Individual Psychological Therapies in Forensic Settings PDF

i INDIVIDUAL PSYCHOLOGICAL THERAPIES IN FORENSIC SETTINGS From the ‘nothing works’ maxim of the 1970s to evidence-​based interventions to challenge recidivism and promote pro-social behaviour, psychological therapy has played an important role in rehabilitation and risk reduction within forensic set...

i INDIVIDUAL PSYCHOLOGICAL THERAPIES IN FORENSIC SETTINGS From the ‘nothing works’ maxim of the 1970s to evidence-​based interventions to challenge recidivism and promote pro-social behaviour, psychological therapy has played an important role in rehabilitation and risk reduction within forensic settings in recent years. And yet the typical group therapy model isn’t always the appropriate path to take. In this important new book, the aims and effectiveness of individual therapies within forensic settings, both old and new, are assessed and discussed. Including contributions from authors based in the UK, North America, Europe, Australia and New Zealand, a broad range of therapies are covered, including Cognitive Behavioural Therapy, Mentalisation Based Therapy, Schema Therapy, Acceptance and Commitment Therapy and Compassion Focused Therapy. Each chapter provides: an assessment of the evidence base for effectiveness; the adaptations required in a forensic setting; whether the therapy is aimed at recidivism or psychological change; the client or patient characteristics it is aimed at; and a case study of the therapy in action. The final section of the book looks at ethical issues, the relationship between individual and group-based treatment, therapist supervision and deciding which therapies and therapists to select. This is essential reading for probation staff, psychologists, criminal justice and liaison workers and specialist treatment staff. It will also be a valuable resource for any student of forensic or clinical psychology. Jason Davies is Professor of Forensic and Clinical Psychology at Swansea University, UK and a Consultant Forensic and Clinical Psychologist with ABMU Health Board in South Wales. He has worked in high, medium and low secure mental health settings, and is the author of Supervision for Forensic Practitioners (Routledge 2015). Dr Claire Nagi is a Chartered Psychologist and Registered Forensic Psychologist with ABMU Health Board in South Wales, UK. She is Associate Clinical Tutor at the Department of Applied Psychology, Cardiff Metropolitan University, Wales, UK. She has worked in prison, forensic mental health and community NHS services. ii iii INDIVIDUAL PSYCHOLOGICAL THERAPIES IN FORENSIC SETTINGS Research and Practice Edited by Jason Davies and Claire Nagi iv v First published 2017 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2017 selection and editorial matter, Jason Davies and Claire Nagi; individual chapters, the contributors The right of the editor to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloguing in Publication Data A catalog record for this title has been requested. ISBN: 978-1-138-95571-4 (hbk) ISBN: 978-1-138-95572-1 (pbk) ISBN: 978-1-315-66613-6 (ebk) Typeset in Bembo by Out of House Publishing v JD: For Susie, Bryn and Freya CN: For my late parents, Norman and Miranda vi v vii CONTENTS List of contributors 1 Introduction Claire Nagi and Jason Davies ix 1 PART I Individual therapies 9 2 Acceptance and Commitment Therapy David Brillhart 11 3 Cognitive-​Behavioural Therapy Andrew Day 28 4 Cognitive Analytic Therapy Karen Shannon and Philip Pollock 41 5 Exploring Compassion Focused Therapy in forensic settings: an evolutionary and social-​contextual approach Paul Gilbert 59 6 Eye Movement Desensitisation and Reprocessing with sexual offenders Ronald J. Ricci and Cheryl A. Clayton 85 viii viii Contents 7 Mentalisation based treatment Gill McGauley 100 8 Personal construct psychotherapy Adrian Needs and Lawrence Jones 121 9 Psychodynamic psychotherapy Nigel Beail 142 10 Schema Therapy Marije Keulen-​de Vos and David P. Bernstein 157 11 Sensorimotor psychotherapy Naomi Murphy 180 PART II Key issues associated with individual therapies 195 12 Individual psychological therapy with associated groupwork Claire Nagi and Jason Davies 197 13 Ethical issues in the treatment of offenders Tony Ward 213 14 Supervising the therapists Jason Davies and Claire Nagi 228 15 Selecting therapies and therapists Jason Davies and Claire Nagi 243 16 Conclusions and future directions Jason Davies and Claire Nagi 257 Subject index Author index 265 272 ix CONTRIBUTORS Nigel Beail is Professor of Psychology at the Clinical Psychology Unit, Department of Psychology at the University of Sheffield, UK. In addition, he is Consultant Clinical Psychologist and Professional Lead for Psychological Services for South West Yorkshire Partnership NHS Foundation Trust. He has published extensively on practice-​based research from his clinical work. David P. Bernstein, PhD is Professor of Forensic Psychotherapy, an endowed chair sponsored by Maastricht University and Forensic Psychiatric