Rep36 Understanding Personality Disorder

3.3.2c Violent offenders
Cognitive-behavioural interventions for violent
offenders have shown some evidence of
effectiveness, but this research mainly derives
from North American studies (Baldock, 1998;
Kemshall, 2000; Motuik 
et al
., 1996). An early
study examining reconviction rates for offenders
participating in a community based cognitive
behavioural programme run by the Wiltshire

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Probation service, indicated that overall the
results were positive, with evidence of
improvements in offending behaviour after one
year (Sugg, 2000). The programmes for violent
offenders are still in relatively early stages of roll
out and evaluation results are awaited. 
3.3.2d Therapeutic communities
Research has also shown that concept based
therapeutic communities are effective in terms of
both reduced drug use and lower levels of re-
offending following treatment (Lipton 
et al
.,
2002). Evaluations such as these have led some
authors to conclude that concept based
therapeutic communities should be the ‘treatment
of choice’ for drug misusers (Wexler, 1997).
Research on prison democratic therapeutic
communities has also shown consistently that
men who participate in this form of treatment
improve on a range of measures such as
relationships with staff, self-esteem, anxiety,
hostility and general psychological health
(Rawlings, 1998; Shine; 2000). These effects were
most pronounced in men who participated in
therapy for 12–18 months or more. However,
evidence for the effectiveness of democratic
therapeutic communities in reducing re-
offending is equivocal (McMurran, 2002). 
Although evidence for the effectiveness for
the treatment approaches described above is
generally encouraging, they may not be suitable
for all types of offenders. Some studies have
found that recidivism rates following treatment
have increased for offenders who score highly on
the PCL-R. One study (Rice, Harris, & Cormier,
1992) followed up a sample of men who
attended a therapeutic community in a
maximum-security establishment in Canada.
Those who scored low on the PCL-R had lower
reconviction rates than a matched control group
who did not receive treatment, indicating a
positive treatment effect for this group. However,
those offenders who scored high on the PCL-R
had higher reconviction rates than the control
group for violent offences. This suggests that, for
this group, the treatment had made the men
more dangerous. An evaluation of a cognitive-
behavioural treatment programme for sex
offenders in Warkworth, Canada also found that
sex offenders who scored highly on the PCL-R
had reconviction rates that were greater than
might be expected if they had not received
treatment (Seto & Barbaree, 1998). 
However, research on the effectiveness of
treatment for psychopathic offenders is still at a
relatively early stage. It is also important to note
that most research to date has involved
evaluating approaches that have not been
designed to meet the treatment needs of
psychopathic offenders. In recognition of this
the Prison Service and the Department of Health
have developed a programme for psychopathic
offenders, which is currently being piloted at a
number of sites. 
A position paper by the Forensic Clinical
Psychology Special Interest Group suggested that
all research participants should be screened for
psychopathy and that treatment outcome studies
should routinely report results for psychopaths
and non-psychopaths separately (Cousins &
Bailes, 2000). This would help to establish
criteria that could identify treatment resistant
individuals as well as increase understanding of
the relationship between psychopathy and
personality disorder.