Rep36 Understanding Personality Disorder

3.3.1c Violent offenders
Several programmes have been designed to
target the treatment needs of violent offenders.
An example is Controlling Anger and Learning
to Manage it (CALM) (Winogran 
et al
., 1997).
The goals of the CALM programme are to assist
offenders to understand the factors that trigger
their anger and aggression. Offenders learn to
challenge the cognitions that create, sustain and
escalate emotional arousal; they learn skills to
reduce their levels of emotional arousal and
skills to resolve conflict effectively. They also
learn to manage other negative emotions related
to offending and plan how to deal with relapse
into former patterns of aggression. The
programme is multi-modal, drawing on several
different intervention strategies, proven to be
effective in both the treatment of anger and
offending behaviour. It aims to facilitate change
through the processes of cognitive preparation,
self-monitoring and self-regulation, cognitive
restructuring, social skills acquisition, and
rehearsal/practice. Motivational enhancement
exercises help offenders define for themselves
the value of regulating their expression of anger
and reducing their levels of aggression.
Participants begin to define their own
anger/aggression cycle that will contribute to the
final relapse prevention planning phase at the
end of the programme.
3.3.1d Therapeutic communities
Most of the approaches accredited by the Home
Office are primarily aimed at reducing the risk
of re-offending. Whilst this is clearly an
important aim of any treatment approach with
offenders, it is important to remember that many
personality disordered offenders present with
significant clinical and management problems
within institutions. These include self-harm or
suicide ideation, aggressive behaviour, personal
distress, mood instability, excessive emotionality
and low self-esteem. Problems such as these can
lead to personality disordered offenders being
high users of medical and psychological services
in forensic settings. Treatment approaches need
to take account of these problems in designing
appropriate interventions.
The therapeutic community approach
(described in section 2.1.6) has been adapted for
use in forensic settings, and aims to address both
the symptoms of personality disorder and reduce
the risk of re-offending (Cullen, Jones &

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Woodward, 1997; HM Prison Service, 2003). In
the Prison Service, there are currently two
establishments that are run as therapeutic
communities: Grendon and Dovegate, plus a
number of smaller units within prisons.
Although concept based therapeutic
communities focus on the assessment and
treatment of substance misuse, in practice many
of the participants will also meet the criteria for
personality disorder (Verheul, 
et al
., 1995).
There are currently a number of concept based
therapeutic communities run in the prisons as