Center de Rooyse Wissel. He received his doctoral degree in Clinical Psychology from New York University in 1990, and joined the faculty of Maastricht University in 2004. He has published extensively on personality disorders, psychological trauma and forensic psychology. He is an internationally known expert on Schema Therapy, an integrative therapy for personality disorders. He has served as Vice-​President of the International Society for Schema Therapy, and President of the Association for Research in Personality Disorders. David Brillhart, PsyD is a licensed psychologist specialising in Acceptance and Commitment Therapy (ACT) with high-​risk and special needs violent offenders in correctional and forensic settings. He developed his ACT Behind Bars workshop based on his ACT forensic work and outcome measures of his 20-​month pilot study using ACT with Sexually Violent Persons (SVP). He has also presented and facilitated workshops nationally and internationally for correctional and forensic-​based clinicians using ACT. Working with this difficult population gives him the opportunity to help non-​forensic clients navigate life’s ‘roadblocks’ at his private practice, ACT II Psychology. For more information, visit http://​actiipsychology.com Cheryl A. Clayton is a Licensed Clinical Social Worker and a Virginia Certified Sex Offender Treatment Provider. She is the Director of Specialised Treatment Services x x List of Contributors of Virginia for Resources for Human Development, Inc. Her clinical expertise is in the areas of assessing and treating youths and adults who have committed sexual offences. She has specialised in the treatment of sexual offenders and their families since 1994. She is a Board Member of the Virginia Sex Offender Treatment Association. Her area of specialisation is the research and treatment of sex offenders, with a particular interest in trauma effects and EMDR which she has presented nationally. Andrew Day is a Professor in the Australian Aboriginal and Torres Strait Islander Centre at James Cook University in Queensland, Australia. Before joining academia he was employed as a clinical psychologist in South Australia and the UK, having gained his Doctorate in Clinical Psychology from the University of Birmingham and his Masters in Applied Criminological Psychology from the University of London. He is widely published in many areas of forensic psychology, with a focus on the development of effective and evidence-based approaches to offender rehabilitation. Paul Gilbert, FBPsS, PhD, OBE was Professor of Clinical Psychology (University of Derby) and Consultant Clinical Psychologist (Derbyshire Healthcare Foundation Trust) until his retirement in 2016. He has researched evolutionary approaches to psychopathology for more than 40 years with a special focus on mood, shame and self-​criticism and their treatment –​for which Compassion Focused Therapy was developed. He was made a Fellow of the British Psychological Society in 1993; was president of the British Association for Behavioural and Cognitive Psychotherapy in 2003; was a member of the UK Government’s NICE guidelines for depression (2002–​2004); and was awarded an OBE in 2011. He has written or edited 21 books and more than 200 papers. In 2006 he established the charity Compassionate Mind Foundation (www.compassionatemind.co.uk). Lawrence Jones trained as a Forensic Psychologist after working with hard-​to-​ place ex-​offenders in the community. He worked in and eventually managed a prison-​based therapeutic community. He then trained as a Clinical Psychologist at Rampton Hospital where he helped to set up personality disorder services and is now Head of Psychology. He teaches on the clinical psychology courses at Leicester and Sheffield, and the Nottingham and Lincoln forensic psychology courses. He is a former chair of the Division of Forensic Psychology and has published on therapeutic communities, engagement, offence paralleling behaviour, trauma and interventions with ‘personality disordered’ ‘offenders’. Marije Keulen-​de Vos, PhD is a senior researcher at Forensic Psychiatric Center de Rooyse Wissel. She also manages the development and implementation of evidence-based care pathways for psychotic, intellectually disabled and personality disordered offenders. She received her doctorate degree in clinical psychology from the University of Maastricht, the Netherlands. She is an expert on Schema Therapy. xi List of Contributors xi Recently, she has adapted Schema Therapy for offenders with an intellectual disability. Her research focuses on forensic treatment, intellectual disability and sex offenders. Gill McGauley, MD was Professor of Forensic Psychotherapy and Medical Education, and Head of The Centre for Clinical Education at St George’s University of London. She worked clinically in the NHS as a Consultant Psychiatrist in Forensic Psychotherapy using psychodynamic and psychological therapies to treat mentally disordered offenders. She was involved in developing and delivering