The views of male forensic inpatients on how treatment for personality disorder works

Abstract

Although there are now a number of psychological therapies for personality disorder, there has been relatively little research into the processes by which these therapies work. One way to explore this is to seek patients' views on the process of change. This study explores the process of change among male forensic inpatients with primary diagnoses of personality disorder. Twelve patients in a high secure personality disorder service completed a semi-structured interview about their experiences of personal change. Thematic analysis of participants' responses indicated that participants observed change in a variety of domains: core beliefs, awareness and behaviour. Consistent with previous psychotherapy research, interactions with therapists were seen as very important, but so was the wider interpersonal environment, while specific therapeutic techniques were cited relatively rarely. These results suggest that more attention should be paid to the effects of the wider interpersonal environment on therapeutic change processes with this population.

Processes of change in an offender personality disorder pathway prison progression unit

“…These changes were seen as occurring primarily through the development of trusting relationships forged with staff, particularly during key work sessions. These findings accord with the Willmot and McMurran () study and reflect the importance of the therapeutic relationship in effecting change (Spinhoven et al, ).…”

“…As these pathways are new, it is important to investigate their effectiveness and how they may work. A qualitative approach to understanding how treatment for personality disorder works for male offenders detained for treatment in a secure hospital was feasible and productive (Willmot and McMurran, ). In this, the men reported improved self‐esteem, improved insight and understanding, reduced egocentricity, improved empathy, acceptance of responsibility for their behaviour, development of feelings of being worth changing and increased optimism about the possibility of change.…”

Offenders With Antisocial Personality Disorder Display More Impairments in Mentalizing

“…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).…”

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

“…These findings also suggest that further identifying the behaviours that promote therapeutic attachment, and training therapists and other staff to adopt these behaviours, would promote therapeutic change in inpatient personality disorder services. The attachment literature and the findings of Willmot and McMurran (2013) suggest this is more likely to occur when a patient experience being consistently accepted, trusted, and valued by an individual who is also able to provide safety and emotion regulation. Walters (2006) reported that self-report measures of change can reliably inform forensic risk assessments and can enhance judgements made using structured risk assessment tools.…”

“…To begin to clarify what changes and how changes occur, Willmot and McMurran (2013) interviewed 12 male patients in a high secure personality disorder treatment service to identify their perceptions of how they had changed in treatment and the processes that contributed to these changes. Participants described changes in a number of specific areas that clustered in three superordinate themes: (1) Self, which encompassed enhanced feelings of self-worth, greater understanding of the self, and improved self-regulation skills; (2) Other people, particularly being able to trust others better, improved empathy, and perspective taking ability, and better interpersonal skills; and (3) Future thinking, including more positive beliefs about their future, improved ability to face up to the future, and increased goal-directed behaviour.…”