Rep36 Understanding Personality Disorder

3.3.1 Psychological interventions with
personality disordered offenders in forensic
settings
A range of treatment interventions are available
for offenders serving custodial and community
sentences and those detained under the Mental
Health Act in medium or high security
conditions. However, although the diagnostic
category of personality disorder is routinely used
in secure services for patients detained under
the Mental Health Act, this is not the case for
offenders serving custodial or community
sentences. Because of this, it is difficult to
ascertain how many of the offenders undertaking
treatment programmes in prisons or on
community sentences are personality disordered.
As prevalence rates for personality disorders
(particularly antisocial) are very high in forensic
populations, it is likely that a considerable
proportion of those treated in these settings
meet the diagnostic criteria for at least one
personality disorder, although the precise figures
are a matter for future research. However, little is
known about how personality disorders mediate
antisocial behaviour. Ideally, individuals who are
accepted onto treatment programmes should be
routinely assessed for personality disorders prior
to admission. This would facilitate a better
understanding of how particular categories of
disorder respond to treatment in forensic
settings and the relationship between personality
disturbance and offending behaviour.
Most interventions provided by the prison
and probation services are aimed at reducing the
risk of re-offending, rather than treating the
symptoms of personality disorder. In recent
years, the development of interventions offered
to offenders has been greatly influenced by a
widely cited body of research evidence
collectively known as ‘What Works’. Based on
aggregated data from hundreds of studies, this
literature has proposed that certain types of
approaches can be effective in reducing re-
offending if properly implemented (i.e. using
appropriate methods, targeted at appropriate
groups of offenders, delivered with high quality
and consistency and supported by good after-
care). For example, McGuire (2002) summarised
the results of 30 meta-analytic reviews published
between 1985 and 2001. The results indicated
that those approaches targeted on ‘criminogenic
needs’ (risk factors that predispose individuals to
offending) and delivered using behavioural,
cognitive-behavioural and social learning
methods were the most promising in reducing
recidivism. Although most of the studies were
carried out in Canada and North America,
European meta-analyses were broadly in line
with these conclusions (Redondo 
et al
., 1997).
The reductions in re-offending rates were
typically around 5–10 per cent, although higher
reductions in re-offending have been reported
for programmes that followed the principles of
effective implementation more closely (Vennard,
Sugg & Hedderman, 1997). Approaches based
on psychodynamic methods were generally
ineffective and in some cases seemed to increase
recidivism (see Cooke & Philip, 2001 for a
summary). Although the evidence suggests that
psychodynamic approaches are unsuitable when
given as stand alone treatments, their efficacy for
personality disordered offenders may be
enhanced when integrated with cognitive
behavioural approaches and delivered in
structured therapeutic environments (see, for
example, Reiss, Grubin & Meux, 1996). 
In the light of the What Works research
reviews, the Home Office has developed a set of
criteria to accredit programmes and