forensic psychotherapy services to imprisoned women. Her research interests included the relevance of attachment theory to violent offenders and the application of Mentalisation Based Treatment to personality disordered offenders. She published widely in the fields of forensic psychotherapy, forensic mental health, attachment and personality disorder in offenders. Professor McGauley passed away in July 2016, shortly after her chapter was completed. Dr Naomi Murphy has worked with forensic service users across forensic settings over a 20-​year period. She is Clinical Director of the Fens Service for Offenders with Personality Disorder at HMP Whitemoor. The treatment programme offered reflects her understanding of the role that trauma and attachment failure play in the development and maintenance of personality disorder and offending behaviour. This dual interest led her to explore sensorimotor theory and the ways in which developmental somatic experience could be incorporated into treatment. She is co-​ editor of Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs (Routledge). Dr Adrian Needs worked in HM Prison Service in the UK for 14 years. Work ranged from assessment and treatment of lifers and sex offenders to the management of individuals with personality disorders, from the facilitation of staff teams to the design and delivery of training for staff in specialised units. Non-​routine activities included providing negotiation advice in hostage and firearms incidents and post-​incident counselling to prison staff. He is currently course leader of the MSc Forensic Psychology course at the University of Portsmouth and earlier played a prominent role in steering the formulation of national standards for postgraduate training in forensic psychology. Dr Philip Pollock is a Consultant Forensic Clinical Psychologist, Head of Adult Mental Health specialty for a Health and Social Care Trust in Northern Ireland and Clinical Director of FACET Forensic Psychology Services Ltd. He is a consultant and trainer, and provides expert witness and psychological services worldwide. He has published extensively in several areas including personality disorder, sexual offending, forensic psychotherapy and homicide offenders. He is author of Cognitive Analytic Therapy for Adult Survivors of Childhood Abuse (Wiley 2001), the editor of Cognitive Analytic Therapy for Offenders (Routledge 2006) and is completing a new book on paedophilic killers (Wiley). xii xii List of Contributors Ronald J. Ricci, PhD, LMFT is a Virginia Certified Sex Offender Treatment Provider and Certified EMDR Consultant and Practitioner. He holds a Governor-appointed seat on the Pennsylvania Sex Offender Assessment Board. He served as Clinical Director for Sex Offender Services for Resources For Human Development, Inc. of Philadelphia, PA, and Clinical Director of Virginia SO Services for Specialised Treatment Services of Virginia. He provides clinical consultation for the adolescent Sexual Responsibility Program at Devereux’s Kanner Center in West Chester, PA, and for Psychological and Forensic Services, PLLC of Fredericksburg,VA. His area of specialisation is the research and treatment of sex offenders, with a particular interest in trauma effects and EMDR which he has presented nationally and internationally. Dr Karen Shannon is a Clinical Psychologist, ACAT practitioner, supervisor and trainer, and Trustee for ACAT. She has worked in high, medium and community NHS forensic services for more than 18 years. She has broad experience of the application of CAT in consultation, court, risk assessments and staff management in a variety of forensic, adult mental health and voluntary sector settings. She is director of Dr Karen Shannon Associates and has published in several areas concerning the practical application of CAT, including supervising those working with forensic clients; risk assessment and management; and as a framework for male aggression and violence. Tony Ward, PhD is a Professor of Clinical Psychology at Victoria University of Wellington, New Zealand, and has previously taught clinical and forensic psychology at Canterbury, Melbourne and Deakin universities. He has more than 390 academic publications and his research interests are offender desistance and rehabilitation, forensic and correctional ethics, and theoretical issues in psychopathology. His books include Desistance From Sex Offending: Alternatives to Throwing Away the Keys, co-​authored with Richard Laws (Guilford 2010), and Evolutionary Criminology, co-​authored with Russil Durrant (Academic Press 2015). About the editors Jason Davies is Professor of Forensic and Clinical Psychology at Swansea University, UK and a Consultant Forensic and Clinical Psychologist with ABMU Health Board in South Wales. He has worked in high, medium and low secure mental health settings, inpatient and community rehabilitation and prison and probation services. He leads research and evaluation of the Offender Personality Disorder Pathway within Wales. He has