Forensic environments are different from clinical contexts in several essential ways. Firstly, many of the patients you might see are mandated to complete therapy, and the therapy focuses on reducing the risk of violence or some other criminal offence. Clinical issues and problems are less of a priority. Secondly, the forensic context is also different in critical environmental ways. Patients have less control over the context, and there is danger from others often. No one can be trusted, grudges are to be held, and walking away is not an option when called out by others, mocked, or belittled in some way.
Considering these challenging circumstances, it is no surprise that forensic populations have a higher prevalence of PD, psychopathy, risk of criminal behaviour, and various other problematic behaviours. Indeed forensic patients, compared to clinical and hospital contexts, are more likely to have personality disorders. These clients rarely present to a regular clinical context for psychological treatment. And if they do so, then it’s typically not for their mental health reasons…
The Risk-Needs-Responsivity model is used to guide decision-making concerning offender rehabilitation.
The Risk-Needs-Responsivity highlights that the best way of managing and engaging offenders is to target those with the highest risk – attempting to address the characteristics and factors about that individual that make them risky – and doing it in ways that account for the offenders’ idiosyncratic characteristics…
Now the challenge in most forensic contexts is not so much figuring out who is high risk or what they might need to change about themselves to reduce their risk of recidivism … but rather it is about engaging them in ways that allow them – the patients – to be able to benefit from any treatment that you deliver or attempt to deliver.
Dealing with this responsivity issue is where schema therapy comes to the fore. Because therapy-interfering behaviours are conceptualized as evidence of the client’s maladaptive coping modes… Modes that have emerged in childhood to assist them with being able to survive…
