Rep36 Understanding Personality Disorder

3.3 Psychological interventions in forensic settings

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George
George is 45 years old and serving a 14-year prison sentence for aggravated burglary and rape. He
had a long history of previous offending involving a wide range of crimes including arson, thefts,
violence, drugs and fraud. He also had convictions for various breaches of bail and supervision
orders, plus attempted escapes from custody.
During his childhood he exhibited severe behavioural problems and was sometimes described as
‘out of control’. In his local area he was known for tormenting neighbours and was involved in fire
setting and vandalism. At school he was involved in persistent truanting and many disruptive incidents
including stabbing a teacher with a compass and bullying and extortion activities. Because of his
disruptive behaviour at home and school he spent much of his childhood in Local Authority homes.
Staff views were divided: some noted that he could be sincere and charming; others were more
sceptical, describing him as unable to separate fact from fantasy and always looking to exploit others
for his own ends. His intelligence was assessed as above average but he obtained few qualifications.
After leaving school he was employed in a variety of short-term jobs but either left quickly or
was fired for misdemeanours such as stealing from employers. He spent most of his adult life in
prison or on community sentences. In between he drifted from one part of the country to
another. He had been involved in numerous short-term relationships and had fathered several
children but maintained little contact with them and quickly moved on to form new relationships.
His current offence explanation changed several times. Initially he stated that he could not
remember what happened but later argued that the victim consented and falsely claimed she was
raped in order to gain compensation. In the most recent account, he claimed that the offence was
a ‘misunderstanding’ with tragic consequences for many people, including himself. The police
reports indicated that the offence was a callous and sadistic attack and that the victim was lucky to
escape with her life. George argued that he was innocent throughout his trial and made an
unsuccessful appeal against his conviction.
George enrolled for several prison treatment programmes and there was evidence that these
were beneficial, at least in the short term. Self-report questionnaires, completed before and after
participation, showed improvements on impulsiveness, socialisation and self-esteem. This was
confirmed by improvements in self-management, as assessed by an officer-completed behaviour
checklist. However, reports on his progress included some worrying observations. For example,
therapy staff commented that although he sometimes made valuable and insightful contributions
to the sessions, he would often dominate the group proceedings and seemed to like being in
control. His contributions were frequently verbose and rambling and it was occasionally difficult to
assess whether he was telling the truth, as his narrative sometimes contained contradictions. They
also commented that several times he made hostile and vindictive verbal attacks on other group
members or therapy staff. When it was pointed out how frightening this could be, he seemed
unconcerned and claimed that he was the only member of the group with the honesty to speak his
mind: ‘if you don’t like the heat – get out of the kitchen.’ Staff felt that he would often look for
opportunities to split the therapy team and play one member against another. Although he
appeared adept at learning the language of therapy, and appeared to make some genuine
improvements, there was limited evidence that he could put this into practice on a sustained basis.
As one prison officer commented: ‘he talks the talk but can’t walk the walk.’ 
Reports in his file gave differing views; staff who interviewed him on an individual basis
sometimes described him as co-operative, remorseful and showing a genuine desire to change. On
the other hand, prison staff who observed his behaviour over time were more sceptical, reporting
that he was very manipulative and had a quick temper. His prison record contained reports of
several assaults and a hostage incident. Security information reports indicated that he was
suspected of being involved in scams and activities such as dealing in drugs or illegal pornography. 
Although George appeared to accept some responsibility for his problems (and these improved
following treatment) he would quickly enter into long justifications for his criminal record when
questioned. He argued that he was a victim of ‘the system’ and that crime was his way of coping.
He would occasionally enter into long diatribes, listing the injustices he had suffered, and his
mood would range from bitter resentment and anger to tearfulness. He claimed to be depressed
by the separation from his children but, when asked, could not remember simple details about
them such as their birthdays. He did not appear to have coherent plans for his future but appeared
to spend a lot of his time involved in complaints and litigation against the prison authorities. 

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interventions that are most likely to reduce
offending. Examples of the criteria are having a
clear model of change backed by research
evidence, specifying how the programme targets
criminogenic needs in offenders, using
appropriate methods and having in place
monitoring and evaluation systems. The prison
and probation service now has a curriculum of
programmes that have been accredited under
this system. A number of the same programmes
are run in secure services for patients detained
under the Mental Health Act. Some examples
are given below.