published on topics such as service development, interventions, sadistic interest and staff supervision including a recent book Supervision for Forensic Practitioners (Routledge). He is also co-​editor of Research in Practice for Forensic Professionals (Routledge) with Kerry Sheldon and Kevin Howells. xiii newgenprepdf List of Contributors xiii Dr Claire Nagi is a Forensic Psychologist who has worked in medium, low and community forensic services for over ten years. She received her doctorate degree in forensic psychology practice from the University of Birmingham, UK in 2007. She currently works in Low Secure Services with ABMU Health Board, South Wales and is a Clinical Tutor on the Forensic Psychology programmes at Cardiff Metropolitan University, UK. Her research focuses on forensic mental health and offender intervention, which she has presented nationally and internationally. xiv 1 1 1 INTRODUCTION Claire Nagi and Jason Davies Individual psychological therapies have a long history, although their application within forensic contexts has been eclipsed by group intervention. Over the last three decades there have been numerous meta-​analyses published on the efficacy of various Offender Behaviour Programmes which stand as testament to the value and impact that a groupwork format can bring when delivered according to the ‘what works’ principles. However, individually delivered treatments continue to be provided in some services and settings as the modality of choice, or where groupwork is unfeasible or contra-​indicated, to complement or support group treatment or as an ‘intervention of last resort’. This chapter will provide the context and rationale for focusing on individually delivered interventions within forensic settings. This chapter concludes with a brief précis of the sections of the book and the chapters contained within them. Individual therapy in forensic settings Psychological therapy has played an important role in rehabilitation and risk reduction within forensic settings. Over the last 40 years, the challenge of ‘nothing works’ widely attributed to Martinson (1974) has been replaced by evidence that some interventions (e.g. psychological, social and occupational) can promote prosocial thinking and behaviour, reduce risk and foster desistance from crime. An important cornerstone has been the recognition and promotion of the Risk Needs Responsivity principles first articulated by Bonta and Andrews (2017) and built upon by many practitioners and academics. Psychologically based interventions have shown themselves to be important in addressing risk factors, with a range of evidence supporting the delivery of such treatment (e.g. see McGuire, 2013, for a review). In large part, psychoeducational group treatment (Day, Kozar, & Davey, 2 2 Claire Nagi and Jason Davies 2013) has dominated this arena. The reasons for group treatment being employed might include resource management, perceived cost effectiveness and the addition of a group process element to treatment (see Davies, in press). However, forensic services research that not everyone benefits from group-​based interventions, has led some to begin to describe when individual interventions might be selected as the preferred modality (see Polaschek, 2011, 2013; O’Brien, Sullivan, & Daffern, 2016). Thus the task of describing, choosing, delivering and evidencing individual treatment is a timely one moving individually delivered interventions from a somewhat niche position of use only in highly specialist settings to a more mainstream position. Individually delivered treatments are increasingly being employed as the ‘first line’ approach when working with those with complex needs such as those with mental health needs and those with responsivity issues or idiosyncratic offending. This is in addition to their widespread use as a precursor to group-​based intervention (e.g. engagement and preparatory work) and as a secondary ‘pragmatic’ option (e.g. when group treatment is not feasible such as when there are insufficient individuals to form a group). In recent years there has also been an expansion of intervention packages that use both individual and group-​based therapy. Often each modality is used for specific purposes such as the group setting for imparting knowledge and rehearsing skills and individual components for personalisation, maintaining engagement and addressing responsivity issues. These combined modality approaches are discussed more fully in Chapter 12. Psychological therapies have developed from a single treatment in the form of psychodynamic therapy to a wide range of treatments that vary in length and their underpinning theory. Theories of change and thus therapy have included various grouping and schools such as Psychoanalytic/​dynamic (e.g. Freud, 1949; Jung, 1966); Humanistic (e.g. Maslow, 1943; Rogers, 1951); Behavioural (e.g. Watson, 1924; Pavlov, 1927; Skinner, 1953); Cognitive (e.g. Beck, 1976; Ellis, 1957); and ‘third wave’ therapies (e.g. Linehan, 1993; Segal, Williams, & Teasdale, 