Delivering effective therapeutic interventions for men with severe personality disorder within a high secure prison

Abstract

The Fens Unit is a government-initiated facility for male prisoners reaching criteria for Dangerous and Severe Personality Disorder (DSPD). Prisoners are assessed using a standardised process; those meeting criteria engage in a five-year treatment programme using a cognitive interpersonal model. Personality disorder is seen as a combination of coping strategies, developed in response to experience, which results in dysfunctions of thinking, feeling, behaviour and interpersonal relationships. These dysfunctions are linked to offending. Therefore, in order to reduce risk, multiphasic interventions – individual and group therapies – specifically target each dysfunction area, focusing on the developmental experiences that generated them. Each man's individual risk factors become treatment targets that are addressed in every aspect of the programme. All staff on the unit, clinical and operational, attempt to improve the quality of interpersonal relationships the prisoner has access to in order to create remedial experiences that are necessary to attain the capacity to develop socially adaptive cognitive, emotional and behavioural responses. This paper describes the treatment provided to these prisoners and the outcomes for the first cohort to have completed treatment (n=18). Results indicate that there is a reduction in violent behaviour, a higher than expected attendance at therapy, a decrease in actuarial risk measures and the majority of men are successfully managed in lower security after programme completion.