Forensic psychotherapy

Forensic Psychotherapy is the application of psychological knowledge to the treatment of patients who have mental illnesses who commit violent acts against others or themselves involving both the conscious and unconscious motivations. Commonly applied diagnoses would include personality disorder and psychosis. The link between personality disorder and offending is not firmly established although many of those who commit offences have one or more personality disorders. The term forensic psychotherapy is usually associated with Psychodynamic psychotherapy, including group psychotherapy and the therapeutic community approach. Cognitive behavioral therapy is more commonly associated with the field of psychology, particularly Forensic Psychology. Forensic psychotherapists may collaborate with other professionals, such as physicians, social workers, and other psychologists to best serve the client's needs and may work in various settings including prisons, inpatient settings, and outpatient settings. Forensic psychologists encompasses four types of work: clinical work, supervisory work, clinical meetings, and consultation. Guidelines have been set to ensure proficiency in the field of Forensic Psychology.

Contentious Area

It has been difficult to illustrate a clear link between psychological interventions that successfully reduce the incidence of offending and those that do not and clearly nothing has led to the elimination of crime. At times this difficulty has contributed to a profound pessimism about the effectiveness of any form of treatment.^[1] This was particularly so in the United States of America but this pessimism regarding the effectiveness of treatment spread to the United Kingdom ^[2] and arguably adversely affected the provision of rehabilitative treatments. The development of cognitive behavioural therapy which made it possible to demonstrate an effect upon some attitudes and offending behaviours and for this to be measured in controlled research studies led to the introduction of structured treatment programmes in prisons across Canada, the United States, the United Kingdom and more recently, mainland Europe. For a period there have been positive benefits in the provision of resources particularly in prison settings. However, there has been serious conflict as professionals compete for limited resources and one model claimed superiority over another.

It has remained difficult to establish with great certainty which methods, if any, are effective over a significant period of time. However psychodynamic forensic psychotherapy has been shown to have some effect ^[3] as have Therapeutic Communities ^[4]

Role of Forensic Psychologists

Forensic psychologists encompass four types of work. The first type, clinical work, includes providing assessment and treatment to clients both in an in individual setting and group setting. The second type, supervisory work, includes providing supervision to trainees and other mental health professionals. The third type, clinical meetings, include engaging in meetings, reviews, and conferences regarding patients and clients. The last type, consultation, includes providing information in a consultation to an institution.

Forensic psychologists are able to determine treatability, management, and risk assessment. Areas of concern include potential risk and confidentiality.

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Settings

Forensic psychologists work in many locations. Forensic psychologists work in high security locations such as hospitals and prisons. Medium security settings include regional secure units. Minimal security settings are local forensic units. Non secure inpatient unites are residential communities and specialist in patient units. Non-secure out-patient units are non-residential therapeutic communities, day hospitals and specialist centres. Community settings are settings in which patients are managed by community forensic teams.

The Forensic Patient

Most forensic patients have disturbed backgrounds. They often have minimal impulse control, therefore having criminal records. They do not respect authority. Forensic patients often exhibit deviant behavior socially and sexually. They often have a history of emotional deprivation. This may include abuse, neglect, and embarrassment. The crime is never condoned, but tried to be understood. Reasons for assessment must be clearly stated so as to not confuse the patient. Boundaries must be set immediately. Transference and countertransference are likely to occur while working with forensic patients. It is vital to distinguish between offenders who have a mental illness and offenders who do not.

Forensic Psychotherapy

The aim of forensic psychotherapy is to not only understand the crime the person has committed, but to understand the person as a whole within his/her environment. Forensic psychotherapy may involve group work, individual work, work with victims, work with families as well as within therapeutic communities.

Working from the premise that the offender has a complex internal world which may be characterized by punitive and unreliable internal representations of paternal and other figures, psychotherapy can shed light on the unconscious impulses, conflicts, and primitive defense mechanisms, involved in his or her destructive actions and "acting out". It helps to understand the triggers to the violent acts and timing of the acts. Forensic psychotherapy aims to help the offender understand why they committed the act and take responsibility for it, aiming to prevent future crimes committed.^[6]

The intimacy and profound experience of therapy may enable an offender to reframe and restructure these harsh images which tend to blunt sensitivities and, when projected out onto others, act as a rationale or driving force for criminal acting out. The patient may develop self-awareness, and an awareness of the nature of their deeds, and ultimately be able to live a more adjusted life. The effectiveness of psychodynamic psychotherapy, as is the case with other psychological therapies, is limited far as behavioral change for antisocial personality or psychopathic offenders. These two types of offenders comprise the primary diagnostic group found in forensic psychotherapy work. The evidence which is emerging, suggests that a range and variety of treatments may be most helpful for such offenders.

Treatment of high risk offenders poses particular problems of perverse transference and counter transference which can undermine and confound effective treatment so it would be usual to expect such treatment to be conducted by experienced practitioners who are well supported and supervised.

Guidelines for Forensic Psychotherapy

The American Academy for Forensic Psychology and the American Psychology Law Society published the Speciality Guidelines for Forensic Psychologists in 1991. It provides direction to forensic psychologists in identifying competent practice, practicing responsibly, establishing relationships with parties involved and identifying issues. APA also created guidelines in the 1990s for new forensic psychologists. In 1994 the Guidelines for Child Custody Evaluations in Divorce Proceedings was adopted by the APA Council of Representatives ^[7] to promote proficiency. In 1998 the Guidelines for Psychological Evaluations in Child Protection Matters was adopted by the APA Council of Representatives as well.

Certification is done statewide and nationwide to ensure competence. More classes are being offered in Forensic Psychology and more opportunities are available at the graduate and post graduate level.

References

1. ↑ Martinson R. 1974, What Works?- Questions and Answers About Prison Reform. The Public Interest. 35. p 22-54
2. ↑ Maguire J.What Works: Reducing Offending. Wiley. Chichester. 1999
3. ↑ Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003;160: 1223-32
4. ↑ Taylor R. A seven year reconviction study of HMP Grendon. Home Office Research Unit, London 2000.
5. ↑ McGauley, Gill; Humphrey, Martin (2003). "Contribution of forensic psychotherapy to the care of forensic patients". Advances in Psychiatric Treatment. 9 (2): 117–124. doi:10.1192/apt.01.43. 
6. ↑ Welldon, Estella (2015). "Definition of forensic psychotherapy and its aims". international journal of applied psychoanalytic studies. 12 (2): 96–105. doi:10.1002/aps.1442. 
7. ↑ Otto, Randy; Heilbrun, Kirk (2002). "The Practice of Forensic Psychology". American Psychologist. 57: 5–18. doi:10.1037/0003-066x.57.1.5. 

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External links

• International Association for Forensic Psychotherapy

1. ↑ Welldon, Estela (1993). "Forensic Psychotherapy and Group Analysis" (PDF). Group Analysis. 26: 487–502. doi:10.1177/0533316493264009.