2002; Hayes, Strosahl, & Wilson, 1999). Each of these has introduced their own unique view on aspects such as the nature of personality, the causes and resolution of psychological difficulties, psychological strengths, emotions, relationships and motivation. Treatment efficacy and effectiveness for such individual therapies in non-​forensic settings has been demonstrated through a large number of studies (e.g. Butler, Chapman, Forman, & Beck, 2006; Kahl, Winter, & Schweiger, 2012; Fonagy, 2015). For our purposes at this point, it is sufficient to note that many therapies have been shown to be better than nothing and that there is evidence of a significant effect for many of the treatments presented. For example, reviews of psychodynamic therapy have shown it to be effective for some difficulties but not others when compared to inactive control conditions (e.g. waiting list or treatment as usual) (Fonagy, 2015; Leichsenring & Leibing, 2007). Similarly, Cognitive Behavioural Therapy (CBT) has shown itself to be effective for some problems (e.g. Hofmann et al., 2012) with the evidence for third-wave therapies being mixed (e.g. Piet & Hougaard, 2011; van der Velden et al., 2015; Öst, 2008; Kahl et al., 2012). 3 Introduction 3 These therapies have also had an impact on approaches to working with those who are in correctional or forensic services, for example through direct behaviour modification or in addressing cognitions believed to be associated with certain behaviour. Although there have been studies investigating the impact of individual psychological therapies in forensic settings, by way of comparison, this does not match the level and type of research conducted on this topic within the mental health field to date. Nonetheless, evidence of treatment efficacy within offender populations has been demonstrated (e.g. McGuire, 2013) warranting further exploration of the role of individual psychological therapies within forensic contexts.The chapters in Part I of this book provide a description which will provide the reader with some insight into the distinct features (and in many cases specialist language) associated with each of the interventions included. They also provide the opportunity to consider aspects common to more than one approach. The authors of each therapy chapter in this book present a summary of key evidence from non-​forensic and forensic settings, allowing the reader to determine the type and scale of evidence for the intervention presented. Definitions For the purpose of this book, the use of terms such as client, individual, offender and patient have been left to the author(s) of each chapter and are intended as interchangeable (unless otherwise stated). However, we note that those within forensic settings often associate with the term prisoner or patient as this recognises their non-​voluntary detention. In reference to the context, a forensic setting is defined as any forensic mental health setting (i.e. inpatient or community) and any correctional setting (i.e. prison or probation/​parole). It is also important to note that the primary focus of this text is on psychological therapies for adults. Within this, authors have not specifically commented on issues of difference (e.g. gender, ethnicity or diagnostic group) unless there are significant adaptations made to the intervention for specific groups. The one exception is the chapter on psychodynamic therapy which focuses on working with individuals with Intellectual and Developmental Disability (IDD). As a result, this chapter highlights developmental considerations which readers can consider when examining the other approaches contained within this book. Finally, the ‘individuals’ presented as the case study in each chapter are highly anonymised or are fictitious amalgamations of several individuals that have been constructed to give a clear example of key aspects of the therapy in practice. Scope and content Although we have tried to provide a sample of widely used and emerging therapies that can be implemented, it is accepted that this is not an exhaustive, encyclopaedic review of all possible treatments that could be delivered. Although this book contains therapies across a spectrum of approaches, evidently the breadth of individual 4 4 Claire Nagi and Jason Davies therapies delivered within forensic settings has meant that therapeutic approaches have been omitted. It is important to emphasise that this book is not an endorsement or recommendation of specific therapies –​readers should also not infer anything from treatment approaches being included or absent from this book. Nevertheless, this book will provide the reader with a range of different therapies currently used to enable them to consider methods for selecting individual therapy approaches and/​or therapists for particular needs or clients. This idea of treatment selection is discussed further in Chapter 15. This book will allow the reader to examine therapies (old and new) as described by those who practise