An attachment‐based model of therapeutic change processes in the treatment of personality disorder among male forensic inpatients

Abstract

Purpose. This study explores the processes of change during treatment among male forensic inpatients with primary diagnoses of personality disorder.Method. Fifty patients in a high secure personality disorder treatment service completed a checklist about how they had changed during treatment and the factors that had caused that change.Results. The results support a limited reparenting attachment-based model of therapeutic change. Self-reported levels of change were highly correlated with measures of patient functioning, though significant levels of change did not occur until the later stages of treatment.Conclusions. The behaviour of therapists was particularly important throughout treatment, though participants in the final stage of therapy reported that the behaviour of other staff was as important as that of therapists, suggesting that, by this stage of treatment they are able to extend their range of supportive and therapeutic relationships.

Offenders With Antisocial Personality Disorder Display More Impairments in Mentalizing

“…In discussing the challenges of developing MBT for people with ASPD, Yakeley (2014) reflects on how such patients find it difficult to identify their own internal states of mind as well as finding thinking about other's needs alien but, nonetheless, describes some success with the adaptation of MBT. A study of the processes of change for an attachment-based model of therapeutic change with forensic inpatients with a primary diagnosis of personality disorder, suggested that a key change, as described by participants, was improved mentalizing through enhanced trust, empathy and perspective-taking (Willmot & McMurran, 2014a).…”

“…Encouraging mentalizing has been shown to reduce school violence (Fonagy, Twemlow, Vernberg, Sacco, & Little, 2005;, and mentalization-based treatment (MBT) has demonstrable success in treating symptoms of impulsivity in individuals with comorbid BPD and ASPD (Bateman et al, submitted). Other studies of forensic patients with personality disorders have found that participants who were interviewed about their views of the processes by which therapeutic changes occurred tended to identify realizations that reflected improved mentalizing (Willmot & McMurran, 2013, 2014b).…”

A Qualitative Evaluation of Recovery Processes Experienced by Mentally Disordered Offenders Following a Group Treatment Program

“…Moreover, learning to manage their risk through identifying triggers and boundaries was clearly defined as a specific goal of recovery for participants. The second superordinate theme, "Social Relationships", emphasised the significance of attachment in the process of psychological treatment for MDSOs (Craissati, 2009;Willmot & McMurran, 2014). It is therefore unsurprising that issues of mistrust emerge, a common maladaptive schema which can raise a barrier to recovery (Szlachcic et al, 2015;Young, Klosko, & Weishaar, 2003).…”

“…Clarke et al, 2013), some individuals may also be traumatised by their own offending behaviour, feeling coerced (and therefore humiliated) into displays of behaviour in front of peers and vicarious exposure to others' offending (Levenson, 2014). Additionally, while treatment groups can foster social bonding leading to a willingness to learn, acceptance of role models and commitment to change (Willmot & McMurran, 2014), our participants were experiencing disorders which manifest in anxious and/or paranoid behaviours and our data suggest that some had difficulty bonding with others in the group and in trusting both them and the facilitators. In clinical practice, it is often observed that offering treatment programmes to individuals with severe personality disorders may not engender total self-insight and immediate self-management strategies but, rather, they sensitise the awareness of supervisors to the range and expression of the underlying disorders (Thornton & Blud, 2007).…”

Applying a Strengths-Based Psychoeducational Model of Rehabilitation to the Treatment of Intimate Partner Violence: Program Theory and Logic Model

“…The TA has been established as important to therapeutic change (Willmot & McMurran, 2014) and treatment outcomes (Marshall & Serran, 2004; Ross, Polaschek, & Ward, 2008; Taft & Murphy, 2007; Taft, Murphy, King, Musser, & DeDeyn, 2003). However, therapists experience challenges to forming working alliances with offenders who have personality, educational, and motivational difficulties (Ross et al, 2008).…”