Forensic Group Psychotherapy: The Portman Clinic Approach by John Woods and Andrew Williams (review)

Abstract

issn 0362-4021 © 2015 Eastern Group Psychotherapy Society group, Vol. 39, No. 2, Summer 2015 181 1 Program Director, Forensic Psychiatry Fellowship, New York University School of Medicine, New York City. Correspondence should be addressed to Bipin Subedi, MD, Bellevue Hospital Center, NBV 19W18, 462 1st Avenue, New York, NY 10016. E-mail: Bipin.Subedi@nyumc.org. Book Review Forensic Group Psychotherapy: The Portman Clinic Approach. Edited by John Woods and Andrew Williams. London: Karnac Books, 2014, 240 pp. Reviewed by Bipin Subedi1 The primary aims of the criminal justice system are to punish, rehabilitate, and prevent future offending. This is complicated by the fact that certain offenders, especially those who have engaged in sexual or violent crimes, are often thought to be minimally responsive to interventions and at high risk of recidivism. Correctional programming has traditionally been time limited, behaviorally based, and embedded in external motivations for treatment. Some argue that this practice may lend itself to superficial and fragile behavioral change. Clinical experience has demonstrated that an internally driven transformation is more reliably associated with improved outcomes. Is there a way to encourage this type of psychological development in those with a history of incarceration? Forensic Group Psychotherapy: The Portman Clinic Approach, edited by John Woods and Andrew Williams, explores the potential value of group-based psychodynamic and analytic treatment for those with a history of sexual and violent offenses. The Portman Clinic is located in London and has provided psychotherapy to violent offenders and those with “damaging” sexual behaviors since 1993 (Portman Clinic, 2015). Woods is a psychotherapist and Williams is a psychiatrist at this treatment center. Together, they have compiled a volume of papers divided into chapters written by former and current colleagues describing the group forensic psychotherapy program at the clinic. The sections address a variety of topics and are structured around theory, case examples, and personal reflection. The authors believe that delinquent behavior partially stems from difficulty 182 subedi managing dynamic conflicts related to past trauma. This is consistent with findings of high rates of abuse and neglect in certain types of offenders, in addition to the trauma associated with incarceration itself (James & Glaze, 2006). Forensic group therapy is approached as a trauma-informed group treatment for individuals who have a history of arrest and/or deviant sexual behavior. The purpose of the group is to create a contained space that fosters exploration of material that may be too stimulating and threatening (both for the patient and clinician) in individual treatment . The group offers a place for patients with shared dysfunctional histories to express themselves without fear of judgment or retribution. Behavior is not taken at face value, and both the group members and the group leader direct their interventions toward understanding the meaning behind the action. The first several chapters describe the important elements of group psychotherapy in the forensic population. This includes the significance of the frame and recognition of common countertransference reactions. The need to address confidentiality, the benefits of a team approach, and the importance of selecting appropriate clients are also highlighted. Given the broad scope of this endeavor, the work here is long term, with a preferred commitment of several years. The Portman Clinic exists within the boundaries of the National Health Service and outside of the criminal justice system. This helps place the focus on rehabilitation rather than punishment. This also directs the responsibility for change and transformation toward the client. The chapters following the introduction highlight particular themes that have surfaced in the work of the clinic. These include the reflections of a first-year therapist, issues regarding therapist gender and pregnancy, and applying group therapy to those with pedophilia, antisocial personality disorder, and intellectual limitations. The importance of the trauma narrative is reinforced in the chapter on pedophilia. Through a discussion of theory and case examples, the authors highlight the potential benefits of targeting underlying psychological themes and the therapeutic power of a group where members, who have all been ostracized from society and were encouraged to repress discussions of their impulses, have a forum to speak. The setting fosters honesty regarding sexually deviant feelings, and collusion is controlled for through feedback from multiple group members. Similarly...