Transcript Psychological Therapies with Female MDO’s

Psychological Therapies with
Women in Forensic Mental
Health Settings
Dr Patricia Mooney
Consultant Clinical Psychologist
Rowanbank Clinic
CLINICAL FORUM: WOMEN IN FORENSIC MENTAL HEALTH SETTINGS
07 February 2014, SPS College, Polmont
Background
• Moving away from offence focussed interventions
towards work based on underlying needs
– Similar needs may underpin different offences
– Same type of offence may have different underpinning needs
• Forensic Matrix doesn’t explicitly mention women
– Evidence base in forensic literature mostly studies men
– Evidence base for psychological therapies generally doesn’t
specifically study women
• Same therapeutic approaches used as with men
– Overall frequency of which type of approach used may differ
• Similar methods of delivery than men
– Though individual needs or vulnerabilities are considered
Psychological Approaches
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Cognitive Behavioural Therapy (CBT)
Cognitive Analytic Therapy (CAT)
Schema Focussed Therapy
Mentalisation Based Therapy (MBT)
Positive Behaviour Support (PBS) /Applied
Behaviour Analysis (ABA)
• Less so Dialetcial Behaviour Therapy
(DBT)
Methods of Delivery
• Individual work with ward psychologist
• Individual work with other therapist
– e.g. through Psychological Therapies Service
or ward staff
• Group work
• Systemic/ ward based work
– e.g. psychological formulation sessions
– behaviour support/management plans
Case Examples
Considerations
• High level of complexity
– High rates of sexual abuse histories
– Mix of personality difficulties and mental health problems
– Elevated rates of Borderline Personality Disorder
• Family issues
– Higher rates of women were main caregiver prior to offences
• Multiple and possibly competing psychological needs
– e.g. victim and victimiser
• Ward dynamics
* Issues not exclusive to women, though arguably more prevalent
Conclusions
• Broadly similar approaches as with male
forensic patients
• Gender brings some further considerations
• Worth considering links between services
to build on evidence base?
• Challenging but rewarding work
• Questions?