 55 clinicians were recruited from English specialist forensic and non-forensic personality disorder services. Our findings reveal that the perceived barriers to engagement for those with PD are in the most part congruent with the impediments outlined in the MORM. However, we do find some additional barriers relevant specifically to people with PD. A Treatment Readiness Model for Personality Disorder (TReMoPeD), which is an augmented version of the MORM, is presented. This model provides guidance for ways of taking action to improve a client's chance of engaging with services. Copyright

Based upon a functional approach to understanding aggression, we aimed to identify the occurrence of and to describe the features of three types of alcohol-related violence defined a priori by ultimate goals: (1) violence in pursuit of nonsocial profit-based goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. A sample of 149 young men with offences of violence that were alcohol related was interviewed. Cases were classified and detailed information from the first ten cases in each class (N=30) was subjected to thematic analysis. Intoxicated violence in pursuit of nonsocial profit-based goals was opportunistic and motivated by the desire for more alcohol or drugs. Violence, in these cases, although serious, appeared to be brief. Intoxicated violence in pursuit of social dominance goals was typically precipitated by past or current insult or injury, and was accompanied by strong anger and an adrenaline rush. Attacks were ferocious, and robbing the victim was not uncommon, perhaps to inflict additional humiliation. Feelings of pride and satisfaction were typical and expressions of remorse were uncommon. Regarding intoxicated violence as defence in response to threat, attacks were often expected, and in some cases the respondent made a pre-emptive strike. Weapon use was common in this group. Fear was experienced, but so too was anger. Feelings of excitement were not reported and remorse was common. Further validation of these types is warranted, and the potential implications of these findings for prevention and treatment are discussed.

No abstract

Purpose. Improving the effectiveness of offender treatment programmes is important and one approach is to attend to their content. The aim here was to identify triggers to alcohol-related violence to inform the development of programmes to treat this problem. Method.Information from 149 young male offenders' accounts of incidents of alcohol-related violence was studied using thematic analysis.Results. Sixteen triggers for violence were identified and these were organized into six themes: (1) being offended by someone, (2) seeing an opportunity for material gain, (3) seeing others in need of help, (4) perception of threat, (5) distress, and (6) wanting a fight.Discussion. The implications of the results for developing treatments for alcoholrelated violence are presented. First, identifying triggers should be part of the treatment programme and ways of avoiding triggers should be addressed. Second, changing values, specifically hypermasculine and antisocial values, could attenuate the rewards signalled by the triggers. Third, methods of reducing the potency of triggers would be of value and would include addressing issues of need for respect and responses to perceived disrespect. Fourth, non-violent ways of helping people who are in trouble need to be introduced. Fifth, coping with threat cues through distraction and increasing self-awareness would reduce the effects of 'alcohol myopia'. Sixth, seeking fights for excitement could be reduced by examining the costs through motivational procedures. Finally, and self-evidently, a primary target of treatment programmes to reduce alcoholrelated violence should be to reduce the level and frequency of alcohol intoxication.

One strategy for reducing premature termination of therapy is to offer pre‐therapy preparation. Here, we describe an intervention targeting alexithymia in offenders with personality disorders. ‘Making Your Emotions Work for You’ is a one‐day group intervention consisting of four evidence‐based components: Psychoeducation, Recognizing Emotions, Self‐Awareness and Seeking Information. Pre‐intervention and post‐intervention scores on measures of alexithymia (Toronto Alexithymia Scale‐20 (TAS‐20)) and psychological mindedness (Balanced Index of Psychological Mindedness (BIPM)) are presented for five male personality‐disordered offenders. This small sample showed consistent scores in the dysfunctional direction on both psychometric measures, indicating that there does appear to be a need to address alexithymia in this group. Overall, participants reported positive experiences with the intervention. No reliable pre‐intervention to post‐intervention changes were observed on TAS‐20 scores. On the BIPM Interest scale, reliable improvement was observed for three participants and reliable deterioration for one participant. On the BIPM Insight scale, one participant reliably improved, and one reliably deteriorated. While alexithymia may not be changed by this intervention, participants may become more interested in exploring their emotions, which may enhance engagement in therapy. Copyright © 2011 John Wiley & Sons, Ltd.

Purpose. Alcohol‐related violence is a serious problem and treatments for high‐risk individuals need to be developed. Classification helps to route people into appropriate treatments. Drawing on animal research, we define alcohol‐related violence in relation to ultimate goals. We propose three types of violence: (1) violence in the pursuit of material goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. The aim is to explore factors that we expect to relate to this tripartite typology, with the aim of providing a preliminary validation. Method. Participants were 149 young male prisoners who had committed an offence of violence that was alcohol related. Semi‐structured interviews elicited information about the offence that enabled classification into one of the three types. Differences between groups were examined at the event level – level of violence during the offence and alcohol consumption before the offence – and at group level – trait aggression, trait anxiety, anger control, and alcohol–aggression outcome expectancies. Results. No differences were found in levels of violence or alcohol consumption. Those whose violence was in the pursuit of material goals were high on trait aggression, trait anger, trait anxiety, and anger suppression. Those who used violence in the pursuit of social dominance showed high trait aggression and trait anger. Those whose violence was a defence in response to threat showed lower trait aggression and trait anger. Conclusion. The findings are discussed in relation to differential group profiles and treatment needs.

Purpose -This paper seeks to highlight the findings from a research project on improving treatment engagement for clients with personality difficulties.Design/methodology/approach -The authors provide an overview of the studies conducted to date. These are a systematic review of the literature examining non-completion of psychosocial treatment by people with personality disorder, a systematic review of assessments to measure treatment engagement, and a Delphi survey of both staff and patients' views on factors that impact on engagement in psychosocial treatment for this client group.Findings -Poor engagement with psychosocial treatment is an issue for clients with personality disorder and rates of non-completion are high. Discontinuation of treatment is associated with adverse clinical outcomes. Although a number of assessments exist for measuring engagement, none can be described as comprehensive and few are adequately validated. Engagement factors identified from the survey were broadly in keeping with previous work, but additional factors specific to this client group were identified. A treatment readiness model for people with personality difficulties is described.Practical implications -Research outputs from the project are a set of specifications for good practice in facilitating engagement, and a web-based training package aimed at helping staff improve their understanding of their clients' engagement issues.Originality/value -The findings will be useful to service managers as well as clinicians working directly with people with personality difficulties. Improving client engagement will improve clinical outcomes and service cost-efficiency.