them, providing details of the approach and the therapy evidence base. Many of the therapies included can be or are also delivered in group formats; however, within this book we focus on their application in a one-​to-​one format. Our desire is to bring together examples of practice from a range of settings, countries and approaches, in order to showcase ten treatments that can be provided individually and set the scene for reasserting the need to actively consider and examine the place for individual therapy in forensic settings. The chapters in this book are written by contributors, many of whom are active practitioner-​researchers, with extensive experience from across the globe including the United Kingdom, Europe, America, Australia and New Zealand. The book is divided into two parts. In the first, ten therapies are described with most of the chapters using a common framework, in which core information about the therapy, its use in forensic settings and the current state of the evidence base for the therapy is presented. In this section, each chapter will also outline the practicalities faced within practice, including therapy adaptations required for offender populations. In Part I, the chapters have been sequenced in alphabetical order. A brief outline of the chapters in Part I is provided next. The most widely used basis for group-​based interventions within correctional settings is the CBT approach. In Chapter 3, Andrew Day highlights the limited guidance available to therapists in relation to the specifics of CBT when used with forensic clients. He considers adaptations that are needed to implement the approach in the forensic setting and explores approaches to assessing the quality and integrity of treatment. As an extension of cognitive approaches, a third-​wave therapy, namely Acceptance and Commitment Therapy (ACT), is described by David Brillhart in Chapter 2. ACT is an action-​focused cognitive-​behavioural/​mindfulness therapy that fosters the development of acceptance of those things that cannot be changed while promoting purposeful living through six core processes.This chapter outlines the evidence base for ACT with offender populations and describes therapy adaptations required for ACT when addressing offender risk. In Chapter 8, Kelly’s Personal Construct Therapy (PCT; Kelly, 1955) is presented by Adrian Needs and Lawrence Jones. Despite a long history in forensic settings, the use of PCT has waxed and waned over the years. In this chapter, the authors examine the use of PCT in a prison setting along with the ways the approach lends itself to assessing individual change. In addition to its use as an approach in its own right, PCT has influenced (and has incorporated aspects into) many other therapy approaches. This includes Cognitive Analytic Therapy (CAT) 5 Introduction 5 which is presented by Karen Shannon and Philip Pollock in Chapter 4.This therapeutic model integrates aspects of PCT, cognitive therapy and psychoanalytic ideas. From its origins as a brief therapy for use in the UK National Health Service, the theory and application has been broadened to include complex cases such as those of personality disorder and offender populations. Through case examples, Chapter 4 describes use of CAT with ‘hard to help’ clients and as an explicit framework to inform staff/​team/​system care and risk management. In Chapter 6, another integrative therapy –​Eye Movement Desensitisation and Reprocessing (EMDR) –​is presented by Ronald Ricci and Cheryl Clayton. This approach has been widely used outside the forensic arena as a therapy for trauma and anxiety-​based disorders (Shapiro, 1989). They describe the application of EMDR within forensic settings with specific attention to its role as part of a wider package of intervention and management. A final integrative approach, schema therapy, is presented by Marije Keulen-​de Vos and David Bernstein in Chapter 10. Schema therapy was first described by Jeffrey Young in the 1990s (e.g.Young, 1990) and was originally developed for working with complex individuals. As a result it has been widely adopted in services for individuals with personality disorder and latterly in forensic settings. It has been subject to a number of research studies in forensic settings, some of which are presented by the authors. The oldest form of psychotherapy –​psychodynamic psychotherapy –​is described by Nigel Beail in Chapter 9. This approach has been widely used within specialist forensic services for several decades. The chapter provides an introduction to a Kleinian-​informed framework and uses a case example drawn from work in forensic IDD services in the community. In Chapter 7, Gill McGauley presents Mentalisation Based Therapy (MBT), which has its roots in psychoanalytic approaches. Originally developed as a treatment for borderline personality disorder, MBT has since been used more widely. The adaptations needed to the original MBT model, to broaden the applicability of the treatment for offender populations, is