Nothing left to lose? Freedom and compulsion in the treatment of dangerous offenders

Abstract

The ‘Dangerous and Severe Personality Disorder’ (DSPD) programme was established following the particularly high-profile double murder of a mother and one of her two daughters: thevery kind of stranger killing that, although in fact extremely rare, the public identifies with most fearfully. This article will examine the dynamics involved in offering dangerous offenders the chance to engage with a society that has hitherto refused to acknowledge them as full members, in the context of a medium-secure DSPD unit that operates as an adapted therapeutic community. While the treatment programme contains undoubted elements of coercion, in return the men are invited to take a full part in the process of change: a hallmark of the treatment model is its philosophy of working collaboratively with them in reaching an understanding of their internal worlds, the external reality of their situation and whether and how much they wish to address either. Most have reached a time when they want to embrace a different future, for hitherto, their lives and minds have been painful places within which to exist. Such an endeavour is fraught with ambivalence, not only on the part of a frightened and judgemental metropolitan ‘in-group’ – including many of the professionals who might be called upon to facilitate the process – but also those individuals who have learned that to risk becoming attached to anyone at all is to invite betrayal. Working in such an environment also provides the staff with something of the experience of being rejected, and the temptation to retreat into the shelter of the‘microcosm’ needs constantly to be resisted. Questions about the nature of freedom of choice with respect to this encounter – both its desirability and perhaps its impossibility – will be explored from the perspective of both patients and clinicians.