described in some detail, along with the outline of a UK feasibility study currently being conducted. There are several emerging therapies being delivered in forensic settings, two of which are considered in this book. In Chapter 5, Paul Gilbert describes the underpinning theory of Compassion Focused Therapy (CFT), developed by himself and colleagues (e.g. Gilbert, 1992, 2000, 2005) for individuals experiencing shame and self-​critical and attacking thoughts. The process of applying a compassion model to forensic settings is outlined which provides a challenge to some of the assumptions and ‘custom and practice’ evident in many forensic services. Delivering an intervention that ‘goes beyond’ the traditional realms of talking-​based psychotherapy is detailed by Naomi Murphy in Chapter 10. Sensorimotor psychotherapy recognises that physical (body) responses might be important in addressing trauma and for reducing future risk. In considering the use of this novel approach in a high secure prison within the UK, this chapter prompts a fresh look at the ways in which treatments are provided and the assumptions about how change takes place. Together, Chapters 5 and 10 provide both an introduction to two therapies and an 6 6 Claire Nagi and Jason Davies opportunity to examine current thinking about offending and some of the possible roots to offending. Part II of this book considers a number of key issues relating to providing individual therapies in forensic settings from various perspectives. In Chapter 12 we examine the use of individual psychological therapy alongside group-​based interventions –​so-​called combined modality approaches. The merits and disadvantages of each modality are discussed along with ways in which combined approaches can be provided. This chapter also highlights the need for high-​quality outcome evaluation to determine for whom combined approaches might be most effective and resource efficient. Ethical issues in the treatment of offenders (regardless of the treatment modality) are examined by Tony Ward in Chapter 13. By exploring clusters of ethical problems and dilemmas he considers how notions of moral and human rights can be employed to guide ethical practice. One avenue for examining ethical treatment is through the supervision provided to those therapists delivering interventions and influencing service design. It is generally agreed that providing competent treatment requires that the therapist is supervised, with many of the interventions described in Part I having guidelines or requirements for this. In Chapter 14 we consider the role and functions of supervision, and some of the competencies required for those undertaking this task. Perhaps the most perplexing issues in delivering individual therapy are which one(s) to provide and who should deliver it. In Chapter 15 we consider approaches to selecting therapies and therapists and examine the apparent equivalence of many therapies.We consider approaches to therapist accreditation and examine the ideas of common factors. We argue that evaluation should be used routinely to help practitioners identify ‘what works’ in individual cases and outline some guiding principles for those providing individual therapies in forensic settings. The book concludes by drawing out some general themes that have emerged from the chapters, provides a summary of some of the main issues for individual therapies within forensic settings and describes the challenge of developing an evidence base for individual therapy that researchers and practitioners should combine forces to address. Conclusion This book is intended to provide the reader with the knowledge and understanding to make informed decisions regarding individual psychological treatment within their forensic practice. Our hope is that readers will at least consider the role that individual interventions may play, while also being mindful of the many important areas for consideration in order to successfully implement such an approach. References Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press. 7 Introduction 7 Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A.T. (2006).The empirical status of cognitive-​behavioral therapy: A review of meta-​analyses. Clinical Psychology Review, 26, 17–​31. Bonta, J., & Andrews, D. A. (2017). The psychology of criminal conduct (6th edn). New York: Routledge. Davies, J. (in press). An examination of individual versus group treatment in correctional settings. In Devon Polaschek, Andrew Day and Clive Hollin (Eds), Handbook of Psychology and Corrections. Wiley. Day, A., Kozar, C., & Davey, L. (2013). Treatment approaches and offending behaviour programs: Some critical issues. Aggression and Violent Behavior, 18, 630–​635. doi:10.1016/​ j.avb.2013.07.019 Ellis, A. (1957). Rational psychotherapy and individual psychology. Journal of Individual Psychology, 13, 38–​44. Fonagy, P. (2015). The effectiveness of psychodynamic psychotherapies: An update. 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